{"id":705,"date":"2019-08-02T13:01:49","date_gmt":"2019-08-02T11:01:49","guid":{"rendered":"http:\/\/pihouse.pl\/?page_id=705"},"modified":"2019-08-02T13:27:53","modified_gmt":"2019-08-02T11:27:53","slug":"705-2","status":"publish","type":"page","link":"https:\/\/pihouse.pl\/en\/705-2\/","title":{"rendered":"Elementor #705"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"705\" class=\"elementor elementor-705\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-5f170e2 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"5f170e2\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-b7c0c9b\" data-id=\"b7c0c9b\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6bea61a elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"6bea61a\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;button_width&quot;:&quot;100&quot;,&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Nowy formularz\" aria-label=\"Nowy formularz\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"705\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"6bea61a\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"PI-House \u2013 Centrum Bada\u0144 Klinicznych\" \/>\n\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-name elementor-col-100\">\n\t\t\t\t\t<span class=\"form-header\">Informacje podstawowe<\/span>\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_5 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tImi\u0119\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_5]\" id=\"form-field-field_5\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Imi\u0119\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-email elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNazwisko\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[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Nazwisko\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-message elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-message\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tE-mail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[message]\" id=\"form-field-message\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"E-mail\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_1 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTelefon\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_1]\" id=\"form-field-field_1\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Numer telefonu\" required=\"required\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_2 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tData urodzenia\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_2]\" id=\"form-field-field_2\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field\" placeholder=\"Data urodzenia\" required=\"required\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_4 elementor-col-100\">\n\t\t\t\t\t<span class=\"form-header\">Adres do korespondencji<\/span>\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-field_6 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tKod pocztowy\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"number\" name=\"form_fields[field_6]\" id=\"form-field-field_6\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Kod pocztowy\" min=\"\" max=\"\" >\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_7 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMiejscowo\u015b\u0107\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_7]\" id=\"form-field-field_7\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Miejscowo\u015b\u0107\">\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_3 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tUlica, numer\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_3]\" id=\"form-field-field_3\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Ulica, numer domu\">\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_8 elementor-col-100\">\n\t\t\t\t\t<span class=\"form-text\">Szanowni Pa\u0144stwo, udzielenie odpowiedzi na pytania zawarte w poni\u017cszej ankiecie pozwoli nam wybra\u0107 odpowiedni\u0105 dla Pa\u0144stwa propozycj\u0119 bada\u0144 diagnostycznych oraz konsultacji lekarskich. Udzia\u0142 w naszych programach bezp\u0142atnych bada\u0144 jest ca\u0142kowicie dobrowolny.<\/span>\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_9 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCzy kiedykolwiek korzysta\u0142\/a Pan\/Pani z us\u0142ug w Centrum Bada\u0144 Klinicznych PI HOUSE?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Tak \" id=\"form-field-field_9-0\" name=\"form_fields[field_9]\" required=\"required\"> <label for=\"form-field-field_9-0\">Tak <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Nie\" id=\"form-field-field_9-1\" name=\"form_fields[field_9]\" required=\"required\"> <label for=\"form-field-field_9-1\">Nie<\/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_10 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_10\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCzy przeby\u0142\/a Pan\/Pani udokumentowany wypisem zawa\u0142 serca lub udar m\u00f3zgu?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Tak \" id=\"form-field-field_10-0\" name=\"form_fields[field_10]\" required=\"required\"> <label for=\"form-field-field_10-0\">Tak <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Nie\" id=\"form-field-field_10-1\" name=\"form_fields[field_10]\" required=\"required\"> <label for=\"form-field-field_10-1\">Nie<\/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_11 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_11\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tJe\u015bli tak to kiedy?