{"id":17756,"date":"2025-04-09T16:02:21","date_gmt":"2025-04-09T14:02:21","guid":{"rendered":"https:\/\/gezonde-darmflora.nl\/hacerse-donante\/"},"modified":"2025-05-08T17:11:29","modified_gmt":"2025-05-08T15:11:29","slug":"hacerse-donante","status":"publish","type":"page","link":"https:\/\/gezonde-darmflora.nl\/es\/hacerse-donante\/","title":{"rendered":"Hacerse donante"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row full_width=\u00bbstretch_row_content_no_spaces\u00bb][vc_column]\r\n    <div class=\"page-title\">\r\n        <div class=\"container\">\r\n            <div class=\"row\">\r\n                <div class=\"col\">\r\n                    <h1>Hacerse donante<\/h1>\r\n                <\/div>\r\n            <\/div>\r\n        <\/div>\r\n    <\/div>\r\n\r\n    [\/vc_column][\/vc_row][vc_row][vc_column]<style id=\"wpforms-css-vars-17750\">\n\t\t\t\t#wpforms-17750 {\n\t\t\t\t\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-17750\"><form id=\"wpforms-form-17750\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"17750\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/es\/wp-json\/wp\/v2\/pages\/17756\" data-token=\"3c847e943955949031c03da5e222bf7b\" data-token-time=\"1776705500\"><noscript class=\"wpforms-error-noscript\">Por favor, activa JavaScript en tu navegador para completar este formulario.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Por favor, activa JavaScript en tu navegador para completar este formulario.<\/div><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#066aab\" data-scroll=\"1\" role=\"progressbar\" aria-valuenow=\"1\" aria-valuemin=\"1\" aria-valuemax=\"12\" tabindex=\"-1\"><span class=\"wpforms-page-indicator-page-title\" ><\/span><span class=\"wpforms-page-indicator-page-title-sep\" style=\"display:none;\"> - <\/span><span class=\"wpforms-page-indicator-steps\">Paso <span class=\"wpforms-page-indicator-steps-current\">1<\/span> de 12<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:8.3333333333333%;background-color:#066aab\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-17750-field_1-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"1\"><div id=\"wpforms-17750-field_1\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17750-field_1-error\"><h4>Datos personales<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17750-field_152-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"152\"><fieldset><legend class=\"wpforms-field-label\">Nombre <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-17750-field_152\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][152][first]\" aria-errormessage=\"wpforms-17750-field_152-error\" required><label for=\"wpforms-17750-field_152\" class=\"wpforms-field-sublabel after\">Nombre<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-17750-field_152-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][152][last]\" aria-errormessage=\"wpforms-17750-field_152-last-error\" required><label for=\"wpforms-17750-field_152-last\" class=\"wpforms-field-sublabel after\">Apellidos<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-17750-field_2-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_2\">Fecha de nacimiento <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-17750-field_2\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][2][date]\" aria-errormessage=\"wpforms-17750-field_2-error\" required><a title=\"Borrar fecha\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Borrar fecha\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-17750-field_153-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"153\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_153\">Correo electr\u00f3nico <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-17750-field_153\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][153]\" spellcheck=\"false\" aria-errormessage=\"wpforms-17750-field_153-error\" required><\/div><div id=\"wpforms-17750-field_4-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_4\"> Tel\u00e9fono m\u00f3vil <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" aria-errormessage=\"wpforms-17750-field_4-error\" required><\/div><div id=\"wpforms-17750-field_154-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"154\"><fieldset><legend class=\"wpforms-field-label\">Direcci\u00f3n<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-17750-field_154\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][154][address1]\" aria-errormessage=\"wpforms-17750-field_154-error\" ><label for=\"wpforms-17750-field_154\" class=\"wpforms-field-sublabel after\">Direcci\u00f3n (l\u00ednea 1)<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-17750-field_154-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][154][city]\" aria-errormessage=\"wpforms-17750-field_154-city-error\" ><label for=\"wpforms-17750-field_154-city\" class=\"wpforms-field-sublabel after\">Ciudad<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-17750-field_154-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][154][state]\" aria-errormessage=\"wpforms-17750-field_154-state-error\" ><label for=\"wpforms-17750-field_154-state\" class=\"wpforms-field-sublabel after\">Estado \/ Provincia \/ Regi\u00f3n<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-17750-field_154-postal\" class=\"wpforms-field-address-postal\" name=\"wpforms[fields][154][postal]\" aria-errormessage=\"wpforms-17750-field_154-postal-error\" ><label for=\"wpforms-17750-field_154-postal\" class=\"wpforms-field-sublabel after\">C\u00f3digo postal<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-17750-field_154-country\" class=\"wpforms-field-address-country\" name=\"wpforms[fields][154][country]\" aria-errormessage=\"wpforms-17750-field_154-country-error\" ><option class=\"placeholder\" value=\"\" selected disabled>--- Selecciona country ---<\/option><option value=\"AF\" >Afganist\u00e1n<\/option><option value=\"AL\" >Albania<\/option><option value=\"DE\" >Alemania<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguila<\/option><option value=\"AG\" >Antigua y Barbuda<\/option><option value=\"AQ\" >Ant\u00e1rtica<\/option><option value=\"DZ\" >Argelia<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaiy\u00e1n<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BH\" >Bar\u00e9in<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Ben\u00edn<\/option><option value=\"BM\" >Bermudas<\/option><option value=\"BY\" >Bielorrusia<\/option><option value=\"BO\" >Bolivia (Estado Plurinacional de)<\/option><option value=\"BQ\" >Bonaire, San Eustaquio y Saba<\/option><option value=\"BA\" >Bosnia y Herzegovina<\/option><option value=\"BW\" >Botsuana<\/option><option value=\"BR\" >Brasil<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"BT\" >But\u00e1n<\/option><option value=\"BE\" >B\u00e9lgica<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Camboya<\/option><option value=\"CM\" >Camer\u00fan<\/option><option value=\"CA\" >Canad\u00e1<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CY\" >Chipre<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoras<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Rep\u00fablica Democr\u00e1tica del)<\/option><option value=\"KR\" >Corea (Rep\u00fablica de)<\/option><option value=\"KP\" >Corea del Norte<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"CI\" >Costa de Marfil<\/option><option value=\"HR\" >Croacia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Curazao<\/option><option value=\"DK\" >Dinamarca<\/option><option value=\"DM\" >Dominica<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egipto<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"AE\" >Emiratos \u00c1rabes Unidos<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"SK\" >Eslovaquia<\/option><option value=\"SI\" >Eslovenia<\/option><option value=\"ES\" >Espa\u00f1a<\/option><option value=\"VA\" >Estado de la Ciudad del Vaticano<\/option><option value=\"US\" >Estados Unidos de America<\/option><option value=\"EE\" >Estonia<\/option><option value=\"ET\" >Etiop\u00eda<\/option><option value=\"RU\" >Federaci\u00f3n Rusa<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"PH\" >Filipinas<\/option><option value=\"FI\" >Finlandia<\/option><option value=\"FR\" >Francia<\/option><option value=\"GA\" >Gab\u00f3n<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GD\" >Granada<\/option><option value=\"GR\" >Grecia<\/option><option value=\"GL\" >Groenlandia<\/option><option value=\"GP\" >Guadalupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GF\" >Guayana Francesa<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GQ\" >Guinea Ecuatorial<\/option><option value=\"GW\" >Guinea-Bis\u00e1u<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Hait\u00ed<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungr\u00eda<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Irlanda (Rep\u00fablica de)<\/option><option value=\"IR\" >Ir\u00e1n (Rep\u00fablica Isl\u00e1mica de)<\/option><option value=\"BV\" >Isla Bouvet<\/option><option value=\"NF\" >Isla Norfolk<\/option><option value=\"IM\" >Isla de Man<\/option><option value=\"CX\" >Isla de Navidad<\/option><option value=\"IS\" >Islandia<\/option><option value=\"KY\" >Islas Caim\u00e1n<\/option><option value=\"CC\" >Islas Cocos<\/option><option value=\"CK\" >Islas Cook<\/option><option value=\"FO\" >Islas Faroe<\/option><option value=\"HM\" >Islas Heard y McDonald<\/option><option value=\"FK\" >Islas Malvinas (Falkland)<\/option><option value=\"MP\" >Islas Marianas del Norte<\/option><option value=\"MH\" >Islas Marshall<\/option><option value=\"SB\" >Islas Salom\u00f3n<\/option><option value=\"TC\" >Islas Turcas y Caicos<\/option><option value=\"UM\" >Islas Ultramarinas Menores de Estados Unidos<\/option><option value=\"VI\" >Islas V\u00edrgenes (EE.UU.)