{"id":14947,"date":"2022-04-05T11:45:55","date_gmt":"2022-04-05T11:45:55","guid":{"rendered":"https:\/\/trans.pakumed.de\/customer-feedback-form-user-2\/"},"modified":"2024-02-26T08:38:59","modified_gmt":"2024-02-26T08:38:59","slug":"customer-feedback-form-user-2","status":"publish","type":"page","link":"https:\/\/pakumed.de\/en\/customer-feedback-form-user-2\/","title":{"rendered":"ccustomer feedback port catheter systems (user)"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"14947\" class=\"elementor elementor-14947 elementor-7410\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-62c8b96e elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"62c8b96e\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;motion_fx_motion_fx_scrolling&quot;:&quot;yes&quot;,&quot;background_background&quot;:&quot;classic&quot;,&quot;motion_fx_devices&quot;:[&quot;desktop&quot;,&quot;tablet&quot;,&quot;mobile&quot;]}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\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-100 elementor-top-column elementor-element elementor-element-5268f054\" data-id=\"5268f054\" 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-3f4905d elementor-widget elementor-widget-image\" data-id=\"3f4905d\" 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\" width=\"350\" height=\"125\" src=\"https:\/\/pakumed.de\/wp-content\/uploads\/2021\/10\/PM-Logo-Kolor-350x125-1.png\" class=\"attachment-large size-large wp-image-14617\" alt=\"\" srcset=\"https:\/\/pakumed.de\/wp-content\/uploads\/2021\/10\/PM-Logo-Kolor-350x125-1.png 350w, https:\/\/pakumed.de\/wp-content\/uploads\/2021\/10\/PM-Logo-Kolor-350x125-1-300x107.png 300w\" sizes=\"(max-width: 350px) 100vw, 350px\" \/>\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<div class=\"elementor-element elementor-element-155c711b elementor-widget elementor-widget-heading\" data-id=\"155c711b\" 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\">Questionnaire for market observation port catheter systems <\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5a26b32 elementor-widget elementor-widget-heading\" data-id=\"5a26b32\" 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<h4 class=\"elementor-heading-title elementor-size-default\">Customer Feedback User English<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-63c7c586 elementor-button-align-center elementor-widget elementor-widget-form\" data-id=\"63c7c586\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;further&quot;,&quot;step_previous_label&quot;:&quot;back&quot;,&quot;step_type&quot;:&quot;text&quot;,&quot;button_width&quot;:&quot;100&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\" name=\"eng-AnokryoKombiset\" aria-label=\"eng-AnokryoKombiset\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"14947\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"63c7c586\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"ccustomer feedback port catheter systems (user)\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"14947\"\/>\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-step elementor-field-group elementor-column elementor-field-group-field_3e4c7b2 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Informations\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"\" ><\/div>\n\n\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_dc43dd5 elementor-col-100\">\n\t\t\t\t\tDear Sir or Madam,<br><br>\n\nAgainst the background above, we are dependent on your support within the framework of the practical implementation of the EU Regulation 2017\/745 enacted by European Parliament and the Council. <br>Feedback from long-standing customers and users, who have known and used our products for a long time and are therefore able to evaluate them adequately, is of particular help to us. The evaluation of your answers is anonymous. and no conclusions about individual customers are included in the corresponding evaluation. \n\n \n\n<br><br>The questionnaire is divided into the following topics:<br><br>\n\nI. Information on the feedback provider (medical background) \n\n<br>I. Information on the feedback provider (medical background) \n\n<br>III. Patient group to be treated \n\n<br>IV. Implantation and application of the implant (port catheter system) and its components \n\n<br>V. Remarks\/comments \n\n<br><br>We kindly ask you to take a few moments to answer the questionnaire. The questionnaire will take about 5-10 minutes to complete. \n\n<br>Your answers will help us to improve medical products in the future, to make them even safer and to make them available in the usual form.<br><br>\n\nThank you very much for your support!<br>\n \n\nThe team of PakuMed gmbh<br><br>\n\n\n<p style=\"font-size:20px;font-weight:600\">Contact:<\/p>\n\nPakuMed medical products gmbh<br><br>\n\nIm L\u00f6wental 79<br>\n45239 Essen <br><br>\n\nE-Mail: <a style=\"color: #1BA2E0;\" href=\"mailTo:info@pakumed.de\">info@pakumed.de<\/a><br>\nTel.: +49 201 \u2013 43 70 97 \u2013 0\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_e5dfdfd elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\" user\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"\" ><\/div>\n\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-geschlecht elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-geschlecht\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tName (optional)\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[geschlecht]\" id=\"form-field-geschlecht\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Name\">\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-select elementor-field-group elementor-column elementor-field-group-alter elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-alter\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCustomer group\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[alter]\" id=\"form-field-alter\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Hospital\">Hospital<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Surgery \">Surgery <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Sales partner\">Sales partner<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Pharmacy\">Pharmacy<\/option>\n\t\t\t\t\t\t\t<\/select>\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-select elementor-field-group elementor-column elementor-field-group-groesse elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-groesse\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tArea\/Department\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[groesse]\" id=\"form-field-groesse\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Oncology\">Oncology<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Surgery\">Surgery<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Dermatology\">Dermatology<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Other\">Other<\/option>\n\t\t\t\t\t\t\t<\/select>\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-text elementor-field-group elementor-column elementor-field-group-field_ac95bf9 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ac95bf9\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIf \"Other\" was selected\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[field_ac95bf9]\" id=\"form-field-field_ac95bf9\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"If yes, which one(s)?\">\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-select elementor-field-group elementor-column elementor-field-group-gewicht elementor-col-25 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-gewicht\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tProfession\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[gewicht]\" id=\"form-field-gewicht\" class=\"elementor-field-textual elementor-size-lg\" required=\"required\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Doctor\">Doctor<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nursing staff\">Nursing staff<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Other\">Other<\/option>\n\t\t\t\t\t\t\t<\/select>\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-text elementor-field-group elementor-column elementor-field-group-field_8769c07 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8769c07\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIf \"Other\" was selected\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[field_8769c07]\" id=\"form-field-field_8769c07\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"If yes, which one(s)?\">\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-field_5355ebe elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5355ebe\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tName of the establishment\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[field_5355ebe]\" id=\"form-field-field_5355ebe\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"optional\">\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-step elementor-field-group elementor-column elementor-field-group-field_6d03c86 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Product details\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"\" ><\/div>\n\n\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_c434bc7 elementor-col-25\">\n\t\t\t\t\t<p style=\"text-align:left;\">Product<\/p><input style=\"margin-bottom: -15px;\" class=\"elementor-field elementor-size-sm elementor-field-textual\" type=\"text\" value=\"PORT CATHETER SYSTEMS\" readonly>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_874e819 elementor-col-25 elementor-field-type-select-multiple\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_874e819\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tArticle no:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_874e819][]\" id=\"form-field-field_874e819\" class=\"elementor-field-textual elementor-size-lg\" multiple=\"\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"111243 F \">111243 F <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"111244 P-N \">111244 P-N <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"111245 P-SET \">111245 P-SET <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"111246 V \">111246 V <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"111246 V-PU \">111246 V-PU <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"111246 V-SET \">111246 V-SET <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"111246 V-PU-SET \">111246 V-PU-SET <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"111248 V \">111248 V <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"111248 V-PU \">111248 V-PU <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"111248 V-SET \">111248 V-SET <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"111248 V-PU-SET \">111248 V-PU-SET <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"111248 G-SET \">111248 G-SET <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"111251 A \">111251 A <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"111252 D-PU \">111252 D-PU <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"111255 D \">111255 D <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"111257 V-PU-SET \">111257 V-PU-SET <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"111258 V-UA \">111258 V-UA <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"111259 AS\/PT \">111259 AS\/PT <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"111262 DR \">111262 DR <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"111263 APH \">111263 APH <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"unknown\">unknown<\/option>\n\t\t\t\t\t\t\t<\/select>\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-text elementor-field-group elementor-column elementor-field-group-field_c893f43 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c893f43\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLot\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[field_c893f43]\" id=\"form-field-field_c893f43\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"optional\">\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-step elementor-field-group elementor-column elementor-field-group-field_2373b40 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"patient\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_8ee29ba elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8ee29ba\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPatient group\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_8ee29ba]\" id=\"form-field-field_8ee29ba\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Adults \">Adults <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Children\">Children<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"both\">both<\/option>\n\t\t\t\t\t\t\t<\/select>\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-select elementor-field-group elementor-column elementor-field-group-field_43857d3 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_43857d3\" 