{"id":9,"date":"2024-09-03T12:41:42","date_gmt":"2024-09-03T16:41:42","guid":{"rendered":"https:\/\/iqsalud.app\/iqtag\/registration\/"},"modified":"2024-09-18T21:24:11","modified_gmt":"2024-09-19T01:24:11","slug":"registro","status":"publish","type":"page","link":"https:\/\/iqtaghealth.com\/iqtag\/","title":{"rendered":"Registro"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"9\" class=\"elementor elementor-9\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7b11fbbf e-con-full e-flex wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-parent\" data-id=\"7b11fbbf\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7543d85c elementor-widget elementor-widget-shortcode\" data-id=\"7543d85c\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\"><style type=\"text\/css\">#user-registration-form-8 form .user-registration-multi-part-indicator.progress .user-registration-multi-part-indicator-progress, #user-registration-form-8 form .user-registration-multi-part-indicator.circle .user-registration-multi-part-indicator-title.active::before, #user-registration-form-8 form .user-registration-multi-part-indicator.circle .user-registration-multi-part-indicator-title.active::after, #user-registration-form-8 form .user-registration-multi-part-indicator.arrow .user-registration-multi-part-indicator-title.active {background-color: #dd3333;}#user-registration-form-8 form .user-registration-multi-part-indicator.arrow .user-registration-multi-part-indicator-title.active::before {border-left-color: #dd3333;}#user-registration-form-8 form .user-registration-multi-part-indicator.arrow .user-registration-multi-part-indicator-title.active::after {border-top-color: #dd3333;border-bottom-color: #dd3333;}<\/style>\t<div class='user-registration ur-frontend-form ur-frontend-form--rounded  ur-multipart-form' id='user-registration-form-8'>\n\t\t\t\t\t<form method='post' class='register' data-form-id=\"8\"\n\t\t\t\tdata-enable-strength-password=\"\" data-minimum-password-strength=\"3\"\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t \"enctype=multipart\/form-data\" \"enctype=multipart\/form-data\" data-captcha-enabled=\"\">\n\n\t\t\t\t<div class=\"user-registration-multi-part-indicator arrow\" data-indicator=\"arrow\" data-current-part=\"1\" data-total=\"5\"><ul class=\"user-registration-multi-part--steps-list\"><li class=\"user-registration-multi-part-indicator-title active\">Personal<\/li><li class=\"user-registration-multi-part-indicator-title \">Contact<\/li><li class=\"user-registration-multi-part-indicator-title \">Health Data<\/li><li class=\"user-registration-multi-part-indicator-title \">Design<\/li><li class=\"user-registration-multi-part-indicator-title \">Delivery<\/li><\/ul><span class=\"user-registration-multi-part-previewer\" data-part-preview-1=\"0\" data-part-preview-2=\"false\" data-part-preview-3=\"false\" data-part-preview-4=\"false\" data-part-preview-5=\"false\" ><\/span><\/div><div class=\"user-registration-part user-registration-part-1\" ><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:99%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"profile_pic_url\" class=\"ur-field-item field-profile_picture foto\" data-ref-id=\"profile_pic_url\">\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"uraf-profile-picture-upload form-row\">\n\t\t\t<div id=\"profile_pic_url_field\" data-priority=\"\">\n\t\t\t\t<label for=\"profile_pic_url\" class=\"ur-label\">Profile Photo \t\t\t\t\t\t<abbr class=\"required\"\n\t\t\t\t\t\t\t\ttitle=\"required\">*<\/abbr><span class=\"ur-portal-tooltip\" data-tip=\"Sube una foto de perfil para tu tag personal, preferiblemente en fondo blanco.\"><\/span><\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" class=\"profile-preview\" alt=\"profile-picture\" src=\"https:\/\/secure.gravatar.com\/avatar\/?s=96&d=mm&r=g\" style='max-width:96px; max-height:96px;' >\n\t\t\t\t<span class=\"uraf-profile-picture-upload-node\" style=\"height: 0;width: 0;margin: 0;padding: 0;float: left;border: 0;overflow: hidden;\">\n\t\t\t\t<input type=\"file\" id=\"ur-profile-pic\" name=\"profile-pic\" class=\"profile-pic-upload\" size=\"\" accept=\"image\/jpeg,image\/gif,image\/png\" data-crop-picture=\"\" \/>\n\t\t\t\t\t<input  data-rules=\"\" type=\"hidden\" class=\"uraf-profile-picture-input input-text ur-frontend-field\" name=\"profile_pic_url\" id=\"profile_pic_url\" placeholder=\"\"  value=\"\" required=\"required\" data-label=\"Profile Photo\"\/>\t\t\t\t<\/span>\n\t\t\t<\/div>\n\t\t\t\t\t<button type=\"button\" class=\"button uraf-profile-picture-remove hide-if-no-js\" data-attachment-id=\"\"  style=display:none>Eliminar<\/button>\n\t\t\t\t\t<button type=\"button\" class=\"button wp_uraf_take_snapshot hide-if-no-js\" style=>Tomar Foto<\/button>\n\t\t\t\n\t\t<button type=\"button\" class=\"button wp_uraf_profile_picture_upload hide-if-no-js\" style=>Cargar Archivo<\/button>\n\t\t\t\t\t<div style=\"clear:both; margin-bottom: 20px\"><\/div>\n\n\t\t<\/div>\n\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"ocultar_foto\" class=\"ur-field-item field-checkbox ocultar_foto\" data-ref-id=\"ocultar_foto\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"ocultar_foto_field\" data-priority=\"\" ><label class=\"ur-label\" data-label=\"Hide profile photo\"><\/label><ul ><li class=\"ur-checkbox-list\"><input data-rules=\"\" data-id=\"ocultar_foto[]\" data-label=\"Hide profile photo\" data-value=\"Hide profile photo\" type=\"checkbox\" class=\"input-checkbox ur-frontend-field \" name=\"ocultar_foto[]\" id=\"ocultar_foto_Hide profile photo\" value=\"Hide profile photo\" \/><label class=\"ur-checkbox-label\" for=\"ocultar_foto_Hide profile photo\">Hide profile photo<\/label> <\/li><\/ul><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-1\" ><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"first_name\" class=\"ur-field-item field-first_name \" data-ref-id=\"first_name\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"first_name_field\" data-priority=\"\" ><label for=\"first_name\" class=\"ur-label\">Name <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"first_name\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"first_name\" id=\"first_name\" placeholder=\"First Name\"  value=\"\" required=\"required\" data-label=\"Name\" \/><span class=\"ur-icon ur-icon-input-first-name\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-2\"\n\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"last_name\" class=\"ur-field-item field-last_name \" data-ref-id=\"last_name\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"last_name_field\" data-priority=\"\" ><label for=\"last_name\" class=\"ur-label\">Last Name <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"last_name\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"last_name\" id=\"last_name\" placeholder=\"Last Name\"  value=\"\" required=\"required\" data-label=\"Last Name\" \/><span class=\"ur-icon ur-icon-input-last-name\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-1\" ><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"html_1726718959\" class=\"ur-field-item field-html \" data-ref-id=\"html_1726718959\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"html_1726718959\" data-priority=\"\"> <input type=\"hidden\" data-rules=\"\" data-id=\"html_1726718959\" value=\"\" class=\" ur-frontend-field \" name=\"html_1726718959\" id=\"html_1726718959\" \/> <div class=\"html_1726718959\"><div style='    margin-top: 7px;'>  \u00a0 <\/div><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"nacionalidad\" class=\"ur-field-item field-country \" data-ref-id=\"nacionalidad\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"nacionalidad_field\" data-priority=\"\" ><label for=\"nacionalidad\" class=\"ur-label\">Nationality <abbr