{"id":5552,"date":"2024-11-25T23:09:34","date_gmt":"2024-11-25T15:09:34","guid":{"rendered":"https:\/\/health.exebrain.com\/?page_id=5552"},"modified":"2024-12-13T00:55:41","modified_gmt":"2024-12-12T16:55:41","slug":"exebrain-form","status":"publish","type":"page","link":"https:\/\/health.exebrain.com\/en\/exebrain-form\/","title":{"rendered":"Assessment"},"content":{"rendered":"<div class='fluentform ff-default fluentform_wrapper_6  ff_guten_block ff_guten_block-6 ffs_custom_wrap'><form data-form_id=\"6\" id=\"fluentform_6\" class=\"frm-fluent-form fluent_form_6 ff-el-form-top ff_form_instance_6_1 ff-form-loading ffs_custom\" data-form_instance=\"ff_form_instance_6_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 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class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u5e74\u9f61\">\u5e74\u9f61<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1_2f58518d23139d90bc1f5e333ec24a51'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"20\u6b72\u4ee5\u4e0b\"  id='input_radio_1_2f58518d23139d90bc1f5e333ec24a51' aria-label='20\u6b72\u4ee5\u4e0b' aria-invalid='false' aria-required=true> <span>20\u6b72\u4ee5\u4e0b<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1_06c31582d76b770d1f7e5b4c58e59910'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"21-34\u6b72\"  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class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_14_faf9cc32f66a6346f8599f3cfb6d8fe9'><input  type=\"radio\" name=\"input_radio_14\" data-name=\"input_radio_14\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u5317\u5317\u57fa\"  id='input_radio_14_faf9cc32f66a6346f8599f3cfb6d8fe9' aria-label='\u5317\u5317\u57fa' aria-invalid='false' aria-required=true> <span>\u5317\u5317\u57fa<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_14_7c1e063a9b53b4554c1706d2111b3227'><input  type=\"radio\" name=\"input_radio_14\" data-name=\"input_radio_14\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u65b0\u7af9\"  id='input_radio_14_7c1e063a9b53b4554c1706d2111b3227' aria-label='\u65b0\u7af9' aria-invalid='false' aria-required=true> <span>\u65b0\u7af9<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_14_d1f0b8dc1e177782707522633ef96c31'><input  type=\"radio\" name=\"input_radio_14\" data-name=\"input_radio_14\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u6843\u5712\"  id='input_radio_14_d1f0b8dc1e177782707522633ef96c31' aria-label='\u6843\u5712' aria-invalid='false' aria-required=true> <span>\u6843\u5712<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_14_0bb39d894aa2edd489bbbec0fd880def'><input  type=\"radio\" name=\"input_radio_14\" data-name=\"input_radio_14\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u4e2d\u90e8\"  id='input_radio_14_0bb39d894aa2edd489bbbec0fd880def' aria-label='\u4e2d\u90e8' aria-invalid='false' aria-required=true> <span>\u4e2d\u90e8<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_14_16c4dbf271fc2793fe458588603a2846'><input  type=\"radio\" name=\"input_radio_14\" data-name=\"input_radio_14\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u5357\u90e8\"  id='input_radio_14_16c4dbf271fc2793fe458588603a2846' aria-label='\u5357\u90e8' aria-invalid='false' aria-required=true> <span>\u5357\u90e8<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_14_9a846fb3d64476238a786d427ea75f36'><input  type=\"radio\" name=\"input_radio_14\" data-name=\"input_radio_14\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u6771\u90e8\"  id='input_radio_14_9a846fb3d64476238a786d427ea75f36' aria-label='\u6771\u90e8' aria-invalid='false' aria-required=true> <span>\u6771\u90e8<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_14_a47f34934336f747e11126440e8b8ce5'><input  type=\"radio\" name=\"input_radio_14\" data-name=\"input_radio_14\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u96e2\u5cf6\"  id='input_radio_14_a47f34934336f747e11126440e8b8ce5' aria-label='\u96e2\u5cf6' aria-invalid='false' aria-required=true> <span>\u96e2\u5cf6<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_14_0b7912f0fb5c7a735c680eedf490e63d'><input  type=\"radio\" name=\"input_radio_14\" data-name=\"input_radio_14\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u5176\u4ed6\"  id='input_radio_14_0b7912f0fb5c7a735c680eedf490e63d' aria-label='\u5176\u4ed6' aria-invalid='false' aria-required=true> <span>\u5176\u4ed6<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_6_input_text_4' id='label_ff_6_input_text_4' aria-label=\"\u5c45\u4f4f\u5730\uff5c\u5176\u4ed6\">\u5c45\u4f4f\u5730\uff5c\u5176\u4ed6<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_4\" class=\"ff-el-form-control\" placeholder=\"\u8acb\u586b\u5beb\u60a8\u7684\u5c45\u4f4f\u5730\" data-name=\"input_text_4\" id=\"ff_6_input_text_4\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u5de5\u4f5c\u7522\u696d\u5225\">\u5de5\u4f5c\u7522\u696d\u5225<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_c11a064359cbe28ba5fece12fbfd4d70'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u4e0a\u73ed\u65cf\"  id='input_radio_2_c11a064359cbe28ba5fece12fbfd4d70' aria-label='\u4e0a\u73ed\u65cf' aria-invalid='false' aria-required=true> <span>\u4e0a\u73ed\u65cf<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_d54e4f502d3582979cfce720f9ea3163'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u5546\u696d\"  