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<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_43857d3]\" id=\"form-field-field_43857d3\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"male \">male <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"female \">female <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"diverse\">diverse<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"mixed\">mixed<\/option>\n\t\t\t\t\t\t\t<\/select>\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-text elementor-field-group elementor-column elementor-field-group-field_0063399 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0063399\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPatient age\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[field_0063399]\" id=\"form-field-field_0063399\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"from - to\">\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-field_38b1f4f elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_38b1f4f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIndication\/ Application\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[field_38b1f4f]\" id=\"form-field-field_38b1f4f\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"optional\">\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-step elementor-field-group elementor-column elementor-field-group-field_576ad20 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Product\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-erkrankung elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-erkrankung\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat are port catheter systems used for in your facility? \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=\"checkbox\" value=\"\" id=\"form-field-erkrankung-0\" name=\"form_fields[erkrankung][]\"> <label for=\"form-field-erkrankung-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Chemotherapy\" id=\"form-field-erkrankung-1\" name=\"form_fields[erkrankung][]\"> <label for=\"form-field-erkrankung-1\">Chemotherapy<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Apheresis\" id=\"form-field-erkrankung-2\" name=\"form_fields[erkrankung][]\"> <label for=\"form-field-erkrankung-2\">Apheresis<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Dialysis\" id=\"form-field-erkrankung-3\" name=\"form_fields[erkrankung][]\"> <label for=\"form-field-erkrankung-3\">Dialysis<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Ascites\" id=\"form-field-erkrankung-4\" name=\"form_fields[erkrankung][]\"> <label for=\"form-field-erkrankung-4\">Ascites<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"(Pleural) drainage\" id=\"form-field-erkrankung-5\" name=\"form_fields[erkrankung][]\"> <label for=\"form-field-erkrankung-5\">(Pleural) drainage<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"artificial nutrition \" id=\"form-field-erkrankung-6\" name=\"form_fields[erkrankung][]\"> <label for=\"form-field-erkrankung-6\">artificial nutrition <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"for blood collection\" id=\"form-field-erkrankung-7\" name=\"form_fields[erkrankung][]\"> <label for=\"form-field-erkrankung-7\">for blood collection<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"High pressure injection\" id=\"form-field-erkrankung-8\" name=\"form_fields[erkrankung][]\"> <label for=\"form-field-erkrankung-8\">High pressure injection<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Blood transfusion \" id=\"form-field-erkrankung-9\" name=\"form_fields[erkrankung][]\"> <label for=\"form-field-erkrankung-9\">Blood transfusion <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"prenatal nutrition\" id=\"form-field-erkrankung-10\" name=\"form_fields[erkrankung][]\"> <label for=\"form-field-erkrankung-10\">prenatal nutrition<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"perioperative\" id=\"form-field-erkrankung-11\" name=\"form_fields[erkrankung][]\"> <label for=\"form-field-erkrankung-11\">perioperative<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Other\" id=\"form-field-erkrankung-12\" name=\"form_fields[erkrankung][]\"> <label for=\"form-field-erkrankung-12\">Other<\/label><\/span><\/div>\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-erkrankungandere elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-erkrankungandere\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tOnly to be filled in if other or additional diseases are selected.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-lg\" name=\"form_fields[erkrankungandere]\" id=\"form-field-erkrankungandere\" rows=\"4\" placeholder=\"Optional\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_2f4bd63 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2f4bd63\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre the port catheter systems flushed? \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_2f4bd63]\" id=\"form-field-field_2f4bd63\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"After each therapy \">After each therapy <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"every month \">every month <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"every 3 months \">every 3 months <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"&gt; 3 month \">&gt; 3 month <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"never\">never<\/option>\n\t\t\t\t\t\t\t<\/select>\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-select elementor-field-group elementor-column elementor-field-group-field_dcb58c4 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_dcb58c4\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIf port catheter systems are blocked after completion of therapy\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_dcb58c4]\" id=\"form-field-field_dcb58c4\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"no \">no <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes, with heparin \">Yes, with heparin <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Not known \">Not known <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes with\">Yes with<\/option>\n\t\t\t\t\t\t\t<\/select>\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-text elementor-field-group elementor-column elementor-field-group-field_8cb171a elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8cb171a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tComplete if \"Yes with\" is selected\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[field_8cb171a]\" id=\"form-field-field_8cb171a\" class=\"elementor-field elementor-size-lg  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-select elementor-field-group elementor-column elementor-field-group-field_f66103f elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f66103f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre port catheter systems blocked antimicrobially? \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_f66103f]\" id=\"form-field-field_f66103f\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes, with citrate \">Yes, with citrate <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes, with taurolidine \">Yes, with taurolidine <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"unknown\">unknown<\/option>\n\t\t\t\t\t\t\t<\/select>\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-select elementor-field-group elementor-column elementor-field-group-field_cc002fc elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_cc002fc\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre you aware of any complications in connection with port catheter systems from the manufacturer PakuMed?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_cc002fc]\" id=\"form-field-field_cc002fc\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"yes\">yes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"no\">no<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Clogging of the system \">Clogging of the system <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Infection \">Infection <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Thromboses \">Thromboses <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Catheter rupture \">Catheter rupture <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Slipping of the port chamber \">Slipping of the port chamber <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Misalignment\">Misalignment<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Other\">Other<\/option>\n\t\t\t\t\t\t\t<\/select>\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-text elementor-field-group elementor-column elementor-field-group-field_5451d37 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5451d37\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFill in if \"Other\" was selected\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[field_5451d37]\" id=\"form-field-field_5451d37\" class=\"elementor-field elementor-size-lg  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-step elementor-field-group elementor-column elementor-field-group-field_0a388ec elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Implantation\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_cad33a4 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_cad33a4\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre implantations of port catheter systems of the manufacturer PakuMed carried out regularly? \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_cad33a4]\" id=\"form-field-field_cad33a4\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"yes\">yes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"no\">no<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"irregular\">irregular<\/option>\n\t\t\t\t\t\t\t<\/select>\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-select elementor-field-group elementor-column elementor-field-group-field_7b1c635 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7b1c635\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre implants performed at your clinic as inpatient or outpatient procedures? \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_7b1c635]\" id=\"form-field-field_7b1c635\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"stationary \">stationary <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"outpatient\">outpatient<\/option>\n\t\t\t\t\t\t\t<\/select>\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-select elementor-field-group elementor-column elementor-field-group-field_b2dd9fc elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b2dd9fc\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHow long does a routine implantation at your clinic usually take? \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_b2dd9fc]\" id=\"form-field-field_b2dd9fc\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"0.5 hrs.\">0.5 hrs.<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"&lt;1 hrs.\">&lt;1 hrs.<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"&gt; 1 hrs.\">&gt; 1 hrs.<\/option>\n\t\t\t\t\t\t\t<\/select>\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-select elementor-field-group elementor-column elementor-field-group-field_c980920 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c980920\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWho performs the implantation?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_c980920]\" id=\"form-field-field_c980920\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Specialists with many years of experience \">Specialists with many years of experience <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Residents in training \">Residents in training <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Both\">Both<\/option>\n\t\t\t\t\t\t\t<\/select>\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-select elementor-field-group elementor-column elementor-field-group-field_bf6f7f8 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_bf6f7f8\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHave there been any complications with the implantation of a PakuMed port catheter system in the past? \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_bf6f7f8]\" id=\"form-field-field_bf6f7f8\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"yes\">yes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"no\">no<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"If yes, which ones?\">If yes, which ones?<\/option>\n\t\t\t\t\t\t\t<\/select>\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-text elementor-field-group elementor-column elementor-field-group-field_3917889 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3917889\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFill in if \"If yes, which?\" is selected\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[field_3917889]\" id=\"form-field-field_3917889\" class=\"elementor-field elementor-size-lg  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-select elementor-field-group elementor-column elementor-field-group-field_fa38963 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_fa38963\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDo you use supplementary accessories within the framework of the implantation which are not provided by the manufacturer PakuMed with the product? \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_fa38963]\" id=\"form-field-field_fa38963\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes, which ones?