{"id":5325,"date":"2016-02-16T20:15:55","date_gmt":"2016-02-16T18:15:55","guid":{"rendered":"https:\/\/www.grupopoliclinica.es\/en\/?page_id=5325"},"modified":"2024-02-07T09:23:32","modified_gmt":"2024-02-07T07:23:32","slug":"contact-our-international-department","status":"publish","type":"page","link":"https:\/\/www.grupopoliclinica.es\/en\/contact-our-international-department\/","title":{"rendered":"Contact our international department"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"5325\" class=\"elementor elementor-5325 elementor-4874\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-3c24445 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"3c24445\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-66 elementor-top-column elementor-element elementor-element-4b3e6e2\" data-id=\"4b3e6e2\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0f51d8f elementor-widget elementor-widget-html\" data-id=\"0f51d8f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<script>\njQuery(document).ready(function($){\n    $('#solicitar-tratamiento a').click(function(){\n        if($('#tratamiento-internacional').is(':visible')){\n            $('#tratamiento-internacional').hide();\n        }else{\n            $('#tratamiento-internacional').show();\n        }\n    })\n});\n<\/script>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-30b914a elementor-section-content-middle elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"30b914a\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-309f9a4\" data-id=\"309f9a4\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-90b6892 elementor-widget elementor-widget-heading\" data-id=\"90b6892\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Contact our international department<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-7d7be5b\" data-id=\"7d7be5b\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-548b5f7 elementor-align-right elementor-mobile-align-center elementor-widget elementor-widget-button\" data-id=\"548b5f7\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"solicitar-tratamiento\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"#tratamiento-internacional\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Request Treatment<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<div class=\"elementor-element elementor-element-a9cc83f elementor-widget elementor-widget-text-editor\" data-id=\"a9cc83f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: justify;\">Contact our international department. We\u2019d be delighted to meet your needs. How can we help you?<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-220b532 elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"220b532\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" id=\"en_contacto_departamento_internacional\" name=\"EN Contacto Departamento Internacional\" aria-label=\"EN Contacto Departamento Internacional\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"5325\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"220b532\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Contact Our International Department - Grupo Policl\u00ednica\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"5325\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tName\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEmail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-message elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-message\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMessage\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[message]\" id=\"form-field-message\" rows=\"6\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_4b7cb53 elementor-col-100\">\n\t\t\t\t\t<p style=\"font-size:10px;margin-bottom:0px\">POLICL\u00cdNICA NTRA.SRA. DEL ROSARIO S.L.U is responsible for processing the personal data of the data subject and informs you that this data will be processed in accordance with the provisions of Regulation (EU) 2016\/679, of 27 April, (GDPR) and Organic Law 3\/2018, of 5 December, (LOPDGDD), for which reason the following processing information is provided:  <\/p>\n<p style=\"font-size:10px;margin-bottom:0\"><u>Purposes and lawfulness of the processing:<\/u>  <\/p>\n<ul style=\"font-size:10px\">\n<li><u>For the provision of health care and the proper management of the health care and administrative <\/u>services required for the same (keeping of medical records, appointments, check-ups, issuing of certificates of attendance in accordance with the regulations, handling of communications with patients, etc.), on the basis of art. 6.1.b GDPR, for the performance of a contract or pre-contract to which the data subject is a party and which, in the processing of data relating to health, is covered by the exception provided for in art. 9.2.h GDPR, as the processing is necessary for the purposes of preventive or occupational medicine, assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment or the management of health and social care systems and services. <\/li>\n<li><u>For the billing, collection and accounting <\/u>of our services, for the fulfilment of our legal obligations, in accordance with art. 6.1.c RGPD. \n<u>Data retention criteria:<\/u> Data shall be kept for no longer than is necessary to fulfil the purpose of the processing or for as long as is required by law and, when no longer necessary for that purpose, shall be deleted with appropriate security measures to ensure anonymisation or total destruction of the data. \n<br\/>\n<u>Communication of data:<\/u> For the purposes set out above, the user consents to the transfer of his\/her personal data to companies within Grupo Policl\u00ednica (EIVICONSULTA, S.L.U, CLINICA PREMIUM IBIZA, S.L.U, CLINICA VILAPARC, S.L.U and LOGISTICA PRODUCTOS SANITARIOS, S.L.U), insurance companies and other entities authorised by law. <\/li>\n<li><u>Rights of the data subject:<\/u> At any time, you may exercise your rights of access, rectification, portability and cancellation of your data, as well as the right to restrict or oppose its processing, by contacting POLICL\u00cdNICA NTRA.SRA.DEL ROSARIO S.L.U., by email: lopd@grupopoliclinica.es or info@grupopoliclinica.es or by post: POLICL\u00cdNICA NTRA.SRA. DEL ROSARIO S.L.U, VIA ROMANA S\/N C.P. 07800, IBIZA (BALEARIC ISLANDS). You also have the right to lodge a complaint with the Spanish Data Protection Agency (www.aepd.es) if you consider that the processing does not comply with the regulations in force. <\/li>\n<\/ul>\n<p style=\"font-size:10px;margin-bottom:0\"><span style=\"text-decoration: underline;\">Contact information to exercise their rights:<\/span> <a href=\"mailto:lopd@www.grupopoliclinica.es\">lopd@www.grupopoliclinica.es<\/a>. <span style=\"text-decoration: underline;\">Contact details of the<\/span>\n<span style=\"text-decoration: underline;\">data protection officer:<\/span> <a href=\"mailto:dpd@grupopoliclinica.es\">dpd@grupopoliclinica.es<\/a><\/p>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-accept_privacy elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[accept_privacy]\" id=\"form-field-accept_privacy\" class=\"elementor-field elementor-size-md  elementor-acceptance-field\" required=\"required\">\n\t\t\t\t<label for=\"form-field-accept_privacy\">I have read and accept the <a href=\"\/en\/privacy-policy\/\">Privacy Policy<\/a><\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-recaptcha_v3 elementor-field-group elementor-column elementor-field-group-field_ebeb728 elementor-col-100 recaptcha_v3-bottomright\">\n\t\t\t\t\t<div class=\"elementor-field\" id=\"form-field-field_ebeb728\"><div class=\"elementor-g-recaptcha\" data-sitekey=\"6LfRaKIUAAAAANBTUfBLV5NBHAc7EwPTDFdeHmXL\" data-type=\"v3\" data-action=\"Form\" data-badge=\"bottomright\" data-size=\"invisible\"><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-md\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Send<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-145c6a3\" data-id=\"145c6a3\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-614db0b elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"614db0b\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-e8e82b3\" data-id=\"e8e82b3\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-cdd5328 elementor-view-stacked elementor-shape-square elementor-position-block-start elementor-mobile-position-block-start elementor-widget elementor-widget-icon-box\" data-id=\"cdd5328\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<a href=\"tel:+34971301916;228\" class=\"elementor-icon\" tabindex=\"-1\" aria-label=\"International Dpt. Phone\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-phone\"><\/i>\t\t\t\t<\/a>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\n\t\t\t\t\t\t\t\t\t<h4 class=\"elementor-icon-box-title\">\n\t\t\t\t\t\t<a href=\"tel:+34971301916;228\" >\n\t\t\t\t\t\t\tInternational Dpt. Phone\t\t\t\t\t\t<\/a>\n\t\t\t\t\t<\/h4>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<p class=\"elementor-icon-box-description\">\n\t\t\t\t\t\t+34 971 30 19 16 (ext. 228)<br>(8:00 - 15:00)\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<div class=\"elementor-element elementor-element-3ac34c3 elementor-widget elementor-widget-image\" data-id=\"3ac34c3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" src=\"https:\/\/www.grupopoliclinica.es\/wp-content\/uploads\/elementor\/thumbs\/recepcion-ppal-qfou5o24vncof4jj7pdrn0a5r8ak5520pn45aagdxc.jpg\" title=\"recepci\u00f3n ppal\" alt=\"recepci\u00f3n ppal\" loading=\"lazy\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-7682dd9 contenido-oculto elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"7682dd9\" data-element_type=\"section\" data-e-type=\"section\" id=\"tratamiento-internacional\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-439d9ab\" data-id=\"439d9ab\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-9d67675 elementor-widget elementor-widget-heading\" data-id=\"9d67675\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Did you decide to have a treatment with us? <\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b2df92d elementor-widget elementor-widget-text-editor\" data-id=\"b2df92d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: justify;\"><span lang=\"EN-US\">If so, please fill in our health questionnaire and we will contact you as soon as possible.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fd3fca4 elementor-widget elementor-widget-html\" data-id=\"fd3fca4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div 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\tif($(this).val() == 'Yes'){ \r\n    \t\t$('.elementor-field-group-diabetes_si').show();\r\n    \t\t$('.elementor-field-group-diabetes_si input').prop(\"required\", true);\t\r\n    \t}else{\r\n    \t\t$('.elementor-field-group-diabetes_si').hide();\t\r\n    \t\t$('.elementor-field-group-diabetes_si input').prop(\"required\", false);\r\n    \t}\r\n    });\r\n\r\n    $('body').on('change','.elementor-field-group-tiroides input',function(){\r\n    \tif($(this).val() == 'Yes'){ \r\n    \t\t$('.elementor-field-group-tiroides_si').show();\r\n    \t\t$('.elementor-field-group-tiroides_si input').prop(\"required\", true);\t\r\n    \t}else{\r\n    \t\t$('.elementor-field-group-tiroides_si').hide();\t\r\n    \t\t$('.elementor-field-group-tiroides_si input').prop(\"required\", false);\r\n    \t}\r\n    });\r\n\r\n    $('body').on('change','.elementor-field-group-sanguinea input',function(){\r\n    \tif($(this).val() == 'Yes'){ \r\n    \t\t$('.elementor-field-group-sanguinea_si').show();\r\n    \t\t$('.elementor-field-group-sanguinea_otra').show();   \t\t\r\n    \t\t$('.elementor-field-group-sanguinea_si input').prop(\"required\", true);\r\n    \t\t$('.elementor-field-group-sanguinea_otra input').prop(\"required\", true);\t\r\n    \t}else{\r\n    \t\t$('.elementor-field-group-sanguinea_si').hide();\r\n    \t\t$('.elementor-field-group-sanguinea_otra').hide();  \r\n    \t\t$('.elementor-field-group-sanguinea_si input').prop(\"required\", false);\r\n    \t\t$('.elementor-field-group-sanguinea_otra input').prop(\"required\", false);\r\n    \t}\r\n    });\r\n\r\n    $('body').on('change','.elementor-field-group-respiratoria input',function(){\r\n    \tif($(this).val() == 'Yes'){ \r\n    \t\t$('.elementor-field-group-respiratoria_si').show();\r\n    \t\t$('.elementor-field-group-respiratoria_otra').show();   \t\t\r\n    \t\t$('.elementor-field-group-respiratoria_si input').prop(\"required\", true);\r\n    \t\t$('.elementor-field-group-respiratoria_otra input').prop(\"required\", true);\t\r\n    \t}else{\r\n    \t\t$('.elementor-field-group-respiratoria_si').hide();\r\n    \t\t$('.elementor-field-group-respiratoria_otra').hide();  \r\n    \t\t$('.elementor-field-group-respiratoria_si input').prop(\"required\", false);\r\n    \t\t$('.elementor-field-group-respiratoria_otra input').prop(\"required\", false);\r\n    \t}\r\n    });\r\n\r\n    $('body').on('change','.elementor-field-group-renales input',function(){\r\n    \tif($(this).val() == 'Yes'){ \r\n    \t\t$('.elementor-field-group-dialisis').show();\r\n    \t\t$('.elementor-field-group-dialisis input').prop(\"required\", true);\t\r\n    \t}else{\r\n    \t\t$('.elementor-field-group-dialisis').hide();\t\r\n    \t\t$('.elementor-field-group-dialisis input').prop(\"required\", false);\r\n    \t}\r\n    });\r\n\r\n    $('body').on('change','.elementor-field-group-higado input',function(){\r\n    \tif($(this).val() == 'Yes'){ \r\n    \t\t$('.elementor-field-group-higado_si').show();\r\n    \t\t$('.elementor-field-group-higado_otra').show();   \t\t\r\n    \t\t$('.elementor-field-group-higado_si input').prop(\"required\", true);\r\n    \t\t$('.elementor-field-group-higado_otra input').prop(\"required\", true);\t\r\n    \t}else{\r\n    \t\t$('.elementor-field-group-higado_si').hide();\r\n    \t\t$('.elementor-field-group-higado_otra').hide();  \r\n    \t\t$('.elementor-field-group-higado_si input').prop(\"required\", false);\r\n    \t\t$('.elementor-field-group-higado_otra input').prop(\"required\", false);\r\n    \t}\r\n    });\r\n\r\n    $('body').on('change','.elementor-field-group-hematologicos input',function(){\r\n    \tif($(this).val() == 'Yes'){ \r\n    \t\t$('.elementor-field-group-hematologicos_si').show();\r\n    \t\t$('.elementor-field-group-hematologicos_otra').show();   \t\t\r\n    \t\t$('.elementor-field-group-hematologicos_si input').prop(\"required\", true);\r\n    \t\t$('.elementor-field-group-hematologicos_otra input').prop(\"required\", true);\t\r\n    \t}else{\r\n    \t\t$('.elementor-field-group-hematologicos_si').hide();\r\n    \t\t$('.elementor-field-group-hematologicos_otra').hide();  \r\n    \t\t$('.elementor-field-group-hematologicos_si input').prop(\"required\", false);\r\n    \t\t$('.elementor-field-group-hematologicos_otra input').prop(\"required\", false);\r\n    \t}\r\n    });\r\n\r\n    $('body').on('change','.elementor-field-group-oncologico input',function(){\r\n    \tif($(this).val() == 'Yes'){ \r\n    \t\t$('.elementor-field-group-oncologico_si').show();\r\n    \t\t$('.elementor-field-group-tratamiento').show();   \t\t\r\n    \t\t$('.elementor-field-group-oncologico_si input').prop(\"required\", true);\r\n    \t\t$('.elementor-field-group-tratamiento input').prop(\"required\", true);\t\r\n    \t}else{\r\n    \t\t$('.elementor-field-group-oncologico_si').hide();\r\n    \t\t$('.elementor-field-group-tratamiento').hide();  \r\n    \t\t$('.elementor-field-group-oncologico_si input').prop(\"required\", false);\r\n    \t\t$('.elementor-field-group-tratamiento input').prop(\"required\", false);\r\n    \t}\r\n    });\r\n\r\n    $('body').on('change','.elementor-field-group-mental input',function(){\r\n    \tif($(this).val() == 'Yes'){ \r\n    \t\t$('.elementor-field-group-mental_si').show();\r\n    \t\t$('.elementor-field-group-mental_otra').show();   \t\t\r\n    \t\t$('.elementor-field-group-mental_si input').prop(\"required\", true);\r\n    \t\t$('.elementor-field-group-mental_otra input').prop(\"required\", true);\t\r\n    \t}else{\r\n    \t\t$('.elementor-field-group-mental_si').hide();\r\n    \t\t$('.elementor-field-group-mental_otra').hide();  \r\n    \t\t$('.elementor-field-group-mental_si input').prop(\"required\", false);\r\n    \t\t$('.elementor-field-group-mental_otra input').prop(\"required\", false);\r\n    \t}\r\n    });\r\n\r\n    $('body').on('change','.elementor-field-group-neurologico input',function(){\r\n    \tif($(this).val() == 'Yes'){ \r\n    \t\t$('.elementor-field-group-neurologico_si').show();\r\n    \t\t$('.elementor-field-group-neurologico_si input').prop(\"required\", true);\t\r\n    \t}else{\r\n    \t\t$('.elementor-field-group-neurologico_si').hide();\t\r\n    \t\t$('.elementor-field-group-neurologico_si input').prop(\"required\", false);\r\n    \t}\r\n    });\r\n\r\n    $('body').on('change','.elementor-field-group-anestesia input',function(){\r\n    \tif($(this).val() == 'Yes'){ \r\n    \t\t$('.elementor-field-group-anestesia_si').show();\r\n    \t\t$('.elementor-field-group-anestesia_si input').prop(\"required\", true);\t\r\n    \t}else{\r\n    \t\t$('.elementor-field-group-anestesia_si').hide();\t\r\n    \t\t$('.elementor-field-group-anestesia_si input').prop(\"required\", false);\r\n    \t}\r\n    });\r\n\r\n    $('body').on('change','.elementor-field-group-alergia input',function(){\r\n    \tif($(this).val() == 'Yes'){ \r\n    \t\t$('.elementor-field-group-alergia_si').show();\r\n    \t\t$('.elementor-field-group-alergia_cual').show();   \t\t\r\n    \t\t$('.elementor-field-group-alergia_si input').prop(\"required\", true);\r\n    \t\t$('.elementor-field-group-alergia_cual input').prop(\"required\", true);\t\r\n    \t}else{\r\n    \t\t$('.elementor-field-group-alergia_si').hide();\r\n    \t\t$('.elementor-field-group-alergia_cual').hide();  \r\n    \t\t$('.elementor-field-group-alergia_si input').prop(\"required\", false);\r\n    \t\t$('.elementor-field-group-alergia_cual input').prop(\"required\", false);\r\n    \t}\r\n    });\r\n\r\n    $('body').on('change','.elementor-field-group-medicacion input',function(){\r\n    \tif($(this).val() == 'Yes'){ \r\n    \t\t$('.elementor-field-group-medicacion_cual').show();\r\n    \t\t$('.elementor-field-group-medicacion_cual input').prop(\"required\", true);\t\r\n    \t}else{\r\n    \t\t$('.elementor-field-group-medicacion_cual').hide();\t\r\n    \t\t$('.elementor-field-group-medicacion_cual