{"id":11241,"date":"2022-11-30T14:23:42","date_gmt":"2022-11-30T19:23:42","guid":{"rendered":"https:\/\/starmed.care\/dossier-du-patient\/"},"modified":"2023-01-25T10:17:50","modified_gmt":"2023-01-25T15:17:50","slug":"dossier-du-patient","status":"publish","type":"page","link":"https:\/\/starmed.care\/fr\/dossier-du-patient\/","title":{"rendered":"Dossier du patient"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"11241\" class=\"elementor elementor-11241\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-37c8744 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"37c8744\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-ef570ed\" data-id=\"ef570ed\" data-element_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-e2a19a7 elementor-widget elementor-widget-heading\" data-id=\"e2a19a7\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">DOSSIER DU PATIENT<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-3368c4e elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"3368c4e\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-f3ce840\" data-id=\"f3ce840\" data-element_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-3df4dbf elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"3df4dbf\" data-element_type=\"widget\" data-settings=\"{&quot;button_width&quot;:&quot;25&quot;,&quot;step_next_label&quot;:&quot;Suivant&quot;,&quot;step_previous_label&quot;:&quot;Pr\\u00e9c\\u00e9dent&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Formulaire pour les patients\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"11241\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"3df4dbf\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"StarMed Healthcare\" \/>\n\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_6a84962 elementor-col-25 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6a84962\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate du service\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_6a84962]\" id=\"form-field-field_6a84962\" class=\"elementor-field elementor-size-xs  elementor-field-textual\" placeholder=\"MM\/DD\/YY\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_002584a elementor-col-25 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_002584a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNom de famille\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_002584a]\" id=\"form-field-field_002584a\" class=\"elementor-field elementor-size-xs  elementor-field-textual\" placeholder=\"dernier\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_349896b elementor-col-25 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_349896b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPr\u00e9nom\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_349896b]\" id=\"form-field-field_349896b\" class=\"elementor-field elementor-size-xs  elementor-field-textual\" placeholder=\"premi\u00e8rement\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_0cf4d4a elementor-col-25 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0cf4d4a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDATE DE NAISSANCE\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_0cf4d4a]\" id=\"form-field-field_0cf4d4a\" class=\"elementor-field elementor-size-xs  elementor-field-textual\" placeholder=\"MM\/DD\/YY\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_f0ad6eb elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f0ad6eb\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPlainte du chef\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Exposition possible \u00e0 un nouveau coronavirus (COVID-19)\" id=\"form-field-field_f0ad6eb-0\" name=\"form_fields[field_f0ad6eb]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_f0ad6eb-0\">Exposition possible \u00e0 un nouveau coronavirus (COVID-19)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Exposition confirm\u00e9e au nouveau coronavirus (COVID-19)\" id=\"form-field-field_f0ad6eb-1\" name=\"form_fields[field_f0ad6eb]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_f0ad6eb-1\">Exposition confirm\u00e9e au nouveau coronavirus (COVID-19)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Diagnostic confirm\u00e9 d&#039;une infection par le COVID-19\" id=\"form-field-field_f0ad6eb-2\" name=\"form_fields[field_f0ad6eb]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_f0ad6eb-2\">Diagnostic confirm\u00e9 d'une infection par le COVID-19<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Autre\" id=\"form-field-field_f0ad6eb-3\" name=\"form_fields[field_f0ad6eb]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_f0ad6eb-3\">Autre<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_2e736d0 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2e736d0\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSi Autre ci-dessus, d\u00e9tails ici :\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-xs\" name=\"form_fields[field_2e736d0]\" id=\"form-field-field_2e736d0\" rows=\"4\" placeholder=\"r\u00e9ponse\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_8ea99f1 elementor-col-100\">\n\t\t\t\t\t<br><hr><br>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_3036c01 elementor-col-100\">\n\t\t\t\t\t<big><b>HISTOIRE DE LA MALADIE ACTUELLE \/ REVUE DES SYST\u00c8MES<\/b><\/big>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_44b5712 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_44b5712\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEst-il possible que vous ayez \u00e9t\u00e9 expos\u00e9 au COVID-19 ?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"OUI\" id=\"form-field-field_44b5712-0\" name=\"form_fields[field_44b5712]\"> <label for=\"form-field-field_44b5712-0\">OUI<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON\" id=\"form-field-field_44b5712-1\" name=\"form_fields[field_44b5712]\"> <label for=\"form-field-field_44b5712-1\">NON<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_28f09ed elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_28f09ed\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSi possible, veuillez donner le contexte : quand, o\u00f9, etc... ?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-xs\" name=\"form_fields[field_28f09ed]\" id=\"form-field-field_28f09ed\" rows=\"4\" placeholder=\"d\u00e9tails ici\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_1dc8502 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1dc8502\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAvez-vous \u00e9t\u00e9 test\u00e9 auparavant ?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"OUI\" id=\"form-field-field_1dc8502-0\" name=\"form_fields[field_1dc8502]\"> <label for=\"form-field-field_1dc8502-0\">OUI<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON\" id=\"form-field-field_1dc8502-1\" name=\"form_fields[field_1dc8502]\"> <label for=\"form-field-field_1dc8502-1\">NON<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_a2e7a4e elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a2e7a4e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSi vous avez r\u00e9pondu OUI \u00e0 la question ci-dessus, indiquez la date du dernier test, les r\u00e9sultats et tout autre d\u00e9tail pertinent :\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-xs\" name=\"form_fields[field_a2e7a4e]\" id=\"form-field-field_a2e7a4e\" rows=\"4\" placeholder=\"d\u00e9tails ici\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_593242d elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_593242d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPortez-vous un masque et estimez-vous que cela contribue \u00e0 limiter la propagation communautaire des infections au COVID-19 ?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Il porte un masque, il pense que \u00e7a l&#039;aide.\" id=\"form-field-field_593242d-0\" name=\"form_fields[field_593242d]\"> <label for=\"form-field-field_593242d-0\">Il porte un masque, il pense que \u00e7a l'aide.<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Porte un masque, mais n&#039;a pas l&#039;impression que cela l&#039;aide.\" id=\"form-field-field_593242d-1\" name=\"form_fields[field_593242d]\"> <label for=\"form-field-field_593242d-1\">Porte un masque, mais n'a pas l'impression que cela l'aide.<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Ne porte pas de masque mais pense que le port de masques aide.\" id=\"form-field-field_593242d-2\" name=\"form_fields[field_593242d]\"> <label for=\"form-field-field_593242d-2\">Ne porte pas de masque mais pense que le port de masques aide.<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Ne porte pas de masque, ne pense pas que cela l&#039;aide.\" id=\"form-field-field_593242d-3\" name=\"form_fields[field_593242d]\"> <label for=\"form-field-field_593242d-3\">Ne porte pas de masque, ne pense pas que cela l'aide.<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_1a2a76b elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1a2a76b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAvez-vous voyag\u00e9 r\u00e9cemment ?