{"id":5470,"date":"2025-01-08T10:43:48","date_gmt":"2025-01-08T10:43:48","guid":{"rendered":"https:\/\/zerospike.org\/registration\/"},"modified":"2025-01-08T10:43:48","modified_gmt":"2025-01-08T10:43:48","slug":"registration","status":"publish","type":"page","link":"https:\/\/zerospike.org\/ja\/registration\/","title":{"rendered":"Registration"},"content":{"rendered":"<style><\/style><div class='rmformui'><div id='rm-form-container' class='rmform-design--matchmytheme-container'><form id='rmform-module-3' class='rmform-ui rmform-custom-form rmform-custom-form-3 rmform-design--matchmytheme' action='' method='post' enctype='multipart\/form-data'data-form-id='3' data-design='matchmytheme' data-style='two_columns' data-type='1' data-trp-original-action=\"\"><div class='rmform-page'><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-richtext-143' class='rmform-col rmform-col-12'><div class='rmform-field' data-field-id='143'><div class=\"rmform-control\" ><p><strong>INFORMAZIONI SULLA PERSONA CHE COMPILA IL MODULO<br \/><\/strong>Modulo compilato da medico\/genitore\/assistente sociale\/paziente<\/p><\/div><span class='rmform-error-message' id='rmform-richtext_143-error'><\/span><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-checkbox-148' class='rm-address-field-wrap rmform-col rmform-col-12'><div class='rmform-field' data-field-id='148'><span class=\"rmform-label\" > Ruolo<span class='rmform-req-symbol'>*<\/span><\/span><div class='rmform-field-vertical-row' data-field-col='1'><label class='rmform-check' for='checkbox_148_0'><input name=\"Checkbox_148[]\" class=\"rmform-control checkbox_148\" aria-describedby=\"rm-note-148\" type=\"checkbox\" onchange=\"rmToggleOtherText(this)\" required aria-required=\"true\" aria-labelledby=\"label_id_Checkbox_148_0\" id=\"checkbox_148_0\" value=\"Medico\"  ><span class='rmform-label rmform-radio-check' id='label_id_Checkbox_148_0'>Medico<\/span><\/label><label class='rmform-check' for='checkbox_148_1'><input name=\"Checkbox_148[]\" class=\"rmform-control checkbox_148\" aria-describedby=\"rm-note-148\" type=\"checkbox\" onchange=\"rmToggleOtherText(this)\" required aria-required=\"true\" aria-labelledby=\"label_id_Checkbox_148_1\" id=\"checkbox_148_1\" value=\"Genitore\"  ><span class='rmform-label rmform-radio-check' id='label_id_Checkbox_148_1'>Genitore<\/span><\/label><label class='rmform-check' for='checkbox_148_2'><input name=\"Checkbox_148[]\" class=\"rmform-control checkbox_148\" aria-describedby=\"rm-note-148\" type=\"checkbox\" onchange=\"rmToggleOtherText(this)\" required aria-required=\"true\" aria-labelledby=\"label_id_Checkbox_148_2\" id=\"checkbox_148_2\" value=\"Assistente Sociale\"  ><span class='rmform-label rmform-radio-check' id='label_id_Checkbox_148_2'>Assistente Sociale<\/span><\/label><label class='rmform-check' for='checkbox_148_3'><input name=\"Checkbox_148[]\" class=\"rmform-control checkbox_148\" aria-describedby=\"rm-note-148\" type=\"checkbox\" onchange=\"rmToggleOtherText(this)\" required aria-required=\"true\" aria-labelledby=\"label_id_Checkbox_148_3\" id=\"checkbox_148_3\" value=\"Paziente\"  ><span class='rmform-label rmform-radio-check' id='label_id_Checkbox_148_3'>Paziente<\/span><\/label><\/div><span class='rmform-error-message' id='rmform-checkbox_148-error'><\/span><div id='rm-note-148' class='rmform-note' style='display: none;'><\/div><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-username-14' class='rmform-col rmform-col-12'><div class='rmform-field' data-field-id='14'><label for=\"input_id_Username_14\" id=\"label_id_Username_14\" class=\"rmform-label\"  > Username<span class='rmform-req-symbol'>*<\/span> <\/label><input type=\"text\" name=\"username\" class=\"rmform-control\" aria-describedby=\"rm-note-14\" id=\"input_id_Username_14\" autocomplete=\"username\" aria-labelledby=\"label_id_Username_14\" placeholder=\"Inserire un nome utente a scelta\" required aria-required=\"true\"   ><span class='rmform-error-message' id='rmform-username-error'><\/span><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-userpassword-15' class='rmform-col rmform-col-12'><div class='rmform-field' data-field-id='15'><label for=\"input_id_UserPassword_15\" id=\"label_id_UserPassword_15\" class=\"rmform-label\" > Password<span class='rmform-req-symbol'>*<\/span> <\/label><div class='rmform-toggle-wrap'><span class='rm-togglePassword rm-pwd-togglePassword'><\/span><input type=\"password\" name=\"pwd\" class=\"rmform-control rm-pwd-control\" aria-describedby=\"rm-note-15\" id=\"input_id_UserPassword_15\" aria-labelledby=\"label_id_UserPassword_15\" required aria-required=\"true\" autocomplete=\"new-password\" placeholder=\"Imposta la tua password\"  ><\/div><span class='rmform-error-message' id='rmform-pwd-error'><\/span><div id='rm-note-15' class='rmform-note' style='display: none;'>La password deve essere di almeno 7 caratteri.