{"id":18734,"date":"2023-01-03T13:22:12","date_gmt":"2023-01-03T12:22:12","guid":{"rendered":"https:\/\/www.oscare.be\/?page_id=18734"},"modified":"2023-01-03T16:33:10","modified_gmt":"2023-01-03T15:33:10","slug":"slachtoffers-vuurwerk","status":"publish","type":"page","link":"https:\/\/www.oscare.be\/nl\/slachtoffers-vuurwerk\/","title":{"rendered":"Slachtoffers vuurwerk"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">Slachtoffers door vuurwerk<\/h2>\n\n\n\n<p style=\"font-size:16px\">Van oud naar nieuw gaat nog steeds gepaard met heel veel vuurwerk. Ook dit jaar was dit het geval en dit ondanks het afraden door brandweer en andere organisaties. Steden organiseren een vuurwerkspektakel dat voorzien is van al de veiligheidsnormen die er bestaan. Helaas zijn er nog heel wat particulieren die zelf vuurwerk, al dan niet illegaal vuurwerk, afschieten op straat of in hun achtertuin. Dit brengt heel wat risico\u2019s met zich mee en soms ook lichamelijk letsels bij de aansteker van het vuurwerk, maar ook bij omstanders.<\/p>\n\n\n\n<p style=\"font-size:16px\">Om te kunnen wegen op het beleid en om correcte maatregelen te nemen ivm particulier vuurwerk, willen wij nagaan of er slachtoffers opgenomen werden in uw ziekenhuis of artsenpraktijk.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity is-style-wide\"\/>\n\n\n\n<p style=\"font-size:16px\">OPGELET! Indien u meer dan 5 slachtoffers in behandeling heeft of gehad heeft dan vragen wij u om dit formulier nogmaals in te vullen. Wij danken u alvast voor u bijdrage aan een veiligere toekomst.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity is-style-wide\"\/>\n\n\n<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_49' style='display:none'><form method='post' enctype='multipart\/form-data'  id='gform_49'  action='\/nl\/wp-json\/wp\/v2\/pages\/18734' data-formid='49' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LdTd3MjAAAAAJlmTkphXevFb7iu4Qt7x_SspEkG' data-tabindex='0'><input id=\"input_0ba1829edcc7433ba3241ff93778be7f\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_0ba1829edcc7433ba3241ff93778be7f\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_49' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_49_3\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Algemene informatie<\/h3><div class='gsection_description' id='gfield_description_49_3'>Om een overzicht te kunnen maken van de verschillende ongevallen hebben wij enkele gegevens nodig van uw organisatie.<\/div><\/div><div id=\"field_49_1\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_1'>Naam ziekenhuis of artsenpraktijk<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_49_1' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_49_4\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_4'>In welke provincie ligt het ziekenhuis of de artsenpraktijk?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_4' id='input_49_4' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Antwerpen' >Antwerpen<\/option><option value='Henegouwen' >Henegouwen<\/option><option value='Limburg' >Limburg<\/option><option value='Luik' >Luik<\/option><option value='Luxemburg' >Luxemburg<\/option><option value='Namen' >Namen<\/option><option value='Oost-Vlaanderen' >Oost-Vlaanderen<\/option><option value='Vlaams-Brabant' >Vlaams-Brabant<\/option><option value='Waals-Brabant' >Waals-Brabant<\/option><option value='West-Vlaanderen' >West-Vlaanderen<\/option><option value='Brussels Hoofdstedelijk Gewest' >Brussels Hoofdstedelijk Gewest<\/option><\/select><\/div><\/div><fieldset id=\"field_49_8\" class=\"gfield gfield--type-name gfield--width-full field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Jouw gegevens (niet verplicht)<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_49_8'>\n                            \n                            <span id='input_49_8_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_8.3' id='input_49_8_3' value=''   aria-required='false'   placeholder='Voornaam'  \/>\n                                                    <label for='input_49_8_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Eerste<\/label>\n                                                <\/span>\n                            \n                            <span id='input_49_8_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_8.6' id='input_49_8_6' value=''   aria-required='false'   placeholder='Achternaam'  \/>\n                                                    <label for='input_49_8_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_49_10\" class=\"gfield gfield--type-text gfield--width-full gf_left_half gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_10'>Jouw funcite (niet verplicht)<\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_49_10' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_49_9\" class=\"gfield gfield--type-email gfield--width-full gf_right_half gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_9'>Email (niet verplicht)<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_9' id='input_49_9' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_49_5\" class=\"gfield gfield--type-radio gfield--type-choice gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Heeft u vuurwerkslachtoffers in behandeling (gehad)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_49_5'>\n\t\t\t<div class='gchoice gchoice_49_5_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Ja'  id='choice_49_5_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_49_5_0' id='label_49_5_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_49_5_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Neen'  id='choice_49_5_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_49_5_1' id='label_49_5_1' class='gform-field-label gform-field-label--type-inline'>Neen<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_49_6\" class=\"gfield gfield--type-select gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_6'>Hoeveel slachtoffers waren het?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_6' id='input_49_6' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='Meer dan 5' >Meer dan 5<\/option><\/select><\/div><\/div><div id=\"field_49_7\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Informatie van het slachtoffer<\/h3><div class='gsection_description' id='gfield_description_49_7'>Wij willen geen expliciete gegevens van de slachtoffers (vb. naam, adres,&#8230;.). De informatie die wij wensen dienen om cijfers te kunnen verzamelen. Op die manier kunnen wij een duidelijke strategie opmaken om in de toekomst deze slachtoffers te vermeiden\/verminderen.