{"id":4302,"date":"2022-02-18T14:50:04","date_gmt":"2022-02-18T14:50:04","guid":{"rendered":"https:\/\/phaxis.com\/?page_id=4302"},"modified":"2022-09-07T19:11:00","modified_gmt":"2022-09-07T19:11:00","slug":"echo-tech-skills-checklist","status":"publish","type":"page","link":"https:\/\/phaxis.com\/travel-healthcare\/skills-checklist\/echo-tech-skills-checklist\/","title":{"rendered":"Echo Tech Skills Checklist"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"4302\" class=\"elementor elementor-4302\" 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-254d6261 elementor-section-height-min-height elementor-section-boxed elementor-section-height-default jltma-glass-effect-no\" data-id=\"254d6261\" 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-f906d3 jltma-glass-effect-no\" data-id=\"f906d3\" 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-2c2ad075 elementor-section-height-min-height elementor-section-items-stretch elementor-section-full_width elementor-section-height-default jltma-glass-effect-no\" data-id=\"2c2ad075\" 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-380339d2 jltma-glass-effect-no\" data-id=\"380339d2\" 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-18e30828 elementor-section-full_width elementor-section-content-top elementor-section-height-default elementor-section-height-default jltma-glass-effect-no\" data-id=\"18e30828\" 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-48d37967 jltma-glass-effect-no\" data-id=\"48d37967\" 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-470c65d4 jltma-glass-effect-no\" data-id=\"470c65d4\" 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-32c6b543 jltma-glass-effect-no elementor-widget elementor-widget-heading\" data-id=\"32c6b543\" 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\">Echo Tech 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-5b860474 jltma-glass-effect-no\" data-id=\"5b860474\" 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-20c55b85 elementor-view-default jltma-glass-effect-no elementor-widget elementor-widget-icon\" data-id=\"20c55b85\" 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\">Echo Tech 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_unknown gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_29' ><div id='gf_29' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_29' id='gform_29'  action='\/wp-json\/wp\/v2\/pages\/4302#gf_29' data-formid='29' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LdLS5EpAAAAAO0o7fTdC6pgFHgLhNboc1UfgiHJ' data-tabindex='0'><input id=\"input_ca9166898dd4e28ce35a7533051f49d6\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_ca9166898dd4e28ce35a7533051f49d6\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><ul id='gform_fields_29' class='gform_fields left_label form_sublabel_below description_below'><li id=\"field_29_322\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_29_322\"><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_29_322'>\n                            \n                            <span id='input_29_322_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_322.3' id='input_29_322_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_29_322_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_29_322_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_322.6' id='input_29_322_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_29_322_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_29_323\"  class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_29_323\"><label class='gfield_label gform-field-label' for='input_29_323' >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_323' id='input_29_323' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_29_519\"  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_29_519\"><label class='gfield_label gform-field-label' for='input_29_519' >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_519' id='input_29_519' 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_29_269\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_29_269\"><h2 class=\"gsection_title\">AGE OF PATIENTS CARED FOR<\/h2><\/li><li id=\"field_29_2\"  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_29_2\"><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_29_2'>\n\t\t\t<li class='gchoice gchoice_29_2_0'>\n\t\t\t\t<input name='input_2' type='radio' value='0'  id='choice_29_2_0'    \/>\n\t\t\t\t<label for='choice_29_2_0' id='label_29_2_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_29_2_1'>\n\t\t\t\t<input name='input_2' type='radio' value='1'  id='choice_29_2_1'    \/>\n\t\t\t\t<label for='choice_29_2_1' id='label_29_2_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_29_2_2'>\n\t\t\t\t<input name='input_2' type='radio' value='2'  id='choice_29_2_2'    \/>\n\t\t\t\t<label for='choice_29_2_2' id='label_29_2_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_29_2_3'>\n\t\t\t\t<input name='input_2' type='radio' value='3'  id='choice_29_2_3'    \/>\n\t\t\t\t<label for='choice_29_2_3' id='label_29_2_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_3\"  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_29_3\"><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_29_3'>\n\t\t\t<li class='gchoice gchoice_29_3_0'>\n\t\t\t\t<input name='input_3' type='radio' value='0'  id='choice_29_3_0'    \/>\n\t\t\t\t<label for='choice_29_3_0' id='label_29_3_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_29_3_1'>\n\t\t\t\t<input name='input_3' type='radio' value='1'  id='choice_29_3_1'    \/>\n\t\t\t\t<label for='choice_29_3_1' id='label_29_3_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_29_3_2'>\n\t\t\t\t<input name='input_3' type='radio' value='2'  id='choice_29_3_2'    \/>\n\t\t\t\t<label for='choice_29_3_2' id='label_29_3_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_29_3_3'>\n\t\t\t\t<input name='input_3' type='radio' value='3'  id='choice_29_3_3'    \/>\n\t\t\t\t<label for='choice_29_3_3' id='label_29_3_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_4\"  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_29_4\"><label class='gfield_label gform-field-label'  >Toddler(1 - 3 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_29_4'>\n\t\t\t<li class='gchoice gchoice_29_4_0'>\n\t\t\t\t<input name='input_4' type='radio' value='0'  id='choice_29_4_0'    \/>\n\t\t\t\t<label for='choice_29_4_0' id='label_29_4_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_29_4_1'>\n\t\t\t\t<input name='input_4' type='radio' value='1'  id='choice_29_4_1'    \/>\n\t\t\t\t<label for='choice_29_4_1' id='label_29_4_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_29_4_2'>\n\t\t\t\t<input name='input_4' type='radio' value='2'  id='choice_29_4_2'    \/>\n\t\t\t\t<label for='choice_29_4_2' id='label_29_4_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_29_4_3'>\n\t\t\t\t<input name='input_4' type='radio' value='3'  id='choice_29_4_3'    \/>\n\t\t\t\t<label for='choice_29_4_3' id='label_29_4_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_412\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_412\"><label class='gfield_label gform-field-label'  >Preschool (3 - 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_29_412'>\n\t\t\t<li class='gchoice gchoice_29_412_0'>\n\t\t\t\t<input name='input_412' type='radio' value='0'  id='choice_29_412_0'    \/>\n\t\t\t\t<label for='choice_29_412_0' id='label_29_412_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_29_412_1'>\n\t\t\t\t<input name='input_412' type='radio' value='1'  id='choice_29_412_1'    \/>\n\t\t\t\t<label for='choice_29_412_1' id='label_29_412_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_29_412_2'>\n\t\t\t\t<input name='input_412' type='radio' value='2'  id='choice_29_412_2'    \/>\n\t\t\t\t<label for='choice_29_412_2' id='label_29_412_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_29_412_3'>\n\t\t\t\t<input name='input_412' type='radio' value='3'  id='choice_29_412_3'    \/>\n\t\t\t\t<label for='choice_29_412_3' id='label_29_412_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_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_29_272\"><label class='gfield_label gform-field-label'  >School Age (5 - 12 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_29_272'>\n\t\t\t<li class='gchoice gchoice_29_272_0'>\n\t\t\t\t<input name='input_272' type='radio' value='0'  id='choice_29_272_0'    \/>\n\t\t\t\t<label for='choice_29_272_0' id='label_29_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_29_272_1'>\n\t\t\t\t<input name='input_272' type='radio' value='1'  id='choice_29_272_1'    \/>\n\t\t\t\t<label for='choice_29_272_1' id='label_29_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_29_272_2'>\n\t\t\t\t<input name='input_272' type='radio' value='2'  id='choice_29_272_2'    \/>\n\t\t\t\t<label for='choice_29_272_2' id='label_29_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_29_272_3'>\n\t\t\t\t<input name='input_272' type='radio' value='3'  id='choice_29_272_3'    \/>\n\t\t\t\t<label for='choice_29_272_3' id='label_29_272_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_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_29_271\"><label class='gfield_label gform-field-label'  >Adolescents (12 - 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_29_271'>\n\t\t\t<li class='gchoice gchoice_29_271_0'>\n\t\t\t\t<input name='input_271' type='radio' value='0'  id='choice_29_271_0'    \/>\n\t\t\t\t<label for='choice_29_271_0' id='label_29_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_29_271_1'>\n\t\t\t\t<input name='input_271' type='radio' value='1'  id='choice_29_271_1'    \/>\n\t\t\t\t<label for='choice_29_271_1' id='label_29_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_29_271_2'>\n\t\t\t\t<input name='input_271' type='radio' value='2'  id='choice_29_271_2'    \/>\n\t\t\t\t<label for='choice_29_271_2' id='label_29_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_29_271_3'>\n\t\t\t\t<input name='input_271' type='radio' value='3'  id='choice_29_271_3'    \/>\n\t\t\t\t<label for='choice_29_271_3' id='label_29_271_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_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_29_270\"><label class='gfield_label gform-field-label'  >Young Adults (18 - 39 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_29_270'>\n\t\t\t<li class='gchoice gchoice_29_270_0'>\n\t\t\t\t<input name='input_270' type='radio' value='0'  id='choice_29_270_0'    \/>\n\t\t\t\t<label for='choice_29_270_0' id='label_29_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_29_270_1'>\n\t\t\t\t<input name='input_270' type='radio' value='1'  id='choice_29_270_1'    \/>\n\t\t\t\t<label for='choice_29_270_1' id='label_29_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_29_270_2'>\n\t\t\t\t<input name='input_270' type='radio' value='2'  id='choice_29_270_2'    \/>\n\t\t\t\t<label for='choice_29_270_2' id='label_29_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_29_270_3'>\n\t\t\t\t<input name='input_270' type='radio' value='3'  id='choice_29_270_3'    \/>\n\t\t\t\t<label for='choice_29_270_3' id='label_29_270_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_413\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_413\"><label class='gfield_label gform-field-label'  >Middle Adults (39 - 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_29_413'>\n\t\t\t<li class='gchoice gchoice_29_413_0'>\n\t\t\t\t<input name='input_413' type='radio' value='0'  id='choice_29_413_0'    \/>\n\t\t\t\t<label for='choice_29_413_0' id='label_29_413_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_29_413_1'>\n\t\t\t\t<input name='input_413' type='radio' value='1'  id='choice_29_413_1'    \/>\n\t\t\t\t<label for='choice_29_413_1' id='label_29_413_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_29_413_2'>\n\t\t\t\t<input name='input_413' type='radio' value='2'  id='choice_29_413_2'    \/>\n\t\t\t\t<label for='choice_29_413_2' id='label_29_413_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_29_413_3'>\n\t\t\t\t<input name='input_413' type='radio' value='3'  id='choice_29_413_3'    \/>\n\t\t\t\t<label for='choice_29_413_3' id='label_29_413_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_414\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_414\"><label class='gfield_label gform-field-label'  >Older Adults (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_29_414'>\n\t\t\t<li class='gchoice gchoice_29_414_0'>\n\t\t\t\t<input name='input_414' type='radio' value='0'  id='choice_29_414_0'    \/>\n\t\t\t\t<label for='choice_29_414_0' id='label_29_414_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_29_414_1'>\n\t\t\t\t<input name='input_414' type='radio' value='1'  id='choice_29_414_1'    \/>\n\t\t\t\t<label for='choice_29_414_1' id='label_29_414_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_29_414_2'>\n\t\t\t\t<input name='input_414' type='radio' value='2'  id='choice_29_414_2'    \/>\n\t\t\t\t<label for='choice_29_414_2' id='label_29_414_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_29_414_3'>\n\t\t\t\t<input name='input_414' type='radio' value='3'  id='choice_29_414_3'    \/>\n\t\t\t\t<label for='choice_29_414_3' id='label_29_414_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_415\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_415\"><label class='gfield_label gform-field-label'  >Elderly Adults (Over 79+ 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_29_415'>\n\t\t\t<li class='gchoice gchoice_29_415_0'>\n\t\t\t\t<input name='input_415' type='radio' value='0'  id='choice_29_415_0'    \/>\n\t\t\t\t<label for='choice_29_415_0' id='label_29_415_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_29_415_1'>\n\t\t\t\t<input name='input_415' type='radio' value='1'  id='choice_29_415_1'    \/>\n\t\t\t\t<label for='choice_29_415_1' id='label_29_415_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_29_415_2'>\n\t\t\t\t<input name='input_415' type='radio' value='2'  id='choice_29_415_2'    \/>\n\t\t\t\t<label for='choice_29_415_2' id='label_29_415_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_29_415_3'>\n\t\t\t\t<input name='input_415' type='radio' value='3'  id='choice_29_415_3'    \/>\n\t\t\t\t<label for='choice_29_415_3' id='label_29_415_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_359\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_29_359\"><h2 class=\"gsection_title\">GENERAL SKILLS<\/h2><\/li><li id=\"field_29_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_29_274\"><label class='gfield_label gform-field-label'  >Venipuncture\/IV Placement<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_29_274'>\n\t\t\t<li class='gchoice gchoice_29_274_0'>\n\t\t\t\t<input name='input_274' type='radio' value='0'  id='choice_29_274_0'    \/>\n\t\t\t\t<label for='choice_29_274_0' id='label_29_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_29_274_1'>\n\t\t\t\t<input name='input_274' type='radio' value='1'  id='choice_29_274_1'    \/>\n\t\t\t\t<label for='choice_29_274_1' id='label_29_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_29_274_2'>\n\t\t\t\t<input name='input_274' type='radio' value='2'  id='choice_29_274_2'    \/>\n\t\t\t\t<label for='choice_29_274_2' id='label_29_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_29_274_3'>\n\t\t\t\t<input name='input_274' type='radio' value='3'  id='choice_29_274_3'    \/>\n\t\t\t\t<label for='choice_29_274_3' id='label_29_274_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_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_29_273\"><label class='gfield_label gform-field-label'  >Standard 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_29_273'>\n\t\t\t<li class='gchoice gchoice_29_273_0'>\n\t\t\t\t<input name='input_273' type='radio' value='0'  id='choice_29_273_0'    \/>\n\t\t\t\t<label for='choice_29_273_0' id='label_29_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_29_273_1'>\n\t\t\t\t<input name='input_273' type='radio' value='1'  id='choice_29_273_1'    \/>\n\t\t\t\t<label for='choice_29_273_1' id='label_29_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_29_273_2'>\n\t\t\t\t<input name='input_273' type='radio' value='2'  id='choice_29_273_2'    \/>\n\t\t\t\t<label for='choice_29_273_2' id='label_29_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_29_273_3'>\n\t\t\t\t<input name='input_273' type='radio' value='3'  id='choice_29_273_3'    \/>\n\t\t\t\t<label for='choice_29_273_3' id='label_29_273_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_329\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_329\"><label class='gfield_label gform-field-label'  >Isolation 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_29_329'>\n\t\t\t<li class='gchoice gchoice_29_329_0'>\n\t\t\t\t<input name='input_329' type='radio' value='0'  id='choice_29_329_0'    \/>\n\t\t\t\t<label for='choice_29_329_0' id='label_29_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_29_329_1'>\n\t\t\t\t<input name='input_329' type='radio' value='1'  id='choice_29_329_1'    \/>\n\t\t\t\t<label for='choice_29_329_1' id='label_29_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_29_329_2'>\n\t\t\t\t<input name='input_329' type='radio' value='2'  id='choice_29_329_2'    \/>\n\t\t\t\t<label for='choice_29_329_2' id='label_29_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_29_329_3'>\n\t\t\t\t<input name='input_329' type='radio' value='3'  id='choice_29_329_3'    \/>\n\t\t\t\t<label for='choice_29_329_3' id='label_29_329_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_328\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_328\"><label class='gfield_label gform-field-label'  >Pediatric Respiratory\/ Cardiac Arrest<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_29_328'>\n\t\t\t<li class='gchoice gchoice_29_328_0'>\n\t\t\t\t<input name='input_328' type='radio' value='0'  