{"id":14982,"date":"2022-04-05T11:59:04","date_gmt":"2022-04-05T11:59:04","guid":{"rendered":"https:\/\/trans.pakumed.de\/questionnaire-port-catheter-systems-patient\/"},"modified":"2023-06-28T08:12:10","modified_gmt":"2023-06-28T08:12:10","slug":"questionnaire-port-catheter-systems-patient","status":"publish","type":"page","link":"https:\/\/pakumed.de\/en\/questionnaire-port-catheter-systems-patient\/","title":{"rendered":"Customer feedback port catheter systems (patient)"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"14982\" class=\"elementor elementor-14982 elementor-7429\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-1b7a0e2c elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"1b7a0e2c\" 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-4fa99485\" data-id=\"4fa99485\" 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-2497c6c7 elementor-widget elementor-widget-image\" data-id=\"2497c6c7\" 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-457bafd7 elementor-widget elementor-widget-heading\" data-id=\"457bafd7\" 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 of 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-08684f2 elementor-widget elementor-widget-heading\" data-id=\"08684f2\" 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 Patient English<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-42d90dd elementor-button-align-center elementor-widget elementor-widget-form\" data-id=\"42d90dd\" 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=\"14982\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"42d90dd\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Customer feedback port catheter systems (patient)\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"14982\"\/>\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=\"Information\" 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\t\nDear Sir or Madam,\n<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 the European Parliament and the Council.\n<br>\n<br> Dear Sir or Madam, Against 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.\n\nThe evaluation of your answers is anonymous and no conclusions about individual patients are included in the corresponding evaluation.\n<br>\n<br>The questionnaire is divided into the following topics:\n<br>\n<br>I. Information about the patient \n<br>II. product details \n<br>III. Treatment information \n<br>IV. Information on the implant (port catheter system) \n<br>V. General \n<br>\n<br>Please take 5-10 minutes to answer the questionnaire.\n<br>\nYour 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.\n<br>\n<br>Thank you very much for your support!\n\n<br>The team of PakuMed gmbh<br><br>\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=\"Profile\" 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-geschlecht elementor-col-25 elementor-field-required elementor-mark-required\">\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\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[geschlecht]\" id=\"form-field-geschlecht\" class=\"elementor-field-textual elementor-size-sm\" required=\"required\">\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<\/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-number 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\tAge\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"number\" name=\"form_fields[alter]\" id=\"form-field-alter\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"30\" min=\"0\" max=\"\" >\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-number 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\tSize\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"number\" name=\"form_fields[groesse]\" id=\"form-field-groesse\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"in cm\" min=\"0\" max=\"\" >\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-number elementor-field-group elementor-column elementor-field-group-gewicht elementor-col-25 elementor-field-required elementor-mark-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\tWeight\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"number\" name=\"form_fields[gewicht]\" id=\"form-field-gewicht\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"in kg\" required=\"required\" min=\"0\" max=\"\" >\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_cc5f08c elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_cc5f08c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDiagnosis\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_cc5f08c]\" id=\"form-field-field_cc5f08c\" rows=\"1\"><\/textarea>\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-select 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\tProduct\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[erkrankung]\" id=\"form-field-erkrankung\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"Port catheter system\">Port catheter system<\/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-erkrankungandere elementor-col-50\">\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\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<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[erkrankungandere]\" id=\"form-field-erkrankungandere\" class=\"elementor-field-textual elementor-size-sm\">\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_4949d20 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4949d20\" 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_4949d20]\" id=\"form-field-field_4949d20\" class=\"elementor-field elementor-size-sm  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_770842f elementor-col-100\">\n\t\t\t\t\t** If you have been implanted with a port catheter system from the manufacturer PakuMed medical products gmbh (Essen, Germany), you will find information on the article no. and lot in your implantation certificate.