<\/div><\/div><div id=\"field_49_12\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Slachtoffer 1<\/h3><\/div><div id=\"field_49_11\" class=\"gfield gfield--type-select gfield--width-full gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_11'>Geslacht<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_11' id='input_49_11' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Man' >Man<\/option><option value='Vrouw' >Vrouw<\/option><option value='X' >X<\/option><\/select><\/div><\/div><div id=\"field_49_13\" class=\"gfield gfield--type-number gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_13'>Leeftijd<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_13' id='input_49_13' type='text' step='any'   value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_49_15\" class=\"gfield gfield--type-checkbox gfield--type-choice gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Type verwonding(en) (meerkeuze)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_49_15'><div class='gchoice gchoice_49_15_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.1' type='checkbox'  value='Oogletsel'  id='choice_49_15_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_15_1' id='label_49_15_1' class='gform-field-label gform-field-label--type-inline'>Oogletsel<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_15_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.2' type='checkbox'  value='Gehoorschade'  id='choice_49_15_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_15_2' id='label_49_15_2' class='gform-field-label gform-field-label--type-inline'>Gehoorschade<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_15_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.3' type='checkbox'  value='Open wonde'  id='choice_49_15_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_15_3' id='label_49_15_3' class='gform-field-label gform-field-label--type-inline'>Open wonde<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_15_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.4' type='checkbox'  value='Brandwonden'  id='choice_49_15_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_15_4' id='label_49_15_4' class='gform-field-label gform-field-label--type-inline'>Brandwonden<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_15_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.5' type='checkbox'  value='Andere'  id='choice_49_15_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_15_5' id='label_49_15_5' class='gform-field-label gform-field-label--type-inline'>Andere<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_49_21\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Getroffen lichaamsdeel (meerkeuze)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_49_21'><div class='gchoice gchoice_49_21_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.1' type='checkbox'  value='Aangezicht'  id='choice_49_21_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_21_1' id='label_49_21_1' class='gform-field-label gform-field-label--type-inline'>Aangezicht<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_21_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.2' type='checkbox'  value='Ogen'  id='choice_49_21_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_21_2' id='label_49_21_2' class='gform-field-label gform-field-label--type-inline'>Ogen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_21_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.3' type='checkbox'  value='Handen'  id='choice_49_21_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_21_3' id='label_49_21_3' class='gform-field-label gform-field-label--type-inline'>Handen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_21_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.4' type='checkbox'  value='Romp'  id='choice_49_21_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_21_4' id='label_49_21_4' class='gform-field-label gform-field-label--type-inline'>Romp<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_21_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.5' type='checkbox'  value='Armen'  id='choice_49_21_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_21_5' id='label_49_21_5' class='gform-field-label gform-field-label--type-inline'>Armen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_21_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.6' type='checkbox'  value='Vingers'  id='choice_49_21_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_21_6' id='label_49_21_6' class='gform-field-label gform-field-label--type-inline'>Vingers<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_21_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.7' type='checkbox'  value='Benen'  id='choice_49_21_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_21_7' id='label_49_21_7' class='gform-field-label gform-field-label--type-inline'>Benen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_21_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.8' type='checkbox'  value='Voeten'  id='choice_49_21_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_21_8' id='label_49_21_8' class='gform-field-label gform-field-label--type-inline'>Voeten<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_21_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.9' type='checkbox'  value='Andere'  id='choice_49_21_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_21_9' id='label_49_21_9' class='gform-field-label gform-field-label--type-inline'>Andere<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_49_16\" class=\"gfield gfield--type-text gfield--width-full gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_16'>U heeft &#039;andere&#039; aangeduid bij type verwonding(en)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_49_16'>Geef een korte omschrijving van de verwonding.