{"id":3884,"date":"2022-02-16T22:34:13","date_gmt":"2022-02-16T22:34:13","guid":{"rendered":"https:\/\/phaxis.com\/?page_id=3884"},"modified":"2022-09-07T19:39:33","modified_gmt":"2022-09-07T19:39:33","slug":"telemetry-progressive-care-unit-rn-skills-checklist","status":"publish","type":"page","link":"https:\/\/phaxis.com\/travel-healthcare\/skills-checklist\/telemetry-progressive-care-unit-rn-skills-checklist\/","title":{"rendered":"Telemetry \/ Progressive Care Unit RN Skills Checklist"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"3884\" class=\"elementor elementor-3884\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t\t\t\t<section class=\"has_ma_el_bg_slider elementor-section elementor-inner-section elementor-element elementor-element-3afd1545 elementor-section-height-min-height elementor-section-boxed elementor-section-height-default jltma-glass-effect-no\" data-id=\"3afd1545\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_ma_el_bg_slider elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-f8852f jltma-glass-effect-no\" data-id=\"f8852f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_ma_el_bg_slider elementor-section elementor-top-section elementor-element elementor-element-76e95493 elementor-section-height-min-height elementor-section-items-stretch elementor-section-full_width elementor-section-height-default jltma-glass-effect-no\" data-id=\"76e95493\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_ma_el_bg_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-218c8d64 jltma-glass-effect-no\" data-id=\"218c8d64\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<section class=\"has_ma_el_bg_slider elementor-section elementor-inner-section elementor-element elementor-element-69d53fd7 elementor-section-full_width elementor-section-content-top elementor-section-height-default elementor-section-height-default jltma-glass-effect-no\" data-id=\"69d53fd7\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_ma_el_bg_slider elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-7707419c jltma-glass-effect-no\" data-id=\"7707419c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_ma_el_bg_slider elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-4e1cfaa6 jltma-glass-effect-no\" data-id=\"4e1cfaa6\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7561edcc jltma-glass-effect-no elementor-widget elementor-widget-heading\" data-id=\"7561edcc\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.17.0 - 08-11-2023 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h2 class=\"elementor-heading-title elementor-size-default\">Telemetry \/ Progressive Care Unit RN Skills Checklist<\/h2>\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<div class=\"has_ma_el_bg_slider elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-b3cddad jltma-glass-effect-no\" data-id=\"b3cddad\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-794b8370 elementor-view-default jltma-glass-effect-no elementor-widget elementor-widget-icon\" data-id=\"794b8370\" data-element_type=\"widget\" data-widget_type=\"icon.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-icon-wrapper\">\n\t\t\t<a class=\"elementor-icon\" href=\"#elementor-action%3Aaction%3Dpopup%3Aopen%26settings%3DeyJpZCI6IjUxNiIsInRvZ2dsZSI6ZmFsc2V9\">\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" width=\"27\" height=\"20\" viewBox=\"0 0 27 20\"><g id=\"Group_2\" data-name=\"Group 2\" transform=\"translate(-1840 -60)\"><g id=\"Group_1\" data-name=\"Group 1\"><image id=\"Menu\" width=\"27\" height=\"20\" transform=\"translate(1840 60)\" xlink:href=\"data:image\/png;base64,iVBORw0KGgoAAAANSUhEUgAAABsAAAAUCAYAAAB8gkaAAAAABHNCSVQICAgIfAhkiAAAAJNJREFUSEtj\/P\/\/\/2EGBgYbIKY1OMIItOwt0BYhWtsENP8dyDIVIEOHDpZdAVlGB3sgVoxaRpWgpnsw8gOdrUgVp+M35D7IZ\/eBahToYNkDkGW3gBap0sGy2yDLuKCWMdLQQlBmBltGQztQjR61jCpBTfdgBFUvJlRxOn5DzoB89hGoho8Oln0CWbYNaJEnHSzbDgAo1kxSPzU7mgAAAABJRU5ErkJggg==\"><\/image><\/g><\/g><\/svg>\t\t\t<\/a>\n\t\t<\/div>\n\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\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_ma_el_bg_slider elementor-section elementor-top-section elementor-element elementor-element-18a735c elementor-section-boxed elementor-section-height-default elementor-section-height-default jltma-glass-effect-no\" data-id=\"18a735c\" data-element_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=\"has_ma_el_bg_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-aa57110 jltma-glass-effect-no\" data-id=\"aa57110\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<section class=\"has_ma_el_bg_slider elementor-section elementor-inner-section elementor-element elementor-element-a5e135c elementor-section-boxed elementor-section-height-default elementor-section-height-default jltma-glass-effect-no\" data-id=\"a5e135c\" data-element_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=\"has_ma_el_bg_slider elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-6575745 jltma-glass-effect-no\" data-id=\"6575745\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-09a385b jltma-glass-effect-no elementor-widget elementor-widget-heading\" data-id=\"09a385b\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Telemetry \/ Progressive Care Unit RN Skills Checklist<\/h1>\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<div class=\"has_ma_el_bg_slider elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-0e502eb jltma-glass-effect-no\" data-id=\"0e502eb\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-9df5989 elementor-align-right jltma-glass-effect-no elementor-widget elementor-widget-button\" data-id=\"9df5989\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm elementor-animation-grow\" href=\"\/skills-checklist\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-icon elementor-align-icon-left\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"remixicon ri-arrow-left-s-fill\"><\/i>\t\t\t<\/span>\n\t\t\t\t\t\t<span class=\"elementor-button-text\">Back to Skills Checklist Main<\/span>\n\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t<\/div>\n\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\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<div class=\"elementor-element elementor-element-bf35aea jltma-glass-effect-no elementor-widget elementor-widget-text-editor\" data-id=\"bf35aea\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.17.0 - 08-11-2023 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<p>Please rate your experience \/ frequency (within the last year) using the following scale (check the appropriate boxes below):<\/p><ul><li>0 = No Experience \/ Observed Only<\/li><li>1 = Limited Experience \/ Rarely Done (&lt;6 times\/year)<\/li><li>2 = May Need Some Review \/ Occasionally Done (1 &#8211; 2 times\/month)<\/li><li>3 = Experienced \/ Frequently Done (daily or weekly)<\/li><\/ul>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0595d97 jltma-glass-effect-no elementor-widget elementor-widget-shortcode\" data-id=\"0595d97\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\"><script type=\"text\/javascript\">var 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e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_chrome gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_10' ><div id='gf_10' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_10' id='gform_10'  action='\/wp-json\/wp\/v2\/pages\/3884#gf_10' data-formid='10' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LdLS5EpAAAAAO0o7fTdC6pgFHgLhNboc1UfgiHJ' data-tabindex='0'><input id=\"input_018af4b388ab9bbae95ab87f7e462dc7\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_018af4b388ab9bbae95ab87f7e462dc7\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><ul id='gform_fields_10' class='gform_fields left_label form_sublabel_below description_below'><li id=\"field_10_369\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_369\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_369'>\n                            \n                            <span id='input_10_369_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_369.3' id='input_10_369_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_10_369_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_369_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_369.6' id='input_10_369_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_10_369_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_10_370\"  class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_370\"><label class='gfield_label gform-field-label' for='input_10_370' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_370' id='input_10_370' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_10_374\"  class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_374\"><label class='gfield_label gform-field-label' for='input_10_374' >Recruiter&#039;s Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_374' id='input_10_374' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Bibha Adhikari' >Bibha Adhikari<\/option><option value='Bobby Lutz' >Bobby Lutz<\/option><option value='Brad Donathan' >Brad Donathan<\/option><option value='Bradley Kurtz' >Bradley Kurtz<\/option><option value='Brian Wright' >Brian Wright<\/option><option value='Kaitlin Bockhaus' >Kaitlin Bockhaus<\/option><option value='Kalie DeFillippo' >Kalie DeFillippo<\/option><option value='Kylie Estridge' >Kylie Estridge<\/option><option value='Lauren Courtney' >Lauren Courtney<\/option><option value='Taylor Cunningham' >Taylor Cunningham<\/option><option value='Tripp Mann' >Tripp Mann<\/option><option value='Tyrell Davenport' >Tyrell Davenport<\/option><option value='Whitney Fields' >Whitney Fields<\/option><\/select><\/div><\/li><li id=\"field_10_305\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_305\"><h2 class=\"gsection_title\">TYPE OF FACILITY EXPERIENCE<\/h2><\/li><li id=\"field_10_304\"  class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_inline checklist_input_line field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_304\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >TYPE OF FACILITY EXPERIENCE<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_10_304'><li class='gchoice gchoice_10_304_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_304.1' type='checkbox'  value='Acute Hospital Level 1'  id='choice_10_304_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_304_1' id='label_10_304_1' class='gform-field-label gform-field-label--type-inline'>Acute Hospital Level 1<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_304_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_304.2' type='checkbox'  value='Acute Hospital Level 2'  id='choice_10_304_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_304_2' id='label_10_304_2' class='gform-field-label gform-field-label--type-inline'>Acute Hospital Level 2<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_304_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_304.3' type='checkbox'  value='Acute Hospital Level 3'  id='choice_10_304_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_304_3' id='label_10_304_3' class='gform-field-label gform-field-label--type-inline'>Acute Hospital Level 3<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_304_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_304.4' type='checkbox'  value='CAH (Critical Access Hospital)'  id='choice_10_304_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_304_4' id='label_10_304_4' class='gform-field-label gform-field-label--type-inline'>CAH (Critical Access Hospital)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_304_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_304.5' type='checkbox'  value='Unknown or No Trauma Designation'  id='choice_10_304_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_304_5' id='label_10_304_5' class='gform-field-label gform-field-label--type-inline'>Unknown or No Trauma Designation<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_304_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_304.6' type='checkbox'  value='Long-Term Acute Care (LTAC)'  id='choice_10_304_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_304_6' id='label_10_304_6' class='gform-field-label gform-field-label--type-inline'>Long-Term Acute Care (LTAC)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_304_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_304.7' type='checkbox'  value='Rehab'  id='choice_10_304_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_304_7' id='label_10_304_7' class='gform-field-label gform-field-label--type-inline'>Rehab<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_304_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_304.8' type='checkbox'  value='Skilled Nursing Facility (SNF)'  id='choice_10_304_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_304_8' id='label_10_304_8' class='gform-field-label gform-field-label--type-inline'>Skilled Nursing Facility (SNF)<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_7\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_7\"><h2 class=\"gsection_title\">AGE OF PATIENTS CARED FOR<\/h2><\/li><li id=\"field_10_8\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_8\"><label class='gfield_label gform-field-label'  >Newborn\/Neonate (birth to 30 days)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_8'>\n\t\t\t<li class='gchoice gchoice_10_8_0'>\n\t\t\t\t<input name='input_8' type='radio' value='0'  id='choice_10_8_0'    \/>\n\t\t\t\t<label for='choice_10_8_0' id='label_10_8_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_8_1'>\n\t\t\t\t<input name='input_8' type='radio' value='1'  id='choice_10_8_1'    \/>\n\t\t\t\t<label for='choice_10_8_1' id='label_10_8_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_8_2'>\n\t\t\t\t<input name='input_8' type='radio' value='2'  id='choice_10_8_2'    \/>\n\t\t\t\t<label for='choice_10_8_2' id='label_10_8_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_8_3'>\n\t\t\t\t<input name='input_8' type='radio' value='3'  id='choice_10_8_3'    \/>\n\t\t\t\t<label for='choice_10_8_3' id='label_10_8_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_9\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_9\"><label class='gfield_label gform-field-label'  >Infant (31 days to 12 months)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_9'>\n\t\t\t<li class='gchoice gchoice_10_9_0'>\n\t\t\t\t<input name='input_9' type='radio' value='0'  id='choice_10_9_0'    \/>\n\t\t\t\t<label for='choice_10_9_0' id='label_10_9_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_9_1'>\n\t\t\t\t<input name='input_9' type='radio' value='1'  id='choice_10_9_1'    \/>\n\t\t\t\t<label for='choice_10_9_1' id='label_10_9_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_9_2'>\n\t\t\t\t<input name='input_9' type='radio' value='2'  id='choice_10_9_2'    \/>\n\t\t\t\t<label for='choice_10_9_2' id='label_10_9_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_9_3'>\n\t\t\t\t<input name='input_9' type='radio' value='3'  id='choice_10_9_3'    \/>\n\t\t\t\t<label for='choice_10_9_3' id='label_10_9_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_10\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_10\"><label class='gfield_label gform-field-label'  >Toddler\/Preschool (13 months to 5 years)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_10'>\n\t\t\t<li class='gchoice gchoice_10_10_0'>\n\t\t\t\t<input name='input_10' type='radio' value='0'  id='choice_10_10_0'    \/>\n\t\t\t\t<label for='choice_10_10_0' id='label_10_10_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_10_1'>\n\t\t\t\t<input name='input_10' type='radio' value='1'  id='choice_10_10_1'    \/>\n\t\t\t\t<label for='choice_10_10_1' id='label_10_10_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_10_2'>\n\t\t\t\t<input name='input_10' type='radio' value='2'  id='choice_10_10_2'    \/>\n\t\t\t\t<label for='choice_10_10_2' id='label_10_10_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_10_3'>\n\t\t\t\t<input name='input_10' type='radio' value='3'  id='choice_10_10_3'    \/>\n\t\t\t\t<label for='choice_10_10_3' id='label_10_10_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_11\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_11\"><label class='gfield_label gform-field-label'  >School Age Child\/adolescent (6 years to 18 years)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_11'>\n\t\t\t<li class='gchoice gchoice_10_11_0'>\n\t\t\t\t<input name='input_11' type='radio' value='0'  id='choice_10_11_0'    \/>\n\t\t\t\t<label for='choice_10_11_0' id='label_10_11_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_11_1'>\n\t\t\t\t<input name='input_11' type='radio' value='1'  id='choice_10_11_1'    \/>\n\t\t\t\t<label for='choice_10_11_1' id='label_10_11_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_11_2'>\n\t\t\t\t<input name='input_11' type='radio' value='2'  id='choice_10_11_2'    \/>\n\t\t\t\t<label for='choice_10_11_2' id='label_10_11_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_11_3'>\n\t\t\t\t<input name='input_11' type='radio' value='3'  id='choice_10_11_3'    \/>\n\t\t\t\t<label for='choice_10_11_3' id='label_10_11_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_12\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_12\"><label class='gfield_label gform-field-label'  >Young Adults\/ Middle Adult (19 years to 64 years)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_12'>\n\t\t\t<li class='gchoice gchoice_10_12_0'>\n\t\t\t\t<input name='input_12' type='radio' value='0'  id='choice_10_12_0'    \/>\n\t\t\t\t<label for='choice_10_12_0' id='label_10_12_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_12_1'>\n\t\t\t\t<input name='input_12' type='radio' value='1'  id='choice_10_12_1'    \/>\n\t\t\t\t<label for='choice_10_12_1' id='label_10_12_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_12_2'>\n\t\t\t\t<input name='input_12' type='radio' value='2'  id='choice_10_12_2'    \/>\n\t\t\t\t<label for='choice_10_12_2' id='label_10_12_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_12_3'>\n\t\t\t\t<input name='input_12' type='radio' value='3'  id='choice_10_12_3'    \/>\n\t\t\t\t<label for='choice_10_12_3' id='label_10_12_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_13\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_13\"><label class='gfield_label gform-field-label'  >Older Adults\/Elderly (65+ years)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_13'>\n\t\t\t<li class='gchoice gchoice_10_13_0'>\n\t\t\t\t<input name='input_13' type='radio' value='0'  id='choice_10_13_0'    \/>\n\t\t\t\t<label for='choice_10_13_0' id='label_10_13_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_13_1'>\n\t\t\t\t<input name='input_13' type='radio' value='1'  id='choice_10_13_1'    \/>\n\t\t\t\t<label for='choice_10_13_1' id='label_10_13_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_13_2'>\n\t\t\t\t<input name='input_13' type='radio' value='2'  id='choice_10_13_2'    \/>\n\t\t\t\t<label for='choice_10_13_2' id='label_10_13_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_13_3'>\n\t\t\t\t<input name='input_13' type='radio' value='3'  id='choice_10_13_3'    \/>\n\t\t\t\t<label for='choice_10_13_3' id='label_10_13_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_14\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_14\"><h2 class=\"gsection_title\">GENERAL SKILLS<\/h2><\/li><li id=\"field_10_15\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_15\"><label class='gfield_label gform-field-label'  >Care of Patient in Restraints<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_15'>\n\t\t\t<li class='gchoice gchoice_10_15_0'>\n\t\t\t\t<input name='input_15' type='radio' value='0'  id='choice_10_15_0'    \/>\n\t\t\t\t<label for='choice_10_15_0' id='label_10_15_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_15_1'>\n\t\t\t\t<input name='input_15' type='radio' value='1'  id='choice_10_15_1'    \/>\n\t\t\t\t<label for='choice_10_15_1' id='label_10_15_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_15_2'>\n\t\t\t\t<input name='input_15' type='radio' value='2'  id='choice_10_15_2'    \/>\n\t\t\t\t<label for='choice_10_15_2' id='label_10_15_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_15_3'>\n\t\t\t\t<input name='input_15' type='radio' value='3'  id='choice_10_15_3'    \/>\n\t\t\t\t<label for='choice_10_15_3' id='label_10_15_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_17\"  