{% extends "mediforms/pdfs/pdf.html" %} {% load i18n %} {% block body %}

{% blocktranslate %}Magnetresonanz-Untersuchung für Begleitpersonen{% endblocktranslate %}

{% include "mediforms/includes/information_text_mrtbegleitung.html" %}

{% blocktranslate %}Fragebogen zur Person und zu Kontraindikationen im Rahmen der Studie{% endblocktranslate %}
{% blocktranslate %}Magnetresonanz-Untersuchung für Begleitpersonen{% endblocktranslate %}

{{ form.last_name.label_tag }} {{ form.instance.last_name }} {{ form.first_name.label_tag }} {{ form.instance.first_name }} {{ form.height.label_tag }} {{ form.instance.height|default_if_none:"" }}
{{ form.date_of_birth.label_tag }} {{ form.instance.date_of_birth }} {{ form.birthplace.label_tag }} {{ form.instance.birthplace|default_if_none:"" }} {{ form.weight.label_tag }} {{ form.instance.weight|default_if_none:"" }}
{{ form.gender.label_tag }} {{ form.instance.get_gender_display|default_if_none:"" }}
{{ form.street.label_tag }} {{ form.instance.street|default_if_none:"" }} {{ form.zip_code.label_tag }} {{ form.instance.zip_code|default_if_none:"" }} {{ form.city.label_tag }} {{ form.instance.city|default_if_none:"" }}
{{ form.phone_number.label_tag }} {{ form.instance.phone_number|default_if_none:"" }} {{ form.mobile_number.label_tag }} {{ form.instance.mobile_number|default_if_none:"" }}
{{ form.email.label_tag }} {{ form.instance.email }}
{% for field in questions_form %} {% endfor %} {% for field in questions_women_form %} {% endfor %}
{{ forloop.counter }}. {{ field.label_tag }} {% if field.field.widget.input_type == "radio" %} {% trans field.value %} {% else %} {{ field.value }} {% endif %}
{% blocktranslate %}NUR FÜR VERSUCHSTEILNEHMERINNEN:{% endblocktranslate %}
{{ field.label_tag }} {% if field.value %}{% trans field.value %}{% endif %}
{% include "mediforms/includes/iup.html" %}
{% include "mediforms/includes/exploration_consent_mrtbegleitung.html" %}
{% include "mediforms/includes/data_storage_and_usage_consent_mrt.html" %}
{% endblock body %}