class=\"required\" title=\"required\">*<\/abbr><\/label><select data-rules=\"\" data-id=\"nacionalidad\" name=\"nacionalidad\" id=\"nacionalidad\" class=\"select ur-frontend-field  \" required=\"required\" data-label=\"Nationality\" data-default=\"VE\" data-allow_clear=\"true\" data-placeholder=\"Selecciona un pa\u00eds\">\n\t\t\t\t\t\t\t<option value=\"AF\" >Afghanistan<\/option><option value=\"AX\" >&#197;land Islands<\/option><option value=\"AL\" >Albania<\/option><option value=\"DZ\" >Algeria<\/option><option value=\"AS\" >American Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua and Barbuda<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\" >Belgium<\/option><option value=\"PW\" >Belau<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouvet Island<\/option><option value=\"BR\" >Brazil<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"VG\" >British Virgin Islands<\/option><option value=\"BN\" >Brunei<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\" >Canada<\/option><option value=\"CV\" >Cape Verde<\/option><option value=\"KY\" >Cayman Islands<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocos (Keeling) Islands<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoros<\/option><option value=\"CG\" >Congo (Brazzaville)<\/option><option value=\"CD\" >Congo (Kinshasa)<\/option><option value=\"CK\" >Cook Islands<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura&ccedil;ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"CZ\" >Czech Republic<\/option><option value=\"DK\" >Denmark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypt<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estonia<\/option><option value=\"ET\" >Ethiopia<\/option><option value=\"FK\" >Falkland Islands<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >France<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"DE\" >Germany<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GR\" >Greece<\/option><option value=\"GL\" >Greenland<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungary<\/option><option value=\"IS\" >Iceland<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IR\" >Iran<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Ireland<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italy<\/option><option value=\"CI\" >Ivory Coast<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordan<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Laos<\/option><option value=\"LV\" >Latvia<\/option><option value=\"LB\" >Lebanon<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libya<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithuania<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao S.A.R., China<\/option><option value=\"MK\" >Macedonia<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia<\/option><option value=\"MD\" >Moldova<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MA\" >Morocco<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NZ\" >New Zealand<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"KP\" >North Korea<\/option><option value=\"NO\" >Norway<\/option><option value=\"OM\" >Oman<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PS\" >Palestinian Territory<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Poland<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RE\" >Reunion<\/option><option value=\"RO\" >Romania<\/option><option value=\"RU\" >Russia<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"BL\" >Saint Barth&eacute;lemy<\/option><option value=\"SH\" >Saint Helena<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"SX\" >Saint Martin (Dutch part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >S&atilde;o Tom&eacute; and Pr&iacute;ncipe<\/option><option value=\"SA\" >Saudi Arabia<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SK\" >Slovakia<\/option><option value=\"SI\" >Slovenia<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"ZA\" >South Africa<\/option><option value=\"GS\" >South Georgia\/Sandwich Islands<\/option><option value=\"KR\" >South Korea<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spain<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SD\" >Sudan<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard and Jan Mayen<\/option><option value=\"SZ\" >Swaziland<\/option><option value=\"SE\" >Sweden<\/option><option value=\"CH\" >Switzerland<\/option><option value=\"SY\" >Syria<\/option><option value=\"TW\" >Taiwan<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania<\/option><option value=\"TH\" >Thailand<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad and Tobago<\/option><option value=\"TN\" >Tunisia<\/option><option value=\"TR\" >Turkey<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom (UK)<\/option><option value=\"US\" >United States (US)<\/option><option value=\"UM\" >United States (US) Minor Outlying Islands<\/option><option value=\"VI\" >United States (US) Virgin Islands<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vatican<\/option><option value=\"VE\"  selected='selected'>Venezuela<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"WS\" >Samoa<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option>\n\t\t\t\t\t\t<\/select><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-2\"\n\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"hijo_menor_edad\" class=\"ur-field-item field-checkbox hijo_menor_edad_check\" data-ref-id=\"hijo_menor_edad\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"hijo_menor_edad_field\" data-priority=\"\" ><label class=\"ur-label\" data-label=\"Under age child without ID\"><\/label><ul ><li class=\"ur-checkbox-list\"><input data-rules=\"\" data-id=\"hijo_menor_edad[]\" data-label=\"Under age child without ID\" data-value=\"Under age child without ID\" type=\"checkbox\" class=\"input-checkbox ur-frontend-field \" name=\"hijo_menor_edad[]\" id=\"hijo_menor_edad_Under age child without ID\" value=\"Under age child without ID\" \/><label class=\"ur-checkbox-label\" for=\"hijo_menor_edad_Under age child without ID\">Under age child without ID<\/label> <\/li><\/ul><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"1\" data-conditional-logic-map=\"{&quot;action&quot;:&quot;hide&quot;,&quot;logic_map&quot;:{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;OR&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;field&quot;,&quot;triggerer_id&quot;:&quot;hijo_menor_edad&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Hijo menor de edad sin c\u00e9dula&quot;}]}]}}\" data-field-id=\"documento_identidad\" class=\"ur-field-item field-text user_login_input\" data-ref-id=\"documento_identidad\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"documento_identidad_field\" data-priority=\"\" ><label for=\"documento_identidad\" class=\"ur-label\">ID Number <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"documento_identidad\" type=\"text\" class=\"input-text   input-text ur-frontend-field \" name=\"documento_identidad\" id=\"documento_identidad\" placeholder=\"\"  value=\"\" required=\"required\" data-label=\"ID Number\" \/><span class=\"ur-icon ur-icon-input-field\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"1\" data-conditional-logic-map=\"{&quot;action&quot;:&quot;show&quot;,&quot;logic_map&quot;:{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;OR&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;field&quot;,&quot;triggerer_id&quot;:&quot;hijo_menor_edad&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Hijo menor de edad sin c\u00e9dula&quot;}]}]}}\" data-field-id=\"cedula_representante\" class=\"ur-field-item field-text \" data-ref-id=\"cedula_representante\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"cedula_representante_field\" data-priority=\"\" ><label for=\"cedula_representante\" class=\"ur-label\">Parent