id='input_radio_2_d54e4f502d3582979cfce720f9ea3163' aria-label='\u5546\u696d' aria-invalid='false' aria-required=true> <span>\u5546\u696d<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_be1a482ad1ec190ac1bbadfe43cc186c'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u670d\u52d9\u696d\"  id='input_radio_2_be1a482ad1ec190ac1bbadfe43cc186c' aria-label='\u670d\u52d9\u696d' aria-invalid='false' aria-required=true> <span>\u670d\u52d9\u696d<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_c586c24b3ec4a5b7d983b40f984ece57'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u8cc7\u8a0a\u696d\"  id='input_radio_2_c586c24b3ec4a5b7d983b40f984ece57' aria-label='\u8cc7\u8a0a\u696d' aria-invalid='false' aria-required=true> <span>\u8cc7\u8a0a\u696d<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_fcdd2ccc7f8362c2a14ee4ce5ea3342f'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u88fd\u9020\u696d\"  id='input_radio_2_fcdd2ccc7f8362c2a14ee4ce5ea3342f' aria-label='\u88fd\u9020\u696d' aria-invalid='false' aria-required=true> <span>\u88fd\u9020\u696d<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_2c8e2a254bc5d26f13700e956ebbdb22'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u904b\u52d5\u54e1\"  id='input_radio_2_2c8e2a254bc5d26f13700e956ebbdb22' aria-label='\u904b\u52d5\u54e1' aria-invalid='false' aria-required=true> <span>\u904b\u52d5\u54e1<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_7954f8f187e8660f08a01d516d81e02b'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u8ecd\u3001\u516c\u3001\u6559\"  id='input_radio_2_7954f8f187e8660f08a01d516d81e02b' aria-label='\u8ecd\u3001\u516c\u3001\u6559' aria-invalid='false' aria-required=true> <span>\u8ecd\u3001\u516c\u3001\u6559<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_d677509561ab1084d8186afbdbd8bcfb'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u8fb2\u6797\u6f01\u7267\u696d\"  id='input_radio_2_d677509561ab1084d8186afbdbd8bcfb' aria-label='\u8fb2\u6797\u6f01\u7267\u696d' aria-invalid='false' aria-required=true> <span>\u8fb2\u6797\u6f01\u7267\u696d<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_af0b80229fcf65b010afb61a130a229a'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u91ab\u7642\u4fdd\u5065\u696d\"  id='input_radio_2_af0b80229fcf65b010afb61a130a229a' aria-label='\u91ab\u7642\u4fdd\u5065\u696d' aria-invalid='false' aria-required=true> <span>\u91ab\u7642\u4fdd\u5065\u696d<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_bc1edc4ba6e275c0f97fae107f52953d'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u5ee3\u544a\u5a92\u9ad4\u696d\"  id='input_radio_2_bc1edc4ba6e275c0f97fae107f52953d' aria-label='\u5ee3\u544a\u5a92\u9ad4\u696d' aria-invalid='false' aria-required=true> <span>\u5ee3\u544a\u5a92\u9ad4\u696d<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_2deade690ab227b7b2ce5566086f6691'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u5bb6\u7ba1\"  id='input_radio_2_2deade690ab227b7b2ce5566086f6691' aria-label='\u5bb6\u7ba1' aria-invalid='false' aria-required=true> <span>\u5bb6\u7ba1<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_3a9df5f6806cce2517833f9396664f09'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u5b78\u751f\"  id='input_radio_2_3a9df5f6806cce2517833f9396664f09' aria-label='\u5b78\u751f' aria-invalid='false' aria-required=true> <span>\u5b78\u751f<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_4175f5c904a7f2763975f7b4bd76fc76'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u5176\u4ed6\"  id='input_radio_2_4175f5c904a7f2763975f7b4bd76fc76' aria-label='\u5176\u4ed6' aria-invalid='false' aria-required=true> <span>\u5176\u4ed6<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_6_input_text_1' id='label_ff_6_input_text_1' aria-label=\"\u5de5\u4f5c\u8077\u7a31\">\u5de5\u4f5c\u8077\u7a31<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_1\" class=\"ff-el-form-control\" data-name=\"input_text_1\" id=\"ff_6_input_text_1\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u60a8\u81ea\u89ba\u6709\u54ea\u4e9b\u56f0\u64fe\uff1f\uff08\u53ef\u8907\u9078\uff09\">\u60a8\u81ea\u89ba\u6709\u54ea\u4e9b\u56f0\u64fe\uff1f\uff08\u53ef\u8907\u9078\uff09<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_90ca810d36008edb6b2e7cc1c1ae89ff'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u7761\u7720\u969c\u7919\"  id='checkbox_90ca810d36008edb6b2e7cc1c1ae89ff' aria-label='\u7761\u7720\u969c\u7919' aria-invalid='false' aria-required=true> <span>\u7761\u7720\u969c\u7919<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_49e6a41c48f116076352fefadbc82518'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u8a18\u61b6\u529b\u8870\u9000\"  id='checkbox_49e6a41c48f116076352fefadbc82518' aria-label='\u8a18\u61b6\u529b\u8870\u9000' aria-invalid='false' aria-required=true> <span>\u8a18\u61b6\u529b\u8870\u9000<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_c69496c4c501910ca7437b5acdabc8e8'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u6ce8\u610f\u529b\u4e0d\u8db3\"  id='checkbox_c69496c4c501910ca7437b5acdabc8e8' aria-label='\u6ce8\u610f\u529b\u4e0d\u8db3' aria-invalid='false' aria-required=true> <span>\u6ce8\u610f\u529b\u4e0d\u8db3<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_e64bc2eba489a03fb5d66604582a0bb3'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u60c5\u7dd2\u9ad8\u4f4e\u4e0d\u7a69\u5b9a\"  