{"id":366,"date":"2024-01-16T18:18:13","date_gmt":"2024-01-16T17:18:13","guid":{"rendered":"https:\/\/www.sagefemme-toulouse.fr\/?page_id=366"},"modified":"2024-01-16T18:19:58","modified_gmt":"2024-01-16T17:19:58","slug":"consultations-prenatales-et-suivi-de-grossesse-2","status":"publish","type":"page","link":"https:\/\/www.sagefemme-toulouse.fr\/index.php\/consultations-prenatales-et-suivi-de-grossesse-2\/","title":{"rendered":"Fiche de renseignements"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"366\" class=\"elementor elementor-366\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b38ecf4 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"b38ecf4\" 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-eff2442\" data-id=\"eff2442\" 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-7d2f8a3 elementor-widget elementor-widget-wp-widget-wpforms-widget\" data-id=\"7d2f8a3\" data-element_type=\"widget\" data-widget_type=\"wp-widget-wpforms-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-351\"><form id=\"wpforms-form-351\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"351\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/366\" data-token=\"3b1bcfaf9e062181bb5092956c3adb51\"><noscript class=\"wpforms-error-noscript\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/noscript><div class=\"wpforms-hidden\" id=\"wpforms-error-noscript\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/div><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#066aab\" data-scroll=\"1\" role=\"progressbar\" aria-valuenow=\"1\" aria-valuemin=\"1\" aria-valuemax=\"3\" tabindex=\"-1\"><span class=\"wpforms-page-indicator-page-title\" data-page-3-title=\"GROSSESSE ACTUELLE\"><\/span><span class=\"wpforms-page-indicator-page-title-sep\" style=\"display:none;\"> - <\/span><span class=\"wpforms-page-indicator-steps\">\u00c9tape <span class=\"wpforms-page-indicator-steps-current\">1<\/span> sur 3<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:33.333333333333%;background-color:#066aab\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-351-field_18-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"18\"><\/div><div id=\"wpforms-351-field_4-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"4\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-351-field_4\" aria-hidden=\"false\">Mise en page<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-33-33-33\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-351-field_3-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-351-field_3\">Nom de jeune fille<\/label><input type=\"text\" id=\"wpforms-351-field_3\" class=\"wpforms-field-medium\" name=\"wpforms[fields][3]\" aria-errormessage=\"wpforms-351-field_3-error\" ><\/div><div id=\"wpforms-351-field_2-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-351-field_2\">Nom d&#039;\u00e9pouse<\/label><input type=\"text\" id=\"wpforms-351-field_2\" class=\"wpforms-field-small\" name=\"wpforms[fields][2]\" aria-errormessage=\"wpforms-351-field_2-error\" ><\/div><div id=\"wpforms-351-field_8-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-351-field_8\">Pr\u00e9nom<\/label><input type=\"text\" id=\"wpforms-351-field_8\" class=\"wpforms-field-small\" name=\"wpforms[fields][8]\" aria-errormessage=\"wpforms-351-field_8-error\" ><\/div><div id=\"wpforms-351-field_10-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-351-field_10\">Date de naissance<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-351-field_10\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"d\/m\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][10][date]\" aria-errormessage=\"wpforms-351-field_10-error\" ><a title=\"Effacer la date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-351-field_15-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-351-field_15\">T\u00e9l\u00e9phone<\/label><input type=\"tel\" id=\"wpforms-351-field_15\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][15]\" aria-errormessage=\"wpforms-351-field_15-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-351-field_14-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"14\"><fieldset><legend class=\"wpforms-field-label\">Adresse<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-351-field_14\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][14][address1]\" aria-errormessage=\"wpforms-351-field_14-error\" ><label