<\/div><div class='ginput_container ginput_container_text'><input name='input_16' id='input_49_16' type='text' value='' class='large'  aria-describedby=\"gfield_description_49_16\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_49_18\" class=\"gfield gfield--type-text gfield--width-full gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_18'>U heeft &#039;andere&#039; aangeduid bij getroffen lichaamsdeel<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_49_18'>Geef een korte omschrijving van het lichaamsdeel dat getroffen is.<\/div><div class='ginput_container ginput_container_text'><input name='input_18' id='input_49_18' type='text' value='' class='large'  aria-describedby=\"gfield_description_49_18\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_49_20\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_20'>U heeft &#039;brandwonden&#039; aangeduid bij type verwonding(en)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_49_20'>Welke hoogste graad van brandwonden heeft het slachtoffer opgelopen?<\/div><div class='ginput_container ginput_container_select'><select name='input_20' id='input_49_20' class='large gfield_select'  aria-describedby=\"gfield_description_49_20\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='Eerste graad' >Eerste graad<\/option><option value='Tweede graad' >Tweede graad<\/option><option value='Derde graad' >Derde graad<\/option><\/select><\/div><\/div><div id=\"field_49_22\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Slachtoffer 2<\/h3><\/div><div id=\"field_49_23\" class=\"gfield gfield--type-select gfield--width-full gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_23'>Geslacht<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_23' id='input_49_23' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Man' >Man<\/option><option value='Vrouw' >Vrouw<\/option><option value='X' >X<\/option><\/select><\/div><\/div><div id=\"field_49_24\" class=\"gfield gfield--type-number gfield--width-full gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_24'>Leeftijd<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_24' id='input_49_24' type='text' step='any'   value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_49_25\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Type verwonding(en) (meerkeuze)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_49_25'><div class='gchoice gchoice_49_25_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.1' type='checkbox'  value='Oogletsel'  id='choice_49_25_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_25_1' id='label_49_25_1' class='gform-field-label gform-field-label--type-inline'>Oogletsel<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_25_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.2' type='checkbox'  value='Gehoorschade'  id='choice_49_25_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_25_2' id='label_49_25_2' class='gform-field-label gform-field-label--type-inline'>Gehoorschade<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_25_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.3' type='checkbox'  value='Open wonde'  id='choice_49_25_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_25_3' id='label_49_25_3' class='gform-field-label gform-field-label--type-inline'>Open wonde<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_25_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.4' type='checkbox'  value='Brandwonden'  id='choice_49_25_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_25_4' id='label_49_25_4' class='gform-field-label gform-field-label--type-inline'>Brandwonden<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_25_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.5' type='checkbox'  value='Andere'  id='choice_49_25_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_25_5' id='label_49_25_5' class='gform-field-label gform-field-label--type-inline'>Andere<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_49_26\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Getroffen lichaamsdeel (meerkeuze)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_49_26'><div class='gchoice gchoice_49_26_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.1' type='checkbox'  value='Aangezicht'  id='choice_49_26_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_26_1' id='label_49_26_1' class='gform-field-label gform-field-label--type-inline'>Aangezicht<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_26_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.2' type='checkbox'  value='Ogen'  id='choice_49_26_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_26_2' id='label_49_26_2' class='gform-field-label gform-field-label--type-inline'>Ogen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_26_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.3' type='checkbox'  value='Handen'  id='choice_49_26_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_26_3' id='label_49_26_3' class='gform-field-label gform-field-label--type-inline'>Handen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_26_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.4' type='checkbox'  value='Romp'  id='choice_49_26_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_26_4' id='label_49_26_4' class='gform-field-label gform-field-label--type-inline'>Romp<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_26_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.5' type='checkbox'  value='Armen'  id='choice_49_26_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_26_5' id='label_49_26_5' class='gform-field-label gform-field-label--type-inline'>Armen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_26_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.6' type='checkbox'  value='Vingers'  id='choice_49_26_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_26_6' id='label_49_26_6' class='gform-field-label gform-field-label--type-inline'>Vingers<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_26_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.7' type='checkbox'  value='Benen'  id='choice_49_26_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_26_7' id='label_49_26_7' class='gform-field-label gform-field-label--type-inline'>Benen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_26_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.8' type='checkbox'  value='Voeten'  id='choice_49_26_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_26_8' id='label_49_26_8' class='gform-field-label gform-field-label--type-inline'>Voeten<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_26_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.9' type='checkbox'  value='Andere'  id='choice_49_26_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_26_9' id='label_49_26_9' class='gform-field-label gform-field-label--type-inline'>Andere<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_49_27\" class=\"gfield gfield--type-text gfield--width-full gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_27'>U heeft &#039;andere&#039; aangeduid bij type verwonding(en)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_49_27'>Geef een korte omschrijving van de verwonding.