<\/div><\/div><\/div><div id='rm-cnf-userpassword-15' class='rmform-col rmform-col-12'><div class='rmform-field' data-field-id='15'><label for=\"input_id_UserPassword_15_cnf\" id=\"label_id_UserPassword_15_cnf\" class=\"rmform-label\"  >Enter password again<span class='rmform-req-symbol'>*<\/span> <\/label><div class='rmform-c-toggle-wrap'><span class='rm-togglePassword'><\/span><input type=\"password\" name=\"password_confirmation\" class=\"rmform-control password_confirmation_15\" aria-describedby=\"rm-note-15\" id=\"input_id_UserPassword_15_cnf\" aria-labelledby=\"label_id_UserPassword_15_cnf\" required aria-required=\"true\" autocomplete=\"new-password\" placeholder=\"Repeat your password\"  ><\/div><span class='rmform-error-message' id='rmform-password_confirmation-error'><\/span><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-email-16' class='rmform-col rmform-col-12'><div class='rmform-field' data-field-id='16'><label for=\"input_id_Email_16\" id=\"label_id_Email_16\" class=\"rmform-label\"  >  \u30e1\u30fc\u30eb\u30a2\u30c9\u30ec\u30b9<span class='rmform-req-symbol'>*<\/span><\/label><input type=\"email\" name=\"Email_16\" class=\"rmform-control\" aria-describedby=\"rm-note-16\" id=\"input_id_Email_16\" data-fieldtype=\"Email\" aria-labelledby=\"label_id_Email_16\" value=\"\" placeholder=\"Il vostro indirizzo e-mail\" required data-primary=\"1\" aria-required=\"true\"  ><span class='rmform-error-message' id='rmform-email_16-error'><\/span><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-richtext-145' class='rmform-col rmform-col-12'><div class='rmform-field' data-field-id='145'><div class=\"rmform-control\" ><p><strong>INFORMAZIONI SUL PAZIENTE<\/strong><\/p><\/div><span class='rmform-error-message' id='rmform-richtext_145-error'><\/span><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-fname-144' class='rmform-col rmform-col-12'><div class='rmform-field' data-field-id='144'><label for=\"input_id_Fname_144\" id=\"label_id_Fname_144\" class=\"rmform-label\" > Nome<span class='rmform-req-symbol'>*<\/span><\/label><input type=\"text\" name=\"Fname_144\" class=\"rmform-control\" aria-describedby=\"rm-note-144\" id=\"input_id_Fname_144\" aria-labelledby=\"label_id_Fname_144\" value=\"\" placeholder=\"\" minlength=\"\" maxlength=\"\" required aria-required=\"true\"  ><span class='rmform-error-message' id='rmform-fname_144-error'><\/span><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-lname-18' class='rmform-col rmform-col-12'><div class='rmform-field' data-field-id='18'><label for=\"input_id_Lname_18\" id=\"label_id_Lname_18\" class=\"rmform-label\" > Cognome<span class='rmform-req-symbol'>*<\/span><\/label><input type=\"text\" name=\"Lname_18\" class=\"rmform-control\" aria-describedby=\"rm-note-18\" id=\"input_id_Lname_18\" aria-labelledby=\"label_id_Lname_18\" value=\"\" placeholder=\"\" minlength=\"\" maxlength=\"\" required aria-required=\"true\"  ><span class='rmform-error-message' id='rmform-lname_18-error'><\/span><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-bdate-19' class='rmform-col rmform-col-12'><div class='rmform-field' data-field-id='19'><label for=\"input_id_Bdate_19\" id=\"label_id_Bdate_19\" class=\"rmform-label\" > Data di Nascita<span class='rmform-req-symbol'>*<\/span><\/label><input type=\"text\" name=\"Bdate_19\" class=\"rmform-control bdaydatepicker\" aria-describedby=\"rm-note-19\" autocomplete=\"off\" readonly data-dateformat=\"mm\/dd\/yy\" aria-labelledby=\"label_id_Bdate_19\" id=\"input_id_Bdate_19\" required_max_range=\"04\/27\/2026\" required_min_range=\"\" placeholder=\"\" required aria-required=\"true\"  ><span class='rmform-error-message' id='rmform-bdate_19-error'><\/span><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-checkbox-139' class='rm-address-field-wrap rmform-col rmform-col-12'><div class='rmform-field' data-field-id='139'><span class=\"rmform-label\" > Genere<span class='rmform-req-symbol'>*<\/span><\/span><div class='rmform-field-vertical-row' data-field-col='1'><label class='rmform-check' for='checkbox_139_0'><input name=\"Checkbox_139[]\" class=\"rmform-control checkbox_139\" aria-describedby=\"rm-note-139\" type=\"checkbox\" onchange=\"rmToggleOtherText(this)\" required aria-required=\"true\" aria-labelledby=\"label_id_Checkbox_139_0\" id=\"checkbox_139_0\" value=\"Femminile\"  ><span class='rmform-label rmform-radio-check' id='label_id_Checkbox_139_0'>Femminile<\/span><\/label><label class='rmform-check' for='checkbox_139_1'><input name=\"Checkbox_139[]\" class=\"rmform-control checkbox_139\" aria-describedby=\"rm-note-139\" type=\"checkbox\" onchange=\"rmToggleOtherText(this)\" required aria-required=\"true\" aria-labelledby=\"label_id_Checkbox_139_1\" id=\"checkbox_139_1\" value=\"Maschio\"  ><span class='rmform-label rmform-radio-check' id='label_id_Checkbox_139_1'>Maschio<\/span><\/label><\/div><span class='rmform-error-message' id='rmform-checkbox_139-error'><\/span><div id='rm-note-139' class='rmform-note' style='display: none;'><\/div><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-jqueryuidate-21' class='rmform-col rmform-col-12'><div class='rmform-field' data-field-id='21'><label for=\"input_id_jQueryUIDate_21\" id=\"label_id_jQueryUIDate_21\" class=\"rmform-label\" > Data di inizio dell'integrazione con NAC aumentata<span class='rmform-req-symbol'>*<\/span><\/label><input type=\"text\" name=\"jQueryUIDate_21\" class=\"rmform-control datepicker\" aria-describedby=\"rm-note-21\" autocomplete=\"off\" readonly data-dateformat=\"mm\/dd\/yy\" data-fieldtype=\"jQueryUIDate\" aria-labelledby=\"label_id_jQueryUIDate_21\" id=\"input_id_jQueryUIDate_21\" placeholder=\"\" required aria-required=\"true\"  ><span class='rmform-error-message' id='rmform-jqueryuidate_21-error'><\/span><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-number-22' class='rmform-col