for=\"wpforms-351-field_14\" class=\"wpforms-field-sublabel after \">Adresse ligne\u00a01<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-351-field_14-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][14][city]\" aria-errormessage=\"wpforms-351-field_14-city-error\" ><label for=\"wpforms-351-field_14-city\" class=\"wpforms-field-sublabel after \">Ville<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-351-field_14-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][14][state]\" value=\"France\" aria-errormessage=\"wpforms-351-field_14-state-error\" ><label for=\"wpforms-351-field_14-state\" class=\"wpforms-field-sublabel after \">\u00c9tat \/ Province \/ R\u00e9gion<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-351-field_14-postal\" class=\"wpforms-field-address-postal\" name=\"wpforms[fields][14][postal]\" aria-errormessage=\"wpforms-351-field_14-postal-error\" ><label for=\"wpforms-351-field_14-postal\" class=\"wpforms-field-sublabel after \">Code postal<\/label><\/div><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><\/div><\/div><\/div><div id=\"wpforms-351-field_5-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"5\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-351-field_5\" aria-hidden=\"false\">Mise en page<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-33-33-33\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-351-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-351-field_11\">Nom de l&#039;enfant<\/label><input type=\"text\" id=\"wpforms-351-field_11\" class=\"wpforms-field-small\" name=\"wpforms[fields][11]\" aria-errormessage=\"wpforms-351-field_11-error\" ><\/div><div id=\"wpforms-351-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-351-field_12\">Pr\u00e9nom de l&#039;enfant<\/label><input type=\"text\" id=\"wpforms-351-field_12\" class=\"wpforms-field-small\" name=\"wpforms[fields][12]\" aria-errormessage=\"wpforms-351-field_12-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-351-field_71-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"71\"><label class=\"wpforms-field-label\" for=\"wpforms-351-field_71\">Profession P\u00e8re<\/label><input type=\"text\" id=\"wpforms-351-field_71\" class=\"wpforms-field-small\" name=\"wpforms[fields][71]\" aria-errormessage=\"wpforms-351-field_71-error\" ><\/div><div id=\"wpforms-351-field_70-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"70\"><label class=\"wpforms-field-label\" for=\"wpforms-351-field_70\">Profession M\u00e8re<\/label><input type=\"text\" id=\"wpforms-351-field_70\" class=\"wpforms-field-small\" name=\"wpforms[fields][70]\" aria-errormessage=\"wpforms-351-field_70-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-351-field_72-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"72\"><fieldset><legend class=\"wpforms-field-label\">Sexe <\/legend><ul id=\"wpforms-351-field_72\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_72_1\" name=\"wpforms[fields][72][]\" value=\"G\" aria-errormessage=\"wpforms-351-field_72_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_72_1\">G<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_72_2\" name=\"wpforms[fields][72][]\" value=\"F\" aria-errormessage=\"wpforms-351-field_72_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_72_2\">F<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-351-field_20-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"20\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"1\" data-formid=\"351\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Suivant<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-351-field_22-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"22\"><div id=\"wpforms-351-field_22\" class=\"wpforms-field-medium wpforms-field-row\" name=\"wpforms[fields][22]\" aria-errormessage=\"wpforms-351-field_22-error\"><h4>ANTECEDENTS<\/h4>\n<p>&nbsp;<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-351-field_24-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"24\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-351-field_24\" aria-hidden=\"false\">Mise en page<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-351-field_51-container\" class=\"wpforms-field wpforms-field-richtext wpforms-field-medium\" data-field-id=\"51\"><fieldset><legend class=\"wpforms-field-label\">M\u00e9dicaux<\/legend><div