{"id":27525,"date":"2022-06-21T10:11:59","date_gmt":"2022-06-21T10:11:59","guid":{"rendered":"https:\/\/www.cudeca.org\/?page_id=27525"},"modified":"2022-06-21T10:11:59","modified_gmt":"2022-06-21T10:11:59","slug":"paciente","status":"publish","type":"page","link":"https:\/\/www.cudeca.org\/en\/patient\/","title":{"rendered":"Patient"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column]\n                <div class='gf_browser_gecko gform_wrapper' id='gform_wrapper_21' style='display:none'><div id='gf_21' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_21'  action=\"\/en\/wp-json\/wp\/v2\/pages\/27525#gf_21\"> \r\n <input type='hidden' class='gforms-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/>\n        <div id='gf_progressbar_wrapper_21' class='gf_progressbar_wrapper'>\n            <h3 class='gf_progressbar_title'>Step 1 of 4 - Datos del Paciente\n        <\/h3>\n            <div class='gf_progressbar'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_25' style='width:25%;'><span>25%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform_body'><div id='gform_page_21_1' class='gform_page' >\n                                    <div class='gform_page_fields'><ul id='gform_fields_21' class='gform_fields top_label form_sublabel_below description_below'><li id='field_21_46'  class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'>PATIENT&#039;S PERSONAL DETAILS<\/h2><div class='gsection_description' id='gfield_description_21_46'>In this form we register personal data of a patient who is going to be attended by CUDECA Foundation. We will ask you for a photo of your identity documents, please try to have them ready.<\/div><\/li><li class=\"gfmc-column gfmc-column50 gfmc-row-1-column gfmc-row-1-col-1-of-2\"><ul class=\"flex-wrapper flex-wrapper-2\"><li id='field_21_1'  class='gfield gfield_contains_required field_sublabel_above field_description_above gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex'  >Name y Middle Name<span class='gfield_required'>*<\/span><\/label><div class='gfield_description' id='gfield_description_21_1'>This field is mandatory. \nPlease enter the same as on your identity card.<\/div><div class='ginput_complex ginput_container no_prefix has_first_name has_middle_name no_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_21_1'>\n                            \n                            <span id='input_21_1_3_container' class='name_first' >\n                                                    <label for='input_21_1_3' >Name<\/label>\n                                                    <input type='text' name='input_1.3' id='input_21_1_3' value='' aria-label='First name'   aria-required=\"true\" aria-invalid=\"false\" placeholder='Name'\/>\n                                                <\/span>\n                            <span id='input_21_1_4_container' class='name_middle' >\n                                                    <label for='input_21_1_4' >Middle name<\/label>\n                                                    <input type='text' name='input_1.4' id='input_21_1_4' value='' aria-label='Middle name'   aria-required=\"true\" aria-invalid=\"false\" placeholder='Surname'\/>\n                                                <\/span>\n                            \n                            \n                        <\/div><\/li><\/ul><\/li><li class=\"gfmc-column gfmc-column50 gfmc-row-1-column gfmc-row-1-col-2-of-2\"><ul class=\"flex-wrapper flex-wrapper-2\"><li id='field_21_93'  class='gfield field_sublabel_above field_description_above gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex'  ><\/label><div class='gfield_description' id='gfield_description_21_93'>        \n\n<\/div><div class='ginput_complex ginput_container no_prefix no_first_name no_middle_name has_last_name no_suffix gf_name_has_1 ginput_container_name' id='input_21_93'>\n                            \n                            \n                            \n                            <span id='input_21_93_6_container' class='name_last' >\n                                                            <label for='input_21_93_6' >Last name<\/label>\n                                                            <input type='text' name='input_93.6' id='input_21_93_6' value='' aria-label='Last name'    aria-invalid=\"false\" placeholder='Last name'\/>\n                                                        <\/span>\n                            \n                        <\/div><\/li><\/ul><\/li><li id='field_21_97'  class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'><\/h2><\/li><li class=\"gfmc-column gfmc-column50 gfmc-row-2-column gfmc-row-2-col-1-of-2\"><ul class=\"flex-wrapper flex-wrapper-2\"><li id='field_21_19'  class='gfield field_sublabel_below field_description_above gfield_visibility_visible' ><label class='gfield_label'  >Marital status<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_21_19'><li class='gchoice_21_19_0'><input name='input_19' type='radio' value='Married'  id='choice_21_19_0'    \/><label for='choice_21_19_0' id='label_21_19_0'>Married<\/label><\/li><li class='gchoice_21_19_1'><input name='input_19' type='radio' value='Single'  id='choice_21_19_1'    \/><label for='choice_21_19_1' id='label_21_19_1'>Single<\/label><\/li><li class='gchoice_21_19_2'><input name='input_19' type='radio' value='Widowed'  id='choice_21_19_2'    \/><label for='choice_21_19_2' id='label_21_19_2'>Widowed<\/label><\/li><li class='gchoice_21_19_3'><input name='input_19' type='radio' value='Divorced'  