id='choice_29_328_0'    \/>\n\t\t\t\t<label for='choice_29_328_0' id='label_29_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_29_328_1'>\n\t\t\t\t<input name='input_328' type='radio' value='1'  id='choice_29_328_1'    \/>\n\t\t\t\t<label for='choice_29_328_1' id='label_29_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_29_328_2'>\n\t\t\t\t<input name='input_328' type='radio' value='2'  id='choice_29_328_2'    \/>\n\t\t\t\t<label for='choice_29_328_2' id='label_29_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_29_328_3'>\n\t\t\t\t<input name='input_328' type='radio' value='3'  id='choice_29_328_3'    \/>\n\t\t\t\t<label for='choice_29_328_3' id='label_29_328_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_327\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_327\"><label class='gfield_label gform-field-label'  >Adult Respiratory\/ Cardiac Arrest<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_29_327'>\n\t\t\t<li class='gchoice gchoice_29_327_0'>\n\t\t\t\t<input name='input_327' type='radio' value='0'  id='choice_29_327_0'    \/>\n\t\t\t\t<label for='choice_29_327_0' id='label_29_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_29_327_1'>\n\t\t\t\t<input name='input_327' type='radio' value='1'  id='choice_29_327_1'    \/>\n\t\t\t\t<label for='choice_29_327_1' id='label_29_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_29_327_2'>\n\t\t\t\t<input name='input_327' type='radio' value='2'  id='choice_29_327_2'    \/>\n\t\t\t\t<label for='choice_29_327_2' id='label_29_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_29_327_3'>\n\t\t\t\t<input name='input_327' type='radio' value='3'  id='choice_29_327_3'    \/>\n\t\t\t\t<label for='choice_29_327_3' id='label_29_327_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_397\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_397\"><label class='gfield_label gform-field-label'  >Crash Carts<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_29_397'>\n\t\t\t<li class='gchoice gchoice_29_397_0'>\n\t\t\t\t<input name='input_397' type='radio' value='0'  id='choice_29_397_0'    \/>\n\t\t\t\t<label for='choice_29_397_0' id='label_29_397_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_29_397_1'>\n\t\t\t\t<input name='input_397' type='radio' value='1'  id='choice_29_397_1'    \/>\n\t\t\t\t<label for='choice_29_397_1' id='label_29_397_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_29_397_2'>\n\t\t\t\t<input name='input_397' type='radio' value='2'  id='choice_29_397_2'    \/>\n\t\t\t\t<label for='choice_29_397_2' id='label_29_397_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_29_397_3'>\n\t\t\t\t<input name='input_397' type='radio' value='3'  id='choice_29_397_3'    \/>\n\t\t\t\t<label for='choice_29_397_3' id='label_29_397_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_416\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_416\"><label class='gfield_label gform-field-label'  >Defibrillators<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_29_416'>\n\t\t\t<li class='gchoice gchoice_29_416_0'>\n\t\t\t\t<input name='input_416' type='radio' value='0'  id='choice_29_416_0'    \/>\n\t\t\t\t<label for='choice_29_416_0' id='label_29_416_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_29_416_1'>\n\t\t\t\t<input name='input_416' type='radio' value='1'  id='choice_29_416_1'    \/>\n\t\t\t\t<label for='choice_29_416_1' id='label_29_416_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_29_416_2'>\n\t\t\t\t<input name='input_416' type='radio' value='2'  id='choice_29_416_2'    \/>\n\t\t\t\t<label for='choice_29_416_2' id='label_29_416_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_29_416_3'>\n\t\t\t\t<input name='input_416' type='radio' value='3'  id='choice_29_416_3'    \/>\n\t\t\t\t<label for='choice_29_416_3' id='label_29_416_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_417\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_417\"><label class='gfield_label gform-field-label'  >12 Lead EKG<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_29_417'>\n\t\t\t<li class='gchoice gchoice_29_417_0'>\n\t\t\t\t<input name='input_417' type='radio' value='0'  id='choice_29_417_0'    \/>\n\t\t\t\t<label for='choice_29_417_0' id='label_29_417_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_29_417_1'>\n\t\t\t\t<input name='input_417' type='radio' value='1'  id='choice_29_417_1'    \/>\n\t\t\t\t<label for='choice_29_417_1' id='label_29_417_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_29_417_2'>\n\t\t\t\t<input name='input_417' type='radio' value='2'  id='choice_29_417_2'    \/>\n\t\t\t\t<label for='choice_29_417_2' id='label_29_417_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_29_417_3'>\n\t\t\t\t<input name='input_417' type='radio' value='3'  id='choice_29_417_3'    \/>\n\t\t\t\t<label for='choice_29_417_3' id='label_29_417_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_418\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_418\"><label class='gfield_label gform-field-label'  >Stress Testing<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_29_418'>\n\t\t\t<li class='gchoice gchoice_29_418_0'>\n\t\t\t\t<input name='input_418' type='radio' value='0'  id='choice_29_418_0'    \/>\n\t\t\t\t<label for='choice_29_418_0' id='label_29_418_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_29_418_1'>\n\t\t\t\t<input name='input_418' type='radio' value='1'  id='choice_29_418_1'    \/>\n\t\t\t\t<label for='choice_29_418_1' id='label_29_418_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_29_418_2'>\n\t\t\t\t<input name='input_418' type='radio' value='2'  id='choice_29_418_2'    \/>\n\t\t\t\t<label for='choice_29_418_2' id='label_29_418_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_29_418_3'>\n\t\t\t\t<input name='input_418' type='radio' value='3'  id='choice_29_418_3'    \/>\n\t\t\t\t<label for='choice_29_418_3' id='label_29_418_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_419\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_419\"><label class='gfield_label gform-field-label'  >Holter 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_29_419'>\n\t\t\t<li class='gchoice gchoice_29_419_0'>\n\t\t\t\t<input name='input_419' type='radio' value='0'  id='choice_29_419_0'    \/>\n\t\t\t\t<label for='choice_29_419_0' id='label_29_419_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_29_419_1'>\n\t\t\t\t<input name='input_419' type='radio' value='1'  id='choice_29_419_1'    \/>\n\t\t\t\t<label for='choice_29_419_1' id='label_29_419_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_29_419_2'>\n\t\t\t\t<input name='input_419' type='radio' value='2'  id='choice_29_419_2'    \/>\n\t\t\t\t<label for='choice_29_419_2' id='label_29_419_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_29_419_3'>\n\t\t\t\t<input name='input_419' type='radio' value='3'  id='choice_29_419_3'    \/>\n\t\t\t\t<label for='choice_29_419_3' id='label_29_419_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_420\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_29_420\"><h2 class=\"gsection_title\">WORK SETTING<\/h2><\/li><li id=\"field_29_326\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_326\"><label class='gfield_label gform-field-label'  >Adult Acute 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_29_326'>\n\t\t\t<li class='gchoice gchoice_29_326_0'>\n\t\t\t\t<input name='input_326' type='radio' value='0'  id='choice_29_326_0'    \/>\n\t\t\t\t<label for='choice_29_326_0' id='label_29_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_29_326_1'>\n\t\t\t\t<input name='input_326' type='radio' value='1'  id='choice_29_326_1'    \/>\n\t\t\t\t<label for='choice_29_326_1' id='label_29_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_29_326_2'>\n\t\t\t\t<input name='input_326' type='radio' value='2'  id='choice_29_326_2'    \/>\n\t\t\t\t<label for='choice_29_326_2' id='label_29_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_29_326_3'>\n\t\t\t\t<input name='input_326' type='radio' value='3'  id='choice_29_326_3'    \/>\n\t\t\t\t<label for='choice_29_326_3' id='label_29_326_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_401\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_401\"><label class='gfield_label gform-field-label'  >Adult Outpatient<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_29_401'>\n\t\t\t<li class='gchoice gchoice_29_401_0'>\n\t\t\t\t<input name='input_401' type='radio' value='0'  id='choice_29_401_0'    \/>\n\t\t\t\t<label for='choice_29_401_0' id='label_29_401_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_29_401_1'>\n\t\t\t\t<input name='input_401' type='radio' value='1'  id='choice_29_401_1'    \/>\n\t\t\t\t<label for='choice_29_401_1' id='label_29_401_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_29_401_2'>\n\t\t\t\t<input name='input_401' type='radio' value='2'  id='choice_29_401_2'    \/>\n\t\t\t\t<label for='choice_29_401_2' id='label_29_401_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_29_401_3'>\n\t\t\t\t<input name='input_401' type='radio' value='3'  id='choice_29_401_3'    \/>\n\t\t\t\t<label for='choice_29_401_3' id='label_29_401_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_402\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_402\"><label class='gfield_label gform-field-label'  >Pediatric Acute 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_29_402'>\n\t\t\t<li class='gchoice gchoice_29_402_0'>\n\t\t\t\t<input name='input_402' type='radio' value='0'  id='choice_29_402_0'    \/>\n\t\t\t\t<label for='choice_29_402_0' id='label_29_402_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_29_402_1'>\n\t\t\t\t<input name='input_402' type='radio' value='1'  id='choice_29_402_1'    \/>\n\t\t\t\t<label for='choice_29_402_1' id='label_29_402_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_29_402_2'>\n\t\t\t\t<input name='input_402' type='radio' value='2'  id='choice_29_402_2'    \/>\n\t\t\t\t<label for='choice_29_402_2' id='label_29_402_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_29_402_3'>\n\t\t\t\t<input name='input_402' type='radio' value='3'  id='choice_29_402_3'    \/>\n\t\t\t\t<label for='choice_29_402_3' id='label_29_402_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_403\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_403\"><label class='gfield_label gform-field-label'  >Pediatric Outpatient<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_29_403'>\n\t\t\t<li class='gchoice gchoice_29_403_0'>\n\t\t\t\t<input name='input_403' type='radio' value='0'  id='choice_29_403_0'    \/>\n\t\t\t\t<label for='choice_29_403_0' id='label_29_403_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_29_403_1'>\n\t\t\t\t<input name='input_403' type='radio' value='1'  id='choice_29_403_1'    \/>\n\t\t\t\t<label for='choice_29_403_1' id='label_29_403_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_29_403_2'>\n\t\t\t\t<input name='input_403' type='radio' value='2'  id='choice_29_403_2'    \/>\n\t\t\t\t<label for='choice_29_403_2' id='label_29_403_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_29_403_3'>\n\t\t\t\t<input name='input_403' type='radio' value='3'  id='choice_29_403_3'    \/>\n\t\t\t\t<label for='choice_29_403_3' id='label_29_403_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_421\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_29_421\"><h2 class=\"gsection_title\">ADULT ECHO<\/h2><\/li><li id=\"field_29_404\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_404\"><label class='gfield_label gform-field-label'  >Routine<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_29_404'>\n\t\t\t<li class='gchoice gchoice_29_404_0'>\n\t\t\t\t<input name='input_404' type='radio' value='0'  id='choice_29_404_0'    \/>\n\t\t\t\t<label for='choice_29_404_0' id='label_29_404_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_29_404_1'>\n\t\t\t\t<input name='input_404' type='radio' value='1'  id='choice_29_404_1'    \/>\n\t\t\t\t<label for='choice_29_404_1' id='label_29_404_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_29_404_2'>\n\t\t\t\t<input name='input_404' type='radio' value='2'  id='choice_29_404_2'    \/>\n\t\t\t\t<label for='choice_29_404_2' id='label_29_404_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_29_404_3'>\n\t\t\t\t<input name='input_404' type='radio' value='3'  id='choice_29_404_3'    \/>\n\t\t\t\t<label for='choice_29_404_3' id='label_29_404_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_405\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_405\"><label class='gfield_label gform-field-label'  >3-D Echo<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_29_405'>\n\t\t\t<li class='gchoice gchoice_29_405_0'>\n\t\t\t\t<input name='input_405' type='radio' value='Yes'  id='choice_29_405_0'    \/>\n\t\t\t\t<label for='choice_29_405_0' id='label_29_405_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_29_405_1'>\n\t\t\t\t<input name='input_405' type='radio' value='No'  id='choice_29_405_1'    \/>\n\t\t\t\t<label for='choice_29_405_1' id='label_29_405_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_406\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_406\"><label class='gfield_label gform-field-label'  >Pedoff Probe<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_29_406'>\n\t\t\t<li class='gchoice gchoice_29_406_0'>\n\t\t\t\t<input name='input_406' type='radio' value='0'  id='choice_29_406_0'    \/>\n\t\t\t\t<label for='choice_29_406_0' id='label_29_406_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_29_406_1'>\n\t\t\t\t<input name='input_406' type='radio' value='1'  id='choice_29_406_1'    \/>\n\t\t\t\t<label for='choice_29_406_1' id='label_29_406_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_29_406_2'>\n\t\t\t\t<input name='input_406' type='radio' value='2'  id='choice_29_406_2'    \/>\n\t\t\t\t<label for='choice_29_406_2' id='label_29_406_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_29_406_3'>\n\t\t\t\t<input name='input_406' type='radio' value='3'  id='choice_29_406_3'    \/>\n\t\t\t\t<label for='choice_29_406_3' id='label_29_406_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_407\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_407\"><label class='gfield_label gform-field-label'  >Transesophageal Echo<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_29_407'>\n\t\t\t<li class='gchoice gchoice_29_407_0'>\n\t\t\t\t<input name='input_407' type='radio' value='0'  id='choice_29_407_0'    \/>\n\t\t\t\t<label for='choice_29_407_0' id='label_29_407_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_29_407_1'>\n\t\t\t\t<input name='input_407' type='radio' value='1'  id='choice_29_407_1'    \/>\n\t\t\t\t<label for='choice_29_407_1' id='label_29_407_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_29_407_2'>\n\t\t\t\t<input name='input_407' type='radio' value='2'  id='choice_29_407_2'    \/>\n\t\t\t\t<label for='choice_29_407_2' id='label_29_407_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_29_407_3'>\n\t\t\t\t<input name='input_407' type='radio' value='3'  id='choice_29_407_3'    \/>\n\t\t\t\t<label for='choice_29_407_3' id='label_29_407_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_422\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_422\"><label class='gfield_label gform-field-label'  >Stress Echo<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_29_422'>\n\t\t\t<li class='gchoice gchoice_29_422_0'>\n\t\t\t\t<input name='input_422' type='radio' value='0'  id='choice_29_422_0'    \/>\n\t\t\t\t<label for='choice_29_422_0' id='label_29_422_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_29_422_1'>\n\t\t\t\t<input name='input_422' type='radio' value='1'  id='choice_29_422_1'    \/>\n\t\t\t\t<label for='choice_29_422_1' id='label_29_422_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_29_422_2'>\n\t\t\t\t<input name='input_422' type='radio' value='2'  id='choice_29_422_2'    \/>\n\t\t\t\t<label for='choice_29_422_2' id='label_29_422_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_29_422_3'>\n\t\t\t\t<input name='input_422' type='radio' value='3'  id='choice_29_422_3'    \/>\n\t\t\t\t<label for='choice_29_422_3' id='label_29_422_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_423\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_423\"><label class='gfield_label gform-field-label'  >Pharmacological Stress Echo<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_29_423'>\n\t\t\t<li class='gchoice gchoice_29_423_0'>\n\t\t\t\t<input name='input_423' type='radio' value='0'  id='choice_29_423_0'    \/>\n\t\t\t\t<label for='choice_29_423_0' id='label_29_423_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_29_423_1'>\n\t\t\t\t<input name='input_423' type='radio' value='1'  id='choice_29_423_1'    \/>\n\t\t\t\t<label for='choice_29_423_1' id='label_29_423_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_29_423_2'>\n\t\t\t\t<input name='input_423' type='radio' value='2'  id='choice_29_423_2'    \/>\n\t\t\t\t<label for='choice_29_423_2' id='label_29_423_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_29_423_3'>\n\t\t\t\t<input name='input_423' type='radio' value='3'  id='choice_29_423_3'    \/>\n\t\t\t\t<label for='choice_29_423_3' id='label_29_423_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_424\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_424\"><label class='gfield_label gform-field-label'  >Post-Cath Echo<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_29_424'>\n\t\t\t<li class='gchoice gchoice_29_424_0'>\n\t\t\t\t<input name='input_424' type='radio' value='0'  id='choice_29_424_0'    \/>\n\t\t\t\t<label for='choice_29_424_0' id='label_29_424_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_29_424_1'>\n\t\t\t\t<input name='input_424' type='radio' value='1'  id='choice_29_424_1'    \/>\n\t\t\t\t<label for='choice_29_424_1' id='label_29_424_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_29_424_2'>\n\t\t\t\t<input