{"id":2689,"date":"2026-02-02T10:30:23","date_gmt":"2026-02-02T14:30:23","guid":{"rendered":"https:\/\/resolvegeneralagency.com\/?page_id=2689"},"modified":"2026-06-16T12:47:41","modified_gmt":"2026-06-16T16:47:41","slug":"cotizacion-personalizada-rga","status":"publish","type":"page","link":"https:\/\/resolvegeneralagency.com\/en\/cotizacion-personalizada-rga\/","title":{"rendered":"Custom Quote"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2689\" class=\"elementor elementor-2689\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7b4cbbd e-flex e-con-boxed sc_layouts_column_icons_position_left e-con e-parent\" data-id=\"7b4cbbd\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;shape_divider_bottom&quot;:&quot;tilt&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-shape elementor-shape-bottom\" aria-hidden=\"true\" data-negative=\"false\">\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 1000 100\" preserveAspectRatio=\"none\">\n\t<path class=\"elementor-shape-fill\" d=\"M0,6V0h1000v100L0,6z\"\/>\n<\/svg>\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fd734c7 sc_fly_static elementor-widget elementor-widget-trx_elm_post_title\" data-id=\"fd734c7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"trx_elm_post_title.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"trx-addons-post-title-wrap\"><h1 class=\"elementor-heading-title trx-addons-post-title sc_layouts_title_caption\">Cotizaci\u00f3n Personalizada<\/h1><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-c44fa8a e-flex e-con-boxed sc_layouts_column_icons_position_left e-con e-parent\" data-id=\"c44fa8a\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-3a69458 e-con-full e-flex sc_layouts_column_icons_position_left e-con e-child\" data-id=\"3a69458\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div data-animation-type=\"block\" class=\"elementor-element elementor-element-109b8f5 animation_type_block sc_fly_static elementor-invisible elementor-widget elementor-widget-heading\" data-id=\"109b8f5\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;ta_fadeinup&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">REsolve General Agency<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div data-animation-type=\"block\" class=\"elementor-element elementor-element-8d09e5c animation_type_block sc_fly_static elementor-invisible elementor-widget elementor-widget-heading\" data-id=\"8d09e5c\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;ta_fadeinup&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Cotizaci\u00f3n Aliados de <br> la Salud<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-64b0331 elementor-widget__width-initial elementor-widget-tablet__width-inherit sc_fly_static elementor-widget elementor-widget-text-editor\" data-id=\"64b0331\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p><b>Esta solicitud es \u00fanicamente para clientes nuevos y una cubierta individual<\/b><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5e2f7ec elementor-widget__width-initial elementor-widget-mobile__width-inherit elementor-widget-tablet__width-inherit sc_fly_static elementor-widget elementor-widget-shortcode\" data-id=\"5e2f7ec\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class='fluentform ff-default fluentform_wrapper_8 ffs_custom_wrap'><form data-form_id=\"8\" id=\"fluentform_8\" class=\"frm-fluent-form fluent_form_8 ff-el-form-top ff_form_instance_8_1 ff-form-loading ff-form-has-steps ff_has_dynamic_smartcode ff_calc_form fluentform_has_payment ffs_custom\" data-form_instance=\"ff_form_instance_8_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: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Cotizador Final (#8) Testing<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='2689' \/><input type=\"hidden\" id=\"_fluentform_8_fluentformnonce\" name=\"_fluentform_8_fluentformnonce\" value=\"658c029e1d\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/2689\" \/><div class='ff-step-container' data-name=\"step_start-8_46\" data-disable_auto_focus=\"no\" data-enable_auto_slider=\"no\" data-enable_step_data_persistency=\"no\" data-enable_step_page_resume=\"no\" data-animation_type=\"slide\" data-progress_layout=\"top\" data-progress_indicator=\"progress-bar\" ><div class='ff-step-header ff-step-header--progress'><div class='ff-step-progress-wrap'><div class='ff-el-progress-status' aria-live='polite'><\/div><div class='ff-el-progress'><div role='progressbar' class='ff-el-progress-bar'><span><\/span><\/div><\/div><ul style='display: none' class='ff-el-progress-title'><li>Nombre del solicitante<\/li><li>Evaluaci\u00f3n Inicial<\/li><li>Preguntas de Suscripci\u00f3n<\/li><li>Prima Preliminar<\/li><li>Pago de p\u00f3liza<\/li><\/ul><\/div><\/div><span class='ff_step_start'><\/span><div class='ff-step-body'><div class=\"fluentform-step active\" data-name=\"step_start-8_46\" data-disable_auto_focus=\"no\" data-enable_auto_slider=\"no\" data-enable_step_data_persistency=\"no\" data-enable_step_page_resume=\"no\" data-animation_type=\"slide\" data-progress_layout=\"top\" data-progress_indicator=\"progress-bar\" ><div data-name=\"ff_cn_id_1\"  class='ff-t-container ff-column-container ff_columns_total_1 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class=\"ff-el-group ff-el-section-break  ff_center\" data-name=\"section_break-8_1\" ><h3 class='ff-el-section-title'>Informaci\u00f3n Profesional<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div data-type=\"name-element\" data-name=\"names\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_8_names_first_name_' id='label_ff_8_names_first_name_' >Nombre<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[first_name]\" id=\"ff_8_names_first_name_\" class=\"ff-el-form-control\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_8_names_middle_name_' id='label_ff_8_names_middle_name_' >Apellido Paterno<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[middle_name]\" id=\"ff_8_names_middle_name_\" class=\"ff-el-form-control\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_8_names_last_name_' id='label_ff_8_names_last_name_' >Apellido Materno<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[last_name]\" id=\"ff_8_names_last_name_\" class=\"ff-el-form-control\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_8_datetime_1' id='label_ff_8_datetime_1' aria-label=\"Fecha de Nacimiento\">Fecha de Nacimiento<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Fecha de Nacimiento Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='m\/d\/Y' type=\"text\" name=\"datetime_1\" id=\"ff_8_datetime_1\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"datetime_1\"  aria-invalid='false' aria-required=true><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00bfLa direcci\u00f3n f\u00edsica y postal son la misma?\">\u00bfLa direcci\u00f3n f\u00edsica y postal son la misma?<\/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_783ce5605ed95553aa9b5f4c6b0d0bce'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"S\u00ed\"  id='input_radio_783ce5605ed95553aa9b5f4c6b0d0bce' aria-label='S\u00ed' aria-invalid='false' aria-required=true> <span>S\u00ed<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_8339372bd11ead1562c2e969f470ce73'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_radio_8339372bd11ead1562c2e969f470ce73' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-8_2\" ><p><strong>Direcci\u00f3n F\u00edsica<\/strong><\/p><\/div><div data-name=\"ff_cn_id_2\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_8_direccion' id='label_ff_8_direccion' aria-label=\"Direcci\u00f3n\">Direcci\u00f3n<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"direccion\" class=\"ff-el-form-control\" data-name=\"direccion\" id=\"ff_8_direccion\"  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 for='ff_8_pais' id='label_ff_8_pais' aria-label=\"Pa\u00eds\">Pa\u00eds<\/label><\/div><div class='ff-el-input--content'><select name=\"pais\" id=\"ff_8_pais\" class=\"ff-el-form-control\" data-name=\"pais\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"true\" aria-labelledby=\"label_ff_8_pais\"><option value=\"\">Seleciona<\/option><option value=\"Puerto Rico\"  >Puerto Rico<\/option><option value=\"Estados Unidos\"  >Estados Unidos<\/option><\/select><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_8_cuidad' id='label_ff_8_cuidad' aria-label=\"Cuidad\">Cuidad<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"cuidad\" class=\"ff-el-form-control\" data-name=\"cuidad\" id=\"ff_8_cuidad\"  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 for='ff_8_zip_code' id='label_ff_8_zip_code' aria-label=\"C\u00f3digo Postal\">C\u00f3digo Postal<\/label><\/div><div class='ff-el-input--content'><input type=\"number\" name=\"zip_code\" id=\"ff_8_zip_code\" class=\"ff-el-form-control\" data-name=\"zip_code\" inputmode=\"numeric\" step=\"any\" max=\"99999\" aria-valuemax=\"99999\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html has-conditions' tabindex='-1' data-name=\"custom_html-8_3\" ><p><strong>Direcci\u00f3n Postal<\/strong><\/p><\/div><div data-name=\"ff_cn_id_3\"  class='ff-t-container ff-column-container ff_columns_total_2 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_8_direccion_1' id='label_ff_8_direccion_1' aria-label=\"Direcci\u00f3n\">Direcci\u00f3n<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"direccion_1\" class=\"ff-el-form-control\" data-name=\"direccion_1\" id=\"ff_8_direccion_1\"  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 for='ff_8_pais_1' id='label_ff_8_pais_1' aria-label=\"Pa\u00eds\">Pa\u00eds<\/label><\/div><div class='ff-el-input--content'><select name=\"pais_1\" id=\"ff_8_pais_1\" class=\"ff-el-form-control\" data-name=\"pais_1\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"true\" aria-labelledby=\"label_ff_8_pais_1\"><option value=\"\">Seleciona<\/option><option value=\"Puerto Rico\"  >Puerto Rico<\/option><option value=\"Estados Unidos\"  >Estados Unidos<\/option><\/select><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_8_cuidad_1' id='label_ff_8_cuidad_1' aria-label=\"Cuidad\">Cuidad<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"cuidad_1\" class=\"ff-el-form-control\" data-name=\"cuidad_1\" id=\"ff_8_cuidad_1\"  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 for='ff_8_zip_code_1' id='label_ff_8_zip_code_1' aria-label=\"C\u00f3digo Postal\">C\u00f3digo Postal<\/label><\/div><div class='ff-el-input--content'><input type=\"number\" name=\"zip_code_1\" id=\"ff_8_zip_code_1\" class=\"ff-el-form-control\" data-name=\"zip_code_1\" inputmode=\"numeric\" step=\"any\" max=\"99999\" aria-valuemax=\"99999\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_4\"  class='ff-t-container ff-column-container ff_columns_total_1 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_8_email' id='label_ff_8_email' aria-label=\"Correo Electr\u00f3nico\">Correo Electr\u00f3nico<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" id=\"ff_8_email\" class=\"ff-el-form-control\" data-name=\"email\"  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 for='ff_8_phone_1' id='label_ff_8_phone_1' aria-label=\"Tel\u00e9fono\">Tel\u00e9fono<\/label><\/div><div class='ff-el-input--content'><input name=\"phone_1\" class=\"ff-el-form-control ff-el-phone\" type=\"tel\" data-name=\"phone_1\" id=\"ff_8_phone_1\" inputmode=\"tel\"  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 for='ff_8_lugar_trabajo' id='label_ff_8_lugar_trabajo' aria-label=\"Lugares donde trabaja. *Nuestra p\u00f3liza solo cubre el territorio de Puerto Rico.