id='choice_21_19_3'    \/><label for='choice_21_19_3' id='label_21_19_3'>Divorced<\/label><\/li><\/ul><\/div><\/li><\/ul><\/li><li class=\"gfmc-column gfmc-column50 gfmc-row-2-column gfmc-row-2-col-2-of-2\"><ul class=\"flex-wrapper flex-wrapper-2\"><li id='field_21_27'  class='gfield field_sublabel_below field_description_above gfield_visibility_visible' ><label class='gfield_label'  >Occupation<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_21_27'><li class='gchoice_21_27_0'><input name='input_27' type='radio' value='Retired'  id='choice_21_27_0'    \/><label for='choice_21_27_0' id='label_21_27_0'>Retired<\/label><\/li><li class='gchoice_21_27_1'><input name='input_27' type='radio' value='Self-employed'  id='choice_21_27_1'    \/><label for='choice_21_27_1' id='label_21_27_1'>Self-employed<\/label><\/li><li class='gchoice_21_27_2'><input name='input_27' type='radio' value='Employed person'  id='choice_21_27_2'    \/><label for='choice_21_27_2' id='label_21_27_2'>Employed person<\/label><\/li><li class='gchoice_21_27_3'><input name='input_27' type='radio' value='Home worker'  id='choice_21_27_3'    \/><label for='choice_21_27_3' id='label_21_27_3'>Home worker<\/label><\/li><li class='gchoice_21_27_4'><input name='input_27' type='radio' value='Disability pensioner'  id='choice_21_27_4'    \/><label for='choice_21_27_4' id='label_21_27_4'>Disability pensioner<\/label><\/li><\/ul><\/div><\/li><\/ul><\/li><li id='field_21_62'  class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'><\/h2><\/li><li class=\"gfmc-column gfmc-column50 gfmc-row-3-column gfmc-row-3-col-1-of-2\"><ul class=\"flex-wrapper flex-wrapper-2\"><li id='field_21_18'  class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_21_18' >Gender<\/label><div class='ginput_container ginput_container_select'><select name='input_18' id='input_21_18' class='small gfield_select'    aria-invalid=\"false\"><option value='Male' >Male<\/option><option value='Female' >Female<\/option><option value='I do not answer' >I do not answer<\/option><\/select><\/div><\/li><\/ul><\/li><li class=\"gfmc-column gfmc-column50 gfmc-row-3-column gfmc-row-3-col-2-of-2\"><ul class=\"flex-wrapper flex-wrapper-2\"><li id='field_21_23'  class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_21_23' >Number of children<\/label><div class='ginput_container ginput_container_number'><input name='input_23' id='input_21_23' type='number' step='any' min='0' max='20' value='' class='small'      aria-invalid=\"false\" \/><div class='instruction '>Please enter a number from <strong>0<\/strong> to <strong>20<\/strong>.<\/div><\/div><\/li><\/ul><\/li><li id='field_21_69'  class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'><\/h2><\/li><li class=\"gfmc-column gfmc-column50 gfmc-row-4-column gfmc-row-4-col-1-of-2\"><ul class=\"flex-wrapper flex-wrapper-2\"><li id='field_21_26'  class='gfield field_sublabel_above field_description_above gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex'  >Country of birth<\/label>    \n                    <div class='ginput_complex ginput_container has_country ginput_container_address' id='input_21_26' >\n                        <input type='hidden' class='gform_hidden' name='input_26.4' id='input_21_26_4' value=''\/><span class='ginput_left address_country' id='input_21_26_6_container' >\n                                        <label for='input_21_26_6' id='input_21_26_6_label' >Country<\/label>\n                                        <select name='input_26.6' id='input_21_26_6'   ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darrussalam' >Brunei Darrussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Congo, Republic of the' >Congo, Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czech Republic' >Czech Republic<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini (Swaziland)' >Eswatini (Swaziland)<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard and McDonald Islands' >Heard and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macau' >Macau<\/option><option value='Macedonia' >Macedonia<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Korea' >North Korea<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Romania' >Romania<\/option><option value='Russia' >Russia<\/option><option value='Rwanda' >Rwanda<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena' >Saint Helena<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia' >South Georgia<\/option><option value='South Korea' >South Korea<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen Islands' >Svalbard and Jan Mayen Islands<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria' >Syria<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania' >Tanzania<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkey' >Turkey<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><\/select>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><\/ul><\/li><li class=\"gfmc-column gfmc-column50 gfmc-row-4-column gfmc-row-4-col-2-of-2\"><ul class=\"flex-wrapper flex-wrapper-2\"><li id='field_21_22'  class='gfield gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_21_22' >Date of birth<span class='gfield_required'>*<\/span><\/label><div class='gfield_description' id='gfield_description_21_22'>You should use two digits for the day, two for the month and four for the year, e.g. 06\/03\/1970.