id=\"wp-wpforms-351-field_51-wrap\" class=\"wp-core-ui wp-editor-wrap tmce-active\"><link rel='stylesheet' id='dashicons-css' href='https:\/\/www.sagefemme-toulouse.fr\/wp-includes\/css\/dashicons.min.css?ver=6.4.8' type='text\/css' media='all' \/>\n<link rel='stylesheet' id='editor-buttons-css' href='https:\/\/www.sagefemme-toulouse.fr\/wp-includes\/css\/editor.min.css?ver=6.4.8' type='text\/css' media='all' \/>\n<style>.wpforms-field-richtext .insert-media.add_media { display: none !important; }<\/style>\n<div id=\"wp-wpforms-351-field_51-editor-tools\" class=\"wp-editor-tools hide-if-no-js\"><div class=\"wp-editor-tabs\"><button type=\"button\" id=\"wpforms-351-field_51-tmce\" class=\"wp-switch-editor switch-tmce\" data-wp-editor-id=\"wpforms-351-field_51\">Visuel<\/button>\n<button type=\"button\" id=\"wpforms-351-field_51-html\" class=\"wp-switch-editor switch-html\" data-wp-editor-id=\"wpforms-351-field_51\">Texte<\/button>\n<\/div>\n<\/div>\n<div id=\"wp-wpforms-351-field_51-editor-container\" class=\"wp-editor-container\"><div id=\"qt_wpforms-351-field_51_toolbar\" class=\"quicktags-toolbar hide-if-no-js\"><\/div><textarea class=\"wp-editor-area\" style=\"height: 120px\" autocomplete=\"off\" cols=\"40\" name=\"wpforms[fields][51]\" id=\"wpforms-351-field_51\"><\/textarea><\/div>\n<\/div>\n\n<\/fieldset><\/div><div id=\"wpforms-351-field_53-container\" class=\"wpforms-field wpforms-field-richtext wpforms-field-medium\" data-field-id=\"53\"><fieldset><legend class=\"wpforms-field-label\">Chirurgicaux<\/legend><div id=\"wp-wpforms-351-field_53-wrap\" class=\"wp-core-ui wp-editor-wrap tmce-active\"><style>.wpforms-field-richtext .insert-media.add_media { display: none !important; }<\/style>\n<div id=\"wp-wpforms-351-field_53-editor-tools\" class=\"wp-editor-tools hide-if-no-js\"><div class=\"wp-editor-tabs\"><button type=\"button\" id=\"wpforms-351-field_53-tmce\" class=\"wp-switch-editor switch-tmce\" data-wp-editor-id=\"wpforms-351-field_53\">Visuel<\/button>\n<button type=\"button\" id=\"wpforms-351-field_53-html\" class=\"wp-switch-editor switch-html\" data-wp-editor-id=\"wpforms-351-field_53\">Texte<\/button>\n<\/div>\n<\/div>\n<div id=\"wp-wpforms-351-field_53-editor-container\" class=\"wp-editor-container\"><div id=\"qt_wpforms-351-field_53_toolbar\" class=\"quicktags-toolbar hide-if-no-js\"><\/div><textarea class=\"wp-editor-area\" style=\"height: 120px\" autocomplete=\"off\" cols=\"40\" name=\"wpforms[fields][53]\" id=\"wpforms-351-field_53\"><\/textarea><\/div>\n<\/div>\n\n<\/fieldset><\/div><div id=\"wpforms-351-field_52-container\" class=\"wpforms-field wpforms-field-richtext wpforms-field-medium\" data-field-id=\"52\"><fieldset><legend class=\"wpforms-field-label\">Gyn\u00e9cologiques<\/legend><div id=\"wp-wpforms-351-field_52-wrap\" class=\"wp-core-ui wp-editor-wrap tmce-active\"><style>.wpforms-field-richtext .insert-media.add_media { display: none !important; }<\/style>\n<div id=\"wp-wpforms-351-field_52-editor-tools\" class=\"wp-editor-tools hide-if-no-js\"><div class=\"wp-editor-tabs\"><button type=\"button\" id=\"wpforms-351-field_52-tmce\" class=\"wp-switch-editor switch-tmce\" data-wp-editor-id=\"wpforms-351-field_52\">Visuel<\/button>\n<button type=\"button\" id=\"wpforms-351-field_52-html\" class=\"wp-switch-editor switch-html\" data-wp-editor-id=\"wpforms-351-field_52\">Texte<\/button>\n<\/div>\n<\/div>\n<div id=\"wp-wpforms-351-field_52-editor-container\" class=\"wp-editor-container\"><div id=\"qt_wpforms-351-field_52_toolbar\" class=\"quicktags-toolbar hide-if-no-js\"><\/div><textarea class=\"wp-editor-area\" style=\"height: 120px\" autocomplete=\"off\" cols=\"40\" name=\"wpforms[fields][52]\" id=\"wpforms-351-field_52\"><\/textarea><\/div>\n<\/div>\n\n<\/fieldset><\/div><div id=\"wpforms-351-field_54-container\" class=\"wpforms-field wpforms-field-richtext wpforms-field-medium\" data-field-id=\"54\"><fieldset><legend class=\"wpforms-field-label\">Obst\u00e9tricaux<\/legend><div id=\"wp-wpforms-351-field_54-wrap\" class=\"wp-core-ui wp-editor-wrap tmce-active\"><style>.wpforms-field-richtext .insert-media.add_media { display: none !important; }<\/style>\n<div id=\"wp-wpforms-351-field_54-editor-tools\" class=\"wp-editor-tools hide-if-no-js\"><div class=\"wp-editor-tabs\"><button type=\"button\" id=\"wpforms-351-field_54-tmce\" class=\"wp-switch-editor