name='input_424' type='radio' value='2'  id='choice_29_424_2'    \/>\n\t\t\t\t<label for='choice_29_424_2' id='label_29_424_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_29_424_3'>\n\t\t\t\t<input name='input_424' type='radio' value='3'  id='choice_29_424_3'    \/>\n\t\t\t\t<label for='choice_29_424_3' id='label_29_424_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_425\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_425\"><label class='gfield_label gform-field-label'  >Post-Surgical Echo<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_29_425'>\n\t\t\t<li class='gchoice gchoice_29_425_0'>\n\t\t\t\t<input name='input_425' type='radio' value='0'  id='choice_29_425_0'    \/>\n\t\t\t\t<label for='choice_29_425_0' id='label_29_425_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_29_425_1'>\n\t\t\t\t<input name='input_425' type='radio' value='1'  id='choice_29_425_1'    \/>\n\t\t\t\t<label for='choice_29_425_1' id='label_29_425_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_29_425_2'>\n\t\t\t\t<input name='input_425' type='radio' value='2'  id='choice_29_425_2'    \/>\n\t\t\t\t<label for='choice_29_425_2' id='label_29_425_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_29_425_3'>\n\t\t\t\t<input name='input_425' type='radio' value='3'  id='choice_29_425_3'    \/>\n\t\t\t\t<label for='choice_29_425_3' id='label_29_425_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_426\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_426\"><label class='gfield_label gform-field-label'  >Imaging with Contrast 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_29_426'>\n\t\t\t<li class='gchoice gchoice_29_426_0'>\n\t\t\t\t<input name='input_426' type='radio' value='0'  id='choice_29_426_0'    \/>\n\t\t\t\t<label for='choice_29_426_0' id='label_29_426_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_29_426_1'>\n\t\t\t\t<input name='input_426' type='radio' value='1'  id='choice_29_426_1'    \/>\n\t\t\t\t<label for='choice_29_426_1' id='label_29_426_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_29_426_2'>\n\t\t\t\t<input name='input_426' type='radio' value='2'  id='choice_29_426_2'    \/>\n\t\t\t\t<label for='choice_29_426_2' id='label_29_426_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_29_426_3'>\n\t\t\t\t<input name='input_426' type='radio' value='3'  id='choice_29_426_3'    \/>\n\t\t\t\t<label for='choice_29_426_3' id='label_29_426_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_427\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_427\"><label class='gfield_label gform-field-label'  >Sterilization Procedures<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_29_427'>\n\t\t\t<li class='gchoice gchoice_29_427_0'>\n\t\t\t\t<input name='input_427' type='radio' value='0'  id='choice_29_427_0'    \/>\n\t\t\t\t<label for='choice_29_427_0' id='label_29_427_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_29_427_1'>\n\t\t\t\t<input name='input_427' type='radio' value='1'  id='choice_29_427_1'    \/>\n\t\t\t\t<label for='choice_29_427_1' id='label_29_427_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_29_427_2'>\n\t\t\t\t<input name='input_427' type='radio' value='2'  id='choice_29_427_2'    \/>\n\t\t\t\t<label for='choice_29_427_2' id='label_29_427_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_29_427_3'>\n\t\t\t\t<input name='input_427' type='radio' value='3'  id='choice_29_427_3'    \/>\n\t\t\t\t<label for='choice_29_427_3' id='label_29_427_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_428\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_428\"><label class='gfield_label gform-field-label'  >2-Dimensional<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_29_428'>\n\t\t\t<li class='gchoice gchoice_29_428_0'>\n\t\t\t\t<input name='input_428' type='radio' value='0'  id='choice_29_428_0'    \/>\n\t\t\t\t<label for='choice_29_428_0' id='label_29_428_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_29_428_1'>\n\t\t\t\t<input name='input_428' type='radio' value='1'  id='choice_29_428_1'    \/>\n\t\t\t\t<label for='choice_29_428_1' id='label_29_428_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_29_428_2'>\n\t\t\t\t<input name='input_428' type='radio' value='2'  id='choice_29_428_2'    \/>\n\t\t\t\t<label for='choice_29_428_2' id='label_29_428_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_29_428_3'>\n\t\t\t\t<input name='input_428' type='radio' value='3'  id='choice_29_428_3'    \/>\n\t\t\t\t<label for='choice_29_428_3' id='label_29_428_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_429\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_429\"><label class='gfield_label gform-field-label'  >M-Mode<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_29_429'>\n\t\t\t<li class='gchoice gchoice_29_429_0'>\n\t\t\t\t<input name='input_429' type='radio' value='0'  id='choice_29_429_0'    \/>\n\t\t\t\t<label for='choice_29_429_0' id='label_29_429_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_29_429_1'>\n\t\t\t\t<input name='input_429' type='radio' value='1'  id='choice_29_429_1'    \/>\n\t\t\t\t<label for='choice_29_429_1' id='label_29_429_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_29_429_2'>\n\t\t\t\t<input name='input_429' type='radio' value='2'  id='choice_29_429_2'    \/>\n\t\t\t\t<label for='choice_29_429_2' id='label_29_429_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_29_429_3'>\n\t\t\t\t<input name='input_429' type='radio' value='3'  id='choice_29_429_3'    \/>\n\t\t\t\t<label for='choice_29_429_3' id='label_29_429_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_430\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_430\"><label class='gfield_label gform-field-label'  >PW Doppler<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_29_430'>\n\t\t\t<li class='gchoice gchoice_29_430_0'>\n\t\t\t\t<input name='input_430' type='radio' value='0'  id='choice_29_430_0'    \/>\n\t\t\t\t<label for='choice_29_430_0' id='label_29_430_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_29_430_1'>\n\t\t\t\t<input name='input_430' type='radio' value='1'  id='choice_29_430_1'    \/>\n\t\t\t\t<label for='choice_29_430_1' id='label_29_430_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_29_430_2'>\n\t\t\t\t<input name='input_430' type='radio' value='2'  id='choice_29_430_2'    \/>\n\t\t\t\t<label for='choice_29_430_2' id='label_29_430_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_29_430_3'>\n\t\t\t\t<input name='input_430' type='radio' value='3'  id='choice_29_430_3'    \/>\n\t\t\t\t<label for='choice_29_430_3' id='label_29_430_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_431\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_431\"><label class='gfield_label gform-field-label'  >CW Doppler<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_29_431'>\n\t\t\t<li class='gchoice gchoice_29_431_0'>\n\t\t\t\t<input name='input_431' type='radio' value='0'  id='choice_29_431_0'    \/>\n\t\t\t\t<label for='choice_29_431_0' id='label_29_431_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_29_431_1'>\n\t\t\t\t<input name='input_431' type='radio' value='1'  id='choice_29_431_1'    \/>\n\t\t\t\t<label for='choice_29_431_1' id='label_29_431_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_29_431_2'>\n\t\t\t\t<input name='input_431' type='radio' value='2'  id='choice_29_431_2'    \/>\n\t\t\t\t<label for='choice_29_431_2' id='label_29_431_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_29_431_3'>\n\t\t\t\t<input name='input_431' type='radio' value='3'  id='choice_29_431_3'    \/>\n\t\t\t\t<label for='choice_29_431_3' id='label_29_431_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_432\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_432\"><label class='gfield_label gform-field-label'  >Color Doppler<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_29_432'>\n\t\t\t<li class='gchoice gchoice_29_432_0'>\n\t\t\t\t<input name='input_432' type='radio' value='0'  id='choice_29_432_0'    \/>\n\t\t\t\t<label for='choice_29_432_0' id='label_29_432_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_29_432_1'>\n\t\t\t\t<input name='input_432' type='radio' value='1'  id='choice_29_432_1'    \/>\n\t\t\t\t<label for='choice_29_432_1' id='label_29_432_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_29_432_2'>\n\t\t\t\t<input name='input_432' type='radio' value='2'  id='choice_29_432_2'    \/>\n\t\t\t\t<label for='choice_29_432_2' id='label_29_432_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_29_432_3'>\n\t\t\t\t<input name='input_432' type='radio' value='3'  id='choice_29_432_3'    \/>\n\t\t\t\t<label for='choice_29_432_3' id='label_29_432_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_433\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_433\"><label class='gfield_label gform-field-label'  >Parasternal Long Axis View<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_29_433'>\n\t\t\t<li class='gchoice gchoice_29_433_0'>\n\t\t\t\t<input name='input_433' type='radio' value='0'  id='choice_29_433_0'    \/>\n\t\t\t\t<label for='choice_29_433_0' id='label_29_433_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_29_433_1'>\n\t\t\t\t<input name='input_433' type='radio' value='1'  id='choice_29_433_1'    \/>\n\t\t\t\t<label for='choice_29_433_1' id='label_29_433_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_29_433_2'>\n\t\t\t\t<input name='input_433' type='radio' value='2'  id='choice_29_433_2'    \/>\n\t\t\t\t<label for='choice_29_433_2' id='label_29_433_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_29_433_3'>\n\t\t\t\t<input name='input_433' type='radio' value='3'  id='choice_29_433_3'    \/>\n\t\t\t\t<label for='choice_29_433_3' id='label_29_433_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_434\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_434\"><label class='gfield_label gform-field-label'  >Right Ventricular Inflow Tract (RVIT)<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_29_434'>\n\t\t\t<li class='gchoice gchoice_29_434_0'>\n\t\t\t\t<input name='input_434' type='radio' value='0'  id='choice_29_434_0'    \/>\n\t\t\t\t<label for='choice_29_434_0' id='label_29_434_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_29_434_1'>\n\t\t\t\t<input name='input_434' type='radio' value='1'  id='choice_29_434_1'    \/>\n\t\t\t\t<label for='choice_29_434_1' id='label_29_434_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_29_434_2'>\n\t\t\t\t<input name='input_434' type='radio' value='2'  id='choice_29_434_2'    \/>\n\t\t\t\t<label for='choice_29_434_2' id='label_29_434_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_29_434_3'>\n\t\t\t\t<input name='input_434' type='radio' value='3'  id='choice_29_434_3'    \/>\n\t\t\t\t<label for='choice_29_434_3' id='label_29_434_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_435\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_435\"><label class='gfield_label gform-field-label'  >Right Ventricular Outflow Tract (RVOT)<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_29_435'>\n\t\t\t<li class='gchoice gchoice_29_435_0'>\n\t\t\t\t<input name='input_435' type='radio' value='0'  id='choice_29_435_0'    \/>\n\t\t\t\t<label for='choice_29_435_0' id='label_29_435_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_29_435_1'>\n\t\t\t\t<input name='input_435' type='radio' value='1'  id='choice_29_435_1'    \/>\n\t\t\t\t<label for='choice_29_435_1' id='label_29_435_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_29_435_2'>\n\t\t\t\t<input name='input_435' type='radio' value='2'  id='choice_29_435_2'    \/>\n\t\t\t\t<label for='choice_29_435_2' id='label_29_435_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_29_435_3'>\n\t\t\t\t<input name='input_435' type='radio' value='3'  id='choice_29_435_3'    \/>\n\t\t\t\t<label for='choice_29_435_3' id='label_29_435_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_436\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_436\"><label class='gfield_label gform-field-label'  >4-Chamber View<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_29_436'>\n\t\t\t<li class='gchoice gchoice_29_436_0'>\n\t\t\t\t<input name='input_436' type='radio' value='0'  id='choice_29_436_0'    \/>\n\t\t\t\t<label for='choice_29_436_0' id='label_29_436_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_29_436_1'>\n\t\t\t\t<input name='input_436' type='radio' value='1'  id='choice_29_436_1'    \/>\n\t\t\t\t<label for='choice_29_436_1' id='label_29_436_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_29_436_2'>\n\t\t\t\t<input name='input_436' type='radio' value='2'  id='choice_29_436_2'    \/>\n\t\t\t\t<label for='choice_29_436_2' id='label_29_436_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_29_436_3'>\n\t\t\t\t<input name='input_436' type='radio' value='3'  id='choice_29_436_3'    \/>\n\t\t\t\t<label for='choice_29_436_3' id='label_29_436_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_437\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_437\"><label class='gfield_label gform-field-label'  >2-Chamber View<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_29_437'>\n\t\t\t<li class='gchoice gchoice_29_437_0'>\n\t\t\t\t<input name='input_437' type='radio' value='0'  id='choice_29_437_0'    \/>\n\t\t\t\t<label for='choice_29_437_0' id='label_29_437_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_29_437_1'>\n\t\t\t\t<input name='input_437' type='radio' value='1'  id='choice_29_437_1'    \/>\n\t\t\t\t<label for='choice_29_437_1' id='label_29_437_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_29_437_2'>\n\t\t\t\t<input name='input_437' type='radio' value='2'  id='choice_29_437_2'    \/>\n\t\t\t\t<label for='choice_29_437_2' id='label_29_437_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_29_437_3'>\n\t\t\t\t<input name='input_437' type='radio' value='3'  id='choice_29_437_3'    \/>\n\t\t\t\t<label for='choice_29_437_3' id='label_29_437_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_438\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_438\"><label class='gfield_label gform-field-label'  >Diastolic Dysfunction Evaluation<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_29_438'>\n\t\t\t<li class='gchoice gchoice_29_438_0'>\n\t\t\t\t<input name='input_438' type='radio' value='0'  id='choice_29_438_0'    \/>\n\t\t\t\t<label for='choice_29_438_0' id='label_29_438_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_29_438_1'>\n\t\t\t\t<input name='input_438' type='radio' value='1'  id='choice_29_438_1'    \/>\n\t\t\t\t<label for='choice_29_438_1' id='label_29_438_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_29_438_2'>\n\t\t\t\t<input name='input_438' type='radio' value='2'  id='choice_29_438_2'    \/>\n\t\t\t\t<label for='choice_29_438_2' id='label_29_438_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_29_438_3'>\n\t\t\t\t<input name='input_438' type='radio' value='3'  id='choice_29_438_3'    \/>\n\t\t\t\t<label for='choice_29_438_3' id='label_29_438_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_439\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_439\"><label class='gfield_label gform-field-label'  >Subcostal View<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_29_439'>\n\t\t\t<li class='gchoice gchoice_29_439_0'>\n\t\t\t\t<input name='input_439' type='radio' value='0'  id='choice_29_439_0'    \/>\n\t\t\t\t<label for='choice_29_439_0' id='label_29_439_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_29_439_1'>\n\t\t\t\t<input name='input_439' type='radio' value='1'  id='choice_29_439_1'    \/>\n\t\t\t\t<label for='choice_29_439_1' id='label_29_439_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_29_439_2'>\n\t\t\t\t<input name='input_439' type='radio' value='2'  id='choice_29_439_2'    \/>\n\t\t\t\t<label for='choice_29_439_2' id='label_29_439_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_29_439_3'>\n\t\t\t\t<input name='input_439' type='radio' value='3'  id='choice_29_439_3'    \/>\n\t\t\t\t<label for='choice_29_439_3' id='label_29_439_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_360\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_29_360\"><h2 class=\"gsection_title\">SPECIAL VIEWS<\/h2><\/li><li id=\"field_29_408\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_408\"><label class='gfield_label gform-field-label'  >Pulmonary Veins<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_29_408'>\n\t\t\t<li class='gchoice gchoice_29_408_0'>\n\t\t\t\t<input name='input_408' type='radio' value='0'  id='choice_29_408_0'    \/>\n\t\t\t\t<label for='choice_29_408_0' id='label_29_408_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_29_408_1'>\n\t\t\t\t<input name='input_408' type='radio' value='1'  id='choice_29_408_1'    \/>\n\t\t\t\t<label for='choice_29_408_1' id='label_29_408_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_29_408_2'>\n\t\t\t\t<input name='input_408' type='radio' value='2'  id='choice_29_408_2'    \/>\n\t\t\t\t<label for='choice_29_408_2' id='label_29_408_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_29_408_3'>\n\t\t\t\t<input name='input_408' type='radio' value='3'  id='choice_29_408_3'    \/>\n\t\t\t\t<label for='choice_29_408_3' id='label_29_408_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_325\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_325\"><label class='gfield_label gform-field-label'  >Hepatic Veins<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_29_325'>\n\t\t\t<li class='gchoice gchoice_29_325_0'>\n\t\t\t\t<input name='input_325' type='radio' value='0'  id='choice_29_325_0'    \/>\n\t\t\t\t<label for='choice_29_325_0' id='label_29_325_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_29_325_1'>\n\t\t\t\t<input name='input_325' type='radio' value='1'  id='choice_29_325_1'    \/>\n\t\t\t\t<label