\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_11]\" id=\"form-field-field_11\" 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-radio elementor-field-group elementor-column elementor-field-group-field_12 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_12\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCzy ma Pan\/Pani migotanie przedsionk\u00f3w? Czy w zwi\u0105zku z tym za\u017cywa Pan\/Pani leki?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Tak \" id=\"form-field-field_12-0\" name=\"form_fields[field_12]\" required=\"required\"> <label for=\"form-field-field_12-0\">Tak <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Nie\" id=\"form-field-field_12-1\" name=\"form_fields[field_12]\" required=\"required\"> <label for=\"form-field-field_12-1\">Nie<\/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_13 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_13\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tJe\u015bli tak to jakie?\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_13]\" id=\"form-field-field_13\" 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-radio elementor-field-group elementor-column elementor-field-group-field_14 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_14\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCzy przeby\u0142\/a Pan\/Pani zabieg (lub operacj\u0119) serca: balonikowanie, wszczepienie stentu, by-passy lub zabieg koronanografii?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Tak \" id=\"form-field-field_14-0\" name=\"form_fields[field_14]\" required=\"required\"> <label for=\"form-field-field_14-0\">Tak <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Nie\" id=\"form-field-field_14-1\" name=\"form_fields[field_14]\" required=\"required\"> <label for=\"form-field-field_14-1\">Nie<\/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_19 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_19\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tJe\u015bli tak to kiedy?\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_19]\" id=\"form-field-field_19\" 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-radio elementor-field-group elementor-column elementor-field-group-field_16 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_16\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCzy stosuje Pan\/Pani leki na cholesterol (np. Roswera, Romazic, Zahron, Zaranta, Simvacard, Zocor, Tulip, Sortis, Atoris, Atrox, Torvalipin i inne)?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Tak \" id=\"form-field-field_16-0\" name=\"form_fields[field_16]\" required=\"required\"> <label for=\"form-field-field_16-0\">Tak <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Nie\" id=\"form-field-field_16-1\" name=\"form_fields[field_16]\" required=\"required\"> <label for=\"form-field-field_16-1\">Nie<\/label><\/span><\/div>\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-field_17 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_17\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tJe\u015bli tak, to prosz\u0119 poda\u0107 w jakiej dawce (mg)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"number\" name=\"form_fields[field_17]\" id=\"form-field-field_17\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" min=\"\" max=\"\" >\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_18 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_18\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCzy choruje Pan\/Pani na cukrzyc\u0119 typu 1 ?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Tak \" id=\"form-field-field_18-0\" name=\"form_fields[field_18]\" required=\"required\"> <label for=\"form-field-field_18-0\">Tak <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Nie\" id=\"form-field-field_18-1\" name=\"form_fields[field_18]\" required=\"required\"> <label for=\"form-field-field_18-1\">Nie<\/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_21 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_21\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tJe\u015bli tak to od kiedy ?\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_21]\" id=\"form-field-field_21\" 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-radio elementor-field-group elementor-column elementor-field-group-field_20 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_20\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCzy choruje Pan\/Pani na cukrzyc\u0119 typu 2 ?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Tak \" id=\"form-field-field_20-0\" name=\"form_fields[field_20]\" required=\"required\"> <label for=\"form-field-field_20-0\">Tak <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Nie\" id=\"form-field-field_20-1\" name=\"form_fields[field_20]\" required=\"required\"> <label for=\"form-field-field_20-1\">Nie<\/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_27 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_27\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tJe\u015bli tak to od kiedy ?\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_27]\" id=\"form-field-field_27\" 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-radio elementor-field-group elementor-column elementor-field-group-field_22 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_22\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCzy mia\u0142 Pan\/Pani zdiagnozowan\u0105 mia\u017cd\u017cyc\u0119 badaniem USG metod\u0105 Dopplera?