<\/option><option value=\"VG\" >Islas V\u00edrgenes (brit\u00e1nicas)<\/option><option value=\"GS\" >Islas del sur de Georgia y del sur de Sandwich<\/option><option value=\"AX\" >Islas \u00c5land<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italia<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Jap\u00f3n<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordania<\/option><option value=\"QA\" >Katar<\/option><option value=\"KZ\" >Kazajist\u00e1n<\/option><option value=\"KE\" >Kenia<\/option><option value=\"KG\" >Kirguist\u00e1n<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"LS\" >Lesoto<\/option><option value=\"LV\" >Letonia<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libia<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lituania<\/option><option value=\"LU\" >Luxemburgo<\/option><option value=\"LB\" >L\u00edbano<\/option><option value=\"MO\" >Macao<\/option><option value=\"MK\" >Macedonia del Norte (Rep\u00fablica de)<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MY\" >Malasia<\/option><option value=\"MW\" >Malaui<\/option><option value=\"MV\" >Maldivas<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MA\" >Marruecos<\/option><option value=\"MQ\" >Martinica<\/option><option value=\"MU\" >Mauricio<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"FM\" >Micronesia (Estados Federados de)<\/option><option value=\"MD\" >Moldavia (Rep\u00fablica de)<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"MX\" >M\u00e9xico<\/option><option value=\"MC\" >M\u00f3naco<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NO\" >Noruega<\/option><option value=\"NC\" >Nueva Caledonia<\/option><option value=\"NZ\" >Nueva Zelanda<\/option><option value=\"NE\" >N\u00edger<\/option><option value=\"OM\" >Om\u00e1n<\/option><option value=\"PK\" >Pakist\u00e1n<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestina (Estado de)<\/option><option value=\"PA\" >Panam\u00e1<\/option><option value=\"PG\" >Pap\u00faa Nueva Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"NL\" >Pa\u00edses Bajos<\/option><option value=\"PE\" >Per\u00fa<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PF\" >Polinesia Francesa<\/option><option value=\"PL\" >Polonia<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"GB\" >Reino Unido de Gran Breta\u00f1a e Irlanda del Norte<\/option><option value=\"CF\" >Rep\u00fablica Central de \u00c1frica<\/option><option value=\"CZ\" >Rep\u00fablica Checa<\/option><option value=\"DO\" >Rep\u00fablica Dominicana<\/option><option value=\"LA\" >Rep\u00fablica Popular Democr\u00e1tica de Laos<\/option><option value=\"SY\" >Rep\u00fablica \u00c1rabe Siria<\/option><option value=\"RE\" >Reuni\u00f3n<\/option><option value=\"RW\" >Ruanda<\/option><option value=\"RO\" >Ruman\u00eda<\/option><option value=\"KN\" >Saint Kitts y Nevis<\/option><option value=\"WS\" >Samoa<\/option><option value=\"AS\" >Samoa Americana<\/option><option value=\"BL\" >San Bartolom\u00e9<\/option><option value=\"SM\" >San Marino<\/option><option value=\"MF\" >San Mart\u00edn (parte francesa)<\/option><option value=\"SX\" >San Mart\u00edn (parte holandesa)<\/option><option value=\"PM\" >San Pedro y Miquel\u00f3n<\/option><option value=\"VC\" >San Vicente y las Granadinas<\/option><option value=\"SH\" >Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option value=\"LC\" >Santa Luc\u00eda<\/option><option value=\"ST\" >Santo Tom\u00e9 y Pr\u00edncipe<\/option><option value=\"SA\" >Saud\u00ed Arabia<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leona<\/option><option value=\"SG\" >Singapur<\/option><option value=\"SO\" >Somalia<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SZ\" >Suazilandia (Reino de)<\/option><option value=\"ZA\" >Sud\u00e1frica<\/option><option value=\"SD\" >Sud\u00e1n<\/option><option value=\"SS\" >Sud\u00e1n del sur<\/option><option value=\"SE\" >Suecia<\/option><option value=\"CH\" >Suiza<\/option><option value=\"SR\" >Surinam<\/option><option value=\"SJ\" >Svalbard y Jan Mayen<\/option><option value=\"EH\" >S\u00e1hara Occidental<\/option><option value=\"TH\" >Tailandia<\/option><option value=\"TW\" >Taiw\u00e1n, Rep\u00fablica de China<\/option><option value=\"TZ\" >Tanzania (Rep\u00fablica Unida de)<\/option><option value=\"TJ\" >Tayikist\u00e1n<\/option><option value=\"IO\" >Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option value=\"TF\" >Tierras Australes y Ant\u00e1rticas Francesas<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad y Tobago<\/option><option value=\"TM\" >Turkmenist\u00e1n<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TN\" >T\u00fanez<\/option><option value=\"TR\" >T\u00fcrkiye<\/option><option value=\"UA\" >Ucrania<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekist\u00e1n<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VE\" >Venezuela (Rep\u00fablica Bolivariana de)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"WF\" >Wallis y Futuna<\/option><option value=\"YE\" >Yemen<\/option><option value=\"DJ\" >Yibuti<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabue<\/option><\/select><label for=\"wpforms-17750-field_154-country\" class=\"wpforms-field-sublabel after\">Pa\u00eds<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-17750-field_6-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"6\"><fieldset><legend class=\"wpforms-field-label\">G\u00e9nero <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_6\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_6_1\" name=\"wpforms[fields][6]\" value=\"Hombre\" aria-errormessage=\"wpforms-17750-field_6_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_6_1\">Hombre<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_6_2\" name=\"wpforms[fields][6]\" value=\"Mujer\" aria-errormessage=\"wpforms-17750-field_6_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_6_2\">Mujer<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_7-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"7\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"1\" data-formid=\"17750\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\"> Siguiente<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-17750-field_8-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"8\"><\/div><div id=\"wpforms-17750-field_10-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"10\"><div id=\"wpforms-17750-field_10\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17750-field_10-error\"><h4>Datos corporales y salud general<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17750-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_11\">\u00bfCu\u00e1l es su peso? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" aria-errormessage=\"wpforms-17750-field_11-error\" aria-describedby=\"wpforms-17750-field_11-description\" required><div id=\"wpforms-17750-field_11-description\" class=\"wpforms-field-description\">En kilos<\/div><\/div><div id=\"wpforms-17750-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_12\">\u00bfCu\u00e1l es su estatura? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" aria-errormessage=\"wpforms-17750-field_12-error\" aria-describedby=\"wpforms-17750-field_12-description\" required><div id=\"wpforms-17750-field_12-description\" class=\"wpforms-field-description\">En CM<\/div><\/div><div id=\"wpforms-17750-field_13-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_13\">\u00bfCu\u00e1l es su IMC? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_13\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][13]\" aria-errormessage=\"wpforms-17750-field_13-error\" aria-describedby=\"wpforms-17750-field_13-description\" required><div id=\"wpforms-17750-field_13-description\" class=\"wpforms-field-description\">En cm\/kg2<\/div><\/div><div id=\"wpforms-17750-field_14-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_14\">\u00bfCu\u00e1l es su profesi\u00f3n\/estudio? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_14\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][14]\" aria-errormessage=\"wpforms-17750-field_14-error\" required><\/div><div id=\"wpforms-17750-field_15-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_15\">\u00bfCu\u00e1l es su nivel de estudios? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_15\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][15]\" aria-errormessage=\"wpforms-17750-field_15-error\" required><\/div><div id=\"wpforms-17750-field_16-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_16\">\u00bfCu\u00e1l es la composici\u00f3n de su familia? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_16\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][16]\" aria-errormessage=\"wpforms-17750-field_16-error\" required><\/div><div id=\"wpforms-17750-field_17-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"17\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"2\" data-formid=\"17750\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\"> Anterior<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"2\" data-formid=\"17750\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\"> Siguiente<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3  \" data-page=\"3\" style=\"display:none;\"><div id=\"wpforms-17750-field_18-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"18\"><div id=\"wpforms-17750-field_18\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17750-field_18-error\"><h4>Historial m\u00e9dico<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17750-field_19-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"19\"><fieldset><legend class=\"wpforms-field-label\">\u00bfNaci\u00f3 por parto natural o por ces\u00e1rea? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_19\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_19_1\" name=\"wpforms[fields][19]\" value=\"Naturalmente\" aria-errormessage=\"wpforms-17750-field_19_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_19_1\">Naturalmente<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_19_2\" name=\"wpforms[fields][19]\" value=\"Ces\u00e1rea\" aria-errormessage=\"wpforms-17750-field_19_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_19_2\">Ces\u00e1rea<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_20-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"20\"><fieldset><legend class=\"wpforms-field-label\">\u00bfTiene hijos?       <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_20\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_20_1\" name=\"wpforms[fields][20]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_20_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_20_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_20_2\" name=\"wpforms[fields][20]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_20_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_20_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_22-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"22\"><fieldset><legend class=\"wpforms-field-label\">\u00bfLe han rechazado alguna vez durante un examen (como donante o de otro tipo)?  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_22\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_22_1\" name=\"wpforms[fields][22]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_22_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_22_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_22_2\" name=\"wpforms[fields][22]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_22_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_22_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_23-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"23\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_23\">Por qu\u00e9 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-17750-field_23\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][23]\" aria-errormessage=\"wpforms-17750-field_23-error\" required><\/textarea><\/div><div id=\"wpforms-17750-field_24-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"24\"><fieldset><legend class=\"wpforms-field-label\">\u00bfHa donado sangre alguna vez?     <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_24\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_24_1\" name=\"wpforms[fields][24]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_24_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_24_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_24_2\" name=\"wpforms[fields][24]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_24_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_24_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_27-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"27\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_27\">En caso afirmativo, \u00bfcu\u00e1ndo fue la \u00faltima vez? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-17750-field_27\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][27][date]\" aria-errormessage=\"wpforms-17750-field_27-error\" required><a title=\"Borrar fecha\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Borrar fecha\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-17750-field_28-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"28\"><fieldset><legend class=\"wpforms-field-label\">\u00bfHa visitado alguna vez a un especialista (m\u00e9dico en el hospital)?          <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_28\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_28_1\" name=\"wpforms[fields][28]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_28_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_28_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_28_2\" name=\"wpforms[fields][28]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_28_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_28_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_29-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"29\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_29\">\u00bfCu\u00e1ndo? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-17750-field_29\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][29][date]\" aria-errormessage=\"wpforms-17750-field_29-error\" required><a title=\"Borrar fecha\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Borrar fecha\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-17750-field_30-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"30\"><fieldset><legend class=\"wpforms-field-label\">\u00bfEst\u00e1 vacunado contra el covid-19? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_30\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_30_1\" name=\"wpforms[fields][30]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_30_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_30_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_30_2\" name=\"wpforms[fields][30]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_30_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_30_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_31-container\" class=\"wpforms-field wpforms-field-number wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"31\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_31\">\u00bfCu\u00e1ntas veces? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-17750-field_31\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][31]\" step=\"any\" aria-errormessage=\"wpforms-17750-field_31-error\" required><\/div><div id=\"wpforms-17750-field_32-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"32\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_32\">\u00bfQu\u00e9 fabricante? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_32\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][32]\" aria-errormessage=\"wpforms-17750-field_32-error\" required><\/div><div id=\"wpforms-17750-field_33-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"33\"><fieldset><legend class=\"wpforms-field-label\">\u00bfToma medicamentos?     <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_33\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_33_1\" name=\"wpforms[fields][33]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_33_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_33_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_33_2\" name=\"wpforms[fields][33]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_33_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_33_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_34-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"34\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_34\">En caso afirmativo, \u00bfqu\u00e9 medicamentos recibi\u00f3? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_34\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][34]\" aria-errormessage=\"wpforms-17750-field_34-error\" required><\/div><div id=\"wpforms-17750-field_35-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"35\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_35\">\u00bfEn qu\u00e9 a\u00f1o se inici\u00f3 este tratamiento?      <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_35\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][35]\" aria-errormessage=\"wpforms-17750-field_35-error\" required><\/div><div id=\"wpforms-17750-field_36-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"36\"><fieldset><legend class=\"wpforms-field-label\">\u00bfHa estado deprimido en el pasado?        <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_36\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_36_1\" name=\"wpforms[fields][36]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_36_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_36_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_36_2\" name=\"wpforms[fields][36]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_36_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_36_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_37-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"37\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_37\">\u00bfCu\u00e1ndo empez\u00f3 esto y durante cu\u00e1nto tiempo?          <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_37\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][37]\" aria-errormessage=\"wpforms-17750-field_37-error\" required><\/div><div id=\"wpforms-17750-field_38-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"38\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_38\">\u00bfHa tomado alguna medicaci\u00f3n para ello?  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_38\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][38]\" aria-errormessage=\"wpforms-17750-field_38-error\" required><\/div><div id=\"wpforms-17750-field_39-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"39\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"3\" data-formid=\"17750\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\"> Anterior<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"3\" data-formid=\"17750\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\"> Siguiente<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-4  \" data-page=\"4\" style=\"display:none;\"><div id=\"wpforms-17750-field_40-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"40\"><div id=\"wpforms-17750-field_40\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17750-field_40-error\"><h4>Trastornos cr\u00f3nicos y herencia<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17750-field_41-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"41\"><fieldset><legend class=\"wpforms-field-label\">\u00bfHa recibido tratamiento para el autismo?      <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_41\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_41_1\" name=\"wpforms[fields][41]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_41_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_41_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_41_2\" name=\"wpforms[fields][41]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_41_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_41_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_42-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"42\"><fieldset><legend class=\"wpforms-field-label\">\u00bfLe han hecho alguna vez la prueba de la diabetes?          <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_42\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_42_1\" name=\"wpforms[fields][42]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_42_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_42_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_42_2\" name=\"wpforms[fields][42]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_42_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_42_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_43-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"43\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_43\">\u00bfCu\u00e1l fue el resultado? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_43\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][43]\" aria-errormessage=\"wpforms-17750-field_43-error\" required><\/div><div id=\"wpforms-17750-field_44-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"44\"><fieldset><legend class=\"wpforms-field-label\"> \u00bfLa diabetes es cosa de familia?   <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_44\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_44_1\" name=\"wpforms[fields][44]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_44_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_44_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_44_2\" name=\"wpforms[fields][44]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_44_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_44_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_45-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"45\"><fieldset><legend class=\"wpforms-field-label\">\u00bfHay antecedentes familiares de esquizofrenia\/bipolaridad o trastornos de ansiedad?      <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_45\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_45_1\" name=\"wpforms[fields][45]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_45_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_45_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_45_2\" name=\"wpforms[fields][45]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_45_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_45_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_46-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"46\"><fieldset><legend class=\"wpforms-field-label\">\u00bfLa enfermedad de Creuzfeldt Jakob es hereditaria?  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_46\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_46_1\" name=\"wpforms[fields][46]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_46_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_46_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_46_2\" name=\"wpforms[fields][46]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_46_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_46_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_47-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"47\"><fieldset><legend class=\"wpforms-field-label\">\u00bfHay antecedentes de demencia en su familia antes de los 60 a\u00f1os? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_47\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_47_1\" name=\"wpforms[fields][47]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_47_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_47_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_47_2\" name=\"wpforms[fields][47]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_47_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_47_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_48-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"48\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"4\" data-formid=\"17750\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\"> Anterior<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"4\" data-formid=\"17750\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\"> Siguiente<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-5  \" data-page=\"5\" style=\"display:none;\"><div id=\"wpforms-17750-field_49-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"49\"><div id=\"wpforms-17750-field_49\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17750-field_49-error\"><h4>Entorno y zonas de riesgo<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17750-field_50-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"50\"><fieldset><legend class=\"wpforms-field-label\">\u00bfTiene animales dom\u00e9sticos? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_50\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_50_1\" name=\"wpforms[fields][50]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_50_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_50_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_50_2\" name=\"wpforms[fields][50]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_50_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_50_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_51-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"51\"><fieldset><legend class=\"wpforms-field-label\">\u00bfHa nacido en un pa\u00eds no europeo o ha vivido m\u00e1s de 5 a\u00f1os en un pa\u00eds no europeo?      <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_51\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_51_1\" name=\"wpforms[fields][51]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_51_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_51_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_51_2\" name=\"wpforms[fields][51]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_51_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_51_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_52-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"52\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_52\">\u00bfD\u00f3nde y cu\u00e1ndo? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_52\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][52]\" aria-errormessage=\"wpforms-17750-field_52-error\" required><\/div><div id=\"wpforms-17750-field_53-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"53\"><fieldset><legend class=\"wpforms-field-label\">\u00bfHa permanecido en el Reino Unido m\u00e1s de 6 meses entre 1980 y 1996? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_53\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_53_1\" name=\"wpforms[fields][53]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_53_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_53_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_53_2\" name=\"wpforms[fields][53]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_53_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_53_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_54-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"54\"><fieldset><legend class=\"wpforms-field-label\">\u00bfHa estado en los tr\u00f3picos en los dos \u00faltimos a\u00f1os? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_54\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_54_1\" name=\"wpforms[fields][54]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_54_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_54_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_54_2\" name=\"wpforms[fields][54]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_54_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_54_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_55-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"55\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_55\">\u00bfD\u00f3nde y en qu\u00e9 a\u00f1o? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_55\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][55]\" aria-errormessage=\"wpforms-17750-field_55-error\" required><\/div><div id=\"wpforms-17750-field_56-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"56\"><fieldset><legend class=\"wpforms-field-label\">\u00bfHa tenido malaria alguna vez?         <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_56\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_56_1\" name=\"wpforms[fields][56]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_56_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_56_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_56_2\" name=\"wpforms[fields][56]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_56_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_56_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_57-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"57\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_57\">\u00bfEn qu\u00e9 a\u00f1o? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_57\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][57]\" aria-errormessage=\"wpforms-17750-field_57-error\" required><\/div><div id=\"wpforms-17750-field_58-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"58\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_58\">\u00bfSabe de qu\u00e9 tipo? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_58\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][58]\" aria-errormessage=\"wpforms-17750-field_58-error\" required><\/div><div id=\"wpforms-17750-field_59-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"59\"><fieldset><legend class=\"wpforms-field-label\">\u00bfHa padecido alguna vez enfermedades infecciosas especiales?                   <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_59\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_59_1\" name=\"wpforms[fields][59]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_59_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_59_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_59_2\" name=\"wpforms[fields][59]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_59_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_59_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_60-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"60\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_60\">\u00bfQu\u00e9 enfermedades infecciosas? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_60\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][60]\" aria-errormessage=\"wpforms-17750-field_60-error\" required><\/div><div id=\"wpforms-17750-field_61-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"61\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"5\" data-formid=\"17750\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\"> Anterior<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"5\" data-formid=\"17750\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\"> Siguiente<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-6  \" data-page=\"6\" style=\"display:none;\"><div id=\"wpforms-17750-field_62-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"62\"><div id=\"wpforms-17750-field_62\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17750-field_62-error\"><h4>Riesgos profesionales y de exposici\u00f3n<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17750-field_63-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"63\"><fieldset><legend class=\"wpforms-field-label\">\u00bfTiene riesgo profesional de contraer enfermedades infecciosas transmitidas por la sangre?  (actualmente contacto diario con pacientes) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_63\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_63_1\" name=\"wpforms[fields][63]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_63_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_63_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_63_2\" name=\"wpforms[fields][63]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_63_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_63_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_64-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"64\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_64\">En caso afirmativo, \u00bfa saber? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_64\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][64]\" aria-errormessage=\"wpforms-17750-field_64-error\" required><\/div><div id=\"wpforms-17750-field_65-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"65\"><fieldset><legend class=\"wpforms-field-label\">\u00bfHa sufrido alguna vez una lesi\u00f3n por pinchazo de aguja? (por ejemplo, \u00bfuna lesi\u00f3n con una aguja untada con sangre de otra persona, u otro objeto punzante untado con sangre?)      <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_65\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_65_1\" name=\"wpforms[fields][65]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_65_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_65_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_65_2\" name=\"wpforms[fields][65]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_65_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_65_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_66-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"66\"><fieldset><legend class=\"wpforms-field-label\">\u00bfLe han administrado alguna vez productos sangu\u00edneos en el torrente sangu\u00edneo?   (por ejemplo, transfusiones de sangre)? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_66\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_66_1\" name=\"wpforms[fields][66]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_66_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_66_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_66_2\" name=\"wpforms[fields][66]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_66_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_66_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_67-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"67\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_67\">\u00bfCu\u00e1ndo? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-17750-field_67\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][67][date]\" aria-errormessage=\"wpforms-17750-field_67-error\" required><a title=\"Borrar fecha\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Borrar fecha\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-17750-field_68-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"68\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"6\" data-formid=\"17750\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\"> Anterior<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"6\" data-formid=\"17750\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\"> Siguiente<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-7  \" data-page=\"7\" style=\"display:none;\"><div id=\"wpforms-17750-field_69-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"69\"><div id=\"wpforms-17750-field_69\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17750-field_69-error\"><h4>Comportamiento de riesgo<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17750-field_70-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"70\"><fieldset><legend class=\"wpforms-field-label\">\u00bfTe has inyectado alguna vez drogas en las venas (por v\u00eda intravenosa)?    <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_70\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_70_1\" name=\"wpforms[fields][70]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_70_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_70_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_70_2\" name=\"wpforms[fields][70]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_70_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_70_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_71-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"71\"><fieldset><legend class=\"wpforms-field-label\">\u00bfHas esnifado drogas alguna vez?     <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_71\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_71_1\" name=\"wpforms[fields][71]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_71_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_71_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_71_2\" name=\"wpforms[fields][71]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_71_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_71_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_72-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"72\"><fieldset><legend class=\"wpforms-field-label\">\u00bfTe has tatuado alguna vez?      <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_72\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_72_1\" name=\"wpforms[fields][72]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_72_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_72_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_72_2\" name=\"wpforms[fields][72]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_72_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_72_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_73-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"73\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_73\"> En caso afirmativo, \u00bfen qu\u00e9 pa\u00eds se coloc\u00f3 y cu\u00e1ndo? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_73\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][73]\" aria-errormessage=\"wpforms-17750-field_73-error\" required><\/div><div id=\"wpforms-17750-field_74-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"74\"><fieldset><legend class=\"wpforms-field-label\"> \u00bfTe has hecho alguna vez un piercing\/pendientes?          <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_74\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_74_1\" name=\"wpforms[fields][74]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_74_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_74_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_74_2\" name=\"wpforms[fields][74]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_74_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_74_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_76-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"76\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_76\"> En caso afirmativo, \u00bfen qu\u00e9 pa\u00eds se ambient\u00f3?     <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_76\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][76]\" aria-errormessage=\"wpforms-17750-field_76-error\" required><\/div><div id=\"wpforms-17750-field_75-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"75\"><fieldset><legend class=\"wpforms-field-label\"> \u00bfTe has sometido alguna vez a acupuntura?   <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_75\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_75_1\" name=\"wpforms[fields][75]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_75_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_75_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_75_2\" name=\"wpforms[fields][75]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_75_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_75_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_77-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"77\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_77\"> En caso afirmativo, \u00bfen qu\u00e9 pa\u00eds? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_77\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][77]\" aria-errormessage=\"wpforms-17750-field_77-error\" required><\/div><div id=\"wpforms-17750-field_78-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"78\"><fieldset><legend class=\"wpforms-field-label\"> \u00bfTe has sometido alguna vez a un tratamiento con hormona del crecimiento?       <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_78\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_78_1\" name=\"wpforms[fields][78]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_78_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_78_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_78_2\" name=\"wpforms[fields][78]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_78_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_78_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_79-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"79\"><fieldset><legend class=\"wpforms-field-label\"> \u00bfHa donado tejidos alguna vez? (por ejemplo, c\u00f3rnea)             <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_79\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_79_1\" name=\"wpforms[fields][79]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_79_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_79_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_79_2\" name=\"wpforms[fields][79]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_79_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_79_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_80-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"80\"><fieldset><legend class=\"wpforms-field-label\">\u00bfSe ha sometido alguna vez a un trasplante capilar?    <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_80\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_80_1\" name=\"wpforms[fields][80]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_80_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_80_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_80_2\" name=\"wpforms[fields][80]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_80_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_80_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_81-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"81\"><fieldset><legend class=\"wpforms-field-label\">\u00bfSe ha sometido alguna vez a una intervenci\u00f3n quir\u00fargica o a un tratamiento cl\u00ednico en el extranjero?       <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_81\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_81_1\" name=\"wpforms[fields][81]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_81_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_81_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_81_2\" name=\"wpforms[fields][81]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_81_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_81_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_82-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"82\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_82\">En caso afirmativo, \u00bfd\u00f3nde y cu\u00e1ndo? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_82\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][82]\" aria-errormessage=\"wpforms-17750-field_82-error\" required><\/div><div id=\"wpforms-17750-field_83-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"83\"><fieldset><legend class=\"wpforms-field-label\">\u00bfHa tenido una nueva pareja sexual en el \u00faltimo a\u00f1o? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_83\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_83_1\" name=\"wpforms[fields][83]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_83_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_83_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_83_2\" name=\"wpforms[fields][83]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_83_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_83_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_84-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"84\"><fieldset><legend class=\"wpforms-field-label\">\u00bfHas tenido alguna vez contacto sexual con un usuario de drogas intravenosas? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_84\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_84_1\" name=\"wpforms[fields][84]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_84_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_84_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_84_2\" name=\"wpforms[fields][84]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_84_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_84_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_85-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"85\"><fieldset><legend class=\"wpforms-field-label\">\u00bfHa tenido alguna vez contacto sexual con alguien que posteriormente se descubri\u00f3 que estaba infectado por el VIH\/HTLV\/Hepatitis\/Lues? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_85\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_85_1\" name=\"wpforms[fields][85]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_85_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_85_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_85_2\" name=\"wpforms[fields][85]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_85_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_85_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_86-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"86\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">\u00bfCon qu\u00e9? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_86\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_86_1\" name=\"wpforms[fields][86]\" value=\"VIH\" aria-errormessage=\"wpforms-17750-field_86_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_86_1\">VIH<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_86_2\" name=\"wpforms[fields][86]\" value=\"Lues\" aria-errormessage=\"wpforms-17750-field_86_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_86_2\">Lues<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_86_3\" name=\"wpforms[fields][86]\" value=\"Hepatitis\" aria-errormessage=\"wpforms-17750-field_86_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_86_3\">Hepatitis<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_86_4\" name=\"wpforms[fields][86]\" value=\"HTLV\" aria-errormessage=\"wpforms-17750-field_86_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_86_4\">HTLV<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_86_5\" name=\"wpforms[fields][86]\" value=\"Otros:\" aria-errormessage=\"wpforms-17750-field_86_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_86_5\">Otros:<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_87-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"87\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_87\">Otros: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_87\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][87]\" aria-errormessage=\"wpforms-17750-field_87-error\" required><\/div><div id=\"wpforms-17750-field_88-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"88\"><fieldset><legend class=\"wpforms-field-label\">\u00bfHa tenido alguna vez una enfermedad de transmisi\u00f3n sexual (ETS)? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_88\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_88_1\" name=\"wpforms[fields][88]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_88_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_88_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_88_2\" name=\"wpforms[fields][88]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_88_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_88_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_89-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"89\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_89\">\u00bfCu\u00e1l? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_89\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][89]\" aria-errormessage=\"wpforms-17750-field_89-error\" required><\/div><div id=\"wpforms-17750-field_90-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"90\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"7\" data-formid=\"17750\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\"> Anterior<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"7\" data-formid=\"17750\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\"> Siguiente<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-8  \" data-page=\"8\" style=\"display:none;\"><div id=\"wpforms-17750-field_91-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"91\"><div id=\"wpforms-17750-field_91\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17750-field_91-error\"><h4>Vacunas<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17750-field_92-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"92\"><fieldset><legend class=\"wpforms-field-label\">\u00bfHa sido vacunado (es decir, no ha recibido una sola inyecci\u00f3n de inmunoglobulina) contra la hepatitis A? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_92\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_92_1\" name=\"wpforms[fields][92]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_92_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_92_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_92_2\" name=\"wpforms[fields][92]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_92_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_92_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_94-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"94\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">\u00bfEra suficiente el t\u00edtulo? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_94\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_94_1\" name=\"wpforms[fields][94]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_94_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_94_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_94_2\" name=\"wpforms[fields][94]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_94_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_94_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_95-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"95\"><fieldset><legend class=\"wpforms-field-label\">\u00bfHa sido vacunado (es decir, no ha recibido una sola inyecci\u00f3n de inmunoglobulina) contra la hepatitis B? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_95\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_95_1\" name=\"wpforms[fields][95]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_95_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_95_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_95_2\" name=\"wpforms[fields][95]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_95_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_95_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_96-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"96\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">\u00bfEra suficiente el t\u00edtulo? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_96\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_96_1\" name=\"wpforms[fields][96]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_96_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_96_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_96_2\" name=\"wpforms[fields][96]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_96_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_96_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_97-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"97\"><fieldset><legend class=\"wpforms-field-label\">\u00bfHay enfermedades hereditarias en la familia? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_97\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_97_1\" name=\"wpforms[fields][97]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_97_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_97_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_97_2\" name=\"wpforms[fields][97]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_97_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_97_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_98-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"98\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_98\">\u00bfCu\u00e1les? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_98\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][98]\" aria-errormessage=\"wpforms-17750-field_98-error\" required><\/div><div id=\"wpforms-17750-field_99-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"99\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"8\" data-formid=\"17750\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\"> Anterior<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"8\" data-formid=\"17750\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\"> Siguiente<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-9  \" data-page=\"9\" style=\"display:none;\"><div id=\"wpforms-17750-field_100-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"100\"><fieldset><legend class=\"wpforms-field-label\">\u00bfQu\u00e9 tipo de heces tiene? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_100\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_100_1\" name=\"wpforms[fields][100]\" value=\"Tipo 1\" aria-errormessage=\"wpforms-17750-field_100_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_100_1\">Tipo 1<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_100_2\" name=\"wpforms[fields][100]\" value=\"Tipo 2\" aria-errormessage=\"wpforms-17750-field_100_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_100_2\">Tipo 2<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_100_3\" name=\"wpforms[fields][100]\" value=\"Tipo 3\" aria-errormessage=\"wpforms-17750-field_100_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_100_3\">Tipo 3<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_100_4\" name=\"wpforms[fields][100]\" value=\"Tipo 4\" aria-errormessage=\"wpforms-17750-field_100_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_100_4\">Tipo 4<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_100_5\" name=\"wpforms[fields][100]\" value=\"Tipo 5\" aria-errormessage=\"wpforms-17750-field_100_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_100_5\">Tipo 5<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_100_6\" name=\"wpforms[fields][100]\" value=\"Tipo 6\" aria-errormessage=\"wpforms-17750-field_100_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_100_6\">Tipo 6<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_100_7\" name=\"wpforms[fields][100]\" value=\"Tipo 7\" aria-errormessage=\"wpforms-17750-field_100_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_100_7\">Tipo 7<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_101-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"101\"><div id=\"wpforms-17750-field_101\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17750-field_101-error\"><h4>Salud intestinal<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17750-field_102-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"102\"><div id=\"wpforms-17750-field_102\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17750-field_102-error\"><p><img decoding=\"async\" height=\"568\" width=\"440\" alt=\"\" src=\"https:\/\/gezonde-darmflora.nl\/wp-content\/uploads\/2024\/04\/Picture-1.jpg\" class=\"alignnone wp-image-17408 size-full\" srcset=\"https:\/\/gezonde-darmflora.nl\/wp-content\/uploads\/2024\/04\/Picture-1.jpg 440w, https:\/\/gezonde-darmflora.nl\/wp-content\/uploads\/2024\/04\/Picture-1-232x300.jpg 232w\" sizes=\"(max-width: 440px) 100vw, 440px\" \/><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17750-field_103-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"103\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_103\">\u00bfCu\u00e1ntas veces al d\u00eda defeca por t\u00e9rmino medio? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-17750-field_103\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][103]\" step=\"any\" aria-errormessage=\"wpforms-17750-field_103-error\" required><\/div><div id=\"wpforms-17750-field_105-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"105\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">\u00bfTiene un patr\u00f3n de deposiciones regular? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_105\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_105_1\" name=\"wpforms[fields][105]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_105_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_105_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_105_2\" name=\"wpforms[fields][105]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_105_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_105_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_106-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"106\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\"> \u00bfSufre de flatulencias diarias excesivas? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_106\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_106_1\" name=\"wpforms[fields][106]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_106_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_106_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_106_2\" name=\"wpforms[fields][106]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_106_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_106_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_107-container\" class=\"wpforms-field wpforms-field-number wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"107\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_107\"> En caso afirmativo, \u00bfcon qu\u00e9 frecuencia al d\u00eda? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-17750-field_107\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][107]\" step=\"any\" aria-errormessage=\"wpforms-17750-field_107-error\" required><\/div><div id=\"wpforms-17750-field_108-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"108\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\"> \u00bfHa sido tratado alguna vez por una infecci\u00f3n intestinal? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_108\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_108_1\" name=\"wpforms[fields][108]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_108_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_108_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_108_2\" name=\"wpforms[fields][108]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_108_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_108_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_109-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"109\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_109\"> \u00bfCu\u00e1ndo fue la \u00faltima vez? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-17750-field_109\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][109][date]\" aria-errormessage=\"wpforms-17750-field_109-error\" required><a title=\"Borrar fecha\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Borrar fecha\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-17750-field_110-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"110\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">\u00bfPadece una enfermedad intestinal cr\u00f3nica?  (por ejemplo, enfermedad de Crohn\/colitis ulcerosa\/enfermedad cel\u00edaca)     <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_110\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_110_1\" name=\"wpforms[fields][110]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_110_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_110_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_110_2\" name=\"wpforms[fields][110]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_110_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_110_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_111-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"111\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_111\">En caso afirmativo, \u00bfcu\u00e1l? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_111\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][111]\" aria-errormessage=\"wpforms-17750-field_111-error\" required><\/div>\t\t<div id=\"wpforms-17750-field_3-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"3\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-17750-field_3\" > \u00bfCon se<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-17750-field_3\" class=\"wpforms-field-medium\" name=\"wpforms[fields][3]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-17750-field_112-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"112\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">\u00bfToma alguna vez productos especiales para el tr\u00e1nsito intestinal?  (\u00bfactividades\/yakult\/actimel etc?)       <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_112\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_112_1\" name=\"wpforms[fields][112]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_112_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_112_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_112_2\" name=\"wpforms[fields][112]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_112_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_112_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_113-container\" class=\"wpforms-field wpforms-field-number wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"113\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_113\">\u00bfCu\u00e1ntas veces? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-17750-field_113\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][113]\" step=\"any\" aria-errormessage=\"wpforms-17750-field_113-error\" aria-describedby=\"wpforms-17750-field_113-description\" required><div id=\"wpforms-17750-field_113-description\" class=\"wpforms-field-description\">... veces al d\u00eda<\/div><\/div><div id=\"wpforms-17750-field_114-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"114\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">\u00bfSufre alguna vez (m\u00e1s de una vez al mes) de dificultad para defecar (estre\u00f1imiento), de modo que tiene que hacer un gran esfuerzo para expulsar las heces?   <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_114\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_114_1\" name=\"wpforms[fields][114]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_114_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_114_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_114_2\" name=\"wpforms[fields][114]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_114_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_114_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_115-container\" class=\"wpforms-field wpforms-field-number wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"115\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_115\">En caso afirmativo, \u00bfcon qu\u00e9 frecuencia al mes por t\u00e9rmino medio? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-17750-field_115\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][115]\" step=\"any\" aria-errormessage=\"wpforms-17750-field_115-error\" aria-describedby=\"wpforms-17750-field_115-description\" required><div id=\"wpforms-17750-field_115-description\" class=\"wpforms-field-description\">... tiempos<\/div><\/div><div id=\"wpforms-17750-field_116-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"116\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">\u00bfSufre de hemorroides?                  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_116\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_116_1\" name=\"wpforms[fields][116]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_116_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_116_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_116_2\" name=\"wpforms[fields][116]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_116_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_116_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_117-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"117\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">\u00bfSuele tener retortijones intestinales?     <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_117\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_117_1\" name=\"wpforms[fields][117]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_117_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_117_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_117_2\" name=\"wpforms[fields][117]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_117_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_117_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_118-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"118\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">\u00bfToma alguna vez medicaci\u00f3n para facilitar\/lentificar los movimientos intestinales?          <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_118\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_118_1\" name=\"wpforms[fields][118]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_118_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_118_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_118_2\" name=\"wpforms[fields][118]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_118_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_118_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_119-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"119\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">\u00bfToma alguna vez ciertos alimentos (ciruelas\/fibras) para facilitar el tr\u00e1nsito intestinal? para aliviar?      <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_119\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_119_1\" name=\"wpforms[fields][119]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_119_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_119_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_119_2\" name=\"wpforms[fields][119]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_119_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_119_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_120-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"120\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">\u00bfLe vienen de familia los trastornos intestinales?               <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_120\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_120_1\" name=\"wpforms[fields][120]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_120_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_120_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_120_2\" name=\"wpforms[fields][120]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_120_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_120_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_122-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"122\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_122\">En caso afirmativo, \u00bfcu\u00e1les y con qui\u00e9n? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-17750-field_122\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][122]\" aria-errormessage=\"wpforms-17750-field_122-error\" required><\/textarea><\/div><div id=\"wpforms-17750-field_123-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"123\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">\u00bfTiene c\u00e1ncer de colon o p\u00f3lipos en su familia?       <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_123\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_123_1\" name=\"wpforms[fields][123]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_123_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_123_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_123_2\" name=\"wpforms[fields][123]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_123_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_123_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_124-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"124\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_124\">\u00bfCon qui\u00e9n? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_124\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][124]\" aria-errormessage=\"wpforms-17750-field_124-error\" required><\/div><div id=\"wpforms-17750-field_125-container\" class=\"wpforms-field wpforms-field-number wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"125\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_125\">\u00bfA qu\u00e9 edad? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-17750-field_125\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][125]\" step=\"any\" aria-errormessage=\"wpforms-17750-field_125-error\" required><\/div><div id=\"wpforms-17750-field_126-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"126\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"9\" data-formid=\"17750\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\"> Anterior<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"9\" data-formid=\"17750\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\"> Siguiente<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-10  \" data-page=\"10\" style=\"display:none;\"><div id=\"wpforms-17750-field_127-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"127\"><div id=\"wpforms-17750-field_127\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17750-field_127-error\"><h4>Uso de antibi\u00f3ticos<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17750-field_128-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"128\"><fieldset><legend class=\"wpforms-field-label\">\u00bfHa tomado antibi\u00f3ticos alguna vez? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_128\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_128_1\" name=\"wpforms[fields][128]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_128_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_128_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_128_2\" name=\"wpforms[fields][128]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_128_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_128_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_129-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"129\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\"> \u00bfHa tomado antibi\u00f3ticos en los \u00faltimos tres meses? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_129\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_129_1\" name=\"wpforms[fields][129]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_129_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_129_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_129_2\" name=\"wpforms[fields][129]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_129_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_129_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_131-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"131\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_131\"> \u00bfRecuerdas qu\u00e9 antibi\u00f3tico? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_131\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][131]\" aria-errormessage=\"wpforms-17750-field_131-error\" required><\/div><div id=\"wpforms-17750-field_132-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"132\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_132\"> \u00bfCu\u00e1ndo y durante cu\u00e1ntos d\u00edas? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_132\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][132]\" aria-errormessage=\"wpforms-17750-field_132-error\" required><\/div><div id=\"wpforms-17750-field_133-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"133\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\"> \u00bfHa tomado antibi\u00f3ticos en el \u00faltimo a\u00f1o? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_133\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_133_1\" name=\"wpforms[fields][133]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_133_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_133_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_133_2\" name=\"wpforms[fields][133]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_133_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_133_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_134-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"134\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_134\">\u00bfRecuerdas qu\u00e9 antibi\u00f3tico? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_134\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][134]\" aria-errormessage=\"wpforms-17750-field_134-error\" required><\/div><div id=\"wpforms-17750-field_135-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"135\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_135\">\u00bfCu\u00e1ndo y durante cu\u00e1ntos d\u00edas? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17750-field_135\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][135]\" aria-errormessage=\"wpforms-17750-field_135-error\" required><\/div><div id=\"wpforms-17750-field_136-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"136\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"10\" data-formid=\"17750\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\"> Anterior<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"10\" data-formid=\"17750\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\"> Siguiente<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-11  \" data-page=\"11\" style=\"display:none;\"><div id=\"wpforms-17750-field_137-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"137\"><div id=\"wpforms-17750-field_137\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17750-field_137-error\"><h4>Cuestiones sanitarias adicionales<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17750-field_138-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"138\"><fieldset><legend class=\"wpforms-field-label\">\u00bfHa sufrido alguna vez una hemorragia rectal? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_138\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_138_1\" name=\"wpforms[fields][138]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_138_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_138_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_138_2\" name=\"wpforms[fields][138]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_138_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_138_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_140-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"140\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">\u00bfSe han llevado a cabo investigaciones adicionales? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_140\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_140_1\" name=\"wpforms[fields][140]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_140_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_140_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_140_2\" name=\"wpforms[fields][140]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_140_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_140_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_141-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"141\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_141\">\u00bfCu\u00e1les fueron los resultados? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-17750-field_141\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][141]\" aria-errormessage=\"wpforms-17750-field_141-error\" required><\/textarea><\/div><div id=\"wpforms-17750-field_142-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"142\"><fieldset><legend class=\"wpforms-field-label\">\u00bfHa tenido fiebre en las \u00faltimas dos semanas? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_142\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_142_1\" name=\"wpforms[fields][142]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_142_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_142_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_142_2\" name=\"wpforms[fields][142]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_142_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_142_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_143-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"143\"><fieldset><legend class=\"wpforms-field-label\">\u00bfHa tenido diarrea en los \u00faltimos 3 meses? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_143\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_143_1\" name=\"wpforms[fields][143]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_143_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_143_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_143_2\" name=\"wpforms[fields][143]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_143_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_143_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17750-field_144-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"144\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17750-field_144\">\u00bfCu\u00e1ndo empez\u00f3 y cu\u00e1nto dur\u00f3? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-17750-field_144\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][144]\" aria-errormessage=\"wpforms-17750-field_144-error\" required><\/textarea><\/div><div id=\"wpforms-17750-field_145-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"145\"><fieldset><legend class=\"wpforms-field-label\">\u00bfSufre de alergias? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17750-field_145\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_145_1\" name=\"wpforms[fields][145]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-17750-field_145_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17750-field_145_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17750-field_145_2\" name=\"wpforms[fields][145]\" value=\"No\" aria-errormessage=\"wpforms-17750-field_145_2-error\" required ><label class=\"wpforms-field-label-inline\" 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