\">Lugares donde trabaja. *Nuestra p\u00f3liza solo cubre el territorio de Puerto Rico. <\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"lugar_trabajo\" class=\"ff-el-form-control\" data-name=\"lugar_trabajo\" id=\"ff_8_lugar_trabajo\"  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=\"\u00bfUsted tiene alguna p\u00f3liza vigente?\">\u00bfUsted tiene alguna p\u00f3liza vigente?<\/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_35_37273fb7509becc9a0152c47bac8f48f'><input  type=\"radio\" name=\"input_radio_35\" data-name=\"input_radio_35\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"S\u00ed\"  id='input_radio_35_37273fb7509becc9a0152c47bac8f48f' aria-label='S\u00ed' aria-invalid='false' aria-required=true> <span>S\u00ed<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_35_22de4446b4fb64a355bbd9f5417fb72f'><input  type=\"radio\" name=\"input_radio_35\" data-name=\"input_radio_35\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_radio_35_22de4446b4fb64a355bbd9f5417fb72f' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/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_8_input_text_38' id='label_ff_8_input_text_38' aria-label=\"Si escogi\u00f3 que s\u00ed, entonces, \u00bfCu\u00e1l ser\u00eda la compa\u00f1\u00eda con la cual tiene la p\u00f3liza vigente?\">Si escogi\u00f3 que s\u00ed, entonces, \u00bfCu\u00e1l ser\u00eda la compa\u00f1\u00eda con la cual tiene la p\u00f3liza vigente?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_38\" class=\"ff-el-form-control\" data-name=\"input_text_38\" id=\"ff_8_input_text_38\"  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=\"Selecciona su especialidad (el l\u00edmite de responsabilidad ser\u00e1 $100,000 por incidente \/ $300,000 agregado anual.)\">Selecciona su especialidad (el l\u00edmite de responsabilidad ser\u00e1 $100,000 por incidente \/ $300,000 agregado anual.)<\/label><div class=\"ff-el-tooltip\" data-content=\"Esta p\u00f3liza aplica su primer a\u00f1o con una cubierta b\u00e1sica y puede aumentar en a\u00f1os posteriores.\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><select name=\"payment_input_1\" class=\"ff-el-form-control ff_payment_item\" data-payment_item=\"yes\" data-name=\"payment_input_1\" id=\"payment_input_1_0d47f5f95b5f5dbe2195a17597d74ed5\" ><option value=\"\" data-payment_value=\"\" data-calc_value=\"\" >Seleccione una opci\u00f3n<\/option><option value=\"Audiologists\" data-payment_value=\"253\" data-calc_value=\"253\" >Audiologists<\/option><option value=\"Dental Hygienists\" data-payment_value=\"250\" data-calc_value=\"250\" >Dental Hygienists<\/option><option value=\"Medical Laboratory Techninicians\" data-payment_value=\"250\" data-calc_value=\"250\" >Medical Laboratory Techninicians<\/option><option value=\"Medical Technologists\" data-payment_value=\"345\" data-calc_value=\"345\" >Medical Technologists<\/option><option value=\"Nutritionist (RDNs)\" data-payment_value=\"250\" data-calc_value=\"250\" >Nutritionist (RDNs)<\/option><option value=\"Nutritionist\/Dietitians\" data-payment_value=\"250\" data-calc_value=\"250\" >Nutritionist\/Dietitians<\/option><option value=\"Ocuppational Therapists\" data-payment_value=\"250\" data-calc_value=\"250\" >Ocuppational Therapists<\/option><option value=\"Opticians\" data-payment_value=\"250\" data-calc_value=\"250\" >Opticians<\/option><option value=\"Optometrist\" data-payment_value=\"284\" data-calc_value=\"284\" >Optometrist<\/option><option value=\"Psychologist\" data-payment_value=\"253\" data-calc_value=\"253\" >Psychologist<\/option><option value=\"Respiratory Therapists\" data-payment_value=\"304\" data-calc_value=\"304\" >Respiratory Therapists<\/option><option value=\"Speech Pathology\" data-payment_value=\"250\" data-calc_value=\"250\" >Speech Pathology<\/option><option value=\"X-Ray Technicians\" data-payment_value=\"253\" data-calc_value=\"253\" >X-Ray Technicians<\/option><option value=\"Nurse: Anesthetists\" data-payment_value=\"709\" data-calc_value=\"709\" >Nurse: Anesthetists<\/option><option value=\"Nurse: Licensed Practical Nurse (LPN)\" data-payment_value=\"250\" data-calc_value=\"250\" >Nurse: Licensed Practical Nurse (LPN)<\/option><option value=\"Nurse: Registered Nurse (RN)\" data-payment_value=\"253\" data-calc_value=\"253\" >Nurse: Registered Nurse (RN)<\/option><option value=\"Nurse: Nurse Practitioner (NP)\" data-payment_value=\"405\" data-calc_value=\"405\" >Nurse: Nurse Practitioner (NP)<\/option><option value=\"Naturopathy\" data-payment_value=\"250\" data-calc_value=\"250\" >Naturopathy<\/option><option value=\"Physiotherapists (Physical Therapy)\" data-payment_value=\"266\" data-calc_value=\"266\" >Physiotherapists (Physical Therapy)<\/option><option value=\"Physiotherapists (Other)\" data-payment_value=\"266\" data-calc_value=\"266\" >Physiotherapists (Other)<\/option><option value=\"Physician Assistant\" data-payment_value=\"922\" data-calc_value=\"922\" >Physician Assistant<\/option><option value=\"Surgical Technicians\" data-payment_value=\"507\" data-calc_value=\"507\" >Surgical Technicians<\/option><\/select><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-8_4\" ><p><b>Set-Up Rule:\u00a0<\/b>Est\u00e1 p\u00f3liza aplicando su primer a\u00f1o con una cubierta b\u00e1sica y puede aumentar en a\u00f1os posteriores.<\/p><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_5\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p style=\"text-align: left\"><strong data-start=\"127\" data-end=\"156\">Audi\u00f3logos: <\/strong>Especialistas que diagnostican y tratan problemas de audici\u00f3n y equilibrio mediante evaluaciones cl\u00ednicas.<\/p><\/div><hr \/><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_6\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p style=\"text-align: left\"><strong data-start=\"267\" data-end=\"311\">Higienistas Dentales: <\/strong>Profesionales enfocados en la prevenci\u00f3n oral, realizando limpiezas, evaluaciones y educaci\u00f3n al paciente.<\/p><\/div><hr \/><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_7\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p style=\"text-align: left\"><strong data-start=\"422\" data-end=\"490\">T\u00e9cnicos de Laboratorio Cl\u00ednico: <\/strong>Encargados de realizar pruebas de laboratorio para detectar, diagnosticar y monitorear condiciones de salud.<\/p><\/div><hr \/><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_8\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p style=\"text-align: left\"><strong data-start=\"603\" data-end=\"649\">Tecn\u00f3logos M\u00e9dicos: <\/strong>Profesionales que analizan muestras complejas y garantizan resultados precisos para el diagn\u00f3stico cl\u00ednico.<\/p><\/div><hr \/><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_9\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p style=\"text-align: left\"><strong data-start=\"761\" data-end=\"813\">Nutricionistas Registrados: <\/strong>Especialistas en alimentaci\u00f3n que dise\u00f1an planes nutricionales basados en necesidades m\u00e9dicas y de salud.<\/p><\/div><hr \/><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_10\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p style=\"text-align: left\"><strong data-start=\"923\" data-end=\"977\">Nutricionistas\/Dietistas: <\/strong>Profesionales que orientan sobre h\u00e1bitos alimenticios saludables para mejorar la calidad de vida.<\/p><\/div><hr \/><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_11\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p style=\"text-align: left\"><strong data-start=\"1079\" data-end=\"1133\">Terapistas Ocupacionales: <\/strong>Ayudan a pacientes a recuperar habilidades para realizar actividades diarias de manera independiente.<\/p><\/div><hr \/><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_12\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p style=\"text-align: left\"><strong data-start=\"1239\" data-end=\"1262\">\u00d3pticos: <\/strong>Expertos en la adaptaci\u00f3n y ajuste de lentes y equipos visuales seg\u00fan prescripci\u00f3n m\u00e9dica.<\/p><\/div><hr \/><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_13\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p style=\"text-align: left\"><strong data-start=\"1357\" data-end=\"1385\">Opt\u00f3metras: <\/strong>Profesionales que eval\u00faan la visi\u00f3n, detectan problemas oculares y prescriben lentes correctivos.<\/p><\/div><hr \/><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_14\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p style=\"text-align: left\"><strong data-start=\"1487\" data-end=\"1516\">Psic\u00f3logos: <\/strong>Especialistas en salud mental que ayudan a manejar emociones, conductas y bienestar psicol\u00f3gico.<\/p><\/div><hr \/><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_15\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p style=\"text-align: left\"><strong data-start=\"1617\" data-end=\"1670\">Terapistas Respiratorios: <\/strong>Profesionales que tratan condiciones pulmonares y ayudan a mejorar la funci\u00f3n respiratoria.<\/p><\/div><hr \/><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_16\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p style=\"text-align: left\"><strong data-start=\"1766\" data-end=\"1808\">Pat\u00f3logos del Habla: <\/strong>Especialistas en trastornos del habla, lenguaje y comunicaci\u00f3n en ni\u00f1os y adultos.<\/p><\/div><hr \/><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_17\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p style=\"text-align: left\"><strong data-start=\"1895\" data-end=\"1938\">T\u00e9cnicos de Rayos X: <\/strong>Encargados de realizar estudios de imagen para apoyar diagn\u00f3sticos m\u00e9dicos precisos.<\/p><\/div><hr \/><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_18\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p style=\"text-align: left\"><strong data-start=\"2069\" data-end=\"2118\">Enfermeros Anestesistas: <\/strong>Profesionales especializados en la administraci\u00f3n de anestesia y monitoreo del paciente durante procedimientos.<\/p><\/div><hr \/><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_19\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p style=\"text-align: left\"><strong data-start=\"2234\" data-end=\"2310\">Enfermeros Pr\u00e1cticos Licenciados: <\/strong>Brindan cuidados b\u00e1sicos al paciente bajo supervisi\u00f3n m\u00e9dica o de enfermer\u00eda avanzada.<\/p><\/div><hr \/><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_20\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p style=\"text-align: left\"><strong data-start=\"2401\" data-end=\"2458\">Enfermeros Registrados: <\/strong>Profesionales que coordinan el cuidado del paciente, administran tratamientos y educan sobre salud.<\/p><\/div><hr \/><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_21\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p style=\"text-align: left\"><strong data-start=\"2562\" data-end=\"2622\">Enfermeros Practicantes: <\/strong>Enfermeros con formaci\u00f3n avanzada que pueden diagnosticar, tratar y prescribir medicamentos.<\/p><\/div><hr \/><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_22\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p style=\"text-align: left\"><strong data-start=\"2719\" data-end=\"2748\">Naturopat\u00eda: <\/strong>Enfoque de salud que utiliza m\u00e9todos naturales para promover el bienestar y prevenir enfermedades.