{"id":37123,"date":"2023-12-28T18:16:04","date_gmt":"2023-12-28T18:16:04","guid":{"rendered":"https:\/\/clinicmono.com\/halsokontroll-formular-kosmetisk\/"},"modified":"2024-02-26T02:02:16","modified_gmt":"2024-02-26T02:02:16","slug":"health-check-form-cosmetic","status":"publish","type":"page","link":"https:\/\/clinicmono.com\/sv\/health-check-form-cosmetic\/","title":{"rendered":"H\u00e4lsokontroll Formul\u00e4r Kosmetisk"},"content":{"rendered":"<section class=\"l-section wpb_row height_custom with_img\"><div class=\"l-section-img\" role=\"img\" data-img-width=\"1920\" data-img-height=\"400\" style=\"background-image: url(https:\/\/clinicmono.com\/wp-content\/uploads\/2023\/05\/call1.jpg);background-repeat: no-repeat;background-size: auto;\"><\/div><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"wpb_text_column\"><div class=\"wpb_wrapper\"><h1 style=\"text-align: center;\">Formul\u00e4r f\u00f6r h\u00e4lsokontroll<\/h1>\n<\/div><\/div><nav class=\"g-breadcrumbs separator_icon align_center\" itemscope itemtype=\"http:\/\/schema.org\/BreadcrumbList\"><div class=\"g-breadcrumbs-item\" itemscope itemprop=\"itemListElement\" itemtype=\"http:\/\/schema.org\/ListItem\"><a itemprop=\"item\" href=\"https:\/\/clinicmono.com\/sv\/\"><span itemprop=\"name\">Klinik Mono<\/span><\/a><meta itemprop=\"position\" content=\"1\"\/><\/div><div class=\"g-breadcrumbs-separator\"><i class=\"far fa-angle-double-right\"><\/i><\/div><div class=\"g-breadcrumbs-item\">Sidor<\/div><\/nav><\/div><\/div><\/div><\/div><\/div><\/section><section class=\"l-section wpb_row height_custom\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"g-cols wpb_row hide_on_tablets hide_on_mobiles via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"wpforms-container wpforms-render-modern\" id=\"wpforms-42100\"><form id=\"wpforms-form-42100\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"42100\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/sv\/wp-json\/wp\/v2\/pages\/37123\" data-token=\"9ce9bbbf87873ac1e0699808caa138a1\" data-token-time=\"1775436127\"><noscript class=\"wpforms-error-noscript\">Aktivera JavaScript i din webbl\u00e4sare f\u00f6r att fylla i formul\u00e4ret.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Aktivera JavaScript i din webbl\u00e4sare f\u00f6r att fylla i formul\u00e4ret.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-42100-field_69-container\" class=\"wpforms-field wpforms-field-select wpforms-one-fourth wpforms-field-select-style-classic\" data-field-id=\"69\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_69\">Meriterande status   <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-42100-field_69\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][69]\" required=\"required\"><option value=\"Enkel\"  selected='selected' class=\"choice-1 depth-1\"  >Enkel<\/option><option value=\"Gift\"  class=\"choice-2 depth-1\"  >Gift<\/option><option value=\"Skild\"  class=\"choice-3 depth-1\"  >Skild<\/option><option value=\"\u00c4nka\"  class=\"choice-4 depth-1\"  >\u00c4nka<\/option><\/select><\/div><div id=\"wpforms-42100-field_1-container\" class=\"wpforms-field wpforms-field-text wpforms-one-fourth\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_1\">Namn <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-42100-field_1\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][1]\" placeholder=\"Namn\" aria-errormessage=\"wpforms-42100-field_1-error\" required><\/div><div id=\"wpforms-42100-field_70-container\" class=\"wpforms-field wpforms-field-text wpforms-one-fourth\" data-field-id=\"70\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_70\">Efternamn <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-42100-field_70\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][70]\" placeholder=\"Efternamn\" aria-errormessage=\"wpforms-42100-field_70-error\" required><\/div><div id=\"wpforms-42100-field_4-container\" class=\"wpforms-field wpforms-field-email wpforms-one-fourth\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_4\">E-post <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-42100-field_4\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][4]\" placeholder=\"E-post\" spellcheck=\"false\" aria-errormessage=\"wpforms-42100-field_4-error\" required><\/div><div id=\"wpforms-42100-field_132-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"132\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_132\">F\u00f6delsedag<\/label><input type=\"text\" id=\"wpforms-42100-field_132\" class=\"wpforms-field-large\" name=\"wpforms[fields][132]\" aria-errormessage=\"wpforms-42100-field_132-error\" ><\/div><div id=\"wpforms-42100-field_75-container\" class=\"wpforms-field wpforms-field-text wpforms-one-fifth\" data-field-id=\"75\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_75\">Yrke<\/label><input type=\"text\" id=\"wpforms-42100-field_75\" class=\"wpforms-field-large\" name=\"wpforms[fields][75]\" aria-errormessage=\"wpforms-42100-field_75-error\" ><\/div><div id=\"wpforms-42100-field_76-container\" class=\"wpforms-field wpforms-field-text wpforms-one-fifth\" data-field-id=\"76\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_76\">H\u00f6jd<\/label><input type=\"text\" id=\"wpforms-42100-field_76\" class=\"wpforms-field-large\" name=\"wpforms[fields][76]\" aria-errormessage=\"wpforms-42100-field_76-error\" ><\/div><div id=\"wpforms-42100-field_77-container\" class=\"wpforms-field wpforms-field-text wpforms-one-fifth\" data-field-id=\"77\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_77\">Vikt<\/label><input type=\"text\" id=\"wpforms-42100-field_77\" class=\"wpforms-field-large\" name=\"wpforms[fields][77]\" aria-errormessage=\"wpforms-42100-field_77-error\" ><\/div><div id=\"wpforms-42100-field_78-container\" class=\"wpforms-field wpforms-field-text wpforms-one-fifth\" data-field-id=\"78\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_78\">BMI-index<\/label><input type=\"text\" id=\"wpforms-42100-field_78\" class=\"wpforms-field-large\" name=\"wpforms[fields][78]\" aria-errormessage=\"wpforms-42100-field_78-error\" ><\/div><div id=\"wpforms-42100-field_79-container\" class=\"wpforms-field wpforms-field-text wpforms-two-thirds\" data-field-id=\"79\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_79\">Land<\/label><input type=\"text\" id=\"wpforms-42100-field_79\" class=\"wpforms-field-large\" name=\"wpforms[fields][79]\" aria-errormessage=\"wpforms-42100-field_79-error\" ><\/div><div id=\"wpforms-42100-field_3-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-third\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_3\">Telefonnummer <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-42100-field_3\" class=\"wpforms-field-large wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][3]\" placeholder=\"Telefonnummer\" aria-label=\"Telefonnummer\" aria-errormessage=\"wpforms-42100-field_3-error\" required><\/div><div id=\"wpforms-42100-field_82-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"82\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_82\">Adress<\/label><input type=\"text\" id=\"wpforms-42100-field_82\" class=\"wpforms-field-large\" name=\"wpforms[fields][82]\" placeholder=\"Adress\/stad\/stat\" aria-errormessage=\"wpforms-42100-field_82-error\" ><\/div><div id=\"wpforms-42100-field_83-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"83\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_83\">R\u00f6kning: (Om ja, ange antal):<\/label><input type=\"text\" id=\"wpforms-42100-field_83\" class=\"wpforms-field-large\" name=\"wpforms[fields][83]\" aria-errormessage=\"wpforms-42100-field_83-error\" ><\/div><div id=\"wpforms-42100-field_84-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"84\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_84\">  Alkohol: (Om ja, ange m\u00e4ngd):<\/label><input type=\"text\" id=\"wpforms-42100-field_84\" class=\"wpforms-field-large\" name=\"wpforms[fields][84]\" aria-errormessage=\"wpforms-42100-field_84-error\" ><\/div><div id=\"wpforms-42100-field_85-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"85\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_85\">Andra \u00e4mnen: (Om ja, specificera):<\/label><input type=\"text\" id=\"wpforms-42100-field_85\" class=\"wpforms-field-large\" name=\"wpforms[fields][85]\" aria-errormessage=\"wpforms-42100-field_85-error\" ><\/div><div id=\"wpforms-42100-field_86-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"86\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_86\">  Datum f\u00f6r senaste menstruation:<\/label><input type=\"text\" id=\"wpforms-42100-field_86\" class=\"wpforms-field-large\" name=\"wpforms[fields][86]\" aria-errormessage=\"wpforms-42100-field_86-error\" ><\/div><div