{"id":1764,"date":"2024-08-16T05:17:14","date_gmt":"2024-08-16T05:17:14","guid":{"rendered":"https:\/\/consciousconception.life\/?page_id=1764"},"modified":"2026-05-09T07:16:25","modified_gmt":"2026-05-09T07:16:25","slug":"egg-donors","status":"publish","type":"page","link":"https:\/\/soulconsciouscreation.com\/es\/egg-donors\/","title":{"rendered":"Donantes de \u00d3vulos"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"1764\" class=\"elementor elementor-1764\">\n\t\t\t\t<div class=\"elementor-element elementor-element-e26f629 e-flex e-con-boxed e-con e-parent\" data-id=\"e26f629\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-706881a e-con-full e-flex e-con e-child\" data-id=\"706881a\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-47fe53a elementor-widget elementor-widget-heading\" data-id=\"47fe53a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Convi\u00e9rtete en DONANTE<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-969bbac elementor-widget elementor-widget-text-editor\" data-id=\"969bbac\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Por favor llena tus datos e informaci\u00f3n completando el siguiente cuestionario!<\/p>\t\t\t\t\t\t\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\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-42168fd e-flex e-con-boxed e-con e-parent\" data-id=\"42168fd\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-25c9fb2 e-flex e-con-boxed e-con e-child\" data-id=\"25c9fb2\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4b98434 elementor-widget elementor-widget-shortcode\" data-id=\"4b98434\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-1762 forminator-design--flat  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-1762\" data-uid=\"6a1a149c870b4\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-1762\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-1762 forminator-design--flat  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"1762\"\n\t\t\t\tenctype=\"multipart\/form-data\" data-color-option=\"default\" data-design=\"flat\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6a1a149c870b4\" action=\"\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"section-1\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Informaci\u00f3n<\/h2><hr class=\"forminator-border\" style=\"border: 2px solid #3895b2;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a1a149c870b4\" id=\"forminator-field-name-1_6a1a149c870b4-label\" class=\"forminator-label\">Nombre Completo <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"\" id=\"forminator-field-name-1_6a1a149c870b4\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6a1a149c870b4\" id=\"forminator-field-phone-1_6a1a149c870b4-label\" class=\"forminator-label\">Tel\u00e9fono <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-1_6a1a149c870b4\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a1a149c870b4\" id=\"forminator-field-email-1_6a1a149c870b4-label\" class=\"forminator-label\">Correo electr\u00f3nico <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\" id=\"forminator-field-email-1_6a1a149c870b4\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-2\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Introducci\u00f3n<\/h2><hr class=\"forminator-border\" style=\"border: 2px solid #3895b2;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-1762__field--select-1_6a1a149c870b4\" id=\"forminator-form-1762__field--select-1_6a1a149c870b4-label\" class=\"forminator-label\">Agencia<\/label><select  id=\"forminator-form-1762__field--select-1_6a1a149c870b4\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-1\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1762__field--select-1_6a1a149c870b4-label\"><option value=\"one\"  data-calculation=\"0\">R<\/option><option value=\"two\"  data-calculation=\"0\">S<\/option><option value=\"N\"  data-calculation=\"0\">N<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-1\" class=\"forminator-field-upload forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-upload-1_6a1a149c870b4\" id=\"forminator-field-upload-1_6a1a149c870b4-label\" class=\"forminator-label\">Foto de perfil <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-file-upload\" data-element=\"upload-1_6a1a149c870b4\"><input type=\"file\" name=\"upload-1\" id=\"forminator-field-upload-1_6a1a149c870b4\" class=\"forminator-input-file-required do-validate\" accept=\".avif,.svgz,.json,.jpg,.jpeg,.jpe,.png,.heic,.webp\" tabindex=\"-1\"><button id=\"forminator-field-upload-1_6a1a149c870b4_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-1_6a1a149c870b4\">Choose File<\/button><span data-empty-text=\"No file chosen\">No file chosen<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Delete uploaded file<\/span><\/button><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_6a1a149c870b4\" id=\"forminator-field-text-1_6a1a149c870b4-label\" class=\"forminator-label\">Ciudad de nacimiento <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_6a1a149c870b4\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_6a1a149c870b4\" id=\"forminator-field-date-1-picker_6a1a149c870b4-label\" class=\"forminator-label\">Fecha de nacimiento <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"\" id=\"forminator-field-date-1-picker_6a1a149c870b4\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd-mm-yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-6\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-6a1a149c870b4-label\"><span id=\"forminator-radiogroup-radio-1-6a1a149c870b4-label\" class=\"forminator-label\">\u00bfC\u00f3mo conociste el programa de donantes? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-6a1a149c870b4\" class=\"forminator-radio\" title=\"Google\"><input type=\"radio\" name=\"radio-1\" value=\"one\" id=\"forminator-field-radio-1-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Google<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-6a1a149c870b4\" class=\"forminator-radio\" title=\"Redes sociales\"><input type=\"radio\" name=\"radio-1\" value=\"two\" id=\"forminator-field-radio-1-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Redes sociales<\/span><\/label><label id=\"forminator-field-radio-1-label-3\" for=\"forminator-field-radio-1-3-6a1a149c870b4\" class=\"forminator-radio\" title=\"Amigo\/conocido\"><input type=\"radio\" name=\"radio-1\" value=\"Amigo-conocido\" id=\"forminator-field-radio-1-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-1-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Amigo\/conocido<\/span><\/label><label id=\"forminator-field-radio-1-label-4\" for=\"forminator-field-radio-1-4-6a1a149c870b4\" class=\"forminator-radio\" title=\"Agencia\"><input type=\"radio\" name=\"radio-1\" value=\"Agencia\" id=\"forminator-field-radio-1-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-1-label-4\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Agencia<\/span><\/label><label id=\"forminator-field-radio-1-label-5\" for=\"forminator-field-radio-1-5-6a1a149c870b4\" class=\"forminator-radio\" title=\"Other\"><input type=\"radio\" name=\"radio-1\" value=\"Other\" id=\"forminator-field-radio-1-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-1-label-5\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Other<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_6a1a149c870b4\" id=\"forminator-field-text-2_6a1a149c870b4-label\" class=\"forminator-label\">Ciudad de nacimiento <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_6a1a149c870b4\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_6a1a149c870b4\" id=\"forminator-field-text-3_6a1a149c870b4-label\" class=\"forminator-label\">Ubicaci\u00f3n actual <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"\" id=\"forminator-field-text-3_6a1a149c870b4\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-form-1762__field--select-2_6a1a149c870b4\" id=\"forminator-form-1762__field--select-2_6a1a149c870b4-label\" class=\"forminator-label\">Etnia <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-1762__field--select-2_6a1a149c870b4\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-2\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecciona una opci\u00f3n\" data-search=\"false\" data-search-placeholder=\"Selecciona una opci\u00f3n\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1762__field--select-2_6a1a149c870b4-label\"><option value=\"\"  >Selecciona una opci\u00f3n<\/option><option value=\"one\"  data-calculation=\"0\">Africana<\/option><option value=\"two\"  data-calculation=\"0\">Ind\u00edgena<\/option><option value=\"Cauc\u00e1sica\"  data-calculation=\"0\">Cauc\u00e1sica<\/option><option value=\"Jud\u00eda\"  data-calculation=\"0\">Jud\u00eda<\/option><option value=\"Mestiza\"  data-calculation=\"0\">Mestiza<\/option><option value=\"Asi\u00e1tica\"  data-calculation=\"0\">Asi\u00e1tica<\/option><option value=\"N\u00f3rdica\"  data-calculation=\"0\">N\u00f3rdica<\/option><\/select><\/div><\/div><div id=\"select-3\" class=\"forminator-field-select forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-form-1762__field--select-3_6a1a149c870b4\" id=\"forminator-form-1762__field--select-3_6a1a149c870b4-label\" class=\"forminator-label\">Complexi\u00f3n <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-1762__field--select-3_6a1a149c870b4\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-3\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecciona una opci\u00f3n\" data-search=\"false\" data-search-placeholder=\"Selecciona una opci\u00f3n\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1762__field--select-3_6a1a149c870b4-label\"><option value=\"\"  >Selecciona una opci\u00f3n<\/option><option value=\"one\"  data-calculation=\"0\">Delgada<\/option><option value=\"two\"  data-calculation=\"0\">Curvil\u00ednea<\/option><option value=\"Atl\u00e9tica\"  data-calculation=\"0\">Atl\u00e9tica<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-6\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-6a1a149c870b4-label\"><span id=\"forminator-radiogroup-radio-2-6a1a149c870b4-label\" class=\"forminator-label\">Alcohol <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-6a1a149c870b4\" class=\"forminator-radio\" title=\"Si\"><input type=\"radio\" name=\"radio-2\" value=\"one\" id=\"forminator-field-radio-2-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Si<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-6a1a149c870b4\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-2\" value=\"two\" id=\"forminator-field-radio-2-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><div id=\"radio-3\" class=\"forminator-field-radio forminator-col forminator-col-6\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-3-6a1a149c870b4-label\"><span id=\"forminator-radiogroup-radio-3-6a1a149c870b4-label\" class=\"forminator-label\">Cigarro <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-3-label-1\" for=\"forminator-field-radio-3-1-6a1a149c870b4\" class=\"forminator-radio\" title=\"Si\"><input type=\"radio\" name=\"radio-3\" value=\"one\" id=\"forminator-field-radio-3-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-3-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Si<\/span><\/label><label id=\"forminator-field-radio-3-label-2\" for=\"forminator-field-radio-3-2-6a1a149c870b4\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-3\" value=\"two\" id=\"forminator-field-radio-3-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-3-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-4\" class=\"forminator-field-select forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-form-1762__field--select-4_6a1a149c870b4\" id=\"forminator-form-1762__field--select-4_6a1a149c870b4-label\" class=\"forminator-label\">Tez <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-1762__field--select-4_6a1a149c870b4\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-4\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecciona una opci\u00f3n\" data-search=\"false\" data-search-placeholder=\"Selecciona una opci\u00f3n\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1762__field--select-4_6a1a149c870b4-label\"><option value=\"\"  >Selecciona una opci\u00f3n<\/option><option value=\"one\"  data-calculation=\"0\">Blanca<\/option><option value=\"two\"  data-calculation=\"0\">Morena clara<\/option><option value=\"Morena\"  data-calculation=\"0\">Morena<\/option><option value=\"Mulata\"  data-calculation=\"0\">Mulata<\/option><option value=\"Negra\"  data-calculation=\"0\">Negra<\/option><\/select><\/div><\/div><div id=\"radio-4\" class=\"forminator-field-radio forminator-col forminator-col-6\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-4-6a1a149c870b4-label\"><span id=\"forminator-radiogroup-radio-4-6a1a149c870b4-label\" class=\"forminator-label\">Embarazo <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-4-label-1\" for=\"forminator-field-radio-4-1-6a1a149c870b4\" class=\"forminator-radio\" title=\"Si\"><input type=\"radio\" name=\"radio-4\" value=\"one\" id=\"forminator-field-radio-4-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-4-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Si<\/span><\/label><label id=\"forminator-field-radio-4-label-2\" for=\"forminator-field-radio-4-2-6a1a149c870b4\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-4\" value=\"two\" id=\"forminator-field-radio-4-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-4-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-5\" class=\"forminator-field-select forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-form-1762__field--select-5_6a1a149c870b4\" id=\"forminator-form-1762__field--select-5_6a1a149c870b4-label\" class=\"forminator-label\">Color de los ojos <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-1762__field--select-5_6a1a149c870b4\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-5\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecciona una opci\u00f3n\" data-search=\"false\" data-search-placeholder=\"Selecciona una opci\u00f3n\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1762__field--select-5_6a1a149c870b4-label\"><option value=\"\"  >Selecciona una opci\u00f3n<\/option><option value=\"one\"  data-calculation=\"0\">Azul<\/option><option value=\"two\"  data-calculation=\"0\">Verde<\/option><option value=\"Marr\u00f3n-claro\"  data-calculation=\"0\">Marr\u00f3n claro<\/option><option value=\"Marr\u00f3n\"  data-calculation=\"0\">Marr\u00f3n<\/option><option value=\"Gris\"  data-calculation=\"0\">Gris<\/option><option value=\"Negro\"  data-calculation=\"0\">Negro<\/option><\/select><\/div><\/div><div id=\"select-6\" class=\"forminator-field-select forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-form-1762__field--select-6_6a1a149c870b4\" id=\"forminator-form-1762__field--select-6_6a1a149c870b4-label\" class=\"forminator-label\">Tipo de cabello <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-1762__field--select-6_6a1a149c870b4\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-6\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecciona una opci\u00f3n\" data-search=\"false\" data-search-placeholder=\"Selecciona una opci\u00f3n\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1762__field--select-6_6a1a149c870b4-label\"><option value=\"\"  >Selecciona una opci\u00f3n<\/option><option value=\"one\"  data-calculation=\"0\">Afro<\/option><option value=\"two\"  data-calculation=\"0\">Rizado<\/option><option value=\"Marr\u00f3n-claro\"  data-calculation=\"0\">Liso<\/option><option value=\"Marr\u00f3n\"  data-calculation=\"0\">Ondulado<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-7\" class=\"forminator-field-select forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-form-1762__field--select-7_6a1a149c870b4\" id=\"forminator-form-1762__field--select-7_6a1a149c870b4-label\" class=\"forminator-label\">Color de pelo <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-1762__field--select-7_6a1a149c870b4\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-7\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecciona una opci\u00f3n\" data-search=\"false\" data-search-placeholder=\"Selecciona una opci\u00f3n\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1762__field--select-7_6a1a149c870b4-label\"><option value=\"\"  >Selecciona una opci\u00f3n<\/option><option value=\"one\"  data-calculation=\"0\">Rubio<\/option><option value=\"two\"  data-calculation=\"0\">Pelirojo<\/option><option value=\"Marr\u00f3n-claro\"  data-calculation=\"0\">Marr\u00f3n claro<\/option><option value=\"Marr\u00f3n\"  data-calculation=\"0\">Marr\u00f3n<\/option><option value=\"Negro\"  data-calculation=\"0\">Negro<\/option><\/select><\/div><\/div><div id=\"radio-5\" class=\"forminator-field-radio forminator-col forminator-col-6\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-5-6a1a149c870b4-label\"><span id=\"forminator-radiogroup-radio-5-6a1a149c870b4-label\" class=\"forminator-label\">Pecas <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-5-label-1\" for=\"forminator-field-radio-5-1-6a1a149c870b4\" class=\"forminator-radio\" title=\"Si\"><input type=\"radio\" name=\"radio-5\" value=\"one\" id=\"forminator-field-radio-5-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-5-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Si<\/span><\/label><label id=\"forminator-field-radio-5-label-2\" for=\"forminator-field-radio-5-2-6a1a149c870b4\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-5\" value=\"two\" id=\"forminator-field-radio-5-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-5-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_6a1a149c870b4\" id=\"forminator-field-text-4_6a1a149c870b4-label\" class=\"forminator-label\">Altura (cm) <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"\" id=\"forminator-field-text-4_6a1a149c870b4\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"text-5\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-5_6a1a149c870b4\" id=\"forminator-field-text-5_6a1a149c870b4-label\" class=\"forminator-label\">Peso (kg) <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-5\" value=\"\" placeholder=\"\" id=\"forminator-field-text-5_6a1a149c870b4\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-8\" class=\"forminator-field-select forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-form-1762__field--select-8_6a1a149c870b4\" id=\"forminator-form-1762__field--select-8_6a1a149c870b4-label\" class=\"forminator-label\">Estado civil <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-1762__field--select-8_6a1a149c870b4\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-8\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecciona una opci\u00f3n\" data-search=\"false\" data-search-placeholder=\"Selecciona una opci\u00f3n\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1762__field--select-8_6a1a149c870b4-label\"><option value=\"\"  >Selecciona una opci\u00f3n<\/option><option value=\"one\"  data-calculation=\"0\">Soltera<\/option><option value=\"two\"  data-calculation=\"0\">Casada<\/option><option value=\"En-una-relaci\u00f3n\"  data-calculation=\"0\">En una relaci\u00f3n<\/option><\/select><\/div><\/div><div id=\"text-6\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-6_6a1a149c870b4\" id=\"forminator-field-text-6_6a1a149c870b4-label\" class=\"forminator-label\">Religi\u00f3n: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-6\" value=\"\" placeholder=\"\" id=\"forminator-field-text-6_6a1a149c870b4\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-7\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-7_6a1a149c870b4\" id=\"forminator-field-text-7_6a1a149c870b4-label\" class=\"forminator-label\">Origen \u00e9tnico paterno <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-7\" value=\"\" placeholder=\"\" id=\"forminator-field-text-7_6a1a149c870b4\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"text-8\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-8_6a1a149c870b4\" id=\"forminator-field-text-8_6a1a149c870b4-label\" class=\"forminator-label\">Origen \u00e9tnico materno <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-8\" value=\"\" placeholder=\"\" id=\"forminator-field-text-8_6a1a149c870b4\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-9\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-9_6a1a149c870b4\" id=\"forminator-field-text-9_6a1a149c870b4-label\" class=\"forminator-label\">Abuela materna - Origen \u00e9tnico <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-9\" value=\"\" placeholder=\"\" id=\"forminator-field-text-9_6a1a149c870b4\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"text-10\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-10_6a1a149c870b4\" id=\"forminator-field-text-10_6a1a149c870b4-label\" class=\"forminator-label\">Abuela paterna - Origen \u00e9tnico <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-10\" value=\"\" placeholder=\"\" id=\"forminator-field-text-10_6a1a149c870b4\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-12\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-12_6a1a149c870b4\" id=\"forminator-field-text-12_6a1a149c870b4-label\" class=\"forminator-label\">Abuelo materno - Origen \u00e9tnico <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-12\" value=\"\" placeholder=\"\" id=\"forminator-field-text-12_6a1a149c870b4\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"text-11\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-11_6a1a149c870b4\" id=\"forminator-field-text-11_6a1a149c870b4-label\" class=\"forminator-label\">Abuelo paterno - Origen \u00e9tnico <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-11\" value=\"\" placeholder=\"\" id=\"forminator-field-text-11_6a1a149c870b4\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-6\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-6-6a1a149c870b4-label\"><span id=\"forminator-radiogroup-radio-6-6a1a149c870b4-label\" class=\"forminator-label\">\u00bfCual es tu tipo de sangre? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-6-label-1\" for=\"forminator-field-radio-6-1-6a1a149c870b4\" class=\"forminator-radio forminator-radio-inline\" title=\"A +\"><input type=\"radio\" name=\"radio-6\" value=\"one\" id=\"forminator-field-radio-6-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-6-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">A +<\/span><\/label><label id=\"forminator-field-radio-6-label-2\" for=\"forminator-field-radio-6-2-6a1a149c870b4\" class=\"forminator-radio forminator-radio-inline\" title=\"A -\"><input type=\"radio\" name=\"radio-6\" value=\"two\" id=\"forminator-field-radio-6-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-6-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">A -<\/span><\/label><label id=\"forminator-field-radio-6-label-3\" for=\"forminator-field-radio-6-3-6a1a149c870b4\" class=\"forminator-radio forminator-radio-inline\" title=\"B +\"><input type=\"radio\" name=\"radio-6\" value=\"B-+\" id=\"forminator-field-radio-6-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-6-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">B +<\/span><\/label><label id=\"forminator-field-radio-6-label-4\" for=\"forminator-field-radio-6-4-6a1a149c870b4\" class=\"forminator-radio forminator-radio-inline\" title=\"B -\"><input type=\"radio\" name=\"radio-6\" value=\"B--\" id=\"forminator-field-radio-6-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-6-label-4\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">B -<\/span><\/label><label id=\"forminator-field-radio-6-label-5\" for=\"forminator-field-radio-6-5-6a1a149c870b4\" class=\"forminator-radio forminator-radio-inline\" title=\"AB +\"><input type=\"radio\" name=\"radio-6\" value=\"AB-+\" id=\"forminator-field-radio-6-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-6-label-5\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">AB +<\/span><\/label><label id=\"forminator-field-radio-6-label-6\" for=\"forminator-field-radio-6-6-6a1a149c870b4\" class=\"forminator-radio forminator-radio-inline\" title=\"AB -\"><input type=\"radio\" name=\"radio-6\" value=\"AB--\" id=\"forminator-field-radio-6-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-6-label-6\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">AB -<\/span><\/label><label id=\"forminator-field-radio-6-label-7\" for=\"forminator-field-radio-6-7-6a1a149c870b4\" class=\"forminator-radio forminator-radio-inline\" title=\"O +\"><input type=\"radio\" name=\"radio-6\" value=\"O-+\" id=\"forminator-field-radio-6-7-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-6-label-7\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">O +<\/span><\/label><label id=\"forminator-field-radio-6-label-8\" for=\"forminator-field-radio-6-8-6a1a149c870b4\" class=\"forminator-radio forminator-radio-inline\" title=\"O -\"><input type=\"radio\" name=\"radio-6\" value=\"O--\" id=\"forminator-field-radio-6-8-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-6-label-8\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">O -<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-3\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Informaci\u00f3n del donante<\/h2><hr class=\"forminator-border\" style=\"border: 2px solid #3895b2;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-7\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-7-6a1a149c870b4-label\"><span id=\"forminator-radiogroup-radio-7-6a1a149c870b4-label\" class=\"forminator-label\">Pruebas gen\u00e9ticas <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-7-label-1\" for=\"forminator-field-radio-7-1-6a1a149c870b4\" class=\"forminator-radio forminator-radio-inline\" title=\"Si\"><input type=\"radio\" name=\"radio-7\" value=\"one\" id=\"forminator-field-radio-7-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-7-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Si<\/span><\/label><label id=\"forminator-field-radio-7-label-2\" for=\"forminator-field-radio-7-2-6a1a149c870b4\" class=\"forminator-radio forminator-radio-inline\" title=\"No\"><input type=\"radio\" name=\"radio-7\" value=\"two\" id=\"forminator-field-radio-7-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-7-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-13\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-13_6a1a149c870b4\" id=\"forminator-field-text-13_6a1a149c870b4-label\" class=\"forminator-label\">Detalles de las pruebas gen\u00e9ticas <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-13\" value=\"\" placeholder=\"\" id=\"forminator-field-text-13_6a1a149c870b4\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-8\" class=\"forminator-field-radio forminator-col forminator-col-6\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-8-6a1a149c870b4-label\"><span id=\"forminator-radiogroup-radio-8-6a1a149c870b4-label\" class=\"forminator-label\">Donante anterior <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-8-label-1\" for=\"forminator-field-radio-8-1-6a1a149c870b4\" class=\"forminator-radio\" title=\"Si\"><input type=\"radio\" name=\"radio-8\" value=\"one\" id=\"forminator-field-radio-8-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-8-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Si<\/span><\/label><label id=\"forminator-field-radio-8-label-2\" for=\"forminator-field-radio-8-2-6a1a149c870b4\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-8\" value=\"two\" id=\"forminator-field-radio-8-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-8-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><div id=\"text-14\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-14_6a1a149c870b4\" id=\"forminator-field-text-14_6a1a149c870b4-label\" class=\"forminator-label\">Donanciones anteriores <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-14\" value=\"\" placeholder=\"\" id=\"forminator-field-text-14_6a1a149c870b4\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-15\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-15_6a1a149c870b4\" id=\"forminator-field-text-15_6a1a149c870b4-label\" class=\"forminator-label\">Promedio de ovocitos aspirados <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-15\" value=\"\" placeholder=\"\" id=\"forminator-field-text-15_6a1a149c870b4\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"text-16\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-16_6a1a149c870b4\" id=\"forminator-field-text-16_6a1a149c870b4-label\" class=\"forminator-label\">Promedio de ovocitos maduros <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-16\" value=\"\" placeholder=\"\" id=\"forminator-field-text-16_6a1a149c870b4\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-9\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-9-6a1a149c870b4-label\"><span id=\"forminator-radiogroup-radio-9-6a1a149c870b4-label\" class=\"forminator-label\">Embarazo logrado en donaciones anteriores <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-9-label-1\" for=\"forminator-field-radio-9-1-6a1a149c870b4\" class=\"forminator-radio\" title=\"Si\"><input type=\"radio\" name=\"radio-9\" value=\"one\" id=\"forminator-field-radio-9-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-9-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Si<\/span><\/label><label id=\"forminator-field-radio-9-label-2\" for=\"forminator-field-radio-9-2-6a1a149c870b4\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-9\" value=\"two\" id=\"forminator-field-radio-9-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-9-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-4\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Fotos<\/h2><hr class=\"forminator-border\" style=\"border: 2px solid #3895b2;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-2\" class=\"forminator-field-upload forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-upload-2_6a1a149c870b4\" id=\"forminator-field-upload-2_6a1a149c870b4-label\" class=\"forminator-label\">Imagen de cuerpo entero <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-file-upload\" data-element=\"upload-2_6a1a149c870b4\"><input type=\"file\" name=\"upload-2\" id=\"forminator-field-upload-2_6a1a149c870b4\" class=\"forminator-input-file-required do-validate\" accept=\".avif,.svgz,.json,.jpg,.jpeg,.jpe,.png,.heic,.webp\" tabindex=\"-1\"><button id=\"forminator-field-upload-2_6a1a149c870b4_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-2_6a1a149c870b4\">Choose File<\/button><span data-empty-text=\"No file chosen\">No file chosen<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Delete uploaded file<\/span><\/button><\/div><\/div><\/div><div id=\"upload-3\" class=\"forminator-field-upload forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-upload-3_6a1a149c870b4\" id=\"forminator-field-upload-3_6a1a149c870b4-label\" class=\"forminator-label\">Fotograf\u00eda de tu ni\u00f1ez <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-file-upload\" data-element=\"upload-3_6a1a149c870b4\"><input type=\"file\" name=\"upload-3\" id=\"forminator-field-upload-3_6a1a149c870b4\" class=\"forminator-input-file-required do-validate\" accept=\".avif,.svgz,.json,.jpg,.jpeg,.jpe,.png,.heic,.webp\" tabindex=\"-1\"><button id=\"forminator-field-upload-3_6a1a149c870b4_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-3_6a1a149c870b4\">Choose File<\/button><span data-empty-text=\"No file chosen\">No file chosen<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Delete uploaded file<\/span><\/button><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-5\" class=\"forminator-field-upload forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-upload-5_6a1a149c870b4\" id=\"forminator-field-upload-5_6a1a149c870b4-label\" class=\"forminator-label\">3 Fotograf\u00edas adicionales: <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-multi-upload\" data-element=\"upload-5_6a1a149c870b4\"><input type=\"file\" name=\"upload-5[]\" id=\"forminator-field-upload-5_6a1a149c870b4\" class=\"forminator-input-file-required do-validate forminator-field-upload-5_6a1a149c870b4-1762\" multiple=\"multiple\" data-method=\"ajax\" accept=\".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.webp,.avif,.ico,.heic,.psd,.xcf,.svgz,.json\" data-limit=\"3\" data-limit-message=\"You can upload a maximum of 3 files.\" data-size=\"10000000\" data-size-message=\"Maximum file size allowed is 10 MB. \" data-filetype=\"jpg|jpeg|jpe|gif|png|bmp|tiff|tif|webp|avif|ico|heic|psd|xcf|svgz|json\" data-filetype-message=\"file extension is not allowed.\"><div class=\"forminator-multi-upload-message\" aria-hidden=\"true\"><span class=\"forminator-icon-upload\" aria-hidden=\"true\"><\/span><p>Drag and Drop (or) <a class=\"forminator-upload-file--forminator-field-upload-5_6a1a149c870b4\" href=\"#\" onclick=\"return false;\">Choose Files<\/a><\/p><\/div><\/div><ul class=\"forminator-uploaded-files upload-container-upload-5_6a1a149c870b4\"><\/ul><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-5\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Bio personal de la donante de \u00f3vulos<\/h2><hr class=\"forminator-border\" style=\"border: 2px solid #3895b2;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6a1a149c870b4\" id=\"forminator-field-textarea-1_6a1a149c870b4-label\" class=\"forminator-label\">\u00bfPor qu\u00e9 ha decidido convertirse en donante de \u00f3vulos? <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_6a1a149c870b4\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:80px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6a1a149c870b4\" id=\"forminator-field-textarea-2_6a1a149c870b4-label\" class=\"forminator-label\">\u00bfCu\u00e1l es su ocupaci\u00f3n actual? <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_6a1a149c870b4\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:80px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-3\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_6a1a149c870b4\" id=\"forminator-field-textarea-3_6a1a149c870b4-label\" class=\"forminator-label\">\u00bfCu\u00e1les son tus aspiraciones profesionales? <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_6a1a149c870b4\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:80px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-4\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-4_6a1a149c870b4\" id=\"forminator-field-textarea-4_6a1a149c870b4-label\" class=\"forminator-label\">\u00bfTienes habilidades o pasatiempos especiales? Por ejemplo, \u00bfsobresale en atletismo, arte, cocina, habilidades musicales, etc.? <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-4\" placeholder=\"\" id=\"forminator-field-textarea-4_6a1a149c870b4\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:80px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-5\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-5_6a1a149c870b4\" id=\"forminator-field-textarea-5_6a1a149c870b4-label\" class=\"forminator-label\">Describe tu personalidad y car\u00e1cter <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-5\" placeholder=\"\" id=\"forminator-field-textarea-5_6a1a149c870b4\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:80px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-6\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-6_6a1a149c870b4\" id=\"forminator-field-textarea-6_6a1a149c870b4-label\" class=\"forminator-label\">\u00bfCuales son sus metas para el futuro? <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-6\" placeholder=\"\" id=\"forminator-field-textarea-6_6a1a149c870b4\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:80px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-6\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Preferencia de viaje<\/h2><hr class=\"forminator-border\" style=\"border: 2px solid #3895b2;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-10\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-10-6a1a149c870b4-label\"><span id=\"forminator-radiogroup-radio-10-6a1a149c870b4-label\" class=\"forminator-label\">Dispuesto a viajar <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-10-label-1\" for=\"forminator-field-radio-10-1-6a1a149c870b4\" class=\"forminator-radio\" title=\"Si\"><input type=\"radio\" name=\"radio-10\" value=\"one\" id=\"forminator-field-radio-10-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-10-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Si<\/span><\/label><label id=\"forminator-field-radio-10-label-2\" for=\"forminator-field-radio-10-2-6a1a149c870b4\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-10\" value=\"two\" id=\"forminator-field-radio-10-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-radio-10-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-7\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Detalle de la facultad o universidad<\/h2><hr class=\"forminator-border\" style=\"border: 2px solid #3895b2;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-9\" class=\"forminator-field-select forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-form-1762__field--select-9_6a1a149c870b4\" id=\"forminator-form-1762__field--select-9_6a1a149c870b4-label\" class=\"forminator-label\">T\u00edtulo m\u00e1s alto <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-1762__field--select-9_6a1a149c870b4\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-9\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecciona una opci\u00f3n\" data-search=\"false\" data-search-placeholder=\"Selecciona una opci\u00f3n\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1762__field--select-9_6a1a149c870b4-label\"><option value=\"\"  >Selecciona una opci\u00f3n<\/option><option value=\"one\"  data-calculation=\"0\">Primaria<\/option><option value=\"two\"  data-calculation=\"0\">Escuela Secundaria<\/option><option value=\"Tecn\u00f3logico\"  data-calculation=\"0\">Tecnol\u00f3gico<\/option><option value=\"Universidad\"  data-calculation=\"0\">Universidad<\/option><option value=\"Post-Grado\"  data-calculation=\"0\">Post Grado<\/option><option value=\"Doctorado\"  data-calculation=\"0\">Doctorado<\/option><\/select><\/div><\/div><div id=\"text-17\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-17_6a1a149c870b4\" id=\"forminator-field-text-17_6a1a149c870b4-label\" class=\"forminator-label\">\u00c1rea de estudio<\/label><input type=\"text\" name=\"text-17\" value=\"\" placeholder=\"\" id=\"forminator-field-text-17_6a1a149c870b4\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-8\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Condiciones m\u00e9dicas<\/h2><hr class=\"forminator-border\" style=\"border: 2px solid #3895b2;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-1-6a1a149c870b4-label\" class=\"forminator-label\">Defecto \/ enfermedad card\u00edaca <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-1-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-1-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"one\" id=\"forminator-field-checkbox-1-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-1-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-1-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-1-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"two\" id=\"forminator-field-checkbox-1-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-1-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-1-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-1-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-1-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-1-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-1-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-1-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Padre\" id=\"forminator-field-checkbox-1-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-1-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-1-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-1-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Hermano\" id=\"forminator-field-checkbox-1-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-1-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-1-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-1-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Otros\" id=\"forminator-field-checkbox-1-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-1-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-2\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-2-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-2-6a1a149c870b4-label\" class=\"forminator-label\">Infarto de miocardio <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-2-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-2-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"one\" id=\"forminator-field-checkbox-2-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-2-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-2-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-2-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"two\" id=\"forminator-field-checkbox-2-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-2-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-2-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-2-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-2-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-2-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-2-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-2-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Padre\" id=\"forminator-field-checkbox-2-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-2-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-2-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-2-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Hermano\" id=\"forminator-field-checkbox-2-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-2-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-2-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-2-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Otros\" id=\"forminator-field-checkbox-2-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-2-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-3\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-3-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-3-6a1a149c870b4-label\" class=\"forminator-label\">Ataque <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-3-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-3-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"one\" id=\"forminator-field-checkbox-3-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-3-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-3-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-3-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"two\" id=\"forminator-field-checkbox-3-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-3-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-3-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-3-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-3-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-3-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-3-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-3-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Padre\" id=\"forminator-field-checkbox-3-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-3-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-3-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-3-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Hermano\" id=\"forminator-field-checkbox-3-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-3-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-3-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-3-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Otros\" id=\"forminator-field-checkbox-3-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-3-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-4\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-4-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-4-6a1a149c870b4-label\" class=\"forminator-label\">Alta presi\u00f3n sangu\u00ednea <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-4-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-4-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"one\" id=\"forminator-field-checkbox-4-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-4-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-4-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-4-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"two\" id=\"forminator-field-checkbox-4-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-4-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-4-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-4-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-4-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-4-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-4-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-4-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Padre\" id=\"forminator-field-checkbox-4-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-4-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-4-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-4-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Hermano\" id=\"forminator-field-checkbox-4-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-4-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-4-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-4-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Otros\" id=\"forminator-field-checkbox-4-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-4-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-5\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-5-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-5-6a1a149c870b4-label\" class=\"forminator-label\">Colesterol alto <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-5-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-5-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"one\" id=\"forminator-field-checkbox-5-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-5-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-5-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-5-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"two\" id=\"forminator-field-checkbox-5-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-5-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-5-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-5-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-5-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-5-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-5-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-5-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"Padre\" id=\"forminator-field-checkbox-5-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-5-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-5-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-5-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"Hermano\" id=\"forminator-field-checkbox-5-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-5-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-5-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-5-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"Otros\" id=\"forminator-field-checkbox-5-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-5-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-6\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-6-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-6-6a1a149c870b4-label\" class=\"forminator-label\">Otra condici\u00f3n del coraz\u00f3n <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-6-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-6-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"one\" id=\"forminator-field-checkbox-6-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-6-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-6-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-6-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"two\" id=\"forminator-field-checkbox-6-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-6-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-6-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-6-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-6-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-6-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-6-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-6-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"Padre\" id=\"forminator-field-checkbox-6-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-6-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-6-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-6-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"Hermano\" id=\"forminator-field-checkbox-6-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-6-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-6-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-6-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"Otros\" id=\"forminator-field-checkbox-6-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-6-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-9\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Sangre<\/h2><hr class=\"forminator-border\" style=\"border: 2px solid #3895b2;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-7\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-7-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-7-6a1a149c870b4-label\" class=\"forminator-label\">Talasemia <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-7-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-7-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"one\" id=\"forminator-field-checkbox-7-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-7-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-7-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-7-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"two\" id=\"forminator-field-checkbox-7-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-7-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-7-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-7-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-7-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-7-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-7-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-7-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Padre\" id=\"forminator-field-checkbox-7-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-7-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-7-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-7-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Hermano\" id=\"forminator-field-checkbox-7-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-7-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-7-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-7-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Otros\" id=\"forminator-field-checkbox-7-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-7-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-8\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-8-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-8-6a1a149c870b4-label\" class=\"forminator-label\">Anemia <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-8-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-8-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"one\" id=\"forminator-field-checkbox-8-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-8-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-8-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-8-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"two\" id=\"forminator-field-checkbox-8-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-8-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-8-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-8-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-8-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-8-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-8-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-8-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"Padre\" id=\"forminator-field-checkbox-8-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-8-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-8-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-8-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"Hermano\" id=\"forminator-field-checkbox-8-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-8-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-8-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-8-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"Otros\" id=\"forminator-field-checkbox-8-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-8-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-9\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-9-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-9-6a1a149c870b4-label\" class=\"forminator-label\">Trastornos de la coagulaci\u00f3n sangu\u00ednea (como trombosis) <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-9-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-9-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"one\" id=\"forminator-field-checkbox-9-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-9-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-9-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-9-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"two\" id=\"forminator-field-checkbox-9-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-9-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-9-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-9-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-9-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-9-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-9-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-9-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Padre\" id=\"forminator-field-checkbox-9-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-9-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-9-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-9-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Hermano\" id=\"forminator-field-checkbox-9-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-9-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-9-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-9-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Otros\" id=\"forminator-field-checkbox-9-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-9-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-10\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-10-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-10-6a1a149c870b4-label\" class=\"forminator-label\">Sobrecarga de hierro \/ cirrosis <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-10-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-10-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"one\" id=\"forminator-field-checkbox-10-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-10-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-10-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-10-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"two\" id=\"forminator-field-checkbox-10-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-10-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-10-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-10-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-10-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-10-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-10-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-10-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"Padre\" id=\"forminator-field-checkbox-10-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-10-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-10-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-10-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"Hermano\" id=\"forminator-field-checkbox-10-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-10-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-10-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-10-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"Otros\" id=\"forminator-field-checkbox-10-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-10-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-11\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-11-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-11-6a1a149c870b4-label\" class=\"forminator-label\">\u00bfTrastornos hemorr\u00e1gicos (hemofilia \/ enfermedad de von Willebrand) ? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-11-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-11-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"one\" id=\"forminator-field-checkbox-11-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-11-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-11-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-11-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"two\" id=\"forminator-field-checkbox-11-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-11-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-11-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-11-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-11-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-11-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-11-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-11-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"Padre\" id=\"forminator-field-checkbox-11-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-11-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-11-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-11-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"Hermano\" id=\"forminator-field-checkbox-11-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-11-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-11-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-11-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"Otros\" id=\"forminator-field-checkbox-11-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-11-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-10\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Respiratorio (pulmones)<\/h2><hr class=\"forminator-border\" style=\"border: 2px solid #3895b2;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-12\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-12-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-12-6a1a149c870b4-label\" class=\"forminator-label\">Asma <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-12-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-12-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-12[]\" value=\"one\" id=\"forminator-field-checkbox-12-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-12-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-12-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-12-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-12[]\" value=\"two\" id=\"forminator-field-checkbox-12-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-12-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-12-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-12-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-12[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-12-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-12-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-12-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-12-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-12[]\" value=\"Padre\" id=\"forminator-field-checkbox-12-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-12-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-12-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-12-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-12[]\" value=\"Hermano\" id=\"forminator-field-checkbox-12-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-12-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-12-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-12-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-12[]\" value=\"Otros\" id=\"forminator-field-checkbox-12-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-12-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-13\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-13-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-13-6a1a149c870b4-label\" class=\"forminator-label\">Otra condici\u00f3n respiratoria <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-13-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-13-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"one\" id=\"forminator-field-checkbox-13-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-13-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-13-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-13-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"two\" id=\"forminator-field-checkbox-13-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-13-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-13-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-13-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-13-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-13-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-13-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-13-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"Padre\" id=\"forminator-field-checkbox-13-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-13-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-13-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-13-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"Hermano\" id=\"forminator-field-checkbox-13-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-13-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-13-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-13-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"Otros\" id=\"forminator-field-checkbox-13-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-13-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-11\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Piel<\/h2><hr class=\"forminator-border\" style=\"border: 2px solid #3895b2;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-14\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-14-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-14-6a1a149c870b4-label\" class=\"forminator-label\">Acn\u00e9 <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-14-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-14-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"one\" id=\"forminator-field-checkbox-14-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-14-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-14-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-14-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"two\" id=\"forminator-field-checkbox-14-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-14-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-14-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-14-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-14-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-14-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-14-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-14-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Padre\" id=\"forminator-field-checkbox-14-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-14-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-14-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-14-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Hermano\" id=\"forminator-field-checkbox-14-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-14-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-14-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-14-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Otros\" id=\"forminator-field-checkbox-14-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-14-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-15\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-15-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-15-6a1a149c870b4-label\" class=\"forminator-label\">C\u00e1ncer de piel \/ melanoma <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-15-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-15-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"one\" id=\"forminator-field-checkbox-15-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-15-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-15-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-15-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"two\" id=\"forminator-field-checkbox-15-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-15-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-15-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-15-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-15-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-15-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-15-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-15-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"Padre\" id=\"forminator-field-checkbox-15-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-15-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-15-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-15-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"Hermano\" id=\"forminator-field-checkbox-15-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-15-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-15-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-15-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"Otros\" id=\"forminator-field-checkbox-15-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-15-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-16\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-16-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-16-6a1a149c870b4-label\" class=\"forminator-label\">Otra condici\u00f3n de la piel <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-16-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-16-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-16[]\" value=\"one\" id=\"forminator-field-checkbox-16-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-16-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-16-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-16-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-16[]\" value=\"two\" id=\"forminator-field-checkbox-16-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-16-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-16-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-16-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-16[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-16-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-16-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-16-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-16-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-16[]\" value=\"Padre\" id=\"forminator-field-checkbox-16-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-16-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-16-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-16-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-16[]\" value=\"Hermano\" id=\"forminator-field-checkbox-16-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-16-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-16-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-16-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-16[]\" value=\"Otros\" id=\"forminator-field-checkbox-16-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-16-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-12\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Genital \/ Reproductiva<\/h2><hr class=\"forminator-border\" style=\"border: 2px solid #3895b2;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-17\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-17-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-17-6a1a149c870b4-label\" class=\"forminator-label\">Reducci\u00f3n incompleta de test\u00edculos <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-17-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-17-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-17[]\" value=\"one\" id=\"forminator-field-checkbox-17-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-17-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-17-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-17-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-17[]\" value=\"two\" id=\"forminator-field-checkbox-17-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-17-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-17-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-17-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-17[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-17-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-17-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-17-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-17-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-17[]\" value=\"Padre\" id=\"forminator-field-checkbox-17-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-17-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-17-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-17-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-17[]\" value=\"Hermano\" id=\"forminator-field-checkbox-17-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-17-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-17-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-17-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-17[]\" value=\"Otros\" id=\"forminator-field-checkbox-17-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-17-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-18\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-18-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-18-6a1a149c870b4-label\" class=\"forminator-label\">2 o m\u00e1s abortos espont\u00e1neos <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-18-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-18-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-18[]\" value=\"one\" id=\"forminator-field-checkbox-18-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-18-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-18-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-18-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-18[]\" value=\"two\" id=\"forminator-field-checkbox-18-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-18-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-18-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-18-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-18[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-18-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-18-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-18-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-18-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-18[]\" value=\"Padre\" id=\"forminator-field-checkbox-18-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-18-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-18-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-18-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-18[]\" value=\"Hermano\" id=\"forminator-field-checkbox-18-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-18-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-18-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-18-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-18[]\" value=\"Otros\" id=\"forminator-field-checkbox-18-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-18-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-19\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-19-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-19-6a1a149c870b4-label\" class=\"forminator-label\">Muerte fetal <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-19-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-19-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-19[]\" value=\"one\" id=\"forminator-field-checkbox-19-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-19-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-19-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-19-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-19[]\" value=\"two\" id=\"forminator-field-checkbox-19-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-19-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-19-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-19-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-19[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-19-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-19-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-19-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-19-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-19[]\" value=\"Padre\" id=\"forminator-field-checkbox-19-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-19-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-19-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-19-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-19[]\" value=\"Hermano\" id=\"forminator-field-checkbox-19-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-19-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-19-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-19-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-19[]\" value=\"Otros\" id=\"forminator-field-checkbox-19-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-19-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-20\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-20-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-20-6a1a149c870b4-label\" class=\"forminator-label\">Muerte infantil <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-20-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-20-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-20[]\" value=\"one\" id=\"forminator-field-checkbox-20-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-20-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-20-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-20-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-20[]\" value=\"two\" id=\"forminator-field-checkbox-20-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-20-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-20-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-20-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-20[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-20-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-20-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-20-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-20-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-20[]\" value=\"Padre\" id=\"forminator-field-checkbox-20-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-20-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-20-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-20-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-20[]\" value=\"Hermano\" id=\"forminator-field-checkbox-20-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-20-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-20-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-20-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-20[]\" value=\"Otros\" id=\"forminator-field-checkbox-20-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-20-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-21\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-21-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-21-6a1a149c870b4-label\" class=\"forminator-label\">Embarazo m\u00faltiple (gemelas, trillizos, etc.) <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-21-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-21-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-21[]\" value=\"one\" id=\"forminator-field-checkbox-21-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-21-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-21-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-21-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-21[]\" value=\"two\" id=\"forminator-field-checkbox-21-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-21-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-21-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-21-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-21[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-21-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-21-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-21-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-21-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-21[]\" value=\"Padre\" id=\"forminator-field-checkbox-21-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-21-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-21-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-21-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-21[]\" value=\"Hermano\" id=\"forminator-field-checkbox-21-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-21-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-21-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-21-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-21[]\" value=\"Otros\" id=\"forminator-field-checkbox-21-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-21-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-22\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-22-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-22-6a1a149c870b4-label\" class=\"forminator-label\">Esterilidad <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-22-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-22-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"one\" id=\"forminator-field-checkbox-22-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-22-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-22-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-22-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"two\" id=\"forminator-field-checkbox-22-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-22-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-22-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-22-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-22-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-22-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-22-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-22-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Padre\" id=\"forminator-field-checkbox-22-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-22-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-22-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-22-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Hermano\" id=\"forminator-field-checkbox-22-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-22-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-22-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-22-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"Otros\" id=\"forminator-field-checkbox-22-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-22-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-23\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-23-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-23-6a1a149c870b4-label\" class=\"forminator-label\">C\u00e1ncer de pr\u00f3stata <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-23-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-23-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-23[]\" value=\"one\" id=\"forminator-field-checkbox-23-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-23-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-23-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-23-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-23[]\" value=\"two\" id=\"forminator-field-checkbox-23-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-23-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-23-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-23-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-23[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-23-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-23-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-23-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-23-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-23[]\" value=\"Padre\" id=\"forminator-field-checkbox-23-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-23-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-23-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-23-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-23[]\" value=\"Hermano\" id=\"forminator-field-checkbox-23-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-23-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-23-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-23-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-23[]\" value=\"Otros\" id=\"forminator-field-checkbox-23-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-23-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-24\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-24-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-24-6a1a149c870b4-label\" class=\"forminator-label\">C\u00e1ncer de ovarios <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-24-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-24-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-24[]\" value=\"one\" id=\"forminator-field-checkbox-24-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-24-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-24-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-24-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-24[]\" value=\"two\" id=\"forminator-field-checkbox-24-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-24-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-24-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-24-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-24[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-24-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-24-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-24-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-24-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-24[]\" value=\"Padre\" id=\"forminator-field-checkbox-24-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-24-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-24-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-24-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-24[]\" value=\"Hermano\" id=\"forminator-field-checkbox-24-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-24-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-24-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-24-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-24[]\" value=\"Otros\" id=\"forminator-field-checkbox-24-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-24-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-25\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-25-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-25-6a1a149c870b4-label\" class=\"forminator-label\">C\u00e1ncer de cuello uterino <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-25-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-25-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-25[]\" value=\"one\" id=\"forminator-field-checkbox-25-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-25-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-25-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-25-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-25[]\" value=\"two\" id=\"forminator-field-checkbox-25-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-25-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-25-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-25-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-25[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-25-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-25-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-25-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-25-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-25[]\" value=\"Padre\" id=\"forminator-field-checkbox-25-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-25-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-25-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-25-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-25[]\" value=\"Hermano\" id=\"forminator-field-checkbox-25-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-25-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-25-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-25-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-25[]\" value=\"Otros\" id=\"forminator-field-checkbox-25-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-25-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-26\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-26-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-26-6a1a149c870b4-label\" class=\"forminator-label\">C\u00e1ncer de mama <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-26-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-26-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-26[]\" value=\"one\" id=\"forminator-field-checkbox-26-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-26-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-26-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-26-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-26[]\" value=\"two\" id=\"forminator-field-checkbox-26-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-26-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-26-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-26-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-26[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-26-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-26-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-26-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-26-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-26[]\" value=\"Padre\" id=\"forminator-field-checkbox-26-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-26-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-26-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-26-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-26[]\" value=\"Hermano\" id=\"forminator-field-checkbox-26-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-26-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-26-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-26-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-26[]\" value=\"Otros\" id=\"forminator-field-checkbox-26-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-26-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-27\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-27-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-27-6a1a149c870b4-label\" class=\"forminator-label\">C\u00e1ncer uterino <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-27-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-27-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-27[]\" value=\"one\" id=\"forminator-field-checkbox-27-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-27-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-27-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-27-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-27[]\" value=\"two\" id=\"forminator-field-checkbox-27-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-27-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-27-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-27-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-27[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-27-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-27-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-27-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-27-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-27[]\" value=\"Padre\" id=\"forminator-field-checkbox-27-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-27-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-27-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-27-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-27[]\" value=\"Hermano\" id=\"forminator-field-checkbox-27-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-27-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-27-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-27-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-27[]\" value=\"Otros\" id=\"forminator-field-checkbox-27-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-27-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-28\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-28-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-28-6a1a149c870b4-label\" class=\"forminator-label\">Otra condici\u00f3n genital \/ reproductiva <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-28-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-28-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-28[]\" value=\"one\" id=\"forminator-field-checkbox-28-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-28-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-28-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-28-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-28[]\" value=\"two\" id=\"forminator-field-checkbox-28-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-28-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-28-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-28-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-28[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-28-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-28-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-28-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-28-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-28[]\" value=\"Padre\" id=\"forminator-field-checkbox-28-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-28-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-28-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-28-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-28[]\" value=\"Hermano\" id=\"forminator-field-checkbox-28-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-28-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-28-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-28-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-28[]\" value=\"Otros\" id=\"forminator-field-checkbox-28-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-28-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-29\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-29-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-29-6a1a149c870b4-label\" class=\"forminator-label\">\u00bfDefectos f\u00edsicos cong\u00e9nitos (defecto card\u00edaco, labio leporino, pie zambo, dedos extra, etc.) ? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-29-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-29-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-29[]\" value=\"one\" id=\"forminator-field-checkbox-29-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-29-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-29-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-29-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-29[]\" value=\"two\" id=\"forminator-field-checkbox-29-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-29-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-29-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-29-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-29[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-29-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-29-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-29-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-29-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-29[]\" value=\"Padre\" id=\"forminator-field-checkbox-29-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-29-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-29-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-29-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-29[]\" value=\"Hermano\" id=\"forminator-field-checkbox-29-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-29-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-29-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-29-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-29[]\" value=\"Otros\" id=\"forminator-field-checkbox-29-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-29-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-13\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Metab\u00f3lico \/ endocrino<\/h2><hr class=\"forminator-border\" style=\"border: 2px solid #3895b2;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-30\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-30-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-30-6a1a149c870b4-label\" class=\"forminator-label\">Diabetes <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-30-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-30-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-30[]\" value=\"one\" id=\"forminator-field-checkbox-30-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-30-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-30-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-30-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-30[]\" value=\"two\" id=\"forminator-field-checkbox-30-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-30-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-30-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-30-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-30[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-30-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-30-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-30-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-30-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-30[]\" value=\"Padre\" id=\"forminator-field-checkbox-30-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-30-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-30-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-30-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-30[]\" value=\"Hermano\" id=\"forminator-field-checkbox-30-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-30-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-30-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-30-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-30[]\" value=\"Otros\" id=\"forminator-field-checkbox-30-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-30-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-31\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-31-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-31-6a1a149c870b4-label\" class=\"forminator-label\">Neurol\u00f3gico <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-31-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-31-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-31[]\" value=\"one\" id=\"forminator-field-checkbox-31-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-31-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-31-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-31-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-31[]\" value=\"two\" id=\"forminator-field-checkbox-31-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-31-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-31-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-31-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-31[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-31-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-31-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-31-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-31-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-31[]\" value=\"Padre\" id=\"forminator-field-checkbox-31-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-31-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-31-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-31-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-31[]\" value=\"Hermano\" id=\"forminator-field-checkbox-31-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-31-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-31-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-31-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-31[]\" value=\"Otros\" id=\"forminator-field-checkbox-31-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-31-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-32\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-32-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-32-6a1a149c870b4-label\" class=\"forminator-label\">Migra\u00f1as <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-32-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-32-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-32[]\" value=\"one\" id=\"forminator-field-checkbox-32-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-32-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-32-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-32-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-32[]\" value=\"two\" id=\"forminator-field-checkbox-32-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-32-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-32-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-32-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-32[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-32-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-32-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-32-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-32-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-32[]\" value=\"Padre\" id=\"forminator-field-checkbox-32-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-32-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-32-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-32-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-32[]\" value=\"Hermano\" id=\"forminator-field-checkbox-32-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-32-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-32-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-32-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-32[]\" value=\"Otros\" id=\"forminator-field-checkbox-32-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-32-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-33\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-33-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-33-6a1a149c870b4-label\" class=\"forminator-label\">Alzheimer <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-33-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-33-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-33[]\" value=\"one\" id=\"forminator-field-checkbox-33-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-33-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-33-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-33-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-33[]\" value=\"two\" id=\"forminator-field-checkbox-33-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-33-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-33-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-33-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-33[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-33-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-33-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-33-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-33-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-33[]\" value=\"Padre\" id=\"forminator-field-checkbox-33-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-33-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-33-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-33-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-33[]\" value=\"Hermano\" id=\"forminator-field-checkbox-33-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-33-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-33-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-33-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-33[]\" value=\"Otros\" id=\"forminator-field-checkbox-33-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-33-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-34\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-34-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-34-6a1a149c870b4-label\" class=\"forminator-label\">Otra condici\u00f3n metab\u00f3lica \/ endocrina <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-34-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-34-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-34[]\" value=\"one\" id=\"forminator-field-checkbox-34-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-34-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-34-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-34-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-34[]\" value=\"two\" id=\"forminator-field-checkbox-34-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-34-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-34-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-34-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-34[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-34-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-34-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-34-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-34-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-34[]\" value=\"Padre\" id=\"forminator-field-checkbox-34-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-34-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-34-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-34-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-34[]\" value=\"Hermano\" id=\"forminator-field-checkbox-34-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-34-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-34-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-34-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-34[]\" value=\"Otros\" id=\"forminator-field-checkbox-34-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-34-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-14\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Salud mental<\/h2><hr class=\"forminator-border\" style=\"border: 2px solid #3895b2;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-35\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-35-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-35-6a1a149c870b4-label\" class=\"forminator-label\">Esquizofrenia <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-35-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-35-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-35[]\" value=\"one\" id=\"forminator-field-checkbox-35-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-35-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-35-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-35-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-35[]\" value=\"two\" id=\"forminator-field-checkbox-35-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-35-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-35-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-35-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-35[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-35-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-35-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-35-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-35-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-35[]\" value=\"Padre\" id=\"forminator-field-checkbox-35-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-35-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-35-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-35-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-35[]\" value=\"Hermano\" id=\"forminator-field-checkbox-35-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-35-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-35-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-35-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-35[]\" value=\"Otros\" id=\"forminator-field-checkbox-35-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-35-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-36\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-36-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-36-6a1a149c870b4-label\" class=\"forminator-label\">Depresi\u00f3n <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-36-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-36-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-36[]\" value=\"one\" id=\"forminator-field-checkbox-36-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-36-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-36-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-36-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-36[]\" value=\"two\" id=\"forminator-field-checkbox-36-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-36-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-36-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-36-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-36[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-36-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-36-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-36-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-36-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-36[]\" value=\"Padre\" id=\"forminator-field-checkbox-36-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-36-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-36-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-36-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-36[]\" value=\"Hermano\" id=\"forminator-field-checkbox-36-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-36-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-36-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-36-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-36[]\" value=\"Otros\" id=\"forminator-field-checkbox-36-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-36-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-37\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-37-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-37-6a1a149c870b4-label\" class=\"forminator-label\">Tendencias suicidas <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-37-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-37-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-37[]\" value=\"one\" id=\"forminator-field-checkbox-37-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-37-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-37-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-37-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-37[]\" value=\"two\" id=\"forminator-field-checkbox-37-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-37-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-37-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-37-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-37[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-37-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-37-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-37-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-37-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-37[]\" value=\"Padre\" id=\"forminator-field-checkbox-37-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-37-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-37-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-37-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-37[]\" value=\"Hermano\" id=\"forminator-field-checkbox-37-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-37-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-37-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-37-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-37[]\" value=\"Otros\" id=\"forminator-field-checkbox-37-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-37-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-38\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-38-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-38-6a1a149c870b4-label\" class=\"forminator-label\">Psicoterapia <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-38-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-38-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-38[]\" value=\"one\" id=\"forminator-field-checkbox-38-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-38-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-38-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-38-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-38[]\" value=\"two\" id=\"forminator-field-checkbox-38-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-38-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-38-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-38-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-38[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-38-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-38-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-38-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-38-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-38[]\" value=\"Padre\" id=\"forminator-field-checkbox-38-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-38-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-38-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-38-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-38[]\" value=\"Hermano\" id=\"forminator-field-checkbox-38-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-38-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-38-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-38-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-38[]\" value=\"Otros\" id=\"forminator-field-checkbox-38-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-38-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-39\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-39-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-39-6a1a149c870b4-label\" class=\"forminator-label\">Abuso de drogas \/ adicci\u00f3n <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-39-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-39-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-39[]\" value=\"one\" id=\"forminator-field-checkbox-39-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-39-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-39-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-39-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-39[]\" value=\"two\" id=\"forminator-field-checkbox-39-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-39-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-39-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-39-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-39[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-39-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-39-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-39-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-39-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-39[]\" value=\"Padre\" id=\"forminator-field-checkbox-39-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-39-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-39-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-39-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-39[]\" value=\"Hermano\" id=\"forminator-field-checkbox-39-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-39-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-39-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-39-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-39[]\" value=\"Otros\" id=\"forminator-field-checkbox-39-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-39-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-40\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-40-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-40-6a1a149c870b4-label\" class=\"forminator-label\">Alcoholismo <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-40-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-40-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-40[]\" value=\"one\" id=\"forminator-field-checkbox-40-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-40-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-40-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-40-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-40[]\" value=\"two\" id=\"forminator-field-checkbox-40-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-40-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-40-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-40-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-40[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-40-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-40-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-40-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-40-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-40[]\" value=\"Padre\" id=\"forminator-field-checkbox-40-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-40-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-40-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-40-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-40[]\" value=\"Hermano\" id=\"forminator-field-checkbox-40-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-40-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-40-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-40-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-40[]\" value=\"Otros\" id=\"forminator-field-checkbox-40-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-40-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-41\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-41-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-41-6a1a149c870b4-label\" class=\"forminator-label\">Convulsiones \/ epilepsia <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-41-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-41-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-41[]\" value=\"one\" id=\"forminator-field-checkbox-41-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-41-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-41-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-41-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-41[]\" value=\"two\" id=\"forminator-field-checkbox-41-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-41-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-41-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-41-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-41[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-41-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-41-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-41-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-41-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-41[]\" value=\"Padre\" id=\"forminator-field-checkbox-41-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-41-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-41-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-41-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-41[]\" value=\"Hermano\" id=\"forminator-field-checkbox-41-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-41-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-41-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-41-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-41[]\" value=\"Otros\" id=\"forminator-field-checkbox-41-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-41-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-42\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-42-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-42-6a1a149c870b4-label\" class=\"forminator-label\">Ansiedad <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-42-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-42-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-42[]\" value=\"one\" id=\"forminator-field-checkbox-42-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-42-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-42-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-42-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-42[]\" value=\"two\" id=\"forminator-field-checkbox-42-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-42-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-42-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-42-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-42[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-42-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-42-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-42-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-42-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-42[]\" value=\"Padre\" id=\"forminator-field-checkbox-42-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-42-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-42-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-42-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-42[]\" value=\"Hermano\" id=\"forminator-field-checkbox-42-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-42-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-42-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-42-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-42[]\" value=\"Otros\" id=\"forminator-field-checkbox-42-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-42-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-43\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-43-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-43-6a1a149c870b4-label\" class=\"forminator-label\">Suicidio \/ intentos de suicidio <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-43-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-43-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-43[]\" value=\"one\" id=\"forminator-field-checkbox-43-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-43-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-43-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-43-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-43[]\" value=\"two\" id=\"forminator-field-checkbox-43-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-43-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-43-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-43-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-43[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-43-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-43-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-43-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-43-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-43[]\" value=\"Padre\" id=\"forminator-field-checkbox-43-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-43-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-43-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-43-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-43[]\" value=\"Hermano\" id=\"forminator-field-checkbox-43-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-43-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-43-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-43-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-43[]\" value=\"Otros\" id=\"forminator-field-checkbox-43-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-43-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-44\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-44-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-44-6a1a149c870b4-label\" class=\"forminator-label\">Trastorno bipolar \/ esquizofrenia <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-44-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-44-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-44[]\" value=\"one\" id=\"forminator-field-checkbox-44-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-44-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-44-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-44-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-44[]\" value=\"two\" id=\"forminator-field-checkbox-44-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-44-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-44-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-44-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-44[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-44-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-44-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-44-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-44-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-44[]\" value=\"Padre\" id=\"forminator-field-checkbox-44-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-44-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-44-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-44-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-44[]\" value=\"Hermano\" id=\"forminator-field-checkbox-44-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-44-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-44-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-44-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-44[]\" value=\"Otros\" id=\"forminator-field-checkbox-44-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-44-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-45\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-45-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-45-6a1a149c870b4-label\" class=\"forminator-label\">Trastornos mentales o emocionales <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-45-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-45-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-45[]\" value=\"one\" id=\"forminator-field-checkbox-45-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-45-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-45-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-45-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-45[]\" value=\"two\" id=\"forminator-field-checkbox-45-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-45-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-45-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-45-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-45[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-45-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-45-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-45-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-45-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-45[]\" value=\"Padre\" id=\"forminator-field-checkbox-45-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-45-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-45-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-45-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-45[]\" value=\"Hermano\" id=\"forminator-field-checkbox-45-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-45-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-45-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-45-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-45[]\" value=\"Otros\" id=\"forminator-field-checkbox-45-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-45-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-46\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-46-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-46-6a1a149c870b4-label\" class=\"forminator-label\">Discapacidad de aprendizaje (incluida la dislexia) <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-46-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-46-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-46[]\" value=\"one\" id=\"forminator-field-checkbox-46-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-46-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-46-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-46-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-46[]\" value=\"two\" id=\"forminator-field-checkbox-46-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-46-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-46-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-46-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-46[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-46-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-46-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-46-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-46-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-46[]\" value=\"Padre\" id=\"forminator-field-checkbox-46-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-46-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-46-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-46-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-46[]\" value=\"Hermano\" id=\"forminator-field-checkbox-46-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-46-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-46-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-46-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-46[]\" value=\"Otros\" id=\"forminator-field-checkbox-46-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-46-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-47\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-47-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-47-6a1a149c870b4-label\" class=\"forminator-label\">Retrasos en el desarrollo \/ bajo coeficiente intelectual <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-47-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-47-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-47[]\" value=\"one\" id=\"forminator-field-checkbox-47-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-47-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-47-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-47-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-47[]\" value=\"two\" id=\"forminator-field-checkbox-47-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-47-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-47-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-47-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-47[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-47-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-47-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-47-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-47-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-47[]\" value=\"Padre\" id=\"forminator-field-checkbox-47-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-47-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-47-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-47-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-47[]\" value=\"Hermano\" id=\"forminator-field-checkbox-47-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-47-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-47-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-47-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-47[]\" value=\"Otros\" id=\"forminator-field-checkbox-47-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-47-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-48\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-48-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-48-6a1a149c870b4-label\" class=\"forminator-label\">\u00bfAutismo, espectro autista \/ s\u00edndrome de Asperger? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-48-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-48-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-48[]\" value=\"one\" id=\"forminator-field-checkbox-48-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-48-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-48-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-48-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-48[]\" value=\"two\" id=\"forminator-field-checkbox-48-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-48-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-48-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-48-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-48[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-48-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-48-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-48-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-48-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-48[]\" value=\"Padre\" id=\"forminator-field-checkbox-48-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-48-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-48-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-48-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-48[]\" value=\"Hermano\" id=\"forminator-field-checkbox-48-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-48-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-48-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-48-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-48[]\" value=\"Otros\" id=\"forminator-field-checkbox-48-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-48-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-49\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-49-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-49-6a1a149c870b4-label\" class=\"forminator-label\">Huntington \/ enfermedad de Alzheimer \/ Parkinson u otros problemas nerviosos <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-49-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-49-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-49[]\" value=\"one\" id=\"forminator-field-checkbox-49-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-49-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-49-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-49-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-49[]\" value=\"two\" id=\"forminator-field-checkbox-49-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-49-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-49-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-49-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-49[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-49-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-49-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-49-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-49-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-49[]\" value=\"Padre\" id=\"forminator-field-checkbox-49-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-49-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-49-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-49-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-49[]\" value=\"Hermano\" id=\"forminator-field-checkbox-49-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-49-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-49-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-49-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-49[]\" value=\"Otros\" id=\"forminator-field-checkbox-49-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-49-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-50\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-50-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-50-6a1a149c870b4-label\" class=\"forminator-label\">Trastorno por d\u00e9ficit de atenci\u00f3n \/ trastorno por d\u00e9ficit de atenci\u00f3n con hiperactividad <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-50-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-50-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-50[]\" value=\"one\" id=\"forminator-field-checkbox-50-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-50-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-50-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-50-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-50[]\" value=\"two\" id=\"forminator-field-checkbox-50-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-50-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-50-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-50-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-50[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-50-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-50-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-50-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-50-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-50[]\" value=\"Padre\" id=\"forminator-field-checkbox-50-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-50-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-50-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-50-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-50[]\" value=\"Hermano\" id=\"forminator-field-checkbox-50-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-50-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-50-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-50-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-50[]\" value=\"Otros\" id=\"forminator-field-checkbox-50-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-50-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-51\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-51-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-51-6a1a149c870b4-label\" class=\"forminator-label\">Otra