switch-tmce\" data-wp-editor-id=\"wpforms-351-field_54\">Visuel<\/button>\n<button type=\"button\" id=\"wpforms-351-field_54-html\" class=\"wp-switch-editor switch-html\" data-wp-editor-id=\"wpforms-351-field_54\">Texte<\/button>\n<\/div>\n<\/div>\n<div id=\"wp-wpforms-351-field_54-editor-container\" class=\"wp-editor-container\"><div id=\"qt_wpforms-351-field_54_toolbar\" class=\"quicktags-toolbar hide-if-no-js\"><\/div><textarea class=\"wp-editor-area\" style=\"height: 120px\" autocomplete=\"off\" cols=\"40\" name=\"wpforms[fields][54]\" id=\"wpforms-351-field_54\"><\/textarea><\/div>\n<\/div>\n\n<\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-351-field_55-container\" class=\"wpforms-field wpforms-field-richtext wpforms-field-medium\" data-field-id=\"55\"><fieldset><legend class=\"wpforms-field-label\">Allergies<\/legend><div id=\"wp-wpforms-351-field_55-wrap\" class=\"wp-core-ui wp-editor-wrap tmce-active\"><style>.wpforms-field-richtext .insert-media.add_media { display: none !important; }<\/style>\n<div id=\"wp-wpforms-351-field_55-editor-tools\" class=\"wp-editor-tools hide-if-no-js\"><div class=\"wp-editor-tabs\"><button type=\"button\" id=\"wpforms-351-field_55-tmce\" class=\"wp-switch-editor switch-tmce\" data-wp-editor-id=\"wpforms-351-field_55\">Visuel<\/button>\n<button type=\"button\" id=\"wpforms-351-field_55-html\" class=\"wp-switch-editor switch-html\" data-wp-editor-id=\"wpforms-351-field_55\">Texte<\/button>\n<\/div>\n<\/div>\n<div id=\"wp-wpforms-351-field_55-editor-container\" class=\"wp-editor-container\"><div id=\"qt_wpforms-351-field_55_toolbar\" class=\"quicktags-toolbar hide-if-no-js\"><\/div><textarea class=\"wp-editor-area\" style=\"height: 120px\" autocomplete=\"off\" cols=\"40\" name=\"wpforms[fields][55]\" id=\"wpforms-351-field_55\"><\/textarea><\/div>\n<\/div>\n\n<\/fieldset><\/div><div id=\"wpforms-351-field_68-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"68\"><fieldset><legend class=\"wpforms-field-label\">Groupe Sanguin<\/legend><ul id=\"wpforms-351-field_68\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_68_1\" name=\"wpforms[fields][68][]\" value=\"A\" aria-errormessage=\"wpforms-351-field_68_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_68_1\">A<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_68_2\" name=\"wpforms[fields][68][]\" value=\"B\" aria-errormessage=\"wpforms-351-field_68_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_68_2\">B<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_68_3\" name=\"wpforms[fields][68][]\" value=\"O\" aria-errormessage=\"wpforms-351-field_68_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_68_3\">O<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_68_4\" name=\"wpforms[fields][68][]\" value=\"AB\" aria-errormessage=\"wpforms-351-field_68_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_68_4\">AB<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_68_5\" name=\"wpforms[fields][68][]\" value=\"Rh\u00e9sus +\" aria-errormessage=\"wpforms-351-field_68_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_68_5\">Rh\u00e9sus +<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_68_6\" name=\"wpforms[fields][68][]\" value=\"Rh\u00e9sus -\" aria-errormessage=\"wpforms-351-field_68_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_68_6\">Rh\u00e9sus -<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-351-field_56-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-trigger\" data-field-id=\"56\"><fieldset><legend class=\"wpforms-field-label\">Tabac<\/legend><ul id=\"wpforms-351-field_56\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_56_1\" name=\"wpforms[fields][56][]\" value=\"Oui\" aria-errormessage=\"wpforms-351-field_56_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_56_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_56_2\" name=\"wpforms[fields][56][]\" value=\"Non\" aria-errormessage=\"wpforms-351-field_56_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_56_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-351-field_61-container\" class=\"wpforms-field wpforms-field-number wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"61\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-351-field_61\">Cigarettes par