id=\"wpforms-42100-field_87-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"87\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_87\">Recept\/l\u00e4kemedel:<\/label><input type=\"text\" id=\"wpforms-42100-field_87\" class=\"wpforms-field-large\" name=\"wpforms[fields][87]\" aria-errormessage=\"wpforms-42100-field_87-error\" ><\/div><div id=\"wpforms-42100-field_88-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"88\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_88\">  Antal graviditeter:<\/label><input type=\"text\" id=\"wpforms-42100-field_88\" class=\"wpforms-field-large\" name=\"wpforms[fields][88]\" aria-errormessage=\"wpforms-42100-field_88-error\" ><\/div><div id=\"wpforms-42100-field_89-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"89\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_89\">Antal levande f\u00f6dda barn:<\/label><input type=\"text\" id=\"wpforms-42100-field_89\" class=\"wpforms-field-large\" name=\"wpforms[fields][89]\" aria-errormessage=\"wpforms-42100-field_89-error\" ><\/div><div id=\"wpforms-42100-field_90-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"90\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_90\">Senaste f\u00f6rlossning (datum):<\/label><input type=\"text\" id=\"wpforms-42100-field_90\" class=\"wpforms-field-large\" name=\"wpforms[fields][90]\" aria-errormessage=\"wpforms-42100-field_90-error\" ><\/div><div id=\"wpforms-42100-field_91-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"91\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_91\">Preventivmetod: (Ange vilken)<\/label><input type=\"text\" id=\"wpforms-42100-field_91\" class=\"wpforms-field-large\" name=\"wpforms[fields][91]\" aria-errormessage=\"wpforms-42100-field_91-error\" ><\/div><div id=\"wpforms-42100-field_92-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"92\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_92\">Om menopaus, datum f\u00f6r utbrott:<\/label><input type=\"text\" id=\"wpforms-42100-field_92\" class=\"wpforms-field-large\" name=\"wpforms[fields][92]\" aria-errormessage=\"wpforms-42100-field_92-error\" ><\/div><div id=\"wpforms-42100-field_94-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"94\"><fieldset><legend class=\"wpforms-field-label\">Anv\u00e4ndning av droger:<\/legend><ul id=\"wpforms-42100-field_94\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_94_1\" name=\"wpforms[fields][94]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_94_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_94_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_94_2\" name=\"wpforms[fields][94]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_94_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_94_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_95-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"95\"><fieldset><legend class=\"wpforms-field-label\">L\u00e4kemedelsallergier\/biverkningar av l\u00e4kemedel:<\/legend><ul id=\"wpforms-42100-field_95\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_95_1\" name=\"wpforms[fields][95]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_95_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_95_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_95_2\" name=\"wpforms[fields][95]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_95_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_95_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_96-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"96\"><fieldset><legend class=\"wpforms-field-label\">Reaktion p\u00e5 anestesi:<\/legend><ul id=\"wpforms-42100-field_96\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_96_1\" name=\"wpforms[fields][96]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_96_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_96_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_96_2\" name=\"wpforms[fields][96]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_96_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_96_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_97-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"97\"><fieldset><legend class=\"wpforms-field-label\">Blodtransfusion:<\/legend><ul id=\"wpforms-42100-field_97\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_97_1\" name=\"wpforms[fields][97]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_97_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_97_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_97_2\" name=\"wpforms[fields][97]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_97_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_97_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_98-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"98\"><fieldset><legend class=\"wpforms-field-label\">Sexuellt \u00f6verf\u00f6rbar sjukdom:<\/legend><ul id=\"wpforms-42100-field_98\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_98_1\" name=\"wpforms[fields][98]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_98_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_98_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_98_2\" name=\"wpforms[fields][98]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_98_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_98_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_99-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"99\"><fieldset><legend class=\"wpforms-field-label\">Hepatit:<\/legend><ul id=\"wpforms-42100-field_99\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_99_1\" name=\"wpforms[fields][99]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_99_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_99_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_99_2\" name=\"wpforms[fields][99]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_99_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_99_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_100-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"100\"><fieldset><legend class=\"wpforms-field-label\">HIV:<\/legend><ul id=\"wpforms-42100-field_100\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_100_1\" name=\"wpforms[fields][100]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_100_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_100_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_100_2\" name=\"wpforms[fields][100]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_100_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_100_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_101-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"101\"><fieldset><legend class=\"wpforms-field-label\">Amning:<\/legend><ul id=\"wpforms-42100-field_101\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_101_1\" name=\"wpforms[fields][101]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_101_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_101_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_101_2\" name=\"wpforms[fields][101]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_101_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_101_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_102-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"102\"><fieldset><legend class=\"wpforms-field-label\">\u00c4rftliga h\u00e4lsoproblem:<\/legend><ul id=\"wpforms-42100-field_102\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_102_1\" name=\"wpforms[fields][102]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_102_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_102_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_102_2\" name=\"wpforms[fields][102]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_102_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_102_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_103-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"103\"><fieldset><legend class=\"wpforms-field-label\">Diabetiker<\/legend><ul id=\"wpforms-42100-field_103\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_103_1\" name=\"wpforms[fields][103]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_103_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_103_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_103_2\" name=\"wpforms[fields][103]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_103_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_103_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_104-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"104\"><fieldset><legend