{"id":425,"date":"2024-01-03T20:31:01","date_gmt":"2024-01-03T20:31:01","guid":{"rendered":"https:\/\/agitation-study.com\/kwestionariusz-kwalifikacyjny\/"},"modified":"2024-01-27T04:37:51","modified_gmt":"2024-01-27T04:37:51","slug":"kwestionariusz-kwalifikacyjny","status":"publish","type":"page","link":"https:\/\/agitation-study.com\/pl\/kwestionariusz-kwalifikacyjny\/","title":{"rendered":"Kwestionariusz kwalifikacyjny"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|tablet&#8221; _builder_version=&#8221;4.23.4&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#003F5A&#8221; use_background_color_gradient=&#8221;on&#8221; background_color_gradient_stops=&#8221;rgba(0,63,90,0.66) 100%|rgba(255,255,255,0) 100%&#8221; background_color_gradient_overlays_image=&#8221;on&#8221; background_image=&#8221;https:\/\/agitation-study.com\/wp-content\/uploads\/2023\/10\/Agitation_Dementia_Alzheimers_Suven_6.jpg&#8221; custom_padding=&#8221;8vw||4vw||false|false&#8221; custom_padding_tablet=&#8221;0vw||0vw||true|false&#8221; custom_padding_phone=&#8221;0vw||0vw||true|false&#8221; hover_enabled=&#8221;0&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;][et_pb_row column_structure=&#8221;3_5,2_5&#8243; make_equal=&#8221;on&#8221; _builder_version=&#8221;4.23&#8243; _module_preset=&#8221;default&#8221; width=&#8221;100%&#8221; max_width=&#8221;100%&#8221; custom_css_main_element=&#8221;align-items:center;&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;3_5&#8243; _builder_version=&#8221;4.23&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;|||6vw|false|false&#8221; custom_padding_tablet=&#8221;|60px||60px|false|true&#8221; custom_padding_phone=&#8221;|60px||60px|false|true&#8221; custom_padding_last_edited=&#8221;on|tablet&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.23.4&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;|600|||||||&#8221; text_text_color=&#8221;#FFFFFF&#8221; text_font_size=&#8221;19px&#8221; header_font=&#8221;||||||||&#8221; header_font_size=&#8221;48px&#8221; header_line_height=&#8221;1.05em&#8221; background_layout=&#8221;dark&#8221; max_width=&#8221;70%&#8221; max_width_tablet=&#8221;100%&#8221; max_width_phone=&#8221;100%&#8221; max_width_last_edited=&#8221;on|phone&#8221; custom_margin=&#8221;18vw||||false|false&#8221; custom_margin_tablet=&#8221;6vw|0vw|||false|false&#8221; custom_margin_phone=&#8221;|0vw|||false|false&#8221; custom_margin_last_edited=&#8221;on|desktop&#8221; animation_style=&#8221;fade&#8221; header_font_size_tablet=&#8221;32px&#8221; header_font_size_phone=&#8221;28px&#8221; header_font_size_last_edited=&#8221;on|phone&#8221; text_text_shadow_style=&#8221;preset3&#8243; text_text_shadow_color=&#8221;rgba(0,0,0,0.85)&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h1>Kwestionariusz kwalifikacyjny<\/h1>\n<p>Sprawd\u017a, czy Ty lub osoba Ci bliska mo\u017cecie kwalifikowa\u0107 si\u0119 do klinicznego badania naukowego maj\u0105cego na celu ocen\u0119 potencjalnych metod leczenia pobudzenia w przebiegu choroby Alzheimera.[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;2_5&#8243; _builder_version=&#8221;4.22.2&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_image src=&#8221;https:\/\/agitation-study.com\/wp-content\/uploads\/2023\/10\/Agitation_Dementia_Alzheimers_Suven_1a.png&#8221; title_text=&#8221;Agitation_Dementia_Alzheimer\u2019s_Suven_1a&#8221; _builder_version=&#8221;4.23&#8243; _module_preset=&#8221;default&#8221; z_index=&#8221;999&#8243; max_width_tablet=&#8221;55%&#8221; max_width_phone=&#8221;60%&#8221; max_width_last_edited=&#8221;on|desktop&#8221; custom_margin=&#8221;||-60%||false|false&#8221; custom_margin_tablet=&#8221;||-30%||false|false&#8221; custom_margin_phone=&#8221;||-15%||false|false&#8221; custom_margin_last_edited=&#8221;on|desktop&#8221; animation_style=&#8221;fold&#8221; animation_direction=&#8221;right&#8221; module_alignment_tablet=&#8221;right&#8221; module_alignment_phone=&#8221;right&#8221; module_alignment_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_image][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|desktop&#8221; _builder_version=&#8221;4.23&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#003F5A&#8221; background_image=&#8221;https:\/\/agitation-study.com\/wp-content\/uploads\/2023\/10\/Agitation_Dementia_Alzheimers_Suven_Background3.png&#8221; parallax=&#8221;on&#8221; custom_padding=&#8221;30px||30px||true|false&#8221; custom_padding_tablet=&#8221;60px||60px||true|false&#8221; custom_padding_phone=&#8221;60px||60px||true|false&#8221; background_last_edited=&#8221;on|tablet&#8221; parallax_tablet=&#8221;off&#8221; background_position_tablet=&#8221;center_right&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.23&#8243; _module_preset=&#8221;default&#8221; width=&#8221;85%&#8221; width_tablet=&#8221;85%&#8221; width_phone=&#8221;85%&#8221; width_last_edited=&#8221;on|tablet&#8221; max_width=&#8221;100%&#8221; max_width_tablet=&#8221;100%&#8221; max_width_phone=&#8221;100%&#8221; max_width_last_edited=&#8221;on|tablet&#8221; custom_padding=&#8221;2vw||2vw||true|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.22.2&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.23.4&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;||||||||&#8221; text_text_color=&#8221;#FFFFFF&#8221; text_font_size=&#8221;22px&#8221; text_line_height=&#8221;1.4em&#8221; max_width=&#8221;60%&#8221; max_width_tablet=&#8221;40%&#8221; max_width_phone=&#8221;100%&#8221; max_width_last_edited=&#8221;on|phone&#8221; custom_padding=&#8221;2vw|3vw|2vw||true|false&#8221; text_font_size_tablet=&#8221;20px&#8221; text_font_size_phone=&#8221;18px&#8221; text_font_size_last_edited=&#8221;on|phone&#8221; text_text_shadow_style=&#8221;preset3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p>Je\u015bli interesuje Ci\u0119 udzia\u0142 w tym klinicznym badaniu naukowym, skontaktuj si\u0119 z najbli\u017cszym o\u015brodkiem badawczym, aby uzyska\u0107 wi\u0119cej informacji.