<\/p><\/div><hr \/><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_23\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p style=\"text-align: left\"><strong data-start=\"2851\" data-end=\"2889\">Fisioterapeutas: <\/strong>Especialistas en rehabilitaci\u00f3n f\u00edsica que ayudan a recuperar movilidad y reducir el dolor.<\/p><\/div><hr \/><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_24\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p style=\"text-align: left\"><strong data-start=\"2851\" data-end=\"2889\">Fisioterapeutas Otros: <\/strong>Especialistas en rehabilitaci\u00f3n f\u00edsica que ayudan a recuperar movilidad y reducir el dolor.<\/p><\/div><hr \/><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_25\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p style=\"text-align: left\"><strong data-start=\"2985\" data-end=\"3027\">Asistente M\u00e9dico: <\/strong>Profesionales que apoyan a los m\u00e9dicos en diagn\u00f3sticos, tratamientos y atenci\u00f3n directa al paciente.<\/p><\/div><hr \/><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_26\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p style=\"text-align: left\"><strong data-start=\"3132\" data-end=\"3179\">T\u00e9cnicos Quir\u00fargicos: <\/strong>Asisten en cirug\u00edas preparando instrumentos, equipos y apoyando al equipo m\u00e9dico durante el procedimiento.<\/p><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_8_numero_licencia' id='label_ff_8_numero_licencia' aria-label=\"Incluir n\u00famero de licencia profesional de la especialidad\">Incluir n\u00famero de licencia profesional de la especialidad<\/label><\/div><div class='ff-el-input--content'><input type=\"number\" name=\"numero_licencia\" id=\"ff_8_numero_licencia\" class=\"ff-el-form-control\" data-name=\"numero_licencia\" inputmode=\"numeric\" step=\"any\"  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 for='ff_8_expiracion_licencia' id='label_ff_8_expiracion_licencia' aria-label=\"Fecha de expiraci\u00f3n de licencia profesional\">Fecha de expiraci\u00f3n de licencia profesional <\/label><div class=\"ff-el-tooltip\" data-content=\"Debe validar que la licencia no est\u00e9 expirada.\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><input  aria-label='Fecha de expiraci\u00f3n de licencia profesional  Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='m\/d\/Y' type=\"text\" name=\"expiracion_licencia\" id=\"ff_8_expiracion_licencia\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"expiracion_licencia\"  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 for='ff_8_file-upload_1' id='label_ff_8_file-upload_1' aria-label=\"Favor de a\u00f1adir el documento de la licencia profesional\">Favor de a\u00f1adir el documento de la licencia profesional<\/label><\/div><div class='ff-el-input--content'><label for='ff_8_file-upload_1' class='ff_file_upload_holder'><span class='ff_upload_btn ff-btn' tabindex='0'>Escoger archivo<\/span> <input type=\"file\" name=\"file-upload\" id=\"ff_8_file-upload_1\" class=\"ff-el-form-control  ff-screen-reader-element\" data-name=\"file-upload\" multiple=\"1\"  aria-invalid='false' aria-required=true><\/label><\/div><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Atr\u00e1s'>Atr\u00e1s<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Continuar'>Continuar<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-8_27\" ><div data-name=\"ff_cn_id_5\"  class='ff-t-container ff-column-container ff_columns_total_1 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class=\"ff-el-group ff-el-section-break  ff_center\" ><h3 class='ff-el-section-title'>Evaluaci\u00f3n Inicial<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00bfRealiza procedimientos est\u00e9ticos?\">\u00bfRealiza procedimientos est\u00e9ticos?<\/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_19cfe8a9ab6d6ca7c97d69b3e9dc4d56'><input  type=\"radio\" name=\"input_radio_10\" data-name=\"input_radio_10\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_radio_10_19cfe8a9ab6d6ca7c97d69b3e9dc4d56' aria-label='S\u00ed' aria-invalid='false' aria-required=true> <span>S\u00ed<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_10_de7a4fdeacbcc19d84bd5a47062e4a0a'><input  type=\"radio\" name=\"input_radio_10\" data-name=\"input_radio_10\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_radio_10_de7a4fdeacbcc19d84bd5a47062e4a0a' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/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_8_input_text_37' id='label_ff_8_input_text_37' aria-label=\"De selecionar S\u00ed, favor especificar\">De selecionar S\u00ed, favor especificar<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_37\" class=\"ff-el-form-control\" data-name=\"input_text_37\" id=\"ff_8_input_text_37\"  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=\"\u00bfTrabaja en Sala de Emergencia \/ CDT?\">\u00bfTrabaja en Sala de Emergencia \/ CDT?<\/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_529c13149db60de24074abe576a204d2'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_radio_1_529c13149db60de24074abe576a204d2' aria-label='S\u00ed' aria-invalid='false' aria-required=true> <span>S\u00ed<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1_f01cbcfab78d730668c54133631191e7'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_radio_1_f01cbcfab78d730668c54133631191e7' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/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_8_input_text_12' id='label_ff_8_input_text_12' aria-label=\"De selecionar S\u00ed, favor especificar\">De selecionar S\u00ed, favor especificar<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_12\" class=\"ff-el-form-control\" data-name=\"input_text_12\" id=\"ff_8_input_text_12\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Atr\u00e1s'>Atr\u00e1s<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Continuar'>Continuar<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-8_28\" ><div data-name=\"ff_cn_id_6\"  class='ff-t-container ff-column-container ff_columns_total_1 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_29\" ><h3 class='ff-el-section-title'>Sigue al proximo paso<\/h3><div class='ff-section_break_desk'><p>Continua el proceso hacia los detalles.<\/p><\/div><hr \/><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" ><h3 class='ff-el-section-title'>Preguntas de Suscripci\u00f3n<\/h3><div class='ff-section_break_desk'><p>Detalles de la cotizaci\u00f3n<\/p>\n<h4>Preguntas de la suscripci\u00f3n<\/h4>\n<p>Si no ves preguntas prosigue<\/p>\n<p><b><span data-olk-copy-source=\"MessageBody\">Aviso:<\/span><\/b> Esta solicitud corresponde a un seguro de Responsabilidad Profesional para Proveedores de Servicios de Salud Aliados bajo la modalidad <i>Claims Made &amp; Reported<\/i>.<\/p><\/div><hr \/><\/div><div class='ff-el-group has-conditions  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00bfCu\u00e1l es la poblaci\u00f3n principal de pacientes\/clientes que atiende?\">\u00bfCu\u00e1l es la poblaci\u00f3n principal de pacientes\/clientes que atiende?<\/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_9f37fab9c32d8092cf17c8573c87f7f1'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Adultos\"  id='checkbox_2_9f37fab9c32d8092cf17c8573c87f7f1' aria-label='Adultos' aria-invalid='false' aria-required=true> <span>Adultos<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_278db1a7cf79b09776520952762c2d5c'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Pedi\u00e1tricos\"  id='checkbox_2_278db1a7cf79b09776520952762c2d5c' aria-label='Pedi\u00e1tricos' aria-invalid='false' aria-required=true> <span>Pedi\u00e1tricos<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_a0c8921f061c28a28ed9e135e280d7e2'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Pacientes hospitalizados\"  id='checkbox_2_a0c8921f061c28a28ed9e135e280d7e2' aria-label='Pacientes hospitalizados' aria-invalid='false' aria-required=true> <span>Pacientes hospitalizados<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_c9e53aaf9c6f7b5159a1f4ce98fd3238'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Pacientes ambulatorios Centros de cuidado prolongado\"  id='checkbox_2_c9e53aaf9c6f7b5159a1f4ce98fd3238' aria-label='Pacientes ambulatorios Centros de cuidado prolongado' aria-invalid='false' aria-required=true> <span>Pacientes ambulatorios Centros de cuidado prolongado<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_3b31652a63fc049bccb16363c8402fe8'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Terapias en hogar\"  id='checkbox_2_3b31652a63fc049bccb16363c8402fe8' aria-label='Terapias en hogar' aria-invalid='false' aria-required=true> <span>Terapias en hogar<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_f460edd9e07ee5a5563f8f20c504d169'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Escuelas\"  id='checkbox_2_f460edd9e07ee5a5563f8f20c504d169' aria-label='Escuelas' aria-invalid='false' aria-required=true> <span>Escuelas<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_86f4ce77165fcea5bc086689482eb383'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Empresas\/ocupacional\"  id='checkbox_2_86f4ce77165fcea5bc086689482eb383' aria-label='Empresas\/ocupacional' aria-invalid='false' aria-required=true> <span>Empresas\/ocupacional<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_2622f289a13d8efaec2902281ecae7d9'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Otros\"  id='checkbox_2_2622f289a13d8efaec2902281ecae7d9' aria-label='Otros' aria-invalid='false' aria-required=true> <span>Otros<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_20' id='label_ff_8_input_text_20' aria-label=\"De selecionar otros, favor especificar\">De selecionar otros, favor especificar<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_20\" class=\"ff-el-form-control\" data-name=\"input_text_20\" id=\"ff_8_input_text_20\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00bfHa estado involucrado directa o indirectamente en alguna reclamaci\u00f3n por impericia m\u00e9dica, incidente, demanda, situaci\u00f3n, investigaci\u00f3n o circunstancia que pudiera resultar en una reclamaci\u00f3n relacionada con sus servicios profesionales, incluyendo incidentes reportados a aseguradoras anteriores?\">\u00bfHa estado involucrado directa o indirectamente en alguna reclamaci\u00f3n por impericia m\u00e9dica, incidente, demanda, situaci\u00f3n, investigaci\u00f3n o circunstancia que pudiera resultar en una reclamaci\u00f3n relacionada con sus servicios profesionales, incluyendo incidentes reportados a aseguradoras anteriores?<\/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_18_f0fcf50dbf932dcf8515236ba192b42b'><input  type=\"radio\" name=\"input_radio_18\" data-name=\"input_radio_18\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_radio_18_f0fcf50dbf932dcf8515236ba192b42b' aria-label='S\u00ed' aria-invalid='false' aria-required=true> <span>S\u00ed<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_18_37ec7e210aeabc8501c9d266034e59cc'><input  type=\"radio\" name=\"input_radio_18\" data-name=\"input_radio_18\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_radio_18_37ec7e210aeabc8501c9d266034e59cc' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_36' id='label_ff_8_input_text_36' aria-label=\"De selecionar S\u00ed, favor especificar\">De selecionar S\u00ed, favor especificar<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_36\" class=\"ff-el-form-control\" data-name=\"input_text_36\" id=\"ff_8_input_text_36\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00bfHa sido objeto de alguna investigaci\u00f3n, acci\u00f3n disciplinaria, suspensi\u00f3n, restricci\u00f3n, revocaci\u00f3n o revisi\u00f3n relacionada con su licencia profesional, privilegios cl\u00ednicos o pr\u00e1ctica profesional por parte de una junta examinadora, organismo regulador, entidad gubernamental o asociaci\u00f3n profesional?