for='choice_29_325_1' id='label_29_325_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_29_325_2'>\n\t\t\t\t<input name='input_325' type='radio' value='2'  id='choice_29_325_2'    \/>\n\t\t\t\t<label for='choice_29_325_2' id='label_29_325_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_29_325_3'>\n\t\t\t\t<input name='input_325' type='radio' value='3'  id='choice_29_325_3'    \/>\n\t\t\t\t<label for='choice_29_325_3' id='label_29_325_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_331\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gf_list_inline checklist_input_line field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_29_331\"><label class='gfield_label gform-field-label'  >Suprasternal Notch<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_29_331'>\n\t\t\t<li class='gchoice gchoice_29_331_0'>\n\t\t\t\t<input name='input_331' type='radio' value='0'  id='choice_29_331_0'    \/>\n\t\t\t\t<label for='choice_29_331_0' id='label_29_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_29_331_1'>\n\t\t\t\t<input name='input_331' type='radio' value='1'  id='choice_29_331_1'    \/>\n\t\t\t\t<label for='choice_29_331_1' id='label_29_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_29_331_2'>\n\t\t\t\t<input name='input_331' type='radio' value='2'  id='choice_29_331_2'    \/>\n\t\t\t\t<label for='choice_29_331_2' id='label_29_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_29_331_3'>\n\t\t\t\t<input name='input_331' type='radio' value='3'  id='choice_29_331_3'    \/>\n\t\t\t\t<label for='choice_29_331_3' id='label_29_331_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_440\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_29_440\"><h2 class=\"gsection_title\">CALCULATIONS<\/h2><\/li><li id=\"field_29_330\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gf_list_inline checklist_input_line field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_29_330\"><label class='gfield_label gform-field-label'  >Simpson\u2019s Rule<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_29_330'>\n\t\t\t<li class='gchoice gchoice_29_330_0'>\n\t\t\t\t<input name='input_330' type='radio' value='0'  id='choice_29_330_0'    \/>\n\t\t\t\t<label for='choice_29_330_0' id='label_29_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_29_330_1'>\n\t\t\t\t<input name='input_330' type='radio' value='1'  id='choice_29_330_1'    \/>\n\t\t\t\t<label for='choice_29_330_1' id='label_29_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_29_330_2'>\n\t\t\t\t<input name='input_330' type='radio' value='2'  id='choice_29_330_2'    \/>\n\t\t\t\t<label for='choice_29_330_2' id='label_29_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_29_330_3'>\n\t\t\t\t<input name='input_330' type='radio' value='3'  id='choice_29_330_3'    \/>\n\t\t\t\t<label for='choice_29_330_3' id='label_29_330_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_334\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_334\"><label class='gfield_label gform-field-label'  >Proximal Isovelocity Surface Area<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_29_334'>\n\t\t\t<li class='gchoice gchoice_29_334_0'>\n\t\t\t\t<input name='input_334' type='radio' value='0'  id='choice_29_334_0'    \/>\n\t\t\t\t<label for='choice_29_334_0' id='label_29_334_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_29_334_1'>\n\t\t\t\t<input name='input_334' type='radio' value='1'  id='choice_29_334_1'    \/>\n\t\t\t\t<label for='choice_29_334_1' id='label_29_334_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_29_334_2'>\n\t\t\t\t<input name='input_334' type='radio' value='2'  id='choice_29_334_2'    \/>\n\t\t\t\t<label for='choice_29_334_2' id='label_29_334_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_29_334_3'>\n\t\t\t\t<input name='input_334' type='radio' value='3'  id='choice_29_334_3'    \/>\n\t\t\t\t<label for='choice_29_334_3' id='label_29_334_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_333\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_333\"><label class='gfield_label gform-field-label'  >Distology with TDI<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_29_333'>\n\t\t\t<li class='gchoice gchoice_29_333_0'>\n\t\t\t\t<input name='input_333' type='radio' value='0'  id='choice_29_333_0'    \/>\n\t\t\t\t<label for='choice_29_333_0' id='label_29_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_29_333_1'>\n\t\t\t\t<input name='input_333' type='radio' value='1'  id='choice_29_333_1'    \/>\n\t\t\t\t<label for='choice_29_333_1' id='label_29_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_29_333_2'>\n\t\t\t\t<input name='input_333' type='radio' value='2'  id='choice_29_333_2'    \/>\n\t\t\t\t<label for='choice_29_333_2' id='label_29_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_29_333_3'>\n\t\t\t\t<input name='input_333' type='radio' value='3'  id='choice_29_333_3'    \/>\n\t\t\t\t<label for='choice_29_333_3' id='label_29_333_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_335\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_335\"><label class='gfield_label gform-field-label'  >LV Strain\/LV Volume<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_29_335'>\n\t\t\t<li class='gchoice gchoice_29_335_0'>\n\t\t\t\t<input name='input_335' type='radio' value='0'  id='choice_29_335_0'    \/>\n\t\t\t\t<label for='choice_29_335_0' id='label_29_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_29_335_1'>\n\t\t\t\t<input name='input_335' type='radio' value='1'  id='choice_29_335_1'    \/>\n\t\t\t\t<label for='choice_29_335_1' id='label_29_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_29_335_2'>\n\t\t\t\t<input name='input_335' type='radio' value='2'  id='choice_29_335_2'    \/>\n\t\t\t\t<label for='choice_29_335_2' id='label_29_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_29_335_3'>\n\t\t\t\t<input name='input_335' type='radio' value='3'  id='choice_29_335_3'    \/>\n\t\t\t\t<label for='choice_29_335_3' id='label_29_335_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_409\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_29_409\"><h2 class=\"gsection_title\">PEDIATRIC ECHO<\/h2><\/li><li id=\"field_29_369\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_369\"><label class='gfield_label gform-field-label'  >Routine<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_29_369'>\n\t\t\t<li class='gchoice gchoice_29_369_0'>\n\t\t\t\t<input name='input_369' type='radio' value='0'  id='choice_29_369_0'    \/>\n\t\t\t\t<label for='choice_29_369_0' id='label_29_369_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_29_369_1'>\n\t\t\t\t<input name='input_369' type='radio' value='1'  id='choice_29_369_1'    \/>\n\t\t\t\t<label for='choice_29_369_1' id='label_29_369_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_29_369_2'>\n\t\t\t\t<input name='input_369' type='radio' value='2'  id='choice_29_369_2'    \/>\n\t\t\t\t<label for='choice_29_369_2' id='label_29_369_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_29_369_3'>\n\t\t\t\t<input name='input_369' type='radio' value='3'  id='choice_29_369_3'    \/>\n\t\t\t\t<label for='choice_29_369_3' id='label_29_369_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_368\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_368\"><label class='gfield_label gform-field-label'  >3-D Echo<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_29_368'>\n\t\t\t<li class='gchoice gchoice_29_368_0'>\n\t\t\t\t<input name='input_368' type='radio' value='0'  id='choice_29_368_0'    \/>\n\t\t\t\t<label for='choice_29_368_0' id='label_29_368_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_29_368_1'>\n\t\t\t\t<input name='input_368' type='radio' value='1'  id='choice_29_368_1'    \/>\n\t\t\t\t<label for='choice_29_368_1' id='label_29_368_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_29_368_2'>\n\t\t\t\t<input name='input_368' type='radio' value='2'  id='choice_29_368_2'    \/>\n\t\t\t\t<label for='choice_29_368_2' id='label_29_368_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_29_368_3'>\n\t\t\t\t<input name='input_368' type='radio' value='3'  id='choice_29_368_3'    \/>\n\t\t\t\t<label for='choice_29_368_3' id='label_29_368_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_367\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_367\"><label class='gfield_label gform-field-label'  >Pedoff Probe<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_29_367'>\n\t\t\t<li class='gchoice gchoice_29_367_0'>\n\t\t\t\t<input name='input_367' type='radio' value='0'  id='choice_29_367_0'    \/>\n\t\t\t\t<label for='choice_29_367_0' id='label_29_367_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_29_367_1'>\n\t\t\t\t<input name='input_367' type='radio' value='1'  id='choice_29_367_1'    \/>\n\t\t\t\t<label for='choice_29_367_1' id='label_29_367_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_29_367_2'>\n\t\t\t\t<input name='input_367' type='radio' value='2'  id='choice_29_367_2'    \/>\n\t\t\t\t<label for='choice_29_367_2' id='label_29_367_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_29_367_3'>\n\t\t\t\t<input name='input_367' type='radio' value='3'  id='choice_29_367_3'    \/>\n\t\t\t\t<label for='choice_29_367_3' id='label_29_367_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_441\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_441\"><label class='gfield_label gform-field-label'  >Transesophageal Echo<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_29_441'>\n\t\t\t<li class='gchoice gchoice_29_441_0'>\n\t\t\t\t<input name='input_441' type='radio' value='0'  id='choice_29_441_0'    \/>\n\t\t\t\t<label for='choice_29_441_0' id='label_29_441_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_29_441_1'>\n\t\t\t\t<input name='input_441' type='radio' value='1'  id='choice_29_441_1'    \/>\n\t\t\t\t<label for='choice_29_441_1' id='label_29_441_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_29_441_2'>\n\t\t\t\t<input name='input_441' type='radio' value='2'  id='choice_29_441_2'    \/>\n\t\t\t\t<label for='choice_29_441_2' id='label_29_441_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_29_441_3'>\n\t\t\t\t<input name='input_441' type='radio' value='3'  id='choice_29_441_3'    \/>\n\t\t\t\t<label for='choice_29_441_3' id='label_29_441_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_410\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_29_410\"><h2 class=\"gsection_title\">PEDIATRIC ANOMALIES<\/h2><\/li><li id=\"field_29_366\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_366\"><label class='gfield_label gform-field-label'  >Aortic Arch Abnormalities\/Vascular Ring<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_29_366'>\n\t\t\t<li class='gchoice gchoice_29_366_0'>\n\t\t\t\t<input name='input_366' type='radio' value='0'  id='choice_29_366_0'    \/>\n\t\t\t\t<label for='choice_29_366_0' id='label_29_366_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_29_366_1'>\n\t\t\t\t<input name='input_366' type='radio' value='1'  id='choice_29_366_1'    \/>\n\t\t\t\t<label for='choice_29_366_1' id='label_29_366_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_29_366_2'>\n\t\t\t\t<input name='input_366' type='radio' value='2'  id='choice_29_366_2'    \/>\n\t\t\t\t<label for='choice_29_366_2' id='label_29_366_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_29_366_3'>\n\t\t\t\t<input name='input_366' type='radio' value='3'  id='choice_29_366_3'    \/>\n\t\t\t\t<label for='choice_29_366_3' id='label_29_366_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_365\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_365\"><label class='gfield_label gform-field-label'  >Arch Sidedness<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_29_365'>\n\t\t\t<li class='gchoice gchoice_29_365_0'>\n\t\t\t\t<input name='input_365' type='radio' value='0'  id='choice_29_365_0'    \/>\n\t\t\t\t<label for='choice_29_365_0' id='label_29_365_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_29_365_1'>\n\t\t\t\t<input name='input_365' type='radio' value='1'  id='choice_29_365_1'    \/>\n\t\t\t\t<label for='choice_29_365_1' id='label_29_365_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_29_365_2'>\n\t\t\t\t<input name='input_365' type='radio' value='2'  id='choice_29_365_2'    \/>\n\t\t\t\t<label for='choice_29_365_2' id='label_29_365_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_29_365_3'>\n\t\t\t\t<input name='input_365' type='radio' value='3'  id='choice_29_365_3'    \/>\n\t\t\t\t<label for='choice_29_365_3' id='label_29_365_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_364\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_364\"><label class='gfield_label gform-field-label'  >Coarctation of the Aorta<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_29_364'>\n\t\t\t<li class='gchoice gchoice_29_364_0'>\n\t\t\t\t<input name='input_364' type='radio' value='0'  id='choice_29_364_0'    \/>\n\t\t\t\t<label for='choice_29_364_0' id='label_29_364_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_29_364_1'>\n\t\t\t\t<input name='input_364' type='radio' value='1'  id='choice_29_364_1'    \/>\n\t\t\t\t<label for='choice_29_364_1' id='label_29_364_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_29_364_2'>\n\t\t\t\t<input name='input_364' type='radio' value='2'  id='choice_29_364_2'    \/>\n\t\t\t\t<label for='choice_29_364_2' id='label_29_364_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_29_364_3'>\n\t\t\t\t<input name='input_364' type='radio' value='3'  id='choice_29_364_3'    \/>\n\t\t\t\t<label for='choice_29_364_3' id='label_29_364_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_442\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_442\"><label class='gfield_label gform-field-label'  >Coronary Artery Anomalies<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_29_442'>\n\t\t\t<li class='gchoice gchoice_29_442_0'>\n\t\t\t\t<input name='input_442' type='radio' value='0'  id='choice_29_442_0'    \/>\n\t\t\t\t<label for='choice_29_442_0' id='label_29_442_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_29_442_1'>\n\t\t\t\t<input name='input_442' type='radio' value='1'  id='choice_29_442_1'    \/>\n\t\t\t\t<label for='choice_29_442_1' id='label_29_442_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_29_442_2'>\n\t\t\t\t<input name='input_442' type='radio' value='2'  id='choice_29_442_2'    \/>\n\t\t\t\t<label for='choice_29_442_2' id='label_29_442_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_29_442_3'>\n\t\t\t\t<input name='input_442' type='radio' value='3'  id='choice_29_442_3'    \/>\n\t\t\t\t<label for='choice_29_442_3' id='label_29_442_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_443\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_443\"><label class='gfield_label gform-field-label'  >Double Outlet Ventricle<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_29_443'>\n\t\t\t<li class='gchoice gchoice_29_443_0'>\n\t\t\t\t<input name='input_443' type='radio' value='0'  id='choice_29_443_0'    \/>\n\t\t\t\t<label for='choice_29_443_0' id='label_29_443_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_29_443_1'>\n\t\t\t\t<input name='input_443' type='radio' value='1'  id='choice_29_443_1'    \/>\n\t\t\t\t<label for='choice_29_443_1' id='label_29_443_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_29_443_2'>\n\t\t\t\t<input name='input_443' type='radio' value='2'  id='choice_29_443_2'    \/>\n\t\t\t\t<label for='choice_29_443_2' id='label_29_443_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_29_443_3'>\n\t\t\t\t<input name='input_443' type='radio' value='3'  id='choice_29_443_3'    \/>\n\t\t\t\t<label for='choice_29_443_3' id='label_29_443_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_444\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_444\"><label class='gfield_label gform-field-label'  >Hypoplastic Heart Syndrome<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_29_444'>\n\t\t\t<li class='gchoice gchoice_29_444_0'>\n\t\t\t\t<input name='input_444' type='radio' value='0'  id='choice_29_444_0'    \/>\n\t\t\t\t<label for='choice_29_444_0' id='label_29_444_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_29_444_1'>\n\t\t\t\t<input name='input_444' type='radio' value='1'  id='choice_29_444_1'    \/>\n\t\t\t\t<label for='choice_29_444_1' id='label_29_444_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_29_444_2'>\n\t\t\t\t<input name='input_444' type='radio' value='2'  id='choice_29_444_2'    \/>\n\t\t\t\t<label for='choice_29_444_2' id='label_29_444_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_29_444_3'>\n\t\t\t\t<input name='input_444' type='radio' value='3'  id='choice_29_444_3'    \/>\n\t\t\t\t<label for='choice_29_444_3' id='label_29_444_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_445\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_445\"><label class='gfield_label gform-field-label'  >Pulmonary Venous Return Anomalies<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_29_445'>\n\t\t\t<li class='gchoice gchoice_29_445_0'>\n\t\t\t\t<input name='input_445' type='radio' value='0'  id='choice_29_445_0'    \/>\n\t\t\t\t<label for='choice_29_445_0' id='label_29_445_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_29_445_1'>\n\t\t\t\t<input name='input_445' type='radio' value='1'  id='choice_29_445_1'    \/>\n\t\t\t\t<label for='choice_29_445_1' id='label_29_445_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_29_445_2'>\n\t\t\t\t<input name='input_445' type='radio' value='2'  id='choice_29_445_2'    \/>\n\t\t\t\t<label for='choice_29_445_2' id='label_29_445_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_29_445_3'>\n\t\t\t\t<input name='input_445' type='radio' value='3'  id='choice_29_445_3'    \/>\n\t\t\t\t<label for='choice_29_445_3' id='label_29_445_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_446\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_446\"><label