rmform-col-12'><div class='rmform-field' data-field-id='22'><label for=\"input_id_Number_22\" id=\"label_id_Number_22\" class=\"rmform-label\" > Numero di capsule di NAC Aumentata al giorno<span class='rmform-req-symbol'>*<\/span><\/label><input type=\"number\" name=\"Number_22\" class=\"rmform-control\" aria-describedby=\"rm-note-22\" value=\"\" id=\"input_id_Number_22\" aria-labelledby=\"label_id_Number_22\" minlength=\"\" maxlength=\"\" placeholder=\"\" required aria-required=\"true\"  ><span class='rmform-error-message' id='rmform-number_22-error'><\/span><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-checkbox-23' class='rm-address-field-wrap rmform-col rmform-col-12'><div class='rmform-field' data-field-id='23'><span class=\"rmform-label\" > Diagnosi<span class='rmform-req-symbol'>*<\/span><\/span><div class='rmform-field-vertical-row' data-field-col='1'><label class='rmform-check' for='checkbox_23_0'><input name=\"Checkbox_23[]\" class=\"rmform-control checkbox_23\" aria-describedby=\"rm-note-23\" type=\"checkbox\" onchange=\"rmToggleOtherText(this)\" required aria-required=\"true\" aria-labelledby=\"label_id_Checkbox_23_0\" id=\"checkbox_23_0\" value=\"Covid\"  ><span class='rmform-label rmform-radio-check' id='label_id_Checkbox_23_0'>Covid<\/span><\/label><label class='rmform-check' for='checkbox_23_1'><input name=\"Checkbox_23[]\" class=\"rmform-control checkbox_23\" aria-describedby=\"rm-note-23\" type=\"checkbox\" onchange=\"rmToggleOtherText(this)\" required aria-required=\"true\" aria-labelledby=\"label_id_Checkbox_23_1\" id=\"checkbox_23_1\" value=\"Long Covid\"  ><span class='rmform-label rmform-radio-check' id='label_id_Checkbox_23_1'>Long Covid<\/span><\/label><label class='rmform-check' for='checkbox_23_2'><input name=\"Checkbox_23[]\" class=\"rmform-control checkbox_23\" aria-describedby=\"rm-note-23\" type=\"checkbox\" onchange=\"rmToggleOtherText(this)\" required aria-required=\"true\" aria-labelledby=\"label_id_Checkbox_23_2\" id=\"checkbox_23_2\" value=\"Ferito dal vaccino Covid\"  ><span class='rmform-label rmform-radio-check' id='label_id_Checkbox_23_2'>Ferito dal vaccino Covid<\/span><\/label><label class='rmform-check' for='checkbox_3'><input name=\"Checkbox_23[]\" class=\"rmform-control checkbox_23\" value=\"\" aria-describedby=\"rm-note-23\" aria-labelledby=\"label_id_Checkbox_23\" type=\"checkbox\" id=\"Checkbox_23_other\" onchange=\"rmToggleOtherText(this)\" required aria-required=\"true\" ><span class='rmform-label rmform-radio-check' id=\"label_id_23_3\" for=\"checkbox_23_2\"  >Altro<\/span><\/label><\/div><input name=\"Checkbox_23_other_input\" class=\"rmform-control checkbox_23\" aria-describedby=\"rm-note-23\" aria-labelledby=\"label_id_Checkbox_23\" type=\"text\" id=\"Checkbox_23_other_input\" style=\"display:none;\" disabled><span class='rmform-error-message' id='rmform-checkbox_23-error'><\/span><div id='rm-note-23' class='rmform-note' style='display: none;'><\/div><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-textbox-24' class='rmform-col rmform-col-12'><div class='rmform-field' data-field-id='24'><label for=\"input_id_Textbox_24\" id=\"label_id_Textbox_24\" class=\"rmform-label\" >  Farmaci<\/label><input type=\"text\" name=\"Textbox_24\" class=\"rmform-control\" aria-describedby=\"rm-note-24\" minlength=\"\" maxlength=\"\" value=\"\" id=\"input_id_Textbox_24\" aria-labelledby=\"label_id_Textbox_24\" placeholder=\"Indicare se si stanno assumendo farmaci\"  ><span class='rmform-error-message' id='rmform-textbox_24-error'><\/span><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-textbox-25' class='rmform-col rmform-col-12'><div class='rmform-field' data-field-id='25'><label for=\"input_id_Textbox_25\" id=\"label_id_Textbox_25\" class=\"rmform-label\" >  Altri integratori<\/label><input type=\"text\" name=\"Textbox_25\" class=\"rmform-control\" aria-describedby=\"rm-note-25\" minlength=\"\" maxlength=\"\" value=\"\" id=\"input_id_Textbox_25\" aria-labelledby=\"label_id_Textbox_25\" placeholder=\"Indicare se si stanno assumendo altri integratori\"  ><span class='rmform-error-message' id='rmform-textbox_25-error'><\/span><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-htmlp-26' class='rmform-col rmform-col-12'><div class='rmform-field' data-field-id='26'><p class=\"rmform-control\" >Elencare i sintomi e attribuire un punteggio da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave, partendo dal giorno zero fino al giorno 30. Inserendo il primo sintomo, appariranno altri campi da compilare.