input').prop(\"required\", false);\r\n    \t}\r\n    });\r\n\r\n    $('body').on('change','.elementor-field-group-hospitalizacion input',function(){\r\n    \tif($(this).val() == 'Yes'){ \r\n    \t\t$('.elementor-field-group-hospitalizacion_cual').show();\r\n    \t\t$('.elementor-field-group-hospitalizacion_cual input').prop(\"required\", true);\t\r\n    \t}else{\r\n    \t\t$('.elementor-field-group-hospitalizacion_cual').hide();\t\r\n    \t\t$('.elementor-field-group-hospitalizacion_cual input').prop(\"required\", false);\r\n    \t}\r\n    });\r\n\r\n});\r\n<\/script>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fa0b678 elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"fa0b678\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" id=\"contacto\" name=\"Contact\" aria-label=\"Contact\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"5325\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"fa0b678\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Contact Our International Department - Grupo Policl\u00ednica\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"5325\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_9bc6415 elementor-col-100\">\n\t\t\t\t\t<strong>PATIENT MEDICAL INFORMATION <\/strong>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-nombre elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-nombre\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tName\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[nombre]\" id=\"form-field-nombre\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-apellidos elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-apellidos\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSurname\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[apellidos]\" id=\"form-field-apellidos\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-sexo elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-sexo\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGender\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[sexo]\" id=\"form-field-sexo\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-nacimiento elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-nacimiento\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate of birth\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[nacimiento]\" id=\"form-field-nacimiento\" class=\"elementor-field elementor-size-md  elementor-field-textual elementor-date-field elementor-use-native\" required=\"required\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-residencia elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-residencia\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCountry of residence\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[residencia]\" id=\"form-field-residencia\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-nacionalidad elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-nacionalidad\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNationality\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[nacionalidad]\" id=\"form-field-nacionalidad\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-identificacion elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-identificacion\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tID Number (identification number, residency number, passport)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[identificacion]\" id=\"form-field-identificacion\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_f119c52 elementor-col-100\">\n\t\t\t\t\tSocial habits:\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-fumador elementor-col-30 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-fumador\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDo you smoke?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-fumador-0\" name=\"form_fields[fumador]\" required=\"required\"> <label for=\"form-field-fumador-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-fumador-1\" name=\"form_fields[fumador]\" required=\"required\"> <label for=\"form-field-fumador-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-alcohol elementor-col-70 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-alcohol\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDo you drink alcohol regularly?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-alcohol-0\" name=\"form_fields[alcohol]\" required=\"required\"> <label for=\"form-field-alcohol-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-alcohol-1\" name=\"form_fields[alcohol]\" required=\"required\"> <label for=\"form-field-alcohol-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-sustancia elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-sustancia\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAny other substances intake? \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[sustancia]\" id=\"form-field-sustancia\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_ea6d6e7 elementor-col-100\">\n\t\t\t\t\t<br\/><strong>PATIENT MEDICAL INFORMATION<\/strong>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-cardiologicos elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-cardiologicos\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHeart Diseases\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-cardiologicos-0\" name=\"form_fields[cardiologicos]\" required=\"required\"> <label for=\"form-field-cardiologicos-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-cardiologicos-1\" name=\"form_fields[cardiologicos]\" required=\"required\"> <label for=\"form-field-cardiologicos-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-cardiologicos_si elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-cardiologicos_si\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSelect which one:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Acute heart attack\" id=\"form-field-cardiologicos_si-0\" name=\"form_fields[cardiologicos_si]\"> <label for=\"form-field-cardiologicos_si-0\">Acute heart attack<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Heart insufficiency\" id=\"form-field-cardiologicos_si-1\" name=\"form_fields[cardiologicos_si]\"> <label