id='checkbox_e64bc2eba489a03fb5d66604582a0bb3' aria-label='\u60c5\u7dd2\u9ad8\u4f4e\u4e0d\u7a69\u5b9a' aria-invalid='false' aria-required=true> <span>\u60c5\u7dd2\u9ad8\u4f4e\u4e0d\u7a69\u5b9a<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_d0e6d3f645288a8dfdf2596c81c7bbab'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u58d3\u529b\u578b\u982d\u75db\u3001\u504f\u982d\u75db\"  id='checkbox_d0e6d3f645288a8dfdf2596c81c7bbab' aria-label='\u58d3\u529b\u578b\u982d\u75db\u3001\u504f\u982d\u75db' aria-invalid='false' aria-required=true> <span>\u58d3\u529b\u578b\u982d\u75db\u3001\u504f\u982d\u75db<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1bad8678e5e8056a9bc246dd9367dad3'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u4e2d\u98a8\u3001\u8166\u50b7\u3001\u5176\u4ed6\"  id='checkbox_1bad8678e5e8056a9bc246dd9367dad3' aria-label='\u4e2d\u98a8\u3001\u8166\u50b7\u3001\u5176\u4ed6' aria-invalid='false' aria-required=true> <span>\u4e2d\u98a8\u3001\u8166\u50b7\u3001\u5176\u4ed6<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_b3ae4a7f32f6df5511ff094906191531'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u5fc3\u60b8\u3001\u751f\u7406\u4e0d\u9069\"  id='checkbox_b3ae4a7f32f6df5511ff094906191531' aria-label='\u5fc3\u60b8\u3001\u751f\u7406\u4e0d\u9069' aria-invalid='false' aria-required=true> <span>\u5fc3\u60b8\u3001\u751f\u7406\u4e0d\u9069<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_87a5c9086cbead5d59f248633c29153a'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u8166\u529b\u4e0d\u582a\u8ca0\u8377\u3001\u4e2d\u9ad8\u968e\u7d93\u7406\u4eba\u3001\u5c08\u696d\u8077\u80fd\"  id='checkbox_87a5c9086cbead5d59f248633c29153a' aria-label='\u8166\u529b\u4e0d\u582a\u8ca0\u8377\u3001\u4e2d\u9ad8\u968e\u7d93\u7406\u4eba\u3001\u5c08\u696d\u8077\u80fd' aria-invalid='false' aria-required=true> <span>\u8166\u529b\u4e0d\u582a\u8ca0\u8377\u3001\u4e2d\u9ad8\u968e\u7d93\u7406\u4eba\u3001\u5c08\u696d\u8077\u80fd<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_c9d88d3e74beec0d772684877df10370'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u66f4\u5e74\u671f\u4e0d\u9069\"  id='checkbox_c9d88d3e74beec0d772684877df10370' aria-label='\u66f4\u5e74\u671f\u4e0d\u9069' aria-invalid='false' aria-required=true> <span>\u66f4\u5e74\u671f\u4e0d\u9069<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_e8cfbab499ac71481a83d4de48927128'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u4ee5\u4e0a\u7686\u7121\"  id='checkbox_e8cfbab499ac71481a83d4de48927128' aria-label='\u4ee5\u4e0a\u7686\u7121' aria-invalid='false' aria-required=true> <span>\u4ee5\u4e0a\u7686\u7121<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_e8277455dbba0b4fa6d1ac28fff641d5'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u5176\u4ed6\"  id='checkbox_e8277455dbba0b4fa6d1ac28fff641d5' aria-label='\u5176\u4ed6' aria-invalid='false' aria-required=true> <span>\u5176\u4ed6<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_6_input_text_2' id='label_ff_6_input_text_2' aria-label=\"\u60a8\u81ea\u89ba\u6709\u54ea\u4e9b\u56f0\u64fe\uff1f\uff08\u5176\u4ed6\uff09\">\u60a8\u81ea\u89ba\u6709\u54ea\u4e9b\u56f0\u64fe\uff1f\uff08\u5176\u4ed6\uff09<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_2\" class=\"ff-el-form-control\" data-name=\"input_text_2\" id=\"ff_6_input_text_2\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u4ee5\u4e0b\u54ea\u4e9b\u7b26\u5408\u60a8\u9019\u4e00\u500b\u6708\u7684\u8fd1\u6cc1\uff1f\uff08\u53ef\u8907\u9078\uff09\">\u4ee5\u4e0b\u54ea\u4e9b\u7b26\u5408\u60a8\u9019\u4e00\u500b\u6708\u7684\u8fd1\u6cc1\uff1f\uff08\u53ef\u8907\u9078\uff09<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_3d333f62d8f46faf13ac52ce762c0025'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u5fc3\u88e1\u60f3\u505a\u67d0\u4e8b\uff0c\u529b\u91cf\u537b\u7121\u6cd5\u9054\u5230\"  id='checkbox_1_3d333f62d8f46faf13ac52ce762c0025' aria-label='\u5fc3\u88e1\u60f3\u505a\u67d0\u4e8b\uff0c\u529b\u91cf\u537b\u7121\u6cd5\u9054\u5230' aria-invalid='false' aria-required=true> <span>\u5fc3\u88e1\u60f3\u505a\u67d0\u4e8b\uff0c\u529b\u91cf\u537b\u7121\u6cd5\u9054\u5230<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_6afee13fa895e5bbcee3e470d77522b5'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u5c0d\u74b0\u5883\u7f3a\u4e4f\u63a7\u5236\u611f\uff0c\u89ba\u5f97\u81ea\u5df1\u904e\u5f80\u7684\u80fd\u529b\u4e0d\u518d\u3001\u5de5\u4f5c\u8868\u73fe\u53cd\u61c9\u50f5\u5316\"  id='checkbox_1_6afee13fa895e5bbcee3e470d77522b5' aria-label='\u5c0d\u74b0\u5883\u7f3a\u4e4f\u63a7\u5236\u611f\uff0c\u89ba\u5f97\u81ea\u5df1\u904e\u5f80\u7684\u80fd\u529b\u4e0d\u518d\u3001\u5de5\u4f5c\u8868\u73fe\u53cd\u61c9\u50f5\u5316' aria-invalid='false' aria-required=true> <span>\u5c0d\u74b0\u5883\u7f3a\u4e4f\u63a7\u5236\u611f\uff0c\u89ba\u5f97\u81ea\u5df1\u904e\u5f80\u7684\u80fd\u529b\u4e0d\u518d\u3001\u5de5\u4f5c\u8868\u73fe\u53cd\u61c9\u50f5\u5316<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_17b5ee5cf5ebf4cb7c8f05199447a775'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u300c\u6c92\u6709\u7279\u5b9a\u539f\u56e0\u300d\u537b\u7dca\u5f35\uff0c\u5c0e\u81f4\u7121\u6cd5\u96c6\u4e2d\u6ce8\u610f\u529b\uff0c\u89ba\u5f97\u4e00\u4e8b\u7121\u6210\"  