\">Yes, which ones?<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"no\">no<\/option>\n\t\t\t\t\t\t\t<\/select>\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-text elementor-field-group elementor-column elementor-field-group-field_b82b88b elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b82b88b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFill in if \"Yes, which?\" was selected\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[field_b82b88b]\" id=\"form-field-field_b82b88b\" class=\"elementor-field elementor-size-lg  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-select elementor-field-group elementor-column elementor-field-group-field_aa1a4a1 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_aa1a4a1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tRefer to the enclosed instructions for use:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_aa1a4a1]\" id=\"form-field-field_aa1a4a1\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"yes\">yes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"no\">no<\/option>\n\t\t\t\t\t\t\t<\/select>\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-select elementor-field-group elementor-column elementor-field-group-field_f9d2ad9 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f9d2ad9\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWould you rate the enclosed instructions for use as helpful? \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_f9d2ad9]\" id=\"form-field-field_f9d2ad9\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"yes\">yes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"no\">no<\/option>\n\t\t\t\t\t\t\t<\/select>\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-select elementor-field-group elementor-column elementor-field-group-field_136b988 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_136b988\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWould you prefer port catheter systems from the manufacturer PakuMed to other products ?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_136b988]\" id=\"form-field-field_136b988\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"yes\">yes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"no\">no<\/option>\n\t\t\t\t\t\t\t<\/select>\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-step elementor-field-group elementor-column elementor-field-group-field_ca1f5d8 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Therapy\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_bd9d58b elementor-col-40\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_bd9d58b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIn which setting do treatments take place in your facility? \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_bd9d58b]\" id=\"form-field-field_bd9d58b\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"stationary\">stationary<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"outpatient\">outpatient<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"both\">both<\/option>\n\t\t\t\t\t\t\t<\/select>\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-select elementor-field-group elementor-column elementor-field-group-field_8198a9c elementor-col-40\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8198a9c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIn which period\/interval do the treatments take place in your facility? \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_8198a9c]\" id=\"form-field-field_8198a9c\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"cyclical\">cyclical<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"acyclic\">acyclic<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Other\">Other<\/option>\n\t\t\t\t\t\t\t<\/select>\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-text elementor-field-group elementor-column elementor-field-group-field_6c4f08a elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6c4f08a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFill in if \"Other\" was selected\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[field_6c4f08a]\" id=\"form-field-field_6c4f08a\" class=\"elementor-field elementor-size-lg  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_746db50 elementor-col-100\">\n\t\t\t\t\t<p style=\"text-align:left;margin-bottom:-2rem;font-size: 18px;\">Satisfaction (0= dissatisfied, 4=very satisfied):<\/p>\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-field_56511fd elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_56511fd\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPuncture\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=\"\" id=\"form-field-field_56511fd-0\" name=\"form_fields[field_56511fd]\"> <label for=\"form-field-field_56511fd-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_56511fd-1\" name=\"form_fields[field_56511fd]\"> <label for=\"form-field-field_56511fd-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_56511fd-2\" name=\"form_fields[field_56511fd]\"> <label for=\"form-field-field_56511fd-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_56511fd-3\" name=\"form_fields[field_56511fd]\"> <label for=\"form-field-field_56511fd-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_56511fd-4\" name=\"form_fields[field_56511fd]\"> <label for=\"form-field-field_56511fd-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_56511fd-5\" name=\"form_fields[field_56511fd]\"> <label for=\"form-field-field_56511fd-5\">4<\/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-field_6d63b5f elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6d63b5f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSafety\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=\"\" id=\"form-field-field_6d63b5f-0\" name=\"form_fields[field_6d63b5f]\"> <label for=\"form-field-field_6d63b5f-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_6d63b5f-1\" name=\"form_fields[field_6d63b5f]\"> <label for=\"form-field-field_6d63b5f-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_6d63b5f-2\" name=\"form_fields[field_6d63b5f]\"> <label for=\"form-field-field_6d63b5f-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_6d63b5f-3\" name=\"form_fields[field_6d63b5f]\"> <label for=\"form-field-field_6d63b5f-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_6d63b5f-4\" name=\"form_fields[field_6d63b5f]\"> <label for=\"form-field-field_6d63b5f-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_6d63b5f-5\" name=\"form_fields[field_6d63b5f]\"> <label for=\"form-field-field_6d63b5f-5\">4<\/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-field_4968c58 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4968c58\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeneral ease of use\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=\"\" id=\"form-field-field_4968c58-0\" name=\"form_fields[field_4968c58]\"> <label for=\"form-field-field_4968c58-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_4968c58-1\" name=\"form_fields[field_4968c58]\"> <label for=\"form-field-field_4968c58-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_4968c58-2\" name=\"form_fields[field_4968c58]\"> <label for=\"form-field-field_4968c58-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_4968c58-3\" name=\"form_fields[field_4968c58]\"> <label for=\"form-field-field_4968c58-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_4968c58-4\" name=\"form_fields[field_4968c58]\"> <label for=\"form-field-field_4968c58-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_4968c58-5\" name=\"form_fields[field_4968c58]\"> <label for=\"form-field-field_4968c58-5\">4<\/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-field_a835bb9 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a835bb9\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeneral handling\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=\"\" id=\"form-field-field_a835bb9-0\" name=\"form_fields[field_a835bb9]\"> <label for=\"form-field-field_a835bb9-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_a835bb9-1\" name=\"form_fields[field_a835bb9]\"> <label for=\"form-field-field_a835bb9-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_a835bb9-2\" name=\"form_fields[field_a835bb9]\"> <label for=\"form-field-field_a835bb9-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_a835bb9-3\" name=\"form_fields[field_a835bb9]\"> <label for=\"form-field-field_a835bb9-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_a835bb9-4\" name=\"form_fields[field_a835bb9]\"> <label for=\"form-field-field_a835bb9-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_a835bb9-5\" name=\"form_fields[field_a835bb9]\"> <label for=\"form-field-field_a835bb9-5\">4<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_45200ff elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Evaluation\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"\" ><\/div>\n\n\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_4ecac98 elementor-col-100\">\n\t\t\t\t\t<p style=\"text-align:left;margin-bottom:-2rem;font-size: 18px;\">Evaluation of the individual components of port catheter systems:<\/p>\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_cbf63ed elementor-col-100\">\n\t\t\t\t\t<p style=\"text-align:left;margin-bottom:-2rem;;\">Please answer these questions if you have come into contact with the accessories.<\/p>\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_4958451 elementor-col-100\">\n\t\t\t\t\t<p style=\"text-align:left;margin-bottom:-2rem;;\">Satisfaction (0= dissatisfied, 4=very satisfied)<\/p>\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-field_88fc334 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_88fc334\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAssessment connection (catheter\/port chamber)\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=\"\" id=\"form-field-field_88fc334-0\" name=\"form_fields[field_88fc334]\"> <label for=\"form-field-field_88fc334-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_88fc334-1\" name=\"form_fields[field_88fc334]\"> <label for=\"form-field-field_88fc334-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_88fc334-2\" name=\"form_fields[field_88fc334]\"> <label for=\"form-field-field_88fc334-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_88fc334-3\" name=\"form_fields[field_88fc334]\"> <label for=\"form-field-field_88fc334-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_88fc334-4\" name=\"form_fields[field_88fc334]\"> <label for=\"form-field-field_88fc334-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_88fc334-5\" name=\"form_fields[field_88fc334]\"> <label for=\"form-field-field_88fc334-5\">4<\/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-field_5778ea3 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5778ea3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAssessment of puncture area\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=\"\" id=\"form-field-field_5778ea3-0\" name=\"form_fields[field_5778ea3]\"> <label for=\"form-field-field_5778ea3-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_5778ea3-1\" name=\"form_fields[field_5778ea3]\"> <label for=\"form-field-field_5778ea3-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_5778ea3-2\" name=\"form_fields[field_5778ea3]\"> <label for=\"form-field-field_5778ea3-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_5778ea3-3\" name=\"form_fields[field_5778ea3]\"> <label for=\"form-field-field_5778ea3-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_5778ea3-4\" name=\"form_fields[field_5778ea3]\"> <label for=\"form-field-field_5778ea3-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_5778ea3-5\" name=\"form_fields[field_5778ea3]\"> <label for=\"form-field-field_5778ea3-5\">4<\/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-field_abca14e elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_abca14e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAssessment of seam holes\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=\"\" id=\"form-field-field_abca14e-0\" name=\"form_fields[field_abca14e]\"> <label for=\"form-field-field_abca14e-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_abca14e-1\" name=\"form_fields[field_abca14e]\"> <label for=\"form-field-field_abca14e-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_abca14e-2\" name=\"form_fields[field_abca14e]\"> <label for=\"form-field-field_abca14e-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_abca14e-3\" name=\"form_fields[field_abca14e]\"> <label for=\"form-field-field_abca14e-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_abca14e-4\" name=\"form_fields[field_abca14e]\"> <label