for=\"form-field-cardiologicos_si-1\">Heart insufficiency<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\" id=\"form-field-cardiologicos_si-2\" name=\"form_fields[cardiologicos_si]\"> <label for=\"form-field-cardiologicos_si-2\"><\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-cardiologicos_otra elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-cardiologicos_otra\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tOthers:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[cardiologicos_otra]\" id=\"form-field-cardiologicos_otra\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-diabetes elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-diabetes\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tInsulin-dependent Diabetic\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-diabetes-0\" name=\"form_fields[diabetes]\" required=\"required\"> <label for=\"form-field-diabetes-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-diabetes-1\" name=\"form_fields[diabetes]\" required=\"required\"> <label for=\"form-field-diabetes-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-diabetes_si elementor-col-66\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-diabetes_si\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSelect which one:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Type I diabetes\" id=\"form-field-diabetes_si-0\" name=\"form_fields[diabetes_si]\"> <label for=\"form-field-diabetes_si-0\">Type I diabetes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Type II diabetes\" id=\"form-field-diabetes_si-1\" name=\"form_fields[diabetes_si]\"> <label for=\"form-field-diabetes_si-1\">Type II diabetes<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-tiroides elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-tiroides\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tThyroid Disorders\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-tiroides-0\" name=\"form_fields[tiroides]\" required=\"required\"> <label for=\"form-field-tiroides-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-tiroides-1\" name=\"form_fields[tiroides]\" required=\"required\"> <label for=\"form-field-tiroides-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-tiroides_si elementor-col-66\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-tiroides_si\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSelect which one:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Hyperactive thyroid \" id=\"form-field-tiroides_si-0\" name=\"form_fields[tiroides_si]\"> <label for=\"form-field-tiroides_si-0\">Hyperactive thyroid <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Underactive thyroid\" id=\"form-field-tiroides_si-1\" name=\"form_fields[tiroides_si]\"> <label for=\"form-field-tiroides_si-1\">Underactive thyroid<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-sanguinea elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-sanguinea\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBlood pressure disorders\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-sanguinea-0\" name=\"form_fields[sanguinea]\" required=\"required\"> <label for=\"form-field-sanguinea-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-sanguinea-1\" name=\"form_fields[sanguinea]\" required=\"required\"> <label for=\"form-field-sanguinea-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-sanguinea_si elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-sanguinea_si\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSelect which one:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"High blood pressure \" id=\"form-field-sanguinea_si-0\" name=\"form_fields[sanguinea_si]\"> <label for=\"form-field-sanguinea_si-0\">High blood pressure <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Low blood pressure \" id=\"form-field-sanguinea_si-1\" name=\"form_fields[sanguinea_si]\"> <label for=\"form-field-sanguinea_si-1\">Low blood pressure <\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-sanguinea_otra elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-sanguinea_otra\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tOthers:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[sanguinea_otra]\" id=\"form-field-sanguinea_otra\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-respiratoria elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-respiratoria\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tRespiratory Diseases\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-respiratoria-0\" name=\"form_fields[respiratoria]\" required=\"required\"> <label for=\"form-field-respiratoria-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-respiratoria-1\" name=\"form_fields[respiratoria]\" required=\"required\"> <label for=\"form-field-respiratoria-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-respiratoria_si elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-respiratoria_si\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSelect which one:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"COPD\" id=\"form-field-respiratoria_si-0\" name=\"form_fields[respiratoria_si]\"> <label for=\"form-field-respiratoria_si-0\">COPD<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Asthma\" id=\"form-field-respiratoria_si-1\" name=\"form_fields[respiratoria_si]\"> <label for=\"form-field-respiratoria_si-1\">Asthma<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Respiratory insufficiency\" id=\"form-field-respiratoria_si-2\" name=\"form_fields[respiratoria_si]\"> <label for=\"form-field-respiratoria_si-2\">Respiratory insufficiency<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-respiratoria_otra elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-respiratoria_otra\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tOthers:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[respiratoria_otra]\" id=\"form-field-respiratoria_otra\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-renales elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-renales\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tKindney Diseases \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-renales-0\" name=\"form_fields[renales]\" required=\"required\"> <label for=\"form-field-renales-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-renales-1\" name=\"form_fields[renales]\" required=\"required\"> <label for=\"form-field-renales-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-dialisis elementor-col-66\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-dialisis\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDyalisis:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-dialisis-0\" name=\"form_fields[dialisis]\"> <label for=\"form-field-dialisis-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-dialisis-1\" name=\"form_fields[dialisis]\"> <label for=\"form-field-dialisis-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-higado elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-higado\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLiver Diseases\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-higado-0\" name=\"form_fields[higado]\" required=\"required\"> <label for=\"form-field-higado-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-higado-1\" name=\"form_fields[higado]\" required=\"required\"> <label for=\"form-field-higado-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-higado_si elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-higado_si\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSelect which one:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Hepatitis A\" id=\"form-field-higado_si-0\" name=\"form_fields[higado_si]\"> <label for=\"form-field-higado_si-0\">Hepatitis A<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Hepatitis B\" id=\"form-field-higado_si-1\" name=\"form_fields[higado_si]\"> <label for=\"form-field-higado_si-1\">Hepatitis B<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Hepatitis C\" id=\"form-field-higado_si-2\" name=\"form_fields[higado_si]\"> <label for=\"form-field-higado_si-2\">Hepatitis C<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-higado_otra elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-higado_otra\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tOthers:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[higado_otra]\" id=\"form-field-higado_otra\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-hematologicos elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-hematologicos\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBlood Disorders\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-hematologicos-0\" name=\"form_fields[hematologicos]\" required=\"required\"> <label for=\"form-field-hematologicos-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-hematologicos-1\" name=\"form_fields[hematologicos]\" required=\"required\"> <label for=\"form-field-hematologicos-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-hematologicos_si elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-hematologicos_si\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSelect which one:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Anemia \" id=\"form-field-hematologicos_si-0\" name=\"form_fields[hematologicos_si]\"> <label for=\"form-field-hematologicos_si-0\">Anemia <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Hemophylia\" id=\"form-field-hematologicos_si-1\" name=\"form_fields[hematologicos_si]\"> <label for=\"form-field-hematologicos_si-1\">Hemophylia<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Coagulation disorders \" id=\"form-field-hematologicos_si-2\" name=\"form_fields[hematologicos_si]\"> <label for=\"form-field-hematologicos_si-2\">Coagulation disorders <\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-hematologicos_otra elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-hematologicos_otra\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tOthers:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[hematologicos_otra]\" id=\"form-field-hematologicos_otra\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-oncologico elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-oncologico\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCancer History\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-oncologico-0\" name=\"form_fields[oncologico]\" required=\"required\"> <label for=\"form-field-oncologico-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-oncologico-1\" name=\"form_fields[oncologico]\" required=\"required\"> <label for=\"form-field-oncologico-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-oncologico_si elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-oncologico_si\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIf yes, explain:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[oncologico_si]\" id=\"form-field-oncologico_si\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-tratamiento elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-tratamiento\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTreatment received:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Chemotherapy\" id=\"form-field-tratamiento-0\" name=\"form_fields[tratamiento]\"> <label for=\"form-field-tratamiento-0\">Chemotherapy<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Radiotherapy\" id=\"form-field-tratamiento-1\" name=\"form_fields[tratamiento]\"> <label for=\"form-field-tratamiento-1\">Radiotherapy<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-vih elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-vih\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAIDS or HIV\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-vih-0\" name=\"form_fields[vih]\"> <label for=\"form-field-vih-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-vih-1\" name=\"form_fields[vih]\"> <label for=\"form-field-vih-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-mental elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-mental\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMental Health Disorders\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-mental-0\" name=\"form_fields[mental]\" required=\"required\"> <label