<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.23.4&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#ebf3f8&#8243; custom_padding=&#8221;40px||40px||true|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.17.4&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;2vw||2vw||true|false&#8221; 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module_alignment=&#8221;center&#8221; custom_margin=&#8221;||40px||false|false&#8221; custom_padding=&#8221;||8px||false|false&#8221; border_width_bottom=&#8221;1px&#8221; border_color_bottom=&#8221;#CCDEEF&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2>Przedstawiciel badania klinicznego skontaktuje si\u0119 z Panem\/Pani\u0105 w celu om\u00f3wienia dodatkowych wymaga\u0144 kwalifikacyjnych i udzielenia odpowiedzi na wszelkie pytania.<\/h2>\n<p>Prosz\u0119 poda\u0107 dane opiekuna, kt\u00f3ry b\u0119dzie pomaga\u0142 potencjalnemu uczestnikowi podczas badania klinicznego.<\/p>\n<p>Je\u015bli Pan\/Pani lub bliska osoba we\u017amie udzia\u0142 w tym badaniu klinicznym, uczestnik powinien mie\u0107 opiekuna, kt\u00f3ry b\u0119dzie mu asystowa\u0142 przez czas trwania badania.<\/p>\n<p>[\/et_pb_text][et_pb_code _builder_version=&#8221;4.23.4&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#FFFFFF&#8221; max_width=&#8221;875px&#8221; 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class='gform_description'><\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; oznacza pola wymagane<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_2' id='gform_2'  action='\/pl\/wp-json\/wp\/v2\/pages\/425#gf_2' data-formid='2' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_19\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_19'>Facebook<\/label><div class='ginput_container'><input name='input_19' id='input_2_19' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_2_19'>To pole jest u\u017cywane do walidacji i powinno pozosta\u0107 niezmienione.<\/div><\/div><div id=\"field_2_1\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_1'>Imi\u0119 opiekuna:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_2_1' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_3\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below 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class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_2_6' type='text' value='' class='large' maxlength='10'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_8\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_8'>Preferowany czas kontaktu:<\/label><div class='ginput_container ginput_container_select'><select name='input_8' id='input_2_8' class='large gfield_select'     aria-invalid=\"false\" ><option value='No preference' >Bez preferencji<\/option><option value='Morning' >Rano<\/option><option value='Afternoon' >Popo\u0142udniu<\/option><option value='Evening' >Wieczorem<\/option><\/select><\/div><\/div><div id=\"field_2_11\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_11'>Imi\u0119 potencjalnego uczestnika:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_2_11' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_12\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_12'>Nazwisko potencjalnego uczestnika:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_2_12' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_13\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_13'>Kod pocztowy potencjalnego uczestnika:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_2_13' type='text' value='' class='large' maxlength='10'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_2_7\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Data urodzenia potencjalnego uczestnika:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div id='input_2_7' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_2_7_1_container'><label for='input_2_7_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Miesi\u0105c<\/label><select name='input_7[]' id='input_2_7_1'   aria-required='true'  ><option value=''>Miesi\u0105c<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_2_7_2_container'><label for='input_2_7_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Dzie\u0144<\/label><select name='input_7[]' id='input_2_7_2'   aria-required='true'  ><option value=''>Dzie\u0144<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_2_7_3_container'><label for='input_2_7_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Rok<\/label><select name='input_7[]' id='input_2_7_3'   aria-required='true'  ><option value=''>Rok<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/fieldset><fieldset id=\"field_2_15\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Czy u\u202fPana\/Pani lub u\u202fPana\/Pani bliskiej osoby rozpoznano pobudzenie w przebiegu ot\u0119pienia typu alzheimerowskiego?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_15'>\n\t\t\t<div class='gchoice gchoice_2_15_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='Tak'  id='choice_2_15_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_15_0' id='label_2_15_0' class='gform-field-label gform-field-label--type-inline'>Tak<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_15_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='Nie'  id='choice_2_15_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_15_1' id='label_2_15_1' class='gform-field-label gform-field-label--type-inline'>Nie<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_16\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Czy u\u202fPana\/Pani lub u\u202fPana\/Pani bliskiej osoby rozpoznano pobudzenie w przebiegu choroby Alzheimera?