class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_inline checklist_input_line field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_17\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Automated Med Dispensing Systems<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_10_17'><li class='gchoice gchoice_10_17_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.1' type='checkbox'  value='Accudose'  id='choice_10_17_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_17_1' id='label_10_17_1' class='gform-field-label gform-field-label--type-inline'>Accudose<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_17_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.2' type='checkbox'  value='Metro'  id='choice_10_17_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_17_2' id='label_10_17_2' class='gform-field-label gform-field-label--type-inline'>Metro<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_17_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.3' type='checkbox'  value='Omnicell'  id='choice_10_17_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_17_3' id='label_10_17_3' class='gform-field-label gform-field-label--type-inline'>Omnicell<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_17_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.4' type='checkbox'  value='Promanager Rx'  id='choice_10_17_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_17_4' id='label_10_17_4' class='gform-field-label gform-field-label--type-inline'>Promanager Rx<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_17_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.5' type='checkbox'  value='Pyxis'  id='choice_10_17_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_17_5' id='label_10_17_5' class='gform-field-label gform-field-label--type-inline'>Pyxis<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_17_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.6' type='checkbox'  value='N\/A'  id='choice_10_17_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_17_6' id='label_10_17_6' class='gform-field-label gform-field-label--type-inline'>N\/A<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_18\"  class=\"gfield gfield--type-text gf_list_inline checklist_input_line field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_18\"><label class='gfield_label gform-field-label' for='input_10_18' >Other Automated Med Dispensing Systems:<\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_10_18' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_10_19\"  class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_inline checklist_input_line field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_19\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Electronic Documentation<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_10_19'><li class='gchoice gchoice_10_19_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.1' type='checkbox'  value='Allscripts'  id='choice_10_19_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_19_1' id='label_10_19_1' class='gform-field-label gform-field-label--type-inline'>Allscripts<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_19_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.2' type='checkbox'  value='Care360'  id='choice_10_19_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_19_2' id='label_10_19_2' class='gform-field-label gform-field-label--type-inline'>Care360<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_19_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.3' type='checkbox'  value='Cerner'  id='choice_10_19_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_19_3' id='label_10_19_3' class='gform-field-label gform-field-label--type-inline'>Cerner<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_19_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.4' type='checkbox'  value='eCLinicalWorks'  id='choice_10_19_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_19_4' id='label_10_19_4' class='gform-field-label gform-field-label--type-inline'>eCLinicalWorks<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_19_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.5' type='checkbox'  value='EPIC'  id='choice_10_19_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_19_5' id='label_10_19_5' class='gform-field-label gform-field-label--type-inline'>EPIC<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_19_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.6' type='checkbox'  value='MACLAB'  id='choice_10_19_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_19_6' id='label_10_19_6' class='gform-field-label gform-field-label--type-inline'>MACLAB<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_19_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.7' type='checkbox'  value='McKesson'  id='choice_10_19_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_19_7' id='label_10_19_7' class='gform-field-label gform-field-label--type-inline'>McKesson<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_19_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.8' type='checkbox'  value='Meditech'  id='choice_10_19_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_19_8' id='label_10_19_8' class='gform-field-label gform-field-label--type-inline'>Meditech<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_19_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.9' type='checkbox'  value='PACS'  id='choice_10_19_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_19_9' id='label_10_19_9' class='gform-field-label gform-field-label--type-inline'>PACS<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_19_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.11' type='checkbox'  value='Soarian'  id='choice_10_19_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_19_11' id='label_10_19_11' class='gform-field-label gform-field-label--type-inline'>Soarian<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_19_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.12' type='checkbox'  value='N\/A'  id='choice_10_19_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_19_12' id='label_10_19_12' class='gform-field-label gform-field-label--type-inline'>N\/A<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_20\"  class=\"gfield gfield--type-text gf_list_inline checklist_input_line field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_20\"><label class='gfield_label gform-field-label' for='input_10_20' >Other Electronic Documentation:<\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_10_20' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_10_21\"  class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_inline checklist_input_line field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_21\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >IV Pumps<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_10_21'><li class='gchoice gchoice_10_21_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.1' type='checkbox'  value='Alaris'  id='choice_10_21_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_21_1' id='label_10_21_1' class='gform-field-label gform-field-label--type-inline'>Alaris<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_21_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.2' type='checkbox'  value='Alibaba'  id='choice_10_21_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_21_2' id='label_10_21_2' class='gform-field-label gform-field-label--type-inline'>Alibaba<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_21_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.3' type='checkbox'  value='Bard'  id='choice_10_21_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_21_3' id='label_10_21_3' class='gform-field-label gform-field-label--type-inline'>Bard<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_21_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.4' type='checkbox'  value='Baxter'  id='choice_10_21_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_21_4' id='label_10_21_4' class='gform-field-label gform-field-label--type-inline'>Baxter<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_21_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.5' type='checkbox'  value='Braun'  id='choice_10_21_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_21_5' id='label_10_21_5' class='gform-field-label gform-field-label--type-inline'>Braun<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_21_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.6' type='checkbox'  value='CADD'  id='choice_10_21_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_21_6' id='label_10_21_6' class='gform-field-label gform-field-label--type-inline'>CADD<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_21_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.7' type='checkbox'  value='IVAC'  id='choice_10_21_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_21_7' id='label_10_21_7' class='gform-field-label gform-field-label--type-inline'>IVAC<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_21_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.8' type='checkbox'  value='Zynomed'  id='choice_10_21_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_21_8' id='label_10_21_8' class='gform-field-label gform-field-label--type-inline'>Zynomed<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_21_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.9' type='checkbox'  value='N\/A'  id='choice_10_21_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_21_9' id='label_10_21_9' class='gform-field-label gform-field-label--type-inline'>N\/A<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_22\"  class=\"gfield gfield--type-text gf_list_inline checklist_input_line field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_22\"><label class='gfield_label gform-field-label' for='input_10_22' >Other IV Pumps:<\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_10_22' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_10_23\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_23\"><label class='gfield_label gform-field-label'  >Peripheral IV Insertion, Care and Maintenance<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_23'>\n\t\t\t<li class='gchoice gchoice_10_23_0'>\n\t\t\t\t<input name='input_23' type='radio' value='0'  id='choice_10_23_0'    \/>\n\t\t\t\t<label for='choice_10_23_0' id='label_10_23_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_23_1'>\n\t\t\t\t<input name='input_23' type='radio' value='1'  id='choice_10_23_1'    \/>\n\t\t\t\t<label for='choice_10_23_1' id='label_10_23_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_23_2'>\n\t\t\t\t<input name='input_23' type='radio' value='2'  id='choice_10_23_2'    \/>\n\t\t\t\t<label for='choice_10_23_2' id='label_10_23_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_23_3'>\n\t\t\t\t<input name='input_23' type='radio' value='3'  id='choice_10_23_3'    \/>\n\t\t\t\t<label for='choice_10_23_3' id='label_10_23_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_24\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_24\"><label class='gfield_label gform-field-label'  >Access\/Management of Implanted Ports<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_24'>\n\t\t\t<li class='gchoice gchoice_10_24_0'>\n\t\t\t\t<input name='input_24' type='radio' value='0'  id='choice_10_24_0'    \/>\n\t\t\t\t<label for='choice_10_24_0' id='label_10_24_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_24_1'>\n\t\t\t\t<input name='input_24' type='radio' value='1'  id='choice_10_24_1'    \/>\n\t\t\t\t<label for='choice_10_24_1' id='label_10_24_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_24_2'>\n\t\t\t\t<input name='input_24' type='radio' value='2'  id='choice_10_24_2'    \/>\n\t\t\t\t<label for='choice_10_24_2' id='label_10_24_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_24_3'>\n\t\t\t\t<input name='input_24' type='radio' value='3'  id='choice_10_24_3'    \/>\n\t\t\t\t<label for='choice_10_24_3' id='label_10_24_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_25\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_25\"><label class='gfield_label gform-field-label'  >Access\/Management of Central Lines (CVL, Hickman, Broviac, Groshong, etc.)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_25'>\n\t\t\t<li class='gchoice gchoice_10_25_0'>\n\t\t\t\t<input name='input_25' type='radio' value='0'  id='choice_10_25_0'    \/>\n\t\t\t\t<label for='choice_10_25_0' id='label_10_25_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_25_1'>\n\t\t\t\t<input name='input_25' type='radio' value='1'  id='choice_10_25_1'    \/>\n\t\t\t\t<label for='choice_10_25_1' id='label_10_25_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_25_2'>\n\t\t\t\t<input name='input_25' type='radio' value='2'  id='choice_10_25_2'    \/>\n\t\t\t\t<label for='choice_10_25_2' id='label_10_25_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_25_3'>\n\t\t\t\t<input name='input_25' type='radio' value='3'  id='choice_10_25_3'    \/>\n\t\t\t\t<label for='choice_10_25_3' id='label_10_25_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_37\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_37\"><label class='gfield_label gform-field-label'  >Cardiac Monitoring\/Interpretation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_37'>\n\t\t\t<li class='gchoice gchoice_10_37_0'>\n\t\t\t\t<input name='input_37' type='radio' value='0'  id='choice_10_37_0'    \/>\n\t\t\t\t<label for='choice_10_37_0' id='label_10_37_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_37_1'>\n\t\t\t\t<input name='input_37' type='radio' value='1'  id='choice_10_37_1'    \/>\n\t\t\t\t<label for='choice_10_37_1' id='label_10_37_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_37_2'>\n\t\t\t\t<input name='input_37' type='radio' value='2'  id='choice_10_37_2'    \/>\n\t\t\t\t<label for='choice_10_37_2' id='label_10_37_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_37_3'>\n\t\t\t\t<input name='input_37' type='radio' value='3'  id='choice_10_37_3'    \/>\n\t\t\t\t<label for='choice_10_37_3' id='label_10_37_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_306\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_306\"><label class='gfield_label gform-field-label'  >PCA\/Epidural pumps<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_306'>\n\t\t\t<li class='gchoice gchoice_10_306_0'>\n\t\t\t\t<input name='input_306' type='radio' value='0'  id='choice_10_306_0'    \/>\n\t\t\t\t<label for='choice_10_306_0' id='label_10_306_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_306_1'>\n\t\t\t\t<input name='input_306' type='radio' value='1'  id='choice_10_306_1'    \/>\n\t\t\t\t<label for='choice_10_306_1' id='label_10_306_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_306_2'>\n\t\t\t\t<input name='input_306' type='radio' value='2'  id='choice_10_306_2'    \/>\n\t\t\t\t<label for='choice_10_306_2' id='label_10_306_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_306_3'>\n\t\t\t\t<input name='input_306' type='radio' value='3'  id='choice_10_306_3'    \/>\n\t\t\t\t<label for='choice_10_306_3' id='label_10_306_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_307\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_307\"><label class='gfield_label gform-field-label'  >Titration of drips<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_307'>\n\t\t\t<li class='gchoice gchoice_10_307_0'>\n\t\t\t\t<input name='input_307' type='radio' value='0'  id='choice_10_307_0'    \/>\n\t\t\t\t<label for='choice_10_307_0' id='label_10_307_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_307_1'>\n\t\t\t\t<input name='input_307' type='radio' value='1'  id='choice_10_307_1'    \/>\n\t\t\t\t<label for='choice_10_307_1' id='label_10_307_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_307_2'>\n\t\t\t\t<input name='input_307' type='radio' value='2'  id='choice_10_307_2'    \/>\n\t\t\t\t<label for='choice_10_307_2' id='label_10_307_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_307_3'>\n\t\t\t\t<input name='input_307' type='radio' value='3'  id='choice_10_307_3'    \/>\n\t\t\t\t<label for='choice_10_307_3' id='label_10_307_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_308\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_308\"><label class='gfield_label gform-field-label'  >Administration of Blood\/Blood Products<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_308'>\n\t\t\t<li class='gchoice gchoice_10_308_0'>\n\t\t\t\t<input name='input_308' type='radio' value='0'  id='choice_10_308_0'    \/>\n\t\t\t\t<label for='choice_10_308_0' id='label_10_308_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_308_1'>\n\t\t\t\t<input name='input_308' type='radio' value='1'  id='choice_10_308_1'    \/>\n\t\t\t\t<label for='choice_10_308_1' id='label_10_308_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_308_2'>\n\t\t\t\t<input name='input_308' type='radio' value='2'  id='choice_10_308_2'    \/>\n\t\t\t\t<label for='choice_10_308_2' id='label_10_308_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_308_3'>\n\t\t\t\t<input name='input_308' type='radio' value='3'  id='choice_10_308_3'    \/>\n\t\t\t\t<label for='choice_10_308_3' id='label_10_308_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_36\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_36\"><label class='gfield_label gform-field-label'  >Dressing Changes<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_36'>\n\t\t\t<li class='gchoice gchoice_10_36_0'>\n\t\t\t\t<input name='input_36' type='radio' value='0'  id='choice_10_36_0'    \/>\n\t\t\t\t<label for='choice_10_36_0' id='label_10_36_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_36_1'>\n\t\t\t\t<input name='input_36' type='radio' value='1'  id='choice_10_36_1'    \/>\n\t\t\t\t<label for='choice_10_36_1' id='label_10_36_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_36_2'>\n\t\t\t\t<input name='input_36' type='radio' value='2'  id='choice_10_36_2'    \/>\n\t\t\t\t<label for='choice_10_36_2' id='label_10_36_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_36_3'>\n\t\t\t\t<input name='input_36' type='radio' value='3'  id='choice_10_36_3'    \/>\n\t\t\t\t<label for='choice_10_36_3' id='label_10_36_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_268\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_268\"><label class='gfield_label gform-field-label'  >Knowledge of Normal Serum Lab Values<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_268'>\n\t\t\t<li class='gchoice gchoice_10_268_0'>\n\t\t\t\t<input name='input_268' type='radio' value='0'  id='choice_10_268_0'    \/>\n\t\t\t\t<label for='choice_10_268_0' id='label_10_268_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_268_1'>\n\t\t\t\t<input name='input_268' type='radio' value='1'  id='choice_10_268_1'    \/>\n\t\t\t\t<label for='choice_10_268_1' id='label_10_268_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_268_2'>\n\t\t\t\t<input name='input_268' type='radio' value='2'  id='choice_10_268_2'    \/>\n\t\t\t\t<label for='choice_10_268_2' id='label_10_268_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_268_3'>\n\t\t\t\t<input name='input_268' type='radio' value='3'  id='choice_10_268_3'    \/>\n\t\t\t\t<label for='choice_10_268_3' id='label_10_268_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_269\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_269\"><label class='gfield_label gform-field-label'  >Obtaining Cultures (Blood, Sputum, Swab, Urine)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_269'>\n\t\t\t<li class='gchoice gchoice_10_269_0'>\n\t\t\t\t<input name='input_269' type='radio' value='0'  id='choice_10_269_0'    \/>\n\t\t\t\t<label for='choice_10_269_0' id='label_10_269_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_269_1'>\n\t\t\t\t<input name='input_269' type='radio' value='1'  id='choice_10_269_1'    \/>\n\t\t\t\t<label for='choice_10_269_1' id='label_10_269_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_269_2'>\n\t\t\t\t<input name='input_269' type='radio' value='2'  id='choice_10_269_2'    \/>\n\t\t\t\t<label for='choice_10_269_2' id='label_10_269_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_269_3'>\n\t\t\t\t<input name='input_269' type='radio' value='3'  id='choice_10_269_3'    \/>\n\t\t\t\t<label for='choice_10_269_3' id='label_10_269_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_270\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_270\"><label