{% extends "mediforms/pdfs/pdf.html" %} {% load i18n %} {% block content %}
{% blocktranslate %}Fragebogen zur Person und zu Kontraindikationen im Rahmen der Studie{% endblocktranslate %}
{% blocktranslate %}Magnetresonanz-Untersuchung bei 7 Tesla pTx{% endblocktranslate %}
{{ form.last_name.label_tag }} | {{ form.instance.last_name }} | {{ form.first_name.label_tag }} | {{ form.instance.first_name }} | {{ form.height.label_tag }} | {{ form.instance.height|default_if_none:"" }} |
---|---|---|---|---|---|
{{ form.date_of_birth.label_tag }} | {{ form.instance.date_of_birth }} | {{ form.birthplace.label_tag }} | {{ form.instance.birthplace|default_if_none:"" }} | {{ form.weight.label_tag }} | {{ form.instance.weight|default_if_none:"" }} |
{{ form.gender.label_tag }} | {{ form.instance.get_gender_display|default_if_none:"" }} | ||||
{{ form.street.label_tag }} | {{ form.instance.street|default_if_none:"" }} | {{ form.zip_code.label_tag }} | {{ form.instance.zip_code|default_if_none:"" }} | {{ form.city.label_tag }} | {{ form.instance.city|default_if_none:"" }} |
{{ form.phone_number.label_tag }} | {{ form.instance.phone_number|default_if_none:"" }} | {{ form.mobile_number.label_tag }} | {{ form.instance.mobile_number|default_if_none:"" }} | ||
{{ form.email.label_tag }} | {{ form.instance.email }} |
{{ forloop.counter }}. {{ field.label_tag }} | {% if field.field.widget.input_type == "radio" %} {% trans field.value %} {% else %} {{ field.value }} {% endif %} |
{% blocktranslate %}NUR FÜR VERSUCHSTEILNEHMERINNEN:{% endblocktranslate %} | |
{{ field.label_tag }} | {% if field.value %}{% trans field.value %}{% endif %} |