class=\"wpforms-field-label\">Insulin:<\/legend><ul id=\"wpforms-42100-field_104\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_104_1\" name=\"wpforms[fields][104]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_104_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_104_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_104_2\" name=\"wpforms[fields][104]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_104_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_104_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_105-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"105\"><fieldset><legend class=\"wpforms-field-label\">Orala antidiabetiska l\u00e4kemedel:<\/legend><ul id=\"wpforms-42100-field_105\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_105_1\" name=\"wpforms[fields][105]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_105_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_105_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_105_2\" name=\"wpforms[fields][105]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_105_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_105_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_106-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"106\"><fieldset><legend class=\"wpforms-field-label\">Blodtryck:<\/legend><ul id=\"wpforms-42100-field_106\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_106_1\" name=\"wpforms[fields][106]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_106_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_106_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_106_2\" name=\"wpforms[fields][106]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_106_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_106_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_107-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"107\"><fieldset><legend class=\"wpforms-field-label\">Cancer:<\/legend><ul id=\"wpforms-42100-field_107\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_107_1\" name=\"wpforms[fields][107]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_107_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_107_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_107_2\" name=\"wpforms[fields][107]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_107_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_107_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_108-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"108\"><fieldset><legend class=\"wpforms-field-label\">Njursjukdom:<\/legend><ul id=\"wpforms-42100-field_108\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_108_1\" name=\"wpforms[fields][108]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_108_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_108_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_108_2\" name=\"wpforms[fields][108]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_108_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_108_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_109-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"109\"><fieldset><legend class=\"wpforms-field-label\">Epilepsi eller anfall:<\/legend><ul id=\"wpforms-42100-field_109\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_109_1\" name=\"wpforms[fields][109]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_109_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_109_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_109_2\" name=\"wpforms[fields][109]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_109_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_109_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_110-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"110\"><fieldset><legend class=\"wpforms-field-label\">Anemi:<\/legend><ul id=\"wpforms-42100-field_110\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_110_1\" name=\"wpforms[fields][110]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_110_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_110_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_110_2\" name=\"wpforms[fields][110]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_110_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_110_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_111-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"111\"><fieldset><legend class=\"wpforms-field-label\">Artrit:<\/legend><ul id=\"wpforms-42100-field_111\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_111_1\" name=\"wpforms[fields][111]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_111_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_111_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_111_2\" name=\"wpforms[fields][111]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_111_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_111_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_112-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"112\"><fieldset><legend class=\"wpforms-field-label\">Astma\/Emfysem:<\/legend><ul id=\"wpforms-42100-field_112\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_112_1\" name=\"wpforms[fields][112]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_112_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_112_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_112_2\" name=\"wpforms[fields][112]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_112_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_112_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_113-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"113\"><fieldset><legend class=\"wpforms-field-label\">Sv\u00e4ljningssv\u00e5righeter\/stroke:<\/legend><ul id=\"wpforms-42100-field_113\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_113_1\" name=\"wpforms[fields][113]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_113_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_113_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_113_2\" name=\"wpforms[fields][113]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_113_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_113_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_114-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"114\"><fieldset><legend class=\"wpforms-field-label\">Onormal vaginal bl\u00f6dning:<\/legend><ul id=\"wpforms-42100-field_114\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_114_1\" name=\"wpforms[fields][114]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_114_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_114_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_114_2\" name=\"wpforms[fields][114]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_114_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_114_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_115-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"115\"><fieldset><legend class=\"wpforms-field-label\">Svullna k\u00f6rtlar:<\/legend><ul id=\"wpforms-42100-field_115\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_115_1\" name=\"wpforms[fields][115]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_115_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_115_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_115_2\" name=\"wpforms[fields][115]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_115_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_115_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_116-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"116\"><fieldset><legend class=\"wpforms-field-label\">\u00c5ngest:<\/legend><ul id=\"wpforms-42100-field_116\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_116_1\" name=\"wpforms[fields][116]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_116_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_116_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_116_2\" name=\"wpforms[fields][116]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_116_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_116_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_117-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"117\"><fieldset><legend class=\"wpforms-field-label\">Reflux:<\/legend><ul id=\"wpforms-42100-field_117\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_117_1\" name=\"wpforms[fields][117]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_117_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_117_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_117_2\" name=\"wpforms[fields][117]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_117_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_117_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_118-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"118\"><fieldset><legend