<\/div><div class='ginput_container ginput_container_text'><input name='input_27' id='input_49_27' type='text' value='' class='large'  aria-describedby=\"gfield_description_49_27\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_49_28\" class=\"gfield gfield--type-text gfield--width-full gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_28'>U heeft &#039;andere&#039; aangeduid bij getroffen lichaamsdeel<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_49_28'>Geef een korte omschrijving van het lichaamsdeel dat getroffen is.<\/div><div class='ginput_container ginput_container_text'><input name='input_28' id='input_49_28' type='text' value='' class='large'  aria-describedby=\"gfield_description_49_28\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_49_29\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_29'>U heeft &#039;brandwonden&#039; aangeduid bij type verwonding(en)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_49_29'>Welke hoogste graad van brandwonden heeft het slachtoffer opgelopen?<\/div><div class='ginput_container ginput_container_select'><select name='input_29' id='input_49_29' class='large gfield_select'  aria-describedby=\"gfield_description_49_29\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='Eerste graad' >Eerste graad<\/option><option value='Tweede graad' >Tweede graad<\/option><option value='Derde graad' >Derde graad<\/option><\/select><\/div><\/div><div id=\"field_49_30\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Slachtoffer 3<\/h3><\/div><div id=\"field_49_31\" class=\"gfield gfield--type-select gfield--width-full gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_31'>Geslacht<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_31' id='input_49_31' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Man' >Man<\/option><option value='Vrouw' >Vrouw<\/option><option value='X' >X<\/option><\/select><\/div><\/div><div id=\"field_49_32\" class=\"gfield gfield--type-number gfield--width-full gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_32'>Leeftijd<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_32' id='input_49_32' type='text' step='any'   value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_49_33\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Type verwonding(en) (meerkeuze)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_49_33'><div class='gchoice gchoice_49_33_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.1' type='checkbox'  value='Oogletsel'  id='choice_49_33_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_33_1' id='label_49_33_1' class='gform-field-label gform-field-label--type-inline'>Oogletsel<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_33_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.2' type='checkbox'  value='Gehoorschade'  id='choice_49_33_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_33_2' id='label_49_33_2' class='gform-field-label gform-field-label--type-inline'>Gehoorschade<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_33_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.3' type='checkbox'  value='Open wonde'  id='choice_49_33_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_33_3' id='label_49_33_3' class='gform-field-label gform-field-label--type-inline'>Open wonde<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_33_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.4' type='checkbox'  value='Brandwonden'  id='choice_49_33_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_33_4' id='label_49_33_4' class='gform-field-label gform-field-label--type-inline'>Brandwonden<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_33_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.5' type='checkbox'  value='Andere'  id='choice_49_33_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_33_5' id='label_49_33_5' class='gform-field-label gform-field-label--type-inline'>Andere<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_49_34\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Getroffen lichaamsdeel (meerkeuze)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_49_34'><div class='gchoice gchoice_49_34_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.1' type='checkbox'  value='Aangezicht'  id='choice_49_34_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_34_1' id='label_49_34_1' class='gform-field-label gform-field-label--type-inline'>Aangezicht<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_34_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.2' type='checkbox'  value='Ogen'  id='choice_49_34_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_34_2' id='label_49_34_2' class='gform-field-label gform-field-label--type-inline'>Ogen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_34_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.3' type='checkbox'  value='Handen'  id='choice_49_34_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_34_3' id='label_49_34_3' class='gform-field-label gform-field-label--type-inline'>Handen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_34_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.4' type='checkbox'  value='Romp'  id='choice_49_34_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_34_4' id='label_49_34_4' class='gform-field-label gform-field-label--type-inline'>Romp<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_34_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.5' type='checkbox'  value='Armen'  id='choice_49_34_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_34_5' id='label_49_34_5' class='gform-field-label gform-field-label--type-inline'>Armen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_34_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.6' type='checkbox'  value='Vingers'  