\">\u00bfHa sido objeto de alguna investigaci\u00f3n, acci\u00f3n disciplinaria, suspensi\u00f3n, restricci\u00f3n, revocaci\u00f3n o revisi\u00f3n relacionada con su licencia profesional, privilegios cl\u00ednicos o pr\u00e1ctica profesional por parte de una junta examinadora, organismo regulador, entidad gubernamental o asociaci\u00f3n profesional?<\/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_19_c3d181fb088b99e55bf6656a87ea3a88'><input  type=\"radio\" name=\"input_radio_19\" data-name=\"input_radio_19\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_radio_19_c3d181fb088b99e55bf6656a87ea3a88' aria-label='S\u00ed' aria-invalid='false' aria-required=true> <span>S\u00ed<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_19_c4639a358b6a2cb3ffe106a23dc975f2'><input  type=\"radio\" name=\"input_radio_19\" data-name=\"input_radio_19\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_radio_19_c4639a358b6a2cb3ffe106a23dc975f2' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_21' id='label_ff_8_input_text_21' aria-label=\"De selecionar S\u00ed, favor especificar\">De selecionar S\u00ed, favor especificar<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_21\" class=\"ff-el-form-control\" data-name=\"input_text_21\" id=\"ff_8_input_text_21\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00bfHa sido objeto de alguna investigaci\u00f3n, auditor\u00eda, sanci\u00f3n o procedimiento relacionado con HIPAA, Medicare, Medicaid, el Departamento de Salud de los Estados Unidos (HHS), o cualquier entidad gubernamental, reguladora o administradora relacionada con su pr\u00e1ctica profesional?\">\u00bfHa sido objeto de alguna investigaci\u00f3n, auditor\u00eda, sanci\u00f3n o procedimiento relacionado con HIPAA, Medicare, Medicaid, el Departamento de Salud de los Estados Unidos (HHS), o cualquier entidad gubernamental, reguladora o administradora relacionada con su pr\u00e1ctica profesional?<\/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_20_906950618b4e3fdde32f97ce580a7dc4'><input  type=\"radio\" name=\"input_radio_20\" data-name=\"input_radio_20\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_radio_20_906950618b4e3fdde32f97ce580a7dc4' aria-label='S\u00ed' aria-invalid='false' aria-required=true> <span>S\u00ed<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_20_ddd51a14eeea43c5e655070821d57054'><input  type=\"radio\" name=\"input_radio_20\" data-name=\"input_radio_20\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_radio_20_ddd51a14eeea43c5e655070821d57054' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_22' id='label_ff_8_input_text_22' aria-label=\"De selecionar S\u00ed, favor especificar\">De selecionar S\u00ed, favor especificar<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_22\" class=\"ff-el-form-control\" data-name=\"input_text_22\" id=\"ff_8_input_text_22\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00bfAlguna compa\u00f1\u00eda de seguros le ha denegado, cancelado, no renovado, restringido o emitido cobertura sujeta a condiciones especiales relacionadas con responsabilidad profesional?\">\u00bfAlguna compa\u00f1\u00eda de seguros le ha denegado, cancelado, no renovado, restringido o emitido cobertura sujeta a condiciones especiales relacionadas con responsabilidad profesional?<\/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_21_f20ff2c6ea10a7947060e86adcb7cbe6'><input  type=\"radio\" name=\"input_radio_21\" data-name=\"input_radio_21\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_radio_21_f20ff2c6ea10a7947060e86adcb7cbe6' aria-label='S\u00ed' aria-invalid='false' aria-required=true> <span>S\u00ed<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_21_cbc4f8988f4ae3145018b2553298c02e'><input  type=\"radio\" name=\"input_radio_21\" data-name=\"input_radio_21\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_radio_21_cbc4f8988f4ae3145018b2553298c02e' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_35' id='label_ff_8_input_text_35' aria-label=\"De selecionar S\u00ed, favor especificar\">De selecionar S\u00ed, favor especificar<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_35\" class=\"ff-el-form-control\" data-name=\"input_text_35\" id=\"ff_8_input_text_35\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_7\"  class='ff-t-container ff-column-container ff_columns_total_1 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00bfHa sido acusado, convicto, declarado culpable o nolo contendere por alg\u00fan delito criminal, excluyendo infracciones menores de tr\u00e1nsito?\">\u00bfHa sido acusado, convicto, declarado culpable o nolo contendere por alg\u00fan delito criminal, excluyendo infracciones menores de tr\u00e1nsito?<\/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_29_93bab5a7692c59fab947b59f601d5d43'><input  type=\"radio\" name=\"input_radio_29\" data-name=\"input_radio_29\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_radio_29_93bab5a7692c59fab947b59f601d5d43' aria-label='S\u00ed' aria-invalid='false' aria-required=true> <span>S\u00ed<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_29_c4113b52906b5e787c2f4ed9d2c0a55f'><input  type=\"radio\" name=\"input_radio_29\" data-name=\"input_radio_29\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_radio_29_c4113b52906b5e787c2f4ed9d2c0a55f' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_29' id='label_ff_8_input_text_29' aria-label=\"De selecionar S\u00ed, favor especificar\">De selecionar S\u00ed, favor especificar<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_29\" class=\"ff-el-form-control\" data-name=\"input_text_29\" id=\"ff_8_input_text_29\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00bfAlg\u00fan hospital, facilidad de salud, organizaci\u00f3n de manejo de cuidado (\u201cManaged Care Organization\u201d) o entidad similar le ha restringido, suspendido, reducido, revocado o colocado en probatoria sus privilegios cl\u00ednicos o profesionales?\">\u00bfAlg\u00fan hospital, facilidad de salud, organizaci\u00f3n de manejo de cuidado (\u201cManaged Care Organization\u201d) o entidad similar le ha restringido, suspendido, reducido, revocado o colocado en probatoria sus privilegios cl\u00ednicos o profesionales?<\/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_30_08a813e0bb03cf6472cf6cf1971766bf'><input  type=\"radio\" name=\"input_radio_30\" data-name=\"input_radio_30\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_radio_30_08a813e0bb03cf6472cf6cf1971766bf' aria-label='S\u00ed' aria-invalid='false' aria-required=true> <span>S\u00ed<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_30_f6361b16d28c2577563c3d9dbc7b029c'><input  type=\"radio\" name=\"input_radio_30\" data-name=\"input_radio_30\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_radio_30_f6361b16d28c2577563c3d9dbc7b029c' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_30' id='label_ff_8_input_text_30' aria-label=\"De selecionar S\u00ed, favor especificar\">De selecionar S\u00ed, favor especificar<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_30\" class=\"ff-el-form-control\" data-name=\"input_text_30\" id=\"ff_8_input_text_30\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00bfHa sido objeto de suspensi\u00f3n, revocaci\u00f3n, restricci\u00f3n, probatoria, censura o cualquier otra acci\u00f3n disciplinaria relacionada con alguna membres\u00eda u organizaci\u00f3n profesional?\">\u00bfHa sido objeto de suspensi\u00f3n, revocaci\u00f3n, restricci\u00f3n, probatoria, censura o cualquier otra acci\u00f3n disciplinaria relacionada con alguna membres\u00eda u organizaci\u00f3n profesional?<\/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_31_4a3a3b58fc2c331616081396091521e6'><input  type=\"radio\" name=\"input_radio_31\" data-name=\"input_radio_31\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_radio_31_4a3a3b58fc2c331616081396091521e6' aria-label='S\u00ed' aria-invalid='false' aria-required=true> <span>S\u00ed<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_31_65cfab1de6891055d034cba34976e7d4'><input  type=\"radio\" name=\"input_radio_31\" data-name=\"input_radio_31\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_radio_31_65cfab1de6891055d034cba34976e7d4' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_31' id='label_ff_8_input_text_31' aria-label=\"De selecionar S\u00ed, favor especificar\">De selecionar S\u00ed, favor especificar<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_31\" class=\"ff-el-form-control\" data-name=\"input_text_31\" id=\"ff_8_input_text_31\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_8\"  class='ff-t-container ff-column-container ff_columns_total_1 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00bfHa sido acusado, convicto, declarado culpable o nolo contendere por alg\u00fan delito criminal, excluyendo infracciones menores de tr\u00e1nsito?\">\u00bfHa sido acusado, convicto, declarado culpable o nolo contendere por alg\u00fan delito criminal, excluyendo infracciones menores de tr\u00e1nsito?<\/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_32_a28a97a7e13576d0c60c5cdc87227451'><input  type=\"radio\" name=\"input_radio_32\" data-name=\"input_radio_32\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_radio_32_a28a97a7e13576d0c60c5cdc87227451' aria-label='S\u00ed' aria-invalid='false' aria-required=true> <span>S\u00ed<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_32_5d83a4fb1a38871cb05ead3d733b25b5'><input  type=\"radio\" name=\"input_radio_32\" data-name=\"input_radio_32\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_radio_32_5d83a4fb1a38871cb05ead3d733b25b5' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_32' id='label_ff_8_input_text_32' aria-label=\"De selecionar S\u00ed, favor especificar\">De selecionar S\u00ed, favor especificar<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_32\" class=\"ff-el-form-control\" data-name=\"input_text_32\" id=\"ff_8_input_text_32\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00bfAlg\u00fan hospital, facilidad de salud, organizaci\u00f3n de manejo de cuidado (\u201cManaged Care Organization\u201d) o entidad similar le ha restringido, suspendido, reducido, revocado o colocado en probatoria sus privilegios cl\u00ednicos o profesionales?\">\u00bfAlg\u00fan hospital, facilidad de salud, organizaci\u00f3n de manejo de cuidado (\u201cManaged Care Organization\u201d) o entidad similar le ha restringido, suspendido, reducido, revocado o colocado en probatoria sus privilegios cl\u00ednicos o profesionales?<\/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_33_1630bd797e970140cb5ae9ab8c06344c'><input  type=\"radio\" name=\"input_radio_33\" data-name=\"input_radio_33\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_radio_33_1630bd797e970140cb5ae9ab8c06344c' aria-label='S\u00ed' aria-invalid='false' aria-required=true> <span>S\u00ed<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_33_6c0e18bad3258fe00f919f3efddd4873'><input  type=\"radio\" name=\"input_radio_33\" data-name=\"input_radio_33\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_radio_33_6c0e18bad3258fe00f919f3efddd4873' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_33' id='label_ff_8_input_text_33' aria-label=\"De selecionar S\u00ed, favor especificar\">De selecionar S\u00ed, favor especificar<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_33\" class=\"ff-el-form-control\" data-name=\"input_text_33\" id=\"ff_8_input_text_33\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00bfHa sido objeto de suspensi\u00f3n, revocaci\u00f3n, restricci\u00f3n, probatoria, censura o cualquier otra acci\u00f3n disciplinaria relacionada con alguna membres\u00eda u organizaci\u00f3n profesional?