condici\u00f3n que requiere hospitalizaci\u00f3n <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-51-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-51-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-51[]\" value=\"one\" id=\"forminator-field-checkbox-51-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-51-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-51-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-51-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-51[]\" value=\"two\" id=\"forminator-field-checkbox-51-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-51-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-51-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-51-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-51[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-51-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-51-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-51-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-51-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-51[]\" value=\"Padre\" id=\"forminator-field-checkbox-51-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-51-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-51-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-51-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-51[]\" value=\"Hermano\" id=\"forminator-field-checkbox-51-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-51-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-51-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-51-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-51[]\" value=\"Otros\" id=\"forminator-field-checkbox-51-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-51-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-15\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Autoinmune<\/h2><hr class=\"forminator-border\" style=\"border: 2px solid #3895b2;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-52\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-52-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-52-6a1a149c870b4-label\" class=\"forminator-label\">Lupus eritematoso sist\u00e9mico <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-52-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-52-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-52[]\" value=\"one\" id=\"forminator-field-checkbox-52-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-52-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-52-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-52-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-52[]\" value=\"two\" id=\"forminator-field-checkbox-52-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-52-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-52-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-52-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-52[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-52-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-52-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-52-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-52-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-52[]\" value=\"Padre\" id=\"forminator-field-checkbox-52-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-52-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-52-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-52-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-52[]\" value=\"Hermano\" id=\"forminator-field-checkbox-52-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-52-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-52-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-52-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-52[]\" value=\"Otros\" id=\"forminator-field-checkbox-52-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-52-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-53\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-53-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-53-6a1a149c870b4-label\" class=\"forminator-label\">Enfermedad renal (ri\u00f1ones poliqu\u00edsticos, insuficiencia renal o c\u00e1lculos renales) <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-53-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-53-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-53[]\" value=\"one\" id=\"forminator-field-checkbox-53-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-53-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-53-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-53-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-53[]\" value=\"two\" id=\"forminator-field-checkbox-53-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-53-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-53-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-53-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-53[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-53-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-53-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-53-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-53-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-53[]\" value=\"Padre\" id=\"forminator-field-checkbox-53-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-53-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-53-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-53-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-53[]\" value=\"Hermano\" id=\"forminator-field-checkbox-53-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-53-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-53-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-53-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-53[]\" value=\"Otros\" id=\"forminator-field-checkbox-53-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-53-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-16\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Otras<\/h2><hr class=\"forminator-border\" style=\"border: 2px solid #3895b2;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-54\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-54-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-54-6a1a149c870b4-label\" class=\"forminator-label\">Fibromialgia <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-54-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-54-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-54[]\" value=\"one\" id=\"forminator-field-checkbox-54-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-54-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-54-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-54-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-54[]\" value=\"two\" id=\"forminator-field-checkbox-54-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-54-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-54-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-54-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-54[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-54-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-54-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-54-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-54-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-54[]\" value=\"Padre\" id=\"forminator-field-checkbox-54-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-54-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-54-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-54-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-54[]\" value=\"Hermano\" id=\"forminator-field-checkbox-54-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-54-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-54-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-54-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-54[]\" value=\"Otros\" id=\"forminator-field-checkbox-54-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-54-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-55\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-55-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-55-6a1a149c870b4-label\" class=\"forminator-label\">Fibrosis qu\u00edstica <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-55-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-55-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-55[]\" value=\"one\" id=\"forminator-field-checkbox-55-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-55-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-55-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-55-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-55[]\" value=\"two\" id=\"forminator-field-checkbox-55-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-55-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-55-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-55-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-55[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-55-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-55-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-55-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-55-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-55[]\" value=\"Padre\" id=\"forminator-field-checkbox-55-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-55-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-55-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-55-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-55[]\" value=\"Hermano\" id=\"forminator-field-checkbox-55-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-55-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-55-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-55-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-55[]\" value=\"Otros\" id=\"forminator-field-checkbox-55-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-55-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-56\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-56-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-56-6a1a149c870b4-label\" class=\"forminator-label\">S\u00edndrome X fr\u00e1gil <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-56-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-56-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-56[]\" value=\"one\" id=\"forminator-field-checkbox-56-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-56-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-56-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-56-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-56[]\" value=\"two\" id=\"forminator-field-checkbox-56-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-56-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-56-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-56-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-56[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-56-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-56-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-56-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-56-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-56[]\" value=\"Padre\" id=\"forminator-field-checkbox-56-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-56-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-56-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-56-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-56[]\" value=\"Hermano\" id=\"forminator-field-checkbox-56-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-56-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-56-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-56-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-56[]\" value=\"Otros\" id=\"forminator-field-checkbox-56-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-56-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-57\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-57-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-57-6a1a149c870b4-label\" class=\"forminator-label\">Hidrocefalia <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-57-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-57-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-57[]\" value=\"one\" id=\"forminator-field-checkbox-57-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-57-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-57-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-57-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-57[]\" value=\"two\" id=\"forminator-field-checkbox-57-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-57-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-57-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-57-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-57[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-57-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-57-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-57-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-57-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-57[]\" value=\"Padre\" id=\"forminator-field-checkbox-57-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-57-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-57-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-57-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-57[]\" value=\"Hermano\" id=\"forminator-field-checkbox-57-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-57-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-57-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-57-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-57[]\" value=\"Otros\" id=\"forminator-field-checkbox-57-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-57-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-58\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-58-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-58-6a1a149c870b4-label\" class=\"forminator-label\">Espina b\u00edfida <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-58-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-58-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-58[]\" value=\"one\" id=\"forminator-field-checkbox-58-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-58-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-58-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-58-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-58[]\" value=\"two\" id=\"forminator-field-checkbox-58-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-58-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-58-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-58-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-58[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-58-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-58-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-58-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-58-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-58[]\" value=\"Padre\" id=\"forminator-field-checkbox-58-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-58-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-58-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-58-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-58[]\" value=\"Hermano\" id=\"forminator-field-checkbox-58-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-58-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-58-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-58-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-58[]\" value=\"Otros\" id=\"forminator-field-checkbox-58-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-58-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-59\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-59-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-59-6a1a149c870b4-label\" class=\"forminator-label\">Tay Sachs <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-59-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-59-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-59[]\" value=\"one\" id=\"forminator-field-checkbox-59-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-59-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-59-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-59-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-59[]\" value=\"two\" id=\"forminator-field-checkbox-59-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-59-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-59-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-59-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-59[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-59-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-59-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-59-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-59-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-59[]\" value=\"Padre\" id=\"forminator-field-checkbox-59-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-59-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-59-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-59-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-59[]\" value=\"Hermano\" id=\"forminator-field-checkbox-59-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-59-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-59-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-59-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-59[]\" value=\"Otros\" id=\"forminator-field-checkbox-59-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-59-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-60\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-60-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-60-6a1a149c870b4-label\" class=\"forminator-label\">Osteoporosis \/ escoliosis <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-60-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-60-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-60[]\" value=\"one\" id=\"forminator-field-checkbox-60-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-60-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-60-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-60-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-60[]\" value=\"two\" id=\"forminator-field-checkbox-60-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-60-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-60-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-60-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-60[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-60-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-60-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-60-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-60-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-60[]\" value=\"Padre\" id=\"forminator-field-checkbox-60-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-60-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-60-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-60-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-60[]\" value=\"Hermano\" id=\"forminator-field-checkbox-60-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-60-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-60-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-60-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-60[]\" value=\"Otros\" id=\"forminator-field-checkbox-60-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-60-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-61\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-61-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-61-6a1a149c870b4-label\" class=\"forminator-label\">Problemas articulares \/ musculares <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-61-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-61-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-61[]\" value=\"one\" id=\"forminator-field-checkbox-61-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-61-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-61-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-61-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-61[]\" value=\"two\" id=\"forminator-field-checkbox-61-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-61-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-61-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-61-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-61[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-61-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-61-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-61-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-61-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-61[]\" value=\"Padre\" id=\"forminator-field-checkbox-61-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-61-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-61-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-61-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-61[]\" value=\"Hermano\" id=\"forminator-field-checkbox-61-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-61-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-61-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-61-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-61[]\" value=\"Otros\" id=\"forminator-field-checkbox-61-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-61-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-62\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-62-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-62-6a1a149c870b4-label\" class=\"forminator-label\">Alergias <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-62-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-62-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-62[]\" value=\"one\" id=\"forminator-field-checkbox-62-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-62-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-62-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-62-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-62[]\" value=\"two\" id=\"forminator-field-checkbox-62-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-62-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-62-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-62-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-62[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-62-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-62-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-62-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-62-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-62[]\" value=\"Padre\" id=\"forminator-field-checkbox-62-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-62-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-62-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-62-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-62[]\" value=\"Hermano\" id=\"forminator-field-checkbox-62-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-62-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-62-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-62-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-62[]\" value=\"Otros\" id=\"forminator-field-checkbox-62-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-62-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-63\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-63-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-63-6a1a149c870b4-label\" class=\"forminator-label\">Eccema \/ psoriasis <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-63-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-63-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-63[]\" value=\"one\" id=\"forminator-field-checkbox-63-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-63-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-63-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-63-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-63[]\" value=\"two\" id=\"forminator-field-checkbox-63-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-63-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-63-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-63-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-63[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-63-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-63-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-63-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-63-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-63[]\" value=\"Padre\" id=\"forminator-field-checkbox-63-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-63-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-63-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-63-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-63[]\" value=\"Hermano\" id=\"forminator-field-checkbox-63-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-63-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-63-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-63-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-63[]\" value=\"Otros\" id=\"forminator-field-checkbox-63-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-63-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-64\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-64-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-64-6a1a149c870b4-label\" class=\"forminator-label\">C\u00e1ncer (de cualquier tipo) <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-64-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-64-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-64[]\" value=\"one\" id=\"forminator-field-checkbox-64-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-64-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-64-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-64-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-64[]\" value=\"two\" id=\"forminator-field-checkbox-64-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-64-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-64-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-64-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-64[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-64-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-64-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-64-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-64-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-64[]\" value=\"Padre\" id=\"forminator-field-checkbox-64-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-64-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-64-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-64-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-64[]\" value=\"Hermano\" id=\"forminator-field-checkbox-64-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-64-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-64-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-64-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-64[]\" value=\"Otros\" id=\"forminator-field-checkbox-64-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-64-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-65\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-65-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-65-6a1a149c870b4-label\" class=\"forminator-label\">Enanismo o estatura inusualmente baja <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-65-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-65-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-65[]\" value=\"one\" id=\"forminator-field-checkbox-65-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-65-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-65-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-65-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-65[]\" value=\"two\" id=\"forminator-field-checkbox-65-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-65-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-65-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-65-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-65[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-65-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-65-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-65-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-65-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-65[]\" value=\"Padre\" id=\"forminator-field-checkbox-65-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-65-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-65-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-65-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-65[]\" value=\"Hermano\" id=\"forminator-field-checkbox-65-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-65-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-65-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-65-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-65[]\" value=\"Otros\" id=\"forminator-field-checkbox-65-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-65-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-66\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-66-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-66-6a1a149c870b4-label\" class=\"forminator-label\">Anorexia \/ bulimia <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-66-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-66-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-66[]\" value=\"one\" id=\"forminator-field-checkbox-66-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-66-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-66-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-66-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-66[]\" value=\"two\" id=\"forminator-field-checkbox-66-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-66-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-66-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-66-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-66[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-66-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-66-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-66-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-66-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-66[]\" value=\"Padre\" id=\"forminator-field-checkbox-66-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-66-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-66-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-66-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-66[]\" value=\"Hermano\" id=\"forminator-field-checkbox-66-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-66-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-66-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-66-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-66[]\" value=\"Otros\" id=\"forminator-field-checkbox-66-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-66-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><div id=\"checkbox-67\" class=\"forminator-field-checkbox forminator-col forminator-col-6\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-67-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-67-6a1a149c870b4-label\" class=\"forminator-label\">Trastorno cromos\u00f3mico (s\u00edndrome de Down o cualquier otro) <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-67-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-67-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-67[]\" value=\"one\" id=\"forminator-field-checkbox-67-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-67-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-67-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-67-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-67[]\" value=\"two\" id=\"forminator-field-checkbox-67-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-67-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-67-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-67-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-67[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-67-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-67-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-67-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-67-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-67[]\" value=\"Padre\" id=\"forminator-field-checkbox-67-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-67-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-67-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-67-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-67[]\" value=\"Hermano\" id=\"forminator-field-checkbox-67-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-67-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-67-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-67-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-67[]\" value=\"Otros\" id=\"forminator-field-checkbox-67-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-67-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-68\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-68-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-68-6a1a149c870b4-label\" class=\"forminator-label\">Problemas gastrointestinales (acidez cr\u00f3nica, hernia de hiato, c\u00e1lculos biliares, \u00falceras, colitis, s\u00edndrome del intestino irritable, enfermedad de Crohn, otros) <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-68-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-68-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-68[]\" value=\"one\" id=\"forminator-field-checkbox-68-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-68-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-68-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-68-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-68[]\" value=\"two\" id=\"forminator-field-checkbox-68-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-68-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-68-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-68-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-68[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-68-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-68-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-68-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-68-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-68[]\" value=\"Padre\" id=\"forminator-field-checkbox-68-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-68-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-68-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-68-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-68[]\" value=\"Hermano\" id=\"forminator-field-checkbox-68-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-68-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-68-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-68-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-68[]\" value=\"Otros\" id=\"forminator-field-checkbox-68-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-68-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-69\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-69-6a1a149c870b4-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-69-6a1a149c870b4-label\" class=\"forminator-label\">Problema de la vista o de los ojos (ceguera, glaucoma, cataratas, daltonismo o cualquier otro) <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-69-1-6a1a149c870b4-label\" for=\"forminator-field-checkbox-69-1-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NINGUNO\"><input type=\"checkbox\" name=\"checkbox-69[]\" value=\"one\" id=\"forminator-field-checkbox-69-1-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-69-1-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NINGUNO<\/span><\/label><label id=\"forminator-field-checkbox-69-2-6a1a149c870b4-label\" for=\"forminator-field-checkbox-69-2-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T\u00fa\"><input type=\"checkbox\" name=\"checkbox-69[]\" value=\"two\" id=\"forminator-field-checkbox-69-2-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-69-2-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T\u00fa<\/span><\/label><label id=\"forminator-field-checkbox-69-3-6a1a149c870b4-label\" for=\"forminator-field-checkbox-69-3-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Mam\u00e1\"><input type=\"checkbox\" name=\"checkbox-69[]\" value=\"Mam\u00e1\" id=\"forminator-field-checkbox-69-3-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-69-3-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mam\u00e1<\/span><\/label><label id=\"forminator-field-checkbox-69-4-6a1a149c870b4-label\" for=\"forminator-field-checkbox-69-4-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Padre\"><input type=\"checkbox\" name=\"checkbox-69[]\" value=\"Padre\" id=\"forminator-field-checkbox-69-4-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-69-4-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Padre<\/span><\/label><label id=\"forminator-field-checkbox-69-5-6a1a149c870b4-label\" for=\"forminator-field-checkbox-69-5-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Hermano\"><input type=\"checkbox\" name=\"checkbox-69[]\" value=\"Hermano\" id=\"forminator-field-checkbox-69-5-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-69-5-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hermano<\/span><\/label><label id=\"forminator-field-checkbox-69-6-6a1a149c870b4-label\" for=\"forminator-field-checkbox-69-6-6a1a149c870b4\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Otros\"><input type=\"checkbox\" name=\"checkbox-69[]\" value=\"Otros\" id=\"forminator-field-checkbox-69-6-6a1a149c870b4\" aria-labelledby=\"forminator-field-checkbox-69-6-6a1a149c870b4-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Otros<\/span><\/label><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Env&iacute;ar<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"c4a9ddcd1c\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/es\/wp-json\/wp\/v2\/pages\/1764\" \/><input type=\"hidden\" name=\"form_id\" value=\"1762\"><input type=\"hidden\" name=\"page_id\" value=\"1764\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/soulconsciouscreation.com\/es\/egg-donors\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"forminator-multifile-hidden\" class=\"forminator-multifile-hidden\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><input type=\"hidden\" name=\"trp-form-language\" value=\"es\"\/><\/form><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-614bc04a elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"614bc04a\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-4460428c\" data-id=\"4460428c\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5dccc812 elementor-widget elementor-widget-image\" data-id=\"5dccc812\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/soulconsciouscreation.com\/es\/\">\n\t\t\t\t\t\t\t<img decoding=\"async\" src=\"https:\/\/soulconsciouscreation.com\/wp-content\/uploads\/elementor\/thumbs\/Conscious-Creation-blanco-qw3l0g5ce6u54u3w3bx1dlummt1yomiyz54oce3nf8.png\" title=\"Conscious Creation blanco\" alt=\"Conscious Creation blanco\" loading=\"lazy\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-65c41e5b elementor-widget elementor-widget-text-editor\" data-id=\"65c41e5b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Empresa Americana Operando en M\u00e9xico<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5ad2d569 elementor-shape-rounded elementor-grid-0 e-grid-align-center elementor-widget elementor-widget-social-icons\" data-id=\"5ad2d569\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"social-icons.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-social-icons-wrapper elementor-grid\" role=\"list\">\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\" role=\"listitem\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-facebook-f elementor-animation-grow elementor-repeater-item-2f307f6\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Facebook-f<\/span>\n\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fab-facebook-f\" viewbox=\"0 0 320 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M279.14 288l14.22-92.66h-88.91v-60.13c0-25.35 12.42-50.06 52.24-50.06h40.42V6.26S260.43 0 225.36 0c-73.22 0-121.08 44.38-121.08 124.72v70.62H22.89V288h81.39v224h100.17V288z\"><\/path><\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\" role=\"listitem\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-instagram elementor-animation-grow elementor-repeater-item-b2c3f2e\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Instagram<\/span>\n\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fab-instagram\" viewbox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M224.1 141c-63.6 0-114.9 51.3-114.9 114.9s51.3 114.9 114.9 114.9S339 319.5 339 255.9 287.7 141 224.1 141zm0 189.6c-41.1 0-74.7-33.5-74.7-74.7s33.5-74.7 74.7-74.7 74.7 33.5 74.7 74.7-33.6 74.7-74.7 74.7zm146.4-194.3c0 14.9-12 26.8-26.8 26.8-14.9 0-26.8-12-26.8-26.8s12-26.8 26.8-26.8 26.8 12 26.8 26.8zm76.1 27.2c-1.7-35.9-9.9-67.7-36.2-93.9-26.2-26.2-58-34.4-93.9-36.2-37-2.1-147.9-2.1-184.9 0-35.8 1.7-67.6 9.9-93.9 36.1s-34.4 58-36.2 93.9c-2.1 37-2.1 147.9 0 184.9 1.7 35.9 9.9 67.7 36.2 93.9s58 34.4 93.9 36.2c37 2.1 147.9 2.1 184.9 0 35.9-1.7 67.7-9.9 93.9-36.2 26.2-26.2 34.4-58 36.2-93.9 2.1-37 2.1-147.8 0-184.8zM398.8 388c-7.8 19.6-22.9 34.7-42.6 42.6-29.5 11.7-99.5 9-132.1 9s-102.7 2.6-132.1-9c-19.6-7.8-34.7-22.9-42.6-42.6-11.7-29.5-9-99.5-9-132.1s-2.6-102.7 9-132.1c7.8-19.6 22.9-34.7 42.6-42.6 29.5-11.7 99.5-9 132.1-9s102.7-2.6 132.1 9c19.6 7.8 34.7 22.9 42.6 42.6 11.7 29.5 9 99.5 9 132.1s2.7 102.7-9 132.1z\"><\/path><\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Convi\u00e9rtete en DONANTE Por favor llena tus datos e informaci\u00f3n completando el siguiente cuestionario! American Company Operating in Mexico Facebook-f Instagram<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"full-width-container","site-content-style":"unboxed","site-sidebar-style":"unboxed","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"disabled","ast-featured-img":"disabled","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"enabled","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-1764","page","type-page","status-publish","hentry"],"aioseo_notices":[],"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"consciousconception.life","author_link":"https:\/\/soulconsciouscreation.com\/es\/author\/consciousconception-life\/"},"rttpg_comment":0,"rttpg_category":null,"rttpg_excerpt":"Convi\u00e9rtete en DONANTE Por favor llena tus datos e informaci\u00f3n completando el siguiente cuestionario! American Company Operating in Mexico Facebook-f Instagram","_links":{"self":[{"href":"https:\/\/soulconsciouscreation.com\/es\/wp-json\/wp\/v2\/pages\/1764","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/soulconsciouscreation.com\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/soulconsciouscreation.com\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/soulconsciouscreation.com\/es\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/soulconsciouscreation.com\/es\/wp-json\/wp\/v2\/comments?post=1764"}],"version-history":[{"count":36,"href":"https:\/\/soulconsciouscreation.com\/es\/wp-json\/wp\/v2\/pages\/1764\/revisions"}],"predecessor-version":[{"id":2942,"href":"https:\/\/soulconsciouscreation.com\/es\/wp-json\/wp\/v2\/pages\/1764\/revisions\/2942"}],"wp:attachment":[{"href":"https:\/\/soulconsciouscreation.com\/es\/wp-json\/wp\/v2\/media?parent=1764"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}