\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_5407d6b elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Treatment\" 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-nutzungsdauer elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-nutzungsdauer\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre you being actively treated at the time?\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[nutzungsdauer]\" id=\"form-field-nutzungsdauer\" class=\"elementor-field-textual elementor-size-sm\">\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-text elementor-field-group elementor-column elementor-field-group-anwendung elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-anwendung\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIn which country are you\/were you treated?\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[anwendung]\" id=\"form-field-anwendung\" class=\"elementor-field elementor-size-sm  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-anwendungstyp elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-anwendungstyp\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre\/were you treated as an inpatient or outpatient?\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[anwendungstyp]\" id=\"form-field-anwendungstyp\" class=\"elementor-field-textual elementor-size-sm\">\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_8d7388c elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8d7388c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHow long does a therapy session usually last?\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_8d7388c]\" id=\"form-field-field_8d7388c\" class=\"elementor-field-textual elementor-size-sm\" required=\"required\">\n\t\t\t\t\t\t\t\t\t<option value=\"&lt;1 hr to 2 hrs.&gt; 2 hrs.\">&lt;1 hr to 2 hrs.&gt; 2 hrs.<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"&gt; 3 hrs.\">&gt; 3 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-text elementor-field-group elementor-column elementor-field-group-behandlungsanzahl elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-behandlungsanzahl\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tContact person \/ attending physician (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[behandlungsanzahl]\" id=\"form-field-behandlungsanzahl\" class=\"elementor-field elementor-size-sm  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-text elementor-field-group elementor-column elementor-field-group-gleitmittelart elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-gleitmittelart\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDepartment \/ Speciality \/ Focus: \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[gleitmittelart]\" id=\"form-field-gleitmittelart\" class=\"elementor-field elementor-size-sm  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-text\">\n\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_d6f8465]\" id=\"form-field-field_d6f8465\" class=\"elementor-field elementor-size-sm \" style=\"display:none !important;\">\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_ee4e290 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Implant\" 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_276e792 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_276e792\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHow long is\/was the port implanted? \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_276e792]\" id=\"form-field-field_276e792\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"&lt;1 year 1 - 3 years 3 - 5 years &gt; 5 years\">&lt;1 year 1 - 3 years 3 - 5 years &gt; 5 years<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"&gt; 10 years\">&gt; 10 years<\/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_e52d581 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e52d581\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhere was the port implanted?\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_e52d581]\" id=\"form-field-field_e52d581\" class=\"elementor-field-textual elementor-size-sm\">\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=\" Outpatient clinic\"> Outpatient clinic<\/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=\" 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-empfehlungdurchandere elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-empfehlungdurchandere\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tOnly to be filled in when selecting others.\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[empfehlungdurchandere]\" id=\"form-field-empfehlungdurchandere\" class=\"elementor-field elementor-size-sm  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-select elementor-field-group elementor-column elementor-field-group-field_41ea71c elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_41ea71c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIs the port system currently being used for 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_41ea71c]\" id=\"form-field-field_41ea71c\" class=\"elementor-field-textual elementor-size-sm\">\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_c83326a elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c83326a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIf yes, how often is your port system used?\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_c83326a]\" id=\"form-field-field_c83326a\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"Monthly \">Monthly <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"1-3 times per week\">1-3 times per week<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"daily \">daily <\/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_089f023 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_089f023\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tOnly to be filled in when selecting others.