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"OUI\" id=\"form-field-field_1a2a76b-0\" name=\"form_fields[field_1a2a76b]\"> <label for=\"form-field-field_1a2a76b-0\">OUI<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON\" id=\"form-field-field_1a2a76b-1\" name=\"form_fields[field_1a2a76b]\"> <label for=\"form-field-field_1a2a76b-1\">NON<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_b4ebca3 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b4ebca3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSi vous r\u00e9pondez OUI \u00e0 la question ci-dessus :\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-xs\" name=\"form_fields[field_b4ebca3]\" id=\"form-field-field_b4ebca3\" rows=\"4\" placeholder=\"d\u00e9tails ici\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_e9b291d elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e9b291d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAvez-vous d\u00fb mettre en quarantaine ou avez-vous \u00e9t\u00e9 mis en quarantaine ?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"OUI\" id=\"form-field-field_e9b291d-0\" name=\"form_fields[field_e9b291d]\"> <label for=\"form-field-field_e9b291d-0\">OUI<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON\" id=\"form-field-field_e9b291d-1\" name=\"form_fields[field_e9b291d]\"> <label for=\"form-field-field_e9b291d-1\">NON<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_05a29be elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_05a29be\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDes sympt\u00f4mes ?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"OUI\" id=\"form-field-field_05a29be-0\" name=\"form_fields[field_05a29be]\"> <label for=\"form-field-field_05a29be-0\">OUI<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON\" id=\"form-field-field_05a29be-1\" name=\"form_fields[field_05a29be]\"> <label for=\"form-field-field_05a29be-1\">NON<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_3ba78bb elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3ba78bb\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSi vous avez r\u00e9pondu NON \u00e0 la question ci-dessus, comment vous sentez-vous aujourd'hui ?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-xs\" name=\"form_fields[field_3ba78bb]\" id=\"form-field-field_3ba78bb\" rows=\"4\" placeholder=\"d\u00e9tails ici\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_2bd4e1c elementor-col-100\">\n\t\t\t\t\t<br><hr><br>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_453febc elementor-col-100\">\n\t\t\t\t\t<big><b>SYMPT\u00d4MES : COCHEZ UNE CASE POUR CHAQUE SYMPT\u00d4ME POSSIBLE CI-DESSOUS<\/b><\/big>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_df4d0f1 elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_df4d0f1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFi\u00e8vre\/frissons\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_df4d0f1-0\" name=\"form_fields[field_df4d0f1]\"> <label for=\"form-field-field_df4d0f1-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_df4d0f1-1\" name=\"form_fields[field_df4d0f1]\"> <label for=\"form-field-field_df4d0f1-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_df4d0f1-2\" name=\"form_fields[field_df4d0f1]\"> <label for=\"form-field-field_df4d0f1-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_3f1e6a2 elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3f1e6a2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFatigue\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_3f1e6a2-0\" name=\"form_fields[field_3f1e6a2]\"> <label for=\"form-field-field_3f1e6a2-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_3f1e6a2-1\" name=\"form_fields[field_3f1e6a2]\"> <label for=\"form-field-field_3f1e6a2-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_3f1e6a2-2\" name=\"form_fields[field_3f1e6a2]\"> <label for=\"form-field-field_3f1e6a2-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_c493e24 elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c493e24\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tToux\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_c493e24-0\" name=\"form_fields[field_c493e24]\"> <label for=\"form-field-field_c493e24-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_c493e24-1\" name=\"form_fields[field_c493e24]\"> <label for=\"form-field-field_c493e24-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_c493e24-2\" name=\"form_fields[field_c493e24]\"> <label for=\"form-field-field_c493e24-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_6b59c52 elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6b59c52\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEssoufflement\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_6b59c52-0\" name=\"form_fields[field_6b59c52]\"> <label for=\"form-field-field_6b59c52-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_6b59c52-1\" name=\"form_fields[field_6b59c52]\"> <label for=\"form-field-field_6b59c52-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_6b59c52-2\" name=\"form_fields[field_6b59c52]\"> <label for=\"form-field-field_6b59c52-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_be922a2 elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_be922a2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNez congestionn\u00e9\/rassurant\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_be922a2-0\" name=\"form_fields[field_be922a2]\"> <label for=\"form-field-field_be922a2-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_be922a2-1\" name=\"form_fields[field_be922a2]\"> <label for=\"form-field-field_be922a2-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_be922a2-2\" name=\"form_fields[field_be922a2]\"> <label for=\"form-field-field_be922a2-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_80268cb elementor-col-100\">\n\t\t\t\t\t<hr>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_b936d8d elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b936d8d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMal de gorge\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_b936d8d-0\" name=\"form_fields[field_b936d8d]\"> <label for=\"form-field-field_b936d8d-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_b936d8d-1\" name=\"form_fields[field_b936d8d]\"> <label for=\"form-field-field_b936d8d-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_b936d8d-2\" name=\"form_fields[field_b936d8d]\"> <label for=\"form-field-field_b936d8d-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_349a2c6 elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_349a2c6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMaux de t\u00eate\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_349a2c6-0\" name=\"form_fields[field_349a2c6]\"> <label for=\"form-field-field_349a2c6-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_349a2c6-1\" name=\"form_fields[field_349a2c6]\"> <label for=\"form-field-field_349a2c6-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_349a2c6-2\" name=\"form_fields[field_349a2c6]\"> <label for=\"form-field-field_349a2c6-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_de636ea elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_de636ea\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMaux du corps\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_de636ea-0\" name=\"form_fields[field_de636ea]\"> <label for=\"form-field-field_de636ea-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_de636ea-1\" name=\"form_fields[field_de636ea]\"> <label for=\"form-field-field_de636ea-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_de636ea-2\" name=\"form_fields[field_de636ea]\"> <label for=\"form-field-field_de636ea-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_48e1394 elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_48e1394\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNaus\u00e9es\/vomissements\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_48e1394-0\" name=\"form_fields[field_48e1394]\"> <label for=\"form-field-field_48e1394-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_48e1394-1\" name=\"form_fields[field_48e1394]\"> <label for=\"form-field-field_48e1394-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_48e1394-2\" name=\"form_fields[field_48e1394]\"> <label for=\"form-field-field_48e1394-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_53077d5 elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_53077d5\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDiarrh\u00e9e\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_53077d5-0\" name=\"form_fields[field_53077d5]\"> <label for=\"form-field-field_53077d5-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_53077d5-1\" name=\"form_fields[field_53077d5]\"> <label for=\"form-field-field_53077d5-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_53077d5-2\" name=\"form_fields[field_53077d5]\"> <label for=\"form-field-field_53077d5-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_98e4798 elementor-col-100\">\n\t\t\t\t\t<hr>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_e83c8b3 elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e83c8b3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPerte du go\u00fbt\/de l'odeur\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_e83c8b3-0\" name=\"form_fields[field_e83c8b3]\"> <label for=\"form-field-field_e83c8b3-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_e83c8b3-1\" name=\"form_fields[field_e83c8b3]\"> <label for=\"form-field-field_e83c8b3-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_e83c8b3-2\" name=\"form_fields[field_e83c8b3]\"> <label for=\"form-field-field_e83c8b3-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_81ca3a7 elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_81ca3a7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDifficult\u00e9 \u00e0 respirer\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_81ca3a7-0\" name=\"form_fields[field_81ca3a7]\"> <label for=\"form-field-field_81ca3a7-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_81ca3a7-1\" name=\"form_fields[field_81ca3a7]\"> <label for=\"form-field-field_81ca3a7-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_81ca3a7-2\" name=\"form_fields[field_81ca3a7]\"> <label for=\"form-field-field_81ca3a7-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_29ade48 elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_29ade48\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDouleur\/pression thoracique\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_29ade48-0\" name=\"form_fields[field_29ade48]\"> <label for=\"form-field-field_29ade48-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_29ade48-1\" name=\"form_fields[field_29ade48]\"> <label for=\"form-field-field_29ade48-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_29ade48-2\" name=\"form_fields[field_29ade48]\"> <label for=\"form-field-field_29ade48-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_f3d7392 elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f3d7392\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNouvelle confusion\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_f3d7392-0\" name=\"form_fields[field_f3d7392]\"> <label for=\"form-field-field_f3d7392-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_f3d7392-1\" name=\"form_fields[field_f3d7392]\"> <label for=\"form-field-field_f3d7392-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_f3d7392-2\" name=\"form_fields[field_f3d7392]\"> <label for=\"form-field-field_f3d7392-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_bede140 elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_bede140\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIncapacit\u00e9 \u00e0 se r\u00e9veiller\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_bede140-0\" name=\"form_fields[field_bede140]\"> <label for=\"form-field-field_bede140-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_bede140-1\" name=\"form_fields[field_bede140]\"> <label for=\"form-field-field_bede140-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_bede140-2\" name=\"form_fields[field_bede140]\"> <label for=\"form-field-field_bede140-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_8187033 elementor-col-100\">\n\t\t\t\t\t<hr>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_bd22b5e elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_bd22b5e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tL\u00e8vres ou visage bleu\u00e2tres\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_bd22b5e-0\" name=\"form_fields[field_bd22b5e]\"> <label for=\"form-field-field_bd22b5e-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_bd22b5e-1\" name=\"form_fields[field_bd22b5e]\"> <label for=\"form-field-field_bd22b5e-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_bd22b5e-2\" name=\"form_fields[field_bd22b5e]\"> <label for=\"form-field-field_bd22b5e-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_1acd55c elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1acd55c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAutres notes HPI et ROS :\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-xs\" name=\"form_fields[field_1acd55c]\" id=\"form-field-field_1acd55c\" rows=\"4\" placeholder=\"d\u00e9tails ici\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_1cd7f96 elementor-col-100\">\n\t\t\t\t\t<hr>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_114072e elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_114072e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tComment ce patient a-t-il \u00e9t\u00e9 \u00e9valu\u00e9 lors de cette rencontre clinique ?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"T\u00c9L\u00c9-SANT\u00c9 (VID\u00c9O + AUDIO pour la plupart\/toutes les rencontres)\" id=\"form-field-field_114072e-0\" name=\"form_fields[field_114072e]\"> <label for=\"form-field-field_114072e-0\">T\u00c9L\u00c9-SANT\u00c9 (VID\u00c9O + AUDIO pour la plupart\/toutes les rencontres)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"TELEPHONE (AUDIO SEULEMENT pour la plupart\/toutes les rencontres)\" id=\"form-field-field_114072e-1\" name=\"form_fields[field_114072e]\"> <label for=\"form-field-field_114072e-1\">TELEPHONE (AUDIO SEULEMENT pour la plupart\/toutes les rencontres)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"EN PERSONNE (face \u00e0 face)\" id=\"form-field-field_114072e-2\" name=\"form_fields[field_114072e]\"> <label for=\"form-field-field_114072e-2\">EN PERSONNE (face \u00e0 face)<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_00ce8df elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_00ce8df\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLe patient consent \u00e0 une visite vid\u00e9o selon les directives du CDC pendant la pand\u00e9mie de COVID-19.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"OUI\" id=\"form-field-field_00ce8df-0\" name=\"form_fields[field_00ce8df]\"> <label for=\"form-field-field_00ce8df-0\">OUI<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON\" id=\"form-field-field_00ce8df-1\" name=\"form_fields[field_00ce8df]\"> <label for=\"form-field-field_00ce8df-1\">NON<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_c2e80da elementor-col-100\">\n\t\t\t\t\t<hr>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_222fe28 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_222fe28\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tROS : Un ROS complet a \u00e9t\u00e9 effectu\u00e9 et s'est av\u00e9r\u00e9 n\u00e9gatif, \u00e0 l'exception de ce qui est indiqu\u00e9 ci-dessus.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"OUI\" id=\"form-field-field_222fe28-0\" name=\"form_fields[field_222fe28]\"> <label for=\"form-field-field_222fe28-0\">OUI<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON\" id=\"form-field-field_222fe28-1\" name=\"form_fields[field_222fe28]\"> <label for=\"form-field-field_222fe28-1\">NON<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_18d5842 elementor-col-100\">\n\t\t\t\t\t<br><hr><br>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_53d782f elementor-col-100\">\n\t\t\t\t\t<big><b>ANT\u00c9C\u00c9DENTS M\u00c9DICAUX \/ SOCIAUX \/ FAMILIAUX<\/b><\/big>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_0532009 elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0532009\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAsthme\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_0532009-0\" name=\"form_fields[field_0532009]\"> <label for=\"form-field-field_0532009-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_0532009-1\" name=\"form_fields[field_0532009]\"> <label for=\"form-field-field_0532009-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_0532009-2\" name=\"form_fields[field_0532009]\"> <label for=\"form-field-field_0532009-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_0d019eb elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0d019eb\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDiab\u00e8te\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_0d019eb-0\" name=\"form_fields[field_0d019eb]\"> <label for=\"form-field-field_0d019eb-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_0d019eb-1\" name=\"form_fields[field_0d019eb]\"> <label for=\"form-field-field_0d019eb-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_0d019eb-2\" name=\"form_fields[field_0d019eb]\"> <label for=\"form-field-field_0d019eb-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_e35bb1d elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e35bb1d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHypertension art\u00e9rielle\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_e35bb1d-0\" name=\"form_fields[field_e35bb1d]\"> <label for=\"form-field-field_e35bb1d-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_e35bb1d-1\" name=\"form_fields[field_e35bb1d]\"> <label for=\"form-field-field_e35bb1d-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_e35bb1d-2\" name=\"form_fields[field_e35bb1d]\"> <label for=\"form-field-field_e35bb1d-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_71ca2f3 elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_71ca2f3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMaladies cardiaques\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_71ca2f3-0\" name=\"form_fields[field_71ca2f3]\"> <label for=\"form-field-field_71ca2f3-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_71ca2f3-1\" name=\"form_fields[field_71ca2f3]\"> <label for=\"form-field-field_71ca2f3-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_71ca2f3-2\" name=\"form_fields[field_71ca2f3]\"> <label for=\"form-field-field_71ca2f3-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_44f121a elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_44f121a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMaladie du foie\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_44f121a-0\" name=\"form_fields[field_44f121a]\"> <label for=\"form-field-field_44f121a-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_44f121a-1\" name=\"form_fields[field_44f121a]\"> <label for=\"form-field-field_44f121a-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_44f121a-2\" name=\"form_fields[field_44f121a]\"> <label