ID <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"cedula_representante\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"cedula_representante\" id=\"cedula_representante\" placeholder=\"\"  value=\"\" required=\"required\" data-label=\"Parent ID\" \/><span class=\"ur-icon ur-icon-input-field\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-1\" ><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"1\" data-conditional-logic-map=\"{&quot;action&quot;:&quot;show&quot;,&quot;logic_map&quot;:{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;OR&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;AND&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;field&quot;,&quot;triggerer_id&quot;:&quot;hijo_menor_edad&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Hijo menor de edad sin c\u00e9dula&quot;}]}]}}\" data-field-id=\"nombre_representante\" class=\"ur-field-item field-text \" data-ref-id=\"nombre_representante\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"nombre_representante_field\" data-priority=\"\" ><label for=\"nombre_representante\" class=\"ur-label\">Parent First Name <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"nombre_representante\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"nombre_representante\" id=\"nombre_representante\" placeholder=\"\"  value=\"\" required=\"required\" data-label=\"Parent First Name\" \/><span class=\"ur-icon ur-icon-input-field\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-2\"\n\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"1\" data-conditional-logic-map=\"{&quot;action&quot;:&quot;show&quot;,&quot;logic_map&quot;:{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;OR&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;field&quot;,&quot;triggerer_id&quot;:&quot;hijo_menor_edad&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Hijo menor de edad sin c\u00e9dula&quot;}]}]}}\" data-field-id=\"apellido_representante\" class=\"ur-field-item field-text \" data-ref-id=\"apellido_representante\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"apellido_representante_field\" data-priority=\"\" ><label for=\"apellido_representante\" class=\"ur-label\">Parent Last Name <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"apellido_representante\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"apellido_representante\" id=\"apellido_representante\" placeholder=\"\"  value=\"\" required=\"required\" data-label=\"Parent Last Name\" \/><span class=\"ur-icon ur-icon-input-field\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-1\" ><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"fecha_nacimiento\" class=\"ur-field-item field-date datepicker_normal\" data-ref-id=\"fecha_nacimiento\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"fecha_nacimiento_field\" data-priority=\"\" ><label for=\"fecha_nacimiento\" class=\"ur-label\">Birthdate <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <span class=\"input-wrapper\"> <input type=\"hidden\" id=\"formated_date\" value=\"\"\/><input data-rules=\"\" data-id=\"fecha_nacimiento\" type=\"text\" data-field-type=\"date\" value=\"\" class=\"input-text input-date ur-frontend-field \" name=\"fecha_nacimiento\" id=\"fecha_nacimiento\" placeholder=\"\"  required=\"required\" data-date-format=\"d\/m\/Y\" data-locale=\"es\" data-label=\"Birthdate\" \/><span class=\"ur-icon ur-icon-calendar\"><\/span><\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-2\"\n\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"telefono\" class=\"ur-field-item field-phone \" data-ref-id=\"telefono\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"telefono\" data-priority=\"\"><label for=\"Phone Number\" class=\"ur-label\">Phone Number <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input data-rules=\"\" data-inputmask=\"'mask':''\" data-id=\"telefono\" type=\"text\" value=\"\" class=\" ur-frontend-field  ur-masked-input\" name=\"telefono\" id=\"telefono\" required=\"required\" data-label=\"Phone Number\"\/> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-1\" ><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:99%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"user_email\" class=\"ur-field-item field-user_email \" data-ref-id=\"user_email\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"user_email_field\" data-priority=\"\" ><label for=\"user_email\" class=\"ur-label\">Email <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"user_email\" type=\"email\" class=\"input-text   input-email ur-frontend-field  \" name=\"user_email\" id=\"user_email\" placeholder=\"One per registered user\"  value=\"\" required=\"required\" data-label=\"Email\" \/><span class=\"ur-icon ur-icon-email\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"nota\" class=\"ur-field-item field-html \" data-ref-id=\"nota\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"nota\" data-priority=\"\"> <input type=\"hidden\" data-rules=\"\" data-id=\"nota\" value=\"\" class=\" ur-frontend-field \" name=\"nota\" id=\"nota\" \/> <div class=\"nota\">Nota:  \n* No puede haber 2 o m\u00e1s usuarios registrados con el mismo correo electr\u00f3nico. <br>\n.\n\n\n\n<\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"user_login\" class=\"ur-field-item field-user_login \" data-ref-id=\"user_login\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"user_login_field\" data-priority=\"\" ><label for=\"user_login\" class=\"ur-label\">User name <abbr class=\"required\" title=\"required\">*<\/abbr><span class=\"ur-portal-tooltip\" data-tip=\"Sin dejar espacios Ej: fabiancastro123\"><\/span><\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"user_login\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"user_login\" id=\"user_login\" placeholder=\"No Spaces Ex: fabiancastro321\"  value=\"\" required=\"required\" data-label=\"User name\" data-username-character=\"1\"\/><span class=\"ur-icon ur-icon-user\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-1\" ><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"user_pass\" class=\"ur-field-item field-user_pass \" data-ref-id=\"user_pass\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required hide_show_password\" id=\"user_pass_field\" data-priority=\"\"><label for=\"user_pass\" class=\"ur-label\">Password <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <span class=\"input-wrapper\"> <span class=\"password-input-group input-form-field-icons\"><input data-rules=\"\" data-id=\"user_pass\" type=\"password\" class=\"input-text  input-password ur-frontend-field  \" name=\"user_pass\" id=\"user_pass\" placeholder=\"\"  value=\"\" required=\"required\" data-label=\"Password\" \/><a href=\"javaScript:void(0)\" class=\"password_preview dashicons dashicons-hidden\" title=\" Show password \"><\/a><\/span><span class=\"ur-icon ur-icon-password\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-2\"\n\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"user_confirm_password\" class=\"ur-field-item field-user_confirm_password \" data-ref-id=\"user_confirm_password\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required hide_show_password\" id=\"user_confirm_password_field\" data-priority=\"\"><label for=\"user_confirm_password\" class=\"ur-label\">Confirm Password <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <span class=\"input-wrapper\"> <span class=\"password-input-group input-form-field-icons\"><input data-rules=\"\" data-id=\"user_confirm_password\" type=\"password\" class=\"input-text  input-password ur-frontend-field  \" name=\"user_confirm_password\" id=\"user_confirm_password\" placeholder=\"\"  value=\"\" required=\"required\" data-label=\"Confirm Password\" \/><a href=\"javaScript:void(0)\" class=\"password_preview dashicons