class='gfield_label gform-field-label'  >Tetralogy of Fallot<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_29_446'>\n\t\t\t<li class='gchoice gchoice_29_446_0'>\n\t\t\t\t<input name='input_446' type='radio' value='0'  id='choice_29_446_0'    \/>\n\t\t\t\t<label for='choice_29_446_0' id='label_29_446_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_29_446_1'>\n\t\t\t\t<input name='input_446' type='radio' value='1'  id='choice_29_446_1'    \/>\n\t\t\t\t<label for='choice_29_446_1' id='label_29_446_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_29_446_2'>\n\t\t\t\t<input name='input_446' type='radio' value='2'  id='choice_29_446_2'    \/>\n\t\t\t\t<label for='choice_29_446_2' id='label_29_446_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_29_446_3'>\n\t\t\t\t<input name='input_446' type='radio' value='3'  id='choice_29_446_3'    \/>\n\t\t\t\t<label for='choice_29_446_3' id='label_29_446_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_447\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_447\"><label class='gfield_label gform-field-label'  >Transposition of the Great Vessels<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_29_447'>\n\t\t\t<li class='gchoice gchoice_29_447_0'>\n\t\t\t\t<input name='input_447' type='radio' value='0'  id='choice_29_447_0'    \/>\n\t\t\t\t<label for='choice_29_447_0' id='label_29_447_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_29_447_1'>\n\t\t\t\t<input name='input_447' type='radio' value='1'  id='choice_29_447_1'    \/>\n\t\t\t\t<label for='choice_29_447_1' id='label_29_447_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_29_447_2'>\n\t\t\t\t<input name='input_447' type='radio' value='2'  id='choice_29_447_2'    \/>\n\t\t\t\t<label for='choice_29_447_2' id='label_29_447_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_29_447_3'>\n\t\t\t\t<input name='input_447' type='radio' value='3'  id='choice_29_447_3'    \/>\n\t\t\t\t<label for='choice_29_447_3' id='label_29_447_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_448\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_448\"><label class='gfield_label gform-field-label'  >Tricuspid and Pulmonary Atresia<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_29_448'>\n\t\t\t<li class='gchoice gchoice_29_448_0'>\n\t\t\t\t<input name='input_448' type='radio' value='0'  id='choice_29_448_0'    \/>\n\t\t\t\t<label for='choice_29_448_0' id='label_29_448_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_29_448_1'>\n\t\t\t\t<input name='input_448' type='radio' value='1'  id='choice_29_448_1'    \/>\n\t\t\t\t<label for='choice_29_448_1' id='label_29_448_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_29_448_2'>\n\t\t\t\t<input name='input_448' type='radio' value='2'  id='choice_29_448_2'    \/>\n\t\t\t\t<label for='choice_29_448_2' id='label_29_448_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_29_448_3'>\n\t\t\t\t<input name='input_448' type='radio' value='3'  id='choice_29_448_3'    \/>\n\t\t\t\t<label for='choice_29_448_3' id='label_29_448_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_449\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_449\"><label class='gfield_label gform-field-label'  >Truncus Arteriosus<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_29_449'>\n\t\t\t<li class='gchoice gchoice_29_449_0'>\n\t\t\t\t<input name='input_449' type='radio' value='0'  id='choice_29_449_0'    \/>\n\t\t\t\t<label for='choice_29_449_0' id='label_29_449_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_29_449_1'>\n\t\t\t\t<input name='input_449' type='radio' value='1'  id='choice_29_449_1'    \/>\n\t\t\t\t<label for='choice_29_449_1' id='label_29_449_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_29_449_2'>\n\t\t\t\t<input name='input_449' type='radio' value='2'  id='choice_29_449_2'    \/>\n\t\t\t\t<label for='choice_29_449_2' id='label_29_449_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_29_449_3'>\n\t\t\t\t<input name='input_449' type='radio' value='3'  id='choice_29_449_3'    \/>\n\t\t\t\t<label for='choice_29_449_3' id='label_29_449_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_450\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_450\"><label class='gfield_label gform-field-label'  >Univentricular Heart Anomalies<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_29_450'>\n\t\t\t<li class='gchoice gchoice_29_450_0'>\n\t\t\t\t<input name='input_450' type='radio' value='0'  id='choice_29_450_0'    \/>\n\t\t\t\t<label for='choice_29_450_0' id='label_29_450_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_29_450_1'>\n\t\t\t\t<input name='input_450' type='radio' value='1'  id='choice_29_450_1'    \/>\n\t\t\t\t<label for='choice_29_450_1' id='label_29_450_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_29_450_2'>\n\t\t\t\t<input name='input_450' type='radio' value='2'  id='choice_29_450_2'    \/>\n\t\t\t\t<label for='choice_29_450_2' id='label_29_450_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_29_450_3'>\n\t\t\t\t<input name='input_450' type='radio' value='3'  id='choice_29_450_3'    \/>\n\t\t\t\t<label for='choice_29_450_3' id='label_29_450_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_411\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_29_411\"><h2 class=\"gsection_title\">PEDIATRIC POST-SURGICAL SCANS<\/h2><\/li><li id=\"field_29_363\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_363\"><label class='gfield_label gform-field-label'  >Arterial Switch<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_29_363'>\n\t\t\t<li class='gchoice gchoice_29_363_0'>\n\t\t\t\t<input name='input_363' type='radio' value='0'  id='choice_29_363_0'    \/>\n\t\t\t\t<label for='choice_29_363_0' id='label_29_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_29_363_1'>\n\t\t\t\t<input name='input_363' type='radio' value='1'  id='choice_29_363_1'    \/>\n\t\t\t\t<label for='choice_29_363_1' id='label_29_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_29_363_2'>\n\t\t\t\t<input name='input_363' type='radio' value='2'  id='choice_29_363_2'    \/>\n\t\t\t\t<label for='choice_29_363_2' id='label_29_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_29_363_3'>\n\t\t\t\t<input name='input_363' type='radio' value='3'  id='choice_29_363_3'    \/>\n\t\t\t\t<label for='choice_29_363_3' id='label_29_363_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_362\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_362\"><label class='gfield_label gform-field-label'  >Blalock-Taussig<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_29_362'>\n\t\t\t<li class='gchoice gchoice_29_362_0'>\n\t\t\t\t<input name='input_362' type='radio' value='0'  id='choice_29_362_0'    \/>\n\t\t\t\t<label for='choice_29_362_0' id='label_29_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_29_362_1'>\n\t\t\t\t<input name='input_362' type='radio' value='1'  id='choice_29_362_1'    \/>\n\t\t\t\t<label for='choice_29_362_1' id='label_29_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_29_362_2'>\n\t\t\t\t<input name='input_362' type='radio' value='2'  id='choice_29_362_2'    \/>\n\t\t\t\t<label for='choice_29_362_2' id='label_29_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_29_362_3'>\n\t\t\t\t<input name='input_362' type='radio' value='3'  id='choice_29_362_3'    \/>\n\t\t\t\t<label for='choice_29_362_3' id='label_29_362_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_361\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_361\"><label class='gfield_label gform-field-label'  >Damus-Kaye-Stansel<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_29_361'>\n\t\t\t<li class='gchoice gchoice_29_361_0'>\n\t\t\t\t<input name='input_361' type='radio' value='0'  id='choice_29_361_0'    \/>\n\t\t\t\t<label for='choice_29_361_0' id='label_29_361_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_29_361_1'>\n\t\t\t\t<input name='input_361' type='radio' value='1'  id='choice_29_361_1'    \/>\n\t\t\t\t<label for='choice_29_361_1' id='label_29_361_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_29_361_2'>\n\t\t\t\t<input name='input_361' type='radio' value='2'  id='choice_29_361_2'    \/>\n\t\t\t\t<label for='choice_29_361_2' id='label_29_361_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_29_361_3'>\n\t\t\t\t<input name='input_361' type='radio' value='3'  id='choice_29_361_3'    \/>\n\t\t\t\t<label for='choice_29_361_3' id='label_29_361_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_451\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_451\"><label class='gfield_label gform-field-label'  >Fontan<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_29_451'>\n\t\t\t<li class='gchoice gchoice_29_451_0'>\n\t\t\t\t<input name='input_451' type='radio' value='0'  id='choice_29_451_0'    \/>\n\t\t\t\t<label for='choice_29_451_0' id='label_29_451_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_29_451_1'>\n\t\t\t\t<input name='input_451' type='radio' value='1'  id='choice_29_451_1'    \/>\n\t\t\t\t<label for='choice_29_451_1' id='label_29_451_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_29_451_2'>\n\t\t\t\t<input name='input_451' type='radio' value='2'  id='choice_29_451_2'    \/>\n\t\t\t\t<label for='choice_29_451_2' id='label_29_451_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_29_451_3'>\n\t\t\t\t<input name='input_451' type='radio' value='3'  id='choice_29_451_3'    \/>\n\t\t\t\t<label for='choice_29_451_3' id='label_29_451_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_452\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_452\"><label class='gfield_label gform-field-label'  >Glenn<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_29_452'>\n\t\t\t<li class='gchoice gchoice_29_452_0'>\n\t\t\t\t<input name='input_452' type='radio' value='0'  id='choice_29_452_0'    \/>\n\t\t\t\t<label for='choice_29_452_0' id='label_29_452_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_29_452_1'>\n\t\t\t\t<input name='input_452' type='radio' value='1'  id='choice_29_452_1'    \/>\n\t\t\t\t<label for='choice_29_452_1' id='label_29_452_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_29_452_2'>\n\t\t\t\t<input name='input_452' type='radio' value='2'  id='choice_29_452_2'    \/>\n\t\t\t\t<label for='choice_29_452_2' id='label_29_452_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_29_452_3'>\n\t\t\t\t<input name='input_452' type='radio' value='3'  id='choice_29_452_3'    \/>\n\t\t\t\t<label for='choice_29_452_3' id='label_29_452_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_453\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_453\"><label class='gfield_label gform-field-label'  >Konno<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_29_453'>\n\t\t\t<li class='gchoice gchoice_29_453_0'>\n\t\t\t\t<input name='input_453' type='radio' value='0'  id='choice_29_453_0'    \/>\n\t\t\t\t<label for='choice_29_453_0' id='label_29_453_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_29_453_1'>\n\t\t\t\t<input name='input_453' type='radio' value='1'  id='choice_29_453_1'    \/>\n\t\t\t\t<label for='choice_29_453_1' id='label_29_453_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_29_453_2'>\n\t\t\t\t<input name='input_453' type='radio' value='2'  id='choice_29_453_2'    \/>\n\t\t\t\t<label for='choice_29_453_2' id='label_29_453_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_29_453_3'>\n\t\t\t\t<input name='input_453' type='radio' value='3'  id='choice_29_453_3'    \/>\n\t\t\t\t<label for='choice_29_453_3' id='label_29_453_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_454\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_454\"><label class='gfield_label gform-field-label'  >Mustard<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_29_454'>\n\t\t\t<li class='gchoice gchoice_29_454_0'>\n\t\t\t\t<input name='input_454' type='radio' value='0'  id='choice_29_454_0'    \/>\n\t\t\t\t<label for='choice_29_454_0' id='label_29_454_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_29_454_1'>\n\t\t\t\t<input name='input_454' type='radio' value='1'  id='choice_29_454_1'    \/>\n\t\t\t\t<label for='choice_29_454_1' id='label_29_454_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_29_454_2'>\n\t\t\t\t<input name='input_454' type='radio' value='2'  id='choice_29_454_2'    \/>\n\t\t\t\t<label for='choice_29_454_2' id='label_29_454_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_29_454_3'>\n\t\t\t\t<input name='input_454' type='radio' value='3'  id='choice_29_454_3'    \/>\n\t\t\t\t<label for='choice_29_454_3' id='label_29_454_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_455\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_455\"><label class='gfield_label gform-field-label'  >Norwood<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_29_455'>\n\t\t\t<li class='gchoice gchoice_29_455_0'>\n\t\t\t\t<input name='input_455' type='radio' value='0'  id='choice_29_455_0'    \/>\n\t\t\t\t<label for='choice_29_455_0' id='label_29_455_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_29_455_1'>\n\t\t\t\t<input name='input_455' type='radio' value='1'  id='choice_29_455_1'    \/>\n\t\t\t\t<label for='choice_29_455_1' id='label_29_455_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_29_455_2'>\n\t\t\t\t<input name='input_455' type='radio' value='2'  id='choice_29_455_2'    \/>\n\t\t\t\t<label for='choice_29_455_2' id='label_29_455_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_29_455_3'>\n\t\t\t\t<input name='input_455' type='radio' value='3'  id='choice_29_455_3'    \/>\n\t\t\t\t<label for='choice_29_455_3' id='label_29_455_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_456\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_456\"><label class='gfield_label gform-field-label'  >Rastelli<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_29_456'>\n\t\t\t<li class='gchoice gchoice_29_456_0'>\n\t\t\t\t<input name='input_456' type='radio' value='0'  id='choice_29_456_0'    \/>\n\t\t\t\t<label for='choice_29_456_0' id='label_29_456_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_29_456_1'>\n\t\t\t\t<input name='input_456' type='radio' value='1'  id='choice_29_456_1'    \/>\n\t\t\t\t<label for='choice_29_456_1' id='label_29_456_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_29_456_2'>\n\t\t\t\t<input name='input_456' type='radio' value='2'  id='choice_29_456_2'    \/>\n\t\t\t\t<label for='choice_29_456_2' id='label_29_456_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_29_456_3'>\n\t\t\t\t<input name='input_456' type='radio' value='3'  id='choice_29_456_3'    \/>\n\t\t\t\t<label for='choice_29_456_3' id='label_29_456_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_457\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_457\"><label class='gfield_label gform-field-label'  >Sano<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_29_457'>\n\t\t\t<li class='gchoice gchoice_29_457_0'>\n\t\t\t\t<input name='input_457' type='radio' value='0'  id='choice_29_457_0'    \/>\n\t\t\t\t<label for='choice_29_457_0' id='label_29_457_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_29_457_1'>\n\t\t\t\t<input name='input_457' type='radio' value='1'  id='choice_29_457_1'    \/>\n\t\t\t\t<label for='choice_29_457_1' id='label_29_457_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_29_457_2'>\n\t\t\t\t<input name='input_457' type='radio' value='2'  id='choice_29_457_2'    \/>\n\t\t\t\t<label for='choice_29_457_2' id='label_29_457_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_29_457_3'>\n\t\t\t\t<input name='input_457' type='radio' value='3'  id='choice_29_457_3'    \/>\n\t\t\t\t<label for='choice_29_457_3' id='label_29_457_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_458\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_458\"><label class='gfield_label gform-field-label'  >Sennig<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_29_458'>\n\t\t\t<li class='gchoice gchoice_29_458_0'>\n\t\t\t\t<input name='input_458' type='radio' value='0'  id='choice_29_458_0'    \/>\n\t\t\t\t<label for='choice_29_458_0' id='label_29_458_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_29_458_1'>\n\t\t\t\t<input name='input_458' type='radio' value='1'  id='choice_29_458_1'    \/>\n\t\t\t\t<label for='choice_29_458_1' id='label_29_458_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_29_458_2'>\n\t\t\t\t<input name='input_458' type='radio' value='2'  id='choice_29_458_2'    \/>\n\t\t\t\t<label for='choice_29_458_2' id='label_29_458_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_29_458_3'>\n\t\t\t\t<input name='input_458' type='radio' value='3'  id='choice_29_458_3'    \/>\n\t\t\t\t<label for='choice_29_458_3' id='label_29_458_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_459\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_29_459\"><h2 class=\"gsection_title\">COMPUTERIZED CHARTING<\/h2><\/li><li id=\"field_29_461\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_29_461\"><h2 class=\"gsection_title\">EMR<\/h2><\/li><li id=\"field_29_460\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_460\"><label class='gfield_label gform-field-label'  >eClinicalworks<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_29_460'>\n\t\t\t<li class='gchoice gchoice_29_460_0'>\n\t\t\t\t<input name='input_460' type='radio' value='0'  id='choice_29_460_0'    \/>\n\t\t\t\t<label for='choice_29_460_0' id='label_29_460_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_29_460_1'>\n\t\t\t\t<input name='input_460' type='radio' value='1'  id='choice_29_460_1'    \/>\n\t\t\t\t<label for='choice_29_460_1' id='label_29_460_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_29_460_2'>\n\t\t\t\t<input name='input_460' type='radio' value='2'  id='choice_29_460_2'    \/>\n\t\t\t\t<label for='choice_29_460_2' id='label_29_460_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_29_460_3'>\n\t\t\t\t<input