for=\"form-field-field_abca14e-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_abca14e-5\" name=\"form_fields[field_abca14e]\"> <label for=\"form-field-field_abca14e-5\">4<\/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-field_3100b39 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3100b39\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAssessment material\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=\"\" id=\"form-field-field_3100b39-0\" name=\"form_fields[field_3100b39]\"> <label for=\"form-field-field_3100b39-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_3100b39-1\" name=\"form_fields[field_3100b39]\"> <label for=\"form-field-field_3100b39-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_3100b39-2\" name=\"form_fields[field_3100b39]\"> <label for=\"form-field-field_3100b39-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_3100b39-3\" name=\"form_fields[field_3100b39]\"> <label for=\"form-field-field_3100b39-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_3100b39-4\" name=\"form_fields[field_3100b39]\"> <label for=\"form-field-field_3100b39-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_3100b39-5\" name=\"form_fields[field_3100b39]\"> <label for=\"form-field-field_3100b39-5\">4<\/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-field_48dbaba elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_48dbaba\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeneral User-friendliness\/handling\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=\"\" id=\"form-field-field_48dbaba-0\" name=\"form_fields[field_48dbaba]\"> <label for=\"form-field-field_48dbaba-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_48dbaba-1\" name=\"form_fields[field_48dbaba]\"> <label for=\"form-field-field_48dbaba-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_48dbaba-2\" name=\"form_fields[field_48dbaba]\"> <label for=\"form-field-field_48dbaba-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_48dbaba-3\" name=\"form_fields[field_48dbaba]\"> <label for=\"form-field-field_48dbaba-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_48dbaba-4\" name=\"form_fields[field_48dbaba]\"> <label for=\"form-field-field_48dbaba-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_48dbaba-5\" name=\"form_fields[field_48dbaba]\"> <label for=\"form-field-field_48dbaba-5\">4<\/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-field_fbec130 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_fbec130\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeneral ergonomics\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=\"\" id=\"form-field-field_fbec130-0\" name=\"form_fields[field_fbec130]\"> <label for=\"form-field-field_fbec130-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_fbec130-1\" name=\"form_fields[field_fbec130]\"> <label for=\"form-field-field_fbec130-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_fbec130-2\" name=\"form_fields[field_fbec130]\"> <label for=\"form-field-field_fbec130-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_fbec130-3\" name=\"form_fields[field_fbec130]\"> <label for=\"form-field-field_fbec130-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_fbec130-4\" name=\"form_fields[field_fbec130]\"> <label for=\"form-field-field_fbec130-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_fbec130-5\" name=\"form_fields[field_fbec130]\"> <label for=\"form-field-field_fbec130-5\">4<\/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-field_284972a elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_284972a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeneral design of the product\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=\"\" id=\"form-field-field_284972a-0\" name=\"form_fields[field_284972a]\"> <label for=\"form-field-field_284972a-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_284972a-1\" name=\"form_fields[field_284972a]\"> <label for=\"form-field-field_284972a-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_284972a-2\" name=\"form_fields[field_284972a]\"> <label for=\"form-field-field_284972a-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_284972a-3\" name=\"form_fields[field_284972a]\"> <label for=\"form-field-field_284972a-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_284972a-4\" name=\"form_fields[field_284972a]\"> <label for=\"form-field-field_284972a-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_284972a-5\" name=\"form_fields[field_284972a]\"> <label for=\"form-field-field_284972a-5\">4<\/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-field_468f530 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_468f530\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMeets clinical requirement\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=\"\" id=\"form-field-field_468f530-0\" name=\"form_fields[field_468f530]\"> <label for=\"form-field-field_468f530-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_468f530-1\" name=\"form_fields[field_468f530]\"> <label for=\"form-field-field_468f530-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_468f530-2\" name=\"form_fields[field_468f530]\"> <label for=\"form-field-field_468f530-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_468f530-3\" name=\"form_fields[field_468f530]\"> <label for=\"form-field-field_468f530-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_468f530-4\" name=\"form_fields[field_468f530]\"> <label for=\"form-field-field_468f530-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_468f530-5\" name=\"form_fields[field_468f530]\"> <label for=\"form-field-field_468f530-5\">4<\/label><\/span><\/div>\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_6bb5900 elementor-col-100\">\n\t\t\t\t\t<p style=\"text-align:left;margin-bottom:-2rem;font-size: 18px;\">Catheter:<\/p>\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-field_dcef47e elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_dcef47e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAssessment of buckling resistance\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=\"\" id=\"form-field-field_dcef47e-0\" name=\"form_fields[field_dcef47e]\"> <label for=\"form-field-field_dcef47e-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_dcef47e-1\" name=\"form_fields[field_dcef47e]\"> <label for=\"form-field-field_dcef47e-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_dcef47e-2\" name=\"form_fields[field_dcef47e]\"> <label for=\"form-field-field_dcef47e-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_dcef47e-3\" name=\"form_fields[field_dcef47e]\"> <label for=\"form-field-field_dcef47e-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_dcef47e-4\" name=\"form_fields[field_dcef47e]\"> <label for=\"form-field-field_dcef47e-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_dcef47e-5\" name=\"form_fields[field_dcef47e]\"> <label for=\"form-field-field_dcef47e-5\">4<\/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-field_95fd9af elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_95fd9af\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAssessment length\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=\"\" id=\"form-field-field_95fd9af-0\" name=\"form_fields[field_95fd9af]\"> <label for=\"form-field-field_95fd9af-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_95fd9af-1\" name=\"form_fields[field_95fd9af]\"> <label for=\"form-field-field_95fd9af-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_95fd9af-2\" name=\"form_fields[field_95fd9af]\"> <label for=\"form-field-field_95fd9af-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_95fd9af-3\" name=\"form_fields[field_95fd9af]\"> <label for=\"form-field-field_95fd9af-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_95fd9af-4\" name=\"form_fields[field_95fd9af]\"> <label for=\"form-field-field_95fd9af-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_95fd9af-5\" name=\"form_fields[field_95fd9af]\"> <label for=\"form-field-field_95fd9af-5\">4<\/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-field_345ecd0 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_345ecd0\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAssessment diameter\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=\"\" id=\"form-field-field_345ecd0-0\" name=\"form_fields[field_345ecd0]\"> <label for=\"form-field-field_345ecd0-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_345ecd0-1\" name=\"form_fields[field_345ecd0]\"> <label for=\"form-field-field_345ecd0-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_345ecd0-2\" name=\"form_fields[field_345ecd0]\"> <label for=\"form-field-field_345ecd0-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_345ecd0-3\" name=\"form_fields[field_345ecd0]\"> <label for=\"form-field-field_345ecd0-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_345ecd0-4\" name=\"form_fields[field_345ecd0]\"> <label for=\"form-field-field_345ecd0-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_345ecd0-5\" name=\"form_fields[field_345ecd0]\"> <label for=\"form-field-field_345ecd0-5\">4<\/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-field_f33d58a elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f33d58a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAssessment marking\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=\"\" id=\"form-field-field_f33d58a-0\" name=\"form_fields[field_f33d58a]\"> <label for=\"form-field-field_f33d58a-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_f33d58a-1\" name=\"form_fields[field_f33d58a]\"> <label for=\"form-field-field_f33d58a-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_f33d58a-2\" name=\"form_fields[field_f33d58a]\"> <label for=\"form-field-field_f33d58a-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_f33d58a-3\" name=\"form_fields[field_f33d58a]\"> <label for=\"form-field-field_f33d58a-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_f33d58a-4\" name=\"form_fields[field_f33d58a]\"> <label for=\"form-field-field_f33d58a-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_f33d58a-5\" name=\"form_fields[field_f33d58a]\"> <label for=\"form-field-field_f33d58a-5\">4<\/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-field_566d5f2 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_566d5f2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTop design assessment\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=\"\" id=\"form-field-field_566d5f2-0\" name=\"form_fields[field_566d5f2]\"> <label for=\"form-field-field_566d5f2-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_566d5f2-1\" name=\"form_fields[field_566d5f2]\"> <label for=\"form-field-field_566d5f2-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_566d5f2-2\" name=\"form_fields[field_566d5f2]\"> <label for=\"form-field-field_566d5f2-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_566d5f2-3\" name=\"form_fields[field_566d5f2]\"> <label for=\"form-field-field_566d5f2-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_566d5f2-4\" name=\"form_fields[field_566d5f2]\"> <label for=\"form-field-field_566d5f2-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_566d5f2-5\" name=\"form_fields[field_566d5f2]\"> <label for=\"form-field-field_566d5f2-5\">4<\/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-field_dc6546f elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_dc6546f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAssessment material\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=\"\" id=\"form-field-field_dc6546f-0\" name=\"form_fields[field_dc6546f]\"> <label for=\"form-field-field_dc6546f-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_dc6546f-1\" name=\"form_fields[field_dc6546f]\"> <label for=\"form-field-field_dc6546f-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_dc6546f-2\" name=\"form_fields[field_dc6546f]\"> <label for=\"form-field-field_dc6546f-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_dc6546f-3\" name=\"form_fields[field_dc6546f]\"> <label for=\"form-field-field_dc6546f-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_dc6546f-4\" name=\"form_fields[field_dc6546f]\"> <label for=\"form-field-field_dc6546f-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_dc6546f-5\" name=\"form_fields[field_dc6546f]\"> <label for=\"form-field-field_dc6546f-5\">4<\/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-field_9ef9f62 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9ef9f62\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeneral User-friendliness\/handling\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=\"\" id=\"form-field-field_9ef9f62-0\" name=\"form_fields[field_9ef9f62]\"> <label for=\"form-field-field_9ef9f62-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_9ef9f62-1\" name=\"form_fields[field_9ef9f62]\"> <label for=\"form-field-field_9ef9f62-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_9ef9f62-2\" name=\"form_fields[field_9ef9f62]\"> <label for=\"form-field-field_9ef9f62-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_9ef9f62-3\" name=\"form_fields[field_9ef9f62]\"> <label