class='gfield_label gform-field-label'  >Care of Patient with Burns<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_270'>\n\t\t\t<li class='gchoice gchoice_10_270_0'>\n\t\t\t\t<input name='input_270' type='radio' value='0'  id='choice_10_270_0'    \/>\n\t\t\t\t<label for='choice_10_270_0' id='label_10_270_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_270_1'>\n\t\t\t\t<input name='input_270' type='radio' value='1'  id='choice_10_270_1'    \/>\n\t\t\t\t<label for='choice_10_270_1' id='label_10_270_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_270_2'>\n\t\t\t\t<input name='input_270' type='radio' value='2'  id='choice_10_270_2'    \/>\n\t\t\t\t<label for='choice_10_270_2' id='label_10_270_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_270_3'>\n\t\t\t\t<input name='input_270' type='radio' value='3'  id='choice_10_270_3'    \/>\n\t\t\t\t<label for='choice_10_270_3' id='label_10_270_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_271\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_271\"><label class='gfield_label gform-field-label'  >Care of Patient with HIV\/AIDS<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_271'>\n\t\t\t<li class='gchoice gchoice_10_271_0'>\n\t\t\t\t<input name='input_271' type='radio' value='0'  id='choice_10_271_0'    \/>\n\t\t\t\t<label for='choice_10_271_0' id='label_10_271_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_271_1'>\n\t\t\t\t<input name='input_271' type='radio' value='1'  id='choice_10_271_1'    \/>\n\t\t\t\t<label for='choice_10_271_1' id='label_10_271_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_271_2'>\n\t\t\t\t<input name='input_271' type='radio' value='2'  id='choice_10_271_2'    \/>\n\t\t\t\t<label for='choice_10_271_2' id='label_10_271_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_271_3'>\n\t\t\t\t<input name='input_271' type='radio' value='3'  id='choice_10_271_3'    \/>\n\t\t\t\t<label for='choice_10_271_3' id='label_10_271_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_31\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_31\"><label class='gfield_label gform-field-label'  >Hyperbaric Oxygenation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_31'>\n\t\t\t<li class='gchoice gchoice_10_31_0'>\n\t\t\t\t<input name='input_31' type='radio' value='0'  id='choice_10_31_0'    \/>\n\t\t\t\t<label for='choice_10_31_0' id='label_10_31_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_31_1'>\n\t\t\t\t<input name='input_31' type='radio' value='1'  id='choice_10_31_1'    \/>\n\t\t\t\t<label for='choice_10_31_1' id='label_10_31_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_31_2'>\n\t\t\t\t<input name='input_31' type='radio' value='2'  id='choice_10_31_2'    \/>\n\t\t\t\t<label for='choice_10_31_2' id='label_10_31_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_31_3'>\n\t\t\t\t<input name='input_31' type='radio' value='3'  id='choice_10_31_3'    \/>\n\t\t\t\t<label for='choice_10_31_3' id='label_10_31_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_310\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_310\"><label class='gfield_label gform-field-label'  >Suicide Precautions<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_310'>\n\t\t\t<li class='gchoice gchoice_10_310_0'>\n\t\t\t\t<input name='input_310' type='radio' value='0'  id='choice_10_310_0'    \/>\n\t\t\t\t<label for='choice_10_310_0' id='label_10_310_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_310_1'>\n\t\t\t\t<input name='input_310' type='radio' value='1'  id='choice_10_310_1'    \/>\n\t\t\t\t<label for='choice_10_310_1' id='label_10_310_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_310_2'>\n\t\t\t\t<input name='input_310' type='radio' value='2'  id='choice_10_310_2'    \/>\n\t\t\t\t<label for='choice_10_310_2' id='label_10_310_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_310_3'>\n\t\t\t\t<input name='input_310' type='radio' value='3'  id='choice_10_310_3'    \/>\n\t\t\t\t<label for='choice_10_310_3' id='label_10_310_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_311\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_311\"><label class='gfield_label gform-field-label'  >Post Mortem Cares<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_311'>\n\t\t\t<li class='gchoice gchoice_10_311_0'>\n\t\t\t\t<input name='input_311' type='radio' value='0'  id='choice_10_311_0'    \/>\n\t\t\t\t<label for='choice_10_311_0' id='label_10_311_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_311_1'>\n\t\t\t\t<input name='input_311' type='radio' value='1'  id='choice_10_311_1'    \/>\n\t\t\t\t<label for='choice_10_311_1' id='label_10_311_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_311_2'>\n\t\t\t\t<input name='input_311' type='radio' value='2'  id='choice_10_311_2'    \/>\n\t\t\t\t<label for='choice_10_311_2' id='label_10_311_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_311_3'>\n\t\t\t\t<input name='input_311' type='radio' value='3'  id='choice_10_311_3'    \/>\n\t\t\t\t<label for='choice_10_311_3' id='label_10_311_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_32\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_32\"><label class='gfield_label gform-field-label'  >Knowledge of current Joint Commission National Patient Safety Goals<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_32'>\n\t\t\t<li class='gchoice gchoice_10_32_0'>\n\t\t\t\t<input name='input_32' type='radio' value='0'  id='choice_10_32_0'    \/>\n\t\t\t\t<label for='choice_10_32_0' id='label_10_32_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_32_1'>\n\t\t\t\t<input name='input_32' type='radio' value='1'  id='choice_10_32_1'    \/>\n\t\t\t\t<label for='choice_10_32_1' id='label_10_32_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_32_2'>\n\t\t\t\t<input name='input_32' type='radio' value='2'  id='choice_10_32_2'    \/>\n\t\t\t\t<label for='choice_10_32_2' id='label_10_32_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_32_3'>\n\t\t\t\t<input name='input_32' type='radio' value='3'  id='choice_10_32_3'    \/>\n\t\t\t\t<label for='choice_10_32_3' id='label_10_32_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_34\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_34\"><label class='gfield_label gform-field-label'  >Knowledge of &quot;Do Not Use Abbreviations&quot;<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_34'>\n\t\t\t<li class='gchoice gchoice_10_34_0'>\n\t\t\t\t<input name='input_34' type='radio' value='0'  id='choice_10_34_0'    \/>\n\t\t\t\t<label for='choice_10_34_0' id='label_10_34_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_34_1'>\n\t\t\t\t<input name='input_34' type='radio' value='1'  id='choice_10_34_1'    \/>\n\t\t\t\t<label for='choice_10_34_1' id='label_10_34_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_34_2'>\n\t\t\t\t<input name='input_34' type='radio' value='2'  id='choice_10_34_2'    \/>\n\t\t\t\t<label for='choice_10_34_2' id='label_10_34_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_34_3'>\n\t\t\t\t<input name='input_34' type='radio' value='3'  id='choice_10_34_3'    \/>\n\t\t\t\t<label for='choice_10_34_3' id='label_10_34_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_33\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_33\"><label class='gfield_label gform-field-label'  >Do you have charge\/supervisor experience?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_33'>\n\t\t\t<li class='gchoice gchoice_10_33_0'>\n\t\t\t\t<input name='input_33' type='radio' value='Y'  id='choice_10_33_0'    \/>\n\t\t\t\t<label for='choice_10_33_0' id='label_10_33_0' class='gform-field-label gform-field-label--type-inline'>Y<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_33_1'>\n\t\t\t\t<input name='input_33' type='radio' value='N'  id='choice_10_33_1'    \/>\n\t\t\t\t<label for='choice_10_33_1' id='label_10_33_1' class='gform-field-label gform-field-label--type-inline'>N<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_39\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_39\"><h2 class=\"gsection_title\">MEDICATION KNOWLEDGE AND USE OF<\/h2><\/li><li id=\"field_10_40\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_40\"><label class='gfield_label gform-field-label'  >Moderate\/Conscious Sedation &amp; Reversal Agents<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_40'>\n\t\t\t<li class='gchoice gchoice_10_40_0'>\n\t\t\t\t<input name='input_40' type='radio' value='0'  id='choice_10_40_0'    \/>\n\t\t\t\t<label for='choice_10_40_0' id='label_10_40_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_40_1'>\n\t\t\t\t<input name='input_40' type='radio' value='1'  id='choice_10_40_1'    \/>\n\t\t\t\t<label for='choice_10_40_1' id='label_10_40_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_40_2'>\n\t\t\t\t<input name='input_40' type='radio' value='2'  id='choice_10_40_2'    \/>\n\t\t\t\t<label for='choice_10_40_2' id='label_10_40_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_40_3'>\n\t\t\t\t<input name='input_40' type='radio' value='3'  id='choice_10_40_3'    \/>\n\t\t\t\t<label for='choice_10_40_3' id='label_10_40_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_48\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_48\"><label class='gfield_label gform-field-label'  >Calculate mcg\/min and mcg\/kg\/min<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_48'>\n\t\t\t<li class='gchoice gchoice_10_48_0'>\n\t\t\t\t<input name='input_48' type='radio' value='0'  id='choice_10_48_0'    \/>\n\t\t\t\t<label for='choice_10_48_0' id='label_10_48_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_48_1'>\n\t\t\t\t<input name='input_48' type='radio' value='1'  id='choice_10_48_1'    \/>\n\t\t\t\t<label for='choice_10_48_1' id='label_10_48_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_48_2'>\n\t\t\t\t<input name='input_48' type='radio' value='2'  id='choice_10_48_2'    \/>\n\t\t\t\t<label for='choice_10_48_2' id='label_10_48_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_48_3'>\n\t\t\t\t<input name='input_48' type='radio' value='3'  id='choice_10_48_3'    \/>\n\t\t\t\t<label for='choice_10_48_3' id='label_10_48_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_47\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_47\"><label class='gfield_label gform-field-label'  >Antiemetics<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_47'>\n\t\t\t<li class='gchoice gchoice_10_47_0'>\n\t\t\t\t<input name='input_47' type='radio' value='0'  id='choice_10_47_0'    \/>\n\t\t\t\t<label for='choice_10_47_0' id='label_10_47_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_47_1'>\n\t\t\t\t<input name='input_47' type='radio' value='1'  id='choice_10_47_1'    \/>\n\t\t\t\t<label for='choice_10_47_1' id='label_10_47_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_47_2'>\n\t\t\t\t<input name='input_47' type='radio' value='2'  id='choice_10_47_2'    \/>\n\t\t\t\t<label for='choice_10_47_2' id='label_10_47_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_47_3'>\n\t\t\t\t<input name='input_47' type='radio' value='3'  id='choice_10_47_3'    \/>\n\t\t\t\t<label for='choice_10_47_3' id='label_10_47_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_46\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_46\"><label class='gfield_label gform-field-label'  >Amiodarone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_46'>\n\t\t\t<li class='gchoice gchoice_10_46_0'>\n\t\t\t\t<input name='input_46' type='radio' value='0'  id='choice_10_46_0'    \/>\n\t\t\t\t<label for='choice_10_46_0' id='label_10_46_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_46_1'>\n\t\t\t\t<input name='input_46' type='radio' value='1'  id='choice_10_46_1'    \/>\n\t\t\t\t<label for='choice_10_46_1' id='label_10_46_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_46_2'>\n\t\t\t\t<input name='input_46' type='radio' value='2'  id='choice_10_46_2'    \/>\n\t\t\t\t<label for='choice_10_46_2' id='label_10_46_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_46_3'>\n\t\t\t\t<input name='input_46' type='radio' value='3'  id='choice_10_46_3'    \/>\n\t\t\t\t<label for='choice_10_46_3' id='label_10_46_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_45\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_45\"><label class='gfield_label gform-field-label'  >Cardizem<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_45'>\n\t\t\t<li class='gchoice gchoice_10_45_0'>\n\t\t\t\t<input name='input_45' type='radio' value='0'  id='choice_10_45_0'    \/>\n\t\t\t\t<label for='choice_10_45_0' id='label_10_45_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_45_1'>\n\t\t\t\t<input name='input_45' type='radio' value='1'  id='choice_10_45_1'    \/>\n\t\t\t\t<label for='choice_10_45_1' id='label_10_45_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_45_2'>\n\t\t\t\t<input name='input_45' type='radio' value='2'  id='choice_10_45_2'    \/>\n\t\t\t\t<label for='choice_10_45_2' id='label_10_45_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_45_3'>\n\t\t\t\t<input name='input_45' type='radio' value='3'  id='choice_10_45_3'    \/>\n\t\t\t\t<label for='choice_10_45_3' id='label_10_45_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_44\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_44\"><label class='gfield_label gform-field-label'  >Decadron<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_44'>\n\t\t\t<li class='gchoice gchoice_10_44_0'>\n\t\t\t\t<input name='input_44' type='radio' value='0'  id='choice_10_44_0'    \/>\n\t\t\t\t<label for='choice_10_44_0' id='label_10_44_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_44_1'>\n\t\t\t\t<input name='input_44' type='radio' value='1'  id='choice_10_44_1'    \/>\n\t\t\t\t<label for='choice_10_44_1' id='label_10_44_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_44_2'>\n\t\t\t\t<input name='input_44' type='radio' value='2'  id='choice_10_44_2'    \/>\n\t\t\t\t<label for='choice_10_44_2' id='label_10_44_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_44_3'>\n\t\t\t\t<input name='input_44' type='radio' value='3'  id='choice_10_44_3'    \/>\n\t\t\t\t<label for='choice_10_44_3' id='label_10_44_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_43\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_43\"><label class='gfield_label gform-field-label'  >Dilantin<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_43'>\n\t\t\t<li class='gchoice gchoice_10_43_0'>\n\t\t\t\t<input name='input_43' type='radio' value='0'  id='choice_10_43_0'    \/>\n\t\t\t\t<label for='choice_10_43_0' id='label_10_43_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_43_1'>\n\t\t\t\t<input name='input_43' type='radio' value='1'  id='choice_10_43_1'    \/>\n\t\t\t\t<label for='choice_10_43_1' id='label_10_43_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_43_2'>\n\t\t\t\t<input name='input_43' type='radio' value='2'  id='choice_10_43_2'    \/>\n\t\t\t\t<label for='choice_10_43_2' id='label_10_43_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_43_3'>\n\t\t\t\t<input name='input_43' type='radio' value='3'  id='choice_10_43_3'    \/>\n\t\t\t\t<label for='choice_10_43_3' id='label_10_43_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_42\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_42\"><label class='gfield_label gform-field-label'  >Magnesium Sulfate<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_42'>\n\t\t\t<li class='gchoice gchoice_10_42_0'>\n\t\t\t\t<input name='input_42' type='radio' value='0'  id='choice_10_42_0'    \/>\n\t\t\t\t<label for='choice_10_42_0' id='label_10_42_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_42_1'>\n\t\t\t\t<input name='input_42' type='radio' value='1'  id='choice_10_42_1'    \/>\n\t\t\t\t<label for='choice_10_42_1' id='label_10_42_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_42_2'>\n\t\t\t\t<input name='input_42' type='radio' value='2'  id='choice_10_42_2'    \/>\n\t\t\t\t<label for='choice_10_42_2' id='label_10_42_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_42_3'>\n\t\t\t\t<input name='input_42' type='radio' value='3'  id='choice_10_42_3'    \/>\n\t\t\t\t<label for='choice_10_42_3' id='label_10_42_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_41\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_41\"><label class='gfield_label gform-field-label'  >Phenobarbital<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_41'>\n\t\t\t<li class='gchoice gchoice_10_41_0'>\n\t\t\t\t<input name='input_41' type='radio' value='0'  id='choice_10_41_0'    \/>\n\t\t\t\t<label for='choice_10_41_0' id='label_10_41_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_41_1'>\n\t\t\t\t<input name='input_41' type='radio' value='1'  id='choice_10_41_1'    \/>\n\t\t\t\t<label for='choice_10_41_1' id='label_10_41_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_41_2'>\n\t\t\t\t<input name='input_41' type='radio' value='2'  id='choice_10_41_2'    \/>\n\t\t\t\t<label for='choice_10_41_2' id='label_10_41_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_41_3'>\n\t\t\t\t<input name='input_41' type='radio' value='3'  id='choice_10_41_3'    \/>\n\t\t\t\t<label for='choice_10_41_3' id='label_10_41_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_58\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_58\"><label class='gfield_label gform-field-label'  >Steroids<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_58'>\n\t\t\t<li class='gchoice gchoice_10_58_0'>\n\t\t\t\t<input name='input_58' type='radio' value='0'  id='choice_10_58_0'    \/>\n\t\t\t\t<label for='choice_10_58_0' id='label_10_58_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_58_1'>\n\t\t\t\t<input name='input_58' type='radio' value='1'  id='choice_10_58_1'    \/>\n\t\t\t\t<label for='choice_10_58_1' id='label_10_58_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_58_2'>\n\t\t\t\t<input name='input_58' type='radio' value='2'  id='choice_10_58_2'    \/>\n\t\t\t\t<label for='choice_10_58_2' id='label_10_58_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_58_3'>\n\t\t\t\t<input name='input_58' type='radio' value='3'  id='choice_10_58_3'    \/>\n\t\t\t\t<label for='choice_10_58_3' id='label_10_58_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_57\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_57\"><label class='gfield_label gform-field-label'  >Valium<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_57'>\n\t\t\t<li class='gchoice gchoice_10_57_0'>\n\t\t\t\t<input name='input_57' type='radio' value='0'  id='choice_10_57_0'    \/>\n\t\t\t\t<label for='choice_10_57_0' id='label_10_57_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_57_1'>\n\t\t\t\t<input name='input_57' type='radio' value='1'  id='choice_10_57_1'    \/>\n\t\t\t\t<label for='choice_10_57_1' id='label_10_57_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_57_2'>\n\t\t\t\t<input name='input_57' type='radio' value='2'  id='choice_10_57_2'    \/>\n\t\t\t\t<label for='choice_10_57_2' id='label_10_57_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_57_3'>\n\t\t\t\t<input name='input_57' type='radio' value='3'  id='choice_10_57_3'    \/>\n\t\t\t\t<label for='choice_10_57_3' id='label_10_57_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_56\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_56\"><label class='gfield_label gform-field-label'  >Atropine<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_56'>\n\t\t\t<li class='gchoice gchoice_10_56_0'>\n\t\t\t\t<input name='input_56' type='radio' value='0'  id='choice_10_56_0'    \/>\n\t\t\t\t<label for='choice_10_56_0' id='label_10_56_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_56_1'>\n\t\t\t\t<input name='input_56' type='radio' value='1'  id='choice_10_56_1'    \/>\n\t\t\t\t<label for='choice_10_56_1' id='label_10_56_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_56_2'>\n\t\t\t\t<input name='input_56' type='radio' value='2'  id='choice_10_56_2'    \/>\n\t\t\t\t<label for='choice_10_56_2' id='label_10_56_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_56_3'>\n\t\t\t\t<input name='input_56' type='radio' value='3'  id='choice_10_56_3'    \/>\n\t\t\t\t<label for='choice_10_56_3' id='label_10_56_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_55\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_55\"><label class='gfield_label gform-field-label'  >Diuretics<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_55'>\n\t\t\t<li class='gchoice gchoice_10_55_0'>\n\t\t\t\t<input