class=\"wpforms-field-label\">Br\u00f6stsm\u00e4rta:<\/legend><ul id=\"wpforms-42100-field_118\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_118_1\" name=\"wpforms[fields][118]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_118_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_118_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_118_2\" name=\"wpforms[fields][118]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_118_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_118_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_119-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"119\"><fieldset><legend class=\"wpforms-field-label\">Andf\u00e5ddhet:<\/legend><ul id=\"wpforms-42100-field_119\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_119_1\" name=\"wpforms[fields][119]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_119_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_119_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_119_2\" name=\"wpforms[fields][119]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_119_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_119_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_120-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"120\"><fieldset><legend class=\"wpforms-field-label\">S\u00f6mnsv\u00e5righeter\/Apn\u00e9:<\/legend><ul id=\"wpforms-42100-field_120\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_120_1\" name=\"wpforms[fields][120]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_120_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_120_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_120_2\" name=\"wpforms[fields][120]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_120_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_120_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_121-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"121\"><fieldset><legend class=\"wpforms-field-label\">Illam\u00e5ende:<\/legend><ul id=\"wpforms-42100-field_121\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_121_1\" name=\"wpforms[fields][121]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_121_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_121_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_121_2\" name=\"wpforms[fields][121]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_121_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_121_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_122-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"122\"><fieldset><legend class=\"wpforms-field-label\">Yrsel:<\/legend><ul id=\"wpforms-42100-field_122\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_122_1\" name=\"wpforms[fields][122]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_122_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_122_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_122_2\" name=\"wpforms[fields][122]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_122_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_122_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_123-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"123\"><fieldset><legend class=\"wpforms-field-label\">Bl\u00e5sljud (hj\u00e4rtsjukdom):<\/legend><ul id=\"wpforms-42100-field_123\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_123_1\" name=\"wpforms[fields][123]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_123_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_123_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_123_2\" name=\"wpforms[fields][123]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_123_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_123_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_124-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"124\"><fieldset><legend class=\"wpforms-field-label\">Hj\u00e4rtsvikt (hj\u00e4rtsjukdom):<\/legend><ul id=\"wpforms-42100-field_124\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_124_1\" name=\"wpforms[fields][124]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_124_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_124_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_124_2\" name=\"wpforms[fields][124]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_124_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_124_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_125-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"125\"><fieldset><legend class=\"wpforms-field-label\">Rytmrubbningar (hj\u00e4rtsjukdom):<\/legend><ul id=\"wpforms-42100-field_125\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_125_1\" name=\"wpforms[fields][125]\" value=\"Nej\" aria-errormessage=\"wpforms-42100-field_125_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_125_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_125_2\" name=\"wpforms[fields][125]\" value=\"Ja\" aria-errormessage=\"wpforms-42100-field_125_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_125_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_126-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"126\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_126\">Kirurgisk historia (ange alla kirurgiska ingrepp):<\/label><input type=\"text\" id=\"wpforms-42100-field_126\" class=\"wpforms-field-large\" name=\"wpforms[fields][126]\" aria-errormessage=\"wpforms-42100-field_126-error\" ><\/div><div id=\"wpforms-42100-field_127-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"127\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_127\">Datum f\u00f6r kirurgisk historia:<\/label><input type=\"text\" id=\"wpforms-42100-field_127\" class=\"wpforms-field-large\" name=\"wpforms[fields][127]\" aria-errormessage=\"wpforms-42100-field_127-error\" ><\/div><div id=\"wpforms-42100-field_128-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"128\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_128\">Meddelande<\/label><textarea id=\"wpforms-42100-field_128\" class=\"wpforms-field-large\" name=\"wpforms[fields][128]\" placeholder=\"Meddelande\" aria-errormessage=\"wpforms-42100-field_128-error\" ><\/textarea><\/div><div id=\"wpforms-42100-field_130-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-id=\"130\"><input type=\"hidden\" id=\"wpforms-42100-field_130\" name=\"wpforms[fields][130]\"><\/div><div id=\"wpforms-42100-field_129-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-id=\"129\"><input type=\"hidden\" id=\"wpforms-42100-field_129\" name=\"wpforms[fields][129]\" value=\"https:\/\/clinicmono.com\/sv\/wp-json\/wp\/v2\/pages\/37123 \"><\/div><div id=\"wpforms-42100-field_131-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-id=\"131\"><input type=\"hidden\" id=\"wpforms-42100-field_131\" name=\"wpforms[fields][131]\" value=\" 216.73.216.191 {entry_geolocation}\"><\/div><div id=\"wpforms-42100-field_34-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"34\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Godk\u00e4nnande <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-42100-field_34\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-42100-field_34_1\" name=\"wpforms[fields][34][]\" value=\"Genom att klicka p\u00e5 Skicka godk\u00e4nner du v\u00e5ra &lt;a href=&quot;https:\/\/clinicmono.com\/sv\/villkor\/&quot;&gt;\n  &lt;strong&gt;villkor och best\u00e4mmelser&lt;\/strong&gt;\n&lt;\/a&gt;\" aria-errormessage=\"wpforms-42100-field_34_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_34_1\">Genom att klicka p\u00e5 Skicka godk\u00e4nner du v\u00e5ra <a href=\"https:\/\/clinicmono.com\/sv\/villkor\/\">\n  <strong>villkor och best\u00e4mmelser<\/strong>\n<\/a><\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_133-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"133\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Acceptence (copy) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-42100-field_133\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-42100-field_133_1\" name=\"wpforms[fields][133][]\" value=\"I have read, understood and approved the general terms and conditions, &lt;a target=&quot;_blank&quot; href=&quot;https:\/\/clinicmono.com\/clarification-text-for-health-check-form\/&quot;&gt;the clarification text&lt;\/a&gt;, &lt;a target=&quot;_blank&quot; href=&quot;https:\/\/clinicmono.com\/explict-consent-form-for-health-check-form\/&quot;&gt;the explicit consent text&lt;\/a&gt;.