<\/p><span class='rmform-error-message' id='rmform-htmlp_26-error'><\/span><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-textbox-91' class='rmform-col rmform-col-12'><div class='rmform-field' data-field-id='91'><label for=\"input_id_Textbox_91\" id=\"label_id_Textbox_91\" class=\"rmform-label\" >  Sintomo 1<\/label><input type=\"text\" name=\"Textbox_91\" class=\"rmform-control\" aria-describedby=\"rm-note-91\" minlength=\"\" maxlength=\"\" value=\"\" id=\"input_id_Textbox_91\" aria-labelledby=\"label_id_Textbox_91\" placeholder=\"\"  ><span class='rmform-error-message' id='rmform-textbox_91-error'><\/span><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-number-88' class='rmform-col rmform-col-4'><div class='rmform-field' data-field-id='88'><label for=\"input_id_Number_88\" id=\"label_id_Number_88\" class=\"rmform-label\" > Giorno 0<\/label><input type=\"number\" name=\"Number_88\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-88\" value=\"\" id=\"input_id_Number_88\" aria-labelledby=\"label_id_Number_88\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_91\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_88-error'><\/span><div id='rm-note-88' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-30' class='rmform-col rmform-col-4'><div class='rmform-field' data-field-id='30'><label for=\"input_id_Number_30\" id=\"label_id_Number_30\" class=\"rmform-label\" > Giorno 3<\/label><input type=\"number\" name=\"Number_30\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-30\" value=\"\" id=\"input_id_Number_30\" aria-labelledby=\"label_id_Number_30\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_91\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_30-error'><\/span><div id='rm-note-30' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-36' class='rmform-col rmform-col-4'><div class='rmform-field' data-field-id='36'><label for=\"input_id_Number_36\" id=\"label_id_Number_36\" class=\"rmform-label\" > Giorno 7<\/label><input type=\"number\" name=\"Number_36\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-36\" value=\"\" id=\"input_id_Number_36\" aria-labelledby=\"label_id_Number_36\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_91\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_36-error'><\/span><div id='rm-note-36' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-number-32' class='rmform-col rmform-col-3'><div class='rmform-field' data-field-id='32'><label for=\"input_id_Number_32\" id=\"label_id_Number_32\" class=\"rmform-label\" > Giorno 10<\/label><input type=\"number\" name=\"Number_32\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-32\" value=\"\" id=\"input_id_Number_32\" aria-labelledby=\"label_id_Number_32\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_91\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_32-error'><\/span><div id='rm-note-32' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-33' class='rmform-col rmform-col-3'><div class='rmform-field' data-field-id='33'><label for=\"input_id_Number_33\" id=\"label_id_Number_33\" class=\"rmform-label\" > Giorno 15<\/label><input type=\"number\" name=\"Number_33\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-33\" value=\"\" id=\"input_id_Number_33\" aria-labelledby=\"label_id_Number_33\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_91\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_33-error'><\/span><div id='rm-note-33' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-34' class='rmform-col rmform-col-3'><div class='rmform-field' data-field-id='34'><label for=\"input_id_Number_34\" id=\"label_id_Number_34\" class=\"rmform-label\" > Giorno 21<\/label><input type=\"number\" name=\"Number_34\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-34\" value=\"\" id=\"input_id_Number_34\" aria-labelledby=\"label_id_Number_34\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_91\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_34-error'><\/span><div id='rm-note-34' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-35' class='rmform-col rmform-col-3'><div class='rmform-field' data-field-id='35'><label for=\"input_id_Number_35\" id=\"label_id_Number_35\" class=\"rmform-label\" > Giorno 30<\/label><input type=\"number\" name=\"Number_35\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-35\" value=\"\" id=\"input_id_Number_35\" aria-labelledby=\"label_id_Number_35\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_91\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_35-error'><\/span><div id='rm-note-35' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-textbox-41' class='rmform-col rmform-col-12'><div class='rmform-field' data-field-id='41'><label for=\"input_id_Textbox_41\" id=\"label_id_Textbox_41\" class=\"rmform-label\" >  Sintomo 2<\/label><input type=\"text\" name=\"Textbox_41\" class=\"rmform-control  data-conditional-revamp\" aria-describedby=\"rm-note-41\" minlength=\"\" maxlength=\"\" value=\"\" id=\"input_id_Textbox_41\" aria-labelledby=\"label_id_Textbox_41\" placeholder=\"\" data-cond-option=\"Textbox_91\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-textbox_41-error'><\/span><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-number-42' class='rmform-col rmform-col-4'><div class='rmform-field' data-field-id='42'><label for=\"input_id_Number_42\" id=\"label_id_Number_42\" class=\"rmform-label\" > Giorno 0<\/label><input type=\"number\" name=\"Number_42\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-42\" value=\"\" id=\"input_id_Number_42\" aria-labelledby=\"label_id_Number_42\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_41\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_42-error'><\/span><div id='rm-note-42' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-43' class='rmform-col rmform-col-4'><div class='rmform-field' data-field-id='43'><label for=\"input_id_Number_43\" id=\"label_id_Number_43\" class=\"rmform-label\" > Giorno 3<\/label><input