jour<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-351-field_61\" class=\"wpforms-field-medium\" name=\"wpforms[fields][61]\" aria-errormessage=\"wpforms-351-field_61-error\" ><\/div><div id=\"wpforms-351-field_57-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-trigger\" data-field-id=\"57\"><fieldset><legend class=\"wpforms-field-label\">Herp\u00e8s g\u00e9nital<\/legend><ul id=\"wpforms-351-field_57\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_57_1\" name=\"wpforms[fields][57][]\" value=\"Oui\" aria-errormessage=\"wpforms-351-field_57_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_57_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_57_2\" name=\"wpforms[fields][57][]\" value=\"Non\" aria-errormessage=\"wpforms-351-field_57_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_57_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-351-field_33-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"33\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-351-field_33\">Details<\/label><input type=\"text\" id=\"wpforms-351-field_33\" class=\"wpforms-field-medium\" name=\"wpforms[fields][33]\" aria-errormessage=\"wpforms-351-field_33-error\" ><\/div><div id=\"wpforms-351-field_58-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-trigger\" data-field-id=\"58\"><fieldset><legend class=\"wpforms-field-label\">ATCD Transfusion<\/legend><ul id=\"wpforms-351-field_58\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_58_1\" name=\"wpforms[fields][58][]\" value=\"Oui\" aria-errormessage=\"wpforms-351-field_58_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_58_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_58_2\" name=\"wpforms[fields][58][]\" value=\"Non\" aria-errormessage=\"wpforms-351-field_58_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_58_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-351-field_59-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"59\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-351-field_59\">D\u00e9tails <\/label><input type=\"text\" id=\"wpforms-351-field_59\" class=\"wpforms-field-medium\" name=\"wpforms[fields][59]\" aria-errormessage=\"wpforms-351-field_59-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-351-field_17-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"17\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"2\" data-formid=\"351\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Suivant<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3 last \" data-page=\"3\" style=\"display:none;\"><div id=\"wpforms-351-field_6-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"6\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-351-field_6\" aria-hidden=\"false\">Mise en page<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-33-33-33\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-351-field_62-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"62\"><label class=\"wpforms-field-label\" for=\"wpforms-351-field_62\">DDR<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-351-field_62\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][62][date]\" aria-errormessage=\"wpforms-351-field_62-error\" ><a title=\"Effacer la date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-351-field_63-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"63\"><label class=\"wpforms-field-label\" for=\"wpforms-351-field_63\">DDG<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-351-field_63\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][63][date]\" aria-errormessage=\"wpforms-351-field_63-error\" ><a title=\"Effacer la date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-351-field_64-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"64\"><label class=\"wpforms-field-label\" for=\"wpforms-351-field_64\">TP<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-351-field_64\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][64][date]\" aria-errormessage=\"wpforms-351-field_64-error\" ><a title=\"Effacer la date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-351-field_48-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"48\"><label class=\"wpforms-field-label\" for=\"wpforms-351-field_48\">Taille<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-351-field_48\" class=\"wpforms-field-medium\" name=\"wpforms[fields][48]\" aria-errormessage=\"wpforms-351-field_48-error\" ><\/div><div