for=\"form-field-field_44f121a-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_8a77a35 elementor-col-100\">\n\t\t\t\t\t<hr>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_678136a elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_678136a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tImmunod\u00e9prim\u00e9s\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_678136a-0\" name=\"form_fields[field_678136a]\"> <label for=\"form-field-field_678136a-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_678136a-1\" name=\"form_fields[field_678136a]\"> <label for=\"form-field-field_678136a-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_678136a-2\" name=\"form_fields[field_678136a]\"> <label for=\"form-field-field_678136a-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_421f9ec elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_421f9ec\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHypercholest\u00e9rol\u00e9mie\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_421f9ec-0\" name=\"form_fields[field_421f9ec]\"> <label for=\"form-field-field_421f9ec-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_421f9ec-1\" name=\"form_fields[field_421f9ec]\"> <label for=\"form-field-field_421f9ec-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_421f9ec-2\" name=\"form_fields[field_421f9ec]\"> <label for=\"form-field-field_421f9ec-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_f3e71da elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f3e71da\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDz pulmonaire chronique\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_f3e71da-0\" name=\"form_fields[field_f3e71da]\"> <label for=\"form-field-field_f3e71da-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_f3e71da-1\" name=\"form_fields[field_f3e71da]\"> <label for=\"form-field-field_f3e71da-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_f3e71da-2\" name=\"form_fields[field_f3e71da]\"> <label for=\"form-field-field_f3e71da-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_d463acc elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d463acc\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDz r\u00e9naux chroniques avec dialyse\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ADMITS\" id=\"form-field-field_d463acc-0\" name=\"form_fields[field_d463acc]\"> <label for=\"form-field-field_d463acc-0\">ADMITS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"DENIE\" id=\"form-field-field_d463acc-1\" name=\"form_fields[field_d463acc]\"> <label for=\"form-field-field_d463acc-1\">DENIE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_d463acc-2\" name=\"form_fields[field_d463acc]\"> <label for=\"form-field-field_d463acc-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_109c262 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_109c262\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAutre :\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-xs\" name=\"form_fields[field_109c262]\" id=\"form-field-field_109c262\" rows=\"4\" placeholder=\"d\u00e9tails ici\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_6b5d8c6 elementor-col-100\">\n\t\t\t\t\t<hr>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_a5ab6c8 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a5ab6c8\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tM\u00e9dicaments\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_a5ab6c8]\" id=\"form-field-field_a5ab6c8\" class=\"elementor-field elementor-size-xs  elementor-field-textual\" placeholder=\"r\u00e9ponse\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_1b1dd9a elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1b1dd9a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAllergies\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_1b1dd9a]\" id=\"form-field-field_1b1dd9a\" class=\"elementor-field elementor-size-xs  elementor-field-textual\" placeholder=\"r\u00e9ponse\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_619a23b elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_619a23b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tChirurgies\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_619a23b]\" id=\"form-field-field_619a23b\" class=\"elementor-field elementor-size-xs  elementor-field-textual\" placeholder=\"r\u00e9ponse\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ca8f876 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ca8f876\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFumer\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_ca8f876]\" id=\"form-field-field_ca8f876\" class=\"elementor-field elementor-size-xs  elementor-field-textual\" placeholder=\"r\u00e9ponse\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_5bc711e elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5bc711e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAlcool\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_5bc711e]\" id=\"form-field-field_5bc711e\" class=\"elementor-field elementor-size-xs  elementor-field-textual\" placeholder=\"r\u00e9ponse\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_a762506 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a762506\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHx familial\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_a762506]\" id=\"form-field-field_a762506\" class=\"elementor-field elementor-size-xs  elementor-field-textual\" placeholder=\"r\u00e9ponse\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_bba9668 elementor-col-100\">\n\t\t\t\t\t<br><hr><br>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_942be91 elementor-col-100\">\n\t\t\t\t\t<big><b>EXAMEN PHYSIQUE<\/b><\/big>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_9081337 elementor-col-100\">\n\t\t\t\t\t<small>En raison de la pand\u00e9mie de COVID, si une suspicion d'exposition est possible, les prestataires sont tenus d'initier un contact pendant l'examen physique uniquement en cas de n\u00e9cessit\u00e9 m\u00e9dicale absolue. Veuillez effectuer l'examen physique ci-dessous et inclure le commentaire dans la section ci-dessous. Si possible, enregistrez les signes vitaux.<\/small>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-number elementor-field-group elementor-column elementor-field-group-field_b3e8436 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b3e8436\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHauteur (in.)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"number\" name=\"form_fields[field_b3e8436]\" id=\"form-field-field_b3e8436\" class=\"elementor-field elementor-size-xs  elementor-field-textual\" placeholder=\"hauteur\" min=\"0\" max=\"108\" >\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-number elementor-field-group elementor-column elementor-field-group-field_f2387ba elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f2387ba\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPoids (lbs.)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"number\" name=\"form_fields[field_f2387ba]\" id=\"form-field-field_f2387ba\" class=\"elementor-field elementor-size-xs  elementor-field-textual\" placeholder=\"poids\" min=\"0\" max=\"\" >\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_4e38101 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4e38101\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTemp\u00e9rature (\u00b0F)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_4e38101]\" id=\"form-field-field_4e38101\" class=\"elementor-field elementor-size-xs  elementor-field-textual\" placeholder=\"temp\u00e9rature\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_1f907db elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1f907db\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLes signes vitaux sont ceux rapport\u00e9s par le patient \u00e0 l'aide d'appareils con\u00e7us pour un usage domestique\/personnel.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"OUI\" id=\"form-field-field_1f907db-0\" name=\"form_fields[field_1f907db]\"> <label for=\"form-field-field_1f907db-0\">OUI<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON\" id=\"form-field-field_1f907db-1\" name=\"form_fields[field_1f907db]\"> <label for=\"form-field-field_1f907db-1\">NON<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_3bcf2a2 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3bcf2a2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSi NON \u00e0 la d\u00e9claration ci-dessus :\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-xs\" name=\"form_fields[field_3bcf2a2]\" id=\"form-field-field_3bcf2a2\" rows=\"4\" placeholder=\"d\u00e9tails ici\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_a0df4e3 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a0df4e3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGen : semble bien, ne pr\u00e9sente pas de d\u00e9tresse aigu\u00eb et n'a pas l'air malade.