id='choice_49_34_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_34_6' id='label_49_34_6' class='gform-field-label gform-field-label--type-inline'>Vingers<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_34_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.7' type='checkbox'  value='Benen'  id='choice_49_34_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_34_7' id='label_49_34_7' class='gform-field-label gform-field-label--type-inline'>Benen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_34_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.8' type='checkbox'  value='Voeten'  id='choice_49_34_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_34_8' id='label_49_34_8' class='gform-field-label gform-field-label--type-inline'>Voeten<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_34_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.9' type='checkbox'  value='Andere'  id='choice_49_34_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_34_9' id='label_49_34_9' class='gform-field-label gform-field-label--type-inline'>Andere<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_49_35\" class=\"gfield gfield--type-text gfield--width-full gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_35'>U heeft &#039;andere&#039; aangeduid bij type verwonding(en)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_49_35'>Geef een korte omschrijving van de verwonding.<\/div><div class='ginput_container ginput_container_text'><input name='input_35' id='input_49_35' type='text' value='' class='large'  aria-describedby=\"gfield_description_49_35\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_49_36\" class=\"gfield gfield--type-text gfield--width-full gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_36'>U heeft &#039;andere&#039; aangeduid bij getroffen lichaamsdeel<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_49_36'>Geef een korte omschrijving van het lichaamsdeel dat getroffen is.<\/div><div class='ginput_container ginput_container_text'><input name='input_36' id='input_49_36' type='text' value='' class='large'  aria-describedby=\"gfield_description_49_36\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_49_37\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_37'>U heeft &#039;brandwonden&#039; aangeduid bij type verwonding(en)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_49_37'>Welke hoogste graad van brandwonden heeft het slachtoffer opgelopen?<\/div><div class='ginput_container ginput_container_select'><select name='input_37' id='input_49_37' class='large gfield_select'  aria-describedby=\"gfield_description_49_37\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='Eerste graad' >Eerste graad<\/option><option value='Tweede graad' >Tweede graad<\/option><option value='Derde graad' >Derde graad<\/option><\/select><\/div><\/div><div id=\"field_49_38\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Slachtoffer 4<\/h3><\/div><div id=\"field_49_39\" class=\"gfield gfield--type-select gfield--width-full gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_39'>Geslacht<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_39' id='input_49_39' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Man' >Man<\/option><option value='Vrouw' >Vrouw<\/option><option value='X' >X<\/option><\/select><\/div><\/div><div id=\"field_49_40\" class=\"gfield gfield--type-number gfield--width-full gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_40'>Leeftijd<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_40' id='input_49_40' type='text' step='any'   value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_49_41\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Type verwonding(en) (meerkeuze)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_49_41'><div class='gchoice gchoice_49_41_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.1' type='checkbox'  value='Oogletsel'  id='choice_49_41_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_41_1' id='label_49_41_1' class='gform-field-label gform-field-label--type-inline'>Oogletsel<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_41_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.2' type='checkbox'  value='Gehoorschade'  id='choice_49_41_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_41_2' id='label_49_41_2' class='gform-field-label gform-field-label--type-inline'>Gehoorschade<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_41_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.3' type='checkbox'  value='Open wonde'  id='choice_49_41_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_41_3' id='label_49_41_3' class='gform-field-label gform-field-label--type-inline'>Open wonde<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_41_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.4' type='checkbox'  value='Brandwonden'  id='choice_49_41_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_41_4' id='label_49_41_4' class='gform-field-label gform-field-label--type-inline'>Brandwonden<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_41_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.5' type='checkbox'  value='Andere'  id='choice_49_41_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_41_5' id='label_49_41_5' class='gform-field-label gform-field-label--type-inline'>Andere<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_49_42\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Getroffen lichaamsdeel (meerkeuze)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_49_42'><div class='gchoice gchoice_49_42_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.1' type='checkbox'  value='Aangezicht'  id='choice_49_42_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_42_1' id='label_49_42_1' class='gform-field-label gform-field-label--type-inline'>Aangezicht<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_42_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.2' type='checkbox'  value='Ogen'  id='choice_49_42_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_42_2' id='label_49_42_2' class='gform-field-label gform-field-label--type-inline'>Ogen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_42_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.3' type='checkbox'  value='Handen'  id='choice_49_42_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_42_3' id='label_49_42_3' class='gform-field-label