\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_089f023]\" id=\"form-field-field_089f023\" class=\"elementor-field elementor-size-sm  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-checkbox elementor-field-group elementor-column elementor-field-group-field_5d4fc9e elementor-col-80\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5d4fc9e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat has the port been used for in the past or currently? \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=\"Chemotherapy \" id=\"form-field-field_5d4fc9e-0\" name=\"form_fields[field_5d4fc9e][]\"> <label for=\"form-field-field_5d4fc9e-0\">Chemotherapy <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Apheresis \" id=\"form-field-field_5d4fc9e-1\" name=\"form_fields[field_5d4fc9e][]\"> <label for=\"form-field-field_5d4fc9e-1\">Apheresis <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Dialysis \" id=\"form-field-field_5d4fc9e-2\" name=\"form_fields[field_5d4fc9e][]\"> <label for=\"form-field-field_5d4fc9e-2\">Dialysis <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Ascitis\" id=\"form-field-field_5d4fc9e-3\" name=\"form_fields[field_5d4fc9e][]\"> <label for=\"form-field-field_5d4fc9e-3\">Ascitis<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"(Pleural) drainage \" id=\"form-field-field_5d4fc9e-4\" name=\"form_fields[field_5d4fc9e][]\"> <label for=\"form-field-field_5d4fc9e-4\">(Pleural) drainage <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"artificial nutrition \" id=\"form-field-field_5d4fc9e-5\" name=\"form_fields[field_5d4fc9e][]\"> <label for=\"form-field-field_5d4fc9e-5\">artificial nutrition <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"for blood collection High pressure injection \" id=\"form-field-field_5d4fc9e-6\" name=\"form_fields[field_5d4fc9e][]\"> <label for=\"form-field-field_5d4fc9e-6\">for blood collection High pressure injection <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Blood transfusion \" id=\"form-field-field_5d4fc9e-7\" name=\"form_fields[field_5d4fc9e][]\"> <label for=\"form-field-field_5d4fc9e-7\">Blood transfusion <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"prenatal indication\" id=\"form-field-field_5d4fc9e-8\" name=\"form_fields[field_5d4fc9e][]\"> <label for=\"form-field-field_5d4fc9e-8\">prenatal indication<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Other\" id=\"form-field-field_5d4fc9e-9\" name=\"form_fields[field_5d4fc9e][]\"> <label for=\"form-field-field_5d4fc9e-9\">Other<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_0bc1ddc elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0bc1ddc\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tOnly to be filled in when selecting others.\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_0bc1ddc]\" id=\"form-field-field_0bc1ddc\" class=\"elementor-field elementor-size-sm  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-select elementor-field-group elementor-column elementor-field-group-field_ab5ea3c elementor-col-40\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ab5ea3c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIs your port system flushed (to prevent infection and maintain patency)?\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_ab5ea3c]\" id=\"form-field-field_ab5ea3c\" class=\"elementor-field-textual elementor-size-sm\">\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, after each therapy session \">Yes, after each therapy session <\/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 months\">&gt; 3 months<\/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_ebd1566 elementor-col-40\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ebd1566\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWill your port system be blocked after completion of therapy\/treatment (to prevent infections and maintain patency)?\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_ebd1566]\" id=\"form-field-field_ebd1566\" class=\"elementor-field-textual elementor-size-sm\">\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=\"Yes, with others\">Yes, with others<\/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_2abdab3 elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2abdab3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tOnly to be filled in when selecting others.\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_2abdab3]\" id=\"form-field-field_2abdab3\" class=\"elementor-field elementor-size-sm  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-select elementor-field-group elementor-column elementor-field-group-field_f724ca6 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f724ca6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIs your port system antimicrobial blocked?\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_f724ca6]\" id=\"form-field-field_f724ca6\" class=\"elementor-field-textual elementor-size-sm\">\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-checkbox elementor-field-group elementor-column elementor-field-group-field_dc09480 elementor-col-80\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_dc09480\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWere there any complications related to your port system?