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_16'>\n\t\t\t<div class='gchoice gchoice_2_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Tak'  id='choice_2_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_16_0' id='label_2_16_0' class='gform-field-label gform-field-label--type-inline'>Tak<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Nie'  id='choice_2_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_16_1' id='label_2_16_1' class='gform-field-label gform-field-label--type-inline'>Nie<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_17\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Czy potencjalny uczestnik przyjmuje leki na demencj\u0119?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_17'>\n\t\t\t<div class='gchoice gchoice_2_17_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Tak'  id='choice_2_17_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_17_0' id='label_2_17_0' class='gform-field-label gform-field-label--type-inline'>Tak<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_17_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Nie'  id='choice_2_17_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_17_1' id='label_2_17_1' class='gform-field-label gform-field-label--type-inline'>Nie<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Czy przyjmowali Pa\u0144stwo ten sam lek i t\u0119 sam\u0105 dawk\u0119 przez ostatnie 3 miesi\u0105ce?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_18'>\n\t\t\t<div class='gchoice gchoice_2_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Tak'  id='choice_2_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_18_0' id='label_2_18_0' class='gform-field-label gform-field-label--type-inline'>Tak<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Nie'  id='choice_2_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_18_1' id='label_2_18_1' class='gform-field-label gform-field-label--type-inline'>Nie<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_9\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Zgoda na przysz\u0142e badania<\/legend><div class='ginput_container ginput_container_consent'><input name='input_9.1' id='input_2_9_1' type='checkbox' value='1'    aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_2_9_1' >Wyra\u017cam zgod\u0119 na kontakt w sprawie przysz\u0142ych bada\u0144.<\/label><input type='hidden' name='input_9.2' value='Wyra\u017cam zgod\u0119 na kontakt w sprawie przysz\u0142ych bada\u0144.' class='gform_hidden' \/><input type='hidden' name='input_9.3' value='2' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_2_10\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Polityka prywatno\u015bci<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_10.1' id='input_2_10_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_2_10_1' >Wyra\u017cam zgod\u0119 na <a href=\"\/pl\/privacy-policy\/\" target=\"_blank\">polityk\u0119 prywatno\u015bci<\/a> oraz wyra\u017cam zgod\u0119 na kontakt w sprawie tego badania przez telefon, SMS lub e-mail.<\/label><input type='hidden' name='input_10.2' value='Wyra\u017cam zgod\u0119 na &lt;a href=&quot;\/pl\/privacy-policy\/&quot; target=&quot;_blank&quot;&gt;polityk\u0119 prywatno\u015bci&lt;\/a&gt; oraz wyra\u017cam zgod\u0119 na kontakt w sprawie tego badania przez telefon, SMS lub e-mail.' class='gform_hidden' \/><input type='hidden' name='input_10.3' value='2' class='gform_hidden' \/><\/div><\/fieldset><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_2' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Wy\u015blij'  \/> <input type='hidden' name='gform_ajax' value='form_id=2&amp;title=&amp;description=1&amp;tabindex=0&amp;theme=gravity-theme&amp;styles=[]&amp;hash=c6e916b553e1de322e96204819d899e0' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_2' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_2' id='gform_theme_2' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_2' id='gform_style_settings_2' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_2' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='2' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='7KCG\/ETiWBGYZ1BJn37x+mDrFb7qwe8Pm\/rxG7t8S5KtaFwvet6RkgXQbNwBcdtlyU9KUXExmsfNUHF9gj0oTj6PBKKkNfYScZBsvyiCJX2ouN4=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_2' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_2' id='gform_target_page_number_2' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_2' id='gform_source_page_number_2' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div>\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_2' id='gform_ajax_frame_2' title='Ten element iframe zawiera logik\u0119 wymagan\u0105 do obs\u0142ugi Gravity Forms u\u017cywaj\u0105cych technologii Ajax.'><\/iframe>\n\t\t                <script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 2, 'https:\/\/agitation-study.com\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_2').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_2');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_2').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){form_content.find('form').css('opacity', 0);jQuery('#gform_wrapper_2').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_2').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_2').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_2').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_2').val();gformInitSpinner( 2, 'https:\/\/agitation-study.com\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [2, current_page]);window['gf_submitting_2'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_2').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_2').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [2]);window['gf_submitting_2'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_2').text());}else{jQuery('#gform_2').append(contents);if(window['gformRedirect']) 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