<\/div><div class='ginput_container ginput_container_date'>\n                            <input name='input_22' id='input_21_22' type='text' value='' class='datepicker large dmy datepicker_with_icon'    aria-describedby='input_21_22_date_format' \/>\n                            <span id='input_21_22_date_format' class='screen-reader-text'>Date Format: DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_21_22' class='gform_hidden' value='https:\/\/www.cudeca.org\/wp-content\/plugins\/gravityforms\/images\/calendar.png'\/><\/li><\/ul><\/li><li id='field_21_70'  class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'><\/h2><\/li><li id='field_21_4'  class='gfield field_sublabel_above field_description_above gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex'  >Patient&#039;s address details<\/label><div class='gfield_description' id='gfield_description_21_4'>In the address specify in this order:  \nType of street: Street, Road, Avenue, Square, etc--Street name--Street number--Dwelling details if any: doorway, flat etc.<\/div>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address' id='input_21_4' >\n                         <span class='ginput_full address_line_1' id='input_21_4_1_container' >\n                                        <label for='input_21_4_1' id='input_21_4_1_label' >Address<\/label>\n                                        <input type='text' name='input_4.1' id='input_21_4_1' value=''   placeholder='Address' \/>\n                                    <\/span><span class='ginput_full address_line_2' id='input_21_4_2_container' >\n                                        <label for='input_21_4_2' id='input_21_4_2_label' >additional information from the directorate<\/label>\n                                        <input type='text' name='input_4.2' id='input_21_4_2' value=''   placeholder='Address 2'\/>\n                                    <\/span><span class='ginput_left address_city' id='input_21_4_3_container' >\n                                    <label for='input_21_4_3' id='input_21_4_3_label' >City<\/label>\n                                    <input type='text' name='input_4.3' id='input_21_4_3' value=''   placeholder='City' \/>\n                                 <\/span><span class='ginput_right address_state' id='input_21_4_4_container' >\n                                        <label for='input_21_4_4' id='input_21_4_4_label' >Province<\/label>\n                                        <input type='text' name='input_4.4' id='input_21_4_4' value=''     placeholder='Province \/ State' \/>\n                                      <\/span><span class='ginput_left address_zip' id='input_21_4_5_container' >\n                                    <label for='input_21_4_5' id='input_21_4_5_label' >Post Code<\/label>\n                                    <input type='text' name='input_4.5' id='input_21_4_5' value=''   placeholder='Post Code' \/>\n                                <\/span><span class='ginput_right address_country' id='input_21_4_6_container' >\n                                        <label for='input_21_4_6' id='input_21_4_6_label' >Country<\/label>\n                                        <select name='input_4.6' id='input_21_4_6'   ><option value='' selected='selected'>Country<\/option><option value='Afghanistan' >Afghanistan<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darrussalam' >Brunei Darrussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Congo, Republic of the' >Congo, Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czech Republic' >Czech Republic<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini (Swaziland)' >Eswatini (Swaziland)<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard and McDonald Islands' >Heard and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macau' >Macau<\/option><option value='Macedonia' >Macedonia<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Korea' >North Korea<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Romania' >Romania<\/option><option value='Russia' >Russia<\/option><option value='Rwanda' >Rwanda<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena' >Saint Helena<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia' >South Georgia<\/option><option value='South Korea' >South Korea<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen Islands' >Svalbard and Jan Mayen Islands<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria' >Syria<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania' >Tanzania<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkey' >Turkey<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><\/select>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id='field_21_71'  class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'><\/h2><\/li><li class=\"gfmc-column gfmc-column50 gfmc-row-5-column gfmc-row-5-col-1-of-2\"><ul class=\"flex-wrapper flex-wrapper-2\"><li id='field_21_5'  class='gfield gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_21_5' >Main contact telephone number<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_5' id='input_21_5' type='tel' value='' class='medium'  placeholder='Your Phone Numer' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><\/ul><\/li><li class=\"gfmc-column gfmc-column50 gfmc-row-5-column gfmc-row-5-col-2-of-2\"><ul class=\"flex-wrapper flex-wrapper-2\"><li id='field_21_20'  class='gfield field_sublabel_below field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_21_20' >Other contact telephone number<\/label><div class='ginput_container ginput_container_phone'><input name='input_20' id='input_21_20' type='tel' value='' class='medium'  placeholder='Your Phone Numer'  aria-invalid=\"false\"  \/><\/div><\/li><\/ul><\/li><li id='field_21_2'  class='gfield field_sublabel_below field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_21_2' >E-mail<\/label><div class='gfield_description' id='gfield_description_21_2'>If you are going to use a family member's email address, it is best to have your family member fill in your form and enter the email address there.