\" aria-errormessage=\"wpforms-42100-field_133_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_133_1\">I have read, understood and approved the general terms and conditions, <a target=\"_blank\" href=\"https:\/\/clinicmono.com\/clarification-text-for-health-check-form\/\">the clarification text<\/a>, <a target=\"_blank\" href=\"https:\/\/clinicmono.com\/explict-consent-form-for-health-check-form\/\">the explicit consent text<\/a>.<\/label><\/li><\/ul><\/fieldset><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-field wpforms-field-hp\"><label for=\"wpforms-42100-field-hp\" class=\"wpforms-field-label\">Comment<\/label><input type=\"text\" name=\"wpforms[hp]\" id=\"wpforms-42100-field-hp\" class=\"wpforms-field-medium\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"42100\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/clinicmono.com\/sv\/wp-json\/wp\/v2\/pages\/37123\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-42100\" class=\"wpforms-submit\" data-alt-text=\"Skickar...\" data-submit-text=\"Skicka in\" aria-live=\"assertive\" value=\"wpforms-submit\">Skicka in<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/clinicmono.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Laddar\"><\/div><\/form><\/div>  <!-- .wpforms-container --><\/div><\/div><\/div><\/div><div class=\"g-cols wpb_row hide_on_default hide_on_laptops via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"wpforms-container wpforms-render-modern\" id=\"wpforms-42098\"><form id=\"wpforms-form-42098\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"42098\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/sv\/wp-json\/wp\/v2\/pages\/37123\" data-token=\"0798d1a537e4ae42e283cbb3eacdd8ea\" data-token-time=\"1775436127\"><noscript class=\"wpforms-error-noscript\">Aktivera JavaScript i din webbl\u00e4sare f\u00f6r att fylla i formul\u00e4ret.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Aktivera JavaScript i din webbl\u00e4sare f\u00f6r att fylla i formul\u00e4ret.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-42098-field_69-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"69\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_69\">Meriterande status   <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-42098-field_69\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][69]\" required=\"required\"><option value=\"Enkel\"  selected='selected' class=\"choice-1 depth-1\"  >Enkel<\/option><option value=\"Gift\"  class=\"choice-2 depth-1\"  >Gift<\/option><option value=\"Skild\"  class=\"choice-3 depth-1\"  >Skild<\/option><option value=\"\u00c4nka\"  class=\"choice-4 depth-1\"  >\u00c4nka<\/option><\/select><\/div><div id=\"wpforms-42098-field_1-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_1\">Namn <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-42098-field_1\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][1]\" placeholder=\"Namn\" aria-errormessage=\"wpforms-42098-field_1-error\" required><\/div><div id=\"wpforms-42098-field_70-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"70\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_70\">Efternamn <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-42098-field_70\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][70]\" placeholder=\"Efternamn\" aria-errormessage=\"wpforms-42098-field_70-error\" required><\/div><div id=\"wpforms-42098-field_4-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_4\">E-post <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-42098-field_4\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][4]\" placeholder=\"E-post\" spellcheck=\"false\" aria-errormessage=\"wpforms-42098-field_4-error\" required><\/div><div id=\"wpforms-42098-field_132-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"132\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_132\">F\u00f6delsedag<\/label><input type=\"text\" id=\"wpforms-42098-field_132\" class=\"wpforms-field-large\" name=\"wpforms[fields][132]\" aria-errormessage=\"wpforms-42098-field_132-error\" ><\/div><div id=\"wpforms-42098-field_75-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"75\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_75\">Yrke<\/label><input type=\"text\" id=\"wpforms-42098-field_75\" class=\"wpforms-field-large\" name=\"wpforms[fields][75]\" aria-errormessage=\"wpforms-42098-field_75-error\" ><\/div><div id=\"wpforms-42098-field_76-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"76\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_76\">H\u00f6jd<\/label><input type=\"text\" id=\"wpforms-42098-field_76\" class=\"wpforms-field-large\" name=\"wpforms[fields][76]\" aria-errormessage=\"wpforms-42098-field_76-error\" ><\/div><div id=\"wpforms-42098-field_77-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"77\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_77\">Vikt<\/label><input type=\"text\" id=\"wpforms-42098-field_77\" class=\"wpforms-field-large\" name=\"wpforms[fields][77]\" aria-errormessage=\"wpforms-42098-field_77-error\" ><\/div><div id=\"wpforms-42098-field_78-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"78\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_78\">BMI-index<\/label><input type=\"text\" id=\"wpforms-42098-field_78\" class=\"wpforms-field-large\" name=\"wpforms[fields][78]\" aria-errormessage=\"wpforms-42098-field_78-error\" ><\/div><div id=\"wpforms-42098-field_79-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"79\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_79\">Land<\/label><input type=\"text\" id=\"wpforms-42098-field_79\" class=\"wpforms-field-large\" name=\"wpforms[fields][79]\" aria-errormessage=\"wpforms-42098-field_79-error\" ><\/div><div id=\"wpforms-42098-field_3-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_3\">Telefonnummer <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-42098-field_3\" class=\"wpforms-field-large wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][3]\" placeholder=\"Telefonnummer\" aria-label=\"Telefonnummer\" aria-errormessage=\"wpforms-42098-field_3-error\" required><\/div><div id=\"wpforms-42098-field_82-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"82\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_82\">Adress<\/label><input type=\"text\" id=\"wpforms-42098-field_82\" class=\"wpforms-field-large\" name=\"wpforms[fields][82]\" placeholder=\"Adress\/stad\/stat\" aria-errormessage=\"wpforms-42098-field_82-error\" ><\/div><div id=\"wpforms-42098-field_83-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"83\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_83\">R\u00f6kning: (Om ja, ange antal):<\/label><input type=\"text\" id=\"wpforms-42098-field_83\" class=\"wpforms-field-large\" name=\"wpforms[fields][83]\" aria-errormessage=\"wpforms-42098-field_83-error\" ><\/div><div id=\"wpforms-42098-field_84-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"84\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_84\">  Alkohol: (Om ja, ange m\u00e4ngd):<\/label><input type=\"text\" id=\"wpforms-42098-field_84\" class=\"wpforms-field-large\" name=\"wpforms[fields][84]\" aria-errormessage=\"wpforms-42098-field_84-error\" ><\/div><div id=\"wpforms-42098-field_85-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"85\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_85\">Andra \u00e4mnen: (Om ja, specificera):<\/label><input type=\"text\" id=\"wpforms-42098-field_85\" class=\"wpforms-field-large\" name=\"wpforms[fields][85]\" aria-errormessage=\"wpforms-42098-field_85-error\" ><\/div><div id=\"wpforms-42098-field_86-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"86\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_86\">  Datum f\u00f6r senaste menstruation:<\/label><input type=\"text\" id=\"wpforms-42098-field_86\" class=\"wpforms-field-large\" name=\"wpforms[fields][86]\" aria-errormessage=\"wpforms-42098-field_86-error\" ><\/div><div id=\"wpforms-42098-field_87-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"87\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_87\">Recept\/l\u00e4kemedel:<\/label><input type=\"text\" id=\"wpforms-42098-field_87\" class=\"wpforms-field-large\" name=\"wpforms[fields][87]\" aria-errormessage=\"wpforms-42098-field_87-error\" ><\/div><div id=\"wpforms-42098-field_88-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"88\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_88\">  Antal graviditeter:<\/label><input type=\"text\" id=\"wpforms-42098-field_88\" class=\"wpforms-field-large\" name=\"wpforms[fields][88]\" aria-errormessage=\"wpforms-42098-field_88-error\" ><\/div><div id=\"wpforms-42098-field_89-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"89\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_89\">Antal