id=\"wpforms-351-field_49-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"49\"><label class=\"wpforms-field-label\" for=\"wpforms-351-field_49\">Poids<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-351-field_49\" class=\"wpforms-field-medium\" name=\"wpforms[fields][49]\" aria-errormessage=\"wpforms-351-field_49-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-351-field_44-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-trigger\" data-field-id=\"44\"><fieldset><legend class=\"wpforms-field-label\">Pr\u00e9paration accouchement<\/legend><ul id=\"wpforms-351-field_44\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_44_1\" name=\"wpforms[fields][44][]\" value=\"Oui\" aria-errormessage=\"wpforms-351-field_44_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_44_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_44_2\" name=\"wpforms[fields][44][]\" value=\"Non\" aria-errormessage=\"wpforms-351-field_44_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_44_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-351-field_45-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"45\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-351-field_45\">Effectu\u00e9e avec<\/label><input type=\"text\" id=\"wpforms-351-field_45\" class=\"wpforms-field-medium\" name=\"wpforms[fields][45]\" aria-errormessage=\"wpforms-351-field_45-error\" ><\/div><div id=\"wpforms-351-field_69-container\" class=\"wpforms-field wpforms-field-richtext wpforms-field-medium\" data-field-id=\"69\"><fieldset><legend class=\"wpforms-field-label\">Grossesse actuelle<\/legend><div id=\"wp-wpforms-351-field_69-wrap\" class=\"wp-core-ui wp-editor-wrap tmce-active\"><style>.wpforms-field-richtext .insert-media.add_media { display: none !important; }<\/style>\n<div id=\"wp-wpforms-351-field_69-editor-tools\" class=\"wp-editor-tools hide-if-no-js\"><div class=\"wp-editor-tabs\"><button type=\"button\" id=\"wpforms-351-field_69-tmce\" class=\"wp-switch-editor switch-tmce\" data-wp-editor-id=\"wpforms-351-field_69\">Visuel<\/button>\n<button type=\"button\" id=\"wpforms-351-field_69-html\" class=\"wp-switch-editor switch-html\" data-wp-editor-id=\"wpforms-351-field_69\">Texte<\/button>\n<\/div>\n<\/div>\n<div id=\"wp-wpforms-351-field_69-editor-container\" class=\"wp-editor-container\"><div id=\"qt_wpforms-351-field_69_toolbar\" class=\"quicktags-toolbar hide-if-no-js\"><\/div><textarea class=\"wp-editor-area\" style=\"height: 120px\" autocomplete=\"off\" cols=\"40\" name=\"wpforms[fields][69]\" id=\"wpforms-351-field_69\"><\/textarea><\/div>\n<\/div>\n\n<\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-351-field_40-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"40\"><fieldset><legend class=\"wpforms-field-label\">Toxo<\/legend><ul id=\"wpforms-351-field_40\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_40_1\" name=\"wpforms[fields][40][]\" value=\"IA\" aria-errormessage=\"wpforms-351-field_40_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_40_1\">IA<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_40_2\" name=\"wpforms[fields][40][]\" value=\"NI\" aria-errormessage=\"wpforms-351-field_40_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_40_2\">NI<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-351-field_41-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"41\"><fieldset><legend class=\"wpforms-field-label\">Rub\u00e9ole<\/legend><ul id=\"wpforms-351-field_41\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_41_1\" name=\"wpforms[fields][41][]\" value=\"IA\" aria-errormessage=\"wpforms-351-field_41_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_41_1\">IA<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_41_2\" name=\"wpforms[fields][41][]\" value=\"NI\" aria-errormessage=\"wpforms-351-field_41_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_41_2\">NI<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-351-field_42-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"42\"><fieldset><legend class=\"wpforms-field-label\">HIV<\/legend><ul