dashicons-hidden\" title=\" Show password \"><\/a><\/span><span class=\"ur-icon ur-icon-password-confirm\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-1\" ><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:99%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"direccion\" class=\"ur-field-item field-text \" data-ref-id=\"direccion\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"direccion_field\" data-priority=\"\" ><label for=\"direccion\" class=\"ur-label\">Address (Optional)<\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"direccion\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"direccion\" id=\"direccion\" placeholder=\"\"  value=\"\" data-label=\"Address (Optional)\" \/><span class=\"ur-icon ur-icon-input-field\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-2\" style=\"display:none;\"><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:99%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"persona_contacto\" class=\"ur-field-item field-text \" data-ref-id=\"persona_contacto\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"persona_contacto_field\" data-priority=\"\" ><label for=\"persona_contacto\" class=\"ur-label\">Emergency Contact Person <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"persona_contacto\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"persona_contacto\" id=\"persona_contacto\" placeholder=\"Who to reach in case of emergency\"  value=\"\" required=\"required\" data-label=\"Emergency Contact Person\" \/><span class=\"ur-icon ur-icon-input-field\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-2\" style=\"display:none;\"><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"parentesco\" class=\"ur-field-item field-text \" data-ref-id=\"parentesco\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"parentesco_field\" data-priority=\"\" ><label for=\"parentesco\" class=\"ur-label\">Kinship <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"parentesco\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"parentesco\" id=\"parentesco\" placeholder=\"Ex: Father, Wife, Son\"  value=\"\" required=\"required\" data-label=\"Kinship\" \/><span class=\"ur-icon ur-icon-input-field\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-2\"\n\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"telefono_persona_contacto\" class=\"ur-field-item field-phone \" data-ref-id=\"telefono_persona_contacto\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"telefono_persona_contacto\" data-priority=\"\"><label for=\"Mobile Phone Number\" class=\"ur-label\">Mobile Phone Number <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input data-rules=\"\" data-inputmask=\"'mask':''\" data-id=\"telefono_persona_contacto\" type=\"text\" value=\"\" class=\" ur-frontend-field  ur-masked-input\" name=\"telefono_persona_contacto\" id=\"telefono_persona_contacto\" required=\"required\" data-label=\"Mobile Phone Number\"\/> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-3\" style=\"display:none;\"><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"grupo_sanguineo\" class=\"ur-field-item field-select \" data-ref-id=\"grupo_sanguineo\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"grupo_sanguineo_field\" data-priority=\"\" ><label for=\"grupo_sanguineo\" class=\"ur-label\">Blood Type<\/label><select data-rules=\"\" data-id=\"grupo_sanguineo\" name=\"grupo_sanguineo\" id=\"grupo_sanguineo\" class=\"select ur-frontend-field  \" data-label=\"Blood Type\" data-default=\"Not Known\" data-allow_clear=\"true\" data-placeholder=\"\">\n\t\t\t\t\t\t\t<option value=\"A+\" >A+<\/option><option value=\"O+\" >O+<\/option><option value=\"B+\" >B+<\/option><option value=\"AB+\" >AB+<\/option><option value=\"A-\" >A-<\/option><option value=\"O-\" >O-<\/option><option value=\"B-\" >B-<\/option><option value=\"AB-\" >AB-<\/option><option value=\"Not Known\"  selected='selected'>Not Known<\/option>\n\t\t\t\t\t\t<\/select><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-2\"\n\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-3\" style=\"display:none;\"><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"patologia\" class=\"ur-field-item field-text \" data-ref-id=\"patologia\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"patologia_field\" data-priority=\"\" ><label for=\"patologia\" class=\"ur-label\">Pathology \/ Allergy 1<span class=\"ur-portal-tooltip\" data-tip=\"Escribe el nombre de una enfermedad o alergia que padezcas\"><\/span><\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"patologia\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"patologia\" id=\"patologia\" placeholder=\"\"  value=\"\" data-label=\"Pathology \/ Allergy 1\" \/><span class=\"ur-icon ur-icon-input-field\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-2\"\n\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"tratamiento\" class=\"ur-field-item field-text \" data-ref-id=\"tratamiento\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"tratamiento_field\" data-priority=\"\" ><label for=\"tratamiento\" class=\"ur-label\">Treatment 1<span class=\"ur-portal-tooltip\" data-tip=\"Escribe cu\u00e1l es el tratamiento que usas para tu patolog\u00eda o alergia.\"><\/span><\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"tratamiento\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"tratamiento\" id=\"tratamiento\" placeholder=\"\"  value=\"\" data-label=\"Treatment 1\" \/><span class=\"ur-icon ur-icon-input-field\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-3\" style=\"display:none;\"><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"patologia_2\" class=\"ur-field-item field-text \" data-ref-id=\"patologia_2\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"patologia_2_field\" data-priority=\"\" ><label for=\"patologia_2\" class=\"ur-label\">Pathology \/ Allergy 2<span class=\"ur-portal-tooltip\" data-tip=\"Escribe el nombre de una enfermedad o alergia que padezcas\"><\/span><\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"patologia_2\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"patologia_2\" id=\"patologia_2\" placeholder=\"\"  value=\"\" data-label=\"Pathology \/ Allergy 2\" \/><span class=\"ur-icon ur-icon-input-field\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-2\"\n\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"tratamiento_2\" class=\"ur-field-item field-text \" data-ref-id=\"tratamiento_2\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"tratamiento_2_field\" data-priority=\"\" ><label for=\"tratamiento_2\" class=\"ur-label\">Treatment 2<span class=\"ur-portal-tooltip\" data-tip=\"Escribe cu\u00e1l es el tratamiento que usas para tu patolog\u00eda o alergia.\"><\/span><\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"tratamiento_2\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"tratamiento_2\" id=\"tratamiento_2\" placeholder=\"\"  value=\"\" data-label=\"Treatment 2\" \/><span class=\"ur-icon ur-icon-input-field\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-3\" style=\"display:none;\"><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"patologia_3\" class=\"ur-field-item field-text \" data-ref-id=\"patologia_3\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"patologia_3_field\" data-priority=\"\" ><label for=\"patologia_3\" class=\"ur-label\">Pathology \/ Allergy 3<span class=\"ur-portal-tooltip\" data-tip=\"Escribe el nombre de una enfermedad o alergia que padezcas\"><\/span><\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"patologia_3\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"patologia_3\" id=\"patologia_3\" placeholder=\"\"  value=\"\" data-label=\"Pathology \/ Allergy 3\" \/><span class=\"ur-icon ur-icon-input-field\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-2\"\n\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"tratamiento_3\" class=\"ur-field-item field-text \" data-ref-id=\"tratamiento_3\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"tratamiento_3_field\" data-priority=\"\" ><label for=\"tratamiento_3\" class=\"ur-label\">Treatment 3<span class=\"ur-portal-tooltip\" data-tip=\"Escribe cu\u00e1l es el tratamiento que usas para tu patolog\u00eda o alergia.