\">\u00bfHa sido objeto de suspensi\u00f3n, revocaci\u00f3n, restricci\u00f3n, probatoria, censura o cualquier otra acci\u00f3n disciplinaria relacionada con alguna membres\u00eda u organizaci\u00f3n profesional?<\/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_34_c787327a5e42e50d9bd4c2764e5459d7'><input  type=\"radio\" name=\"input_radio_34\" data-name=\"input_radio_34\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_radio_34_c787327a5e42e50d9bd4c2764e5459d7' aria-label='S\u00ed' aria-invalid='false' aria-required=true> <span>S\u00ed<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_34_749a17d0b37e138551dffd090571d495'><input  type=\"radio\" name=\"input_radio_34\" data-name=\"input_radio_34\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_radio_34_749a17d0b37e138551dffd090571d495' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_34' id='label_ff_8_input_text_34' aria-label=\"De selecionar S\u00ed, favor especificar\">De selecionar S\u00ed, favor especificar<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_34\" class=\"ff-el-form-control\" data-name=\"input_text_34\" id=\"ff_8_input_text_34\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Atr\u00e1s'>Atr\u00e1s<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Continuar'>Continuar<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-8_30\" ><div data-name=\"ff_cn_id_9\"  class='ff-t-container ff-column-container ff_columns_total_1 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class=\"ff-el-group ff-el-section-break  ff_center\" data-name=\"section_break-8_31\" ><h3 class='ff-el-section-title'>Su p\u00f3liza sera evaluada<\/h3><div class='ff-section_break_desk'><p>&nbsp;<\/p>\n<p style=\"text-align: left\"><span style=\"font-weight: 400\">Hemos recibido su solicitud correctamente. Debido a que una o m\u00e1s de sus respuestas requieren evaluaci\u00f3n adicional, su caso ser\u00e1 enviado a la compa\u00f1\u00eda para revisi\u00f3n.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"font-weight: 400\">Un miembro de nuestro personal se estar\u00e1 comunicando con usted a la mayor brevedad posible para orientarle sobre los pr\u00f3ximos pasos.<\/span><\/p><\/div><hr \/><\/div><div class='ff-el-group  ff-custom_html has-conditions' tabindex='-1' data-name=\"custom_html-8_32\" ><p><span style=\"color: #993300\"><strong>Informaci\u00f3n Personal<\/strong><\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><b>Nombre del solicitante:<\/b><span style=\"font-weight: 400\"> <span class=\"ff_dynamic_value\" data-ref=\"names\" data-fallback=\"\"><\/span><\/span><\/li>\n<li style=\"font-weight: 400\"><b>Fecha de Nacimiento:<\/b><span style=\"font-weight: 400\"> <span class=\"ff_dynamic_value\" data-ref=\"datetime_1\" data-fallback=\"\"><\/span><\/span><\/li>\n<li style=\"font-weight: 400\"><b>Direcci\u00f3n F\u00edsica:<\/b><span style=\"font-weight: 400\"> <span class=\"ff_dynamic_value\" data-ref=\"direccion\" data-fallback=\"\"><\/span> <span class=\"ff_dynamic_value\" data-ref=\"cuidad\" data-fallback=\"\"><\/span>, <span class=\"ff_dynamic_value\" data-ref=\"pais\" data-fallback=\"\"><\/span> <span class=\"ff_dynamic_value\" data-ref=\"zip_code\" data-fallback=\"\"><\/span><\/span><\/li>\n<li><b>Direcci\u00f3n Postal:<\/b><span style=\"font-weight: 400\"> <span class=\"ff_dynamic_value\" data-ref=\"direccion_1\" data-fallback=\"\"><\/span> <span class=\"ff_dynamic_value\" data-ref=\"cuidad_1\" data-fallback=\"\"><\/span> <span class=\"ff_dynamic_value\" data-ref=\"pais_1\" data-fallback=\"\"><\/span> <span class=\"ff_dynamic_value\" data-ref=\"zip_code_1\" data-fallback=\"\"><\/span><\/span><\/li>\n<li style=\"font-weight: 400\"><b>Email:<\/b><span style=\"font-weight: 400\"> <span class=\"ff_dynamic_value\" data-ref=\"email\" data-fallback=\"\"><\/span><\/span><\/li>\n<li style=\"font-weight: 400\"><b>Tel\u00e9fono:<\/b><span style=\"font-weight: 400\"> <span class=\"ff_dynamic_value\" data-ref=\"phone_1\" data-fallback=\"\"><\/span><\/span><\/li>\n<li style=\"font-weight: 400\"><b>Lugares donde trabaja:<\/b><span style=\"font-weight: 400\"> <span class=\"ff_dynamic_value\" data-ref=\"lugar_trabajo\" data-fallback=\"\"><\/span><\/span><\/li>\n<li><span style=\"font-weight: 400\"><strong>Selecciona su especialidad (el l\u00edmite de responsabilidad ser\u00e1 $100,000 por incidente \/ $300,000 agregado anual.)<\/strong><span class=\"ff_dynamic_value\" data-ref=\"payment_input_1\" data-fallback=\"\"><\/span><\/span><\/li>\n<li style=\"font-weight: 400\"><b>Incluir n\u00famero de licencia profesional de su especialidad: <\/b><span style=\"font-weight: 400\"><span class=\"ff_dynamic_value\" data-ref=\"numero_licencia\" data-fallback=\"\"><\/span><\/span><\/li>\n<li style=\"font-weight: 400\"><b>Fecha de expiraci\u00f3n de licencia de profesional <\/b><span style=\"font-weight: 400\"><span class=\"ff_dynamic_value\" data-ref=\"expiracion_licencia\" data-fallback=\"\"><\/span><\/span><\/li>\n<\/ul><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Aceptaci\u00f3n\">Aceptaci\u00f3n<\/label><div class=\"ff-el-tooltip\" data-content=\"IMPORTANTE: Confirmo que solo estar\u00e9 cubierto por la profesi\u00f3n indicada en este formulario. No se cubrir\u00e1n otras actividades profesionales fuera de la especialidad seleccionada.\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check- ff_item_selected'><label class='ff-el-form-check-label' for='checkbox_7a1cedd5090964bec0ed4697a78dfe0b'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" checked=\"1\" value=\"Confirmo que he le\u00eddo y comprendido el Aviso Importante, las Confirmaciones del Solicitante, el Consentimiento Electr\u00f3nico y el Aviso de Fraude.\"  id='checkbox_7a1cedd5090964bec0ed4697a78dfe0b' aria-label='Confirmo que he le\u00eddo y comprendido el Aviso Importante, las Confirmaciones del Solicitante, el Consentimiento Electr\u00f3nico y el Aviso de Fraude.' aria-invalid='false' aria-required=false> <span>Confirmo que he le\u00eddo y comprendido el Aviso Importante, las Confirmaciones del Solicitante, el Consentimiento Electr\u00f3nico y el Aviso de Fraude.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check- ff_item_selected'><label class='ff-el-form-check-label' for='checkbox_15b22aaf2e9e3c7779cf463bc1c93221'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" checked=\"1\" value=\"Certifico que la informaci\u00f3n suministrada es correcta y completa a mi mejor conocimiento.\"  id='checkbox_15b22aaf2e9e3c7779cf463bc1c93221' aria-label='Certifico que la informaci\u00f3n suministrada es correcta y completa a mi mejor conocimiento.' aria-invalid='false' aria-required=false> <span>Certifico que la informaci\u00f3n suministrada es correcta y completa a mi mejor conocimiento.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check- ff_item_selected'><label class='ff-el-form-check-label' for='checkbox_11250f692bd1198efb25e030692fee37'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" checked=\"1\" value=\"Autorizo a Puerto Rico Medical Defense Insurance Company y\/o Resolve General Agency a utilizar la informaci\u00f3n provista para prop\u00f3sitos de evaluaci\u00f3n, suscripci\u00f3n y comunicaci\u00f3n relacionada con esta solicitud.\"  id='checkbox_11250f692bd1198efb25e030692fee37' aria-label='Autorizo a Puerto Rico Medical Defense Insurance Company y\/o Resolve General Agency a utilizar la informaci\u00f3n provista para prop\u00f3sitos de evaluaci\u00f3n, suscripci\u00f3n y comunicaci\u00f3n relacionada con esta solicitud.' aria-invalid='false' aria-required=false> <span>Autorizo a Puerto Rico Medical Defense Insurance Company y\/o Resolve General Agency a utilizar la informaci\u00f3n provista para prop\u00f3sitos de evaluaci\u00f3n, suscripci\u00f3n y comunicaci\u00f3n relacionada con esta solicitud.<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_10\"  class='ff-t-container ff-column-container ff_columns_total_1 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class=\"ff-el-group ff-el-section-break  ff_center\" data-name=\"section_break-8_33\" ><h3 class='ff-el-section-title'>Confirmar Cotizaci\u00f3n<\/h3><div class='ff-section_break_desk'><p>&nbsp;<\/p>\n<p style=\"text-align: left\"><b>Declaraciones y Consentimientos<\/b><\/p>\n<p style=\"text-align: left\"><b>Cotizador Web \u2013 Aliados de la Salud<\/b><\/p>\n<p style=\"text-align: left\"><b>Resolve General Agency LLC \/ Puerto Rico Medical Defense Insurance Company (PRMD)<\/b><\/p>\n<p style=\"text-align: left\"><b>AVISO IMPORTANTE<\/b><\/p>\n<p style=\"text-align: left\"><span style=\"font-weight: 400\">Usted (en adelante, \u201cSolicitante\u201d) est\u00e1 solicitando un seguro de responsabilidad profesional para Aliados de la Salud del tipo \u201creclamaciones presentadas\u201d o \u201c<\/span><i><span style=\"font-weight: 400\">Claims Made &amp; Reported<\/span><\/i><span style=\"font-weight: 400\">\u201d que, de ser aprobado, ser\u00eda emitido por Puerto Rico Medical Defense Insurance Company (en adelante, la \u201cCompa\u00f1\u00eda\u201d).<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"font-weight: 400\">Por favor, lea cuidadosamente y complete toda la informaci\u00f3n requerida en esta solicitud. La evaluaci\u00f3n de elegibilidad y emisi\u00f3n de cobertura estar\u00e1 sujeta a la informaci\u00f3n suministrada y a cualquier documentaci\u00f3n adicional que pueda ser requerida.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"font-weight: 400\">La Compa\u00f1\u00eda podr\u00e1 requerir documentaci\u00f3n adicional para completar el proceso de evaluaci\u00f3n y suscripci\u00f3n, en cuyo caso se le notificar\u00e1 por conducto de su representante autorizado de seguros.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"font-weight: 400\">Bajo una p\u00f3liza del tipo <\/span><i><span style=\"font-weight: 400\">Claims Made &amp; Reported<\/span><\/i><span style=\"font-weight: 400\">, la cobertura aplica \u00fanicamente a reclamaciones derivadas de incidentes m\u00e9dicos ocurridos en o despu\u00e9s de la Fecha Retroactiva indicada en la p\u00f3liza, siempre que dichas reclamaciones sean:<\/span><\/p>\n<ul>\n<li style=\"text-align: left\"><span style=\"font-weight: 400\">Presentadas por primera vez contra el asegurado durante el per\u00edodo de vigencia de la p\u00f3liza; y\u00a0<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"font-weight: 400\">Reportadas por escrito a la Compa\u00f1\u00eda conforme a las disposiciones de notificaci\u00f3n establecidas en la p\u00f3liza. <\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\">La cobertura no aplica a incidentes m\u00e9dicos ocurridos antes de la Fecha Retroactiva, salvo que exista una disposici\u00f3n expresa mediante endoso emitido por la Compa\u00f1\u00eda.<\/p>\n<p style=\"text-align: left\">\u00a0<\/p>\n<p style=\"text-align: left\"><b>INFORMACI\u00d3N SOBRE PRIMAS \u201cSTEP-UP\u201d<\/b><\/p>\n<p style=\"text-align: left\"><span style=\"font-weight: 400\">Durante los primeros a\u00f1os de una p\u00f3liza Claims Made &amp; Reported, las primas pueden ser m\u00e1s bajas y aumentar gradualmente hasta alcanzar su nivel de madurez. Estos ajustes pueden ocurrir independientemente de cambios generales en tarifas o clasificaciones de riesgo.