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"CONFIRM\u00c9\" id=\"form-field-field_a0df4e3-0\" name=\"form_fields[field_a0df4e3]\"> <label for=\"form-field-field_a0df4e3-0\">CONFIRM\u00c9<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ABNORMAL\" id=\"form-field-field_a0df4e3-1\" name=\"form_fields[field_a0df4e3]\"> <label for=\"form-field-field_a0df4e3-1\">ABNORMAL<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_a0df4e3-2\" name=\"form_fields[field_a0df4e3]\"> <label for=\"form-field-field_a0df4e3-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_cb969d7 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_cb969d7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSi ce qui pr\u00e9c\u00e8de est ABNORMAL :\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-xs\" name=\"form_fields[field_cb969d7]\" id=\"form-field-field_cb969d7\" rows=\"4\" placeholder=\"d\u00e9tails ici\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_57bdd86 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_57bdd86\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tYeux : pas d'\u00e9coulement, ni d'injection ; pupilles \u00e9gales et rondes ; non ict\u00e9rique.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"CONFIRM\u00c9\" id=\"form-field-field_57bdd86-0\" name=\"form_fields[field_57bdd86]\"> <label for=\"form-field-field_57bdd86-0\">CONFIRM\u00c9<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ABNORMAL\" id=\"form-field-field_57bdd86-1\" name=\"form_fields[field_57bdd86]\"> <label for=\"form-field-field_57bdd86-1\">ABNORMAL<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_57bdd86-2\" name=\"form_fields[field_57bdd86]\"> <label for=\"form-field-field_57bdd86-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_56e074b elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_56e074b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSi ce qui pr\u00e9c\u00e8de est ABNORMAL :\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-xs\" name=\"form_fields[field_56e074b]\" id=\"form-field-field_56e074b\" rows=\"4\" placeholder=\"d\u00e9tails ici\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_8ca0b23 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8ca0b23\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tOreilles : aucune l\u00e9sion externe constat\u00e9e\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"CONFIRM\u00c9\" id=\"form-field-field_8ca0b23-0\" name=\"form_fields[field_8ca0b23]\"> <label for=\"form-field-field_8ca0b23-0\">CONFIRM\u00c9<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ABNORMAL\" id=\"form-field-field_8ca0b23-1\" name=\"form_fields[field_8ca0b23]\"> <label for=\"form-field-field_8ca0b23-1\">ABNORMAL<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_8ca0b23-2\" name=\"form_fields[field_8ca0b23]\"> <label for=\"form-field-field_8ca0b23-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_dcc6ccb elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_dcc6ccb\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSi ce qui pr\u00e9c\u00e8de est ABNORMAL :\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-xs\" name=\"form_fields[field_dcc6ccb]\" id=\"form-field-field_dcc6ccb\" rows=\"4\" placeholder=\"d\u00e9tails ici\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_67fcab7 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_67fcab7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNez : aucune l\u00e9sion externe ni \u00e9coulement n'ont \u00e9t\u00e9 constat\u00e9s.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"CONFIRM\u00c9\" id=\"form-field-field_67fcab7-0\" name=\"form_fields[field_67fcab7]\"> <label for=\"form-field-field_67fcab7-0\">CONFIRM\u00c9<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ABNORMAL\" id=\"form-field-field_67fcab7-1\" name=\"form_fields[field_67fcab7]\"> <label for=\"form-field-field_67fcab7-1\">ABNORMAL<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_67fcab7-2\" name=\"form_fields[field_67fcab7]\"> <label for=\"form-field-field_67fcab7-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_045f283 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_045f283\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSi ce qui pr\u00e9c\u00e8de est ABNORMAL :\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-xs\" name=\"form_fields[field_045f283]\" id=\"form-field-field_045f283\" rows=\"4\" placeholder=\"d\u00e9tails ici\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_8791a6d elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8791a6d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tRespiratoire : Pas de dyspn\u00e9e conversationnelle, pas de cyanose centrale.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"CONFIRM\u00c9\" id=\"form-field-field_8791a6d-0\" name=\"form_fields[field_8791a6d]\"> <label for=\"form-field-field_8791a6d-0\">CONFIRM\u00c9<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ABNORMAL\" id=\"form-field-field_8791a6d-1\" name=\"form_fields[field_8791a6d]\"> <label for=\"form-field-field_8791a6d-1\">ABNORMAL<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_8791a6d-2\" name=\"form_fields[field_8791a6d]\"> <label for=\"form-field-field_8791a6d-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_a9e01a6 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a9e01a6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSi ce qui pr\u00e9c\u00e8de est ABNORMAL :\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-xs\" name=\"form_fields[field_a9e01a6]\" id=\"form-field-field_a9e01a6\" rows=\"4\" placeholder=\"d\u00e9tails ici\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_e299c20 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e299c20\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLe dos : Bonne posture et station\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"CONFIRM\u00c9\" id=\"form-field-field_e299c20-0\" name=\"form_fields[field_e299c20]\"> <label for=\"form-field-field_e299c20-0\">CONFIRM\u00c9<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ABNORMAL\" id=\"form-field-field_e299c20-1\" name=\"form_fields[field_e299c20]\"> <label for=\"form-field-field_e299c20-1\">ABNORMAL<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_e299c20-2\" name=\"form_fields[field_e299c20]\"> <label for=\"form-field-field_e299c20-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_b066855 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b066855\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSi ce qui pr\u00e9c\u00e8de est ABNORMAL :\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-xs\" name=\"form_fields[field_b066855]\" id=\"form-field-field_b066855\" rows=\"4\" placeholder=\"d\u00e9tails ici\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_a141c38 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a141c38\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMSK : force motrice et tonus grossi\u00e8rement normaux ; mouvement global des extr\u00e9mit\u00e9s WNL.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"CONFIRM\u00c9\" id=\"form-field-field_a141c38-0\" name=\"form_fields[field_a141c38]\"> <label for=\"form-field-field_a141c38-0\">CONFIRM\u00c9<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ABNORMAL\" id=\"form-field-field_a141c38-1\" name=\"form_fields[field_a141c38]\"> <label for=\"form-field-field_a141c38-1\">ABNORMAL<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_a141c38-2\" name=\"form_fields[field_a141c38]\"> <label for=\"form-field-field_a141c38-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_24e132b elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_24e132b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSi ce qui pr\u00e9c\u00e8de est ABNORMAL :\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-xs\" name=\"form_fields[field_24e132b]\" id=\"form-field-field_24e132b\" rows=\"4\" placeholder=\"d\u00e9tails ici\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_55cfe02 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_55cfe02\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNeuro : A&amp;O x 3, CN grossi\u00e8rement intact, examen cognitif grossi\u00e8rement normal.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"CONFIRM\u00c9\" id=\"form-field-field_55cfe02-0\" name=\"form_fields[field_55cfe02]\"> <label for=\"form-field-field_55cfe02-0\">CONFIRM\u00c9<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ABNORMAL\" id=\"form-field-field_55cfe02-1\" name=\"form_fields[field_55cfe02]\"> <label for=\"form-field-field_55cfe02-1\">ABNORMAL<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_55cfe02-2\" name=\"form_fields[field_55cfe02]\"> <label for=\"form-field-field_55cfe02-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_62f7efa elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_62f7efa\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSi ce qui pr\u00e9c\u00e8de est ABNORMAL :\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-xs\" name=\"form_fields[field_62f7efa]\" id=\"form-field-field_62f7efa\" rows=\"4\" placeholder=\"d\u00e9tails ici\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_17f4cdc elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_17f4cdc\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPsych : Jugement\/aperception bon, humeur\/affect pleine gamme\/agr\u00e9able, m\u00e9moire r\u00e9cente\/\u00e9loign\u00e9e normale.