type=\"number\" name=\"Number_43\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-43\" value=\"\" id=\"input_id_Number_43\" aria-labelledby=\"label_id_Number_43\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_41\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_43-error'><\/span><div id='rm-note-43' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-44' class='rmform-col rmform-col-4'><div class='rmform-field' data-field-id='44'><label for=\"input_id_Number_44\" id=\"label_id_Number_44\" class=\"rmform-label\" > Giorno 7<\/label><input type=\"number\" name=\"Number_44\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-44\" value=\"\" id=\"input_id_Number_44\" aria-labelledby=\"label_id_Number_44\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_41\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_44-error'><\/span><div id='rm-note-44' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-number-37' class='rmform-col rmform-col-3'><div class='rmform-field' data-field-id='37'><label for=\"input_id_Number_37\" id=\"label_id_Number_37\" class=\"rmform-label\" > Giorno 10<\/label><input type=\"number\" name=\"Number_37\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-37\" value=\"\" id=\"input_id_Number_37\" aria-labelledby=\"label_id_Number_37\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_41\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_37-error'><\/span><div id='rm-note-37' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-38' class='rmform-col rmform-col-3'><div class='rmform-field' data-field-id='38'><label for=\"input_id_Number_38\" id=\"label_id_Number_38\" class=\"rmform-label\" > Giorno 15<\/label><input type=\"number\" name=\"Number_38\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-38\" value=\"\" id=\"input_id_Number_38\" aria-labelledby=\"label_id_Number_38\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_41\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_38-error'><\/span><div id='rm-note-38' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-39' class='rmform-col rmform-col-3'><div class='rmform-field' data-field-id='39'><label for=\"input_id_Number_39\" id=\"label_id_Number_39\" class=\"rmform-label\" > Giorno 21<\/label><input type=\"number\" name=\"Number_39\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-39\" value=\"\" id=\"input_id_Number_39\" aria-labelledby=\"label_id_Number_39\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_41\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_39-error'><\/span><div id='rm-note-39' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-40' class='rmform-col rmform-col-3'><div class='rmform-field' data-field-id='40'><label for=\"input_id_Number_40\" id=\"label_id_Number_40\" class=\"rmform-label\" > Giorno 30<\/label><input type=\"number\" name=\"Number_40\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-40\" value=\"\" id=\"input_id_Number_40\" aria-labelledby=\"label_id_Number_40\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_41\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_40-error'><\/span><div id='rm-note-40' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-textbox-59' class='rmform-col rmform-col-12'><div class='rmform-field' data-field-id='59'><label for=\"input_id_Textbox_59\" id=\"label_id_Textbox_59\" class=\"rmform-label\" >  Sintomo 3<\/label><input type=\"text\" name=\"Textbox_59\" class=\"rmform-control  data-conditional-revamp\" aria-describedby=\"rm-note-59\" minlength=\"\" maxlength=\"\" value=\"\" id=\"input_id_Textbox_59\" aria-labelledby=\"label_id_Textbox_59\" placeholder=\"\" data-cond-option=\"Textbox_41\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-textbox_59-error'><\/span><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-number-60' class='rmform-col rmform-col-4'><div class='rmform-field' data-field-id='60'><label for=\"input_id_Number_60\" id=\"label_id_Number_60\" class=\"rmform-label\" > Giorno 0<\/label><input type=\"number\" name=\"Number_60\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-60\" value=\"\" id=\"input_id_Number_60\" aria-labelledby=\"label_id_Number_60\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_59\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_60-error'><\/span><div id='rm-note-60' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-61' class='rmform-col rmform-col-4'><div class='rmform-field' data-field-id='61'><label for=\"input_id_Number_61\" id=\"label_id_Number_61\" class=\"rmform-label\" > Giorno 3<\/label><input type=\"number\" name=\"Number_61\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-61\" value=\"\" id=\"input_id_Number_61\" aria-labelledby=\"label_id_Number_61\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_59\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_61-error'><\/span><div id='rm-note-61' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-62' class='rmform-col rmform-col-4'><div class='rmform-field' data-field-id='62'><label for=\"input_id_Number_62\" id=\"label_id_Number_62\" class=\"rmform-label\" > Giorno 7<\/label><input type=\"number\" name=\"Number_62\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-62\" value=\"\" id=\"input_id_Number_62\" aria-labelledby=\"label_id_Number_62\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_59\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_62-error'><\/span><div id='rm-note-62' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-number-63' class='rmform-col