for=\"form-field-field_9ef9f62-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_9ef9f62-4\" name=\"form_fields[field_9ef9f62]\"> <label for=\"form-field-field_9ef9f62-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_9ef9f62-5\" name=\"form_fields[field_9ef9f62]\"> <label for=\"form-field-field_9ef9f62-5\">4<\/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-field_37eb3ae elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_37eb3ae\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeneral ergonomics\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=\"\" id=\"form-field-field_37eb3ae-0\" name=\"form_fields[field_37eb3ae]\"> <label for=\"form-field-field_37eb3ae-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_37eb3ae-1\" name=\"form_fields[field_37eb3ae]\"> <label for=\"form-field-field_37eb3ae-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_37eb3ae-2\" name=\"form_fields[field_37eb3ae]\"> <label for=\"form-field-field_37eb3ae-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_37eb3ae-3\" name=\"form_fields[field_37eb3ae]\"> <label for=\"form-field-field_37eb3ae-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_37eb3ae-4\" name=\"form_fields[field_37eb3ae]\"> <label for=\"form-field-field_37eb3ae-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_37eb3ae-5\" name=\"form_fields[field_37eb3ae]\"> <label for=\"form-field-field_37eb3ae-5\">4<\/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-field_1a252f6 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1a252f6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMeets clinical requirements \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=\"\" id=\"form-field-field_1a252f6-0\" name=\"form_fields[field_1a252f6]\"> <label for=\"form-field-field_1a252f6-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_1a252f6-1\" name=\"form_fields[field_1a252f6]\"> <label for=\"form-field-field_1a252f6-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_1a252f6-2\" name=\"form_fields[field_1a252f6]\"> <label for=\"form-field-field_1a252f6-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_1a252f6-3\" name=\"form_fields[field_1a252f6]\"> <label for=\"form-field-field_1a252f6-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_1a252f6-4\" name=\"form_fields[field_1a252f6]\"> <label for=\"form-field-field_1a252f6-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_1a252f6-5\" name=\"form_fields[field_1a252f6]\"> <label for=\"form-field-field_1a252f6-5\">4<\/label><\/span><\/div>\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_ce45446 elementor-col-100\">\n\t\t\t\t\t<p style=\"text-align:left;margin-bottom:-2rem;font-size: 18px;\">Vein hooks:<\/p>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_b7e5ebc elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b7e5ebc\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIs the product mentioned used in the context of implantation ?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_b7e5ebc]\" id=\"form-field-field_b7e5ebc\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"yes\">yes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"no\">no<\/option>\n\t\t\t\t\t\t\t<\/select>\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-radio elementor-field-group elementor-column elementor-field-group-field_9b4215c elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9b4215c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAssessment strength \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=\"\" id=\"form-field-field_9b4215c-0\" name=\"form_fields[field_9b4215c]\"> <label for=\"form-field-field_9b4215c-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_9b4215c-1\" name=\"form_fields[field_9b4215c]\"> <label for=\"form-field-field_9b4215c-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_9b4215c-2\" name=\"form_fields[field_9b4215c]\"> <label for=\"form-field-field_9b4215c-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_9b4215c-3\" name=\"form_fields[field_9b4215c]\"> <label for=\"form-field-field_9b4215c-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_9b4215c-4\" name=\"form_fields[field_9b4215c]\"> <label for=\"form-field-field_9b4215c-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_9b4215c-5\" name=\"form_fields[field_9b4215c]\"> <label for=\"form-field-field_9b4215c-5\">4<\/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-field_80d6b15 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_80d6b15\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAssessment material\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=\"0\" id=\"form-field-field_80d6b15-0\" name=\"form_fields[field_80d6b15]\"> <label for=\"form-field-field_80d6b15-0\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_80d6b15-1\" name=\"form_fields[field_80d6b15]\"> <label for=\"form-field-field_80d6b15-1\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_80d6b15-2\" name=\"form_fields[field_80d6b15]\"> <label for=\"form-field-field_80d6b15-2\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_80d6b15-3\" name=\"form_fields[field_80d6b15]\"> <label for=\"form-field-field_80d6b15-3\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_80d6b15-4\" name=\"form_fields[field_80d6b15]\"> <label for=\"form-field-field_80d6b15-4\">4<\/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-field_86857d3 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_86857d3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeneral User-friendliness\/handling \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=\"\" id=\"form-field-field_86857d3-0\" name=\"form_fields[field_86857d3]\"> <label for=\"form-field-field_86857d3-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_86857d3-1\" name=\"form_fields[field_86857d3]\"> <label for=\"form-field-field_86857d3-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_86857d3-2\" name=\"form_fields[field_86857d3]\"> <label for=\"form-field-field_86857d3-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_86857d3-3\" name=\"form_fields[field_86857d3]\"> <label for=\"form-field-field_86857d3-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_86857d3-4\" name=\"form_fields[field_86857d3]\"> <label for=\"form-field-field_86857d3-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_86857d3-5\" name=\"form_fields[field_86857d3]\"> <label for=\"form-field-field_86857d3-5\">4<\/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-field_8108770 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8108770\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeneral ergonomics\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=\"\" id=\"form-field-field_8108770-0\" name=\"form_fields[field_8108770]\"> <label for=\"form-field-field_8108770-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_8108770-1\" name=\"form_fields[field_8108770]\"> <label for=\"form-field-field_8108770-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_8108770-2\" name=\"form_fields[field_8108770]\"> <label for=\"form-field-field_8108770-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_8108770-3\" name=\"form_fields[field_8108770]\"> <label for=\"form-field-field_8108770-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_8108770-4\" name=\"form_fields[field_8108770]\"> <label for=\"form-field-field_8108770-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_8108770-5\" name=\"form_fields[field_8108770]\"> <label for=\"form-field-field_8108770-5\">4<\/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-field_c0a01f8 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c0a01f8\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMeets clinical requirements\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=\"\" id=\"form-field-field_c0a01f8-0\" name=\"form_fields[field_c0a01f8]\"> <label for=\"form-field-field_c0a01f8-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_c0a01f8-1\" name=\"form_fields[field_c0a01f8]\"> <label for=\"form-field-field_c0a01f8-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_c0a01f8-2\" name=\"form_fields[field_c0a01f8]\"> <label for=\"form-field-field_c0a01f8-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_c0a01f8-3\" name=\"form_fields[field_c0a01f8]\"> <label for=\"form-field-field_c0a01f8-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_c0a01f8-4\" name=\"form_fields[field_c0a01f8]\"> <label for=\"form-field-field_c0a01f8-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_c0a01f8-5\" name=\"form_fields[field_c0a01f8]\"> <label for=\"form-field-field_c0a01f8-5\">4<\/label><\/span><\/div>\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_0b0c3c9 elementor-col-100\">\n\t\t\t\t\t<p style=\"text-align:left;margin-bottom:-2rem;font-size: 18px;\">Filling cannula:<\/p>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_cd84d00 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_cd84d00\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIs the product mentioned used in the context of implantation ?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_cd84d00]\" id=\"form-field-field_cd84d00\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"yes\">yes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"no\">no<\/option>\n\t\t\t\t\t\t\t<\/select>\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-radio elementor-field-group elementor-column elementor-field-group-field_efb7cc5 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_efb7cc5\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAssessment Connection Catheter\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=\"\" id=\"form-field-field_efb7cc5-0\" name=\"form_fields[field_efb7cc5]\"> <label for=\"form-field-field_efb7cc5-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_efb7cc5-1\" name=\"form_fields[field_efb7cc5]\"> <label for=\"form-field-field_efb7cc5-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_efb7cc5-2\" name=\"form_fields[field_efb7cc5]\"> <label for=\"form-field-field_efb7cc5-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_efb7cc5-3\" name=\"form_fields[field_efb7cc5]\"> <label for=\"form-field-field_efb7cc5-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_efb7cc5-4\" name=\"form_fields[field_efb7cc5]\"> <label for=\"form-field-field_efb7cc5-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_efb7cc5-5\" name=\"form_fields[field_efb7cc5]\"> <label for=\"form-field-field_efb7cc5-5\">4<\/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-field_e68e09f elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e68e09f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAssessment Connection Luer-Lock\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=\"\" id=\"form-field-field_e68e09f-0\" name=\"form_fields[field_e68e09f]\"> <label for=\"form-field-field_e68e09f-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_e68e09f-1\" name=\"form_fields[field_e68e09f]\"> <label for=\"form-field-field_e68e09f-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_e68e09f-2\" name=\"form_fields[field_e68e09f]\"> <label for=\"form-field-field_e68e09f-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_e68e09f-3\" name=\"form_fields[field_e68e09f]\"> <label for=\"form-field-field_e68e09f-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_e68e09f-4\" name=\"form_fields[field_e68e09f]\"> <label for=\"form-field-field_e68e09f-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_e68e09f-5\" name=\"form_fields[field_e68e09f]\"> <label for=\"form-field-field_e68e09f-5\">4<\/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-field_13e0600 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_13e0600\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAssessment material\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=\"\" id=\"form-field-field_13e0600-0\" name=\"form_fields[field_13e0600]\"> <label for=\"form-field-field_13e0600-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_13e0600-1\" name=\"form_fields[field_13e0600]\"> <label for=\"form-field-field_13e0600-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_13e0600-2\" name=\"form_fields[field_13e0600]\"> <label for=\"form-field-field_13e0600-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_13e0600-3\" name=\"form_fields[field_13e0600]\"> <label for=\"form-field-field_13e0600-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_13e0600-4\" name=\"form_fields[field_13e0600]\"> <label for=\"form-field-field_13e0600-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_13e0600-5\" name=\"form_fields[field_13e0600]\"> <label for=\"form-field-field_13e0600-5\">4<\/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-field_7d06d53 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7d06d53\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeneral User-friendliness\/handling\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=\"\" id=\"form-field-field_7d06d53-0\" name=\"form_fields[field_7d06d53]\"> <label for=\"form-field-field_7d06d53-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_7d06d53-1\" name=\"form_fields[field_7d06d53]\"> <label