\"><\/span><\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"tratamiento_3\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"tratamiento_3\" id=\"tratamiento_3\" placeholder=\"\"  value=\"\" data-label=\"Treatment 3\" \/><span class=\"ur-icon ur-icon-input-field\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-3\" style=\"display:none;\"><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:99%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"seguro_medico\" class=\"ur-field-item field-text \" data-ref-id=\"seguro_medico\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"seguro_medico_field\" data-priority=\"\" ><label for=\"seguro_medico\" class=\"ur-label\">Medical Insurance<\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"seguro_medico\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"seguro_medico\" id=\"seguro_medico\" placeholder=\"Insurance Company\"  value=\"\" data-label=\"Medical Insurance\" \/><span class=\"ur-icon ur-icon-input-field\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-3\" style=\"display:none;\"><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"numero_poliza_seguro\" class=\"ur-field-item field-text \" data-ref-id=\"numero_poliza_seguro\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"numero_poliza_seguro_field\" data-priority=\"\" ><label for=\"numero_poliza_seguro\" class=\"ur-label\">Insurance No.<span class=\"ur-portal-tooltip\" data-tip=\"Indica el n\u00famero de p\u00f3liza de tu seguro m\u00e9dico\"><\/span><\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"numero_poliza_seguro\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"numero_poliza_seguro\" id=\"numero_poliza_seguro\" placeholder=\"\"  value=\"\" data-label=\"Insurance No.\" \/><span class=\"ur-icon ur-icon-input-field\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-2\"\n\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"telefono_poliza\" class=\"ur-field-item field-phone \" data-ref-id=\"telefono_poliza\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"telefono_poliza\" data-priority=\"\"><label for=\"Insurance Broker Telephone\" class=\"ur-label\">Insurance Broker Telephone<\/label> <input data-rules=\"\" data-inputmask=\"'mask':''\" data-id=\"telefono_poliza\" type=\"text\" value=\"\" class=\" ur-frontend-field  ur-masked-input\" name=\"telefono_poliza\" id=\"telefono_poliza\" data-label=\"Insurance Broker Telephone\"\/> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-3\" style=\"display:none;\"><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:99%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"observaciones_resumen_medico\" class=\"ur-field-item field-textarea \" data-ref-id=\"observaciones_resumen_medico\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"observaciones_resumen_medico_field\" data-priority=\"\" ><label for=\"observaciones_resumen_medico\" class=\"ur-label\">Observations<\/label><textarea style=\"margin-bottom:0px;\" data-rules=\"\" data-id=\"observaciones_resumen_medico\" name=\"observaciones_resumen_medico\" class=\"input-text ur-frontend-field  \" id=\"observaciones_resumen_medico\" placeholder=\"\"  rows=\"2\" cols=\"5\"data-label=\"Observations\"><\/textarea><div style=\"text-align: right; font-size:14px; color:#737373; margin-top:0px;\"> <div class=\"ur-input-count\" data-count-type=\"characters\" style=\"display: inline-block; margin-right: 1px;\">0<\/div><div style=\"display: inline-block;\">&nbsp;characters<\/div><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-4\" style=\"display:none;\"><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:99%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"seleccionar_color_iqtag\" class=\"ur-field-item field-radio iqtag_color\" data-ref-id=\"seleccionar_color_iqtag\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"seleccionar_color_iqtag_field\" data-priority=\"\" ><label for=\"0\" class=\"ur-label\">Select your iQTAG's color <abbr class=\"required\" title=\"required\">*<\/abbr><\/label><ul class=\"user-registration-image-options\"><li class=\"ur-radio-list\"><input data-rules=\"\" data-id=\"seleccionar_color_iqtag\" type=\"radio\" class=\"input-radio ur-frontend-field \" value=\"Blue\" name=\"seleccionar_color_iqtag\" id=\"seleccionar_color_iqtag_Blue\" required=\"required\" data-label=\"Select your iQTAG&#039;s color\" \/  \/> <label for=\"seleccionar_color_iqtag_Blue\" class=\"radio\"><span class=\"user-registration-image-choice\"><img decoding=\"async\" src=\"https:\/\/iqtaghealth.com\/iqtag\/wp-content\/uploads\/2024\/12\/Azul-a-01.png\" alt=\"Blue\" width=\"200px\"><\/span>Blue<\/label><\/li><li class=\"ur-radio-list\"><input data-rules=\"\" data-id=\"seleccionar_color_iqtag\" type=\"radio\" class=\"input-radio ur-frontend-field \" value=\"Violet\" name=\"seleccionar_color_iqtag\" id=\"seleccionar_color_iqtag_Violet\" required=\"required\" data-label=\"Select your iQTAG&#039;s color\" \/  \/> <label for=\"seleccionar_color_iqtag_Violet\" class=\"radio\"><span class=\"user-registration-image-choice\"><img decoding=\"async\" src=\"https:\/\/iqtaghealth.com\/iqtag\/wp-content\/uploads\/2024\/12\/purpura-a-01.png\" alt=\"Violet\" width=\"200px\"><\/span>Violet<\/label><\/li><li class=\"ur-radio-list\"><input data-rules=\"\" data-id=\"seleccionar_color_iqtag\" type=\"radio\" class=\"input-radio ur-frontend-field \" value=\"Green\" name=\"seleccionar_color_iqtag\" id=\"seleccionar_color_iqtag_Green\" required=\"required\" data-label=\"Select your iQTAG&#039;s color\" \/  \/> <label for=\"seleccionar_color_iqtag_Green\" class=\"radio\"><span class=\"user-registration-image-choice\"><img decoding=\"async\" src=\"https:\/\/iqtaghealth.com\/iqtag\/wp-content\/uploads\/2024\/12\/verde-a-01.png\" alt=\"Green\" width=\"200px\"><\/span>Green<\/label><\/li><li class=\"ur-radio-list\"><input data-rules=\"\" data-id=\"seleccionar_color_iqtag\" type=\"radio\" class=\"input-radio ur-frontend-field \" value=\"Grey\" name=\"seleccionar_color_iqtag\" id=\"seleccionar_color_iqtag_Grey\" required=\"required\" data-label=\"Select your iQTAG&#039;s color\" \/  \/> <label for=\"seleccionar_color_iqtag_Grey\" class=\"radio\"><span class=\"user-registration-image-choice\"><img decoding=\"async\" src=\"https:\/\/iqtaghealth.com\/iqtag\/wp-content\/uploads\/2024\/12\/gris-a-01.png\" alt=\"Grey\" width=\"200px\"><\/span>Grey<\/label><\/li><li class=\"ur-radio-list\"><input data-rules=\"\" data-id=\"seleccionar_color_iqtag\" type=\"radio\" class=\"input-radio ur-frontend-field \" value=\"Orange\" name=\"seleccionar_color_iqtag\" id=\"seleccionar_color_iqtag_Orange\" required=\"required\" data-label=\"Select your iQTAG&#039;s color\" \/  \/> <label for=\"seleccionar_color_iqtag_Orange\" class=\"radio\"><span class=\"user-registration-image-choice\"><img decoding=\"async\" src=\"https:\/\/iqtaghealth.com\/iqtag\/wp-content\/uploads\/2024\/12\/naranja-a-01.png\" alt=\"Orange\" width=\"200px\"><\/span>Orange<\/label><\/li><\/ul><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-5\" style=\"display:none;\"><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:99%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"metodo_entrega_toggle\" class=\"ur-field-item field-checkbox toggle\" data-ref-id=\"metodo_entrega_toggle\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"metodo_entrega_toggle_field\" data-priority=\"\" ><label