<\/span><br \/><br \/><\/p>\n<p style=\"text-align: left\"><b>Confirmaciones del Solicitante<\/b><\/p>\n<p style=\"text-align: left\"><span style=\"font-weight: 400\">Al completar esta solicitud, el Solicitante declara y certifica que:<\/span><\/p>\n<ul>\n<li style=\"text-align: left\"><span style=\"font-weight: 400\">Toda la informaci\u00f3n provista en este formulario y en cualquier documento suplementario es verdadera, correcta y completa a su mejor conocimiento.\u00a0<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"font-weight: 400\">Entiende que esta solicitud y cualquier documentaci\u00f3n que el Solicitante someta a solicitud de la Compa\u00f1\u00eda\u00a0 formar\u00e1n parte de la base sobre la cual se evaluar\u00e1 la posible emisi\u00f3n de una p\u00f3liza de seguro.\u00a0<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"font-weight: 400\">Se compromete a notificar a la \u201cResolve General Agency, LLC.\u201d cualquier cambio material relacionado con la informaci\u00f3n suministrada antes de la emisi\u00f3n de la p\u00f3liza.\u00a0<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"font-weight: 400\">Reconoce que completar este cotizador no constituye una garant\u00eda de aceptaci\u00f3n ni de emisi\u00f3n de cobertura.\u00a0<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\">\u00a0<\/p>\n<p style=\"text-align: left\"><b>CONSENTIMIENTO &amp; AUTORIZACIONES\u00a0<\/b><\/p>\n<p style=\"text-align: left\"><span style=\"font-weight: 400\">El solicitante autoriza el uso de medios electr\u00f3nicos y f\u00edsicos para:<\/span><\/p>\n<ul style=\"text-align: left\">\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Recibir comunicaciones relacionadas con la cotizaci\u00f3n o solicitud;\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Intercambiar documentos y formularios;\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Confirmar aceptaci\u00f3n de t\u00e9rminos y consentimientos;\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Recibir notificaciones relacionadas con el proceso de evaluaci\u00f3n y emisi\u00f3n.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Ni la Compa\u00f1\u00eda ni su representante autorizado utilizar\u00e1n la informaci\u00f3n personal obtenida del solicitante para un fin distinto a la gesti\u00f3n de la p\u00f3liza de seguros solicitada.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">El solicitante reconoce que las comunicaciones electr\u00f3nicas tendr\u00e1n la misma validez que las realizadas mediante correo postal y\/o medios f\u00edsicos.<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><br \/><br \/><\/p>\n<p style=\"text-align: left\"><b>AVISO DE FRAUDE<\/b><\/p>\n<p style=\"text-align: left\"><b>Art\u00edculo 27.320 del C\u00f3digo de Seguros de Puerto Rico<\/b><\/p>\n<p style=\"text-align: left\"><span style=\"font-weight: 400\">\u201cCualquier persona que a sabiendas y con la intenci\u00f3n de defraudar presente informaci\u00f3n falsa en una solicitud de seguro, o que presentare, ayudare o hiciere presentar una reclamaci\u00f3n fraudulenta para el pago de una p\u00e9rdida u otro beneficio, o presentare m\u00e1s de una reclamaci\u00f3n por un mismo da\u00f1o o p\u00e9rdida, incurrir\u00e1 en delito grave y convicta que fuere, ser\u00e1 sancionada, por cada violaci\u00f3n con pena de multa no menor de cinco mil (5,000) d\u00f3lares, ni mayor de diez mil (10,000) d\u00f3lares o pena de reclusi\u00f3n por un t\u00e9rmino fijo de tres (3) a\u00f1os, o ambas penas. De mediar circunstancias agravantes, la pena fija establecida podr\u00e1 ser aumentada hasta un m\u00e1ximo de cinco (5) a\u00f1os; de mediar circunstancias atenuantes, podr\u00e1 ser reducida hasta un m\u00ednimo de dos (2).\u201d<\/span><\/p><\/div><hr \/><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-8_34\" ><p><span style=\"color: #993300\"><strong>Informaci\u00f3n Personal<\/strong><\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><b>Nombre del solicitante:<\/b><span style=\"font-weight: 400\"> <span class=\"ff_dynamic_value\" data-ref=\"names\" data-fallback=\"\"><\/span><\/span><\/li>\n<li style=\"font-weight: 400\"><b>Fecha de Nacimiento:<\/b><span style=\"font-weight: 400\"> <span class=\"ff_dynamic_value\" data-ref=\"datetime_1\" data-fallback=\"\"><\/span><\/span><\/li>\n<li style=\"font-weight: 400\"><b>Direcci\u00f3n F\u00edsica:<\/b><span style=\"font-weight: 400\"> <span class=\"ff_dynamic_value\" data-ref=\"direccion\" data-fallback=\"\"><\/span> <span class=\"ff_dynamic_value\" data-ref=\"cuidad\" data-fallback=\"\"><\/span>, <span class=\"ff_dynamic_value\" data-ref=\"pais\" data-fallback=\"\"><\/span> <span class=\"ff_dynamic_value\" data-ref=\"zip_code\" data-fallback=\"\"><\/span><\/span><\/li>\n<li><b>Direcci\u00f3n Postal:<\/b><span style=\"font-weight: 400\"> <span class=\"ff_dynamic_value\" data-ref=\"direccion_1\" data-fallback=\"\"><\/span> <span class=\"ff_dynamic_value\" data-ref=\"cuidad_1\" data-fallback=\"\"><\/span> <span class=\"ff_dynamic_value\" data-ref=\"pais_1\" data-fallback=\"\"><\/span> <span class=\"ff_dynamic_value\" data-ref=\"zip_code_1\" data-fallback=\"\"><\/span><\/span><\/li>\n<li style=\"font-weight: 400\"><b>Email:<\/b><span style=\"font-weight: 400\"> <span class=\"ff_dynamic_value\" data-ref=\"email\" data-fallback=\"\"><\/span><\/span><\/li>\n<li style=\"font-weight: 400\"><b>Tel\u00e9fono:<\/b><span style=\"font-weight: 400\"> <span class=\"ff_dynamic_value\" data-ref=\"phone_1\" data-fallback=\"\"><\/span><\/span><\/li>\n<li style=\"font-weight: 400\"><b>Lugares donde trabaja:<\/b><span style=\"font-weight: 400\"> <span class=\"ff_dynamic_value\" data-ref=\"lugar_trabajo\" data-fallback=\"\"><\/span><\/span><\/li>\n<li><span style=\"font-weight: 400\"><strong>Selecciona su especialidad (el l\u00edmite de responsabilidad ser\u00e1 $100,000 por incidente \/ $300,000 agregado anual.)<\/strong><span class=\"ff_dynamic_value\" data-ref=\"payment_input_1\" data-fallback=\"\"><\/span><\/span><\/li>\n<li style=\"font-weight: 400\"><b>Incluir n\u00famero de licencia profesional de su especialidad: <\/b><span style=\"font-weight: 400\"><span class=\"ff_dynamic_value\" data-ref=\"numero_licencia\" data-fallback=\"\"><\/span><\/span><\/li>\n<li style=\"font-weight: 400\"><b>Fecha de expiraci\u00f3n de licencia de profesional <\/b><span style=\"font-weight: 400\"><span class=\"ff_dynamic_value\" data-ref=\"expiracion_licencia\" data-fallback=\"\"><\/span><\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">\u00a0<\/span><span style=\"color: #993300\"><b>Preguntas<\/b><\/span><\/p>\n<p><b>1. \u00bfRealiza procedimientos est\u00e9ticos?<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\"><span class=\"ff_dynamic_value\" data-ref=\"input_radio_10\" data-fallback=\"\"><\/span>\u00a0<\/span><\/li>\n<\/ul>\n<p><b>2. \u00bfTrabaja en Sala de Emergencia \/ CDT? <\/b><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\"><span class=\"ff_dynamic_value\" data-ref=\"input_radio_1\" data-fallback=\"\"><\/span><\/span><span style=\"font-weight: 400\">\u00a0<span class=\"ff_dynamic_value\" data-ref=\"input_text_12\" data-fallback=\"\"><\/span><\/span><\/li>\n<\/ul>\n<p><strong>3. \u00bfCu\u00e1l es la poblaci\u00f3n principal de pacientes\/clientes que atiende?<\/strong><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\"><span class=\"ff_dynamic_value\" data-ref=\"checkbox_2\" data-fallback=\"\"><\/span><\/span><\/li>\n<\/ul>\n<p><strong>4. \u00bfHa estado involucrado directa o indirectamente en alguna reclamaci\u00f3n por impericia m\u00e9dica, incidente, demanda, situaci\u00f3n, investigaci\u00f3n o circunstancia que pudiera resultar en una reclamaci\u00f3n relacionada con sus servicios profesionales, incluyendo incidentes reportados a aseguradoras anteriores?<\/strong><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\"><span class=\"ff_dynamic_value\" data-ref=\"input_radio_18\" data-fallback=\"\"><\/span><\/span><span style=\"font-weight: 400\">\u00a0<span class=\"ff_dynamic_value\" data-ref=\"input_text_20\" data-fallback=\"\"><\/span><\/span><\/li>\n<\/ul>\n<p><strong>5. \u00bfHa sido objeto de alguna investigaci\u00f3n, acci\u00f3n disciplinaria, suspensi\u00f3n, restricci\u00f3n, revocaci\u00f3n o revisi\u00f3n relacionada con su licencia profesional, privilegios cl\u00ednicos o pr\u00e1ctica profesional por parte de una junta examinadora, organismo regulador, entidad gubernamental o asociaci\u00f3n profesional?<\/strong><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\"><span class=\"ff_dynamic_value\" data-ref=\"input_radio_19\" data-fallback=\"\"><\/span><\/span><span style=\"font-weight: 400\">\u00a0<span class=\"ff_dynamic_value\" data-ref=\"input_text_21\" data-fallback=\"\"><\/span><\/span><\/li>\n<\/ul>\n<p><strong>6. \u00bfHa sido objeto de alguna investigaci\u00f3n, auditor\u00eda, sanci\u00f3n o procedimiento relacionado con HIPAA, Medicare, Medicaid, el Departamento de Salud de los Estados Unidos (HHS), o cualquier entidad gubernamental, reguladora o administradora relacionada con su pr\u00e1ctica profesional?<\/strong><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\"><span class=\"ff_dynamic_value\" data-ref=\"input_radio_20\" data-fallback=\"\"><\/span> <\/span><span style=\"font-weight: 400\"><span class=\"ff_dynamic_value\" data-ref=\"input_text_22\" data-fallback=\"\"><\/span><\/span><\/li>\n<\/ul>\n<p><strong>7. \u00bfAlguna compa\u00f1\u00eda de seguros le ha denegado, cancelado, no renovado, restringido o emitido cobertura sujeta a condiciones especiales relacionadas con responsabilidad profesional?<\/strong><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\"><span class=\"ff_dynamic_value\" data-ref=\"input_radio_21\" data-fallback=\"\"><\/span><\/span><span style=\"font-weight: 400\">\u00a0<span class=\"ff_dynamic_value\" data-ref=\"input_text_35\" data-fallback=\"\"><\/span><\/span><\/li>\n<\/ul>\n<p><strong>8. \u00bfHa sido acusado, convicto, declarado culpable o nolo contendere por alg\u00fan delito criminal, excluyendo infracciones menores de tr\u00e1nsito?<\/strong><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\"><span class=\"ff_dynamic_value\" data-ref=\"input_radio_29\" data-fallback=\"\"><\/span><\/span><span style=\"font-weight: 400\">\u00a0<span class=\"ff_dynamic_value\" data-ref=\"input_text_29\" data-fallback=\"\"><\/span><\/span><\/li>\n<\/ul>\n<p><strong>9. \u00bfAlg\u00fan hospital, facilidad de salud, organizaci\u00f3n de manejo de cuidado (\u201cManaged Care Organization\u201d) o entidad similar le ha restringido, suspendido, reducido, revocado o colocado en probatoria sus privilegios cl\u00ednicos o profesionales?<\/strong><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\"><span class=\"ff_dynamic_value\" data-ref=\"input_radio_30\" data-fallback=\"\"><\/span><\/span><span style=\"font-weight: 400\">\u00a0<span class=\"ff_dynamic_value\" data-ref=\"input_text_30\" data-fallback=\"\"><\/span><\/span><\/li>\n<\/ul>\n<p><strong>10. \u00bfHa sido objeto de suspensi\u00f3n, revocaci\u00f3n, restricci\u00f3n, probatoria, censura o cualquier otra acci\u00f3n disciplinaria relacionada con alguna membres\u00eda u organizaci\u00f3n profesional?<\/strong><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\"><span class=\"ff_dynamic_value\" data-ref=\"input_radio_31\" data-fallback=\"\"><\/span><\/span><span style=\"font-weight: 400\"> <span class=\"ff_dynamic_value\" data-ref=\"input_text_31\" data-fallback=\"\"><\/span><\/span><\/li>\n<\/ul><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric_field_2' id='label_ff_8_numeric_field_2' aria-label=\"Prima de Poliza\">Prima de Poliza<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric_field_2\" id=\"ff_8_numeric_field_2\" class=\"ff-el-form-control  ff_has_formula\" data-name=\"numeric_field_2\" data-calculation_formula=\"{payment.payment_input_1}\" readonly=\"1\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Aceptaci\u00f3n\">Aceptaci\u00f3n<\/label><div class=\"ff-el-tooltip\" data-content=\"IMPORTANTE: Confirmo que solo estar\u00e9 cubierto por la profesi\u00f3n indicada en este formulario. No se cubrir\u00e1n otras actividades profesionales fuera de la especialidad seleccionada.