for=\"form-field-field_7d06d53-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_7d06d53-2\" name=\"form_fields[field_7d06d53]\"> <label for=\"form-field-field_7d06d53-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_7d06d53-3\" name=\"form_fields[field_7d06d53]\"> <label for=\"form-field-field_7d06d53-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_7d06d53-4\" name=\"form_fields[field_7d06d53]\"> <label for=\"form-field-field_7d06d53-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_7d06d53-5\" name=\"form_fields[field_7d06d53]\"> <label for=\"form-field-field_7d06d53-5\">4<\/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-field_d9e8c0b elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d9e8c0b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeneral ergonomics\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=\"\" id=\"form-field-field_d9e8c0b-0\" name=\"form_fields[field_d9e8c0b]\"> <label for=\"form-field-field_d9e8c0b-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_d9e8c0b-1\" name=\"form_fields[field_d9e8c0b]\"> <label for=\"form-field-field_d9e8c0b-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_d9e8c0b-2\" name=\"form_fields[field_d9e8c0b]\"> <label for=\"form-field-field_d9e8c0b-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_d9e8c0b-3\" name=\"form_fields[field_d9e8c0b]\"> <label for=\"form-field-field_d9e8c0b-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_d9e8c0b-4\" name=\"form_fields[field_d9e8c0b]\"> <label for=\"form-field-field_d9e8c0b-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_d9e8c0b-5\" name=\"form_fields[field_d9e8c0b]\"> <label for=\"form-field-field_d9e8c0b-5\">4<\/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-field_80ec3b5 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_80ec3b5\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMeets clinical requirements\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=\"\" id=\"form-field-field_80ec3b5-0\" name=\"form_fields[field_80ec3b5]\"> <label for=\"form-field-field_80ec3b5-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_80ec3b5-1\" name=\"form_fields[field_80ec3b5]\"> <label for=\"form-field-field_80ec3b5-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_80ec3b5-2\" name=\"form_fields[field_80ec3b5]\"> <label for=\"form-field-field_80ec3b5-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_80ec3b5-3\" name=\"form_fields[field_80ec3b5]\"> <label for=\"form-field-field_80ec3b5-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_80ec3b5-4\" name=\"form_fields[field_80ec3b5]\"> <label for=\"form-field-field_80ec3b5-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_80ec3b5-5\" name=\"form_fields[field_80ec3b5]\"> <label for=\"form-field-field_80ec3b5-5\">4<\/label><\/span><\/div>\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_228b1de elementor-col-100\">\n\t\t\t\t\t<p style=\"text-align:left;margin-bottom:-2rem;font-size: 18px;\">Port needles PK 0925:<\/p>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_8fa0a43 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8fa0a43\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIs the product mentioned used in the context of implantation ?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_8fa0a43]\" id=\"form-field-field_8fa0a43\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"yes\">yes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"no\">no<\/option>\n\t\t\t\t\t\t\t<\/select>\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-radio elementor-field-group elementor-column elementor-field-group-field_092cbe7 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_092cbe7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAssessment of the special tip design (trocar tip)\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=\"\" id=\"form-field-field_092cbe7-0\" name=\"form_fields[field_092cbe7]\"> <label for=\"form-field-field_092cbe7-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_092cbe7-1\" name=\"form_fields[field_092cbe7]\"> <label for=\"form-field-field_092cbe7-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_092cbe7-2\" name=\"form_fields[field_092cbe7]\"> <label for=\"form-field-field_092cbe7-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_092cbe7-3\" name=\"form_fields[field_092cbe7]\"> <label for=\"form-field-field_092cbe7-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_092cbe7-4\" name=\"form_fields[field_092cbe7]\"> <label for=\"form-field-field_092cbe7-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_092cbe7-5\" name=\"form_fields[field_092cbe7]\"> <label for=\"form-field-field_092cbe7-5\">4<\/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-field_40fbf1d elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_40fbf1d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tStitch length assessment\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=\"\" id=\"form-field-field_40fbf1d-0\" name=\"form_fields[field_40fbf1d]\"> <label for=\"form-field-field_40fbf1d-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_40fbf1d-1\" name=\"form_fields[field_40fbf1d]\"> <label for=\"form-field-field_40fbf1d-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_40fbf1d-2\" name=\"form_fields[field_40fbf1d]\"> <label for=\"form-field-field_40fbf1d-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_40fbf1d-3\" name=\"form_fields[field_40fbf1d]\"> <label for=\"form-field-field_40fbf1d-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_40fbf1d-4\" name=\"form_fields[field_40fbf1d]\"> <label for=\"form-field-field_40fbf1d-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_40fbf1d-5\" name=\"form_fields[field_40fbf1d]\"> <label for=\"form-field-field_40fbf1d-5\">4<\/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-field_6737261 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6737261\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAssessment of puncture behaviour\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=\"\" id=\"form-field-field_6737261-0\" name=\"form_fields[field_6737261]\"> <label for=\"form-field-field_6737261-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_6737261-1\" name=\"form_fields[field_6737261]\"> <label for=\"form-field-field_6737261-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_6737261-2\" name=\"form_fields[field_6737261]\"> <label for=\"form-field-field_6737261-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_6737261-3\" name=\"form_fields[field_6737261]\"> <label for=\"form-field-field_6737261-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_6737261-4\" name=\"form_fields[field_6737261]\"> <label for=\"form-field-field_6737261-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_6737261-5\" name=\"form_fields[field_6737261]\"> <label for=\"form-field-field_6737261-5\">4<\/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-field_028e489 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_028e489\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMaterial\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=\"\" id=\"form-field-field_028e489-0\" name=\"form_fields[field_028e489]\"> <label for=\"form-field-field_028e489-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_028e489-1\" name=\"form_fields[field_028e489]\"> <label for=\"form-field-field_028e489-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_028e489-2\" name=\"form_fields[field_028e489]\"> <label for=\"form-field-field_028e489-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_028e489-3\" name=\"form_fields[field_028e489]\"> <label for=\"form-field-field_028e489-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_028e489-4\" name=\"form_fields[field_028e489]\"> <label for=\"form-field-field_028e489-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_028e489-5\" name=\"form_fields[field_028e489]\"> <label for=\"form-field-field_028e489-5\">4<\/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-field_842329c elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_842329c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeneral User-friendliness\/handling\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=\"\" id=\"form-field-field_842329c-0\" name=\"form_fields[field_842329c]\"> <label for=\"form-field-field_842329c-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_842329c-1\" name=\"form_fields[field_842329c]\"> <label for=\"form-field-field_842329c-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_842329c-2\" name=\"form_fields[field_842329c]\"> <label for=\"form-field-field_842329c-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_842329c-3\" name=\"form_fields[field_842329c]\"> <label for=\"form-field-field_842329c-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_842329c-4\" name=\"form_fields[field_842329c]\"> <label for=\"form-field-field_842329c-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_842329c-5\" name=\"form_fields[field_842329c]\"> <label for=\"form-field-field_842329c-5\">4<\/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-field_543ae87 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_543ae87\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeneral ergonomics\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=\"\" id=\"form-field-field_543ae87-0\" name=\"form_fields[field_543ae87]\"> <label for=\"form-field-field_543ae87-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_543ae87-1\" name=\"form_fields[field_543ae87]\"> <label for=\"form-field-field_543ae87-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_543ae87-2\" name=\"form_fields[field_543ae87]\"> <label for=\"form-field-field_543ae87-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_543ae87-3\" name=\"form_fields[field_543ae87]\"> <label for=\"form-field-field_543ae87-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_543ae87-4\" name=\"form_fields[field_543ae87]\"> <label for=\"form-field-field_543ae87-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_543ae87-5\" name=\"form_fields[field_543ae87]\"> <label for=\"form-field-field_543ae87-5\">4<\/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-field_c4b9e33 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c4b9e33\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeneral design of the product\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=\"\" id=\"form-field-field_c4b9e33-0\" name=\"form_fields[field_c4b9e33]\"> <label for=\"form-field-field_c4b9e33-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_c4b9e33-1\" name=\"form_fields[field_c4b9e33]\"> <label for=\"form-field-field_c4b9e33-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_c4b9e33-2\" name=\"form_fields[field_c4b9e33]\"> <label for=\"form-field-field_c4b9e33-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_c4b9e33-3\" name=\"form_fields[field_c4b9e33]\"> <label for=\"form-field-field_c4b9e33-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_c4b9e33-4\" name=\"form_fields[field_c4b9e33]\"> <label for=\"form-field-field_c4b9e33-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_c4b9e33-5\" name=\"form_fields[field_c4b9e33]\"> <label for=\"form-field-field_c4b9e33-5\">4<\/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-field_1ca3920 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1ca3920\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMeets clinical requirements\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=\"\" id=\"form-field-field_1ca3920-0\" name=\"form_fields[field_1ca3920]\"> <label for=\"form-field-field_1ca3920-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_1ca3920-1\" name=\"form_fields[field_1ca3920]\"> <label for=\"form-field-field_1ca3920-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_1ca3920-2\" name=\"form_fields[field_1ca3920]\"> <label for=\"form-field-field_1ca3920-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_1ca3920-3\" name=\"form_fields[field_1ca3920]\"> <label for=\"form-field-field_1ca3920-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_1ca3920-4\" name=\"form_fields[field_1ca3920]\"> <label for=\"form-field-field_1ca3920-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_1ca3920-5\" name=\"form_fields[field_1ca3920]\"> <label for=\"form-field-field_1ca3920-5\">4<\/label><\/span><\/div>\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_c4267a3 elementor-col-100\">\n\t\t\t\t\t<p style=\"text-align:left;margin-bottom:-2rem;font-size: 18px;\">Introducer set:<\/p>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_5f5e810 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5f5e810\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIs an introducer available in assessed treatment unit?