levande f\u00f6dda barn:<\/label><input type=\"text\" id=\"wpforms-42098-field_89\" class=\"wpforms-field-large\" name=\"wpforms[fields][89]\" aria-errormessage=\"wpforms-42098-field_89-error\" ><\/div><div id=\"wpforms-42098-field_90-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"90\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_90\">Senaste f\u00f6rlossning (datum):<\/label><input type=\"text\" id=\"wpforms-42098-field_90\" class=\"wpforms-field-large\" name=\"wpforms[fields][90]\" aria-errormessage=\"wpforms-42098-field_90-error\" ><\/div><div id=\"wpforms-42098-field_91-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"91\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_91\">Preventivmetod: (Ange vilken)<\/label><input type=\"text\" id=\"wpforms-42098-field_91\" class=\"wpforms-field-large\" name=\"wpforms[fields][91]\" aria-errormessage=\"wpforms-42098-field_91-error\" ><\/div><div id=\"wpforms-42098-field_92-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"92\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_92\">Om menopaus, datum f\u00f6r utbrott:<\/label><input type=\"text\" id=\"wpforms-42098-field_92\" class=\"wpforms-field-large\" name=\"wpforms[fields][92]\" aria-errormessage=\"wpforms-42098-field_92-error\" ><\/div><div id=\"wpforms-42098-field_94-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"94\"><fieldset><legend class=\"wpforms-field-label\">Anv\u00e4ndning av droger:<\/legend><ul id=\"wpforms-42098-field_94\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_94_1\" name=\"wpforms[fields][94]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_94_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_94_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_94_2\" name=\"wpforms[fields][94]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_94_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_94_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_95-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"95\"><fieldset><legend class=\"wpforms-field-label\">L\u00e4kemedelsallergier\/biverkningar av l\u00e4kemedel:<\/legend><ul id=\"wpforms-42098-field_95\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_95_1\" name=\"wpforms[fields][95]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_95_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_95_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_95_2\" name=\"wpforms[fields][95]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_95_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_95_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_96-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"96\"><fieldset><legend class=\"wpforms-field-label\">Reaktion p\u00e5 anestesi:<\/legend><ul id=\"wpforms-42098-field_96\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_96_1\" name=\"wpforms[fields][96]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_96_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_96_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_96_2\" name=\"wpforms[fields][96]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_96_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_96_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_97-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"97\"><fieldset><legend class=\"wpforms-field-label\">Blodtransfusion:<\/legend><ul id=\"wpforms-42098-field_97\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_97_1\" name=\"wpforms[fields][97]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_97_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_97_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_97_2\" name=\"wpforms[fields][97]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_97_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_97_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_98-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"98\"><fieldset><legend class=\"wpforms-field-label\">Sexuellt \u00f6verf\u00f6rbar sjukdom:<\/legend><ul id=\"wpforms-42098-field_98\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_98_1\" name=\"wpforms[fields][98]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_98_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_98_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_98_2\" name=\"wpforms[fields][98]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_98_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_98_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_99-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"99\"><fieldset><legend class=\"wpforms-field-label\">Hepatit:<\/legend><ul id=\"wpforms-42098-field_99\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_99_1\" name=\"wpforms[fields][99]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_99_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_99_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_99_2\" name=\"wpforms[fields][99]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_99_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_99_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_100-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"100\"><fieldset><legend class=\"wpforms-field-label\">HIV:<\/legend><ul id=\"wpforms-42098-field_100\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_100_1\" name=\"wpforms[fields][100]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_100_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_100_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_100_2\" name=\"wpforms[fields][100]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_100_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_100_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_101-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"101\"><fieldset><legend class=\"wpforms-field-label\">Amning:<\/legend><ul id=\"wpforms-42098-field_101\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_101_1\" name=\"wpforms[fields][101]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_101_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_101_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_101_2\" name=\"wpforms[fields][101]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_101_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_101_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_102-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"102\"><fieldset><legend class=\"wpforms-field-label\">\u00c4rftliga h\u00e4lsoproblem:<\/legend><ul id=\"wpforms-42098-field_102\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_102_1\" name=\"wpforms[fields][102]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_102_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_102_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_102_2\" name=\"wpforms[fields][102]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_102_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_102_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_103-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"103\"><fieldset><legend class=\"wpforms-field-label\">Diabetiker<\/legend><ul id=\"wpforms-42098-field_103\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_103_1\" name=\"wpforms[fields][103]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_103_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_103_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_103_2\" name=\"wpforms[fields][103]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_103_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_103_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_104-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"104\"><fieldset><legend class=\"wpforms-field-label\">Insulin:<\/legend><ul id=\"wpforms-42098-field_104\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_104_1\" name=\"wpforms[fields][104]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_104_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_104_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_104_2\" name=\"wpforms[fields][104]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_104_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_104_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_105-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"105\"><fieldset><legend class=\"wpforms-field-label\">Orala antidiabetiska l\u00e4kemedel:<\/legend><ul