id='checkbox_1_17b5ee5cf5ebf4cb7c8f05199447a775' aria-label='\u300c\u6c92\u6709\u7279\u5b9a\u539f\u56e0\u300d\u537b\u7dca\u5f35\uff0c\u5c0e\u81f4\u7121\u6cd5\u96c6\u4e2d\u6ce8\u610f\u529b\uff0c\u89ba\u5f97\u4e00\u4e8b\u7121\u6210' aria-invalid='false' aria-required=true> <span>\u300c\u6c92\u6709\u7279\u5b9a\u539f\u56e0\u300d\u537b\u7dca\u5f35\uff0c\u5c0e\u81f4\u7121\u6cd5\u96c6\u4e2d\u6ce8\u610f\u529b\uff0c\u89ba\u5f97\u4e00\u4e8b\u7121\u6210<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_dc9df69c02aaf02b39f0997e5ad67849'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u5fd8\u8a18\u91cd\u8981\u7684\u7d04\u6703\u3001\u66fe\u7d93\u904e\u7684\u5c0d\u8a71\u6216\u662f\u6700\u8fd1\u767c\u751f\u7684\u4e8b\u4ef6\"  id='checkbox_1_dc9df69c02aaf02b39f0997e5ad67849' aria-label='\u5fd8\u8a18\u91cd\u8981\u7684\u7d04\u6703\u3001\u66fe\u7d93\u904e\u7684\u5c0d\u8a71\u6216\u662f\u6700\u8fd1\u767c\u751f\u7684\u4e8b\u4ef6' aria-invalid='false' aria-required=true> <span>\u5fd8\u8a18\u91cd\u8981\u7684\u7d04\u6703\u3001\u66fe\u7d93\u904e\u7684\u5c0d\u8a71\u6216\u662f\u6700\u8fd1\u767c\u751f\u7684\u4e8b\u4ef6<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_226bc496316e35144a950a776ec6da83'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u89ba\u5f97\u81ea\u5df1\u7684\u5de5\u4f5c\u8207\u793e\u4ea4\u80fd\u529b\u4e0b\u964d\"  id='checkbox_1_226bc496316e35144a950a776ec6da83' aria-label='\u89ba\u5f97\u81ea\u5df1\u7684\u5de5\u4f5c\u8207\u793e\u4ea4\u80fd\u529b\u4e0b\u964d' aria-invalid='false' aria-required=true> <span>\u89ba\u5f97\u81ea\u5df1\u7684\u5de5\u4f5c\u8207\u793e\u4ea4\u80fd\u529b\u4e0b\u964d<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_89306f4125b8e7e52431d2b3d7830102'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u95b1\u8b80\u7406\u89e3\u7684\u80fd\u529b\u4e0b\u964d\"  id='checkbox_1_89306f4125b8e7e52431d2b3d7830102' aria-label='\u95b1\u8b80\u7406\u89e3\u7684\u80fd\u529b\u4e0b\u964d' aria-invalid='false' aria-required=true> <span>\u95b1\u8b80\u7406\u89e3\u7684\u80fd\u529b\u4e0b\u964d<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_b9844246c255be9c18bf0c274f1535a7'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u8868\u9054\u60f3\u6cd5\u3001\u8aaa\u660e\u4e8b\u60c5\u7684\u80fd\u529b\u4e0b\u964d\"  id='checkbox_1_b9844246c255be9c18bf0c274f1535a7' aria-label='\u8868\u9054\u60f3\u6cd5\u3001\u8aaa\u660e\u4e8b\u60c5\u7684\u80fd\u529b\u4e0b\u964d' aria-invalid='false' aria-required=true> <span>\u8868\u9054\u60f3\u6cd5\u3001\u8aaa\u660e\u4e8b\u60c5\u7684\u80fd\u529b\u4e0b\u964d<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_ca7f64ef4efabf49f76118d223c292cd'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u4ee5\u4e0a\u7686\u7121\"  id='checkbox_1_ca7f64ef4efabf49f76118d223c292cd' aria-label='\u4ee5\u4e0a\u7686\u7121' aria-invalid='false' aria-required=true> <span>\u4ee5\u4e0a\u7686\u7121<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_9f047681f5df34c83a204f6f5b482a0e'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u5176\u4ed6\"  id='checkbox_1_9f047681f5df34c83a204f6f5b482a0e' aria-label='\u5176\u4ed6' aria-invalid='false' aria-required=true> <span>\u5176\u4ed6<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_6_input_text_3' id='label_ff_6_input_text_3' aria-label=\"\u4ee5\u4e0b\u54ea\u4e9b\u7b26\u5408\u60a8\u9019\u4e00\u500b\u6708\u7684\u8fd1\u6cc1\uff1f\uff08\u5176\u4ed6\uff09\">\u4ee5\u4e0b\u54ea\u4e9b\u7b26\u5408\u60a8\u9019\u4e00\u500b\u6708\u7684\u8fd1\u6cc1\uff1f\uff08\u5176\u4ed6\uff09<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_3\" class=\"ff-el-form-control\" data-name=\"input_text_3\" id=\"ff_6_input_text_3\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u60a8\u662f\u5426\u66fe\u7d93\u524d\u5f80\u8eab\u5fc3\u79d1\u3001\u795e\u7d93\u79d1\u5c31\u8a3a\uff1f\">\u60a8\u662f\u5426\u66fe\u7d93\u524d\u5f80\u8eab\u5fc3\u79d1\u3001\u795e\u7d93\u79d1\u5c31\u8a3a\uff1f<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_af04d8e9e132a668dd620fb5f9a4804c'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u7121\"  id='input_radio_3_af04d8e9e132a668dd620fb5f9a4804c' aria-label='\u7121' aria-invalid='false' aria-required=true> <span>\u7121<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_088484367446f2351e8817144776bdb2'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u6709\uff0c\u4f46\u5df2\u505c\u6b62\u56de\u8a3a\u81f3\u5c11\u534a\u5e74\u4ee5\u4e0a\"  id='input_radio_3_088484367446f2351e8817144776bdb2' aria-label='\u6709\uff0c\u4f46\u5df2\u505c\u6b62\u56de\u8a3a\u81f3\u5c11\u534a\u5e74\u4ee5\u4e0a' aria-invalid='false' aria-required=true> <span>\u6709\uff0c\u4f46\u5df2\u505c\u6b62\u56de\u8a3a\u81f3\u5c11\u534a\u5e74\u4ee5\u4e0a<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_dcdacf367124e6b5905d4ce6744a8aef'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u6709\uff0c\u76ee\u524d\u4ecd\u6301\u7e8c\u56de\u8a3a\u4e2d\"  id='input_radio_3_dcdacf367124e6b5905d4ce6744a8aef' aria-label='\u6709\uff0c\u76ee\u524d\u4ecd\u6301\u7e8c\u56de\u8a3a\u4e2d' aria-invalid='false' aria-required=true> <span>\u6709\uff0c\u76ee\u524d\u4ecd\u6301\u7e8c\u56de\u8a3a\u4e2d<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u60a8\u66fe\u7d93\u505a\u904e\u54ea\u4e9b\u8a55\u4f30\u982d\u90e8\u5065\u5eb7\u7684\u6aa2\u67e5\uff1f\uff08\u53ef\u8907\u9078\uff09\">\u60a8\u66fe\u7d93\u505a\u904e\u54ea\u4e9b\u8a55\u4f30\u982d\u90e8\u5065\u5eb7\u7684\u6aa2\u67e5\uff1f\uff08\u53ef\u8907\u9078\uff09<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_1a7876d75124c8acf46c01e5b193bb18'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u8166\u6ce2\u6aa2\u67e5\"  