<\/div><div class='ginput_container ginput_container_email'>\n                            <input name='input_2' id='input_21_2' type='email' value='' class='small'     aria-invalid=\"false\" aria-describedby=\"gfield_description_21_2\"\/>\n                        <\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer'>\n                         <input type='button' id='gform_next_button_21_49' class='gform_next_button button' value='Siguiente '  onclick='jQuery(\"#gform_target_page_number_21\").val(\"2\");  jQuery(\"#gform_21\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_21\").val(\"2\");  jQuery(\"#gform_21\").trigger(\"submit\",[true]); } ' \/> <a href='javascript:void(0);' id='gform_save_21_2_link' class='gform_save_link'  onclick='if(window[\"gf_submitting_21\"]){return false;}  if( !jQuery(\"#gform_21\")[0].checkValidity || jQuery(\"#gform_21\")[0].checkValidity()){window[\"gf_submitting_21\"]=true;} jQuery(\"#gform_save_21\").val(1); jQuery(\"#gform_21\").trigger(\"submit\",[true]);' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_21\"]){return false;} if( !jQuery(\"#gform_21\")[0].checkValidity || jQuery(\"#gform_21\")[0].checkValidity()){window[\"gf_submitting_21\"]=true;} jQuery(\"#gform_save_21\").val(1); jQuery(\"#gform_21\").trigger(\"submit\",[true]); }'>Save and continue later<\/a>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_21_2' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_21_2' class='gform_fields top_label form_sublabel_below description_below'><li id='field_21_28'  class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'>PATIENT DOCUMENTS<\/h2><\/li><li class=\"gfmc-column gfmc-column33 gfmc-row-6-column gfmc-row-6-col-1-of-3\"><ul class=\"flex-wrapper flex-wrapper-3\"><li id='field_21_33'  class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label'  >Type of document to be used for registration<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_21_33'><li class='gchoice_21_33_0'><input name='input_33' type='radio' value='DNI or NIF'  id='choice_21_33_0'    \/><label for='choice_21_33_0' id='label_21_33_0'>DNI or NIF<\/label><\/li><li class='gchoice_21_33_1'><input name='input_33' type='radio' value='NIE'  id='choice_21_33_1'    \/><label for='choice_21_33_1' id='label_21_33_1'>NIE<\/label><\/li><li class='gchoice_21_33_2'><input name='input_33' type='radio' value='PASSPORT'  id='choice_21_33_2'    \/><label for='choice_21_33_2' id='label_21_33_2'>PASSPORT<\/label><\/li><li class='gchoice_21_33_3'><input name='input_33' type='radio' value='I HAVE NO DOCUMENTATION'  id='choice_21_33_3'    \/><label for='choice_21_33_3' id='label_21_33_3'>I HAVE NO DOCUMENTATION<\/label><\/li><\/ul><\/div><\/li><\/ul><\/li><li class=\"gfmc-column gfmc-column33 gfmc-row-6-column gfmc-row-6-col-2-of-3\"><ul class=\"flex-wrapper flex-wrapper-3\"><li id='field_21_32'  class='gfield gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_21_32' >DNI-NIF Number<span class='gfield_required'>*<\/span><\/label><div class='gfield_description' id='gfield_description_21_32'>Write only numbers and letters, do not use spaces, slashes or dashes. <\/div><div class='ginput_container ginput_container_text'><input name='input_32' id='input_21_32' type='text' value='' class='medium'  aria-describedby=\"gfield_description_21_32\"   aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><li id='field_21_53'  class='gfield gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_21_53' >NIE Number<span class='gfield_required'>*<\/span><\/label><div class='gfield_description' id='gfield_description_21_53'>Write only numbers and letters, do not use spaces, slashes or dashes. <\/div><div class='ginput_container ginput_container_text'><input name='input_53' id='input_21_53' type='text' value='' class='medium'  aria-describedby=\"gfield_description_21_53\"   aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><li id='field_21_54'  class='gfield gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_21_54' >PASSPORT Number<span class='gfield_required'>*<\/span><\/label><div class='gfield_description' id='gfield_description_21_54'>Write only numbers and letters, do not use spaces, slashes or dashes. <\/div><div class='ginput_container ginput_container_text'><input name='input_54' id='input_21_54' type='text' value='' class='medium'  aria-describedby=\"gfield_description_21_54\"   aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><\/ul><\/li><li class=\"gfmc-column gfmc-column33 gfmc-row-6-column gfmc-row-6-col-3-of-3\"><ul class=\"flex-wrapper flex-wrapper-3\"><li id='field_21_39'  class='gfield field_sublabel_below field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_21_39' >Identity Document<\/label><div class='gfield_description' id='gfield_description_21_39'>Upload a photo of your identity card here<\/div><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='20971520' \/><input name='input_39' id='input_21_39' type='file' class='large' aria-describedby='validation_message_21_39 live_validation_message_21_39 extensions_message_21_39' onchange='javascript:gformValidateFileSize( this, 20971520 );'  \/><span id='extensions_message_21_39' class='screen-reader-text'><\/span><div