for=\"form-field-mental-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-mental-1\" name=\"form_fields[mental]\" required=\"required\"> <label for=\"form-field-mental-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-mental_si elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-mental_si\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSelect which one:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Anxiety \" id=\"form-field-mental_si-0\" name=\"form_fields[mental_si]\"> <label for=\"form-field-mental_si-0\">Anxiety <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Depression\" id=\"form-field-mental_si-1\" name=\"form_fields[mental_si]\"> <label for=\"form-field-mental_si-1\">Depression<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-mental_otra elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-mental_otra\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tOthers:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[mental_otra]\" id=\"form-field-mental_otra\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-neurologico elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-neurologico\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNeurological problems\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-neurologico-0\" name=\"form_fields[neurologico]\" required=\"required\"> <label for=\"form-field-neurologico-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-neurologico-1\" name=\"form_fields[neurologico]\" required=\"required\"> <label for=\"form-field-neurologico-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-neurologico_si elementor-col-66\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-neurologico_si\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIf yes, explain:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[neurologico_si]\" id=\"form-field-neurologico_si\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-anestesia elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-anestesia\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tReactions to Anesthesia\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-anestesia-0\" name=\"form_fields[anestesia]\" required=\"required\"> <label for=\"form-field-anestesia-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-anestesia-1\" name=\"form_fields[anestesia]\" required=\"required\"> <label for=\"form-field-anestesia-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-anestesia_si elementor-col-66\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-anestesia_si\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIf yes, explain:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[anestesia_si]\" id=\"form-field-anestesia_si\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-alergia elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-alergia\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tKnown Allergies\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-alergia-0\" name=\"form_fields[alergia]\" required=\"required\"> <label for=\"form-field-alergia-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-alergia-1\" name=\"form_fields[alergia]\" required=\"required\"> <label for=\"form-field-alergia-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-alergia_si elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-alergia_si\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSelect which one:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Medication\" id=\"form-field-alergia_si-0\" name=\"form_fields[alergia_si]\"> <label for=\"form-field-alergia_si-0\">Medication<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Latex \" id=\"form-field-alergia_si-1\" name=\"form_fields[alergia_si]\"> <label for=\"form-field-alergia_si-1\">Latex <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yode\" id=\"form-field-alergia_si-2\" name=\"form_fields[alergia_si]\"> <label for=\"form-field-alergia_si-2\">Yode<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Food allergies\" id=\"form-field-alergia_si-3\" name=\"form_fields[alergia_si]\"> <label for=\"form-field-alergia_si-3\">Food allergies<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-alergia_cual elementor-col-30\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-alergia_cual\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIf yes, explain: \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[alergia_cual]\" id=\"form-field-alergia_cual\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_9a9f1bd elementor-col-100\">\n\t\t\t\t\t<br\/><strong>MEDICAL HISTORY<\/strong>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-medicacion elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-medicacion\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tRegular medication intake?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-medicacion-0\" name=\"form_fields[medicacion]\" required=\"required\"> <label for=\"form-field-medicacion-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-medicacion-1\" name=\"form_fields[medicacion]\" required=\"required\"> <label for=\"form-field-medicacion-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-medicacion_cual elementor-col-66\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-medicacion_cual\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIf yes, list every medication you are on and explain why: \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[medicacion_cual]\" id=\"form-field-medicacion_cual\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-hospitalizacion elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-hospitalizacion\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHave you been hospitalized, undergone surgery or received any medical care?