id=\"wpforms-42098-field_105\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_105_1\" name=\"wpforms[fields][105]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_105_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_105_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_105_2\" name=\"wpforms[fields][105]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_105_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_105_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_106-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"106\"><fieldset><legend class=\"wpforms-field-label\">Blodtryck:<\/legend><ul id=\"wpforms-42098-field_106\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_106_1\" name=\"wpforms[fields][106]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_106_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_106_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_106_2\" name=\"wpforms[fields][106]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_106_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_106_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_107-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"107\"><fieldset><legend class=\"wpforms-field-label\">Cancer:<\/legend><ul id=\"wpforms-42098-field_107\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_107_1\" name=\"wpforms[fields][107]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_107_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_107_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_107_2\" name=\"wpforms[fields][107]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_107_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_107_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_108-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"108\"><fieldset><legend class=\"wpforms-field-label\">Njursjukdom:<\/legend><ul id=\"wpforms-42098-field_108\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_108_1\" name=\"wpforms[fields][108]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_108_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_108_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_108_2\" name=\"wpforms[fields][108]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_108_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_108_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_109-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"109\"><fieldset><legend class=\"wpforms-field-label\">Epilepsi eller anfall:<\/legend><ul id=\"wpforms-42098-field_109\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_109_1\" name=\"wpforms[fields][109]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_109_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_109_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_109_2\" name=\"wpforms[fields][109]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_109_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_109_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_110-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"110\"><fieldset><legend class=\"wpforms-field-label\">Anemi:<\/legend><ul id=\"wpforms-42098-field_110\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_110_1\" name=\"wpforms[fields][110]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_110_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_110_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_110_2\" name=\"wpforms[fields][110]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_110_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_110_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_111-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"111\"><fieldset><legend class=\"wpforms-field-label\">Artrit:<\/legend><ul id=\"wpforms-42098-field_111\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_111_1\" name=\"wpforms[fields][111]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_111_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_111_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_111_2\" name=\"wpforms[fields][111]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_111_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_111_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_112-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"112\"><fieldset><legend class=\"wpforms-field-label\">Astma\/Emfysem:<\/legend><ul id=\"wpforms-42098-field_112\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_112_1\" name=\"wpforms[fields][112]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_112_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_112_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_112_2\" name=\"wpforms[fields][112]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_112_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_112_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_113-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"113\"><fieldset><legend class=\"wpforms-field-label\">Sv\u00e4ljningssv\u00e5righeter\/stroke:<\/legend><ul id=\"wpforms-42098-field_113\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_113_1\" name=\"wpforms[fields][113]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_113_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_113_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_113_2\" name=\"wpforms[fields][113]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_113_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_113_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_114-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"114\"><fieldset><legend class=\"wpforms-field-label\">Onormal vaginal bl\u00f6dning:<\/legend><ul id=\"wpforms-42098-field_114\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_114_1\" name=\"wpforms[fields][114]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_114_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_114_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_114_2\" name=\"wpforms[fields][114]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_114_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_114_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_115-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"115\"><fieldset><legend class=\"wpforms-field-label\">Svullna k\u00f6rtlar:<\/legend><ul id=\"wpforms-42098-field_115\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_115_1\" name=\"wpforms[fields][115]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_115_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_115_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_115_2\" name=\"wpforms[fields][115]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_115_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_115_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_116-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"116\"><fieldset><legend class=\"wpforms-field-label\">\u00c5ngest:<\/legend><ul id=\"wpforms-42098-field_116\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_116_1\" name=\"wpforms[fields][116]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_116_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_116_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_116_2\" name=\"wpforms[fields][116]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_116_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_116_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_117-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"117\"><fieldset><legend class=\"wpforms-field-label\">Reflux:<\/legend><ul id=\"wpforms-42098-field_117\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_117_1\" name=\"wpforms[fields][117]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_117_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_117_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_117_2\" name=\"wpforms[fields][117]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_117_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_117_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_118-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"118\"><fieldset><legend class=\"wpforms-field-label\">Br\u00f6stsm\u00e4rta:<\/legend><ul id=\"wpforms-42098-field_118\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_118_1\" name=\"wpforms[fields][118]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_118_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_118_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_118_2\" name=\"wpforms[fields][118]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_118_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_118_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_119-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"119\"><fieldset><legend