id='checkbox_2_1a7876d75124c8acf46c01e5b193bb18' aria-label='\u8166\u6ce2\u6aa2\u67e5' aria-invalid='false' aria-required=true> <span>\u8166\u6ce2\u6aa2\u67e5<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_2c62b33d433847c61832df4d32ed1e5f'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u96fb\u8166\u65b7\u5c64\u6383\u63cf(CT)\u6aa2\u67e5\"  id='checkbox_2_2c62b33d433847c61832df4d32ed1e5f' aria-label='\u96fb\u8166\u65b7\u5c64\u6383\u63cf(CT)\u6aa2\u67e5' aria-invalid='false' aria-required=true> <span>\u96fb\u8166\u65b7\u5c64\u6383\u63cf(CT)\u6aa2\u67e5<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_1e4c305f8d63317931e7f42bd66f2f1a'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u6838\u78c1\u5171\u632f\u9020\u5f71(MRI)\u6aa2\u67e5\"  id='checkbox_2_1e4c305f8d63317931e7f42bd66f2f1a' aria-label='\u6838\u78c1\u5171\u632f\u9020\u5f71(MRI)\u6aa2\u67e5' aria-invalid='false' aria-required=true> <span>\u6838\u78c1\u5171\u632f\u9020\u5f71(MRI)\u6aa2\u67e5<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_f9a9913d42f21e9f882a0f436e4657fe'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u4ee5\u4e0a\u7686\u7121\"  id='checkbox_2_f9a9913d42f21e9f882a0f436e4657fe' aria-label='\u4ee5\u4e0a\u7686\u7121' aria-invalid='false' aria-required=true> <span>\u4ee5\u4e0a\u7686\u7121<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u60a8\u904e\u53bb\u6216\u73fe\u5728\u662f\u5426\u6b63\u5728\u670d\u85e5\uff1f\">\u60a8\u904e\u53bb\u6216\u73fe\u5728\u662f\u5426\u6b63\u5728\u670d\u85e5\uff1f<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_4_f59c75ca13ee3ea28c11bffd620a5c1f'><input  type=\"radio\" name=\"input_radio_4\" data-name=\"input_radio_4\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u6c92\u6709\"  id='input_radio_4_f59c75ca13ee3ea28c11bffd620a5c1f' aria-label='\u6c92\u6709' aria-invalid='false' aria-required=true> <span>\u6c92\u6709<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_4_5d262b19d0019098cb8de9e65533f83f'><input  type=\"radio\" name=\"input_radio_4\" data-name=\"input_radio_4\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u904e\u53bb\u6709\uff0c\u73fe\u5df2\u505c\u85e5\u3002\"  id='input_radio_4_5d262b19d0019098cb8de9e65533f83f' aria-label='\u904e\u53bb\u6709\uff0c\u73fe\u5df2\u505c\u85e5\u3002' aria-invalid='false' aria-required=true> <span>\u904e\u53bb\u6709\uff0c\u73fe\u5df2\u505c\u85e5\u3002<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_4_e2802121d5715459169b22d376084ed2'><input  type=\"radio\" name=\"input_radio_4\" data-name=\"input_radio_4\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u73fe\u5728\u6709\u670d\u85e5\"  id='input_radio_4_e2802121d5715459169b22d376084ed2' aria-label='\u73fe\u5728\u6709\u670d\u85e5' aria-invalid='false' aria-required=true> <span>\u73fe\u5728\u6709\u670d\u85e5<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u82e5\u6211\u5011\u6bd4\u55bb\u60a8\u76ee\u524d\u7684\u5927\u8166\u904b\u4f5c\u6548\u80fd\u5206\u6578\u662f50\u5206\uff0c\u60a8\u671f\u76fc\u5927\u8166\u935b\u934a\u5f8c\u53ef\u4ee5\u9032\u6b65\u5230\u5e7e\u5206\uff1f\">\u82e5\u6211\u5011\u6bd4\u55bb\u60a8\u76ee\u524d\u7684\u5927\u8166\u904b\u4f5c\u6548\u80fd\u5206\u6578\u662f50\u5206\uff0c\u60a8\u671f\u76fc\u5927\u8166\u935b\u934a\u5f8c\u53ef\u4ee5\u9032\u6b65\u5230\u5e7e\u5206\uff1f<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_5_0d003d2ffda65d2c2e207cf6e7316530'><input  type=\"radio\" name=\"input_radio_5\" data-name=\"input_radio_5\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"60\u5206\"  id='input_radio_5_0d003d2ffda65d2c2e207cf6e7316530' aria-label='60\u5206' aria-invalid='false' aria-required=true> <span>60\u5206<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_5_2a1751271776054ce16449e6a9e09e8a'><input  type=\"radio\" name=\"input_radio_5\" data-name=\"input_radio_5\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"70\u5206\"  id='input_radio_5_2a1751271776054ce16449e6a9e09e8a' aria-label='70\u5206' aria-invalid='false' aria-required=true> <span>70\u5206<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_5_070cf4f58f40b4499200625b6dfc0ec0'><input  type=\"radio\" name=\"input_radio_5\" data-name=\"input_radio_5\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"80\u5206\"  id='input_radio_5_070cf4f58f40b4499200625b6dfc0ec0' aria-label='80\u5206' aria-invalid='false' aria-required=true> <span>80\u5206<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_5_8da63768e98fe319c5177ec2c76245b7'><input  type=\"radio\" name=\"input_radio_5\" data-name=\"input_radio_5\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"90\u5206\"  id='input_radio_5_8da63768e98fe319c5177ec2c76245b7' aria-label='90\u5206' aria-invalid='false' aria-required=true> <span>90\u5206<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_5_a8151c3258abe972735d3b6c65d00900'><input  type=\"radio\" name=\"input_radio_5\" data-name=\"input_radio_5\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"99\u5206\"  id='input_radio_5_a8151c3258abe972735d3b6c65d00900' aria-label='99\u5206' aria-invalid='false' aria-required=true> <span>99\u5206<\/span><\/label><\/div><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-6_1\" ><h3 class='ff-el-section-title'>\u7c21\u5f0f\u5065\u5eb7\u91cf\u8868<\/h3><div class='ff-section_break_desk'><p>\u8aaa\u660e\uff1a<br \/>\u672c\u91cf\u8868\u6240\u5217\u8209\u7684\u554f\u984c\u662f\u70ba\u5354\u52a9\u60a8\u77ad\u89e3\u60a8\u7684\u8eab\u5fc3\u9069\u61c9\u72c0\u6cc1\uff0c\u8acb\u60a8\u4ed4\u7d30\u56de\u60f3\u5728\u6700\u8fd1\u4e00\u661f\u671f\u4e2d(\u5305\u62ec\u4eca\u5929)\uff0c\u9019\u4e9b\u554f\u984c\u4f7f\u60a8\u611f\u5230\u56f0\u64fe\u6216\u82e6\u60f1\u7684\u7a0b\u5ea6\uff0c\u7136\u5f8c\u5708\u9078\u4e00\u500b\u60a8\u8a8d\u70ba\u6700\u80fd\u4ee3\u8868\u60a8\u611f\u89ba\u7684\u7b54\u6848\u3002<\/p>\n<div><br \/>\u8cc7\u6599\u53c3\u8003 :<br \/>\u570b\u7acb\u53f0\u5927\u91ab\u5b78\u9662\u7cbe\u795e\u79d1\u6559\u6388\u66a8\u7cbe\u795e\u90e8\u4e3b\u6cbb\u91ab\u5e2b \u674e\u660e\u6ff1\u91ab\u5e2b \u3002<\/div><\/div><hr \/><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"1. \u7761\u7720\u56f0\u96e3\uff0c\u8b6c\u5982\u96e3\u4ee5\u5165\u7761\u3001\u6613\u9192\u6216\u65e9\u9192\u3002\">1. \u7761\u7720\u56f0\u96e3\uff0c\u8b6c\u5982\u96e3\u4ee5\u5165\u7761\u3001\u6613\u9192\u6216\u65e9\u9192\u3002<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_7_d0298a4a59d64478800c4588f0c323fa'><input  type=\"radio\" name=\"input_radio_7\" data-name=\"input_radio_7\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u5b8c\u5168\u6c92\u6709\"  id='input_radio_7_d0298a4a59d64478800c4588f0c323fa' aria-label='\u5b8c\u5168\u6c92\u6709' aria-invalid='false' aria-required=true> <span>\u5b8c\u5168\u6c92\u6709<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_7_61854214b25530e49aa4b64945c19977'><input  type=\"radio\" name=\"input_radio_7\" data-name=\"input_radio_7\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u8f15\u5fae\"  id='input_radio_7_61854214b25530e49aa4b64945c19977' aria-label='\u8f15\u5fae' aria-invalid='false' aria-required=true> <span>\u8f15\u5fae<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_7_98973426c53f1c4b39263f9e4c827257'><input  type=\"radio\" name=\"input_radio_7\" data-name=\"input_radio_7\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u4e2d\u7b49\u7a0b\u5ea6\"  id='input_radio_7_98973426c53f1c4b39263f9e4c827257' aria-label='\u4e2d\u7b49\u7a0b\u5ea6' aria-invalid='false' aria-required=true> <span>\u4e2d\u7b49\u7a0b\u5ea6<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_7_4092f01f4240e8164162ce129f35f73f'><input  type=\"radio\" name=\"input_radio_7\" data-name=\"input_radio_7\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u5f37\u70c8\"  id='input_radio_7_4092f01f4240e8164162ce129f35f73f' aria-label='\u5f37\u70c8' aria-invalid='false' aria-required=true> <span>\u5f37\u70c8<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_7_80c12306e4a849d4bd5e1325c07a583e'><input  type=\"radio\" name=\"input_radio_7\" data-name=\"input_radio_7\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u975e\u5e38\u5f37\u70c8\"  id='input_radio_7_80c12306e4a849d4bd5e1325c07a583e' aria-label='\u975e\u5e38\u5f37\u70c8' aria-invalid='false' aria-required=true> <span>\u975e\u5e38\u5f37\u70c8<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"2. \u611f\u89ba\u7dca\u5f35\u4e0d\u5b89\u3002\">2. \u611f\u89ba\u7dca\u5f35\u4e0d\u5b89\u3002<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_8_2e28a7242fb9fcec68595b3a11f12698'><input  type=\"radio\" name=\"input_radio_8\" data-name=\"input_radio_8\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u5b8c\u5168\u6c92\u6709\"  id='input_radio_8_2e28a7242fb9fcec68595b3a11f12698' aria-label='\u5b8c\u5168\u6c92\u6709' aria-invalid='false' aria-required=true> <span>\u5b8c\u5168\u6c92\u6709<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_8_29036c3be3d89fe41f575c7ab86b3ce0'><input  type=\"radio\" name=\"input_radio_8\" data-name=\"input_radio_8\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u8f15\u5fae\"  id='input_radio_8_29036c3be3d89fe41f575c7ab86b3ce0' aria-label='\u8f15\u5fae' aria-invalid='false' aria-required=true> <span>\u8f15\u5fae<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_8_fa698d90408f969b496f199a720816d8'><input  type=\"radio\" name=\"input_radio_8\" data-name=\"input_radio_8\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u4e2d\u7b49\u7a0b\u5ea6\"  id='input_radio_8_fa698d90408f969b496f199a720816d8' aria-label='\u4e2d\u7b49\u7a0b\u5ea6' aria-invalid='false' aria-required=true> <span>\u4e2d\u7b49\u7a0b\u5ea6<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_8_a7020f85f09adaadde8a14f741f294aa'><input  type=\"radio\" name=\"input_radio_8\" data-name=\"input_radio_8\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u5f37\u70c8\"  id='input_radio_8_a7020f85f09adaadde8a14f741f294aa' aria-label='\u5f37\u70c8' aria-invalid='false' aria-required=true> <span>\u5f37\u70c8<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_8_91c21dd466eb9a02f8343ba917ddb2aa'><input  type=\"radio\" name=\"input_radio_8\" data-name=\"input_radio_8\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u975e\u5e38\u5f37\u70c8\"  id='input_radio_8_91c21dd466eb9a02f8343ba917ddb2aa' aria-label='\u975e\u5e38\u5f37\u70c8' aria-invalid='false' aria-required=true> <span>\u975e\u5e38\u5f37\u70c8<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"3. \u89ba\u5f97\u5bb9\u6613\u82e6\u60f1\u6216\u52d5\u6012\u3002\">3. \u89ba\u5f97\u5bb9\u6613\u82e6\u60f1\u6216\u52d5\u6012\u3002<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_9_4d2cbe19e9674a38826ac869e86f085e'><input  type=\"radio\" name=\"input_radio_9\" data-name=\"input_radio_9\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u5b8c\u5168\u6c92\u6709\"  