gform-field-label--type-inline'>Handen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_42_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.4' type='checkbox'  value='Romp'  id='choice_49_42_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_42_4' id='label_49_42_4' class='gform-field-label gform-field-label--type-inline'>Romp<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_42_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.5' type='checkbox'  value='Armen'  id='choice_49_42_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_42_5' id='label_49_42_5' class='gform-field-label gform-field-label--type-inline'>Armen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_42_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.6' type='checkbox'  value='Vingers'  id='choice_49_42_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_42_6' id='label_49_42_6' class='gform-field-label gform-field-label--type-inline'>Vingers<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_42_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.7' type='checkbox'  value='Benen'  id='choice_49_42_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_42_7' id='label_49_42_7' class='gform-field-label gform-field-label--type-inline'>Benen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_42_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.8' type='checkbox'  value='Voeten'  id='choice_49_42_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_42_8' id='label_49_42_8' class='gform-field-label gform-field-label--type-inline'>Voeten<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_42_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.9' type='checkbox'  value='Andere'  id='choice_49_42_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_42_9' id='label_49_42_9' class='gform-field-label gform-field-label--type-inline'>Andere<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_49_43\" class=\"gfield gfield--type-text gfield--width-full gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_43'>U heeft &#039;andere&#039; aangeduid bij type verwonding(en)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_49_43'>Geef een korte omschrijving van de verwonding.<\/div><div class='ginput_container ginput_container_text'><input name='input_43' id='input_49_43' type='text' value='' class='large'  aria-describedby=\"gfield_description_49_43\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_49_51\" class=\"gfield gfield--type-text gfield--width-full gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_51'>U heeft &#039;andere&#039; aangeduid bij type verwonding(en)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_49_51'>Geef een korte omschrijving van de verwonding.<\/div><div class='ginput_container ginput_container_text'><input name='input_51' id='input_49_51' type='text' value='' class='large'  aria-describedby=\"gfield_description_49_51\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_49_45\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_45'>U heeft &#039;brandwonden&#039; aangeduid bij type verwonding(en)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_49_45'>Welke hoogste graad van brandwonden heeft het slachtoffer opgelopen?<\/div><div class='ginput_container ginput_container_select'><select name='input_45' id='input_49_45' class='large gfield_select'  aria-describedby=\"gfield_description_49_45\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='Eerste graad' >Eerste graad<\/option><option value='Tweede graad' >Tweede graad<\/option><option value='Derde graad' >Derde graad<\/option><\/select><\/div><\/div><div id=\"field_49_46\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Slachtoffer 5<\/h3><\/div><div id=\"field_49_47\" class=\"gfield gfield--type-select gfield--width-full gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_47'>Geslacht<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_47' id='input_49_47' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Man' >Man<\/option><option value='Vrouw' >Vrouw<\/option><option value='X' >X<\/option><\/select><\/div><\/div><div id=\"field_49_48\" class=\"gfield gfield--type-number gfield--width-full gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_49_48'>Leeftijd<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_48' id='input_49_48' type='text' step='any'   value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_49_49\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Type verwonding(en) (meerkeuze)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_49_49'><div class='gchoice gchoice_49_49_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.1' type='checkbox'  value='Oogletsel'  id='choice_49_49_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_49_1' id='label_49_49_1' class='gform-field-label gform-field-label--type-inline'>Oogletsel<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_49_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.2' type='checkbox'  value='Gehoorschade'  id='choice_49_49_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_49_2' id='label_49_49_2' class='gform-field-label gform-field-label--type-inline'>Gehoorschade<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_49_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.3' type='checkbox'  value='Open wonde'  id='choice_49_49_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_49_3' id='label_49_49_3' class='gform-field-label gform-field-label--type-inline'>Open wonde<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_49_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.4' type='checkbox'  value='Brandwonden'  id='choice_49_49_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_49_4' id='label_49_49_4' class='gform-field-label gform-field-label--type-inline'>Brandwonden<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_49_49_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.5' type='checkbox'  value='Andere'  id='choice_49_49_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_49_49_5' id='label_49_49_5' class='gform-field-label gform-field-label--type-inline'>Andere<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_49_50\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Getroffen lichaamsdeel (meerkeuze)<span 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