class=\"ur-label\" data-label=\"Delivery method\"><\/label><ul ><li class=\"ur-checkbox-list\"><input data-rules=\"\" data-id=\"metodo_entrega_toggle[]\" data-label=\"Delivery method\" data-value=\"1. Delivery method\" type=\"checkbox\" class=\"input-checkbox ur-frontend-field \" name=\"metodo_entrega_toggle[]\" id=\"metodo_entrega_toggle_1. Delivery method\" value=\"1. Delivery method\" \/><label class=\"ur-checkbox-label\" for=\"metodo_entrega_toggle_1. Delivery method\">1. Delivery method<\/label> <\/li><\/ul><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-5\" style=\"display:none;\"><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:99%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"1\" data-conditional-logic-map=\"{&quot;action&quot;:&quot;show&quot;,&quot;logic_map&quot;:{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;AND&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;field&quot;,&quot;triggerer_id&quot;:&quot;metodo_entrega_toggle&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;1. M\u00e9todo de entrega&quot;}]}]}}\" data-field-id=\"M\u00e9todo_de_entrega\" class=\"ur-field-item field-radio \" data-ref-id=\"M\u00e9todo_de_entrega\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"M\u00e9todo_de_entrega_field\" data-priority=\"\" ><ul><li class=\"ur-radio-list\"><input data-rules=\"\" data-id=\"M\u00e9todo_de_entrega\" type=\"radio\" class=\"input-radio ur-frontend-field  \" value=\"Delivery (Free Shipping)\"  name=\"M\u00e9todo_de_entrega\" id=\"M\u00e9todo_de_entrega_Delivery (Free Shipping)\" data-label=\"Delivery method\" \/  \/> <label for=\"M\u00e9todo_de_entrega_Delivery (Free Shipping)\" class=\"radio\">Delivery (Free Shipping)<\/label><\/li><\/ul><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-5\" style=\"display:none;\"><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:99%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"1\" data-conditional-logic-map=\"{&quot;action&quot;:&quot;show&quot;,&quot;logic_map&quot;:{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;AND&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;field&quot;,&quot;triggerer_id&quot;:&quot;metodo_entrega_toggle&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;1. M\u00e9todo de entrega&quot;}]},{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;AND&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;field&quot;,&quot;triggerer_id&quot;:&quot;M\u00e9todo_de_entrega&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Delivery (Env\u00edo con despachadores iQtag)&quot;}]}]}}\" data-field-id=\"fecha_entrega\" class=\"ur-field-item field-date fecha_entrega\" data-ref-id=\"fecha_entrega\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"fecha_entrega_field\" data-priority=\"\" ><label for=\"fecha_entrega\" class=\"ur-label\">Delivery date<\/label> <span class=\"input-wrapper\"> <input type=\"hidden\" id=\"formated_date\" value=\"\"\/><input data-rules=\"\" data-id=\"fecha_entrega\" type=\"text\" data-field-type=\"date\" value=\"\" class=\"input-text input-date ur-frontend-field \" name=\"fecha_entrega\" id=\"fecha_entrega\" placeholder=\"\"  data-date-format=\"d\/m\/Y\" data-locale=\"es\" data-label=\"Delivery date\" \/><span class=\"ur-icon ur-icon-calendar\"><\/span><\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"1\" data-conditional-logic-map=\"{&quot;action&quot;:&quot;show&quot;,&quot;logic_map&quot;:{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;AND&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;field&quot;,&quot;triggerer_id&quot;:&quot;metodo_entrega_toggle&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;1. M\u00e9todo de entrega&quot;}]},{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;AND&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;field&quot;,&quot;triggerer_id&quot;:&quot;M\u00e9todo_de_entrega&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Delivery (Env\u00edo con despachadores iQtag)&quot;}]}]}}\" data-field-id=\"hora_entrega\" class=\"ur-field-item field-radio hora_entrega\" data-ref-id=\"hora_entrega\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"hora_entrega_field\" data-priority=\"\" ><label for=\"8:00 am - 10:00 am\" class=\"ur-label\">Delivery time<\/label><ul><li class=\"ur-radio-list\"><input data-rules=\"\" data-id=\"hora_entrega\" type=\"radio\" class=\"input-radio ur-frontend-field \" value=\"8:00 am - 10:00 am\"  name=\"hora_entrega\" id=\"hora_entrega_8:00 am - 10:00 am\" data-label=\"Delivery time\" data-default=\"8:00 am - 10:00 am\" \/  checked='checked' \/> <label for=\"hora_entrega_8:00 am - 10:00 am\" class=\"radio\">8:00 am - 10:00 am<\/label><\/li><li class=\"ur-radio-list\"><input data-rules=\"\" data-id=\"hora_entrega\" type=\"radio\" class=\"input-radio ur-frontend-field \" value=\"10:00 am - 12:00 pm\"  name=\"hora_entrega\" id=\"hora_entrega_10:00 am - 12:00 pm\" data-label=\"Delivery time\" data-default=\"8:00 am - 10:00 am\" \/  \/> <label for=\"hora_entrega_10:00 am - 12:00 pm\" class=\"radio\">10:00 am - 12:00 pm<\/label><\/li><li class=\"ur-radio-list\"><input data-rules=\"\" data-id=\"hora_entrega\" type=\"radio\" class=\"input-radio ur-frontend-field \" value=\"2:00 pm - 4:00 pm\"  name=\"hora_entrega\" id=\"hora_entrega_2:00 pm - 4:00 pm\" data-label=\"Delivery time\" data-default=\"8:00 am - 10:00 am\" \/  \/> <label for=\"hora_entrega_2:00 pm - 4:00 pm\" class=\"radio\">2:00 pm - 4:00 pm<\/label><\/li><li class=\"ur-radio-list\"><input data-rules=\"\" data-id=\"hora_entrega\" type=\"radio\" class=\"input-radio ur-frontend-field \" value=\"4:00 pm - 6:00 pm\"  name=\"hora_entrega\" id=\"hora_entrega_4:00 pm - 6:00 pm\" data-label=\"Delivery time\" data-default=\"8:00 am - 10:00 am\" \/  \/> <label for=\"hora_entrega_4:00 pm - 6:00 pm\" class=\"radio\">4:00 pm - 6:00 pm<\/label><\/li><\/ul><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-5\" style=\"display:none;\"><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:99%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"1\" data-conditional-logic-map=\"{&quot;action&quot;:&quot;show&quot;,&quot;logic_map&quot;:{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;OR&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;field&quot;,&quot;triggerer_id&quot;:&quot;metodo_entrega_toggle&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;1. M\u00e9todo de entrega&quot;}]},{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;AND&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;field&quot;,&quot;triggerer_id&quot;:&quot;M\u00e9todo_de_entrega&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Pick Up (Retiro en sede iQSALUD)&quot;}]}]}}\" data-field-id=\"direccion_entrega\" class=\"ur-field-item field-textarea \" data-ref-id=\"direccion_entrega\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"direccion_entrega_field\" data-priority=\"\" ><label for=\"direccion_entrega\" class=\"ur-label\">Delivery address<\/label><textarea style=\"margin-bottom:0px;\" data-rules=\"\" data-id=\"direccion_entrega\" name=\"direccion_entrega\" class=\"input-text ur-frontend-field  \" id=\"direccion_entrega\" placeholder=\"\"  rows=\"2\" cols=\"5\"data-label=\"Delivery address\"><\/textarea><div style=\"text-align: right; font-size:14px; color:#737373; margin-top:0px;\"> <div class=\"ur-input-count\" data-count-type=\"characters\" style=\"display: inline-block; margin-right: 1px;\">0<\/div><div style=\"display: inline-block;\">&nbsp;characters<\/div><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"1\" data-conditional-logic-map=\"{&quot;action&quot;:&quot;show&quot;,&quot;logic_map&quot;:{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;AND&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;field&quot;,&quot;triggerer_id&quot;:&quot;metodo_entrega_toggle&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;1. M\u00e9todo