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-hospitalizacion-0\" name=\"form_fields[hospitalizacion]\" required=\"required\"> <label for=\"form-field-hospitalizacion-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-hospitalizacion-1\" name=\"form_fields[hospitalizacion]\" required=\"required\"> <label for=\"form-field-hospitalizacion-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-hospitalizacion_cual elementor-col-66\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-hospitalizacion_cual\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPlease explain and indicate approximate dates: \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[hospitalizacion_cual]\" id=\"form-field-hospitalizacion_cual\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_f673fbf elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f673fbf\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tADDITIONAL INFORMATION\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[field_f673fbf]\" id=\"form-field-field_f673fbf\" rows=\"4\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_dae5314 elementor-col-100\">\n\t\t\t\t\t<p style=\"font-size:10px;margin-bottom:0px\">POLICL\u00cdNICA NTRA.SRA. DEL ROSARIO S.L.U is responsible for processing the personal data of the data subject and informs you that this data will be processed in accordance with the provisions of Regulation (EU) 2016\/679, of 27 April, (GDPR) and Organic Law 3\/2018, of 5 December, (LOPDGDD), for which reason the following processing information is provided:  <\/p>\n<p style=\"font-size:10px;margin-bottom:0\"><u>Purposes and lawfulness of the processing:<\/u>  <\/p>\n<ul style=\"font-size:10px\">\n<li><u>For the provision of health care and the proper management of the health care and administrative <\/u>services required for the same (keeping of medical records, appointments, check-ups, issuing of certificates of attendance in accordance with the regulations, handling of communications with patients, etc.), on the basis of art. 6.1.b GDPR, for the performance of a contract or pre-contract to which the data subject is a party and which, in the processing of data relating to health, is covered by the exception provided for in art. 9.2.h GDPR, as the processing is necessary for the purposes of preventive or occupational medicine, assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment or the management of health and social care systems and services. <\/li>\n<li><u>For the billing, collection and accounting <\/u>of our services, for the fulfilment of our legal obligations, in accordance with art. 6.1.c RGPD. \n<u>Data retention criteria:<\/u> Data shall be kept for no longer than is necessary to fulfil the purpose of the processing or for as long as is required by law and, when no longer necessary for that purpose, shall be deleted with appropriate security measures to ensure anonymisation or total destruction of the data. \n<br\/>\n<u>Communication of data:<\/u> For the purposes set out above, the user consents to the transfer of his\/her personal data to companies within Grupo Policl\u00ednica (EIVICONSULTA, S.L.U, CLINICA PREMIUM IBIZA, S.L.U, CLINICA VILAPARC, S.L.U and LOGISTICA PRODUCTOS SANITARIOS, S.L.U), insurance companies and other entities authorised by law. <\/li>\n<li><u>Rights of the data subject:<\/u> At any time, you may exercise your rights of access, rectification, portability and cancellation of your data, as well as the right to restrict or oppose its processing, by contacting POLICL\u00cdNICA NTRA.SRA.DEL ROSARIO S.L.U., by email: lopd@grupopoliclinica.es or info@grupopoliclinica.es or by post: POLICL\u00cdNICA NTRA.SRA. DEL ROSARIO S.L.U, VIA ROMANA S\/N C.P. 07800, IBIZA (BALEARIC ISLANDS). You also have the right to lodge a complaint with the Spanish Data Protection Agency (www.aepd.es) if you consider that the processing does not comply with the regulations in force. <\/li>\n<\/ul>\n<p style=\"font-size:10px;margin-bottom:0\"><span style=\"text-decoration: underline;\">Contact information to exercise their rights:<\/span> <a href=\"mailto:lopd@www.grupopoliclinica.es\">lopd@www.grupopoliclinica.es<\/a>. <span style=\"text-decoration: underline;\">Contact details of the<\/span>\n<span style=\"text-decoration: underline;\">data protection officer:<\/span> <a href=\"mailto:dpd@grupopoliclinica.es\">dpd@grupopoliclinica.es<\/a><\/p>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_a3a7e4a elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_a3a7e4a]\" id=\"form-field-field_a3a7e4a\" class=\"elementor-field elementor-size-md  elementor-acceptance-field\" required=\"required\">\n\t\t\t\t<label for=\"form-field-field_a3a7e4a\">I have read and accept the <a href=\"\/en\/privacy-policy\/\">Privacy Policy<\/a><\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-recaptcha_v3 elementor-field-group elementor-column elementor-field-group-field_7e10f8a elementor-col-100 recaptcha_v3-bottomright\">\n\t\t\t\t\t<div class=\"elementor-field\" id=\"form-field-field_7e10f8a\"><div class=\"elementor-g-recaptcha\" data-sitekey=\"6LfRaKIUAAAAANBTUfBLV5NBHAc7EwPTDFdeHmXL\" data-type=\"v3\" data-action=\"Form\" data-badge=\"bottomright\" data-size=\"invisible\"><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-md\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Send<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Contact our international department Request Treatment Contact our international department. We\u2019d be delighted to meet your needs. How can we help you? International Dpt. Phone +34 971 30 19 16 (ext. 228)(8:00 &#8211; 15:00) Did you decide to have a treatment with us? If so, please fill in our health questionnaire and we will contact [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-5325","page","type-page","status-publish","hentry"],"acf":[],"featured_image_urls":{},"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/www.grupopoliclinica.es\/en\/wp-json\/wp\/v2\/pages\/5325","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.grupopoliclinica.es\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.grupopoliclinica.es\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.grupopoliclinica.es\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.grupopoliclinica.es\/en\/wp-json\/wp\/v2\/comments?post=5325"}],"version-history":[{"count":0,"href":"https:\/\/www.grupopoliclinica.es\/en\/wp-json\/wp\/v2\/pages\/5325\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.grupopoliclinica.es\/en\/wp-json\/wp\/v2\/media?parent=5325"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}