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Tak \" id=\"form-field-field_22-0\" name=\"form_fields[field_22]\" required=\"required\"> <label for=\"form-field-field_22-0\">Tak <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Nie\" id=\"form-field-field_22-1\" name=\"form_fields[field_22]\" required=\"required\"> <label for=\"form-field-field_22-1\">Nie<\/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_23 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_23\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tJe\u015bli tak to kiedy ?\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_23]\" id=\"form-field-field_23\" 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-radio elementor-field-group elementor-column elementor-field-group-field_24 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_24\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCzy choruje Pan\/Pani na nadci\u015bnienie t\u0119tnicze?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Tak \" id=\"form-field-field_24-0\" name=\"form_fields[field_24]\" required=\"required\"> <label for=\"form-field-field_24-0\">Tak <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Nie\" id=\"form-field-field_24-1\" name=\"form_fields[field_24]\" required=\"required\"> <label for=\"form-field-field_24-1\">Nie<\/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_15 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_15\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tJe\u015bli tak to od kiedy ?\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_15]\" id=\"form-field-field_15\" 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-radio elementor-field-group elementor-column elementor-field-group-field_25 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_25\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCzy zdiagnozowano u Pana\/Pani st\u0142uszczenie w\u0105troby lub zw\u0142\u00f3knienie w\u0105troby?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Tak \" id=\"form-field-field_25-0\" name=\"form_fields[field_25]\" required=\"required\"> <label for=\"form-field-field_25-0\">Tak <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Nie\" id=\"form-field-field_25-1\" name=\"form_fields[field_25]\" required=\"required\"> <label for=\"form-field-field_25-1\">Nie<\/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_26 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_26\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCzy choruje Pan\/Pani na \u0142uszczyc\u0119? Tocze\u0144? Atopowe Zapalenie Sk\u00f3ry? Tr\u0105dzik?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Tak \" id=\"form-field-field_26-0\" name=\"form_fields[field_26]\" required=\"required\"> <label for=\"form-field-field_26-0\">Tak <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Nie\" id=\"form-field-field_26-1\" name=\"form_fields[field_26]\" required=\"required\"> <label for=\"form-field-field_26-1\">Nie<\/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_28 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_28\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tJe\u015bli tak to od kiedy ?\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_28]\" id=\"form-field-field_28\" 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-radio elementor-field-group elementor-column elementor-field-group-field_29 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_29\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCzy zdiagnozowano u Pana\/Pani reumatoidalne zapalenie staw\u00f3w?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Tak \" id=\"form-field-field_29-0\" name=\"form_fields[field_29]\" required=\"required\"> <label for=\"form-field-field_29-0\">Tak <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Nie\" id=\"form-field-field_29-1\" name=\"form_fields[field_29]\" required=\"required\"> <label for=\"form-field-field_29-1\">Nie<\/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_30 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_30\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tJe\u015bli tak to kiedy ?\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_30]\" id=\"form-field-field_30\" 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-radio elementor-field-group elementor-column elementor-field-group-field_31 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_31\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCzy aktualnie przyjmuje Pan\/Pani leki ze wzgl\u0119du na reumatoidalne zapalenie staw\u00f3w, np. Metotreksat?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Tak \" id=\"form-field-field_31-0\" name=\"form_fields[field_31]\" required=\"required\"> <label for=\"form-field-field_31-0\">Tak <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Nie\" id=\"form-field-field_31-1\" name=\"form_fields[field_31]\" required=\"required\"> <label for=\"form-field-field_31-1\">Nie<\/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_32 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_32\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCzy zdiagnozowano u Pana\/Pani chorob\u0119 Alzheimera?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Tak \" id=\"form-field-field_32-0\" name=\"form_fields[field_32]\" required=\"required\"> <label for=\"form-field-field_32-0\">Tak <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Nie\" id=\"form-field-field_32-1\" name=\"form_fields[field_32]\" required=\"required\"> <label for=\"form-field-field_32-1\">Nie<\/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_33 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_33\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCzy zdiagnozowano u Pana\/Pani depresj\u0119?