class='validation_message' id='live_validation_message_21_39'><\/div><\/div><\/li><\/ul><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer'>\n                        <input type='button' id='gform_previous_button_21_55' class='gform_previous_button button' value='Anterior'  onclick='jQuery(\"#gform_target_page_number_21\").val(\"1\");  jQuery(\"#gform_21\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_21\").val(\"1\");  jQuery(\"#gform_21\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_21_55' class='gform_next_button button' value='Siguiente '  onclick='jQuery(\"#gform_target_page_number_21\").val(\"3\");  jQuery(\"#gform_21\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_21\").val(\"3\");  jQuery(\"#gform_21\").trigger(\"submit\",[true]); } ' \/> <a href='javascript:void(0);' id='gform_save_21_3_link' class='gform_save_link'  onclick='if(window[\"gf_submitting_21\"]){return false;}  if( !jQuery(\"#gform_21\")[0].checkValidity || jQuery(\"#gform_21\")[0].checkValidity()){window[\"gf_submitting_21\"]=true;} jQuery(\"#gform_save_21\").val(1); jQuery(\"#gform_21\").trigger(\"submit\",[true]);' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_21\"]){return false;} if( !jQuery(\"#gform_21\")[0].checkValidity || jQuery(\"#gform_21\")[0].checkValidity()){window[\"gf_submitting_21\"]=true;} jQuery(\"#gform_save_21\").val(1); jQuery(\"#gform_21\").trigger(\"submit\",[true]); }'>Save and continue later<\/a>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_21_3' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_21_3' class='gform_fields top_label form_sublabel_below description_below'><li id='field_21_38'  class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'>HEALTH CARE DATA<\/h2><\/li><li class=\"gfmc-column gfmc-column25 gfmc-row-7-column gfmc-row-7-col-1-of-4\"><ul class=\"flex-wrapper flex-wrapper-4\"><li id='field_21_30'  class='gfield field_sublabel_below field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_21_30' >Social security number<\/label><div class='gfield_description' id='gfield_description_21_30'>Write only numbers, do not use spaces, slashes or hyphens. <\/div><div class='ginput_container ginput_container_text'><input name='input_30' id='input_21_30' type='text' value='' class='medium'  aria-describedby=\"gfield_description_21_30\"    aria-invalid=\"false\" \/><\/div><\/li><\/ul><\/li><li class=\"gfmc-column gfmc-column25 gfmc-row-7-column gfmc-row-7-col-2-of-4\"><ul class=\"flex-wrapper flex-wrapper-4\"><li id='field_21_40'  class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_21_40' >Social Security Document<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='20971520' \/><input name='input_40' id='input_21_40' type='file' class='large' aria-describedby='validation_message_21_40 live_validation_message_21_40 extensions_message_21_40' onchange='javascript:gformValidateFileSize( this, 20971520 );'  \/><span id='extensions_message_21_40' class='screen-reader-text'><\/span><div class='validation_message' id='live_validation_message_21_40'><\/div><\/div><div class='gfield_description' id='gfield_description_21_40'>Upload here a photo of the Social Security Document<\/div><\/li><\/ul><\/li><li class=\"gfmc-column gfmc-column25 gfmc-row-7-column gfmc-row-7-col-3-of-4\"><ul class=\"flex-wrapper flex-wrapper-4\"><\/ul><\/li><li class=\"gfmc-column gfmc-column25 gfmc-row-7-column gfmc-row-7-col-4-of-4\"><ul class=\"flex-wrapper flex-wrapper-4\"><li id='field_21_29'  class='gfield field_sublabel_below field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_21_29' >NUHSA Number<\/label><div class='gfield_description' id='gfield_description_21_29'>This is the Andaluc\u00eda health history number, always starting with the letters AN.\nWrite only numbers, do not use spaces, slashes or hyphens. <\/div><div class='ginput_container ginput_container_text'><input name='input_29' id='input_21_29' type='text' value='' class='medium'  aria-describedby=\"gfield_description_21_29\"    aria-invalid=\"false\" \/><\/div><\/li><\/ul><\/li><li id='field_21_85'  class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'><\/h2><\/li><li id='field_21_41'  class='gfield field_sublabel_below field_description_above gfield_visibility_visible' ><label class='gfield_label'  >Medical Reports<\/label><div class='gfield_description' id='gfield_description_21_41'>Upload here a picture of the report you think is most important for your situation. You can upload only two files<\/div><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_21_41' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_21_41&quot;,&quot;container&quot;:&quot;gform_multifile_upload_21_41&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_21_41&quot;,&quot;filelist&quot;:&quot;gform_preview_21_41&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/www.cudeca.org\\\/?gf_page=96ac8aee0a1975c&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/www.cudeca.org\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/www.cudeca.org\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;268435456b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:21,&quot;field_id&quot;:41},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;2&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_21_41&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_21_41' class='gform_drop_area'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<input id='gform_browse_button_21_41' type='button' value='Select files' class='button gform_button_select_files' aria-describedby='extensions_message_21_41'  \/>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span id='extensions_message_21_41' class='screen-reader-text'><\/span><div class='validation_message'>\n\t\t\t\t\t\t\t\t<ul id='gform_multifile_messages_21_41'>\n\t\t\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t\t<\/div><\/div><div id='gform_preview_21_41'><\/div><\/li><li id='field_21_86'  class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'><\/h2><\/li><li class=\"gfmc-column gfmc-column25 gfmc-row-8-column gfmc-row-8-col-1-of-4\"><ul class=\"flex-wrapper flex-wrapper-4\"><li id='field_21_35'  class='gfield gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible' ><label class='gfield_label'  >Health Coverage<span class='gfield_required'>*<\/span><\/label><div class='gfield_description' id='gfield_description_21_35'>Tell us who your health coverage depends on so that we can better coordinate with you.<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_21_35'><li class='gchoice_21_35_0'><input name='input_35' type='radio' value='SANIDAD P\u00daBLICA - SAS'  id='choice_21_35_0'    \/><label for='choice_21_35_0' id='label_21_35_0'>Public Health - SAS<\/label><\/li><li class='gchoice_21_35_1'><input name='input_35' type='radio' value='MUFACE'  id='choice_21_35_1'    \/><label for='choice_21_35_1' id='label_21_35_1'>MUFACE<\/label><\/li><li class='gchoice_21_35_2'><input name='input_35' type='radio' value='ISFAS'  id='choice_21_35_2'    \/><label for='choice_21_35_2' id='label_21_35_2'>ISFAS<\/label><\/li><li class='gchoice_21_35_3'><input name='input_35' type='radio' value='MUGEJU'  id='choice_21_35_3'    \/><label for='choice_21_35_3' id='label_21_35_3'>MUGEJU<\/label><\/li><li class='gchoice_21_35_4'><input name='input_35' type='radio' value='SEGURO PRIVADO SANITARIO EXCLUSIVO'  id='choice_21_35_4'    \/><label for='choice_21_35_4' id='label_21_35_4'>Exclusive Private Health Insurance<\/label><\/li><li class='gchoice_21_35_5'><input name='input_35' type='radio' value='NO TENGO ASISTENCIA SANITARIA'  id='choice_21_35_5'    \/><label for='choice_21_35_5' id='label_21_35_5'>I have no Health Care<\/label><\/li><\/ul><\/div><\/li><\/ul><\/li><li class=\"gfmc-column gfmc-column25 gfmc-row-8-column gfmc-row-8-col-2-of-4\"><ul class=\"flex-wrapper flex-wrapper-4\"><li id='field_21_34'  class='gfield field_sublabel_below field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_21_34' >Health Centre<\/label><div class='ginput_container ginput_container_select'><select name='input_34' id='input_21_34' class='small gfield_select'    aria-invalid=\"false\"><option value='Alameda' >Alameda<\/option><option value='Alcauc\u00edn' >Alcauc\u00edn<\/option><option value='Alfarnate' >Alfarnate<\/option><option value='Alfarnatejo' >Alfarnatejo<\/option><option value='Algarrobo' >Algarrobo<\/option><option value='Algarrobo Costa' >Algarrobo Costa<\/option><option value='Algatoc\u00edn' >Algatoc\u00edn<\/option><option value='Don Jos\u00e9 Molina D\u00edaz' >Don Jos\u00e9 Molina D\u00edaz<\/option><option value='Dr. Francisco Burgos Casero' >Dr. Francisco Burgos Casero<\/option><option value='Dr. Francisco Burgos Casero' >Dr. Francisco Burgos Casero<\/option><option value='Alm\u00e1char' >Alm\u00e1char<\/option><option value='Almargen' >Almargen<\/option><option value='Almog\u00eda' >Almog\u00eda<\/option><option value='Almog\u00eda' >Almog\u00eda<\/option><option value='Alora' >Alora<\/option><option value='Alozaina' >Alozaina<\/option><option value='Alpandeire' >Alpandeire<\/option><option value='Antequera' >Antequera<\/option><option value='Bobadilla Estaci\u00f3n' >Bobadilla Estaci\u00f3n<\/option><option value='Bobadilla Pueblo' >Bobadilla Pueblo<\/option><option value='Antequera Estaci\u00f3n' >Antequera Estaci\u00f3n<\/option><option value='Cartaojal' >Cartaojal<\/option><option value='Colonia Santa Ana' >Colonia Santa Ana<\/option><option value='La Joya-Nogales' >La Joya-Nogales<\/option><option value='\u00c1rchez' >\u00c1rchez<\/option><option value='Archidona' >Archidona<\/option><option value='Estaci\u00f3n de Archidona' >Estaci\u00f3n de Archidona<\/option><option value='Estaci\u00f3n Salinas' >Estaci\u00f3n Salinas<\/option><option value='Ardales' >Ardales<\/option><option value='Arenas' >Arenas<\/option><option value='Daimalos' >Daimalos<\/option><option value='Arriate' >Arriate<\/option><option value='Atajate' >Atajate<\/option><option value='Benadalid' >Benadalid<\/option><option value='Benahav\u00eds' >Benahav\u00eds<\/option><option value='Benahav\u00eds' >Benahav\u00eds<\/option><option value='Benalaur\u00eda' >Benalaur\u00eda<\/option><option value='Arroyo de la Miel-Benalm\u00e1dena' >Arroyo de la Miel-Benalm\u00e1dena<\/option><option value='Torrequebrada' >Torrequebrada<\/option><option value='Benalm\u00e1dena (Alcolea)' >Benalm\u00e1dena (Alcolea)<\/option><option value='Benamargosa' >Benamargosa<\/option><option value='Benamocarra' >Benamocarra<\/option><option value='Benaoj\u00e1n' >Benaoj\u00e1n<\/option><option value='Benarrab\u00e1' >Benarrab\u00e1<\/option><option value='El Borge' >El Borge<\/option><option value='El Burgo' >El Burgo<\/option><option value='Campillos' >Campillos<\/option><option value='Canillas de Aceituno' >Canillas de Aceituno<\/option><option value='Pasada de Granadillo' >Pasada de Granadillo<\/option><option value='Canillas de Albaida' >Canillas de Albaida<\/option><option value='Atalaya' >Atalaya<\/option><option value='Ca\u00f1ete la Real' >Ca\u00f1ete la Real<\/option><option value='Carratraca' >Carratraca<\/option><option