de entrega&quot;}]},{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;AND&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;field&quot;,&quot;triggerer_id&quot;:&quot;M\u00e9todo_de_entrega&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Pick Up (Retiro en sede iQSALUD)&quot;}]}]}}\" data-field-id=\"nombre_persona_pickup\" class=\"ur-field-item field-text \" data-ref-id=\"nombre_persona_pickup\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"nombre_persona_pickup_field\" data-priority=\"\" ><label for=\"nombre_persona_pickup\" class=\"ur-label\">First and Last Name of Person Who Receives<\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"nombre_persona_pickup\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"nombre_persona_pickup\" id=\"nombre_persona_pickup\" placeholder=\"\"  value=\"\" data-label=\"First and Last Name of Person Who Receives\" \/><span class=\"ur-icon ur-icon-input-field\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-5\" style=\"display:none;\"><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"1\" data-conditional-logic-map=\"{&quot;action&quot;:&quot;show&quot;,&quot;logic_map&quot;:{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;AND&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;field&quot;,&quot;triggerer_id&quot;:&quot;metodo_entrega_toggle&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;1. M\u00e9todo de entrega&quot;}]},{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;AND&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;field&quot;,&quot;triggerer_id&quot;:&quot;M\u00e9todo_de_entrega&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Pick Up (Retiro en sede iQSALUD)&quot;}]}]}}\" data-field-id=\"documento_persona_pickup\" class=\"ur-field-item field-number \" data-ref-id=\"documento_persona_pickup\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"documento_persona_pickup_field\" data-priority=\"\" ><label for=\"documento_persona_pickup\" class=\"ur-label\">ID Number<\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"documento_persona_pickup\" type=\"number\" class=\"input-text   input-number ur-frontend-field  \" name=\"documento_persona_pickup\" id=\"documento_persona_pickup\" placeholder=\"\"  value=\"\" data-label=\"ID Number\" step=\"1\" \/><span class=\"ur-icon ur-icon-number\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-2\"\n\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"1\" data-conditional-logic-map=\"{&quot;action&quot;:&quot;show&quot;,&quot;logic_map&quot;:{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;AND&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;field&quot;,&quot;triggerer_id&quot;:&quot;metodo_entrega_toggle&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;1. M\u00e9todo de entrega&quot;}]},{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;AND&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;field&quot;,&quot;triggerer_id&quot;:&quot;M\u00e9todo_de_entrega&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Pick Up (Retiro en sede iQSALUD)&quot;}]}]}}\" data-field-id=\"telefono_persona_pickup\" class=\"ur-field-item field-phone \" data-ref-id=\"telefono_persona_pickup\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"telefono_persona_pickup\" data-priority=\"\"><label for=\"Mobile phone number\" class=\"ur-label\">Mobile phone number<\/label> <input data-rules=\"\" data-inputmask=\"'mask':''\" data-id=\"telefono_persona_pickup\" type=\"text\" value=\"\" class=\" ur-frontend-field  ur-masked-input\" name=\"telefono_persona_pickup\" id=\"telefono_persona_pickup\" data-label=\"Mobile phone number\"\/> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-5\" style=\"display:none;\"><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:99%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"facturacion_toggle\" class=\"ur-field-item field-checkbox toggle\" data-ref-id=\"facturacion_toggle\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"facturacion_toggle_field\" data-priority=\"\" ><label class=\"ur-label\" data-label=\"Billing\"><\/label><ul ><li class=\"ur-checkbox-list\"><input data-rules=\"\" data-id=\"facturacion_toggle[]\" data-label=\"Billing\" data-value=\"2. Billing\" type=\"checkbox\" class=\"input-checkbox ur-frontend-field \" name=\"facturacion_toggle[]\" id=\"facturacion_toggle_2. Billing\" value=\"2. Billing\" \/><label class=\"ur-checkbox-label\" for=\"facturacion_toggle_2. Billing\">2. Billing<\/label> <\/li><\/ul><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-5\" style=\"display:none;\"><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:99%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"1\" data-conditional-logic-map=\"{&quot;action&quot;:&quot;show&quot;,&quot;logic_map&quot;:{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;OR&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;field&quot;,&quot;triggerer_id&quot;:&quot;facturacion_toggle&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;2. Facturaci\u00f3n&quot;}]}]}}\" data-field-id=\"facturacion_nombre\" class=\"ur-field-item field-text \" data-ref-id=\"facturacion_nombre\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"facturacion_nombre_field\" data-priority=\"\" ><label for=\"facturacion_nombre\" class=\"ur-label\">Name or Company Name<\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"facturacion_nombre\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"facturacion_nombre\" id=\"facturacion_nombre\" placeholder=\"\"  value=\"\" data-label=\"Name or Company Name\" \/><span class=\"ur-icon ur-icon-input-field\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-5\" style=\"display:none;\"><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:30%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"1\" data-conditional-logic-map=\"{&quot;action&quot;:&quot;show&quot;,&quot;logic_map&quot;:{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;OR&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;field&quot;,&quot;triggerer_id&quot;:&quot;facturacion_toggle&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;2. Facturaci\u00f3n&quot;}]}]}}\" data-field-id=\"tipo_documento_facturacion\" class=\"ur-field-item field-select \" data-ref-id=\"tipo_documento_facturacion\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"tipo_documento_facturacion_field\" data-priority=\"\" ><label for=\"tipo_documento_facturacion\" class=\"ur-label\">ID Type<\/label><select data-rules=\"\" data-id=\"tipo_documento_facturacion\" name=\"tipo_documento_facturacion\" id=\"tipo_documento_facturacion\" class=\"select ur-frontend-field  \" data-label=\"ID Type\" data-default=\"G\" data-allow_clear=\"true\" data-placeholder=\"- Selecciona un tipo de documento -\">\n\t\t\t\t\t\t\t<option value=\"V\" >V<\/option><option value=\"E\" >E<\/option><option value=\"J\" >J<\/option><option value=\"G\"  selected='selected'>G<\/option>\n\t\t\t\t\t\t<\/select><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-2\"\n\t\t\t\t\t\t\tstyle=\"width:30%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"1\" data-conditional-logic-map=\"{&quot;action&quot;:&quot;show&quot;,&quot;logic_map&quot;:{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;OR&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;field&quot;,&quot;triggerer_id&quot;:&quot;facturacion_toggle&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;2. Facturaci\u00f3n&quot;}]}]}}\" data-field-id=\"numero_documento_facturacion\" class=\"ur-field-item field-number \" data-ref-id=\"numero_documento_facturacion\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"numero_documento_facturacion_field\" data-priority=\"\" ><label