name='input_55' type='radio' value='0'  id='choice_10_55_0'    \/>\n\t\t\t\t<label for='choice_10_55_0' id='label_10_55_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_55_1'>\n\t\t\t\t<input name='input_55' type='radio' value='1'  id='choice_10_55_1'    \/>\n\t\t\t\t<label for='choice_10_55_1' id='label_10_55_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_55_2'>\n\t\t\t\t<input name='input_55' type='radio' value='2'  id='choice_10_55_2'    \/>\n\t\t\t\t<label for='choice_10_55_2' id='label_10_55_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_55_3'>\n\t\t\t\t<input name='input_55' type='radio' value='3'  id='choice_10_55_3'    \/>\n\t\t\t\t<label for='choice_10_55_3' id='label_10_55_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_54\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_54\"><label class='gfield_label gform-field-label'  >Digoxin<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_54'>\n\t\t\t<li class='gchoice gchoice_10_54_0'>\n\t\t\t\t<input name='input_54' type='radio' value='0'  id='choice_10_54_0'    \/>\n\t\t\t\t<label for='choice_10_54_0' id='label_10_54_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_54_1'>\n\t\t\t\t<input name='input_54' type='radio' value='1'  id='choice_10_54_1'    \/>\n\t\t\t\t<label for='choice_10_54_1' id='label_10_54_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_54_2'>\n\t\t\t\t<input name='input_54' type='radio' value='2'  id='choice_10_54_2'    \/>\n\t\t\t\t<label for='choice_10_54_2' id='label_10_54_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_54_3'>\n\t\t\t\t<input name='input_54' type='radio' value='3'  id='choice_10_54_3'    \/>\n\t\t\t\t<label for='choice_10_54_3' id='label_10_54_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_53\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_53\"><label class='gfield_label gform-field-label'  >Dopamine<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_53'>\n\t\t\t<li class='gchoice gchoice_10_53_0'>\n\t\t\t\t<input name='input_53' type='radio' value='0'  id='choice_10_53_0'    \/>\n\t\t\t\t<label for='choice_10_53_0' id='label_10_53_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_53_1'>\n\t\t\t\t<input name='input_53' type='radio' value='1'  id='choice_10_53_1'    \/>\n\t\t\t\t<label for='choice_10_53_1' id='label_10_53_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_53_2'>\n\t\t\t\t<input name='input_53' type='radio' value='2'  id='choice_10_53_2'    \/>\n\t\t\t\t<label for='choice_10_53_2' id='label_10_53_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_53_3'>\n\t\t\t\t<input name='input_53' type='radio' value='3'  id='choice_10_53_3'    \/>\n\t\t\t\t<label for='choice_10_53_3' id='label_10_53_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_52\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_52\"><label class='gfield_label gform-field-label'  >Dobutrex<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_52'>\n\t\t\t<li class='gchoice gchoice_10_52_0'>\n\t\t\t\t<input name='input_52' type='radio' value='0'  id='choice_10_52_0'    \/>\n\t\t\t\t<label for='choice_10_52_0' id='label_10_52_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_52_1'>\n\t\t\t\t<input name='input_52' type='radio' value='1'  id='choice_10_52_1'    \/>\n\t\t\t\t<label for='choice_10_52_1' id='label_10_52_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_52_2'>\n\t\t\t\t<input name='input_52' type='radio' value='2'  id='choice_10_52_2'    \/>\n\t\t\t\t<label for='choice_10_52_2' id='label_10_52_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_52_3'>\n\t\t\t\t<input name='input_52' type='radio' value='3'  id='choice_10_52_3'    \/>\n\t\t\t\t<label for='choice_10_52_3' id='label_10_52_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_51\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_51\"><label class='gfield_label gform-field-label'  >Heparin Drip (Precautions &amp; Maintenance)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_51'>\n\t\t\t<li class='gchoice gchoice_10_51_0'>\n\t\t\t\t<input name='input_51' type='radio' value='0'  id='choice_10_51_0'    \/>\n\t\t\t\t<label for='choice_10_51_0' id='label_10_51_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_51_1'>\n\t\t\t\t<input name='input_51' type='radio' value='1'  id='choice_10_51_1'    \/>\n\t\t\t\t<label for='choice_10_51_1' id='label_10_51_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_51_2'>\n\t\t\t\t<input name='input_51' type='radio' value='2'  id='choice_10_51_2'    \/>\n\t\t\t\t<label for='choice_10_51_2' id='label_10_51_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_51_3'>\n\t\t\t\t<input name='input_51' type='radio' value='3'  id='choice_10_51_3'    \/>\n\t\t\t\t<label for='choice_10_51_3' id='label_10_51_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_50\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_50\"><label class='gfield_label gform-field-label'  >Inderal<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_50'>\n\t\t\t<li class='gchoice gchoice_10_50_0'>\n\t\t\t\t<input name='input_50' type='radio' value='0'  id='choice_10_50_0'    \/>\n\t\t\t\t<label for='choice_10_50_0' id='label_10_50_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_50_1'>\n\t\t\t\t<input name='input_50' type='radio' value='1'  id='choice_10_50_1'    \/>\n\t\t\t\t<label for='choice_10_50_1' id='label_10_50_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_50_2'>\n\t\t\t\t<input name='input_50' type='radio' value='2'  id='choice_10_50_2'    \/>\n\t\t\t\t<label for='choice_10_50_2' id='label_10_50_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_50_3'>\n\t\t\t\t<input name='input_50' type='radio' value='3'  id='choice_10_50_3'    \/>\n\t\t\t\t<label for='choice_10_50_3' id='label_10_50_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_49\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_49\"><label class='gfield_label gform-field-label'  >Inocor<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_49'>\n\t\t\t<li class='gchoice gchoice_10_49_0'>\n\t\t\t\t<input name='input_49' type='radio' value='0'  id='choice_10_49_0'    \/>\n\t\t\t\t<label for='choice_10_49_0' id='label_10_49_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_49_1'>\n\t\t\t\t<input name='input_49' type='radio' value='1'  id='choice_10_49_1'    \/>\n\t\t\t\t<label for='choice_10_49_1' id='label_10_49_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_49_2'>\n\t\t\t\t<input name='input_49' type='radio' value='2'  id='choice_10_49_2'    \/>\n\t\t\t\t<label for='choice_10_49_2' id='label_10_49_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_49_3'>\n\t\t\t\t<input name='input_49' type='radio' value='3'  id='choice_10_49_3'    \/>\n\t\t\t\t<label for='choice_10_49_3' id='label_10_49_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_69\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_69\"><label class='gfield_label gform-field-label'  >Isuprel<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_69'>\n\t\t\t<li class='gchoice gchoice_10_69_0'>\n\t\t\t\t<input name='input_69' type='radio' value='0'  id='choice_10_69_0'    \/>\n\t\t\t\t<label for='choice_10_69_0' id='label_10_69_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_69_1'>\n\t\t\t\t<input name='input_69' type='radio' value='1'  id='choice_10_69_1'    \/>\n\t\t\t\t<label for='choice_10_69_1' id='label_10_69_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_69_2'>\n\t\t\t\t<input name='input_69' type='radio' value='2'  id='choice_10_69_2'    \/>\n\t\t\t\t<label for='choice_10_69_2' id='label_10_69_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_69_3'>\n\t\t\t\t<input name='input_69' type='radio' value='3'  id='choice_10_69_3'    \/>\n\t\t\t\t<label for='choice_10_69_3' id='label_10_69_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_68\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_68\"><label class='gfield_label gform-field-label'  >Lidocaine<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_68'>\n\t\t\t<li class='gchoice gchoice_10_68_0'>\n\t\t\t\t<input name='input_68' type='radio' value='0'  id='choice_10_68_0'    \/>\n\t\t\t\t<label for='choice_10_68_0' id='label_10_68_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_68_1'>\n\t\t\t\t<input name='input_68' type='radio' value='1'  id='choice_10_68_1'    \/>\n\t\t\t\t<label for='choice_10_68_1' id='label_10_68_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_68_2'>\n\t\t\t\t<input name='input_68' type='radio' value='2'  id='choice_10_68_2'    \/>\n\t\t\t\t<label for='choice_10_68_2' id='label_10_68_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_68_3'>\n\t\t\t\t<input name='input_68' type='radio' value='3'  id='choice_10_68_3'    \/>\n\t\t\t\t<label for='choice_10_68_3' id='label_10_68_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_67\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_67\"><label class='gfield_label gform-field-label'  >Neosynephrine\/Nipride<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_67'>\n\t\t\t<li class='gchoice gchoice_10_67_0'>\n\t\t\t\t<input name='input_67' type='radio' value='0'  id='choice_10_67_0'    \/>\n\t\t\t\t<label for='choice_10_67_0' id='label_10_67_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_67_1'>\n\t\t\t\t<input name='input_67' type='radio' value='1'  id='choice_10_67_1'    \/>\n\t\t\t\t<label for='choice_10_67_1' id='label_10_67_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_67_2'>\n\t\t\t\t<input name='input_67' type='radio' value='2'  id='choice_10_67_2'    \/>\n\t\t\t\t<label for='choice_10_67_2' id='label_10_67_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_67_3'>\n\t\t\t\t<input name='input_67' type='radio' value='3'  id='choice_10_67_3'    \/>\n\t\t\t\t<label for='choice_10_67_3' id='label_10_67_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_313\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_313\"><label class='gfield_label gform-field-label'  >Nitroglycerin<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_313'>\n\t\t\t<li class='gchoice gchoice_10_313_0'>\n\t\t\t\t<input name='input_313' type='radio' value='0'  id='choice_10_313_0'    \/>\n\t\t\t\t<label for='choice_10_313_0' id='label_10_313_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_313_1'>\n\t\t\t\t<input name='input_313' type='radio' value='1'  id='choice_10_313_1'    \/>\n\t\t\t\t<label for='choice_10_313_1' id='label_10_313_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_313_2'>\n\t\t\t\t<input name='input_313' type='radio' value='2'  id='choice_10_313_2'    \/>\n\t\t\t\t<label for='choice_10_313_2' id='label_10_313_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_313_3'>\n\t\t\t\t<input name='input_313' type='radio' value='3'  id='choice_10_313_3'    \/>\n\t\t\t\t<label for='choice_10_313_3' id='label_10_313_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_312\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_312\"><label class='gfield_label gform-field-label'  >Pronestyl<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_312'>\n\t\t\t<li class='gchoice gchoice_10_312_0'>\n\t\t\t\t<input name='input_312' type='radio' value='0'  id='choice_10_312_0'    \/>\n\t\t\t\t<label for='choice_10_312_0' id='label_10_312_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_312_1'>\n\t\t\t\t<input name='input_312' type='radio' value='1'  id='choice_10_312_1'    \/>\n\t\t\t\t<label for='choice_10_312_1' id='label_10_312_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_312_2'>\n\t\t\t\t<input name='input_312' type='radio' value='2'  id='choice_10_312_2'    \/>\n\t\t\t\t<label for='choice_10_312_2' id='label_10_312_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_312_3'>\n\t\t\t\t<input name='input_312' type='radio' value='3'  id='choice_10_312_3'    \/>\n\t\t\t\t<label for='choice_10_312_3' id='label_10_312_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_317\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_317\"><label class='gfield_label gform-field-label'  >Morphine<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_317'>\n\t\t\t<li class='gchoice gchoice_10_317_0'>\n\t\t\t\t<input name='input_317' type='radio' value='0'  id='choice_10_317_0'    \/>\n\t\t\t\t<label for='choice_10_317_0' id='label_10_317_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_317_1'>\n\t\t\t\t<input name='input_317' type='radio' value='1'  id='choice_10_317_1'    \/>\n\t\t\t\t<label for='choice_10_317_1' id='label_10_317_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_317_2'>\n\t\t\t\t<input name='input_317' type='radio' value='2'  id='choice_10_317_2'    \/>\n\t\t\t\t<label for='choice_10_317_2' id='label_10_317_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_317_3'>\n\t\t\t\t<input name='input_317' type='radio' value='3'  id='choice_10_317_3'    \/>\n\t\t\t\t<label for='choice_10_317_3' id='label_10_317_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_316\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_316\"><label class='gfield_label gform-field-label'  >Thrombolytic Agents<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_316'>\n\t\t\t<li class='gchoice gchoice_10_316_0'>\n\t\t\t\t<input name='input_316' type='radio' value='0'  id='choice_10_316_0'    \/>\n\t\t\t\t<label for='choice_10_316_0' id='label_10_316_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_316_1'>\n\t\t\t\t<input name='input_316' type='radio' value='1'  id='choice_10_316_1'    \/>\n\t\t\t\t<label for='choice_10_316_1' id='label_10_316_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_316_2'>\n\t\t\t\t<input name='input_316' type='radio' value='2'  id='choice_10_316_2'    \/>\n\t\t\t\t<label for='choice_10_316_2' id='label_10_316_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_316_3'>\n\t\t\t\t<input name='input_316' type='radio' value='3'  id='choice_10_316_3'    \/>\n\t\t\t\t<label for='choice_10_316_3' id='label_10_316_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_314\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_314\"><label class='gfield_label gform-field-label'  >Prep\/Titration of Emergency Drugs<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_314'>\n\t\t\t<li class='gchoice gchoice_10_314_0'>\n\t\t\t\t<input name='input_314' type='radio' value='0'  id='choice_10_314_0'    \/>\n\t\t\t\t<label for='choice_10_314_0' id='label_10_314_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_314_1'>\n\t\t\t\t<input name='input_314' type='radio' value='1'  id='choice_10_314_1'    \/>\n\t\t\t\t<label for='choice_10_314_1' id='label_10_314_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_314_2'>\n\t\t\t\t<input name='input_314' type='radio' value='2'  id='choice_10_314_2'    \/>\n\t\t\t\t<label for='choice_10_314_2' id='label_10_314_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_314_3'>\n\t\t\t\t<input name='input_314' type='radio' value='3'  id='choice_10_314_3'    \/>\n\t\t\t\t<label for='choice_10_314_3' id='label_10_314_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_76\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_76\"><h2 class=\"gsection_title\">NEURO GENERAL SKILLS<\/h2><\/li><li id=\"field_10_77\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_77\"><label class='gfield_label gform-field-label'  >Assessment of Neuro Signs<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_77'>\n\t\t\t<li class='gchoice gchoice_10_77_0'>\n\t\t\t\t<input name='input_77' type='radio' value='0'  id='choice_10_77_0'    \/>\n\t\t\t\t<label for='choice_10_77_0' id='label_10_77_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_77_1'>\n\t\t\t\t<input name='input_77' type='radio' value='1'  id='choice_10_77_1'    \/>\n\t\t\t\t<label for='choice_10_77_1' id='label_10_77_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_77_2'>\n\t\t\t\t<input name='input_77' type='radio' value='2'  id='choice_10_77_2'    \/>\n\t\t\t\t<label for='choice_10_77_2' id='label_10_77_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_77_3'>\n\t\t\t\t<input name='input_77' type='radio' value='3'  id='choice_10_77_3'    \/>\n\t\t\t\t<label for='choice_10_77_3' id='label_10_77_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_78\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_78\"><label class='gfield_label gform-field-label'  >Glascow Coma Scale<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_78'>\n\t\t\t<li class='gchoice gchoice_10_78_0'>\n\t\t\t\t<input name='input_78' type='radio' value='0'  id='choice_10_78_0'    \/>\n\t\t\t\t<label for='choice_10_78_0' id='label_10_78_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_78_1'>\n\t\t\t\t<input name='input_78' type='radio' value='1'  id='choice_10_78_1'    \/>\n\t\t\t\t<label for='choice_10_78_1' id='label_10_78_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_78_2'>\n\t\t\t\t<input name='input_78' type='radio' value='2'  id='choice_10_78_2'    \/>\n\t\t\t\t<label for='choice_10_78_2' id='label_10_78_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_78_3'>\n\t\t\t\t<input name='input_78' type='radio' value='3'  id='choice_10_78_3'    \/>\n\t\t\t\t<label for='choice_10_78_3' id='label_10_78_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_88\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_88\"><label class='gfield_label gform-field-label'  >Seizure Precautions<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_88'>\n\t\t\t<li class='gchoice gchoice_10_88_0'>\n\t\t\t\t<input name='input_88' type='radio' value='0'  id='choice_10_88_0'    \/>\n\t\t\t\t<label for='choice_10_88_0' id='label_10_88_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_88_1'>\n\t\t\t\t<input name='input_88' type='radio' value='1'  id='choice_10_88_1'    \/>\n\t\t\t\t<label for='choice_10_88_1' id='label_10_88_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_88_2'>\n\t\t\t\t<input name='input_88' type='radio' value='2'  id='choice_10_88_2'    \/>\n\t\t\t\t<label for='choice_10_88_2' id='label_10_88_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_88_3'>\n\t\t\t\t<input name='input_88' type='radio' value='3'  id='choice_10_88_3'    \/>\n\t\t\t\t<label for='choice_10_88_3' id='label_10_88_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_87\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_87\"><label class='gfield_label gform-field-label'  >Assist with Lumbar Puncture<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_87'>\n\t\t\t<li class='gchoice gchoice_10_87_0'>\n\t\t\t\t<input name='input_87' type='radio' value='0'  id='choice_10_87_0'    \/>\n\t\t\t\t<label for='choice_10_87_0' id='label_10_87_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_87_1'>\n\t\t\t\t<input name='input_87' type='radio' value='1'  id='choice_10_87_1'    \/>\n\t\t\t\t<label for='choice_10_87_1' id='label_10_87_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_87_2'>\n\t\t\t\t<input name='input_87' type='radio' value='2'  id='choice_10_87_2'    \/>\n\t\t\t\t<label for='choice_10_87_2' id='label_10_87_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_87_3'>\n\t\t\t\t<input name='input_87' type='radio' value='3'  id='choice_10_87_3'    \/>\n\t\t\t\t<label for='choice_10_87_3' id='label_10_87_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_86\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_86\"><label class='gfield_label gform-field-label'  >Halo Traction<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_86'>\n\t\t\t<li class='gchoice gchoice_10_86_0'>\n\t\t\t\t<input name='input_86' type='radio' value='0'  id='choice_10_86_0'    \/>\n\t\t\t\t<label for='choice_10_86_0' id='label_10_86_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_86_1'>\n\t\t\t\t<input name='input_86' type='radio' value='1'  id='choice_10_86_1'    \/>\n\t\t\t\t<label for='choice_10_86_1' id='label_10_86_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_86_2'>\n\t\t\t\t<input name='input_86' type='radio' value='2'  id='choice_10_86_2'    \/>\n\t\t\t\t<label for='choice_10_86_2' id='label_10_86_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_86_3'>\n\t\t\t\t<input name='input_86' type='radio' value='3'  id='choice_10_86_3'    \/>\n\t\t\t\t<label for='choice_10_86_3' id='label_10_86_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_95\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_95\"><h2 class=\"gsection_title\">NEURO - Care of Patient With:<\/h2><\/li><li id=\"field_10_96\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_96\"><label class='gfield_label gform-field-label'  >CVA<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_96'>\n\t\t\t<li