value='Cartajima' >Cartajima<\/option><option value='C\u00e1rtama' >C\u00e1rtama<\/option><option value='C\u00e1rtama-Estaci\u00f3n' >C\u00e1rtama-Estaci\u00f3n<\/option><option value='C\u00e1rtama-Estaci\u00f3n' >C\u00e1rtama-Estaci\u00f3n<\/option><option value='Casabermeja' >Casabermeja<\/option><option value='Casabermeja' >Casabermeja<\/option><option value='Casarabonela' >Casarabonela<\/option><option value='Casares' >Casares<\/option><option value='Co\u00edn' >Co\u00edn<\/option><option value='Colmenar' >Colmenar<\/option><option value='Comares' >Comares<\/option><option value='C\u00f3mpeta' >C\u00f3mpeta<\/option><option value='Cortes de la Frontera' >Cortes de la Frontera<\/option><option value='El Colmenar' >El Colmenar<\/option><option value='La Ca\u00f1ada del Real Tesoro' >La Ca\u00f1ada del Real Tesoro<\/option><option value='Cuevas Bajas' >Cuevas Bajas<\/option><option value='Cuevas de San Marcos' >Cuevas de San Marcos<\/option><option value='Cuevas del Becerro' >Cuevas del Becerro<\/option><option value='C\u00fatar' >C\u00fatar<\/option><option value='Cancelada' >Cancelada<\/option><option value='Estepona' >Estepona<\/option><option value='La Lobilla' >La Lobilla<\/option><option value='Faraj\u00e1n' >Faraj\u00e1n<\/option><option value='Frigiliana' >Frigiliana<\/option><option value='Fuengirola-Oeste' >Fuengirola-Oeste<\/option><option value='Los Boliches' >Los Boliches<\/option><option value='Fuente de Piedra' >Fuente de Piedra<\/option><option value='Gauc\u00edn' >Gauc\u00edn<\/option><option value='Genalguacil' >Genalguacil<\/option><option value='Guaro' >Guaro<\/option><option value='Humilladero' >Humilladero<\/option><option value='Los Carvajales' >Los Carvajales<\/option><option value='Igualeja' >Igualeja<\/option><option value='Ist\u00e1n' >Ist\u00e1n<\/option><option value='Iznate' >Iznate<\/option><option value='Jimera de L\u00edbar' >Jimera de L\u00edbar<\/option><option value='Jubrique' >Jubrique<\/option><option value='J\u00fazcar' >J\u00fazcar<\/option><option value='Benaque' >Benaque<\/option><option value='Macharaviaya' >Macharaviaya<\/option><option value='Campanillas' >Campanillas<\/option><option value='Churriana' >Churriana<\/option><option value='Capuchinos' >Capuchinos<\/option><option value='Carlinda' >Carlinda<\/option><option value='Carranque' >Carranque<\/option><option value='Ciudad Jard\u00edn (Guadalmedina)' >Ciudad Jard\u00edn (Guadalmedina)<\/option><option value='Colonia Santa In\u00e9s-Teatinos' >Colonia Santa In\u00e9s-Teatinos<\/option><option value='Cruz de Humilladero' >Cruz de Humilladero<\/option><option value='Delicias M\u00e1laga' >Delicias M\u00e1laga<\/option><option value='El Palo' >El Palo<\/option><option value='Huelin' >Huelin<\/option><option value='La Luz (Los Girasoles)' >La Luz (Los Girasoles)<\/option><option value='La Roca' >La Roca<\/option><option value='Limonar' >Limonar<\/option><option value='Miraflores de los \u00c1ngeles' >Miraflores de los \u00c1ngeles<\/option><option value='Nueva M\u00e1laga' >Nueva M\u00e1laga<\/option><option value='Palma-Palmilla' >Palma-Palmilla<\/option><option value='Perchel' >Perchel<\/option><option value='Portada Alta' >Portada Alta<\/option><option value='Puerta Blanca' >Puerta Blanca<\/option><option value='San Andr\u00e9s-Torcal' >San Andr\u00e9s-Torcal<\/option><option value='Tiro de Pich\u00f3n' >Tiro de Pich\u00f3n<\/option><option value='Trinidad Jes\u00fas Cautivo' >Trinidad Jes\u00fas Cautivo<\/option><option value='Victoria' >Victoria<\/option><option value='Santa Rosal\u00eda' >Santa Rosal\u00eda<\/option><option value='Ol\u00edas' >Ol\u00edas<\/option><option value='Puerto de la Torre' >Puerto de la Torre<\/option><option value='Manilva' >Manilva<\/option><option value='San Luis de Sabinillas' >San Luis de Sabinillas<\/option><option value='Las Chapas' >Las Chapas<\/option><option value='Las Albarizas' >Las Albarizas<\/option><option value='' ><\/option><option value='Leganitos' >Leganitos<\/option><option value='' ><\/option><option value='La Campana (Nueva Andaluc\u00eda)' >La Campana (Nueva Andaluc\u00eda)<\/option><option value='San Pedro de Alc\u00e1ntara' >San Pedro de Alc\u00e1ntara<\/option><option value='La Cala' >La Cala<\/option><option value='Mijas Pueblo' >Mijas Pueblo<\/option><option value='Las Lagunas' >Las Lagunas<\/option><option value='Moclinejo' >Moclinejo<\/option><option value='Vald\u00e9s' >Vald\u00e9s<\/option><option value='Mollina' >Mollina<\/option><option value='Monda' >Monda<\/option><option value='Montejaque' >Montejaque<\/option><option value='Maro' >Maro<\/option><option value='Nerja' >Nerja<\/option><option value='Oj\u00e9n' >Oj\u00e9n<\/option><option value='Parauta' >Parauta<\/option><option value='Mondr\u00f3n' >Mondr\u00f3n<\/option><option value='Periana' >Periana<\/option><option value='Pizarra' >Pizarra<\/option><option value='Pizarra' >Pizarra<\/option><option value='P\u00fajerra' >P\u00fajerra<\/option><option value='Benagalb\u00f3n' >Benagalb\u00f3n<\/option><option value='Cala del Moral' >Cala del Moral<\/option><option value='Rinc\u00f3n de la Victoria' >Rinc\u00f3n de la Victoria<\/option><option value='Torre de Benagalb\u00f3n' >Torre de Benagalb\u00f3n<\/option><option value='Riogordo' >Riogordo<\/option><option value='La Cimada-Los Prados' >La Cimada-Los Prados<\/option><option value='Montecorto' >Montecorto<\/option><option value='Ronda-Norte' >Ronda-Norte<\/option><option value='Ronda-Sur Santa B\u00e1rbara' >Ronda-Sur Santa B\u00e1rbara<\/option><option value='Serrato' >Serrato<\/option><option