\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check- ff_item_selected'><label class='ff-el-form-check-label' for='checkbox_4_520649948387da997c39423d203ca6c5'><input  type=\"checkbox\" name=\"checkbox_4[]\" data-name=\"checkbox_4\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" checked=\"1\" value=\"Confirmo que he le\u00eddo y comprendido el Aviso Importante, las Confirmaciones del Solicitante, el Consentimiento Electr\u00f3nico y el Aviso de Fraude.\"  id='checkbox_4_520649948387da997c39423d203ca6c5' aria-label='Confirmo que he le\u00eddo y comprendido el Aviso Importante, las Confirmaciones del Solicitante, el Consentimiento Electr\u00f3nico y el Aviso de Fraude.' aria-invalid='false' aria-required=true> <span>Confirmo que he le\u00eddo y comprendido el Aviso Importante, las Confirmaciones del Solicitante, el Consentimiento Electr\u00f3nico y el Aviso de Fraude.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check- ff_item_selected'><label class='ff-el-form-check-label' for='checkbox_4_ca8fc662b883fda96acb5fcfdf2e0656'><input  type=\"checkbox\" name=\"checkbox_4[]\" data-name=\"checkbox_4\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" checked=\"1\" value=\"Certifico que la informaci\u00f3n suministrada es correcta y completa a mi mejor conocimiento.\"  id='checkbox_4_ca8fc662b883fda96acb5fcfdf2e0656' aria-label='Certifico que la informaci\u00f3n suministrada es correcta y completa a mi mejor conocimiento.' aria-invalid='false' aria-required=true> <span>Certifico que la informaci\u00f3n suministrada es correcta y completa a mi mejor conocimiento.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check- ff_item_selected'><label class='ff-el-form-check-label' for='checkbox_4_a712f5c3d995455e835577a19bd5250c'><input  type=\"checkbox\" name=\"checkbox_4[]\" data-name=\"checkbox_4\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" checked=\"1\" value=\"Autorizo a Puerto Rico Medical Defense Insurance Company y\/o Resolve General Agency a utilizar la informaci\u00f3n provista para prop\u00f3sitos de evaluaci\u00f3n, suscripci\u00f3n y comunicaci\u00f3n relacionada con esta solicitud.\"  id='checkbox_4_a712f5c3d995455e835577a19bd5250c' aria-label='Autorizo a Puerto Rico Medical Defense Insurance Company y\/o Resolve General Agency a utilizar la informaci\u00f3n provista para prop\u00f3sitos de evaluaci\u00f3n, suscripci\u00f3n y comunicaci\u00f3n relacionada con esta solicitud.' aria-invalid='false' aria-required=true> <span>Autorizo a Puerto Rico Medical Defense Insurance Company y\/o Resolve General Agency a utilizar la informaci\u00f3n provista para prop\u00f3sitos de evaluaci\u00f3n, suscripci\u00f3n y comunicaci\u00f3n relacionada con esta solicitud.<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-8_35\" ><p><span style=\"color: #993300\"><strong>Firma electr\u00f3nica<\/strong><\/span><\/p>\n<p><span class=\"ff_dynamic_value\" data-ref=\"names\" data-fallback=\"\"><\/span><\/p>\n<p><span style=\"color: #808080\"><em><b>Reconocimiento de Firma Electr\u00f3nica:<\/b> Al firmar electr\u00f3nicamente, acepto que mi firma electr\u00f3nica es el equivalente legal de mi firma manuscrita.<\/em><\/span><\/p><\/div><\/div><\/div><div data-name=\"ff_cn_id_11\"  class='ff-t-container ff-column-container ff_columns_total_1 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class=\"ff-el-group ff-el-section-break  ff_center\" data-name=\"section_break-8_36\" ><h3 class='ff-el-section-title'>Su p\u00f3liza estar\u00e1 en evaluaci\u00f3n<\/h3><div class='ff-section_break_desk'><p>&nbsp;<\/p>\n<p style=\"text-align: left\"><span data-olk-copy-source=\"MessageBody\">Gracias por su inter\u00e9s en solicitar una cotizaci\u00f3n con <b>Resolve General Agency<\/b><\/span>\u00a0para el programa de <b>Aliados de la Salud<\/b>.<\/p>\n<p style=\"text-align: left\">Hemos recibido su solicitud correctamente. Debido a que una o m\u00e1s de sus respuestas requieren evaluaci\u00f3n adicional, su caso ser\u00e1 enviado a la compa\u00f1\u00eda para revisi\u00f3n.<\/p>\n<p style=\"text-align: left\">Un miembro de nuestro personal se estar\u00e1 comunicando con usted a la mayor brevedad posible para orientarle sobre los pr\u00f3ximos pasos.<\/p>\n<p style=\"text-align: left\">Agradecemos la oportunidad de servirle.<\/p>\n<p style=\"text-align: left\"><span data-olk-copy-source=\"MessageBody\">Cordialmente,<\/span><\/p><\/div><hr \/><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-8_37\" ><p><span style=\"color: #993300\"><strong>Informaci\u00f3n Personal<\/strong><\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><b>Nombre del solicitante:<\/b><span style=\"font-weight: 400\"> <span class=\"ff_dynamic_value\" data-ref=\"names\" data-fallback=\"\"><\/span><\/span><\/li>\n<li style=\"font-weight: 400\"><b>Fecha de Nacimiento:<\/b><span style=\"font-weight: 400\"> <span class=\"ff_dynamic_value\" data-ref=\"datetime_1\" data-fallback=\"\"><\/span><\/span><\/li>\n<li style=\"font-weight: 400\"><b>Direcci\u00f3n F\u00edsica:<\/b><span style=\"font-weight: 400\"> <span class=\"ff_dynamic_value\" data-ref=\"direccion\" data-fallback=\"\"><\/span> <span class=\"ff_dynamic_value\" data-ref=\"cuidad\" data-fallback=\"\"><\/span>, <span class=\"ff_dynamic_value\" data-ref=\"pais\" data-fallback=\"\"><\/span> <span class=\"ff_dynamic_value\" data-ref=\"zip_code\" data-fallback=\"\"><\/span><\/span><\/li>\n<li><b>Direcci\u00f3n Postal:<\/b><span style=\"font-weight: 400\"> <span class=\"ff_dynamic_value\" data-ref=\"direccion_1\" data-fallback=\"\"><\/span> <span class=\"ff_dynamic_value\" data-ref=\"cuidad_1\" data-fallback=\"\"><\/span>,<span class=\"ff_dynamic_value\" data-ref=\"pais_1\" data-fallback=\"\"><\/span> <span class=\"ff_dynamic_value\" data-ref=\"zip_code_1\" data-fallback=\"\"><\/span><\/span><\/li>\n<li style=\"font-weight: 400\"><b>Email:<\/b><span style=\"font-weight: 400\"> <span class=\"ff_dynamic_value\" data-ref=\"email\" data-fallback=\"\"><\/span><\/span><\/li>\n<li style=\"font-weight: 400\"><b>Tel\u00e9fono:<\/b><span style=\"font-weight: 400\"> <span class=\"ff_dynamic_value\" data-ref=\"phone_1\" data-fallback=\"\"><\/span><\/span><\/li>\n<li style=\"font-weight: 400\"><b>Lugares donde trabaja:<\/b><span style=\"font-weight: 400\"> <span class=\"ff_dynamic_value\" data-ref=\"lugar_trabajo\" data-fallback=\"\"><\/span><\/span><\/li>\n<li><b>Selecciona su especialidad (el l\u00edmite de responsabilidad ser\u00e1 $100,000 por incidente \/ $300,000 agregado anual.) <\/b><span style=\"font-weight: 400\"><span class=\"ff_dynamic_value\" data-ref=\"payment_input_1\" data-fallback=\"\"><\/span><\/span><\/li>\n<li style=\"font-weight: 400\"><b>Incluir n\u00famero de licencia profesional de su especialidad: <\/b><span style=\"font-weight: 400\"><span class=\"ff_dynamic_value\" data-ref=\"numero_licencia\" data-fallback=\"\"><\/span><\/span><\/li>\n<li style=\"font-weight: 400\"><b>Fecha de expiraci\u00f3n de licencia de profesional <\/b><span style=\"font-weight: 400\"><span class=\"ff_dynamic_value\" data-ref=\"expiracion_licencia\" data-fallback=\"\"><\/span><\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">\u00a0<\/span><span style=\"color: #993300\"><b>Preguntas<\/b><\/span><\/p>\n<ol>\n<li style=\"font-weight: 400\"><b>\u00bfRealiza procedimientos est\u00e9ticos?<\/b>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\"><span class=\"ff_dynamic_value\" data-ref=\"input_radio_10\" data-fallback=\"\"><\/span> <span class=\"ff_dynamic_value\" data-ref=\"input_text\" data-fallback=\"\"><\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400\"><b>\u00bfTrabaja en Sala de Emergencia \/ CDT? <\/b>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\"><span class=\"ff_dynamic_value\" data-ref=\"input_radio_1\" data-fallback=\"\"><\/span><\/span><span style=\"font-weight: 400\">\u00a0<span class=\"ff_dynamic_value\" data-ref=\"input_text_12\" data-fallback=\"\"><\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<p><span style=\"font-weight: 400\"><span class=\"ff_dynamic_value\" data-ref=\"input_radio_31\" data-fallback=\"\"><\/span><\/span><span style=\"font-weight: 400\"> <span class=\"ff_dynamic_value\" data-ref=\"input_text_31\" data-fallback=\"\"><\/span><\/span><\/p><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Aceptaci\u00f3n\">Aceptaci\u00f3n<\/label><div class=\"ff-el-tooltip\" data-content=\"IMPORTANTE: Confirmo que solo estar\u00e9 cubierto por la profesi\u00f3n indicada en este formulario. No se cubrir\u00e1n otras actividades profesionales fuera de la especialidad seleccionada.\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check- ff_item_selected'><label class='ff-el-form-check-label' for='checkbox_5_5baf06747abd2adc7e462654d7f5d44c'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" checked=\"1\" value=\"Confirmo que he le\u00eddo y comprendido el Aviso Importante, las Confirmaciones del Solicitante, el Consentimiento Electr\u00f3nico y el Aviso de Fraude.\"  id='checkbox_5_5baf06747abd2adc7e462654d7f5d44c' aria-label='Confirmo que he le\u00eddo y comprendido el Aviso Importante, las Confirmaciones del Solicitante, el Consentimiento Electr\u00f3nico y el Aviso de Fraude.' aria-invalid='false' aria-required=true> <span>Confirmo que he le\u00eddo y comprendido el Aviso Importante, las Confirmaciones del Solicitante, el Consentimiento Electr\u00f3nico y el Aviso de Fraude.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check- ff_item_selected'><label class='ff-el-form-check-label' for='checkbox_5_8597b59d804f94e4ae82fd0f4bdffac0'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" checked=\"1\" value=\"Certifico que la informaci\u00f3n suministrada es correcta y completa a mi mejor conocimiento.\"  id='checkbox_5_8597b59d804f94e4ae82fd0f4bdffac0' aria-label='Certifico que la informaci\u00f3n suministrada es correcta y completa a mi mejor conocimiento.' aria-invalid='false' aria-required=true> <span>Certifico que la informaci\u00f3n suministrada es correcta y completa a mi mejor conocimiento.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check- ff_item_selected'><label class='ff-el-form-check-label' for='checkbox_5_a41c56f8528fcb9aa3fc8a328b15b34c'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" checked=\"1\" value=\"Autorizo a Puerto Rico Medical Defense Insurance Company y\/o Resolve General Agency a utilizar la informaci\u00f3n provista para prop\u00f3sitos de evaluaci\u00f3n, suscripci\u00f3n y comunicaci\u00f3n relacionada con esta solicitud.\"  id='checkbox_5_a41c56f8528fcb9aa3fc8a328b15b34c' aria-label='Autorizo a Puerto Rico Medical Defense Insurance Company y\/o Resolve General Agency a utilizar la informaci\u00f3n provista para prop\u00f3sitos de evaluaci\u00f3n, suscripci\u00f3n y comunicaci\u00f3n relacionada con esta solicitud.' aria-invalid='false' aria-required=true> <span>Autorizo a Puerto Rico Medical Defense Insurance Company y\/o Resolve General Agency a utilizar la informaci\u00f3n provista para prop\u00f3sitos de evaluaci\u00f3n, suscripci\u00f3n y comunicaci\u00f3n relacionada con esta solicitud.