rmform-col-3'><div class='rmform-field' data-field-id='63'><label for=\"input_id_Number_63\" id=\"label_id_Number_63\" class=\"rmform-label\" > Giorno 10<\/label><input type=\"number\" name=\"Number_63\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-63\" value=\"\" id=\"input_id_Number_63\" aria-labelledby=\"label_id_Number_63\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_59\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_63-error'><\/span><div id='rm-note-63' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-64' class='rmform-col rmform-col-3'><div class='rmform-field' data-field-id='64'><label for=\"input_id_Number_64\" id=\"label_id_Number_64\" class=\"rmform-label\" > Giorno 15<\/label><input type=\"number\" name=\"Number_64\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-64\" value=\"\" id=\"input_id_Number_64\" aria-labelledby=\"label_id_Number_64\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_59\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_64-error'><\/span><div id='rm-note-64' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-65' class='rmform-col rmform-col-3'><div class='rmform-field' data-field-id='65'><label for=\"input_id_Number_65\" id=\"label_id_Number_65\" class=\"rmform-label\" > Giorno 21<\/label><input type=\"number\" name=\"Number_65\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-65\" value=\"\" id=\"input_id_Number_65\" aria-labelledby=\"label_id_Number_65\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_59\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_65-error'><\/span><div id='rm-note-65' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-66' class='rmform-col rmform-col-3'><div class='rmform-field' data-field-id='66'><label for=\"input_id_Number_66\" id=\"label_id_Number_66\" class=\"rmform-label\" > Giorno 30<\/label><input type=\"number\" name=\"Number_66\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-66\" value=\"\" id=\"input_id_Number_66\" aria-labelledby=\"label_id_Number_66\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_59\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_66-error'><\/span><div id='rm-note-66' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-textbox-94' class='rmform-col rmform-col-12'><div class='rmform-field' data-field-id='94'><label for=\"input_id_Textbox_94\" id=\"label_id_Textbox_94\" class=\"rmform-label\" >  Sintomo 4<\/label><input type=\"text\" name=\"Textbox_94\" class=\"rmform-control  data-conditional-revamp\" aria-describedby=\"rm-note-94\" minlength=\"\" maxlength=\"\" value=\"\" id=\"input_id_Textbox_94\" aria-labelledby=\"label_id_Textbox_94\" placeholder=\"\" data-cond-option=\"Textbox_59\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-textbox_94-error'><\/span><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-number-95' class='rmform-col rmform-col-4'><div class='rmform-field' data-field-id='95'><label for=\"input_id_Number_95\" id=\"label_id_Number_95\" class=\"rmform-label\" > Giorno 0<\/label><input type=\"number\" name=\"Number_95\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-95\" value=\"\" id=\"input_id_Number_95\" aria-labelledby=\"label_id_Number_95\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_94\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_95-error'><\/span><div id='rm-note-95' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-96' class='rmform-col rmform-col-4'><div class='rmform-field' data-field-id='96'><label for=\"input_id_Number_96\" id=\"label_id_Number_96\" class=\"rmform-label\" > Giorno 3<\/label><input type=\"number\" name=\"Number_96\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-96\" value=\"\" id=\"input_id_Number_96\" aria-labelledby=\"label_id_Number_96\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_94\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_96-error'><\/span><div id='rm-note-96' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-97' class='rmform-col rmform-col-4'><div class='rmform-field' data-field-id='97'><label for=\"input_id_Number_97\" id=\"label_id_Number_97\" class=\"rmform-label\" > Giorno 7<\/label><input type=\"number\" name=\"Number_97\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-97\" value=\"\" id=\"input_id_Number_97\" aria-labelledby=\"label_id_Number_97\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_94\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_97-error'><\/span><div id='rm-note-97' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-number-98' class='rmform-col rmform-col-3'><div class='rmform-field' data-field-id='98'><label for=\"input_id_Number_98\" id=\"label_id_Number_98\" class=\"rmform-label\" > Giorno 10<\/label><input type=\"number\" name=\"Number_98\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-98\" value=\"\" id=\"input_id_Number_98\" aria-labelledby=\"label_id_Number_98\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_94\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_98-error'><\/span><div id='rm-note-98' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-99' class='rmform-col rmform-col-3'><div class='rmform-field' data-field-id='99'><label for=\"input_id_Number_99\" id=\"label_id_Number_99\" class=\"rmform-label\" > Giorno 15<\/label><input