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"CONFIRM\u00c9\" id=\"form-field-field_17f4cdc-0\" name=\"form_fields[field_17f4cdc]\"> <label for=\"form-field-field_17f4cdc-0\">CONFIRM\u00c9<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"ABNORMAL\" id=\"form-field-field_17f4cdc-1\" name=\"form_fields[field_17f4cdc]\"> <label for=\"form-field-field_17f4cdc-1\">ABNORMAL<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NON REVIS\u00c9\" id=\"form-field-field_17f4cdc-2\" name=\"form_fields[field_17f4cdc]\"> <label for=\"form-field-field_17f4cdc-2\">NON REVIS\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_fbb89e7 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_fbb89e7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSi ce qui pr\u00e9c\u00e8de est ABNORMAL :\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-xs\" name=\"form_fields[field_fbb89e7]\" id=\"form-field-field_fbb89e7\" rows=\"4\" placeholder=\"d\u00e9tails ici\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_93800d7 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_93800d7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAutres notes suppl\u00e9mentaires :\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-xs\" name=\"form_fields[field_93800d7]\" id=\"form-field-field_93800d7\" rows=\"4\" placeholder=\"notes suppl\u00e9mentaires\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_ee7b5ac elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ee7b5ac\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tD\u00c9CLARATION PUBLI\u00c9E\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"&lt;small&gt;En raison de la pand\u00e9mie de COVID, si une suspicion d&#039;exposition est possible, les prestataires sont tenus d&#039;initier un contact pendant l&#039;examen physique uniquement en cas de n\u00e9cessit\u00e9 m\u00e9dicale absolue. Veuillez effectuer l&#039;examen physique ci-dessous et inclure le commentaire dans la section ci-dessous. Si possible, enregistrez les signes vitaux.&lt;\/small&gt;\" id=\"form-field-field_ee7b5ac-0\" name=\"form_fields[field_ee7b5ac]\"> <label for=\"form-field-field_ee7b5ac-0\"><small>En raison de la pand\u00e9mie de COVID, si une suspicion d'exposition est possible, les prestataires sont tenus d'initier un contact pendant l'examen physique uniquement en cas de n\u00e9cessit\u00e9 m\u00e9dicale absolue. Veuillez effectuer l'examen physique ci-dessous et inclure le commentaire dans la section ci-dessous. Si possible, enregistrez les signes vitaux.<\/small><\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_7285346 elementor-col-100\">\n\t\t\t\t\t<br><hr><br>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_a4fe8b8 elementor-col-100\">\n\t\t\t\t\t<big><b>EXAMIN\u00c9 AVEC LE PATIENT<\/b><\/big>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_2dfa9c3 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2dfa9c3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLe patient consent \u00e0 une visite de t\u00e9l\u00e9sant\u00e9 en remplacement d'une visite en clinique en raison d'une possible exposition au COVID-19 pendant la pand\u00e9mie, conform\u00e9ment aux recommandations des CDC. Le patient a \u00e9t\u00e9 vu par le biais de la t\u00e9l\u00e9sant\u00e9 et a \u00e9t\u00e9 \u00e9valu\u00e9 \u00e0 distance au mieux de la capacit\u00e9 de ce fournisseur.  \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_2dfa9c3-0\" name=\"form_fields[field_2dfa9c3]\"> <label for=\"form-field-field_2dfa9c3-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_7ab48c4 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7ab48c4\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIl a \u00e9t\u00e9 conseill\u00e9 au patient de se rendre aux urgences ou d'appeler le 911 en cas de douleur thoracique s\u00e9v\u00e8re, d'essoufflement ou d'urgence non soulag\u00e9e par les m\u00e9dicaments pris \u00e0 domicile. Il a \u00e9t\u00e9 conseill\u00e9 au patient de rester \u00e0 la maison et d'\u00e9viter les contacts inutiles, d'optimiser la nutrition, l'hydratation et le repos. Restez calme et traitez les sympt\u00f4mes g\u00e9rables \u00e0 la maison. Contactez le service de t\u00e9l\u00e9sant\u00e9 pour toute question suppl\u00e9mentaire.  \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_7ab48c4-0\" name=\"form_fields[field_7ab48c4]\"> <label for=\"form-field-field_7ab48c4-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_dd44eff elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_dd44eff\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDiscussion des lignes directrices du CDC (par mise \u00e0 jour du 20 juillet 2020) pour l'arr\u00eat de l'isolement :  <br>- Une strat\u00e9gie bas\u00e9e sur des tests n'est plus recommand\u00e9e pour d\u00e9terminer quand interrompre l'isolement \u00e0 domicile, sauf dans certaines circonstances.<br>- Dans le cas d'une maladie asymptomatique, on peut interrompre l'isolement apr\u00e8s que 10 jours au moins se soient \u00e9coul\u00e9s depuis le premier jour de test RT-PCR positif pour l'ARN du SRAS-CoV-2.<br>- Dans le cas d'une maladie l\u00e9g\u00e8re \u00e0 mod\u00e9r\u00e9e, l'isolement peut \u00eatre interrompu apr\u00e8s qu'au moins 10 jours se soient \u00e9coul\u00e9s depuis l'apparition des sympt\u00f4mes ET qu'au moins 24 heures se soient \u00e9coul\u00e9es sans fi\u00e8vre (sans utilisation de m\u00e9dicaments pour r\u00e9duire la fi\u00e8vre) ET que les autres sympt\u00f4mes se soient att\u00e9nu\u00e9s.<br>- Dans le cas de maladies graves ou critiques ou de patients immunod\u00e9prim\u00e9s, l'isolement peut \u00eatre interrompu apr\u00e8s que 20 jours au moins se sont \u00e9coul\u00e9s depuis l'apparition des sympt\u00f4mes ET que la personne est rest\u00e9e fi\u00e9vreuse pendant au moins 24 heures (sans utilisation de m\u00e9dicaments pour faire baisser la fi\u00e8vre) ET que les autres sympt\u00f4mes se sont att\u00e9nu\u00e9s.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_dd44eff-0\" name=\"form_fields[field_dd44eff]\"> <label for=\"form-field-field_dd44eff-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_6ac556a elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6ac556a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLe patient est inform\u00e9 que ni le test d'anticorps (IgM et IgG) ni le test d'antig\u00e8ne ne sont approuv\u00e9s par la FDA, mais qu'ils ont tous deux re\u00e7u une autorisation d'utilisation d'urgence (EUA) de la FDA dans le cadre de leur Policy for Coronavirus Disease-2019 Tests During the Public Health Emergency, publi\u00e9e le 11 mai 2020, suite \u00e0 la d\u00e9claration f\u00e9d\u00e9rale de l'urgence de sant\u00e9 publique (PHE) d\u00e9clar\u00e9e le 13 mars 2020. Toutes les questions ont \u00e9t\u00e9 r\u00e9pondues. Le patient est inform\u00e9 que si le test d'anticorps est effectu\u00e9 et qu'il est positif, on lui recommandera le test PCR sur \u00e9couvillon COVID-19. Le patient est \u00e9galement inform\u00e9 que si le test d'antig\u00e8ne est effectu\u00e9 et qu'il est n\u00e9gatif, on lui recommandera le test PCR COVID-19 sur \u00e9couvillon. Si un test PCR sur \u00e9couvillon est effectu\u00e9, recommandez une mise en quarantaine jusqu'\u00e0 r\u00e9ception des r\u00e9sultats.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_6ac556a-0\" name=\"form_fields[field_6ac556a]\"> <label for=\"form-field-field_6ac556a-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_8e6f6df elementor-col-100\">\n\t\t\t\t\t<br><hr><br>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_29d17ac elementor-col-100\">\n\t\t\t\t\t<big><b>CODAGE DES FOURNISSEURS<\/b><\/big>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_6183bd0 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6183bd0\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tChoisissez-en un parmi les suivants :\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Z20.828 Exposition suspect\u00e9e\/confirm\u00e9e aux Covid\u00e9s\" id=\"form-field-field_6183bd0-0\" name=\"form_fields[field_6183bd0]\"> <label for=\"form-field-field_6183bd0-0\">Z20.828 Exposition suspect\u00e9e\/confirm\u00e9e aux Covid\u00e9s<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Z20.828 Influenza suspect\u00e9e\" id=\"form-field-field_6183bd0-1\" name=\"form_fields[field_6183bd0]\"> <label for=\"form-field-field_6183bd0-1\">Z20.828 Influenza suspect\u00e9e<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"U07.1 COVID POSITIVE\" id=\"form-field-field_6183bd0-2\" name=\"form_fields[field_6183bd0]\"> <label for=\"form-field-field_6183bd0-2\">U07.1 COVID POSITIVE<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Aucun de ces \u00e9l\u00e9ments\" id=\"form-field-field_6183bd0-3\" name=\"form_fields[field_6183bd0]\"> <label for=\"form-field-field_6183bd0-3\">Aucun de ces \u00e9l\u00e9ments<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_b3d9c70 elementor-col-100\">\n\t\t\t\t\t<hr>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_5cb4cca elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5cb4cca\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tZ71.89 Autre conseil sp\u00e9cifi\u00e9\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_5cb4cca-0\" name=\"form_fields[field_5cb4cca]\"> <label for=\"form-field-field_5cb4cca-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_485d7b0 elementor-col-100\">\n\t\t\t\t\t<hr>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_8f74403 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8f74403\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR51 Mal de t\u00eate\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_8f74403-0\" name=\"form_fields[field_8f74403]\"> <label for=\"form-field-field_8f74403-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_109f6b5 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_109f6b5\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR50.9 Fi\u00e8vre, non sp\u00e9cifi\u00e9e\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_109f6b5-0\" name=\"form_fields[field_109f6b5]\"> <label