class=\"wpforms-field-label\">Andf\u00e5ddhet:<\/legend><ul id=\"wpforms-42098-field_119\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_119_1\" name=\"wpforms[fields][119]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_119_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_119_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_119_2\" name=\"wpforms[fields][119]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_119_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_119_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_120-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"120\"><fieldset><legend class=\"wpforms-field-label\">S\u00f6mnsv\u00e5righeter\/Apn\u00e9:<\/legend><ul id=\"wpforms-42098-field_120\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_120_1\" name=\"wpforms[fields][120]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_120_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_120_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_120_2\" name=\"wpforms[fields][120]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_120_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_120_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_121-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"121\"><fieldset><legend class=\"wpforms-field-label\">Illam\u00e5ende:<\/legend><ul id=\"wpforms-42098-field_121\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_121_1\" name=\"wpforms[fields][121]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_121_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_121_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_121_2\" name=\"wpforms[fields][121]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_121_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_121_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_122-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"122\"><fieldset><legend class=\"wpforms-field-label\">Yrsel:<\/legend><ul id=\"wpforms-42098-field_122\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_122_1\" name=\"wpforms[fields][122]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_122_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_122_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_122_2\" name=\"wpforms[fields][122]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_122_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_122_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_123-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"123\"><fieldset><legend class=\"wpforms-field-label\">Bl\u00e5sljud (hj\u00e4rtsjukdom):<\/legend><ul id=\"wpforms-42098-field_123\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_123_1\" name=\"wpforms[fields][123]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_123_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_123_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_123_2\" name=\"wpforms[fields][123]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_123_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_123_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_124-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"124\"><fieldset><legend class=\"wpforms-field-label\">Hj\u00e4rtsvikt (hj\u00e4rtsjukdom):<\/legend><ul id=\"wpforms-42098-field_124\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_124_1\" name=\"wpforms[fields][124]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_124_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_124_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_124_2\" name=\"wpforms[fields][124]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_124_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_124_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_125-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"125\"><fieldset><legend class=\"wpforms-field-label\">Rytmrubbningar (hj\u00e4rtsjukdom):<\/legend><ul id=\"wpforms-42098-field_125\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_125_1\" name=\"wpforms[fields][125]\" value=\"Nej\" aria-errormessage=\"wpforms-42098-field_125_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_125_1\">Nej<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_125_2\" name=\"wpforms[fields][125]\" value=\"Ja\" aria-errormessage=\"wpforms-42098-field_125_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_125_2\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_126-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"126\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_126\">Kirurgisk historia (ange alla kirurgiska ingrepp):<\/label><input type=\"text\" id=\"wpforms-42098-field_126\" class=\"wpforms-field-large\" name=\"wpforms[fields][126]\" aria-errormessage=\"wpforms-42098-field_126-error\" ><\/div><div id=\"wpforms-42098-field_127-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"127\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_127\">Datum f\u00f6r kirurgisk historia:<\/label><input type=\"text\" id=\"wpforms-42098-field_127\" class=\"wpforms-field-large\" name=\"wpforms[fields][127]\" aria-errormessage=\"wpforms-42098-field_127-error\" ><\/div><div id=\"wpforms-42098-field_128-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"128\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_128\">Meddelande<\/label><textarea id=\"wpforms-42098-field_128\" class=\"wpforms-field-large\" name=\"wpforms[fields][128]\" placeholder=\"Meddelande\" aria-errormessage=\"wpforms-42098-field_128-error\" ><\/textarea><\/div><div id=\"wpforms-42098-field_129-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-id=\"129\"><input type=\"hidden\" id=\"wpforms-42098-field_129\" 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class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-42098-field_133_1\" name=\"wpforms[fields][133][]\" value=\"I have read, understood and approved the general terms and conditions, &lt;a target=&quot;_blank&quot; href=&quot;https:\/\/clinicmono.com\/clarification-text-for-health-check-form\/&quot;&gt;the clarification text&lt;\/a&gt;, &lt;a target=&quot;_blank&quot; href=&quot;https:\/\/clinicmono.com\/explict-consent-form-for-health-check-form\/&quot;&gt;the explicit consent text&lt;\/a&gt;.\" aria-errormessage=\"wpforms-42098-field_133_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_133_1\">I have read, understood and approved the general terms and conditions, <a target=\"_blank\" href=\"https:\/\/clinicmono.com\/clarification-text-for-health-check-form\/\">the clarification text<\/a>, <a target=\"_blank\" href=\"https:\/\/clinicmono.com\/explict-consent-form-for-health-check-form\/\">the explicit consent 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width=\"26\" height=\"26\" alt=\"Laddar\"><\/div><\/form><\/div>  <!-- .wpforms-container --><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/section>\n","protected":false},"excerpt":{"rendered":"Formul\u00e4r f\u00f6r h\u00e4lsokontroll Klinik MonoSidorAktivera JavaScript i din webbl\u00e4sare f\u00f6r att fylla i formul\u00e4ret.Aktivera JavaScript i din webbl\u00e4sare f\u00f6r att fylla i formul\u00e4ret.Meriterande status *EnkelGiftSkild\u00c4nkaNamn *Efternamn *E-post *F\u00f6delsedagYrkeH\u00f6jdViktBMI-indexLandTelefonnummer *AdressR\u00f6kning: (Om ja, ange antal): Alkohol: (Om ja, ange m\u00e4ngd):Andra \u00e4mnen: (Om ja, specificera): Datum f\u00f6r senaste menstruation:Recept\/l\u00e4kemedel: Antal graviditeter:Antal levande f\u00f6dda barn:Senaste f\u00f6rlossning (datum):Preventivmetod: (Ange vilken)Om...","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"rank_math_lock_modified_date":false,"_mi_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"procedure":[],"class_list":["post-37123","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/clinicmono.com\/sv\/wp-json\/wp\/v2\/pages\/37123"}],"collection":[{"href":"https:\/\/clinicmono.com\/sv\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/clinicmono.com\/sv\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/clinicmono.com\/sv\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/clinicmono.com\/sv\/wp-json\/wp\/v2\/comments?post=37123"}],"version-history":[{"count":46,"href":"https:\/\/clinicmono.com\/sv\/wp-json\/wp\/v2\/pages\/37123\/revisions"}],"predecessor-version":[{"id":119784,"href":"https:\/\/clinicmono.com\/sv\/wp-json\/wp\/v2\/pages\/37123\/revisions\/119784"}],"wp:attachment":[{"href":"https:\/\/clinicmono.com\/sv\/wp-json\/wp\/v2\/media?parent=37123"}],"wp:term":[{"taxonomy":"procedure","embeddable":true,"href":"https:\/\/clinicmono.com\/sv\/wp-json\/wp\/v2\/procedure?post=37123"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}