type=\"number\" name=\"Number_99\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-99\" value=\"\" id=\"input_id_Number_99\" aria-labelledby=\"label_id_Number_99\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_94\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_99-error'><\/span><div id='rm-note-99' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-100' class='rmform-col rmform-col-3'><div class='rmform-field' data-field-id='100'><label for=\"input_id_Number_100\" id=\"label_id_Number_100\" class=\"rmform-label\" > Giorno 21<\/label><input type=\"number\" name=\"Number_100\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-100\" value=\"\" id=\"input_id_Number_100\" aria-labelledby=\"label_id_Number_100\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_94\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_100-error'><\/span><div id='rm-note-100' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-101' class='rmform-col rmform-col-3'><div class='rmform-field' data-field-id='101'><label for=\"input_id_Number_101\" id=\"label_id_Number_101\" class=\"rmform-label\" > Giorno 30<\/label><input type=\"number\" name=\"Number_101\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-101\" value=\"\" id=\"input_id_Number_101\" aria-labelledby=\"label_id_Number_101\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_94\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_101-error'><\/span><div id='rm-note-101' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-textbox-137' class='rmform-col rmform-col-12'><div class='rmform-field' data-field-id='137'><label for=\"input_id_Textbox_137\" id=\"label_id_Textbox_137\" class=\"rmform-label\" >  Sintomo 5<\/label><input type=\"text\" name=\"Textbox_137\" class=\"rmform-control  data-conditional-revamp\" aria-describedby=\"rm-note-137\" minlength=\"\" maxlength=\"\" value=\"\" id=\"input_id_Textbox_137\" aria-labelledby=\"label_id_Textbox_137\" placeholder=\"\" data-cond-option=\"Textbox_94\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-textbox_137-error'><\/span><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-number-134' class='rmform-col rmform-col-4'><div class='rmform-field' data-field-id='134'><label for=\"input_id_Number_134\" id=\"label_id_Number_134\" class=\"rmform-label\" > Giorno 0<\/label><input type=\"number\" name=\"Number_134\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-134\" value=\"\" id=\"input_id_Number_134\" aria-labelledby=\"label_id_Number_134\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_137\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_134-error'><\/span><div id='rm-note-134' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-135' class='rmform-col rmform-col-4'><div class='rmform-field' data-field-id='135'><label for=\"input_id_Number_135\" id=\"label_id_Number_135\" class=\"rmform-label\" > Giorno 3<\/label><input type=\"number\" name=\"Number_135\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-135\" value=\"\" id=\"input_id_Number_135\" aria-labelledby=\"label_id_Number_135\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_137\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_135-error'><\/span><div id='rm-note-135' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-136' class='rmform-col rmform-col-4'><div class='rmform-field' data-field-id='136'><label for=\"input_id_Number_136\" id=\"label_id_Number_136\" class=\"rmform-label\" > Giorno 7<\/label><input type=\"number\" name=\"Number_136\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-136\" value=\"\" id=\"input_id_Number_136\" aria-labelledby=\"label_id_Number_136\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_137\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_136-error'><\/span><div id='rm-note-136' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-number-106' class='rmform-col rmform-col-3'><div class='rmform-field' data-field-id='106'><label for=\"input_id_Number_106\" id=\"label_id_Number_106\" class=\"rmform-label\" > Giorno 10<\/label><input type=\"number\" name=\"Number_106\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-106\" value=\"\" id=\"input_id_Number_106\" aria-labelledby=\"label_id_Number_106\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_137\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_106-error'><\/span><div id='rm-note-106' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-107' class='rmform-col rmform-col-3'><div class='rmform-field' data-field-id='107'><label for=\"input_id_Number_107\" id=\"label_id_Number_107\" class=\"rmform-label\" > Giorno 15<\/label><input type=\"number\" name=\"Number_107\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-107\" value=\"\" id=\"input_id_Number_107\" aria-labelledby=\"label_id_Number_107\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_137\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_107-error'><\/span><div id='rm-note-107' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-108' class='rmform-col rmform-col-3'><div class='rmform-field' data-field-id='108'><label for=\"input_id_Number_108\" id=\"label_id_Number_108\" class=\"rmform-label\" > Giorno 21<\/label><input type=\"number\" name=\"Number_108\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-108\" value=\"\" id=\"input_id_Number_108\" aria-labelledby=\"label_id_Number_108\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_137\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_108-error'><\/span><div