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_5f5e810]\" id=\"form-field-field_5f5e810\" class=\"elementor-field-textual elementor-size-lg\" required=\"required\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"yes\">yes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"no\">no<\/option>\n\t\t\t\t\t\t\t<\/select>\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-radio elementor-field-group elementor-column elementor-field-group-field_6fb863e elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6fb863e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAssessment Extent of the insertion kit\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=\"\" id=\"form-field-field_6fb863e-0\" name=\"form_fields[field_6fb863e]\"> <label for=\"form-field-field_6fb863e-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_6fb863e-1\" name=\"form_fields[field_6fb863e]\"> <label for=\"form-field-field_6fb863e-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_6fb863e-2\" name=\"form_fields[field_6fb863e]\"> <label for=\"form-field-field_6fb863e-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_6fb863e-3\" name=\"form_fields[field_6fb863e]\"> <label for=\"form-field-field_6fb863e-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_6fb863e-4\" name=\"form_fields[field_6fb863e]\"> <label for=\"form-field-field_6fb863e-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_6fb863e-5\" name=\"form_fields[field_6fb863e]\"> <label for=\"form-field-field_6fb863e-5\">4<\/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-field_84a2856 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_84a2856\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAssessment guide wire\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=\"\" id=\"form-field-field_84a2856-0\" name=\"form_fields[field_84a2856]\"> <label for=\"form-field-field_84a2856-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_84a2856-1\" name=\"form_fields[field_84a2856]\"> <label for=\"form-field-field_84a2856-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_84a2856-2\" name=\"form_fields[field_84a2856]\"> <label for=\"form-field-field_84a2856-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_84a2856-3\" name=\"form_fields[field_84a2856]\"> <label for=\"form-field-field_84a2856-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_84a2856-4\" name=\"form_fields[field_84a2856]\"> <label for=\"form-field-field_84a2856-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_84a2856-5\" name=\"form_fields[field_84a2856]\"> <label for=\"form-field-field_84a2856-5\">4<\/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-field_cfdda24 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_cfdda24\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAssessment Seldinger cannula\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=\"\" id=\"form-field-field_cfdda24-0\" name=\"form_fields[field_cfdda24]\"> <label for=\"form-field-field_cfdda24-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_cfdda24-1\" name=\"form_fields[field_cfdda24]\"> <label for=\"form-field-field_cfdda24-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_cfdda24-2\" name=\"form_fields[field_cfdda24]\"> <label for=\"form-field-field_cfdda24-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_cfdda24-3\" name=\"form_fields[field_cfdda24]\"> <label for=\"form-field-field_cfdda24-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_cfdda24-4\" name=\"form_fields[field_cfdda24]\"> <label for=\"form-field-field_cfdda24-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_cfdda24-5\" name=\"form_fields[field_cfdda24]\"> <label for=\"form-field-field_cfdda24-5\">4<\/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-field_d62ed33 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d62ed33\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAssessment Peel-Away Sheath\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=\"\" id=\"form-field-field_d62ed33-0\" name=\"form_fields[field_d62ed33]\"> <label for=\"form-field-field_d62ed33-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_d62ed33-1\" name=\"form_fields[field_d62ed33]\"> <label for=\"form-field-field_d62ed33-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_d62ed33-2\" name=\"form_fields[field_d62ed33]\"> <label for=\"form-field-field_d62ed33-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_d62ed33-3\" name=\"form_fields[field_d62ed33]\"> <label for=\"form-field-field_d62ed33-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_d62ed33-4\" name=\"form_fields[field_d62ed33]\"> <label for=\"form-field-field_d62ed33-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_d62ed33-5\" name=\"form_fields[field_d62ed33]\"> <label for=\"form-field-field_d62ed33-5\">4<\/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-field_6f5ae8e elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6f5ae8e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAssessment syringe\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=\"\" id=\"form-field-field_6f5ae8e-0\" name=\"form_fields[field_6f5ae8e]\"> <label for=\"form-field-field_6f5ae8e-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_6f5ae8e-1\" name=\"form_fields[field_6f5ae8e]\"> <label for=\"form-field-field_6f5ae8e-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_6f5ae8e-2\" name=\"form_fields[field_6f5ae8e]\"> <label for=\"form-field-field_6f5ae8e-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_6f5ae8e-3\" name=\"form_fields[field_6f5ae8e]\"> <label for=\"form-field-field_6f5ae8e-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_6f5ae8e-4\" name=\"form_fields[field_6f5ae8e]\"> <label for=\"form-field-field_6f5ae8e-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_6f5ae8e-5\" name=\"form_fields[field_6f5ae8e]\"> <label for=\"form-field-field_6f5ae8e-5\">4<\/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-field_2cd6e32 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2cd6e32\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAssessment scalpel\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=\"\" id=\"form-field-field_2cd6e32-0\" name=\"form_fields[field_2cd6e32]\"> <label for=\"form-field-field_2cd6e32-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_2cd6e32-1\" name=\"form_fields[field_2cd6e32]\"> <label for=\"form-field-field_2cd6e32-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_2cd6e32-2\" name=\"form_fields[field_2cd6e32]\"> <label for=\"form-field-field_2cd6e32-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_2cd6e32-3\" name=\"form_fields[field_2cd6e32]\"> <label for=\"form-field-field_2cd6e32-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_2cd6e32-4\" name=\"form_fields[field_2cd6e32]\"> <label for=\"form-field-field_2cd6e32-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_2cd6e32-5\" name=\"form_fields[field_2cd6e32]\"> <label for=\"form-field-field_2cd6e32-5\">4<\/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-field_95fd65a elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_95fd65a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAssessment of compatibility of the products\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=\"\" id=\"form-field-field_95fd65a-0\" name=\"form_fields[field_95fd65a]\"> <label for=\"form-field-field_95fd65a-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_95fd65a-1\" name=\"form_fields[field_95fd65a]\"> <label for=\"form-field-field_95fd65a-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_95fd65a-2\" name=\"form_fields[field_95fd65a]\"> <label for=\"form-field-field_95fd65a-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_95fd65a-3\" name=\"form_fields[field_95fd65a]\"> <label for=\"form-field-field_95fd65a-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_95fd65a-4\" name=\"form_fields[field_95fd65a]\"> <label for=\"form-field-field_95fd65a-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_95fd65a-5\" name=\"form_fields[field_95fd65a]\"> <label for=\"form-field-field_95fd65a-5\">4<\/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-field_e387f0b elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e387f0b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeneral User-friendliness\/handling\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=\"\" id=\"form-field-field_e387f0b-0\" name=\"form_fields[field_e387f0b]\"> <label for=\"form-field-field_e387f0b-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_e387f0b-1\" name=\"form_fields[field_e387f0b]\"> <label for=\"form-field-field_e387f0b-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_e387f0b-2\" name=\"form_fields[field_e387f0b]\"> <label for=\"form-field-field_e387f0b-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_e387f0b-3\" name=\"form_fields[field_e387f0b]\"> <label for=\"form-field-field_e387f0b-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_e387f0b-4\" name=\"form_fields[field_e387f0b]\"> <label for=\"form-field-field_e387f0b-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_e387f0b-5\" name=\"form_fields[field_e387f0b]\"> <label for=\"form-field-field_e387f0b-5\">4<\/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-field_6072f22 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6072f22\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeneral ergonomics\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=\"\" id=\"form-field-field_6072f22-0\" name=\"form_fields[field_6072f22]\"> <label for=\"form-field-field_6072f22-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_6072f22-1\" name=\"form_fields[field_6072f22]\"> <label for=\"form-field-field_6072f22-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_6072f22-2\" name=\"form_fields[field_6072f22]\"> <label for=\"form-field-field_6072f22-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_6072f22-3\" name=\"form_fields[field_6072f22]\"> <label for=\"form-field-field_6072f22-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_6072f22-4\" name=\"form_fields[field_6072f22]\"> <label for=\"form-field-field_6072f22-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_6072f22-5\" name=\"form_fields[field_6072f22]\"> <label for=\"form-field-field_6072f22-5\">4<\/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-field_3b4bb57 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3b4bb57\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMeets clinical requirements\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=\"\" id=\"form-field-field_3b4bb57-0\" name=\"form_fields[field_3b4bb57]\"> <label for=\"form-field-field_3b4bb57-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_3b4bb57-1\" name=\"form_fields[field_3b4bb57]\"> <label for=\"form-field-field_3b4bb57-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_3b4bb57-2\" name=\"form_fields[field_3b4bb57]\"> <label for=\"form-field-field_3b4bb57-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_3b4bb57-3\" name=\"form_fields[field_3b4bb57]\"> <label for=\"form-field-field_3b4bb57-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_3b4bb57-4\" name=\"form_fields[field_3b4bb57]\"> <label for=\"form-field-field_3b4bb57-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_3b4bb57-5\" name=\"form_fields[field_3b4bb57]\"> <label for=\"form-field-field_3b4bb57-5\">4<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_97ba459 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_97ba459\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tI would choose this product over any other \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_97ba459]\" id=\"form-field-field_97ba459\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"yes\">yes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"no\">no<\/option>\n\t\t\t\t\t\t\t<\/select>\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-html elementor-field-group elementor-column elementor-field-group-field_a94f9a0 elementor-col-100\">\n\t\t\t\t\t<p style=\"text-align:left;margin-bottom:-2rem;font-size: 18px;\">Trocar:<\/p>\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-field_650d150 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_650d150\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tConnection (catheter\/trocar)\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=\"\" id=\"form-field-field_650d150-0\" name=\"form_fields[field_650d150]\"> <label for=\"form-field-field_650d150-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_650d150-1\" name=\"form_fields[field_650d150]\"> <label for=\"form-field-field_650d150-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_650d150-2\" name=\"form_fields[field_650d150]\"> <label for=\"form-field-field_650d150-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_650d150-3\" name=\"form_fields[field_650d150]\"> <label for=\"form-field-field_650d150-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_650d150-4\" name=\"form_fields[field_650d150]\"> <label for=\"form-field-field_650d150-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_650d150-5\" name=\"form_fields[field_650d150]\"> <label for=\"form-field-field_650d150-5\">4<\/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-field_177c438 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_177c438\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLength\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=\"\" id=\"form-field-field_177c438-0\" name=\"form_fields[field_177c438]\"> <label