for=\"numero_documento_facturacion\" class=\"ur-label\">ID Number<\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"numero_documento_facturacion\" type=\"number\" class=\"input-text   input-number ur-frontend-field  \" name=\"numero_documento_facturacion\" id=\"numero_documento_facturacion\" placeholder=\"\"  value=\"\" data-label=\"ID Number\" step=\"1\" \/><span class=\"ur-icon ur-icon-number\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-3\"\n\t\t\t\t\t\t\tstyle=\"width:30%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"1\" data-conditional-logic-map=\"{&quot;action&quot;:&quot;show&quot;,&quot;logic_map&quot;:{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;OR&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;field&quot;,&quot;triggerer_id&quot;:&quot;facturacion_toggle&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;2. Facturaci\u00f3n&quot;}]}]}}\" data-field-id=\"telefono_facturacion\" class=\"ur-field-item field-phone \" data-ref-id=\"telefono_facturacion\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"telefono_facturacion\" data-priority=\"\"><label for=\"Mobile Phone Number\" class=\"ur-label\">Mobile Phone Number<\/label> <input data-rules=\"\" data-inputmask=\"'mask':'(999)9999999'\" data-id=\"telefono_facturacion\" type=\"text\" value=\"\" class=\" ur-frontend-field  ur-masked-input\" name=\"telefono_facturacion\" id=\"telefono_facturacion\" data-label=\"Mobile Phone Number\"\/> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-5\" style=\"display:none;\"><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:99%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"1\" data-conditional-logic-map=\"{&quot;action&quot;:&quot;show&quot;,&quot;logic_map&quot;:{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;OR&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;group&quot;,&quot;logic_gate&quot;:&quot;&quot;,&quot;conditions&quot;:[{&quot;type&quot;:&quot;field&quot;,&quot;triggerer_id&quot;:&quot;facturacion_toggle&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;2. Facturaci\u00f3n&quot;}]}]}}\" data-field-id=\"direccion_fiscal\" class=\"ur-field-item field-text \" data-ref-id=\"direccion_fiscal\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"direccion_fiscal_field\" data-priority=\"\" ><label for=\"direccion_fiscal\" class=\"ur-label\">Address<\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"direccion_fiscal\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"direccion_fiscal\" id=\"direccion_fiscal\" placeholder=\"\"  value=\"\" data-label=\"Address\" \/><span class=\"ur-icon ur-icon-input-field\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-5\" style=\"display:none;\"><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:99%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"terminos_condiciones\" class=\"ur-field-item field-checkbox terminos-condiciones-link\" data-ref-id=\"terminos_condiciones\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"terminos_condiciones_field\" data-priority=\"\" ><label class=\"ur-label\" required=\"required\" data-label=\"Terms and conditions\"> <abbr class=\"required\" title=\"required\">*<\/abbr><\/label><ul ><li class=\"ur-checkbox-list\"><input data-rules=\"\" data-id=\"terminos_condiciones[]\" required=\"required\" data-label=\"Terms and conditions\" data-value=\"I agree with  Terms and Conditions\" type=\"checkbox\" class=\"input-checkbox ur-frontend-field \" name=\"terminos_condiciones[]\" id=\"terminos_condiciones_I agree with  Terms and Conditions\" value=\"I agree with  Terms and Conditions\" \/><label class=\"ur-checkbox-label\" for=\"terminos_condiciones_I agree with  Terms and Conditions\">I agree with  <a href='https:\/\/iqtaghealth.com\/terms-and-condtions' target='_blank'>Terms and Conditions<\/a><\/label> <\/li><\/ul><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><div class=\"user-registration-part user-registration-part-1\" ><div class=\"ur-form-row\">\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\tstyle=\"width:99%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div data-conditional-logic-enabled=\"\" data-field-id=\"codigo_promotor\" class=\"ur-field-item field-text \" data-ref-id=\"codigo_promotor\">\n\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"codigo_promotor_field\" data-priority=\"\" ><label for=\"codigo_promotor\" class=\"ur-label\">iQtag Promo Code<span class=\"ur-portal-tooltip\" data-tip=\"Nombre del promotor de venta que di\u00f3 origen a su registro.\"><\/span><\/label> <span class=\"input-wrapper\"> <input data-rules=\"\" data-id=\"codigo_promotor\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"codigo_promotor\" id=\"codigo_promotor\" placeholder=\"Sales Promoter Code (if you have it)\"  value=\"\" data-label=\"iQtag Promo Code\" maxlength=\"8\" \/><span class=\"ur-icon ur-icon-input-field\"><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"ur-button-container center\" >\n\t\t\t\t\t\t\t<button class=\"user-registration-multi-part-nav user-registration-multi-part-nav-prev btn button\" data-action=\"prev\"  data-label-part-1=\"Previous\" data-label-part-2=\"Previous\" data-label-part-3=\"Previous\" data-label-part-4=\"Previous\" data-label-part-5=\"Previous\" style=\"display:none\">Previous<\/button><button class=\"user-registration-multi-part-nav user-registration-multi-part-nav-next btn button\" data-action=\"next\"  data-label-part-1=\"Next\" data-label-part-2=\"Next\" data-label-part-3=\"Next\" data-label-part-4=\"Next\" data-label-part-5=\"Next\">Next<\/button>\t\t\t\t\t\t\t<button type=\"submit\" class=\"btn button ur-submit-button ur-hidden \" conditional_rules=\"\">\n\t\t\t\t\t\t\t\t<span><\/span>\n\t\t\t\t\t\t\t\tEnviar\t\t\t\t\t\t\t<\/button>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t&nbsp;<button name='user_registration[save_and_continue]' class='user-registration-save-and-continue-button button user-registration-save-and-continue Save' id='user-registration-save-and-continue-8' value='user-registration-save-and-continue'>Save And Continue Later<\/button>\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\n\t\t\t\t<div style=\"clear:both\"><\/div>\n\t\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ur-form-field-icon\" name=\"ur-field-icon\" value=\"1\"\/>\n\t\t\t\t\t\t\t\t<input type=\"hidden\" name=\"ur-registration-language\" value=\"es\"\/>\n\t\t\t\t<input type=\"hidden\" name=\"ur-user-form-id\" value=\"8\"\/>\n\t\t\t\t<input type=\"hidden\" name=\"ur-redirect-url\" value=\"https:\/\/iqtaghealth.com\/shop\/\"\/>\n\t\t\t\t<input type=\"hidden\" id=\"ur_frontend_form_nonce\" name=\"ur_frontend_form_nonce\" value=\"10701e06c0\" \/>\n\t\t\t\t\t\t\t<\/form>\n\t\t\t\n\t\t<div style=\"clear:both\"><\/div>\n\t<\/div>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\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":"closed","template":"","meta":{"footnotes":""},"class_list":["post-9","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/iqtaghealth.com\/iqtag\/wp-json\/wp\/v2\/pages\/9","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/iqtaghealth.com\/iqtag\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/iqtaghealth.com\/iqtag\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/iqtaghealth.com\/iqtag\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/iqtaghealth.com\/iqtag\/wp-json\/wp\/v2\/comments?post=9"}],"version-history":[{"count":32,"href":"https:\/\/iqtaghealth.com\/iqtag\/wp-json\/wp\/v2\/pages\/9\/revisions"}],"predecessor-version":[{"id":412,"href":"https:\/\/iqtaghealth.com\/iqtag\/wp-json\/wp\/v2\/pages\/9\/revisions\/412"}],"wp:attachment":[{"href":"https:\/\/iqtaghealth.com\/iqtag\/wp-json\/wp\/v2\/media?parent=9"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}