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Tak \" id=\"form-field-field_33-0\" name=\"form_fields[field_33]\" required=\"required\"> <label for=\"form-field-field_33-0\">Tak <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Nie\" id=\"form-field-field_33-1\" name=\"form_fields[field_33]\" required=\"required\"> <label for=\"form-field-field_33-1\">Nie<\/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_34 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_34\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCzy cierpi Pan\/Pani na chorob\u0119 afektywn\u0105 dwubiegunow\u0105?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Tak \" id=\"form-field-field_34-0\" name=\"form_fields[field_34]\" required=\"required\"> <label for=\"form-field-field_34-0\">Tak <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Nie\" id=\"form-field-field_34-1\" name=\"form_fields[field_34]\" required=\"required\"> <label for=\"form-field-field_34-1\">Nie<\/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_35 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_35\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCzy zdiagnozowano u Pana\/Pani chorob\u0119 nowotworow\u0105?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Tak \" id=\"form-field-field_35-0\" name=\"form_fields[field_35]\" required=\"required\"> <label for=\"form-field-field_35-0\">Tak <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Nie\" id=\"form-field-field_35-1\" name=\"form_fields[field_35]\" required=\"required\"> <label for=\"form-field-field_35-1\">Nie<\/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_36 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_36\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tJe\u015bli tak to prosz\u0119 poda\u0107 dat\u0119 rozpoznania i jakiego rodzaju by\u0142 to nowotw\u00f3r?\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_36]\" id=\"form-field-field_36\" 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-radio elementor-field-group elementor-column elementor-field-group-field_37 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_37\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCzy choruje Pani\/Pan na inne choroby ni\u017c wymienione w formularzu np. choroby nerek, choroby staw\u00f3w, choroby tarczycy, arytmia, choroba wrzodowa, osteoporoza, astma, POCHP, stwardnienie rozsiane?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Tak \" id=\"form-field-field_37-0\" name=\"form_fields[field_37]\" required=\"required\"> <label for=\"form-field-field_37-0\">Tak <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Nie\" id=\"form-field-field_37-1\" name=\"form_fields[field_37]\" required=\"required\"> <label for=\"form-field-field_37-1\">Nie<\/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_38 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_38\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tJe\u015bli tak - prosz\u0119 poda\u0107, jakie ?\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_38]\" id=\"form-field-field_38\" 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_39 elementor-col-100\">\n\t\t\t\t\t<span class=\"form-header\">Prosz\u0119 poda\u0107 wszystkie leki, jakie Pan\/Pani obecnie przyjmuje wraz z dawkami:<\/span>\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_40 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_40]\" id=\"form-field-field_40\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Nazwa leku\">\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_45 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_45]\" id=\"form-field-field_45\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Dawka\">\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_42 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_42]\" id=\"form-field-field_42\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Nazwa leku\">\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_44 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_44]\" id=\"form-field-field_44\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Dawka\">\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_46 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_46]\" id=\"form-field-field_46\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Nazwa leku\">\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_57 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_57]\" id=\"form-field-field_57\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Dawka\">\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_56 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_56]\" id=\"form-field-field_56\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Nazwa leku\">\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_55 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_55]\" id=\"form-field-field_55\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Dawka\">\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_54 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_54]\" id=\"form-field-field_54\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Nazwa leku\">\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_53 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_53]\" id=\"form-field-field_53\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Dawka\">\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_52 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_52]\" id=\"form-field-field_52\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Nazwa leku\">\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_51 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_51]\" id=\"form-field-field_51\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Dawka\">\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_50 