id='rm-note-108' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><div id='rm-number-109' class='rmform-col rmform-col-3'><div class='rmform-field' data-field-id='109'><label for=\"input_id_Number_109\" id=\"label_id_Number_109\" class=\"rmform-label\" > Giorno 30<\/label><input type=\"number\" name=\"Number_109\" class=\"rmform-control day data-conditional-revamp\" aria-describedby=\"rm-note-109\" value=\"\" id=\"input_id_Number_109\" aria-labelledby=\"label_id_Number_109\" minlength=\"\" maxlength=\"\" placeholder=\"\" data-cond-option=\"Textbox_137\" data-cond-value=\"\" data-cond-operator=\"_not_blank\" data-cond-action=\"show\"  ><span class='rmform-error-message' id='rmform-number_109-error'><\/span><div id='rm-note-109' class='rmform-note' style='display: none;'>Assegnare un punteggio ai sintomi da 0 a 5, dove 0 \u00e8 asintomatico e 5 \u00e8 molto grave.<\/div><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-textarea-56' class='rmform-col rmform-col-12'><div class='rmform-field' data-field-id='56'><label for=\"input_id_Textarea_56\" id=\"label_id_Textarea_56\" class=\"rmform-label\" > Commenti<\/label><textarea name=\"Textarea_56\" class=\"rmform-control\" aria-describedby=\"rm-note-56\" minlength=\"\" maxlength=\"\" cols=\"\" rows=\"\" id=\"input_id_Textarea_56\" placeholder=\"\"  ><\/textarea><span class='rmform-error-message' id='rmform-textarea_56-error'><\/span><\/div><\/div><\/div><\/div><div class='rmform-row'><div class='rmform-row-field-wrap'  style='--rm-field-gutter: 10px;'><div id='rm-privacy-155' class='rm-address-field-wrap rmform-col rmform-col-12'><div class='rmform-field' data-field-id='155'><div class='rmform-privicy-wrap'><input type=\"checkbox\" name=\"Privacy_155\" class=\"rmform-control privacy_155\" aria-describedby=\"rm-note-155\" id=\"input_id_Privacy_155\" value=\"on\" aria-labelledby=\"label_id_Privacy_155\" required aria-required=\"true\" placeholder=\"\"  ><label for=\"input_id_Privacy_155\" id=\"label_id_Privacy_155\" class=\"rmform-label\" > <p>Inviando questo modulo confermate di aver letto e compreso la nostra <a target='_blank' href='https:\/\/zerospike.org\/ja\/privacy-policy-consent\/'>Privacy Policy<\/a>.<\/p> <\/label><\/div><span class='rmform-error-message' id='rmform-privacy_155-error'><\/span><\/div><\/div><\/div><\/div><\/div><div id='rm-last-fields'><input type='hidden' name='paid_role3' id='paid_role_3_1' data-rmdefrole='Patient' data-rmcustomroles='{\"Patient\":{\"is_paid\":false,\"amount\":null},\"Dr. Peers Institute L.L.C\":{\"is_paid\":false,\"amount\":\"\"}}' data-rmfieldtype='price' data-rmfieldprice='' value=''><input type='hidden' name='form_id' value='3'><input type='hidden' name='form_no' value='1'><input type='hidden' name='rm_cond_hidden_fields' id='rm_cond_hidden_fields' value=''><input type='hidden' name='stat_id' value='7476'><div id='rm_form_payment_selector' class='rmform-payment-selector'><label class='rmform-label'>Select a payment method<sup class='required'>&nbsp;*<\/sup><\/label><div class='rm_payment_options'><div class='rmform-payment-option'><input type='radio' id='rm_gateway_paypal' value='paypal' name='rm_payment_method'><label for='rm_gateway_paypal'><img src='https:\/\/zerospike.org\/wp-content\/plugins\/custom-registration-form-builder-with-submission-manager\/images\/\/paypal-logo.png'><\/img><\/label><\/div><div class='rmform-payment-option'><input type='radio' id='rm_gateway_stripe' value='stripe' name='rm_payment_method' checked><label for='rm_gateway_stripe'><img src='https:\/\/zerospike.org\/wp-content\/plugins\/custom-registration-form-builder-with-submission-manager\/images\/\/stripe-logo.png'><\/img><\/label><\/div><\/div><\/div><\/div><div id='rm_form_submit_button' class='rm-form-btn-align-right'><input type='submit' id='rm-form-submit-btn' value='\u9001\u4fe1'><\/div><input type=\"hidden\" name=\"trp-form-language\" value=\"ja\"\/><\/form><\/div><\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_eb_attr":"","_price":"","_stock":"","_tribe_ticket_header":"","_tribe_default_ticket_provider":"","_tribe_ticket_capacity":"","_ticket_start_date":"","_ticket_end_date":"","_tribe_ticket_show_description":"","_tribe_ticket_show_not_going":false,"_tribe_ticket_use_global_stock":"","_tribe_ticket_global_stock_level":"","_global_stock_mode":"","_global_stock_cap":"","_tribe_rsvp_for_event":"","_tribe_ticket_going_count":"","_tribe_ticket_not_going_count":"","_tribe_tickets_list":"[]","_tribe_ticket_has_attendee_info_fields":false,"inspiro_hide_title":false,"footnotes":""},"class_list":["post-5470","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/zerospike.org\/ja\/wp-json\/wp\/v2\/pages\/5470","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/zerospike.org\/ja\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/zerospike.org\/ja\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/zerospike.org\/ja\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/zerospike.org\/ja\/wp-json\/wp\/v2\/comments?post=5470"}],"version-history":[{"count":0,"href":"https:\/\/zerospike.org\/ja\/wp-json\/wp\/v2\/pages\/5470\/revisions"}],"wp:attachment":[{"href":"https:\/\/zerospike.org\/ja\/wp-json\/wp\/v2\/media?parent=5470"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}