for=\"form-field-field_177c438-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_177c438-1\" name=\"form_fields[field_177c438]\"> <label for=\"form-field-field_177c438-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_177c438-2\" name=\"form_fields[field_177c438]\"> <label for=\"form-field-field_177c438-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_177c438-3\" name=\"form_fields[field_177c438]\"> <label for=\"form-field-field_177c438-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_177c438-4\" name=\"form_fields[field_177c438]\"> <label for=\"form-field-field_177c438-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_177c438-5\" name=\"form_fields[field_177c438]\"> <label for=\"form-field-field_177c438-5\">4<\/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-field_15fdc2c elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_15fdc2c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDiameter\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=\"\" id=\"form-field-field_15fdc2c-0\" name=\"form_fields[field_15fdc2c]\"> <label for=\"form-field-field_15fdc2c-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_15fdc2c-1\" name=\"form_fields[field_15fdc2c]\"> <label for=\"form-field-field_15fdc2c-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_15fdc2c-2\" name=\"form_fields[field_15fdc2c]\"> <label for=\"form-field-field_15fdc2c-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_15fdc2c-3\" name=\"form_fields[field_15fdc2c]\"> <label for=\"form-field-field_15fdc2c-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_15fdc2c-4\" name=\"form_fields[field_15fdc2c]\"> <label for=\"form-field-field_15fdc2c-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_15fdc2c-5\" name=\"form_fields[field_15fdc2c]\"> <label for=\"form-field-field_15fdc2c-5\">4<\/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-field_1c585a3 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1c585a3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tStrength\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=\"\" id=\"form-field-field_1c585a3-0\" name=\"form_fields[field_1c585a3]\"> <label for=\"form-field-field_1c585a3-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_1c585a3-1\" name=\"form_fields[field_1c585a3]\"> <label for=\"form-field-field_1c585a3-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_1c585a3-2\" name=\"form_fields[field_1c585a3]\"> <label for=\"form-field-field_1c585a3-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_1c585a3-3\" name=\"form_fields[field_1c585a3]\"> <label for=\"form-field-field_1c585a3-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_1c585a3-4\" name=\"form_fields[field_1c585a3]\"> <label for=\"form-field-field_1c585a3-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_1c585a3-5\" name=\"form_fields[field_1c585a3]\"> <label for=\"form-field-field_1c585a3-5\">4<\/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-field_f34f69f elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f34f69f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMaterial\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=\"\" id=\"form-field-field_f34f69f-0\" name=\"form_fields[field_f34f69f]\"> <label for=\"form-field-field_f34f69f-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_f34f69f-1\" name=\"form_fields[field_f34f69f]\"> <label for=\"form-field-field_f34f69f-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_f34f69f-2\" name=\"form_fields[field_f34f69f]\"> <label for=\"form-field-field_f34f69f-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_f34f69f-3\" name=\"form_fields[field_f34f69f]\"> <label for=\"form-field-field_f34f69f-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_f34f69f-4\" name=\"form_fields[field_f34f69f]\"> <label for=\"form-field-field_f34f69f-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_f34f69f-5\" name=\"form_fields[field_f34f69f]\"> <label for=\"form-field-field_f34f69f-5\">4<\/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-field_5cfdd96 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5cfdd96\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeneral User-friendliness\/handling\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=\"\" id=\"form-field-field_5cfdd96-0\" name=\"form_fields[field_5cfdd96]\"> <label for=\"form-field-field_5cfdd96-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_5cfdd96-1\" name=\"form_fields[field_5cfdd96]\"> <label for=\"form-field-field_5cfdd96-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_5cfdd96-2\" name=\"form_fields[field_5cfdd96]\"> <label for=\"form-field-field_5cfdd96-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_5cfdd96-3\" name=\"form_fields[field_5cfdd96]\"> <label for=\"form-field-field_5cfdd96-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_5cfdd96-4\" name=\"form_fields[field_5cfdd96]\"> <label for=\"form-field-field_5cfdd96-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_5cfdd96-5\" name=\"form_fields[field_5cfdd96]\"> <label for=\"form-field-field_5cfdd96-5\">4<\/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-field_7b5a63a elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7b5a63a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeneral ergonomics\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=\"\" id=\"form-field-field_7b5a63a-0\" name=\"form_fields[field_7b5a63a]\"> <label for=\"form-field-field_7b5a63a-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_7b5a63a-1\" name=\"form_fields[field_7b5a63a]\"> <label for=\"form-field-field_7b5a63a-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_7b5a63a-2\" name=\"form_fields[field_7b5a63a]\"> <label for=\"form-field-field_7b5a63a-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_7b5a63a-3\" name=\"form_fields[field_7b5a63a]\"> <label for=\"form-field-field_7b5a63a-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_7b5a63a-4\" name=\"form_fields[field_7b5a63a]\"> <label for=\"form-field-field_7b5a63a-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_7b5a63a-5\" name=\"form_fields[field_7b5a63a]\"> <label for=\"form-field-field_7b5a63a-5\">4<\/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-field_5f6f9c5 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5f6f9c5\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMeets clinical requirements\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=\"\" id=\"form-field-field_5f6f9c5-0\" name=\"form_fields[field_5f6f9c5]\"> <label for=\"form-field-field_5f6f9c5-0\"><\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"0\" id=\"form-field-field_5f6f9c5-1\" name=\"form_fields[field_5f6f9c5]\"> <label for=\"form-field-field_5f6f9c5-1\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-field_5f6f9c5-2\" name=\"form_fields[field_5f6f9c5]\"> <label for=\"form-field-field_5f6f9c5-2\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-field_5f6f9c5-3\" name=\"form_fields[field_5f6f9c5]\"> <label for=\"form-field-field_5f6f9c5-3\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-field_5f6f9c5-4\" name=\"form_fields[field_5f6f9c5]\"> <label for=\"form-field-field_5f6f9c5-4\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-field_5f6f9c5-5\" name=\"form_fields[field_5f6f9c5]\"> <label for=\"form-field-field_5f6f9c5-5\">4<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_62e00a0 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_62e00a0\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tI would choose this product over any other \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_62e00a0]\" id=\"form-field-field_62e00a0\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"yes\">yes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"no\">no<\/option>\n\t\t\t\t\t\t\t<\/select>\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-step elementor-field-group elementor-column elementor-field-group-field_30d1640 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Finished\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"\" ><\/div>\n\n\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_e5c669e elementor-col-100\">\n\t\t\t\t\t<p style=\"margin-bottom:-2rem;font-size: 18px;\">Functionality<\/p>\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_c49f87c elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c49f87c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat did you like?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-lg\" name=\"form_fields[field_c49f87c]\" id=\"form-field-field_c49f87c\" rows=\"2\"><\/textarea>\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_a10740f elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a10740f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat did you not like about it?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-lg\" name=\"form_fields[field_a10740f]\" id=\"form-field-field_a10740f\" rows=\"2\"><\/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_d814cf3 elementor-col-100\">\n\t\t\t\t\t<p style=\"margin-bottom:-2rem;font-size: 18px;\">Operability:<\/p>\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_6ce64f7 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6ce64f7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat did you like?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-lg\" name=\"form_fields[field_6ce64f7]\" id=\"form-field-field_6ce64f7\" rows=\"2\"><\/textarea>\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_8db7ba7 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8db7ba7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat did you not like about it?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-lg\" name=\"form_fields[field_8db7ba7]\" id=\"form-field-field_8db7ba7\" rows=\"2\"><\/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_4e898f9 elementor-col-100\">\n\t\t\t\t\t<p style=\"margin-bottom:-2rem;font-size: 18px;\">workflows and compatibility:<\/p>\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_0dafc9d elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0dafc9d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat did you like?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-lg\" name=\"form_fields[field_0dafc9d]\" id=\"form-field-field_0dafc9d\" rows=\"2\"><\/textarea>\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_9e99873 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9e99873\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat did you not like about it?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-lg\" name=\"form_fields[field_9e99873]\" id=\"form-field-field_9e99873\" rows=\"2\"><\/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_d8d1085 elementor-col-100\">\n\t\t\t\t\t<p style=\"margin-bottom:-2rem;font-size: 18px;\">Suggestions for improvement:<\/p>\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-empfehlungdurch elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-empfehlungdurch\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDo you have any suggestions for improvement of the evaluated products?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-lg\" name=\"form_fields[empfehlungdurch]\" id=\"form-field-empfehlungdurch\" 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_3220cb0 elementor-col-100\">\n\t\t\t\t\t<p style=\"margin-bottom:-2rem;font-size: 18px;\">Training needs:<\/p>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_7223cb3 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7223cb3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIs there a need for training?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_7223cb3]\" id=\"form-field-field_7223cb3\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"yes\">yes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"no\">no<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"for new staff, if applicable\">for new staff, if applicable<\/option>\n\t\t\t\t\t\t\t<\/select>\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-text elementor-field-group elementor-column elementor-field-group-field_a3b822b elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a3b822b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tComment\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[field_a3b822b]\" id=\"form-field-field_a3b822b\" class=\"elementor-field elementor-size-lg  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-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-sm\" 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>Questionnaire for market observation port catheter systems Customer Feedback User English<\/p>\n","protected":false},"author":3,"featured_media":14827,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_canvas","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-14947","page","type-page","status-publish","has-post-thumbnail","hentry"],"acf":[],"publishpress_future_action":{"enabled":false,"date":"2026-04-27 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