for=\"form-field-field_109f6b5-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_ef9eaf7 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ef9eaf7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR68.83 Frissons (sans fi\u00e8vre)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_ef9eaf7-0\" name=\"form_fields[field_ef9eaf7]\"> <label for=\"form-field-field_ef9eaf7-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_5855ee9 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5855ee9\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR52 Maux de corps\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_5855ee9-0\" name=\"form_fields[field_5855ee9]\"> <label for=\"form-field-field_5855ee9-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_7729ade elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7729ade\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR53.1 Faiblesse\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_7729ade-0\" name=\"form_fields[field_7729ade]\"> <label for=\"form-field-field_7729ade-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_9b63da3 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9b63da3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR53.83 Fatigue, type non sp\u00e9cifi\u00e9\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_9b63da3-0\" name=\"form_fields[field_9b63da3]\"> <label for=\"form-field-field_9b63da3-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_fa72bac elementor-col-100\">\n\t\t\t\t\t<hr>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_41119c0 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_41119c0\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tJ01.90 Sinusite aigu\u00eb, non sp\u00e9cifi\u00e9e\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_41119c0-0\" name=\"form_fields[field_41119c0]\"> <label for=\"form-field-field_41119c0-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_b826535 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b826535\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR09.81 Congestion des sinus nasaux\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_b826535-0\" name=\"form_fields[field_b826535]\"> <label for=\"form-field-field_b826535-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_40a39c6 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_40a39c6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR09.82 \u00c9coulement post-nasal\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_40a39c6-0\" name=\"form_fields[field_40a39c6]\"> <label for=\"form-field-field_40a39c6-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_0aa2570 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0aa2570\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tJ00 Rhinorrh\u00e9e\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_0aa2570-0\" name=\"form_fields[field_0aa2570]\"> <label for=\"form-field-field_0aa2570-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_1bada88 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1bada88\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR06.7 \u00c9ternuement\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_1bada88-0\" name=\"form_fields[field_1bada88]\"> <label for=\"form-field-field_1bada88-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_6fba4ad elementor-col-100\">\n\t\t\t\t\t<hr>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_9497345 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9497345\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR43.0 Perte de l'odorat\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_9497345-0\" name=\"form_fields[field_9497345]\"> <label for=\"form-field-field_9497345-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_864d40d elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_864d40d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR43.2 Perte du go\u00fbt\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_864d40d-0\" name=\"form_fields[field_864d40d]\"> <label for=\"form-field-field_864d40d-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_fe70910 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_fe70910\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR43.9 Trouble de la sensation de l'odeur ou du go\u00fbt\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_fe70910-0\" name=\"form_fields[field_fe70910]\"> <label for=\"form-field-field_fe70910-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_1dadd17 elementor-col-100\">\n\t\t\t\t\t<hr>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_a91d6cd elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a91d6cd\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR05 Toux\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_a91d6cd-0\" name=\"form_fields[field_a91d6cd]\"> <label for=\"form-field-field_a91d6cd-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_b6a8bc6 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b6a8bc6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tJ02.9 Pharyngite aigu\u00eb, non sp\u00e9cifi\u00e9e\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_b6a8bc6-0\" name=\"form_fields[field_b6a8bc6]\"> <label for=\"form-field-field_b6a8bc6-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_11369ee elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_11369ee\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tJ39.2 Gorge irrit\u00e9e\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_11369ee-0\" name=\"form_fields[field_11369ee]\"> <label for=\"form-field-field_11369ee-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_c60c333 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c60c333\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR07.0 Douleur de la gorge\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_c60c333-0\" name=\"form_fields[field_c60c333]\"> <label for=\"form-field-field_c60c333-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_91a5870 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_91a5870\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR09.89 Flegme dans la gorge\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_91a5870-0\" name=\"form_fields[field_91a5870]\"> <label for=\"form-field-field_91a5870-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_5e722c7 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5e722c7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tJ37.0 Congestion du larynx\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_5e722c7-0\" name=\"form_fields[field_5e722c7]\"> <label for=\"form-field-field_5e722c7-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_18e8067 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_18e8067\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tJ98.8 Congestion des voies respiratoires\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_18e8067-0\" name=\"form_fields[field_18e8067]\"> <label for=\"form-field-field_18e8067-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_11985dd elementor-col-100\">\n\t\t\t\t\t<hr>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_6f7690e elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6f7690e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR06.02 Essoufflement\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_6f7690e-0\" name=\"form_fields[field_6f7690e]\"> <label for=\"form-field-field_6f7690e-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_9c6ee73 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9c6ee73\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR06.2 Respiration sifflante\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_9c6ee73-0\" name=\"form_fields[field_9c6ee73]\"> <label for=\"form-field-field_9c6ee73-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_b4daa95 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b4daa95\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR06.4 Respiration laborieuse\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_b4daa95-0\" name=\"form_fields[field_b4daa95]\"> <label for=\"form-field-field_b4daa95-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_ddcb546 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ddcb546\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR06.03 D\u00e9tresse respiratoire\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_ddcb546-0\" name=\"form_fields[field_ddcb546]\"> <label for=\"form-field-field_ddcb546-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_a7d49f0 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a7d49f0\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR06.89 Autres anomalies de la respiration\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_a7d49f0-0\" name=\"form_fields[field_a7d49f0]\"> <label for=\"form-field-field_a7d49f0-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_4cdd5c3 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4cdd5c3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR07.89 Serrement de la poitrine\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_4cdd5c3-0\" name=\"form_fields[field_4cdd5c3]\"> <label for=\"form-field-field_4cdd5c3-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_9a1fd08 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9a1fd08\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR07.1 Douleur thoracique \u00e0 la respiration\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_9a1fd08-0\" name=\"form_fields[field_9a1fd08]\"> <label