id='input_radio_9_4d2cbe19e9674a38826ac869e86f085e' aria-label='\u5b8c\u5168\u6c92\u6709' aria-invalid='false' aria-required=true> <span>\u5b8c\u5168\u6c92\u6709<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_9_bc55a64f7664b16c3591278902d37a18'><input  type=\"radio\" name=\"input_radio_9\" data-name=\"input_radio_9\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u8f15\u5fae\"  id='input_radio_9_bc55a64f7664b16c3591278902d37a18' aria-label='\u8f15\u5fae' aria-invalid='false' aria-required=true> <span>\u8f15\u5fae<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_9_da5ddf9491c6171eede6573207afe05f'><input  type=\"radio\" name=\"input_radio_9\" data-name=\"input_radio_9\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u4e2d\u7b49\u7a0b\u5ea6\"  id='input_radio_9_da5ddf9491c6171eede6573207afe05f' aria-label='\u4e2d\u7b49\u7a0b\u5ea6' aria-invalid='false' aria-required=true> <span>\u4e2d\u7b49\u7a0b\u5ea6<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_9_13741e72df5e54bc0dfb2289e5c1ab05'><input  type=\"radio\" name=\"input_radio_9\" data-name=\"input_radio_9\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u5f37\u70c8\"  id='input_radio_9_13741e72df5e54bc0dfb2289e5c1ab05' aria-label='\u5f37\u70c8' aria-invalid='false' aria-required=true> <span>\u5f37\u70c8<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_9_4b19ab383a435ca565e9c36450174c50'><input  type=\"radio\" name=\"input_radio_9\" data-name=\"input_radio_9\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u975e\u5e38\u5f37\u70c8\"  id='input_radio_9_4b19ab383a435ca565e9c36450174c50' aria-label='\u975e\u5e38\u5f37\u70c8' aria-invalid='false' aria-required=true> <span>\u975e\u5e38\u5f37\u70c8<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"4. \u611f\u89ba\u6182\u9b31\u3001\u5fc3\u60c5\u4f4e\u843d\u3002\">4. \u611f\u89ba\u6182\u9b31\u3001\u5fc3\u60c5\u4f4e\u843d\u3002<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_10_79483700e1b48c33d0c9c7e59b8d8c73'><input  type=\"radio\" name=\"input_radio_10\" data-name=\"input_radio_10\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u5b8c\u5168\u6c92\u6709\"  id='input_radio_10_79483700e1b48c33d0c9c7e59b8d8c73' aria-label='\u5b8c\u5168\u6c92\u6709' aria-invalid='false' aria-required=true> <span>\u5b8c\u5168\u6c92\u6709<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_10_55a4a1227d2d0780fdb3e92af33233e3'><input  type=\"radio\" name=\"input_radio_10\" data-name=\"input_radio_10\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u8f15\u5fae\"  id='input_radio_10_55a4a1227d2d0780fdb3e92af33233e3' aria-label='\u8f15\u5fae' aria-invalid='false' aria-required=true> <span>\u8f15\u5fae<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_10_876c2161e9da9bcd672ee914f64c89e6'><input  type=\"radio\" name=\"input_radio_10\" data-name=\"input_radio_10\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u4e2d\u7b49\u7a0b\u5ea6\"  id='input_radio_10_876c2161e9da9bcd672ee914f64c89e6' aria-label='\u4e2d\u7b49\u7a0b\u5ea6' aria-invalid='false' aria-required=true> <span>\u4e2d\u7b49\u7a0b\u5ea6<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_10_20ae021e1d954087fae6800ca5f767a4'><input  type=\"radio\" name=\"input_radio_10\" data-name=\"input_radio_10\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u5f37\u70c8\"  id='input_radio_10_20ae021e1d954087fae6800ca5f767a4' aria-label='\u5f37\u70c8' aria-invalid='false' aria-required=true> <span>\u5f37\u70c8<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_10_b7fd000ac5fd5371b067a1c8adb126bc'><input  type=\"radio\" name=\"input_radio_10\" data-name=\"input_radio_10\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u975e\u5e38\u5f37\u70c8\"  id='input_radio_10_b7fd000ac5fd5371b067a1c8adb126bc' aria-label='\u975e\u5e38\u5f37\u70c8' aria-invalid='false' aria-required=true> <span>\u975e\u5e38\u5f37\u70c8<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"5. \u89ba\u5f97\u6bd4\u4e0d\u4e0a\u5225\u4eba\u3002\">5. \u89ba\u5f97\u6bd4\u4e0d\u4e0a\u5225\u4eba\u3002<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_11_26227c583b2c3f2fc378bd9b41edfe50'><input  type=\"radio\" name=\"input_radio_11\" data-name=\"input_radio_11\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u5b8c\u5168\u6c92\u6709\"  id='input_radio_11_26227c583b2c3f2fc378bd9b41edfe50' aria-label='\u5b8c\u5168\u6c92\u6709' aria-invalid='false' aria-required=true> <span>\u5b8c\u5168\u6c92\u6709<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_11_3546300d343f3fc4849f998f01366acc'><input  type=\"radio\" name=\"input_radio_11\" data-name=\"input_radio_11\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u8f15\u5fae\"  id='input_radio_11_3546300d343f3fc4849f998f01366acc' aria-label='\u8f15\u5fae' aria-invalid='false' aria-required=true> <span>\u8f15\u5fae<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_11_184e210968f8cd1cf1ce600cdff816e1'><input  type=\"radio\" name=\"input_radio_11\" data-name=\"input_radio_11\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u4e2d\u7b49\u7a0b\u5ea6\"  id='input_radio_11_184e210968f8cd1cf1ce600cdff816e1' aria-label='\u4e2d\u7b49\u7a0b\u5ea6' aria-invalid='false' aria-required=true> <span>\u4e2d\u7b49\u7a0b\u5ea6<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_11_e92f4f25a1d00bfe1d37d12cf7522a09'><input  type=\"radio\" name=\"input_radio_11\" data-name=\"input_radio_11\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u5f37\u70c8\"  