id=\"wpforms-351-field_42\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_42_1\" name=\"wpforms[fields][42][]\" value=\"Positif\" aria-errormessage=\"wpforms-351-field_42_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_42_1\">Positif<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_42_2\" name=\"wpforms[fields][42][]\" value=\"N\u00e9gatif\" aria-errormessage=\"wpforms-351-field_42_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_42_2\">N\u00e9gatif<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-351-field_65-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"65\"><fieldset><legend class=\"wpforms-field-label\">Ag HbS<\/legend><ul id=\"wpforms-351-field_65\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_65_1\" name=\"wpforms[fields][65][]\" value=\"Positif\" aria-errormessage=\"wpforms-351-field_65_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_65_1\">Positif<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_65_2\" name=\"wpforms[fields][65][]\" value=\"N\u00e9gatif\" aria-errormessage=\"wpforms-351-field_65_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_65_2\">N\u00e9gatif<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-351-field_66-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"66\"><fieldset><legend class=\"wpforms-field-label\">H\u00e9patite C<\/legend><ul id=\"wpforms-351-field_66\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_66_1\" name=\"wpforms[fields][66][]\" value=\"Positif\" aria-errormessage=\"wpforms-351-field_66_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_66_1\">Positif<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_66_2\" name=\"wpforms[fields][66][]\" value=\"N\u00e9gatif\" aria-errormessage=\"wpforms-351-field_66_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_66_2\">N\u00e9gatif<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-351-field_67-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"67\"><fieldset><legend class=\"wpforms-field-label\">Syphilis<\/legend><ul id=\"wpforms-351-field_67\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_67_1\" name=\"wpforms[fields][67][]\" value=\"Positif\" aria-errormessage=\"wpforms-351-field_67_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_67_1\">Positif<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-351-field_67_2\" name=\"wpforms[fields][67][]\" value=\"N\u00e9gatif\" aria-errormessage=\"wpforms-351-field_67_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-351-field_67_2\">N\u00e9gatif<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-351-field_50-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"50\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-351-field_50\" aria-hidden=\"false\">Mise en page<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><\/div><\/div><\/div><div id=\"wpforms-351-field_19-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"19\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><\/div><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" style=\"display:none;\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"351\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"1\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-351\" class=\"wpforms-submit\" data-alt-text=\"Envoi en cours\" data-submit-text=\"TERMINER\" aria-live=\"assertive\" value=\"wpforms-submit\">TERMINER<\/button><img decoding=\"async\" src=\"https:\/\/www.sagefemme-toulouse.fr\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Chargement en cours\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\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":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"open","template":"elementor_header_footer","meta":{"footnotes":""},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.sagefemme-toulouse.fr\/index.php\/wp-json\/wp\/v2\/pages\/366"}],"collection":[{"href":"https:\/\/www.sagefemme-toulouse.fr\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.sagefemme-toulouse.fr\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.sagefemme-toulouse.fr\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.sagefemme-toulouse.fr\/index.php\/wp-json\/wp\/v2\/comments?post=366"}],"version-history":[{"count":4,"href":"https:\/\/www.sagefemme-toulouse.fr\/index.php\/wp-json\/wp\/v2\/pages\/366\/revisions"}],"predecessor-version":[{"id":370,"href":"https:\/\/www.sagefemme-toulouse.fr\/index.php\/wp-json\/wp\/v2\/pages\/366\/revisions\/370"}],"wp:attachment":[{"href":"https:\/\/www.sagefemme-toulouse.fr\/index.php\/wp-json\/wp\/v2\/media?parent=366"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}