name='input_460' type='radio' value='3'  id='choice_29_460_3'    \/>\n\t\t\t\t<label for='choice_29_460_3' id='label_29_460_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_462\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_462\"><label class='gfield_label gform-field-label'  >EPIC<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_29_462'>\n\t\t\t<li class='gchoice gchoice_29_462_0'>\n\t\t\t\t<input name='input_462' type='radio' value='0'  id='choice_29_462_0'    \/>\n\t\t\t\t<label for='choice_29_462_0' id='label_29_462_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_29_462_1'>\n\t\t\t\t<input name='input_462' type='radio' value='1'  id='choice_29_462_1'    \/>\n\t\t\t\t<label for='choice_29_462_1' id='label_29_462_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_29_462_2'>\n\t\t\t\t<input name='input_462' type='radio' value='2'  id='choice_29_462_2'    \/>\n\t\t\t\t<label for='choice_29_462_2' id='label_29_462_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_29_462_3'>\n\t\t\t\t<input name='input_462' type='radio' value='3'  id='choice_29_462_3'    \/>\n\t\t\t\t<label for='choice_29_462_3' id='label_29_462_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_463\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_463\"><label class='gfield_label gform-field-label'  >McKesson<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_29_463'>\n\t\t\t<li class='gchoice gchoice_29_463_0'>\n\t\t\t\t<input name='input_463' type='radio' value='0'  id='choice_29_463_0'    \/>\n\t\t\t\t<label for='choice_29_463_0' id='label_29_463_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_29_463_1'>\n\t\t\t\t<input name='input_463' type='radio' value='1'  id='choice_29_463_1'    \/>\n\t\t\t\t<label for='choice_29_463_1' id='label_29_463_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_29_463_2'>\n\t\t\t\t<input name='input_463' type='radio' value='2'  id='choice_29_463_2'    \/>\n\t\t\t\t<label for='choice_29_463_2' id='label_29_463_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_29_463_3'>\n\t\t\t\t<input name='input_463' type='radio' value='3'  id='choice_29_463_3'    \/>\n\t\t\t\t<label for='choice_29_463_3' id='label_29_463_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_464\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_464\"><label class='gfield_label gform-field-label'  >Care 360<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_29_464'>\n\t\t\t<li class='gchoice gchoice_29_464_0'>\n\t\t\t\t<input name='input_464' type='radio' value='0'  id='choice_29_464_0'    \/>\n\t\t\t\t<label for='choice_29_464_0' id='label_29_464_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_29_464_1'>\n\t\t\t\t<input name='input_464' type='radio' value='1'  id='choice_29_464_1'    \/>\n\t\t\t\t<label for='choice_29_464_1' id='label_29_464_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_29_464_2'>\n\t\t\t\t<input name='input_464' type='radio' value='2'  id='choice_29_464_2'    \/>\n\t\t\t\t<label for='choice_29_464_2' id='label_29_464_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_29_464_3'>\n\t\t\t\t<input name='input_464' type='radio' value='3'  id='choice_29_464_3'    \/>\n\t\t\t\t<label for='choice_29_464_3' id='label_29_464_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_465\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_465\"><label class='gfield_label gform-field-label'  >Allscripts<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_29_465'>\n\t\t\t<li class='gchoice gchoice_29_465_0'>\n\t\t\t\t<input name='input_465' type='radio' value='0'  id='choice_29_465_0'    \/>\n\t\t\t\t<label for='choice_29_465_0' id='label_29_465_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_29_465_1'>\n\t\t\t\t<input name='input_465' type='radio' value='1'  id='choice_29_465_1'    \/>\n\t\t\t\t<label for='choice_29_465_1' id='label_29_465_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_29_465_2'>\n\t\t\t\t<input name='input_465' type='radio' value='2'  id='choice_29_465_2'    \/>\n\t\t\t\t<label for='choice_29_465_2' id='label_29_465_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_29_465_3'>\n\t\t\t\t<input name='input_465' type='radio' value='3'  id='choice_29_465_3'    \/>\n\t\t\t\t<label for='choice_29_465_3' id='label_29_465_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_466\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_466\"><label class='gfield_label gform-field-label'  >Cerner<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_29_466'>\n\t\t\t<li class='gchoice gchoice_29_466_0'>\n\t\t\t\t<input name='input_466' type='radio' value='0'  id='choice_29_466_0'    \/>\n\t\t\t\t<label for='choice_29_466_0' id='label_29_466_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_29_466_1'>\n\t\t\t\t<input name='input_466' type='radio' value='1'  id='choice_29_466_1'    \/>\n\t\t\t\t<label for='choice_29_466_1' id='label_29_466_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_29_466_2'>\n\t\t\t\t<input name='input_466' type='radio' value='2'  id='choice_29_466_2'    \/>\n\t\t\t\t<label for='choice_29_466_2' id='label_29_466_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_29_466_3'>\n\t\t\t\t<input name='input_466' type='radio' value='3'  id='choice_29_466_3'    \/>\n\t\t\t\t<label for='choice_29_466_3' id='label_29_466_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_467\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_467\"><label class='gfield_label gform-field-label'  >Optum Insight<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_29_467'>\n\t\t\t<li class='gchoice gchoice_29_467_0'>\n\t\t\t\t<input name='input_467' type='radio' value='0'  id='choice_29_467_0'    \/>\n\t\t\t\t<label for='choice_29_467_0' id='label_29_467_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_29_467_1'>\n\t\t\t\t<input name='input_467' type='radio' value='1'  id='choice_29_467_1'    \/>\n\t\t\t\t<label for='choice_29_467_1' id='label_29_467_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_29_467_2'>\n\t\t\t\t<input name='input_467' type='radio' value='2'  id='choice_29_467_2'    \/>\n\t\t\t\t<label for='choice_29_467_2' id='label_29_467_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_29_467_3'>\n\t\t\t\t<input name='input_467' type='radio' value='3'  id='choice_29_467_3'    \/>\n\t\t\t\t<label for='choice_29_467_3' id='label_29_467_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_468\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_468\"><label class='gfield_label gform-field-label'  >NextGen<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_29_468'>\n\t\t\t<li class='gchoice gchoice_29_468_0'>\n\t\t\t\t<input name='input_468' type='radio' value='0'  id='choice_29_468_0'    \/>\n\t\t\t\t<label for='choice_29_468_0' id='label_29_468_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_29_468_1'>\n\t\t\t\t<input name='input_468' type='radio' value='1'  id='choice_29_468_1'    \/>\n\t\t\t\t<label for='choice_29_468_1' id='label_29_468_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_29_468_2'>\n\t\t\t\t<input name='input_468' type='radio' value='2'  id='choice_29_468_2'    \/>\n\t\t\t\t<label for='choice_29_468_2' id='label_29_468_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_29_468_3'>\n\t\t\t\t<input name='input_468' type='radio' value='3'  id='choice_29_468_3'    \/>\n\t\t\t\t<label for='choice_29_468_3' id='label_29_468_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_469\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_469\"><label class='gfield_label gform-field-label'  >Greenway<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_29_469'>\n\t\t\t<li class='gchoice gchoice_29_469_0'>\n\t\t\t\t<input name='input_469' type='radio' value='0'  id='choice_29_469_0'    \/>\n\t\t\t\t<label for='choice_29_469_0' id='label_29_469_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_29_469_1'>\n\t\t\t\t<input name='input_469' type='radio' value='1'  id='choice_29_469_1'    \/>\n\t\t\t\t<label for='choice_29_469_1' id='label_29_469_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_29_469_2'>\n\t\t\t\t<input name='input_469' type='radio' value='2'  id='choice_29_469_2'    \/>\n\t\t\t\t<label for='choice_29_469_2' id='label_29_469_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_29_469_3'>\n\t\t\t\t<input name='input_469' type='radio' value='3'  id='choice_29_469_3'    \/>\n\t\t\t\t<label for='choice_29_469_3' id='label_29_469_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_470\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_29_470\"><h2 class=\"gsection_title\">PACS<\/h2><\/li><li id=\"field_29_471\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_471\"><label class='gfield_label gform-field-label'  >Ambra Health<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_29_471'>\n\t\t\t<li class='gchoice gchoice_29_471_0'>\n\t\t\t\t<input name='input_471' type='radio' value='0'  id='choice_29_471_0'    \/>\n\t\t\t\t<label for='choice_29_471_0' id='label_29_471_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_29_471_1'>\n\t\t\t\t<input name='input_471' type='radio' value='1'  id='choice_29_471_1'    \/>\n\t\t\t\t<label for='choice_29_471_1' id='label_29_471_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_29_471_2'>\n\t\t\t\t<input name='input_471' type='radio' value='2'  id='choice_29_471_2'    \/>\n\t\t\t\t<label for='choice_29_471_2' id='label_29_471_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_29_471_3'>\n\t\t\t\t<input name='input_471' type='radio' value='3'  id='choice_29_471_3'    \/>\n\t\t\t\t<label for='choice_29_471_3' id='label_29_471_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_472\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_472\"><label class='gfield_label gform-field-label'  >Sectra<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_29_472'>\n\t\t\t<li class='gchoice gchoice_29_472_0'>\n\t\t\t\t<input name='input_472' type='radio' value='0'  id='choice_29_472_0'    \/>\n\t\t\t\t<label for='choice_29_472_0' id='label_29_472_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_29_472_1'>\n\t\t\t\t<input name='input_472' type='radio' value='1'  id='choice_29_472_1'    \/>\n\t\t\t\t<label for='choice_29_472_1' id='label_29_472_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_29_472_2'>\n\t\t\t\t<input name='input_472' type='radio' value='2'  id='choice_29_472_2'    \/>\n\t\t\t\t<label for='choice_29_472_2' id='label_29_472_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_29_472_3'>\n\t\t\t\t<input name='input_472' type='radio' value='3'  id='choice_29_472_3'    \/>\n\t\t\t\t<label for='choice_29_472_3' id='label_29_472_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_473\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_473\"><label class='gfield_label gform-field-label'  >Infinitt<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_29_473'>\n\t\t\t<li class='gchoice gchoice_29_473_0'>\n\t\t\t\t<input name='input_473' type='radio' value='0'  id='choice_29_473_0'    \/>\n\t\t\t\t<label for='choice_29_473_0' id='label_29_473_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_29_473_1'>\n\t\t\t\t<input name='input_473' type='radio' value='1'  id='choice_29_473_1'    \/>\n\t\t\t\t<label for='choice_29_473_1' id='label_29_473_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_29_473_2'>\n\t\t\t\t<input name='input_473' type='radio' value='2'  id='choice_29_473_2'    \/>\n\t\t\t\t<label for='choice_29_473_2' id='label_29_473_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_29_473_3'>\n\t\t\t\t<input name='input_473' type='radio' value='3'  id='choice_29_473_3'    \/>\n\t\t\t\t<label for='choice_29_473_3' id='label_29_473_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_474\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_474\"><label class='gfield_label gform-field-label'  >IBM Merge<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_29_474'>\n\t\t\t<li class='gchoice gchoice_29_474_0'>\n\t\t\t\t<input name='input_474' type='radio' value='0'  id='choice_29_474_0'    \/>\n\t\t\t\t<label for='choice_29_474_0' id='label_29_474_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_29_474_1'>\n\t\t\t\t<input name='input_474' type='radio' value='1'  id='choice_29_474_1'    \/>\n\t\t\t\t<label for='choice_29_474_1' id='label_29_474_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_29_474_2'>\n\t\t\t\t<input name='input_474' type='radio' value='2'  id='choice_29_474_2'    \/>\n\t\t\t\t<label for='choice_29_474_2' id='label_29_474_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_29_474_3'>\n\t\t\t\t<input name='input_474' type='radio' value='3'  id='choice_29_474_3'    \/>\n\t\t\t\t<label for='choice_29_474_3' id='label_29_474_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_475\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_475\"><label class='gfield_label gform-field-label'  >McKesson<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_29_475'>\n\t\t\t<li class='gchoice gchoice_29_475_0'>\n\t\t\t\t<input name='input_475' type='radio' value='0'  id='choice_29_475_0'    \/>\n\t\t\t\t<label for='choice_29_475_0' id='label_29_475_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_29_475_1'>\n\t\t\t\t<input name='input_475' type='radio' value='1'  id='choice_29_475_1'    \/>\n\t\t\t\t<label for='choice_29_475_1' id='label_29_475_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_29_475_2'>\n\t\t\t\t<input name='input_475' type='radio' value='2'  id='choice_29_475_2'    \/>\n\t\t\t\t<label for='choice_29_475_2' id='label_29_475_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_29_475_3'>\n\t\t\t\t<input name='input_475' type='radio' value='3'  id='choice_29_475_3'    \/>\n\t\t\t\t<label for='choice_29_475_3' id='label_29_475_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_476\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_476\"><label class='gfield_label gform-field-label'  >Philips<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_29_476'>\n\t\t\t<li class='gchoice gchoice_29_476_0'>\n\t\t\t\t<input name='input_476' type='radio' value='0'  id='choice_29_476_0'    \/>\n\t\t\t\t<label for='choice_29_476_0' id='label_29_476_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_29_476_1'>\n\t\t\t\t<input name='input_476' type='radio' value='1'  id='choice_29_476_1'    \/>\n\t\t\t\t<label for='choice_29_476_1' id='label_29_476_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_29_476_2'>\n\t\t\t\t<input name='input_476' type='radio' value='2'  id='choice_29_476_2'    \/>\n\t\t\t\t<label for='choice_29_476_2' id='label_29_476_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_29_476_3'>\n\t\t\t\t<input name='input_476' type='radio' value='3'  id='choice_29_476_3'    \/>\n\t\t\t\t<label for='choice_29_476_3' id='label_29_476_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_477\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_477\"><label class='gfield_label gform-field-label'  >FujiFilm<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_29_477'>\n\t\t\t<li class='gchoice gchoice_29_477_0'>\n\t\t\t\t<input name='input_477' type='radio' value='0'  id='choice_29_477_0'    \/>\n\t\t\t\t<label for='choice_29_477_0' id='label_29_477_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_29_477_1'>\n\t\t\t\t<input name='input_477' type='radio' value='1'  id='choice_29_477_1'    \/>\n\t\t\t\t<label for='choice_29_477_1' id='label_29_477_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_29_477_2'>\n\t\t\t\t<input name='input_477' type='radio' value='2'  id='choice_29_477_2'    \/>\n\t\t\t\t<label for='choice_29_477_2' id='label_29_477_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_29_477_3'>\n\t\t\t\t<input name='input_477' type='radio' value='3'  id='choice_29_477_3'    \/>\n\t\t\t\t<label for='choice_29_477_3' id='label_29_477_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_478\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_478\"><label class='gfield_label gform-field-label'  >Impax<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_29_478'>\n\t\t\t<li class='gchoice gchoice_29_478_0'>\n\t\t\t\t<input name='input_478' type='radio' value='0'  id='choice_29_478_0'    \/>\n\t\t\t\t<label for='choice_29_478_0' id='label_29_478_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_29_478_1'>\n\t\t\t\t<input name='input_478' type='radio' value='1'  id='choice_29_478_1'    \/>\n\t\t\t\t<label for='choice_29_478_1' id='label_29_478_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_29_478_2'>\n\t\t\t\t<input name='input_478' type='radio' value='2'  id='choice_29_478_2'    \/>\n\t\t\t\t<label for='choice_29_478_2' id='label_29_478_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_29_478_3'>\n\t\t\t\t<input name='input_478' type='radio' value='3'  id='choice_29_478_3'    \/>\n\t\t\t\t<label for='choice_29_478_3' id='label_29_478_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_479\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_479\"><label class='gfield_label gform-field-label'  >Centricity<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_29_479'>\n\t\t\t<li class='gchoice gchoice_29_479_0'>\n\t\t\t\t<input name='input_479' type='radio' value='0'  id='choice_29_479_0'    \/>\n\t\t\t\t<label for='choice_29_479_0' id='label_29_479_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_29_479_1'>\n\t\t\t\t<input name='input_479' type='radio' value='1'  id='choice_29_479_1'    \/>\n\t\t\t\t<label for='choice_29_479_1' id='label_29_479_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_29_479_2'>\n\t\t\t\t<input name='input_479' type='radio' value='2'  id='choice_29_479_2'    \/>\n\t\t\t\t<label for='choice_29_479_2' id='label_29_479_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_29_479_3'>\n\t\t\t\t<input name='input_479' type='radio' value='3'  id='choice_29_479_3'    \/>\n\t\t\t\t<label for='choice_29_479_3' id='label_29_479_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_480\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_480\"><label class='gfield_label gform-field-label'  >Carestream Vue<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_29_480'>\n\t\t\t<li class='gchoice gchoice_29_480_0'>\n\t\t\t\t<input name='input_480' type='radio' value='0'  id='choice_29_480_0'    \/>\n\t\t\t\t<label for='choice_29_480_0' id='label_29_480_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_29_480_1'>\n\t\t\t\t<input name='input_480' type='radio' value='1'  id='choice_29_480_1'    \/>\n\t\t\t\t<label for='choice_29_480_1' id='label_29_480_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_29_480_2'>\n\t\t\t\t<input name='input_480' type='radio' value='2'  id='choice_29_480_2'    \/>\n\t\t\t\t<label for='choice_29_480_2' id='label_29_480_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_29_480_3'>\n\t\t\t\t<input name='input_480' type='radio' value='3'  id='choice_29_480_3'    \/>\n\t\t\t\t<label for='choice_29_480_3' id='label_29_480_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_481\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_481\"><label class='gfield_label gform-field-label'  >Clarity<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_29_481'>\n\t\t\t<li class='gchoice gchoice_29_481_0'>\n\t\t\t\t<input name='input_481' type='radio' value='0'  id='choice_29_481_0'    \/>\n\t\t\t\t<label for='choice_29_481_0' id='label_29_481_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_29_481_1'>\n\t\t\t\t<input name='input_481' type='radio' value='1'  id='choice_29_481_1'    \/>\n\t\t\t\t<label for='choice_29_481_1' id='label_29_481_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_29_481_2'>\n\t\t\t\t<input name='input_481' type='radio' value='2'  id='choice_29_481_2'    \/>\n\t\t\t\t<label for='choice_29_481_2' id='label_29_481_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_29_481_3'>\n\t\t\t\t<input name='input_481' type='radio' value='3'  id='choice_29_481_3'    \/>\n\t\t\t\t<label for='choice_29_481_3' id='label_29_481_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_482\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_482\"><label class='gfield_label gform-field-label'  >eRad PACS<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_29_482'>\n\t\t\t<li class='gchoice gchoice_29_482_0'>\n\t\t\t\t<input name='input_482' type='radio' value='0'  id='choice_29_482_0'    \/>\n\t\t\t\t<label for='choice_29_482_0' id='label_29_482_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_29_482_1'>\n\t\t\t\t<input name='input_482' type='radio' value='1'  id='choice_29_482_1'    \/>\n\t\t\t\t<label for='choice_29_482_1' id='label_29_482_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_29_482_2'>\n\t\t\t\t<input name='input_482' type='radio' value='2'  id='choice_29_482_2'    \/>\n\t\t\t\t<label for='choice_29_482_2' id='label_29_482_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_29_482_3'>\n\t\t\t\t<input name='input_482' type='radio' value='3'  id='choice_29_482_3'    \/>\n\t\t\t\t<label for='choice_29_482_3' id='label_29_482_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_483\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_483\"><label class='gfield_label gform-field-label'  >Syngo<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_29_483'>\n\t\t\t<li class='gchoice gchoice_29_483_0'>\n\t\t\t\t<input name='input_483' type='radio' value='0'  id='choice_29_483_0'    \/>\n\t\t\t\t<label for='choice_29_483_0' id='label_29_483_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_29_483_1'>\n\t\t\t\t<input name='input_483' type='radio' value='1'  id='choice_29_483_1'    \/>\n\t\t\t\t<label for='choice_29_483_1' id='label_29_483_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_29_483_2'>\n\t\t\t\t<input name='input_483' type='radio' value='2'  id='choice_29_483_2'    \/>\n\t\t\t\t<label for='choice_29_483_2' id='label_29_483_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_29_483_3'>\n\t\t\t\t<input name='input_483' type='radio' value='3'  id='choice_29_483_3'    \/>\n\t\t\t\t<label for='choice_29_483_3' id='label_29_483_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_484\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_29_484\"><h2 class=\"gsection_title\">EQUIPMENT<\/h2><\/li><li id=\"field_29_485\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_485\"><label class='gfield_label gform-field-label'  >Acuson<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_29_485'>\n\t\t\t<li class='gchoice gchoice_29_485_0'>\n\t\t\t\t<input name='input_485' type='radio' value='0'  id='choice_29_485_0'    \/>\n\t\t\t\t<label for='choice_29_485_0' id='label_29_485_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_29_485_1'>\n\t\t\t\t<input name='input_485' type='radio' value='1'  id='choice_29_485_1'    \/>\n\t\t\t\t<label for='choice_29_485_1' id='label_29_485_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_29_485_2'>\n\t\t\t\t<input name='input_485' type='radio' value='2'  id='choice_29_485_2'    \/>\n\t\t\t\t<label for='choice_29_485_2' id='label_29_485_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_29_485_3'>\n\t\t\t\t<input name='input_485' type='radio' value='3'  id='choice_29_485_3'    \/>\n\t\t\t\t<label for='choice_29_485_3' id='label_29_485_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_486\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_486\"><label class='gfield_label gform-field-label'  >Aspen<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_29_486'>\n\t\t\t<li class='gchoice gchoice_29_486_0'>\n\t\t\t\t<input name='input_486' type='radio' value='0'  id='choice_29_486_0'    \/>\n\t\t\t\t<label for='choice_29_486_0' id='label_29_486_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_29_486_1'>\n\t\t\t\t<input name='input_486' type='radio' value='1'  id='choice_29_486_1'    \/>\n\t\t\t\t<label for='choice_29_486_1' id='label_29_486_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_29_486_2'>\n\t\t\t\t<input name='input_486' type='radio' value='2'  id='choice_29_486_2'    \/>\n\t\t\t\t<label for='choice_29_486_2' id='label_29_486_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_29_486_3'>\n\t\t\t\t<input name='input_486' type='radio' value='3'  id='choice_29_486_3'    \/>\n\t\t\t\t<label for='choice_29_486_3' id='label_29_486_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_487\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_487\"><label class='gfield_label gform-field-label'  >Cypress<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_29_487'>\n\t\t\t<li class='gchoice gchoice_29_487_0'>\n\t\t\t\t<input name='input_487' type='radio' value='0'  id='choice_29_487_0'    \/>\n\t\t\t\t<label for='choice_29_487_0' id='label_29_487_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_29_487_1'>\n\t\t\t\t<input name='input_487' type='radio' value='1'  id='choice_29_487_1'    \/>\n\t\t\t\t<label for='choice_29_487_1' id='label_29_487_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_29_487_2'>\n\t\t\t\t<input name='input_487' type='radio' value='2'  id='choice_29_487_2'    \/>\n\t\t\t\t<label for='choice_29_487_2' id='label_29_487_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_29_487_3'>\n\t\t\t\t<input name='input_487' type='radio' value='3'  id='choice_29_487_3'    \/>\n\t\t\t\t<label for='choice_29_487_3' id='label_29_487_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_488\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_488\"><label class='gfield_label gform-field-label'  >Sequoia<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_29_488'>\n\t\t\t<li class='gchoice gchoice_29_488_0'>\n\t\t\t\t<input name='input_488' type='radio' value='0'  id='choice_29_488_0'    \/>\n\t\t\t\t<label for='choice_29_488_0' id='label_29_488_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_29_488_1'>\n\t\t\t\t<input name='input_488' type='radio' value='1'  id='choice_29_488_1'    \/>\n\t\t\t\t<label for='choice_29_488_1' id='label_29_488_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_29_488_2'>\n\t\t\t\t<input name='input_488' type='radio' value='2'  id='choice_29_488_2'    \/>\n\t\t\t\t<label for='choice_29_488_2' id='label_29_488_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_29_488_3'>\n\t\t\t\t<input name='input_488' type='radio' value='3'  id='choice_29_488_3'    \/>\n\t\t\t\t<label for='choice_29_488_3' id='label_29_488_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_489\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_489\"><label class='gfield_label gform-field-label'  >128XP10<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_29_489'>\n\t\t\t<li class='gchoice gchoice_29_489_0'>\n\t\t\t\t<input name='input_489' type='radio' value='0'  id='choice_29_489_0'    \/>\n\t\t\t\t<label for='choice_29_489_0' id='label_29_489_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_29_489_1'>\n\t\t\t\t<input name='input_489' type='radio' value='1'  id='choice_29_489_1'    \/>\n\t\t\t\t<label for='choice_29_489_1' id='label_29_489_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_29_489_2'>\n\t\t\t\t<input name='input_489' type='radio' value='2'  id='choice_29_489_2'    \/>\n\t\t\t\t<label for='choice_29_489_2' id='label_29_489_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_29_489_3'>\n\t\t\t\t<input name='input_489' type='radio' value='3'  id='choice_29_489_3'    \/>\n\t\t\t\t<label for='choice_29_489_3' id='label_29_489_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_490\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_490\"><label class='gfield_label gform-field-label'  >Philips\/ ATL<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_29_490'>\n\t\t\t<li class='gchoice gchoice_29_490_0'>\n\t\t\t\t<input name='input_490' type='radio' value='0'  id='choice_29_490_0'    \/>\n\t\t\t\t<label for='choice_29_490_0' id='label_29_490_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_29_490_1'>\n\t\t\t\t<input name='input_490' type='radio' value='1'  id='choice_29_490_1'    \/>\n\t\t\t\t<label for='choice_29_490_1' id='label_29_490_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_29_490_2'>\n\t\t\t\t<input name='input_490' type='radio' value='2'  id='choice_29_490_2'    \/>\n\t\t\t\t<label for='choice_29_490_2' id='label_29_490_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_29_490_3'>\n\t\t\t\t<input name='input_490' type='radio' value='3'  id='choice_29_490_3'    \/>\n\t\t\t\t<label for='choice_29_490_3' id='label_29_490_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_491\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_491\"><label class='gfield_label gform-field-label'  >HDI 1000<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_29_491'>\n\t\t\t<li class='gchoice gchoice_29_491_0'>\n\t\t\t\t<input name='input_491' type='radio' value='0'  id='choice_29_491_0'    \/>\n\t\t\t\t<label for='choice_29_491_0' id='label_29_491_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_29_491_1'>\n\t\t\t\t<input name='input_491' type='radio' value='1'  id='choice_29_491_1'    \/>\n\t\t\t\t<label for='choice_29_491_1' id='label_29_491_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_29_491_2'>\n\t\t\t\t<input name='input_491' type='radio' value='2'  id='choice_29_491_2'    \/>\n\t\t\t\t<label for='choice_29_491_2' id='label_29_491_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_29_491_3'>\n\t\t\t\t<input name='input_491' type='radio' value='3'  id='choice_29_491_3'    \/>\n\t\t\t\t<label for='choice_29_491_3' id='label_29_491_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_492\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_492\"><label class='gfield_label gform-field-label'  >HDI 3000<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_29_492'>\n\t\t\t<li class='gchoice gchoice_29_492_0'>\n\t\t\t\t<input name='input_492' type='radio' value='0'  id='choice_29_492_0'    \/>\n\t\t\t\t<label for='choice_29_492_0' id='label_29_492_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_29_492_1'>\n\t\t\t\t<input name='input_492' type='radio' value='1'  id='choice_29_492_1'    \/>\n\t\t\t\t<label for='choice_29_492_1' id='label_29_492_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_29_492_2'>\n\t\t\t\t<input name='input_492' type='radio' value='2'  id='choice_29_492_2'    \/>\n\t\t\t\t<label for='choice_29_492_2' id='label_29_492_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_29_492_3'>\n\t\t\t\t<input name='input_492' type='radio' value='3'  id='choice_29_492_3'    \/>\n\t\t\t\t<label for='choice_29_492_3' id='label_29_492_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_493\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_493\"><label class='gfield_label gform-field-label'  >HDI 4000<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_29_493'>\n\t\t\t<li class='gchoice gchoice_29_493_0'>\n\t\t\t\t<input name='input_493' type='radio' value='0'  id='choice_29_493_0'    \/>\n\t\t\t\t<label for='choice_29_493_0' id='label_29_493_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_29_493_1'>\n\t\t\t\t<input name='input_493' type='radio' value='1'  id='choice_29_493_1'    \/>\n\t\t\t\t<label for='choice_29_493_1' id='label_29_493_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_29_493_2'>\n\t\t\t\t<input name='input_493' type='radio' value='2'  id='choice_29_493_2'    \/>\n\t\t\t\t<label for='choice_29_493_2' id='label_29_493_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_29_493_3'>\n\t\t\t\t<input name='input_493' type='radio' value='3'  id='choice_29_493_3'    \/>\n\t\t\t\t<label for='choice_29_493_3' id='label_29_493_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_494\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_494\"><label class='gfield_label gform-field-label'  >HDI 5000<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_29_494'>\n\t\t\t<li class='gchoice gchoice_29_494_0'>\n\t\t\t\t<input name='input_494' type='radio' value='0'  id='choice_29_494_0'    \/>\n\t\t\t\t<label for='choice_29_494_0' id='label_29_494_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_29_494_1'>\n\t\t\t\t<input name='input_494' type='radio' value='1'  id='choice_29_494_1'    \/>\n\t\t\t\t<label for='choice_29_494_1' id='label_29_494_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_29_494_2'>\n\t\t\t\t<input name='input_494' type='radio' value='2'  id='choice_29_494_2'    \/>\n\t\t\t\t<label for='choice_29_494_2' id='label_29_494_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_29_494_3'>\n\t\t\t\t<input name='input_494' type='radio' value='3'  id='choice_29_494_3'    \/>\n\t\t\t\t<label for='choice_29_494_3' id='label_29_494_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_495\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_495\"><label class='gfield_label gform-field-label'  >UM9 HDI<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_29_495'>\n\t\t\t<li class='gchoice gchoice_29_495_0'>\n\t\t\t\t<input name='input_495' type='radio' value='0'  id='choice_29_495_0'    \/>\n\t\t\t\t<label for='choice_29_495_0' id='label_29_495_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_29_495_1'>\n\t\t\t\t<input name='input_495' type='radio' value='1'  id='choice_29_495_1'    \/>\n\t\t\t\t<label for='choice_29_495_1' id='label_29_495_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_29_495_2'>\n\t\t\t\t<input name='input_495' type='radio' value='2'  id='choice_29_495_2'    \/>\n\t\t\t\t<label for='choice_29_495_2' id='label_29_495_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_29_495_3'>\n\t\t\t\t<input name='input_495' type='radio' value='3'  id='choice_29_495_3'    \/>\n\t\t\t\t<label for='choice_29_495_3' id='label_29_495_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_496\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_496\"><label class='gfield_label gform-field-label'  >Philips 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_29_496'>\n\t\t\t<li class='gchoice gchoice_29_496_0'>\n\t\t\t\t<input name='input_496' type='radio' value='0'  id='choice_29_496_0'    \/>\n\t\t\t\t<label for='choice_29_496_0' id='label_29_496_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_29_496_1'>\n\t\t\t\t<input name='input_496' type='radio' value='1'  id='choice_29_496_1'    \/>\n\t\t\t\t<label for='choice_29_496_1' id='label_29_496_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_29_496_2'>\n\t\t\t\t<input name='input_496' type='radio' value='2'  id='choice_29_496_2'    \/>\n\t\t\t\t<label for='choice_29_496_2' id='label_29_496_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_29_496_3'>\n\t\t\t\t<input name='input_496' type='radio' value='3'  id='choice_29_496_3'    \/>\n\t\t\t\t<label for='choice_29_496_3' id='label_29_496_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_497\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_497\"><label class='gfield_label gform-field-label'  >Sonos 1000<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_29_497'>\n\t\t\t<li class='gchoice gchoice_29_497_0'>\n\t\t\t\t<input name='input_497' type='radio' value='0'  id='choice_29_497_0'    \/>\n\t\t\t\t<label for='choice_29_497_0' id='label_29_497_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_29_497_1'>\n\t\t\t\t<input name='input_497' type='radio' value='1'  id='choice_29_497_1'    \/>\n\t\t\t\t<label for='choice_29_497_1' id='label_29_497_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_29_497_2'>\n\t\t\t\t<input name='input_497' type='radio' value='2'  id='choice_29_497_2'    \/>\n\t\t\t\t<label for='choice_29_497_2' id='label_29_497_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_29_497_3'>\n\t\t\t\t<input name='input_497' type='radio' value='3'  id='choice_29_497_3'    \/>\n\t\t\t\t<label for='choice_29_497_3' id='label_29_497_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_498\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_498\"><label