\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=\"yes\" id=\"form-field-field_dc09480-0\" name=\"form_fields[field_dc09480][]\"> <label for=\"form-field-field_dc09480-0\">yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Clogging of the system\" id=\"form-field-field_dc09480-1\" name=\"form_fields[field_dc09480][]\"> <label for=\"form-field-field_dc09480-1\">Clogging of the system<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Infection\" id=\"form-field-field_dc09480-2\" name=\"form_fields[field_dc09480][]\"> <label for=\"form-field-field_dc09480-2\">Infection<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Thrombosis\" id=\"form-field-field_dc09480-3\" name=\"form_fields[field_dc09480][]\"> <label for=\"form-field-field_dc09480-3\">Thrombosis<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Slipping of the port chamber\" id=\"form-field-field_dc09480-4\" name=\"form_fields[field_dc09480][]\"> <label for=\"form-field-field_dc09480-4\">Slipping of the port chamber<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Misalignment\" id=\"form-field-field_dc09480-5\" name=\"form_fields[field_dc09480][]\"> <label for=\"form-field-field_dc09480-5\">Misalignment<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Other\" id=\"form-field-field_dc09480-6\" name=\"form_fields[field_dc09480][]\"> <label for=\"form-field-field_dc09480-6\">Other<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_fbc8086 elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_fbc8086\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tOnly to be filled in when selecting others.\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_fbc8086]\" id=\"form-field-field_fbc8086\" class=\"elementor-field elementor-size-sm  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_0a388ec 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-select elementor-field-group elementor-column elementor-field-group-produktzufriedenheit elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-produktzufriedenheit\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDo you have an implantation card?\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[produktzufriedenheit]\" id=\"form-field-produktzufriedenheit\" class=\"elementor-field-textual elementor-size-sm\">\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-benutzerfreundlichkeit elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-benutzerfreundlichkeit\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDo you have a patient guide available?\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[benutzerfreundlichkeit]\" id=\"form-field-benutzerfreundlichkeit\" class=\"elementor-field-textual elementor-size-sm\">\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_eee0b2d elementor-col-100\">\n\t\t\t\t\tSatisfaction (0= dissatisfied, 4=very satisfied)\n\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-ergonomie elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-ergonomie\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre you generally satisfied with the implant?\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-ergonomie-0\" name=\"form_fields[ergonomie]\"> <label for=\"form-field-ergonomie-0\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-ergonomie-1\" name=\"form_fields[ergonomie]\"> <label for=\"form-field-ergonomie-1\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-ergonomie-2\" name=\"form_fields[ergonomie]\"> <label for=\"form-field-ergonomie-2\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-ergonomie-3\" name=\"form_fields[ergonomie]\"> <label for=\"form-field-ergonomie-3\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-ergonomie-4\" name=\"form_fields[ergonomie]\"> <label for=\"form-field-ergonomie-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-beilage elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-beilage\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre you satisfied with the enclosed information?\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-beilage-0\" name=\"form_fields[beilage]\"> <label for=\"form-field-beilage-0\">0<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1\" id=\"form-field-beilage-1\" name=\"form_fields[beilage]\"> <label for=\"form-field-beilage-1\">1<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2\" id=\"form-field-beilage-2\" name=\"form_fields[beilage]\"> <label for=\"form-field-beilage-2\">2<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"3\" id=\"form-field-beilage-3\" name=\"form_fields[beilage]\"> <label for=\"form-field-beilage-3\">3<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"4\" id=\"form-field-beilage-4\" name=\"form_fields[beilage]\"> <label for=\"form-field-beilage-4\">4<\/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-field_a061b39 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a061b39\" 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<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_a061b39]\" id=\"form-field-field_a061b39\" rows=\"4\"><\/textarea>\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 of port catheter systems Customer feedback Patient English<\/p>\n","protected":false},"author":3,"featured_media":14829,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_canvas","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-14982","page","type-page","status-publish","has-post-thumbnail","hentry"],"acf":[],"publishpress_future_action":{"enabled":false,"date":"2026-04-29 09:07:59","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"translation_priority","extraData":[]},"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"_links":{"self":[{"href":"https:\/\/pakumed.de\/en\/wp-json\/wp\/v2\/pages\/14982","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pakumed.de\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/pakumed.de\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/pakumed.de\/en\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/pakumed.de\/en\/wp-json\/wp\/v2\/comments?post=14982"}],"version-history":[{"count":14,"href":"https:\/\/pakumed.de\/en\/wp-json\/wp\/v2\/pages\/14982\/revisions"}],"predecessor-version":[{"id":17701,"href":"https:\/\/pakumed.de\/en\/wp-json\/wp\/v2\/pages\/14982\/revisions\/17701"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pakumed.de\/en\/wp-json\/wp\/v2\/media\/14829"}],"wp:attachment":[{"href":"https:\/\/pakumed.de\/en\/wp-json\/wp\/v2\/media?parent=14982"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}