class='gchoice gchoice_10_96_0'>\n\t\t\t\t<input name='input_96' type='radio' value='0'  id='choice_10_96_0'    \/>\n\t\t\t\t<label for='choice_10_96_0' id='label_10_96_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_96_1'>\n\t\t\t\t<input name='input_96' type='radio' value='1'  id='choice_10_96_1'    \/>\n\t\t\t\t<label for='choice_10_96_1' id='label_10_96_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_96_2'>\n\t\t\t\t<input name='input_96' type='radio' value='2'  id='choice_10_96_2'    \/>\n\t\t\t\t<label for='choice_10_96_2' id='label_10_96_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_96_3'>\n\t\t\t\t<input name='input_96' type='radio' value='3'  id='choice_10_96_3'    \/>\n\t\t\t\t<label for='choice_10_96_3' id='label_10_96_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_100\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_100\"><label class='gfield_label gform-field-label'  >Seizure Activity<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_100'>\n\t\t\t<li class='gchoice gchoice_10_100_0'>\n\t\t\t\t<input name='input_100' type='radio' value='0'  id='choice_10_100_0'    \/>\n\t\t\t\t<label for='choice_10_100_0' id='label_10_100_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_100_1'>\n\t\t\t\t<input name='input_100' type='radio' value='1'  id='choice_10_100_1'    \/>\n\t\t\t\t<label for='choice_10_100_1' id='label_10_100_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_100_2'>\n\t\t\t\t<input name='input_100' type='radio' value='2'  id='choice_10_100_2'    \/>\n\t\t\t\t<label for='choice_10_100_2' id='label_10_100_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_100_3'>\n\t\t\t\t<input name='input_100' type='radio' value='3'  id='choice_10_100_3'    \/>\n\t\t\t\t<label for='choice_10_100_3' id='label_10_100_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_99\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_99\"><label class='gfield_label gform-field-label'  >Overdose<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_99'>\n\t\t\t<li class='gchoice gchoice_10_99_0'>\n\t\t\t\t<input name='input_99' type='radio' value='0'  id='choice_10_99_0'    \/>\n\t\t\t\t<label for='choice_10_99_0' id='label_10_99_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_99_1'>\n\t\t\t\t<input name='input_99' type='radio' value='1'  id='choice_10_99_1'    \/>\n\t\t\t\t<label for='choice_10_99_1' id='label_10_99_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_99_2'>\n\t\t\t\t<input name='input_99' type='radio' value='2'  id='choice_10_99_2'    \/>\n\t\t\t\t<label for='choice_10_99_2' id='label_10_99_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_99_3'>\n\t\t\t\t<input name='input_99' type='radio' value='3'  id='choice_10_99_3'    \/>\n\t\t\t\t<label for='choice_10_99_3' id='label_10_99_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_98\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_98\"><label class='gfield_label gform-field-label'  >Neuro\/Head Injury\/Trauma<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_98'>\n\t\t\t<li class='gchoice gchoice_10_98_0'>\n\t\t\t\t<input name='input_98' type='radio' value='0'  id='choice_10_98_0'    \/>\n\t\t\t\t<label for='choice_10_98_0' id='label_10_98_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_98_1'>\n\t\t\t\t<input name='input_98' type='radio' value='1'  id='choice_10_98_1'    \/>\n\t\t\t\t<label for='choice_10_98_1' id='label_10_98_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_98_2'>\n\t\t\t\t<input name='input_98' type='radio' value='2'  id='choice_10_98_2'    \/>\n\t\t\t\t<label for='choice_10_98_2' id='label_10_98_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_98_3'>\n\t\t\t\t<input name='input_98' type='radio' value='3'  id='choice_10_98_3'    \/>\n\t\t\t\t<label for='choice_10_98_3' id='label_10_98_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_97\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_97\"><label class='gfield_label gform-field-label'  >Pre\/Post Neuro Surgery<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_97'>\n\t\t\t<li class='gchoice gchoice_10_97_0'>\n\t\t\t\t<input name='input_97' type='radio' value='0'  id='choice_10_97_0'    \/>\n\t\t\t\t<label for='choice_10_97_0' id='label_10_97_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_97_1'>\n\t\t\t\t<input name='input_97' type='radio' value='1'  id='choice_10_97_1'    \/>\n\t\t\t\t<label for='choice_10_97_1' id='label_10_97_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_97_2'>\n\t\t\t\t<input name='input_97' type='radio' value='2'  id='choice_10_97_2'    \/>\n\t\t\t\t<label for='choice_10_97_2' id='label_10_97_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_97_3'>\n\t\t\t\t<input name='input_97' type='radio' value='3'  id='choice_10_97_3'    \/>\n\t\t\t\t<label for='choice_10_97_3' id='label_10_97_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_273\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_273\"><label class='gfield_label gform-field-label'  >Cranial Hemorrhage<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_273'>\n\t\t\t<li class='gchoice gchoice_10_273_0'>\n\t\t\t\t<input name='input_273' type='radio' value='0'  id='choice_10_273_0'    \/>\n\t\t\t\t<label for='choice_10_273_0' id='label_10_273_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_273_1'>\n\t\t\t\t<input name='input_273' type='radio' value='1'  id='choice_10_273_1'    \/>\n\t\t\t\t<label for='choice_10_273_1' id='label_10_273_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_273_2'>\n\t\t\t\t<input name='input_273' type='radio' value='2'  id='choice_10_273_2'    \/>\n\t\t\t\t<label for='choice_10_273_2' id='label_10_273_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_273_3'>\n\t\t\t\t<input name='input_273' type='radio' value='3'  id='choice_10_273_3'    \/>\n\t\t\t\t<label for='choice_10_273_3' id='label_10_273_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_272\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_272\"><label class='gfield_label gform-field-label'  >Multiple Sclerosis<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_272'>\n\t\t\t<li class='gchoice gchoice_10_272_0'>\n\t\t\t\t<input name='input_272' type='radio' value='0'  id='choice_10_272_0'    \/>\n\t\t\t\t<label for='choice_10_272_0' id='label_10_272_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_272_1'>\n\t\t\t\t<input name='input_272' type='radio' value='1'  id='choice_10_272_1'    \/>\n\t\t\t\t<label for='choice_10_272_1' id='label_10_272_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_272_2'>\n\t\t\t\t<input name='input_272' type='radio' value='2'  id='choice_10_272_2'    \/>\n\t\t\t\t<label for='choice_10_272_2' id='label_10_272_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_272_3'>\n\t\t\t\t<input name='input_272' type='radio' value='3'  id='choice_10_272_3'    \/>\n\t\t\t\t<label for='choice_10_272_3' id='label_10_272_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_318\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_318\"><label class='gfield_label gform-field-label'  >Post-Op AV-Shunt<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_318'>\n\t\t\t<li class='gchoice gchoice_10_318_0'>\n\t\t\t\t<input name='input_318' type='radio' value='0'  id='choice_10_318_0'    \/>\n\t\t\t\t<label for='choice_10_318_0' id='label_10_318_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_318_1'>\n\t\t\t\t<input name='input_318' type='radio' value='1'  id='choice_10_318_1'    \/>\n\t\t\t\t<label for='choice_10_318_1' id='label_10_318_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_318_2'>\n\t\t\t\t<input name='input_318' type='radio' value='2'  id='choice_10_318_2'    \/>\n\t\t\t\t<label for='choice_10_318_2' id='label_10_318_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_318_3'>\n\t\t\t\t<input name='input_318' type='radio' value='3'  id='choice_10_318_3'    \/>\n\t\t\t\t<label for='choice_10_318_3' id='label_10_318_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_101\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_101\"><h2 class=\"gsection_title\">CARDIAC GENERAL SKILLS<\/h2><\/li><li id=\"field_10_102\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_102\"><label class='gfield_label gform-field-label'  >Auscultation of Cardiac Sounds<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_102'>\n\t\t\t<li class='gchoice gchoice_10_102_0'>\n\t\t\t\t<input name='input_102' type='radio' value='0'  id='choice_10_102_0'    \/>\n\t\t\t\t<label for='choice_10_102_0' id='label_10_102_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_102_1'>\n\t\t\t\t<input name='input_102' type='radio' value='1'  id='choice_10_102_1'    \/>\n\t\t\t\t<label for='choice_10_102_1' id='label_10_102_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_102_2'>\n\t\t\t\t<input name='input_102' type='radio' value='2'  id='choice_10_102_2'    \/>\n\t\t\t\t<label for='choice_10_102_2' id='label_10_102_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_102_3'>\n\t\t\t\t<input name='input_102' type='radio' value='3'  id='choice_10_102_3'    \/>\n\t\t\t\t<label for='choice_10_102_3' id='label_10_102_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_103\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_103\"><label class='gfield_label gform-field-label'  >Dopplers<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_103'>\n\t\t\t<li class='gchoice gchoice_10_103_0'>\n\t\t\t\t<input name='input_103' type='radio' value='0'  id='choice_10_103_0'    \/>\n\t\t\t\t<label for='choice_10_103_0' id='label_10_103_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_103_1'>\n\t\t\t\t<input name='input_103' type='radio' value='1'  id='choice_10_103_1'    \/>\n\t\t\t\t<label for='choice_10_103_1' id='label_10_103_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_103_2'>\n\t\t\t\t<input name='input_103' type='radio' value='2'  id='choice_10_103_2'    \/>\n\t\t\t\t<label for='choice_10_103_2' id='label_10_103_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_103_3'>\n\t\t\t\t<input name='input_103' type='radio' value='3'  id='choice_10_103_3'    \/>\n\t\t\t\t<label for='choice_10_103_3' id='label_10_103_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_105\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_105\"><label class='gfield_label gform-field-label'  >Tele\/EKG Interpretation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_105'>\n\t\t\t<li class='gchoice gchoice_10_105_0'>\n\t\t\t\t<input name='input_105' type='radio' value='0'  id='choice_10_105_0'    \/>\n\t\t\t\t<label for='choice_10_105_0' id='label_10_105_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_105_1'>\n\t\t\t\t<input name='input_105' type='radio' value='1'  id='choice_10_105_1'    \/>\n\t\t\t\t<label for='choice_10_105_1' id='label_10_105_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_105_2'>\n\t\t\t\t<input name='input_105' type='radio' value='2'  id='choice_10_105_2'    \/>\n\t\t\t\t<label for='choice_10_105_2' id='label_10_105_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_105_3'>\n\t\t\t\t<input name='input_105' type='radio' value='3'  id='choice_10_105_3'    \/>\n\t\t\t\t<label for='choice_10_105_3' id='label_10_105_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_104\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_104\"><label class='gfield_label gform-field-label'  >Defibrillation\/Cardioversion<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_104'>\n\t\t\t<li class='gchoice gchoice_10_104_0'>\n\t\t\t\t<input name='input_104' type='radio' value='0'  id='choice_10_104_0'    \/>\n\t\t\t\t<label for='choice_10_104_0' id='label_10_104_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_104_1'>\n\t\t\t\t<input name='input_104' type='radio' value='1'  id='choice_10_104_1'    \/>\n\t\t\t\t<label for='choice_10_104_1' id='label_10_104_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_104_2'>\n\t\t\t\t<input name='input_104' type='radio' value='2'  id='choice_10_104_2'    \/>\n\t\t\t\t<label for='choice_10_104_2' id='label_10_104_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_104_3'>\n\t\t\t\t<input name='input_104' type='radio' value='3'  id='choice_10_104_3'    \/>\n\t\t\t\t<label for='choice_10_104_3' id='label_10_104_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_275\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_275\"><label class='gfield_label gform-field-label'  >Permanent Pacemaker<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_275'>\n\t\t\t<li class='gchoice gchoice_10_275_0'>\n\t\t\t\t<input name='input_275' type='radio' value='0'  id='choice_10_275_0'    \/>\n\t\t\t\t<label for='choice_10_275_0' id='label_10_275_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_275_1'>\n\t\t\t\t<input name='input_275' type='radio' value='1'  id='choice_10_275_1'    \/>\n\t\t\t\t<label for='choice_10_275_1' id='label_10_275_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_275_2'>\n\t\t\t\t<input name='input_275' type='radio' value='2'  id='choice_10_275_2'    \/>\n\t\t\t\t<label for='choice_10_275_2' id='label_10_275_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_275_3'>\n\t\t\t\t<input name='input_275' type='radio' value='3'  id='choice_10_275_3'    \/>\n\t\t\t\t<label for='choice_10_275_3' id='label_10_275_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_274\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_274\"><label class='gfield_label gform-field-label'  >Temporary Pacemaker<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_274'>\n\t\t\t<li class='gchoice gchoice_10_274_0'>\n\t\t\t\t<input name='input_274' type='radio' value='0'  id='choice_10_274_0'    \/>\n\t\t\t\t<label for='choice_10_274_0' id='label_10_274_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_274_1'>\n\t\t\t\t<input name='input_274' type='radio' value='1'  id='choice_10_274_1'    \/>\n\t\t\t\t<label for='choice_10_274_1' id='label_10_274_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_274_2'>\n\t\t\t\t<input name='input_274' type='radio' value='2'  id='choice_10_274_2'    \/>\n\t\t\t\t<label for='choice_10_274_2' id='label_10_274_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_274_3'>\n\t\t\t\t<input name='input_274' type='radio' value='3'  id='choice_10_274_3'    \/>\n\t\t\t\t<label for='choice_10_274_3' id='label_10_274_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_277\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_277\"><label class='gfield_label gform-field-label'  >AICD<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_277'>\n\t\t\t<li class='gchoice gchoice_10_277_0'>\n\t\t\t\t<input name='input_277' type='radio' value='0'  id='choice_10_277_0'    \/>\n\t\t\t\t<label for='choice_10_277_0' id='label_10_277_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_277_1'>\n\t\t\t\t<input name='input_277' type='radio' value='1'  id='choice_10_277_1'    \/>\n\t\t\t\t<label for='choice_10_277_1' id='label_10_277_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_277_2'>\n\t\t\t\t<input name='input_277' type='radio' value='2'  id='choice_10_277_2'    \/>\n\t\t\t\t<label for='choice_10_277_2' id='label_10_277_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_277_3'>\n\t\t\t\t<input name='input_277' type='radio' value='3'  id='choice_10_277_3'    \/>\n\t\t\t\t<label for='choice_10_277_3' id='label_10_277_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_276\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_276\"><label class='gfield_label gform-field-label'  >Art-Line (Transducer set-up, D\/C)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_276'>\n\t\t\t<li class='gchoice gchoice_10_276_0'>\n\t\t\t\t<input name='input_276' type='radio' value='0'  id='choice_10_276_0'    \/>\n\t\t\t\t<label for='choice_10_276_0' id='label_10_276_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_276_1'>\n\t\t\t\t<input name='input_276' type='radio' value='1'  id='choice_10_276_1'    \/>\n\t\t\t\t<label for='choice_10_276_1' id='label_10_276_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_276_2'>\n\t\t\t\t<input name='input_276' type='radio' value='2'  id='choice_10_276_2'    \/>\n\t\t\t\t<label for='choice_10_276_2' id='label_10_276_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_276_3'>\n\t\t\t\t<input name='input_276' type='radio' value='3'  id='choice_10_276_3'    \/>\n\t\t\t\t<label for='choice_10_276_3' id='label_10_276_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_279\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_279\"><label class='gfield_label gform-field-label'  >Sheath Removal<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_279'>\n\t\t\t<li class='gchoice gchoice_10_279_0'>\n\t\t\t\t<input name='input_279' type='radio' value='0'  id='choice_10_279_0'    \/>\n\t\t\t\t<label for='choice_10_279_0' id='label_10_279_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_279_1'>\n\t\t\t\t<input name='input_279' type='radio' value='1'  id='choice_10_279_1'    \/>\n\t\t\t\t<label for='choice_10_279_1' id='label_10_279_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_279_2'>\n\t\t\t\t<input name='input_279' type='radio' value='2'  id='choice_10_279_2'    \/>\n\t\t\t\t<label for='choice_10_279_2' id='label_10_279_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_279_3'>\n\t\t\t\t<input name='input_279' type='radio' value='3'  id='choice_10_279_3'    \/>\n\t\t\t\t<label for='choice_10_279_3' id='label_10_279_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_106\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_106\"><h2 class=\"gsection_title\">CARDIAC - Care of Patient With:<\/h2><\/li><li id=\"field_10_107\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_107\"><label class='gfield_label gform-field-label'  >Angina<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_107'>\n\t\t\t<li class='gchoice gchoice_10_107_0'>\n\t\t\t\t<input name='input_107' type='radio' value='0'  id='choice_10_107_0'    \/>\n\t\t\t\t<label for='choice_10_107_0' id='label_10_107_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_107_1'>\n\t\t\t\t<input name='input_107' type='radio' value='1'  id='choice_10_107_1'    \/>\n\t\t\t\t<label for='choice_10_107_1' id='label_10_107_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_107_2'>\n\t\t\t\t<input name='input_107' type='radio' value='2'  id='choice_10_107_2'    \/>\n\t\t\t\t<label for='choice_10_107_2' id='label_10_107_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_107_3'>\n\t\t\t\t<input name='input_107' type='radio' value='3'  id='choice_10_107_3'    \/>\n\t\t\t\t<label for='choice_10_107_3' id='label_10_107_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_109\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_109\"><label class='gfield_label gform-field-label'  >CHF<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_109'>\n\t\t\t<li class='gchoice gchoice_10_109_0'>\n\t\t\t\t<input name='input_109' type='radio' value='0'  id='choice_10_109_0'    \/>\n\t\t\t\t<label for='choice_10_109_0' id='label_10_109_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_109_1'>\n\t\t\t\t<input name='input_109' type='radio' value='1'  id='choice_10_109_1'    \/>\n\t\t\t\t<label for='choice_10_109_1' id='label_10_109_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_109_2'>\n\t\t\t\t<input name='input_109' type='radio' value='2'  id='choice_10_109_2'    \/>\n\t\t\t\t<label for='choice_10_109_2' id='label_10_109_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_109_3'>\n\t\t\t\t<input name='input_109' type='radio' value='3'  id='choice_10_109_3'    \/>\n\t\t\t\t<label for='choice_10_109_3' id='label_10_109_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_108\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_108\"><label class='gfield_label gform-field-label'  >Post MI<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_108'>\n\t\t\t<li class='gchoice gchoice_10_108_0'>\n\t\t\t\t<input name='input_108' type='radio' value='0'  id='choice_10_108_0'    \/>\n\t\t\t\t<label for='choice_10_108_0' id='label_10_108_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_108_1'>\n\t\t\t\t<input name='input_108' type='radio' value='1'  id='choice_10_108_1'    \/>\n\t\t\t\t<label for='choice_10_108_1' id='label_10_108_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_108_2'>\n\t\t\t\t<input name='input_108' type='radio' value='2'  id='choice_10_108_2'    \/>\n\t\t\t\t<label for='choice_10_108_2' id='label_10_108_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_108_3'>\n\t\t\t\t<input