value='Salares' >Salares<\/option><option value='Corumbela' >Corumbela<\/option><option value='Sayalonga' >Sayalonga<\/option><option value='Sedella' >Sedella<\/option><option value='Navahermosa' >Navahermosa<\/option><option value='Sierra de Yeguas Manuel Ram\u00f3n Bernal P\u00e1ez' >Sierra de Yeguas Manuel Ram\u00f3n Bernal P\u00e1ez<\/option><option value='Teba' >Teba<\/option><option value='Tolox' >Tolox<\/option><option value='La Carihuela' >La Carihuela<\/option><option value='San Miguel' >San Miguel<\/option><option value='El Morche' >El Morche<\/option><option value='Torrox' >Torrox<\/option><option value='Total\u00e1n' >Total\u00e1n<\/option><option value='Valle de Abdalaj\u00eds' >Valle de Abdalaj\u00eds<\/option><option value='Almayate Alto' >Almayate Alto<\/option><option value='Benajarafe' >Benajarafe<\/option><option value='Cajiz' >Cajiz<\/option><option value='Caleta de V\u00e9lez' >Caleta de V\u00e9lez<\/option><option value='Algarrobo Costa' >Algarrobo Costa<\/option><option value='Torre del Mar' >Torre del Mar<\/option><option value='Triana' >Triana<\/option><option value='V\u00e9lez-M\u00e1laga Norte' >V\u00e9lez-M\u00e1laga Norte<\/option><option value='V\u00e9lez-M\u00e1laga Sur' >V\u00e9lez-M\u00e1laga Sur<\/option><option value='Villanueva de Algaidas' >Villanueva de Algaidas<\/option><option value='Villanueva de la Concepci\u00f3n' >Villanueva de la Concepci\u00f3n<\/option><option value='Villanueva de Tapia' >Villanueva de Tapia<\/option><option value='Villanueva del Rosario' >Villanueva del Rosario<\/option><option value='Villanueva del Trabuco' >Villanueva del Trabuco<\/option><option value='Los Romanes' >Los Romanes<\/option><option value='Vi\u00f1uela' >Vi\u00f1uela<\/option><option value='Yunquera' >Yunquera<\/option><\/select><\/div><\/li><\/ul><\/li><li class=\"gfmc-column gfmc-column25 gfmc-row-8-column gfmc-row-8-col-3-of-4\"><ul class=\"flex-wrapper flex-wrapper-4\"><li id='field_21_37'  class='gfield field_sublabel_below field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_21_37' >Details of your Health Insurance Company (Mutual Insurance Company for Civil Servants)<\/label><div class='gfield_description' id='gfield_description_21_37'>You have indicated that you are a member of a health insurance company, please give us the name of the health insurance company that is 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casy you do not agree with then, we will not be able to record your personal data and our service will not be available.<\/div><\/li><li id='field_21_103'  class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label'  >CONSENT TO POLICY PRIVACY<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_consent'><input name='input_103.1' id='input_21_103_1' type='checkbox' value='1'  aria-describedby='gfield_consent_description_21_103' aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gfield_consent_label\" for='input_21_103_1' ><font color=red>I agree to the privacy policy<\/font><\/label><input type='hidden' name='input_103.2' value='&lt;font color=red&gt;I agree to the privacy policy&lt;\/font&gt;' class='gform_hidden' \/><input type='hidden' name='input_103.3' value='61' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_21_103'>Our privacy policy is available in this link:  <a href=\"https:\/\/www.cudeca.org\/en\/politica-de-privacidad\/\"> Privacy policy - Cudeca Cancer Care Hospice<\/a><\/div><\/li><li id='field_21_104'  class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label'  >CONSENT TRANSFER PERSONAL DATA<\/label><div class='ginput_container ginput_container_consent'><input name='input_104.1' id='input_21_104_1' type='checkbox' value='1'  aria-describedby='gfield_consent_description_21_104'  aria-invalid=\"false\"   \/> <label class=\"gfield_consent_label\" for='input_21_104_1' ><font color=red>Check this box to receive information about our special care and the different activities we organize via email and\/or phone<\/font><\/label><input type='hidden' name='input_104.2' value='&lt;font color=red&gt;Check this box to receive information about our special care and the different activities we organize via email and\/or phone&lt;\/font&gt;' class='gform_hidden' \/><input type='hidden' name='input_104.3' value='61' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_21_104'>The full text of the consent to be signed is available at this link:<br \/>\n<a href=\"https:\/\/www.cudeca.org\/wp-content\/uploads\/2022\/03\/Consentimiento-cesion-datos-personales-del-paciente-v_inglesa.docx\">CONSENT FOR THE TRANSFER OF PERSONAL DATA<\/a><br \/>\n<\/div><\/li><li id='field_21_106'  class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_21_106' >CAPTCHA<\/label><div id='input_21_106' class='ginput_container ginput_recaptcha' data-sitekey='6LfZCkQsAAAAAPQCM5nA78jklRamDtzgIKY4iWbA'  data-theme='light' data-tabindex='0'  data-badge=''><\/div><\/li><li id='field_21_105'  class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'>LEGAL DISCLAIMER<\/h2><div class='gsection_description' id='gfield_description_21_105'><font size=-1> In accordance with the provisions of the regulations in force on the protection of personal data, Regulation (EU) 2016\/679 of April 27, 2016 (GDPR) and the Spanish Organic Law 3\/2018 of December 5 on Data Protection and Guarantee of Digital Rights (LOPDGDDD), we inform you that FUNDACION CUDECA is responsible for the treatment of personal data for administrative, statistical and information purposes. 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