id='input_radio_11_e92f4f25a1d00bfe1d37d12cf7522a09' aria-label='\u5f37\u70c8' aria-invalid='false' aria-required=true> <span>\u5f37\u70c8<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_11_7eba919fe7820585d6bee4436c74e709'><input  type=\"radio\" name=\"input_radio_11\" data-name=\"input_radio_11\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u975e\u5e38\u5f37\u70c8\"  id='input_radio_11_7eba919fe7820585d6bee4436c74e709' aria-label='\u975e\u5e38\u5f37\u70c8' aria-invalid='false' aria-required=true> <span>\u975e\u5e38\u5f37\u70c8<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_6_phone' id='label_ff_6_phone' aria-label=\"\u53ef\u4ee5\u806f\u7e6b\u7684\u96fb\u8a71\">\u53ef\u4ee5\u806f\u7e6b\u7684\u96fb\u8a71<\/label><\/div><div class='ff-el-input--content'><input name=\"phone\" class=\"ff-el-form-control ff-el-phone\" type=\"tel\" data-name=\"phone\" id=\"ff_6_phone\" inputmode=\"tel\"  aria-invalid='false' aria-required=true><\/div><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u65b9\u4fbf\u63a5\u807d\u7684\u6642\u6bb5\uff08\u9810\u7d04\u8aee\u8a62\uff1a\u52d9\u5fc5\u52a0\u5165\u5b98\u65b9line\u4e26\u56de\u50b3\u53ef\u901a\u8a71\u6642\u9593\uff09\">\u65b9\u4fbf\u63a5\u807d\u7684\u6642\u6bb5\uff08\u9810\u7d04\u8aee\u8a62\uff1a\u52d9\u5fc5\u52a0\u5165\u5b98\u65b9line\u4e26\u56de\u50b3\u53ef\u901a\u8a71\u6642\u9593\uff09<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_54585b29f8067bc94d40c9547928ccfb'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u5e73\u65e5 \u4e0a\u5348\"  id='checkbox_3_54585b29f8067bc94d40c9547928ccfb' aria-label='\u5e73\u65e5 \u4e0a\u5348' aria-invalid='false' aria-required=true> <span>\u5e73\u65e5 \u4e0a\u5348<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_b05650e53fa395938c00208ca49bbf03'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u5e73\u65e5 \u4e2d\u5348\"  id='checkbox_3_b05650e53fa395938c00208ca49bbf03' aria-label='\u5e73\u65e5 \u4e2d\u5348' aria-invalid='false' aria-required=true> <span>\u5e73\u65e5 \u4e2d\u5348<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_1bc31fd7291e450d4359eaeaa15cd964'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u5e73\u65e5 \u4e0b\u5348\"  id='checkbox_3_1bc31fd7291e450d4359eaeaa15cd964' aria-label='\u5e73\u65e5 \u4e0b\u5348' aria-invalid='false' aria-required=true> <span>\u5e73\u65e5 \u4e0b\u5348<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u9080\u8acb\u60a8\u52a0\u5165\u6613\u601d\u8166\u5b98\u65b9LINE\uff0c\u6211\u5011\u5c07\u900f\u904e\u5b98\u65b9Line\u63d0\u4f9b\u7dda\u4e0a\u514d\u8cbb\u5c08\u5c6c\u901a\u8a71\u8aee\u8a62\u670d\u52d9\u4ee5\u53ca\u7368\u5bb6\u5927\u8166\u53ef\u5851\u6027\u5f71\u7247\">\u9080\u8acb\u60a8\u52a0\u5165\u6613\u601d\u8166\u5b98\u65b9LINE\uff0c\u6211\u5011\u5c07\u900f\u904e\u5b98\u65b9Line\u63d0\u4f9b\u7dda\u4e0a\u514d\u8cbb\u5c08\u5c6c\u901a\u8a71\u8aee\u8a62\u670d\u52d9\u4ee5\u53ca\u7368\u5bb6\u5927\u8166\u53ef\u5851\u6027\u5f71\u7247<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_13_ffe6c0bf8a4b93d30e90d54461624c3b'><input  type=\"radio\" name=\"input_radio_13\" data-name=\"input_radio_13\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"\u52a0\u5165\u6613\u601d\u8166\u5b98\u65b9LINE\uff0c\u4e26\u5df2\u56de\u50b3\u95dc\u9375\u5b57\u300c\u5fc3\u8166\u9858\u671b\u300d\u624d\u6709\u6210\u529f\u958b\u901a\u5594\"  id='input_radio_13_ffe6c0bf8a4b93d30e90d54461624c3b' aria-label='\u52a0\u5165\u6613\u601d\u8166\u5b98\u65b9LINE\uff0c\u4e26\u5df2\u56de\u50b3\u95dc\u9375\u5b57\u300c\u5fc3\u8166\u9858\u671b\u300d\u624d\u6709\u6210\u529f\u958b\u901a\u5594' aria-invalid='false' aria-required=true> <span>\u52a0\u5165\u6613\u601d\u8166\u5b98\u65b9LINE\uff0c\u4e26\u5df2\u56de\u50b3\u95dc\u9375\u5b57\u300c\u5fc3\u8166\u9858\u671b\u300d\u624d\u6709\u6210\u529f\u958b\u901a\u5594<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u5f9e\u4ec0\u9ebc\u7ba1\u9053\u5f97\u77e5\u300e\u6613\u601d\u8166\u300f\uff1f\">\u5f9e\u4ec0\u9ebc\u7ba1\u9053\u5f97\u77e5\u300e\u6613\u601d\u8166\u300f\uff1f<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_15_7bfcbb5dc074dc346e78d44266852703'><input  type=\"radio\" name=\"input_radio_15\" data-name=\"input_radio_15\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Facebook\u793e\u7fa4\u5a92\u9ad4\"  id='input_radio_15_7bfcbb5dc074dc346e78d44266852703' aria-label='Facebook\u793e\u7fa4\u5a92\u9ad4' aria-invalid='false' aria-required=true> <span>Facebook\u793e\u7fa4\u5a92\u9ad4<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_15_108b9e0e46b7f836492e7248147da4c4'><input  type=\"radio\" name=\"input_radio_15\" data-name=\"input_radio_15\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Instagram\u793e\u7fa4\u5a92\u9ad4\"  id='input_radio_15_108b9e0e46b7f836492e7248147da4c4' aria-label='Instagram\u793e\u7fa4\u5a92\u9ad4' aria-invalid='false' aria-required=true> <span>Instagram\u793e\u7fa4\u5a92\u9ad4<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_15_1e766d17c0afbf0daae714964330960b'><input  type=\"radio\" name=\"input_radio_15\" data-name=\"input_radio_15\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"YouTub\u5f71\u97f3\u5e73\u53f0\"  id='input_radio_15_1e766d17c0afbf0daae714964330960b' aria-label='YouTub\u5f71\u97f3\u5e73\u53f0' aria-invalid='false' aria-required=true> <span>YouTub\u5f71\u97f3\u5e73\u53f0<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_15_64ae3582b025ea54e1a7e368e0b5e279'><input  type=\"radio\" name=\"input_radio_15\" 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