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_50]\" id=\"form-field-field_50\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Nazwa leku\">\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_49 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_49]\" id=\"form-field-field_49\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Dawka\">\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_48 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_48]\" id=\"form-field-field_48\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Nazwa leku\">\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_47 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_47]\" id=\"form-field-field_47\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Dawka\">\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_43 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_43]\" id=\"form-field-field_43\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Nazwa leku\">\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_41 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_41]\" id=\"form-field-field_41\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Dawka\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_58 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_58\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSk\u0105d si\u0119 Pan\/Pani dowiedzia\u0142\/a o dzisiejszej akcji:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Plakaty, ulotki\" id=\"form-field-field_58-0\" name=\"form_fields[field_58]\"> <label for=\"form-field-field_58-0\">Plakaty, ulotki<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Internet\" id=\"form-field-field_58-1\" name=\"form_fields[field_58]\"> <label for=\"form-field-field_58-1\">Internet<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Radio\" id=\"form-field-field_58-2\" name=\"form_fields[field_58]\"> <label for=\"form-field-field_58-2\">Radio<\/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_59 elementor-col-100\">\n\t\t\t\t\t<span class=\"form-text\">\nWyra\u017cam zgod\u0119 na przetwarzanie moich danych osobowych, w tym danych wra\u017cliwych, na podstawie RODO Art. 6 pkt. a. w celu ochrony stanu mojego zdrowia, \u015bwiadczenia na moj\u0105 rzecz us\u0142ug medycznych oraz prowadzenia medycznych bada\u0144 klinicznych przez Centrum Bada\u0144 Klinicznych PI-House sp. z o.o. z siedzib\u0105 w Gda\u0144sku ul. Na Zasp\u0119 3. Zgoda na przetwarzanie moich danych osobowych obejmuje tak\u017ce zgod\u0119 na ich przetwarzanie w przysz\u0142o\u015bci, o ile nie zmieni si\u0119 cel przetwarzania. Zosta\u0142am (-em) poinformowana (-y) o prawie wgl\u0105du i poprawiania danych oraz uzyskania informacji na temat zgromadzonych danych. Jednocze\u015bnie wyra\u017cam zgod\u0119 na wykorzystywanie moich danych, w tym danych wra\u017cliwych, w celu: poinformowania mnie o mo\u017cliwo\u015bci udzia\u0142u w bezp\u0142atnych badaniach profilaktycznych, oceny mo\u017cliwo\u015bci zakwalifikowania mnie do bada\u0144 klinicznych i zaproszenia do udzia\u0142u w takim badaniu. Wyra\u017cam zgod\u0119 na otrzymywanie informacji o ofercie bada\u0144 profilaktycznych lub bada\u0144 klinicznych oraz o zbli\u017caj\u0105cych si\u0119 wizytach w Centrum Bada\u0144 Klinicznych PI-House z wykorzystywaniem \u015brodk\u00f3w komunikowania na odleg\u0142o\u015b\u0107 w postaci kontaktu telefonicznego, maila, smsa lub pisemnego powiadomienia kierowanego na wskazany przeze mnie adres. Wyra\u017cam zgod\u0119 na przetwarzanie moich danych w celach i zakresie wskazanych w niniejszej zgodzie w systemach informatycznych.\n<\/span>\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\">Wy\u015blij<\/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":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-705","page","type-page","status-publish","hentry","entry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Elementor #705 - PI-House \u2013 Centrum Bada\u0144 Klinicznych<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pihouse.pl\/en\/705-2\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Elementor #705 - PI-House \u2013 Centrum Bada\u0144 Klinicznych\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pihouse.pl\/en\/705-2\/\" \/>\n<meta property=\"og:site_name\" content=\"PI-House \u2013 Centrum Bada\u0144 Klinicznych\" \/>\n<meta property=\"article:modified_time\" content=\"2019-08-02T11:27:53+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/pihouse.pl\\\/705-2\\\/\",\"url\":\"https:\\\/\\\/pihouse.pl\\\/705-2\\\/\",\"name\":\"Elementor #705 - PI-House \u2013 Centrum Bada\u0144 Klinicznych\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pihouse.pl\\\/#website\"},\"datePublished\":\"2019-08-02T11:01:49+00:00\",\"dateModified\":\"2019-08-02T11:27:53+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/pihouse.pl\\\/705-2\\\/#breadcrumb\"},\"inLanguage\":\"en-GB\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/pihouse.pl\\\/705-2\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/pihouse.pl\\\/705-2\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Strona g\u0142\u00f3wna\",\"item\":\"https:\\\/\\\/pihouse.pl\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Elementor #705\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/pihouse.pl\\\/#website\",\"url\":\"https:\\\/\\\/pihouse.pl\\\/\",\"name\":\"PI-House \u2013 Centrum Bada\u0144 Klinicznych\",\"description\":\"W okresie naszej dzia\u0142alno\u015bci przeprowadzili\u015bmy wiele bada\u0144 klinicznych. 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