for=\"form-field-field_9a1fd08-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_6e99106 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6e99106\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR07.9 Douleur thoracique, type non sp\u00e9cifi\u00e9\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_6e99106-0\" name=\"form_fields[field_6e99106]\"> <label for=\"form-field-field_6e99106-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_0e22391 elementor-col-100\">\n\t\t\t\t\t<hr>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_2ec6837 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2ec6837\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR11.0 Naus\u00e9es seules\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_2ec6837-0\" name=\"form_fields[field_2ec6837]\"> <label for=\"form-field-field_2ec6837-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_f1c5b7e elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f1c5b7e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR11.2 Naus\u00e9es avec vomissements, non sp\u00e9cifi\u00e9\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_f1c5b7e-0\" name=\"form_fields[field_f1c5b7e]\"> <label for=\"form-field-field_f1c5b7e-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_f12c343 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f12c343\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR11.10 Vomissements, non sp\u00e9cifi\u00e9s\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_f12c343-0\" name=\"form_fields[field_f12c343]\"> <label for=\"form-field-field_f12c343-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_e469688 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e469688\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR10.9 Douleur abdominale, localisation abdominale non pr\u00e9cis\u00e9e\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_e469688-0\" name=\"form_fields[field_e469688]\"> <label for=\"form-field-field_e469688-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_8767330 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8767330\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR19.7 Diarrh\u00e9e, type non sp\u00e9cifi\u00e9\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_8767330-0\" name=\"form_fields[field_8767330]\"> <label for=\"form-field-field_8767330-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_47d4fe9 elementor-col-100\">\n\t\t\t\t\t<hr>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_805492d elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_805492d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tJ22 Infection respiratoire aigu\u00eb\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_805492d-0\" name=\"form_fields[field_805492d]\"> <label for=\"form-field-field_805492d-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_95f2a15 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_95f2a15\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tB34.9 Maladie virale\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_95f2a15-0\" name=\"form_fields[field_95f2a15]\"> <label for=\"form-field-field_95f2a15-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_3c1b4a9 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3c1b4a9\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tJ10 Influenza due \u00e0 un autre virus grippal identifi\u00e9\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_3c1b4a9-0\" name=\"form_fields[field_3c1b4a9]\"> <label for=\"form-field-field_3c1b4a9-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_b299d35 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b299d35\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAutre Dx :\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-xs\" name=\"form_fields[field_b299d35]\" id=\"form-field-field_b299d35\" rows=\"4\" placeholder=\"autre\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_45b2f96 elementor-col-100\">\n\t\t\t\t\t<br><hr><br>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_7db7c91 elementor-col-100\">\n\t\t\t\t\t<big><b>ORDRES DU LAB<\/b><\/big>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_5c9a52e elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5c9a52e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCOVID-19 PCR (U0003)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_5c9a52e-0\" name=\"form_fields[field_5c9a52e]\"> <label for=\"form-field-field_5c9a52e-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_787e01b elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_787e01b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAntig\u00e8ne COVID-19, POC rapide (87811)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_787e01b-0\" name=\"form_fields[field_787e01b]\"> <label for=\"form-field-field_787e01b-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_756ab6b elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_756ab6b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAnticorps COVID-19, POC rapide (86328)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_756ab6b-0\" name=\"form_fields[field_756ab6b]\"> <label for=\"form-field-field_756ab6b-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_c579e55 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c579e55\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tInfluenza A\/B, POC rapide (87804 x2)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_c579e55-0\" name=\"form_fields[field_c579e55]\"> <label for=\"form-field-field_c579e55-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_207e458 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_207e458\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tStrep A, POC rapide (87880)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CONFIRM\u00c9\" id=\"form-field-field_207e458-0\" name=\"form_fields[field_207e458]\"> <label for=\"form-field-field_207e458-0\">CONFIRM\u00c9<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_679b39a elementor-col-100\">\n\t\t\t\t\t<br><hr><br>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_706e77b elementor-col-100\">\n\t\t\t\t\t<big><b>NIVEAU E &amp; M<\/b><\/big>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_9298b91 elementor-col-20\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"99201\" id=\"form-field-field_9298b91-0\" name=\"form_fields[field_9298b91]\"> <label for=\"form-field-field_9298b91-0\">99201<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"99202\" id=\"form-field-field_9298b91-1\" name=\"form_fields[field_9298b91]\"> <label for=\"form-field-field_9298b91-1\">99202<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"99203\" id=\"form-field-field_9298b91-2\" name=\"form_fields[field_9298b91]\"> <label for=\"form-field-field_9298b91-2\">99203<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"99204\" id=\"form-field-field_9298b91-3\" name=\"form_fields[field_9298b91]\"> <label for=\"form-field-field_9298b91-3\">99204<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"99211\" id=\"form-field-field_9298b91-4\" name=\"form_fields[field_9298b91]\"> <label for=\"form-field-field_9298b91-4\">99211<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"99212\" id=\"form-field-field_9298b91-5\" name=\"form_fields[field_9298b91]\"> <label for=\"form-field-field_9298b91-5\">99212<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"99213\" id=\"form-field-field_9298b91-6\" name=\"form_fields[field_9298b91]\"> <label for=\"form-field-field_9298b91-6\">99213<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"99214\" id=\"form-field-field_9298b91-7\" name=\"form_fields[field_9298b91]\"> <label for=\"form-field-field_9298b91-7\">99214<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_02655cf elementor-col-100\">\n\t\t\t\t\t<br><hr><br>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_9155089 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9155089\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSIGNATURE DU FOURNISSEUR :\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-xs\" name=\"form_fields[field_9155089]\" id=\"form-field-field_9155089\" rows=\"4\" placeholder=\"tapez le nom complet et les r\u00e9f\u00e9rences (par exemple, Jane Doe, FNP-C)\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-25 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-lg\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-icon\">\n\t\t\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-upload\"><\/i>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">SOUMETTRE<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-e131c4b elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"e131c4b\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-d573e33\" data-id=\"d573e33\" data-element_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-f8adeb9 elementor-widget elementor-widget-spacer\" data-id=\"f8adeb9\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>DOSSIER DU PATIENT<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"folder":[],"class_list":["post-11241","page","type-page","status-publish","hentry","clearfix"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.9 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Dossier du patient - StarMed Healthcare<\/title>\n<meta name=\"description\" content=\"StarMed Family &amp; Urgent Care offre des services de m\u00e9decine du travail aux employeurs afin 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