name='input_108' type='radio' value='3'  id='choice_10_108_3'    \/>\n\t\t\t\t<label for='choice_10_108_3' id='label_10_108_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_288\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_288\"><label class='gfield_label gform-field-label'  >Pre\/Post Cardiac Cath<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_288'>\n\t\t\t<li class='gchoice gchoice_10_288_0'>\n\t\t\t\t<input name='input_288' type='radio' value='0'  id='choice_10_288_0'    \/>\n\t\t\t\t<label for='choice_10_288_0' id='label_10_288_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_288_1'>\n\t\t\t\t<input name='input_288' type='radio' value='1'  id='choice_10_288_1'    \/>\n\t\t\t\t<label for='choice_10_288_1' id='label_10_288_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_288_2'>\n\t\t\t\t<input name='input_288' type='radio' value='2'  id='choice_10_288_2'    \/>\n\t\t\t\t<label for='choice_10_288_2' id='label_10_288_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_288_3'>\n\t\t\t\t<input name='input_288' type='radio' value='3'  id='choice_10_288_3'    \/>\n\t\t\t\t<label for='choice_10_288_3' id='label_10_288_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_287\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_287\"><label class='gfield_label gform-field-label'  >Pre\/Post Cardiac Surgery<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_287'>\n\t\t\t<li class='gchoice gchoice_10_287_0'>\n\t\t\t\t<input name='input_287' type='radio' value='0'  id='choice_10_287_0'    \/>\n\t\t\t\t<label for='choice_10_287_0' id='label_10_287_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_287_1'>\n\t\t\t\t<input name='input_287' type='radio' value='1'  id='choice_10_287_1'    \/>\n\t\t\t\t<label for='choice_10_287_1' id='label_10_287_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_287_2'>\n\t\t\t\t<input name='input_287' type='radio' value='2'  id='choice_10_287_2'    \/>\n\t\t\t\t<label for='choice_10_287_2' id='label_10_287_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_287_3'>\n\t\t\t\t<input name='input_287' type='radio' value='3'  id='choice_10_287_3'    \/>\n\t\t\t\t<label for='choice_10_287_3' id='label_10_287_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_290\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_290\"><label class='gfield_label gform-field-label'  >Open Sternal Wound (Debridement)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_290'>\n\t\t\t<li class='gchoice gchoice_10_290_0'>\n\t\t\t\t<input name='input_290' type='radio' value='0'  id='choice_10_290_0'    \/>\n\t\t\t\t<label for='choice_10_290_0' id='label_10_290_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_290_1'>\n\t\t\t\t<input name='input_290' type='radio' value='1'  id='choice_10_290_1'    \/>\n\t\t\t\t<label for='choice_10_290_1' id='label_10_290_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_290_2'>\n\t\t\t\t<input name='input_290' type='radio' value='2'  id='choice_10_290_2'    \/>\n\t\t\t\t<label for='choice_10_290_2' id='label_10_290_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_290_3'>\n\t\t\t\t<input name='input_290' type='radio' value='3'  id='choice_10_290_3'    \/>\n\t\t\t\t<label for='choice_10_290_3' id='label_10_290_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_289\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_289\"><label class='gfield_label gform-field-label'  >Heart Transplant<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_289'>\n\t\t\t<li class='gchoice gchoice_10_289_0'>\n\t\t\t\t<input name='input_289' type='radio' value='0'  id='choice_10_289_0'    \/>\n\t\t\t\t<label for='choice_10_289_0' id='label_10_289_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_289_1'>\n\t\t\t\t<input name='input_289' type='radio' value='1'  id='choice_10_289_1'    \/>\n\t\t\t\t<label for='choice_10_289_1' id='label_10_289_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_289_2'>\n\t\t\t\t<input name='input_289' type='radio' value='2'  id='choice_10_289_2'    \/>\n\t\t\t\t<label for='choice_10_289_2' id='label_10_289_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_289_3'>\n\t\t\t\t<input name='input_289' type='radio' value='3'  id='choice_10_289_3'    \/>\n\t\t\t\t<label for='choice_10_289_3' id='label_10_289_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_110\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_110\"><h2 class=\"gsection_title\">RESPIRATORY GENERAL SKILLS<\/h2><\/li><li id=\"field_10_129\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_129\"><label class='gfield_label gform-field-label'  >Establishing an Airway<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_129'>\n\t\t\t<li class='gchoice gchoice_10_129_0'>\n\t\t\t\t<input name='input_129' type='radio' value='0'  id='choice_10_129_0'    \/>\n\t\t\t\t<label for='choice_10_129_0' id='label_10_129_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_129_1'>\n\t\t\t\t<input name='input_129' type='radio' value='1'  id='choice_10_129_1'    \/>\n\t\t\t\t<label for='choice_10_129_1' id='label_10_129_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_129_2'>\n\t\t\t\t<input name='input_129' type='radio' value='2'  id='choice_10_129_2'    \/>\n\t\t\t\t<label for='choice_10_129_2' id='label_10_129_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_129_3'>\n\t\t\t\t<input name='input_129' type='radio' value='3'  id='choice_10_129_3'    \/>\n\t\t\t\t<label for='choice_10_129_3' id='label_10_129_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_128\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_128\"><label class='gfield_label gform-field-label'  >Ambuing Techniques<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_128'>\n\t\t\t<li class='gchoice gchoice_10_128_0'>\n\t\t\t\t<input name='input_128' type='radio' value='0'  id='choice_10_128_0'    \/>\n\t\t\t\t<label for='choice_10_128_0' id='label_10_128_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_128_1'>\n\t\t\t\t<input name='input_128' type='radio' value='1'  id='choice_10_128_1'    \/>\n\t\t\t\t<label for='choice_10_128_1' id='label_10_128_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_128_2'>\n\t\t\t\t<input name='input_128' type='radio' value='2'  id='choice_10_128_2'    \/>\n\t\t\t\t<label for='choice_10_128_2' id='label_10_128_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_128_3'>\n\t\t\t\t<input name='input_128' type='radio' value='3'  id='choice_10_128_3'    \/>\n\t\t\t\t<label for='choice_10_128_3' id='label_10_128_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_127\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_127\"><label class='gfield_label gform-field-label'  >Chest Tubes<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_127'>\n\t\t\t<li class='gchoice gchoice_10_127_0'>\n\t\t\t\t<input name='input_127' type='radio' value='0'  id='choice_10_127_0'    \/>\n\t\t\t\t<label for='choice_10_127_0' id='label_10_127_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_127_1'>\n\t\t\t\t<input name='input_127' type='radio' value='1'  id='choice_10_127_1'    \/>\n\t\t\t\t<label for='choice_10_127_1' id='label_10_127_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_127_2'>\n\t\t\t\t<input name='input_127' type='radio' value='2'  id='choice_10_127_2'    \/>\n\t\t\t\t<label for='choice_10_127_2' id='label_10_127_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_127_3'>\n\t\t\t\t<input name='input_127' type='radio' value='3'  id='choice_10_127_3'    \/>\n\t\t\t\t<label for='choice_10_127_3' id='label_10_127_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_126\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_126\"><label class='gfield_label gform-field-label'  >Pulse Oximetry<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_126'>\n\t\t\t<li class='gchoice gchoice_10_126_0'>\n\t\t\t\t<input name='input_126' type='radio' value='0'  id='choice_10_126_0'    \/>\n\t\t\t\t<label for='choice_10_126_0' id='label_10_126_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_126_1'>\n\t\t\t\t<input name='input_126' type='radio' value='1'  id='choice_10_126_1'    \/>\n\t\t\t\t<label for='choice_10_126_1' id='label_10_126_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_126_2'>\n\t\t\t\t<input name='input_126' type='radio' value='2'  id='choice_10_126_2'    \/>\n\t\t\t\t<label for='choice_10_126_2' id='label_10_126_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_126_3'>\n\t\t\t\t<input name='input_126' type='radio' value='3'  id='choice_10_126_3'    \/>\n\t\t\t\t<label for='choice_10_126_3' id='label_10_126_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_125\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_125\"><label class='gfield_label gform-field-label'  >Interpretation of ABG<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_125'>\n\t\t\t<li class='gchoice gchoice_10_125_0'>\n\t\t\t\t<input name='input_125' type='radio' value='0'  id='choice_10_125_0'    \/>\n\t\t\t\t<label for='choice_10_125_0' id='label_10_125_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_125_1'>\n\t\t\t\t<input name='input_125' type='radio' value='1'  id='choice_10_125_1'    \/>\n\t\t\t\t<label for='choice_10_125_1' id='label_10_125_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_125_2'>\n\t\t\t\t<input name='input_125' type='radio' value='2'  id='choice_10_125_2'    \/>\n\t\t\t\t<label for='choice_10_125_2' id='label_10_125_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_125_3'>\n\t\t\t\t<input name='input_125' type='radio' value='3'  id='choice_10_125_3'    \/>\n\t\t\t\t<label for='choice_10_125_3' id='label_10_125_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_124\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_124\"><label class='gfield_label gform-field-label'  >Use of IPPB<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_124'>\n\t\t\t<li class='gchoice gchoice_10_124_0'>\n\t\t\t\t<input name='input_124' type='radio' value='0'  id='choice_10_124_0'    \/>\n\t\t\t\t<label for='choice_10_124_0' id='label_10_124_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_124_1'>\n\t\t\t\t<input name='input_124' type='radio' value='1'  id='choice_10_124_1'    \/>\n\t\t\t\t<label for='choice_10_124_1' id='label_10_124_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_124_2'>\n\t\t\t\t<input name='input_124' type='radio' value='2'  id='choice_10_124_2'    \/>\n\t\t\t\t<label for='choice_10_124_2' id='label_10_124_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_124_3'>\n\t\t\t\t<input name='input_124' type='radio' value='3'  id='choice_10_124_3'    \/>\n\t\t\t\t<label for='choice_10_124_3' id='label_10_124_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_135\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_135\"><label class='gfield_label gform-field-label'  >Incentive Spirometer<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_135'>\n\t\t\t<li class='gchoice gchoice_10_135_0'>\n\t\t\t\t<input name='input_135' type='radio' value='0'  id='choice_10_135_0'    \/>\n\t\t\t\t<label for='choice_10_135_0' id='label_10_135_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_135_1'>\n\t\t\t\t<input name='input_135' type='radio' value='1'  id='choice_10_135_1'    \/>\n\t\t\t\t<label for='choice_10_135_1' id='label_10_135_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_135_2'>\n\t\t\t\t<input name='input_135' type='radio' value='2'  id='choice_10_135_2'    \/>\n\t\t\t\t<label for='choice_10_135_2' id='label_10_135_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_135_3'>\n\t\t\t\t<input name='input_135' type='radio' value='3'  id='choice_10_135_3'    \/>\n\t\t\t\t<label for='choice_10_135_3' id='label_10_135_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_319\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_319\"><h2 class=\"gsection_title\">GASTROINTESTINAL GENERAL SKILLS<\/h2><\/li><li id=\"field_10_320\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_320\"><label class='gfield_label gform-field-label'  >NG Tube Insertion, Care and Maintenance<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_320'>\n\t\t\t<li class='gchoice gchoice_10_320_0'>\n\t\t\t\t<input name='input_320' type='radio' value='0'  id='choice_10_320_0'    \/>\n\t\t\t\t<label for='choice_10_320_0' id='label_10_320_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_320_1'>\n\t\t\t\t<input name='input_320' type='radio' value='1'  id='choice_10_320_1'    \/>\n\t\t\t\t<label for='choice_10_320_1' id='label_10_320_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_320_2'>\n\t\t\t\t<input name='input_320' type='radio' value='2'  id='choice_10_320_2'    \/>\n\t\t\t\t<label for='choice_10_320_2' id='label_10_320_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_320_3'>\n\t\t\t\t<input name='input_320' type='radio' value='3'  id='choice_10_320_3'    \/>\n\t\t\t\t<label for='choice_10_320_3' id='label_10_320_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_321\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_321\"><label class='gfield_label gform-field-label'  >Gastrostomy Tube<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_321'>\n\t\t\t<li class='gchoice gchoice_10_321_0'>\n\t\t\t\t<input name='input_321' type='radio' value='0'  id='choice_10_321_0'    \/>\n\t\t\t\t<label for='choice_10_321_0' id='label_10_321_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_321_1'>\n\t\t\t\t<input name='input_321' type='radio' value='1'  id='choice_10_321_1'    \/>\n\t\t\t\t<label for='choice_10_321_1' id='label_10_321_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_321_2'>\n\t\t\t\t<input name='input_321' type='radio' value='2'  id='choice_10_321_2'    \/>\n\t\t\t\t<label for='choice_10_321_2' id='label_10_321_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_321_3'>\n\t\t\t\t<input name='input_321' type='radio' value='3'  id='choice_10_321_3'    \/>\n\t\t\t\t<label for='choice_10_321_3' id='label_10_321_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_322\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_322\"><label class='gfield_label gform-field-label'  >Jejunostomy Tube<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_322'>\n\t\t\t<li class='gchoice gchoice_10_322_0'>\n\t\t\t\t<input name='input_322' type='radio' value='0'  id='choice_10_322_0'    \/>\n\t\t\t\t<label for='choice_10_322_0' id='label_10_322_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_322_1'>\n\t\t\t\t<input name='input_322' type='radio' value='1'  id='choice_10_322_1'    \/>\n\t\t\t\t<label for='choice_10_322_1' id='label_10_322_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_322_2'>\n\t\t\t\t<input name='input_322' type='radio' value='2'  id='choice_10_322_2'    \/>\n\t\t\t\t<label for='choice_10_322_2' id='label_10_322_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_322_3'>\n\t\t\t\t<input name='input_322' type='radio' value='3'  id='choice_10_322_3'    \/>\n\t\t\t\t<label for='choice_10_322_3' id='label_10_322_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_323\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_323\"><label class='gfield_label gform-field-label'  >Enterostomal Care<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_323'>\n\t\t\t<li class='gchoice gchoice_10_323_0'>\n\t\t\t\t<input name='input_323' type='radio' value='0'  id='choice_10_323_0'    \/>\n\t\t\t\t<label for='choice_10_323_0' id='label_10_323_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_323_1'>\n\t\t\t\t<input name='input_323' type='radio' value='1'  id='choice_10_323_1'    \/>\n\t\t\t\t<label for='choice_10_323_1' id='label_10_323_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_323_2'>\n\t\t\t\t<input name='input_323' type='radio' value='2'  id='choice_10_323_2'    \/>\n\t\t\t\t<label for='choice_10_323_2' id='label_10_323_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_323_3'>\n\t\t\t\t<input name='input_323' type='radio' value='3'  id='choice_10_323_3'    \/>\n\t\t\t\t<label for='choice_10_323_3' id='label_10_323_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_324\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_324\"><label class='gfield_label gform-field-label'  >Tube feedings<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_324'>\n\t\t\t<li class='gchoice gchoice_10_324_0'>\n\t\t\t\t<input name='input_324' type='radio' value='0'  id='choice_10_324_0'    \/>\n\t\t\t\t<label for='choice_10_324_0' id='label_10_324_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_324_1'>\n\t\t\t\t<input name='input_324' type='radio' value='1'  id='choice_10_324_1'    \/>\n\t\t\t\t<label for='choice_10_324_1' id='label_10_324_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_324_2'>\n\t\t\t\t<input name='input_324' type='radio' value='2'  id='choice_10_324_2'    \/>\n\t\t\t\t<label for='choice_10_324_2' id='label_10_324_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_324_3'>\n\t\t\t\t<input name='input_324' type='radio' value='3'  id='choice_10_324_3'    \/>\n\t\t\t\t<label for='choice_10_324_3' id='label_10_324_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_325\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_325\"><h2 class=\"gsection_title\">GENITOURINARY\/RENAL GENERAL SKILLS<\/h2><\/li><li id=\"field_10_326\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_326\"><label class='gfield_label gform-field-label'  >Peritoneal Dialysis<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_326'>\n\t\t\t<li class='gchoice gchoice_10_326_0'>\n\t\t\t\t<input name='input_326' type='radio' value='0'  id='choice_10_326_0'    \/>\n\t\t\t\t<label for='choice_10_326_0' id='label_10_326_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_326_1'>\n\t\t\t\t<input name='input_326' type='radio' value='1'  id='choice_10_326_1'    \/>\n\t\t\t\t<label for='choice_10_326_1' id='label_10_326_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_326_2'>\n\t\t\t\t<input name='input_326' type='radio' value='2'  id='choice_10_326_2'    \/>\n\t\t\t\t<label for='choice_10_326_2' id='label_10_326_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_326_3'>\n\t\t\t\t<input name='input_326' type='radio' value='3'  id='choice_10_326_3'    \/>\n\t\t\t\t<label for='choice_10_326_3' id='label_10_326_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_327\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_327\"><label class='gfield_label gform-field-label'  >Hemodialysis<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_327'>\n\t\t\t<li class='gchoice gchoice_10_327_0'>\n\t\t\t\t<input name='input_327' type='radio' value='0'  id='choice_10_327_0'    \/>\n\t\t\t\t<label for='choice_10_327_0' id='label_10_327_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_327_1'>\n\t\t\t\t<input name='input_327' type='radio' value='1'  id='choice_10_327_1'    \/>\n\t\t\t\t<label for='choice_10_327_1' id='label_10_327_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_327_2'>\n\t\t\t\t<input name='input_327' type='radio' value='2'  id='choice_10_327_2'    \/>\n\t\t\t\t<label for='choice_10_327_2' id='label_10_327_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_327_3'>\n\t\t\t\t<input name='input_327' type='radio' value='3'  id='choice_10_327_3'    \/>\n\t\t\t\t<label for='choice_10_327_3' id='label_10_327_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_328\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_328\"><label class='gfield_label gform-field-label'  >Foley\/Straight Catheter Insertion<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_328'>\n\t\t\t<li class='gchoice gchoice_10_328_0'>\n\t\t\t\t<input name='input_328' type='radio' value='0'  id='choice_10_328_0'    \/>\n\t\t\t\t<label for='choice_10_328_0' id='label_10_328_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_328_1'>\n\t\t\t\t<input name='input_328' type='radio' value='1'  id='choice_10_328_1'    \/>\n\t\t\t\t<label for='choice_10_328_1' id='label_10_328_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_328_2'>\n\t\t\t\t<input name='input_328' type='radio' value='2'  id='choice_10_328_2'    \/>\n\t\t\t\t<label for='choice_10_328_2' id='label_10_328_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_328_3'>\n\t\t\t\t<input name='input_328' type='radio' value='3'  id='choice_10_328_3'    \/>\n\t\t\t\t<label for='choice_10_328_3' id='label_10_328_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_329\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_329\"><label class='gfield_label gform-field-label'  >GU Irrigations<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_329'>\n\t\t\t<li class='gchoice gchoice_10_329_0'>\n\t\t\t\t<input name='input_329' type='radio' value='0'  id='choice_10_329_0'    \/>\n\t\t\t\t<label for='choice_10_329_0' id='label_10_329_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_329_1'>\n\t\t\t\t<input name='input_329' type='radio' value='1'  id='choice_10_329_1'    \/>\n\t\t\t\t<label for='choice_10_329_1' id='label_10_329_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_329_2'>\n\t\t\t\t<input name='input_329' type='radio' value='2'  id='choice_10_329_2'    \/>\n\t\t\t\t<label for='choice_10_329_2' id='label_10_329_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_329_3'>\n\t\t\t\t<input name='input_329' type='radio' value='3'  id='choice_10_329_3'    \/>\n\t\t\t\t<label for='choice_10_329_3' id='label_10_329_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_330\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_330\"><label class='gfield_label gform-field-label'  >Nephrostomy Tube<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_330'>\n\t\t\t<li class='gchoice gchoice_10_330_0'>\n\t\t\t\t<input name='input_330' type='radio' value='0'  id='choice_10_330_0'    \/>\n\t\t\t\t<label for='choice_10_330_0' id='label_10_330_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_330_1'>\n\t\t\t\t<input name='input_330' type='radio' value='1'  id='choice_10_330_1'    \/>\n\t\t\t\t<label for='choice_10_330_1' id='label_10_330_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_330_2'>\n\t\t\t\t<input name='input_330' type='radio' value='2'  id='choice_10_330_2'    \/>\n\t\t\t\t<label for='choice_10_330_2' id='label_10_330_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_330_3'>\n\t\t\t\t<input name='input_330' type='radio' value='3'  id='choice_10_330_3'    \/>\n\t\t\t\t<label for='choice_10_330_3' id='label_10_330_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_331\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_331\"><label class='gfield_label gform-field-label'  >Suprapubic Tube<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_331'>\n\t\t\t<li class='gchoice gchoice_10_331_0'>\n\t\t\t\t<input name='input_331' type='radio' value='0'  id='choice_10_331_0'    \/>\n\t\t\t\t<label for='choice_10_331_0' id='label_10_331_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_331_1'>\n\t\t\t\t<input name='input_331' type='radio' value='1'  id='choice_10_331_1'    \/>\n\t\t\t\t<label for='choice_10_331_1' id='label_10_331_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_331_2'>\n\t\t\t\t<input name='input_331' type='radio' value='2'  id='choice_10_331_2'    \/>\n\t\t\t\t<label for='choice_10_331_2' id='label_10_331_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_331_3'>\n\t\t\t\t<input name='input_331' type='radio' value='3'  id='choice_10_331_3'    \/>\n\t\t\t\t<label for='choice_10_331_3' id='label_10_331_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_332\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_332\"><label class='gfield_label gform-field-label'  >Electrolyte Imbalance\/Replacement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_332'>\n\t\t\t<li class='gchoice gchoice_10_332_0'>\n\t\t\t\t<input name='input_332' type='radio' value='0'  id='choice_10_332_0'    \/>\n\t\t\t\t<label for='choice_10_332_0' id='label_10_332_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_332_1'>\n\t\t\t\t<input name='input_332' type='radio' value='1'  id='choice_10_332_1'    \/>\n\t\t\t\t<label for='choice_10_332_1' id='label_10_332_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_332_2'>\n\t\t\t\t<input name='input_332' type='radio' value='2'  id='choice_10_332_2'    \/>\n\t\t\t\t<label for='choice_10_332_2' id='label_10_332_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_332_3'>\n\t\t\t\t<input name='input_332' type='radio' value='3'  id='choice_10_332_3'    \/>\n\t\t\t\t<label for='choice_10_332_3' id='label_10_332_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_334\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_334\"><h2 class=\"gsection_title\">GENITOURINARY\/RENAL GENERAL SKILLS<\/h2><\/li><li id=\"field_10_333\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_333\"><label class='gfield_label gform-field-label'  >T.U.R.P.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_333'>\n\t\t\t<li class='gchoice gchoice_10_333_0'>\n\t\t\t\t<input name='input_333' type='radio' value='0'  id='choice_10_333_0'    \/>\n\t\t\t\t<label for='choice_10_333_0' id='label_10_333_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_333_1'>\n\t\t\t\t<input name='input_333' type='radio' value='1'  id='choice_10_333_1'    \/>\n\t\t\t\t<label for='choice_10_333_1' id='label_10_333_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_333_2'>\n\t\t\t\t<input name='input_333' type='radio' value='2'  id='choice_10_333_2'    \/>\n\t\t\t\t<label for='choice_10_333_2' id='label_10_333_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_333_3'>\n\t\t\t\t<input name='input_333' type='radio' value='3'  id='choice_10_333_3'    \/>\n\t\t\t\t<label for='choice_10_333_3' id='label_10_333_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_336\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_336\"><label class='gfield_label gform-field-label'  >Shunts &amp; Fistulas<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_336'>\n\t\t\t<li class='gchoice gchoice_10_336_0'>\n\t\t\t\t<input name='input_336' type='radio' value='0'  id='choice_10_336_0'    \/>\n\t\t\t\t<label for='choice_10_336_0' id='label_10_336_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_336_1'>\n\t\t\t\t<input name='input_336' type='radio' value='1'  id='choice_10_336_1'    \/>\n\t\t\t\t<label for='choice_10_336_1' id='label_10_336_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_336_2'>\n\t\t\t\t<input name='input_336' type='radio' value='2'  id='choice_10_336_2'    \/>\n\t\t\t\t<label for='choice_10_336_2' id='label_10_336_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_336_3'>\n\t\t\t\t<input name='input_336' type='radio' value='3'  id='choice_10_336_3'    \/>\n\t\t\t\t<label for='choice_10_336_3' id='label_10_336_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_335\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_335\"><label class='gfield_label gform-field-label'  >Nephrectomy<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_335'>\n\t\t\t<li class='gchoice gchoice_10_335_0'>\n\t\t\t\t<input name='input_335' type='radio' value='0'  id='choice_10_335_0'    \/>\n\t\t\t\t<label for='choice_10_335_0' id='label_10_335_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_335_1'>\n\t\t\t\t<input name='input_335' type='radio' value='1'  id='choice_10_335_1'    \/>\n\t\t\t\t<label for='choice_10_335_1' id='label_10_335_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_335_2'>\n\t\t\t\t<input name='input_335' type='radio' value='2'  id='choice_10_335_2'    \/>\n\t\t\t\t<label for='choice_10_335_2' id='label_10_335_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_335_3'>\n\t\t\t\t<input name='input_335' type='radio' value='3'  id='choice_10_335_3'    \/>\n\t\t\t\t<label for='choice_10_335_3' id='label_10_335_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_338\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_338\"><label class='gfield_label gform-field-label'  >Renal Transplant<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_338'>\n\t\t\t<li class='gchoice gchoice_10_338_0'>\n\t\t\t\t<input name='input_338' type='radio' value='0'  id='choice_10_338_0'    \/>\n\t\t\t\t<label for='choice_10_338_0' id='label_10_338_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_338_1'>\n\t\t\t\t<input name='input_338' type='radio' value='1'  id='choice_10_338_1'    \/>\n\t\t\t\t<label for='choice_10_338_1' id='label_10_338_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_338_2'>\n\t\t\t\t<input name='input_338' type='radio' value='2'  id='choice_10_338_2'    \/>\n\t\t\t\t<label for='choice_10_338_2' id='label_10_338_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_338_3'>\n\t\t\t\t<input name='input_338' type='radio' value='3'  id='choice_10_338_3'    \/>\n\t\t\t\t<label for='choice_10_338_3' id='label_10_338_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_337\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_337\"><label class='gfield_label gform-field-label'  >Renal Trauma<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_337'>\n\t\t\t<li class='gchoice gchoice_10_337_0'>\n\t\t\t\t<input name='input_337' type='radio' value='0'  id='choice_10_337_0'    \/>\n\t\t\t\t<label for='choice_10_337_0' id='label_10_337_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_337_1'>\n\t\t\t\t<input name='input_337' type='radio' value='1'  id='choice_10_337_1'    \/>\n\t\t\t\t<label for='choice_10_337_1' id='label_10_337_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_337_2'>\n\t\t\t\t<input name='input_337' type='radio' value='2'  id='choice_10_337_2'    \/>\n\t\t\t\t<label for='choice_10_337_2' id='label_10_337_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_337_3'>\n\t\t\t\t<input name='input_337' type='radio' value='3'  id='choice_10_337_3'    \/>\n\t\t\t\t<label for='choice_10_337_3' id='label_10_337_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_339\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_339\"><label class='gfield_label gform-field-label'  >Chronic\/Acute Renal Failure<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_339'>\n\t\t\t<li class='gchoice gchoice_10_339_0'>\n\t\t\t\t<input name='input_339' type='radio' value='0'  id='choice_10_339_0'    \/>\n\t\t\t\t<label for='choice_10_339_0' id='label_10_339_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_339_1'>\n\t\t\t\t<input name='input_339' type='radio' value='1'  id='choice_10_339_1'    \/>\n\t\t\t\t<label for='choice_10_339_1' id='label_10_339_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_339_2'>\n\t\t\t\t<input name='input_339' type='radio' value='2'  id='choice_10_339_2'    \/>\n\t\t\t\t<label for='choice_10_339_2' id='label_10_339_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_339_3'>\n\t\t\t\t<input name='input_339' type='radio' value='3'  id='choice_10_339_3'    \/>\n\t\t\t\t<label for='choice_10_339_3' id='label_10_339_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_340\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_340\"><h2 class=\"gsection_title\">GYNECOLOGY GENERAL SKILLS<\/h2><\/li><li id=\"field_10_343\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_343\"><label class='gfield_label gform-field-label'  >GYN Exam\/Pap<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_343'>\n\t\t\t<li class='gchoice gchoice_10_343_0'>\n\t\t\t\t<input name='input_343' type='radio' value='0'  id='choice_10_343_0'    \/>\n\t\t\t\t<label for='choice_10_343_0' id='label_10_343_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_343_1'>\n\t\t\t\t<input name='input_343' type='radio' value='1'  id='choice_10_343_1'    \/>\n\t\t\t\t<label for='choice_10_343_1' id='label_10_343_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_343_2'>\n\t\t\t\t<input name='input_343' type='radio' value='2'  id='choice_10_343_2'    \/>\n\t\t\t\t<label for='choice_10_343_2' id='label_10_343_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_343_3'>\n\t\t\t\t<input name='input_343' type='radio' value='3'  id='choice_10_343_3'    \/>\n\t\t\t\t<label for='choice_10_343_3' id='label_10_343_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_342\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_342\"><h2 class=\"gsection_title\">GYNECOLOGY - Care of Patient With:<\/h2><\/li><li id=\"field_10_341\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_341\"><label class='gfield_label gform-field-label'  >Ectopic Pregnancy\/Ruptured Ectopic Pregnancy<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_341'>\n\t\t\t<li class='gchoice gchoice_10_341_0'>\n\t\t\t\t<input name='input_341' type='radio' value='0'  id='choice_10_341_0'    \/>\n\t\t\t\t<label for='choice_10_341_0' id='label_10_341_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_341_1'>\n\t\t\t\t<input name='input_341' type='radio' value='1'  id='choice_10_341_1'    \/>\n\t\t\t\t<label for='choice_10_341_1' id='label_10_341_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_341_2'>\n\t\t\t\t<input name='input_341' type='radio' value='2'  id='choice_10_341_2'    \/>\n\t\t\t\t<label for='choice_10_341_2' id='label_10_341_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_341_3'>\n\t\t\t\t<input name='input_341' type='radio' value='3'  id='choice_10_341_3'    \/>\n\t\t\t\t<label for='choice_10_341_3' id='label_10_341_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_344\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_344\"><label class='gfield_label gform-field-label'  >Hysterectomy<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_344'>\n\t\t\t<li class='gchoice gchoice_10_344_0'>\n\t\t\t\t<input name='input_344' type='radio' value='0'  id='choice_10_344_0'    \/>\n\t\t\t\t<label for='choice_10_344_0' id='label_10_344_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_344_1'>\n\t\t\t\t<input name='input_344' type='radio' value='1'  id='choice_10_344_1'    \/>\n\t\t\t\t<label for='choice_10_344_1' id='label_10_344_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_344_2'>\n\t\t\t\t<input name='input_344' type='radio' value='2'  id='choice_10_344_2'    \/>\n\t\t\t\t<label for='choice_10_344_2' id='label_10_344_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_344_3'>\n\t\t\t\t<input name='input_344' type='radio' value='3'  id='choice_10_344_3'    \/>\n\t\t\t\t<label for='choice_10_344_3' id='label_10_344_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_346\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_346\"><h2 class=\"gsection_title\">ORTHOPEDIC GENERAL SKILLS<\/h2><\/li><li id=\"field_10_345\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_345\"><label class='gfield_label gform-field-label'  >Assessment of C\/M\/S<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_345'>\n\t\t\t<li class='gchoice gchoice_10_345_0'>\n\t\t\t\t<input name='input_345' type='radio' value='0'  id='choice_10_345_0'    \/>\n\t\t\t\t<label for='choice_10_345_0' id='label_10_345_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_345_1'>\n\t\t\t\t<input name='input_345' type='radio' value='1'  id='choice_10_345_1'    \/>\n\t\t\t\t<label for='choice_10_345_1' id='label_10_345_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_345_2'>\n\t\t\t\t<input name='input_345' type='radio' value='2'  id='choice_10_345_2'    \/>\n\t\t\t\t<label for='choice_10_345_2' id='label_10_345_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_345_3'>\n\t\t\t\t<input name='input_345' type='radio' value='3'  id='choice_10_345_3'    \/>\n\t\t\t\t<label for='choice_10_345_3' id='label_10_345_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_347\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_347\"><label class='gfield_label gform-field-label'  >K-Wires\/Steinman Pins<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_347'>\n\t\t\t<li class='gchoice gchoice_10_347_0'>\n\t\t\t\t<input name='input_347' type='radio' value='0'  id='choice_10_347_0'    \/>\n\t\t\t\t<label for='choice_10_347_0' id='label_10_347_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_347_1'>\n\t\t\t\t<input name='input_347' type='radio' value='1'  id='choice_10_347_1'    \/>\n\t\t\t\t<label for='choice_10_347_1' id='label_10_347_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_347_2'>\n\t\t\t\t<input name='input_347' type='radio' value='2'  id='choice_10_347_2'    \/>\n\t\t\t\t<label for='choice_10_347_2' id='label_10_347_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_347_3'>\n\t\t\t\t<input name='input_347' type='radio' value='3'  id='choice_10_347_3'    \/>\n\t\t\t\t<label for='choice_10_347_3' id='label_10_347_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_348\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_348\"><label class='gfield_label gform-field-label'  >Removal of Hardware<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_348'>\n\t\t\t<li class='gchoice gchoice_10_348_0'>\n\t\t\t\t<input name='input_348' type='radio' value='0'  id='choice_10_348_0'    \/>\n\t\t\t\t<label for='choice_10_348_0' id='label_10_348_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_348_1'>\n\t\t\t\t<input name='input_348' type='radio' value='1'  id='choice_10_348_1'    \/>\n\t\t\t\t<label for='choice_10_348_1' id='label_10_348_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_348_2'>\n\t\t\t\t<input name='input_348' type='radio' value='2'  id='choice_10_348_2'    \/>\n\t\t\t\t<label for='choice_10_348_2' id='label_10_348_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_348_3'>\n\t\t\t\t<input name='input_348' type='radio' value='3'  id='choice_10_348_3'    \/>\n\t\t\t\t<label for='choice_10_348_3' id='label_10_348_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_349\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_349\"><h2 class=\"gsection_title\">ORTHOPEDIC - Care of Patient With:<\/h2><\/li><li id=\"field_10_350\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_350\"><label class='gfield_label gform-field-label'  >Total Joint Replacement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_350'>\n\t\t\t<li class='gchoice gchoice_10_350_0'>\n\t\t\t\t<input name='input_350' type='radio' value='0'  id='choice_10_350_0'    \/>\n\t\t\t\t<label for='choice_10_350_0' id='label_10_350_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_350_1'>\n\t\t\t\t<input name='input_350' type='radio' value='1'  id='choice_10_350_1'    \/>\n\t\t\t\t<label for='choice_10_350_1' id='label_10_350_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_350_2'>\n\t\t\t\t<input name='input_350' type='radio' value='2'  id='choice_10_350_2'    \/>\n\t\t\t\t<label for='choice_10_350_2' id='label_10_350_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_350_3'>\n\t\t\t\t<input name='input_350' type='radio' value='3'  id='choice_10_350_3'    \/>\n\t\t\t\t<label for='choice_10_350_3' id='label_10_350_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_351\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_351\"><label class='gfield_label gform-field-label'  >Spica Cast\/Body Cast<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_351'>\n\t\t\t<li class='gchoice gchoice_10_351_0'>\n\t\t\t\t<input name='input_351' type='radio' value='0'  id='choice_10_351_0'    \/>\n\t\t\t\t<label for='choice_10_351_0' id='label_10_351_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_351_1'>\n\t\t\t\t<input name='input_351' type='radio' value='1'  id='choice_10_351_1'    \/>\n\t\t\t\t<label for='choice_10_351_1' id='label_10_351_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_351_2'>\n\t\t\t\t<input name='input_351' type='radio' value='2'  id='choice_10_351_2'    \/>\n\t\t\t\t<label for='choice_10_351_2' id='label_10_351_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_351_3'>\n\t\t\t\t<input name='input_351' type='radio' value='3'  id='choice_10_351_3'    \/>\n\t\t\t\t<label for='choice_10_351_3' id='label_10_351_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_352\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_352\"><label class='gfield_label gform-field-label'  >Amputation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_352'>\n\t\t\t<li class='gchoice gchoice_10_352_0'>\n\t\t\t\t<input name='input_352' type='radio' value='0'  id='choice_10_352_0'    \/>\n\t\t\t\t<label for='choice_10_352_0' id='label_10_352_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_352_1'>\n\t\t\t\t<input name='input_352' type='radio' value='1'  id='choice_10_352_1'    \/>\n\t\t\t\t<label for='choice_10_352_1' id='label_10_352_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_352_2'>\n\t\t\t\t<input name='input_352' type='radio' value='2'  id='choice_10_352_2'    \/>\n\t\t\t\t<label for='choice_10_352_2' id='label_10_352_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_352_3'>\n\t\t\t\t<input name='input_352' type='radio' value='3'  id='choice_10_352_3'    \/>\n\t\t\t\t<label for='choice_10_352_3' id='label_10_352_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_353\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_353\"><label class='gfield_label gform-field-label'  >Traction<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_353'>\n\t\t\t<li class='gchoice gchoice_10_353_0'>\n\t\t\t\t<input name='input_353' type='radio' value='0'  id='choice_10_353_0'    \/>\n\t\t\t\t<label for='choice_10_353_0' id='label_10_353_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_353_1'>\n\t\t\t\t<input name='input_353' type='radio' value='1'  id='choice_10_353_1'    \/>\n\t\t\t\t<label for='choice_10_353_1' id='label_10_353_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_353_2'>\n\t\t\t\t<input name='input_353' type='radio' value='2'  id='choice_10_353_2'    \/>\n\t\t\t\t<label for='choice_10_353_2' id='label_10_353_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_353_3'>\n\t\t\t\t<input name='input_353' type='radio' value='3'  id='choice_10_353_3'    \/>\n\t\t\t\t<label for='choice_10_353_3' id='label_10_353_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_355\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_355\"><label class='gfield_label gform-field-label'  >Ortho Trauma<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_355'>\n\t\t\t<li class='gchoice gchoice_10_355_0'>\n\t\t\t\t<input name='input_355' type='radio' value='0'  id='choice_10_355_0'    \/>\n\t\t\t\t<label for='choice_10_355_0' id='label_10_355_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_355_1'>\n\t\t\t\t<input name='input_355' type='radio' value='1'  id='choice_10_355_1'    \/>\n\t\t\t\t<label for='choice_10_355_1' id='label_10_355_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_355_2'>\n\t\t\t\t<input name='input_355' type='radio' value='2'  id='choice_10_355_2'    \/>\n\t\t\t\t<label for='choice_10_355_2' id='label_10_355_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_355_3'>\n\t\t\t\t<input name='input_355' type='radio' value='3'  id='choice_10_355_3'    \/>\n\t\t\t\t<label for='choice_10_355_3' id='label_10_355_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_354\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_354\"><label class='gfield_label gform-field-label'  >Laminectomy<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_354'>\n\t\t\t<li class='gchoice gchoice_10_354_0'>\n\t\t\t\t<input name='input_354' type='radio' value='0'  id='choice_10_354_0'    \/>\n\t\t\t\t<label for='choice_10_354_0' id='label_10_354_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_354_1'>\n\t\t\t\t<input name='input_354' type='radio' value='1'  id='choice_10_354_1'    \/>\n\t\t\t\t<label for='choice_10_354_1' id='label_10_354_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_354_2'>\n\t\t\t\t<input name='input_354' type='radio' value='2'  id='choice_10_354_2'    \/>\n\t\t\t\t<label for='choice_10_354_2' id='label_10_354_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_354_3'>\n\t\t\t\t<input name='input_354' type='radio' value='3'  id='choice_10_354_3'    \/>\n\t\t\t\t<label for='choice_10_354_3' id='label_10_354_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_356\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_356\"><h2 class=\"gsection_title\">ENDOCRINE GENERAL SKILLS<\/h2><\/li><li id=\"field_10_357\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_357\"><label class='gfield_label gform-field-label'  >Diabetic Teaching<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_357'>\n\t\t\t<li class='gchoice gchoice_10_357_0'>\n\t\t\t\t<input name='input_357' type='radio' value='0'  id='choice_10_357_0'    \/>\n\t\t\t\t<label for='choice_10_357_0' id='label_10_357_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_357_1'>\n\t\t\t\t<input name='input_357' type='radio' value='1'  id='choice_10_357_1'    \/>\n\t\t\t\t<label for='choice_10_357_1' id='label_10_357_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_357_2'>\n\t\t\t\t<input name='input_357' type='radio' value='2'  id='choice_10_357_2'    \/>\n\t\t\t\t<label for='choice_10_357_2' id='label_10_357_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_357_3'>\n\t\t\t\t<input name='input_357' type='radio' value='3'  id='choice_10_357_3'    \/>\n\t\t\t\t<label for='choice_10_357_3' id='label_10_357_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_358\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_358\"><label class='gfield_label gform-field-label'  >Blood Glucose Monitoring<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_358'>\n\t\t\t<li class='gchoice gchoice_10_358_0'>\n\t\t\t\t<input name='input_358' type='radio' value='0'  id='choice_10_358_0'    \/>\n\t\t\t\t<label for='choice_10_358_0' id='label_10_358_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_358_1'>\n\t\t\t\t<input name='input_358' type='radio' value='1'  id='choice_10_358_1'    \/>\n\t\t\t\t<label for='choice_10_358_1' id='label_10_358_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_358_2'>\n\t\t\t\t<input name='input_358' type='radio' value='2'  id='choice_10_358_2'    \/>\n\t\t\t\t<label for='choice_10_358_2' id='label_10_358_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_358_3'>\n\t\t\t\t<input name='input_358' type='radio' value='3'  id='choice_10_358_3'    \/>\n\t\t\t\t<label for='choice_10_358_3' id='label_10_358_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_359\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_359\"><h2 class=\"gsection_title\">ENDOCRINE - Care of Patient With:<\/h2><\/li><li id=\"field_10_360\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_360\"><label class='gfield_label gform-field-label'  >Hyper\/Hypoglycemia<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_360'>\n\t\t\t<li class='gchoice gchoice_10_360_0'>\n\t\t\t\t<input name='input_360' type='radio' value='0'  id='choice_10_360_0'    \/>\n\t\t\t\t<label for='choice_10_360_0' id='label_10_360_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_360_1'>\n\t\t\t\t<input name='input_360' type='radio' value='1'  id='choice_10_360_1'    \/>\n\t\t\t\t<label for='choice_10_360_1' id='label_10_360_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_360_2'>\n\t\t\t\t<input name='input_360' type='radio' value='2'  id='choice_10_360_2'    \/>\n\t\t\t\t<label for='choice_10_360_2' id='label_10_360_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_360_3'>\n\t\t\t\t<input name='input_360' type='radio' value='3'  id='choice_10_360_3'    \/>\n\t\t\t\t<label for='choice_10_360_3' id='label_10_360_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_361\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_361\"><h2 class=\"gsection_title\">MEDICATION KNOWLEDGE AND USE OF:<\/h2><\/li><li id=\"field_10_362\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_362\"><label class='gfield_label gform-field-label'  >Insulin (IV,SQ)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_362'>\n\t\t\t<li class='gchoice gchoice_10_362_0'>\n\t\t\t\t<input name='input_362' type='radio' value='0'  id='choice_10_362_0'    \/>\n\t\t\t\t<label for='choice_10_362_0' id='label_10_362_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_362_1'>\n\t\t\t\t<input name='input_362' type='radio' value='1'  id='choice_10_362_1'    \/>\n\t\t\t\t<label for='choice_10_362_1' id='label_10_362_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_362_2'>\n\t\t\t\t<input name='input_362' type='radio' value='2'  id='choice_10_362_2'    \/>\n\t\t\t\t<label for='choice_10_362_2' id='label_10_362_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_362_3'>\n\t\t\t\t<input name='input_362' type='radio' value='3'  id='choice_10_362_3'    \/>\n\t\t\t\t<label for='choice_10_362_3' id='label_10_362_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_363\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_363\"><label class='gfield_label gform-field-label'  >D50<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_363'>\n\t\t\t<li class='gchoice gchoice_10_363_0'>\n\t\t\t\t<input name='input_363' type='radio' value='0'  id='choice_10_363_0'    \/>\n\t\t\t\t<label for='choice_10_363_0' id='label_10_363_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_363_1'>\n\t\t\t\t<input name='input_363' type='radio' value='1'  id='choice_10_363_1'    \/>\n\t\t\t\t<label for='choice_10_363_1' id='label_10_363_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_363_2'>\n\t\t\t\t<input name='input_363' type='radio' value='2'  id='choice_10_363_2'    \/>\n\t\t\t\t<label for='choice_10_363_2' id='label_10_363_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_363_3'>\n\t\t\t\t<input name='input_363' type='radio' value='3'  id='choice_10_363_3'    \/>\n\t\t\t\t<label for='choice_10_363_3' id='label_10_363_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_366\"  class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_inline checklist_input_line field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_366\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >CARDIAC MONITORS:<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_10_366'><li class='gchoice gchoice_10_366_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_366.1' type='checkbox'  value='Hewlett-Packard'  id='choice_10_366_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_366_1' id='label_10_366_1' class='gform-field-label gform-field-label--type-inline'>Hewlett-Packard<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_366_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_366.2' type='checkbox'  value='Lifecare'  id='choice_10_366_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_366_2' id='label_10_366_2' class='gform-field-label gform-field-label--type-inline'>Lifecare<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_366_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_366.3' type='checkbox'  value='Marquette'  id='choice_10_366_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_366_3' id='label_10_366_3' class='gform-field-label gform-field-label--type-inline'>Marquette<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_366_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_366.4' type='checkbox'  value='Menne'  id='choice_10_366_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_366_4' id='label_10_366_4' class='gform-field-label gform-field-label--type-inline'>Menne<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_366_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_366.5' type='checkbox'  value='Nihon-Koder'  id='choice_10_366_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_366_5' id='label_10_366_5' class='gform-field-label gform-field-label--type-inline'>Nihon-Koder<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_366_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_366.6' type='checkbox'  value='Other'  id='choice_10_366_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_366_6' id='label_10_366_6' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_366_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_366.7' type='checkbox'  value='Siemens'  id='choice_10_366_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_366_7' id='label_10_366_7' class='gform-field-label gform-field-label--type-inline'>Siemens<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_366_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_366.8' type='checkbox'  value='Spacelab'  id='choice_10_366_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_366_8' id='label_10_366_8' class='gform-field-label gform-field-label--type-inline'>Spacelab<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_366_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_366.9' type='checkbox'  value='N\/A'  id='choice_10_366_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_366_9' id='label_10_366_9' class='gform-field-label gform-field-label--type-inline'>N\/A<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_364\"  class=\"gfield gfield--type-text gf_list_inline checklist_input_line field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_364\"><label class='gfield_label gform-field-label' for='input_10_364' >Other Cardiac Monitors:<\/label><div class='ginput_container ginput_container_text'><input name='input_364' id='input_10_364' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_10_367\"  class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_inline checklist_input_line field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_367\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >VENTILATORS:<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_10_367'><li class='gchoice gchoice_10_367_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_367.1' type='checkbox'  value='Bear'  id='choice_10_367_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_367_1' id='label_10_367_1' class='gform-field-label gform-field-label--type-inline'>Bear<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_367_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_367.2' type='checkbox'  value='Bennett 7200'  id='choice_10_367_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_367_2' id='label_10_367_2' class='gform-field-label gform-field-label--type-inline'>Bennett 7200<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_367_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_367.3' type='checkbox'  value='CPAP'  id='choice_10_367_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_367_3' id='label_10_367_3' class='gform-field-label gform-field-label--type-inline'>CPAP<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_367_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_367.4' type='checkbox'  value='Emerson'  id='choice_10_367_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_367_4' id='label_10_367_4' class='gform-field-label gform-field-label--type-inline'>Emerson<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_367_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_367.5' type='checkbox'  value='EMV'  id='choice_10_367_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_367_5' id='label_10_367_5' class='gform-field-label gform-field-label--type-inline'>EMV<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_367_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_367.6' type='checkbox'  value='Engstrom\/Erica'  id='choice_10_367_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_367_6' id='label_10_367_6' class='gform-field-label gform-field-label--type-inline'>Engstrom\/Erica<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_367_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_367.7' type='checkbox'  value='MA-I'  id='choice_10_367_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_367_7' id='label_10_367_7' class='gform-field-label gform-field-label--type-inline'>MA-I<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_367_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_367.8' type='checkbox'  value='MA-II'  id='choice_10_367_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_367_8' id='label_10_367_8' class='gform-field-label gform-field-label--type-inline'>MA-II<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_367_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_367.9' type='checkbox'  value='Monihan'  id='choice_10_367_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_367_9' id='label_10_367_9' class='gform-field-label gform-field-label--type-inline'>Monihan<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_367_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_367.11' type='checkbox'  value='Ohio 560'  id='choice_10_367_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_367_11' id='label_10_367_11' class='gform-field-label gform-field-label--type-inline'>Ohio 560<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_367_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_367.12' type='checkbox'  value='Other'  id='choice_10_367_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_367_12' id='label_10_367_12' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_367_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_367.13' type='checkbox'  value='PEEP'  id='choice_10_367_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_367_13' id='label_10_367_13' class='gform-field-label gform-field-label--type-inline'>PEEP<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_367_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_367.14' type='checkbox'  value='Pressure Pre-set'  id='choice_10_367_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_367_14' id='label_10_367_14' class='gform-field-label gform-field-label--type-inline'>Pressure Pre-set<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_367_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_367.15' type='checkbox'  value='Servo'  id='choice_10_367_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_367_15' id='label_10_367_15' class='gform-field-label gform-field-label--type-inline'>Servo<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_367_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_367.16' type='checkbox'  value='Siemens'  id='choice_10_367_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_367_16' id='label_10_367_16' class='gform-field-label gform-field-label--type-inline'>Siemens<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_367_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_367.17' type='checkbox'  value='N\/A'  id='choice_10_367_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_367_17' id='label_10_367_17' class='gform-field-label gform-field-label--type-inline'>N\/A<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_365\"  class=\"gfield gfield--type-text gf_list_inline checklist_input_line field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_365\"><label class='gfield_label gform-field-label' for='input_10_365' >Other Ventilator\/Weaning:<\/label><div class='ginput_container ginput_container_text'><input name='input_365' id='input_10_365' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_10_373\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_373\"><label class='gfield_label gform-field-label' for='input_10_373' >Your Initials<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_373' id='input_10_373' type='text' value='' class='large'  aria-describedby=\"gfield_description_10_373\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_10_373'>I hereby certify that all information contained on this application is true and complete. <\/div><\/li><li id=\"field_10_372\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_372\"><label class='gfield_label gform-field-label' for='input_10_372' >Today&#039;s Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_372' id='input_10_372' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_10_375\"  class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_375\"><label class='gfield_label gform-field-label' for='input_10_375' >Name<\/label><div class='ginput_container'><input name='input_375' id='input_10_375' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_10_375'>This field is for validation purposes and should be left unchanged.<\/div><\/li><\/ul><\/div>\n        <div class='gform_footer left_label'> <input type='submit' id='gform_submit_button_10' class='gform_button button' value='Submit'  onclick='if(window[\"gf_submitting_10\"]){return false;}  if( !jQuery(\"#gform_10\")[0].checkValidity || jQuery(\"#gform_10\")[0].checkValidity()){window[\"gf_submitting_10\"]=true;}  ' 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);\n<\/script>\n<\/div>\n\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\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Telemetry \/ Progressive Care Unit RN Skills Checklist &nbsp; Telemetry \/ Progressive Care Unit RN Skills Checklist Back to Skills Checklist Main Please rate your experience \/ frequency (within the last year) using the following scale (check the appropriate boxes below): 0 = No Experience \/ Observed Only 1 = Limited Experience \/ Rarely Done&hellip; <a class=\"more-link\" href=\"https:\/\/phaxis.com\/travel-healthcare\/skills-checklist\/telemetry-progressive-care-unit-rn-skills-checklist\/\">Continue reading <span class=\"screen-reader-text\">Telemetry \/ Progressive Care Unit RN Skills Checklist<\/span><\/a><\/p>\n","protected":false},"author":4,"featured_media":0,"parent":586,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v21.5 (Yoast SEO v21.5) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Telemetry \/ Progressive Care Unit Rn - Phaxis<\/title>\n<meta name=\"description\" content=\"Careers in Telemetry \/ Progressive Care Unit RN with phaxis are easier to build. 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