class='gfield_label gform-field-label'  >Sonos 2000\/ 2500<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_29_498'>\n\t\t\t<li class='gchoice gchoice_29_498_0'>\n\t\t\t\t<input name='input_498' type='radio' value='0'  id='choice_29_498_0'    \/>\n\t\t\t\t<label for='choice_29_498_0' id='label_29_498_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_29_498_1'>\n\t\t\t\t<input name='input_498' type='radio' value='1'  id='choice_29_498_1'    \/>\n\t\t\t\t<label for='choice_29_498_1' id='label_29_498_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_29_498_2'>\n\t\t\t\t<input name='input_498' type='radio' value='2'  id='choice_29_498_2'    \/>\n\t\t\t\t<label for='choice_29_498_2' id='label_29_498_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_29_498_3'>\n\t\t\t\t<input name='input_498' type='radio' value='3'  id='choice_29_498_3'    \/>\n\t\t\t\t<label for='choice_29_498_3' id='label_29_498_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_499\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_499\"><label class='gfield_label gform-field-label'  >Sonos 5500<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_29_499'>\n\t\t\t<li class='gchoice gchoice_29_499_0'>\n\t\t\t\t<input name='input_499' type='radio' value='0'  id='choice_29_499_0'    \/>\n\t\t\t\t<label for='choice_29_499_0' id='label_29_499_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_29_499_1'>\n\t\t\t\t<input name='input_499' type='radio' value='1'  id='choice_29_499_1'    \/>\n\t\t\t\t<label for='choice_29_499_1' id='label_29_499_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_29_499_2'>\n\t\t\t\t<input name='input_499' type='radio' value='2'  id='choice_29_499_2'    \/>\n\t\t\t\t<label for='choice_29_499_2' id='label_29_499_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_29_499_3'>\n\t\t\t\t<input name='input_499' type='radio' value='3'  id='choice_29_499_3'    \/>\n\t\t\t\t<label for='choice_29_499_3' id='label_29_499_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_500\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_500\"><label class='gfield_label gform-field-label'  >Imagepoint<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_29_500'>\n\t\t\t<li class='gchoice gchoice_29_500_0'>\n\t\t\t\t<input name='input_500' type='radio' value='0'  id='choice_29_500_0'    \/>\n\t\t\t\t<label for='choice_29_500_0' id='label_29_500_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_29_500_1'>\n\t\t\t\t<input name='input_500' type='radio' value='1'  id='choice_29_500_1'    \/>\n\t\t\t\t<label for='choice_29_500_1' id='label_29_500_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_29_500_2'>\n\t\t\t\t<input name='input_500' type='radio' value='2'  id='choice_29_500_2'    \/>\n\t\t\t\t<label for='choice_29_500_2' id='label_29_500_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_29_500_3'>\n\t\t\t\t<input name='input_500' type='radio' value='3'  id='choice_29_500_3'    \/>\n\t\t\t\t<label for='choice_29_500_3' id='label_29_500_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_501\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_501\"><label class='gfield_label gform-field-label'  >Imagepoint HX<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_29_501'>\n\t\t\t<li class='gchoice gchoice_29_501_0'>\n\t\t\t\t<input name='input_501' type='radio' value='0'  id='choice_29_501_0'    \/>\n\t\t\t\t<label for='choice_29_501_0' id='label_29_501_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_29_501_1'>\n\t\t\t\t<input name='input_501' type='radio' value='1'  id='choice_29_501_1'    \/>\n\t\t\t\t<label for='choice_29_501_1' id='label_29_501_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_29_501_2'>\n\t\t\t\t<input name='input_501' type='radio' value='2'  id='choice_29_501_2'    \/>\n\t\t\t\t<label for='choice_29_501_2' id='label_29_501_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_29_501_3'>\n\t\t\t\t<input name='input_501' type='radio' value='3'  id='choice_29_501_3'    \/>\n\t\t\t\t<label for='choice_29_501_3' id='label_29_501_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_502\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_502\"><label class='gfield_label gform-field-label'  >GE<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_29_502'>\n\t\t\t<li class='gchoice gchoice_29_502_0'>\n\t\t\t\t<input name='input_502' type='radio' value='0'  id='choice_29_502_0'    \/>\n\t\t\t\t<label for='choice_29_502_0' id='label_29_502_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_29_502_1'>\n\t\t\t\t<input name='input_502' type='radio' value='1'  id='choice_29_502_1'    \/>\n\t\t\t\t<label for='choice_29_502_1' id='label_29_502_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_29_502_2'>\n\t\t\t\t<input name='input_502' type='radio' value='2'  id='choice_29_502_2'    \/>\n\t\t\t\t<label for='choice_29_502_2' id='label_29_502_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_29_502_3'>\n\t\t\t\t<input name='input_502' type='radio' value='3'  id='choice_29_502_3'    \/>\n\t\t\t\t<label for='choice_29_502_3' id='label_29_502_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_503\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_503\"><label class='gfield_label gform-field-label'  >Logiq 500 PRO<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_29_503'>\n\t\t\t<li class='gchoice gchoice_29_503_0'>\n\t\t\t\t<input name='input_503' type='radio' value='0'  id='choice_29_503_0'    \/>\n\t\t\t\t<label for='choice_29_503_0' id='label_29_503_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_29_503_1'>\n\t\t\t\t<input name='input_503' type='radio' value='1'  id='choice_29_503_1'    \/>\n\t\t\t\t<label for='choice_29_503_1' id='label_29_503_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_29_503_2'>\n\t\t\t\t<input name='input_503' type='radio' value='2'  id='choice_29_503_2'    \/>\n\t\t\t\t<label for='choice_29_503_2' id='label_29_503_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_29_503_3'>\n\t\t\t\t<input name='input_503' type='radio' value='3'  id='choice_29_503_3'    \/>\n\t\t\t\t<label for='choice_29_503_3' id='label_29_503_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_504\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_504\"><label class='gfield_label gform-field-label'  >Logiq 7<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_29_504'>\n\t\t\t<li class='gchoice gchoice_29_504_0'>\n\t\t\t\t<input name='input_504' type='radio' value='0'  id='choice_29_504_0'    \/>\n\t\t\t\t<label for='choice_29_504_0' id='label_29_504_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_29_504_1'>\n\t\t\t\t<input name='input_504' type='radio' value='1'  id='choice_29_504_1'    \/>\n\t\t\t\t<label for='choice_29_504_1' id='label_29_504_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_29_504_2'>\n\t\t\t\t<input name='input_504' type='radio' value='2'  id='choice_29_504_2'    \/>\n\t\t\t\t<label for='choice_29_504_2' id='label_29_504_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_29_504_3'>\n\t\t\t\t<input name='input_504' type='radio' value='3'  id='choice_29_504_3'    \/>\n\t\t\t\t<label for='choice_29_504_3' id='label_29_504_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_505\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_505\"><label class='gfield_label gform-field-label'  >Logiq 700<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_29_505'>\n\t\t\t<li class='gchoice gchoice_29_505_0'>\n\t\t\t\t<input name='input_505' type='radio' value='0'  id='choice_29_505_0'    \/>\n\t\t\t\t<label for='choice_29_505_0' id='label_29_505_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_29_505_1'>\n\t\t\t\t<input name='input_505' type='radio' value='1'  id='choice_29_505_1'    \/>\n\t\t\t\t<label for='choice_29_505_1' id='label_29_505_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_29_505_2'>\n\t\t\t\t<input name='input_505' type='radio' value='2'  id='choice_29_505_2'    \/>\n\t\t\t\t<label for='choice_29_505_2' id='label_29_505_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_29_505_3'>\n\t\t\t\t<input name='input_505' type='radio' value='3'  id='choice_29_505_3'    \/>\n\t\t\t\t<label for='choice_29_505_3' id='label_29_505_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_506\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_506\"><label class='gfield_label gform-field-label'  >Logiq 500MD<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_29_506'>\n\t\t\t<li class='gchoice gchoice_29_506_0'>\n\t\t\t\t<input name='input_506' type='radio' value='0'  id='choice_29_506_0'    \/>\n\t\t\t\t<label for='choice_29_506_0' id='label_29_506_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_29_506_1'>\n\t\t\t\t<input name='input_506' type='radio' value='1'  id='choice_29_506_1'    \/>\n\t\t\t\t<label for='choice_29_506_1' id='label_29_506_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_29_506_2'>\n\t\t\t\t<input name='input_506' type='radio' value='2'  id='choice_29_506_2'    \/>\n\t\t\t\t<label for='choice_29_506_2' id='label_29_506_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_29_506_3'>\n\t\t\t\t<input name='input_506' type='radio' value='3'  id='choice_29_506_3'    \/>\n\t\t\t\t<label for='choice_29_506_3' id='label_29_506_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_507\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_507\"><label class='gfield_label gform-field-label'  >Logiq 9<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_29_507'>\n\t\t\t<li class='gchoice gchoice_29_507_0'>\n\t\t\t\t<input name='input_507' type='radio' value='0'  id='choice_29_507_0'    \/>\n\t\t\t\t<label for='choice_29_507_0' id='label_29_507_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_29_507_1'>\n\t\t\t\t<input name='input_507' type='radio' value='1'  id='choice_29_507_1'    \/>\n\t\t\t\t<label for='choice_29_507_1' id='label_29_507_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_29_507_2'>\n\t\t\t\t<input name='input_507' type='radio' value='2'  id='choice_29_507_2'    \/>\n\t\t\t\t<label for='choice_29_507_2' id='label_29_507_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_29_507_3'>\n\t\t\t\t<input name='input_507' type='radio' value='3'  id='choice_29_507_3'    \/>\n\t\t\t\t<label for='choice_29_507_3' id='label_29_507_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_508\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_508\"><label class='gfield_label gform-field-label'  >Vivid 5<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_29_508'>\n\t\t\t<li class='gchoice gchoice_29_508_0'>\n\t\t\t\t<input name='input_508' type='radio' value='0'  id='choice_29_508_0'    \/>\n\t\t\t\t<label for='choice_29_508_0' id='label_29_508_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_29_508_1'>\n\t\t\t\t<input name='input_508' type='radio' value='1'  id='choice_29_508_1'    \/>\n\t\t\t\t<label for='choice_29_508_1' id='label_29_508_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_29_508_2'>\n\t\t\t\t<input name='input_508' type='radio' value='2'  id='choice_29_508_2'    \/>\n\t\t\t\t<label for='choice_29_508_2' id='label_29_508_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_29_508_3'>\n\t\t\t\t<input name='input_508' type='radio' value='3'  id='choice_29_508_3'    \/>\n\t\t\t\t<label for='choice_29_508_3' id='label_29_508_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_509\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_509\"><label class='gfield_label gform-field-label'  >Vivid 7<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_29_509'>\n\t\t\t<li class='gchoice gchoice_29_509_0'>\n\t\t\t\t<input name='input_509' type='radio' value='0'  id='choice_29_509_0'    \/>\n\t\t\t\t<label for='choice_29_509_0' id='label_29_509_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_29_509_1'>\n\t\t\t\t<input name='input_509' type='radio' value='1'  id='choice_29_509_1'    \/>\n\t\t\t\t<label for='choice_29_509_1' id='label_29_509_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_29_509_2'>\n\t\t\t\t<input name='input_509' type='radio' value='2'  id='choice_29_509_2'    \/>\n\t\t\t\t<label for='choice_29_509_2' id='label_29_509_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_29_509_3'>\n\t\t\t\t<input name='input_509' type='radio' value='3'  id='choice_29_509_3'    \/>\n\t\t\t\t<label for='choice_29_509_3' id='label_29_509_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_510\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_510\"><label class='gfield_label gform-field-label'  >Volusion 730<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_29_510'>\n\t\t\t<li class='gchoice gchoice_29_510_0'>\n\t\t\t\t<input name='input_510' type='radio' value='0'  id='choice_29_510_0'    \/>\n\t\t\t\t<label for='choice_29_510_0' id='label_29_510_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_29_510_1'>\n\t\t\t\t<input name='input_510' type='radio' value='1'  id='choice_29_510_1'    \/>\n\t\t\t\t<label for='choice_29_510_1' id='label_29_510_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_29_510_2'>\n\t\t\t\t<input name='input_510' type='radio' value='2'  id='choice_29_510_2'    \/>\n\t\t\t\t<label for='choice_29_510_2' id='label_29_510_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_29_510_3'>\n\t\t\t\t<input name='input_510' type='radio' value='3'  id='choice_29_510_3'    \/>\n\t\t\t\t<label for='choice_29_510_3' id='label_29_510_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_511\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_511\"><label class='gfield_label gform-field-label'  >Siemens<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_29_511'>\n\t\t\t<li class='gchoice gchoice_29_511_0'>\n\t\t\t\t<input name='input_511' type='radio' value='0'  id='choice_29_511_0'    \/>\n\t\t\t\t<label for='choice_29_511_0' id='label_29_511_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_29_511_1'>\n\t\t\t\t<input name='input_511' type='radio' value='1'  id='choice_29_511_1'    \/>\n\t\t\t\t<label for='choice_29_511_1' id='label_29_511_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_29_511_2'>\n\t\t\t\t<input name='input_511' type='radio' value='2'  id='choice_29_511_2'    \/>\n\t\t\t\t<label for='choice_29_511_2' id='label_29_511_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_29_511_3'>\n\t\t\t\t<input name='input_511' type='radio' value='3'  id='choice_29_511_3'    \/>\n\t\t\t\t<label for='choice_29_511_3' id='label_29_511_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_512\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_512\"><label class='gfield_label gform-field-label'  >Elegra<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_29_512'>\n\t\t\t<li class='gchoice gchoice_29_512_0'>\n\t\t\t\t<input name='input_512' type='radio' value='0'  id='choice_29_512_0'    \/>\n\t\t\t\t<label for='choice_29_512_0' id='label_29_512_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_29_512_1'>\n\t\t\t\t<input name='input_512' type='radio' value='1'  id='choice_29_512_1'    \/>\n\t\t\t\t<label for='choice_29_512_1' id='label_29_512_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_29_512_2'>\n\t\t\t\t<input name='input_512' type='radio' value='2'  id='choice_29_512_2'    \/>\n\t\t\t\t<label for='choice_29_512_2' id='label_29_512_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_29_512_3'>\n\t\t\t\t<input name='input_512' type='radio' value='3'  id='choice_29_512_3'    \/>\n\t\t\t\t<label for='choice_29_512_3' id='label_29_512_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_513\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_513\"><label class='gfield_label gform-field-label'  >Prima<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_29_513'>\n\t\t\t<li class='gchoice gchoice_29_513_0'>\n\t\t\t\t<input name='input_513' type='radio' value='0'  id='choice_29_513_0'    \/>\n\t\t\t\t<label for='choice_29_513_0' id='label_29_513_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_29_513_1'>\n\t\t\t\t<input name='input_513' type='radio' value='1'  id='choice_29_513_1'    \/>\n\t\t\t\t<label for='choice_29_513_1' id='label_29_513_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_29_513_2'>\n\t\t\t\t<input name='input_513' type='radio' value='2'  id='choice_29_513_2'    \/>\n\t\t\t\t<label for='choice_29_513_2' id='label_29_513_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_29_513_3'>\n\t\t\t\t<input name='input_513' type='radio' value='3'  id='choice_29_513_3'    \/>\n\t\t\t\t<label for='choice_29_513_3' id='label_29_513_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_514\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full 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_29_514\"><label class='gfield_label gform-field-label'  >Toshiba<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_29_514'>\n\t\t\t<li class='gchoice gchoice_29_514_0'>\n\t\t\t\t<input name='input_514' type='radio' value='0'  id='choice_29_514_0'    \/>\n\t\t\t\t<label for='choice_29_514_0' id='label_29_514_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_29_514_1'>\n\t\t\t\t<input name='input_514' type='radio' value='1'  id='choice_29_514_1'    \/>\n\t\t\t\t<label for='choice_29_514_1' id='label_29_514_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_29_514_2'>\n\t\t\t\t<input name='input_514' type='radio' value='2'  id='choice_29_514_2'    \/>\n\t\t\t\t<label for='choice_29_514_2' id='label_29_514_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_29_514_3'>\n\t\t\t\t<input name='input_514' type='radio' value='3'  id='choice_29_514_3'    \/>\n\t\t\t\t<label for='choice_29_514_3' id='label_29_514_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_29_515\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gf_list_inline checklist_input_line gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  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