<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Atr\u00e1s'>Atr\u00e1s<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Continuar'>Continuar<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-8_38\" ><div data-name=\"ff_cn_id_12\"  class='ff-t-container ff-column-container ff_columns_total_1 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_39\" ><h3 class='ff-el-section-title'>Finalizar y proceder al pago<\/h3><div class='ff-section_break_desk'><p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400\">Al continuar, ser\u00e1 redirigido(a) a nuestra plataforma segura de pago para completar la transacci\u00f3n.<\/span><\/p><\/div><hr \/><\/div><div class='ff-el-group  ff-payment_summary_component has-conditions' tabindex='-1' data-name=\"payment_summary_component-8_40\" ><div class=\"ff_dynamic_value ff_dynamic_payment_summary\" data-ref=\"payment_summary\"><div class=\"ff_payment_summary\"><\/div><div class=\"ff_payment_summary_fallback\"><p style=\"text-align: left\" data-path-to-node=\"4\"><strong>Declaraciones<\/strong><\/p>\n<p style=\"text-align: left\" data-path-to-node=\"5\">Como Agente Representante, al completar este formulario usted declara y garantiza que:<\/p>\n<ul style=\"text-align: left\" data-path-to-node=\"6\">\n<li>\n<p data-path-to-node=\"6,0,0\"><b data-path-to-node=\"6,0,0\" data-index-in-node=\"0\">Capacidad Legal:<\/b> Posee la autoridad legal necesaria para actuar en representaci\u00f3n de la entidad o persona indicada.<\/p>\n<\/li>\n<li>\n<p data-path-to-node=\"6,1,0\"><b data-path-to-node=\"6,1,0\" data-index-in-node=\"0\">Veracidad:<\/b> Toda la informaci\u00f3n proporcionada es exacta, actual y veraz.<\/p>\n<\/li>\n<li>\n<p data-path-to-node=\"6,2,0\"><b data-path-to-node=\"6,2,0\" data-index-in-node=\"0\">Cumplimiento:<\/b> Se compromete a cumplir con las normativas vigentes y los est\u00e1ndares \u00e9ticos de nuestra organizaci\u00f3n.<\/p>\n<\/li>\n<li>\n<p data-path-to-node=\"6,3,0\"><b data-path-to-node=\"6,3,0\" data-index-in-node=\"0\">Transparencia:<\/b> No existe ning\u00fan conflicto de intereses que le impida ejercer sus funciones de manera objetiva.<\/p>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p style=\"text-align: left\"><strong>Representations, Warranties, and Fraud Notice<\/strong><\/p>\n<p style=\"text-align: left\">Any person who knowingly provides false or misleading information in an insurance application or submits a fraudulent claim is subject to criminal penalties under applicable law.<\/p>\n<p style=\"text-align: left\">The applicant declares that all information provided in this application and any supporting documentation is true, complete, and accurate, and that no material facts have been omitted or misrepresented. This application and its attachments shall form the basis of any insurance contract issued by Puerto Rico Medical Defense Insurance Company (the \u201cCompany\u201d). The applicant agrees to notify the Company of any future material changes affecting the information provided.<\/p>\n<p style=\"text-align: left\">Any material misrepresentation or omission may render the insurance contract null and void or give the Company the right to rescind coverage. Submission of this application does not guarantee coverage. Coverage shall not apply unless and until the Company has received a completed application, issued a premium quote, and received the required premium payment, which must be honored by the financial institution.<\/p>\n<p style=\"text-align: left\">The applicant authorizes the Company to verify credentials and background information and authorizes any relevant third parties to release such information to the Company as necessary for underwriting and coverage purposes.<\/p>\n<p data-path-to-node=\"7\">\u00a0<\/p>\n<p style=\"text-align: left\" data-path-to-node=\"7\"><strong>Consentimientos y Autorizaciones<\/strong><\/p>\n<p style=\"text-align: left\" data-path-to-node=\"8\">Al marcar las casillas correspondientes, usted acepta lo siguiente:<\/p>\n<ol start=\"1\" data-path-to-node=\"9\">\n<li style=\"text-align: left\">\n<p data-path-to-node=\"9,0,0\"><b data-path-to-node=\"9,0,0\" data-index-in-node=\"0\">Tratamiento de Datos:<\/b> Autorizo el uso de mis datos personales para fines de gesti\u00f3n, verificaci\u00f3n de antecedentes y comunicaci\u00f3n profesional.<\/p>\n<\/li>\n<li style=\"text-align: left\">\n<p data-path-to-node=\"9,1,0\"><b data-path-to-node=\"9,1,0\" data-index-in-node=\"0\">Verificaci\u00f3n de Informaci\u00f3n:<\/b> Consiento que la empresa valide la autenticidad de los documentos y certificaciones adjuntas.<\/p>\n<\/li>\n<li>\n<p style=\"text-align: left\" data-path-to-node=\"9,2,0\"><b data-path-to-node=\"9,2,0\" data-index-in-node=\"0\">Uso de Medios Electr\u00f3nicos:<\/b> Acepto recibir notificaciones, contratos y actualizaciones de manera digital con total validez legal.<\/p>\n<\/li>\n<\/ol>\n<p style=\"text-align: left\" data-path-to-node=\"9,2,0\"><strong>Notice:<\/strong> This application is for Claims Made &amp; Reported Allied Health Care Providers Professional Liability Insurance.<\/p>\n<p style=\"text-align: left\" data-path-to-node=\"9,2,0\">If your application is accepted and a policy is issued; coverage applies only to matters described in the policy that arise out of covered medical incidents and are:<\/p>\n<p style=\"text-align: left\">\u2022 First made against you during the policy period, and<br \/>\u2022 Reported to the Company in accordance with the policy\u2019s reporting provisions.<\/p>\n<p style=\"text-align: left\"><br \/><strong>Important:<\/strong> Coverage does not apply to medical incidents that took place prior to the policy\u2019s effective date, unless otherwise stated by endorsement attached to the policy.<\/p><\/div><\/div><\/div><div class='ff-el-group ff-text-left  has-conditions ff_submit_btn_wrapper ff_submit_btn_wrapper_custom'><button class=\"ff-btn ff-btn-submit ff-btn-md ff_btn_style wpf_has_custom_css\" type=\"submit\" name=\"custom_submit_button-8_41\" data-name=\"custom_submit_button-8_41\"  aria-label=\"Proceder al Pago\">Proceder al Pago<\/button><style>form.fluent_form_8 .wpf_has_custom_css.ff-btn-submit { background-color:#1a7efb;border-color:#1a7efb;color:#ffffff;min-width:40%; }form.fluent_form_8 .wpf_has_custom_css.ff-btn-submit:hover { background-color:#ffffff;border-color:#1a7efb;color:#1a7efb;min-width:40%; } <\/style><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"\u00bfDesea un certificado de cubierta?\">\u00bfDesea un certificado de cubierta?<\/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_36_44b5b89ca99641e441c099beb31dca78'><input  type=\"radio\" name=\"input_radio_36\" data-name=\"input_radio_36\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"S\u00ed\"  id='input_radio_36_44b5b89ca99641e441c099beb31dca78' aria-label='S\u00ed' aria-invalid='false' aria-required=false> <span>S\u00ed<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_36_500163d9f1cbbfcc7388e205dcba40c1'><input  type=\"radio\" name=\"input_radio_36\" data-name=\"input_radio_36\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"no\"  id='input_radio_36_500163d9f1cbbfcc7388e205dcba40c1' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-8_42\" ><p><span style=\"color: #993300\"><strong>Lugares de Trabajo<\/strong><\/span><\/p>\n<p><span class=\"ff_dynamic_value\" data-ref=\"lugar_trabajo\" data-fallback=\"\"><\/span><\/p><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_8_datetime' id='label_ff_8_datetime' aria-label=\"Fecha de efectividad\">Fecha de efectividad<\/label><div class=\"ff-el-tooltip\" data-content=\" *La fecha de efectividad corresponder\u00e1 a la fecha de retroactividad.\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><input  aria-label='Fecha de efectividad Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='m\/d\/Y' type=\"text\" name=\"datetime\" id=\"ff_8_datetime\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"datetime\"  aria-invalid='false' aria-required=true><\/div><\/div><\/div><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-8_43\" ><h3 class='ff-el-section-title'>Finalizar y proceder<\/h3><div class='ff-section_break_desk'><p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400\">Al continuar, se le enviara una email con las respuestas y estara en proceso de evaluaci\u00f3n.<\/span><\/p><\/div><hr \/><\/div><div class='ff-el-group ff-text-left  has-conditions ff_submit_btn_wrapper ff_submit_btn_wrapper_custom'><button class=\"ff-btn ff-btn-submit ff-btn-md ff_btn_style wpf_has_custom_css\" type=\"submit\" name=\"custom_submit_button-8_44\" data-name=\"custom_submit_button-8_44\"  aria-label=\"Enviar Informaci\u00f3n\">Enviar Informaci\u00f3n<\/button><style>form.fluent_form_8 .wpf_has_custom_css.ff-btn-submit { background-color:#1a7efb;border-color:#1a7efb;color:#ffffff;min-width:40%; }form.fluent_form_8 .wpf_has_custom_css.ff-btn-submit:hover { background-color:#ffffff;border-color:#1a7efb;color:#1a7efb;min-width:40%; } <\/style><\/div><div class='ff-el-group ff-text-left  has-conditions ff_submit_btn_wrapper ff_submit_btn_wrapper_custom'><button class=\"ff-btn ff-btn-submit ff-btn-md ff_btn_style wpf_has_custom_css\" type=\"submit\" name=\"custom_submit_button-8_45\" data-name=\"custom_submit_button-8_45\"  aria-label=\"Enviar Informaci\u00f3n\">Enviar Informaci\u00f3n<\/button><style>form.fluent_form_8 .wpf_has_custom_css.ff-btn-submit { background-color:#1a7efb;border-color:#1a7efb;color:#ffffff;min-width:40%; }form.fluent_form_8 .wpf_has_custom_css.ff-btn-submit:hover { background-color:#ffffff;border-color:#1a7efb;color:#1a7efb;min-width:40%; } <\/style><\/div>        <div class=\"ff-step-t-container ff-inner_submit_container ff-column-container ff_columns_total_2\">\n            <div class=\"ff-t-cell ff-t-column-1\"><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><\/div><\/div>\n            <div class=\"ff-t-cell ff-t-column-2\">\n                            <\/div>\n        <\/div>\n        <\/div><\/div><\/div>\n        <\/fieldset><\/form><div id='fluentform_8_errors' class='ff-errors-in-stack ff_form_instance_8_1 ff-form-loading_errors ff_form_instance_8_1_errors'><\/div><\/div>            <script type=\"text\/javascript\">\n                window.fluent_form_ff_form_instance_8_1 = {\"id\":\"8\",\"ajaxUrl\":\"https:\\\/\\\/resolvegeneralagency.com\\\/wp-admin\\\/admin-ajax.php\",\"settings\":{\"layout\":{\"labelPlacement\":\"top\",\"helpMessagePlacement\":\"with_label\",\"errorMessagePlacement\":\"inline\",\"cssClassName\":\"\",\"asteriskPlacement\":\"asterisk-right\"},\"restrictions\":{\"denyEmptySubmission\":{\"enabled\":false}}},\"form_instance\":\"ff_form_instance_8_1\",\"form_id_selector\":\"fluentform_8\",\"rules\":{\"names[first_name]\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"names[middle_name]\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"names[last_name]\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"datetime_1\":{\"required\":{\"value\":true,\"message\":\"This field is 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email\"}},\"phone_1\":{\"required\":{\"value\":true,\"global\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\"},\"valid_phone_number\":{\"value\":false,\"global\":true,\"message\":\"Phone number is not valid\",\"global_message\":\"Phone number is not valid\"}},\"lugar_trabajo\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"input_radio_35\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"input_text_38\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"payment_input_1\":{\"required\":{\"value\":true,\"global\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\"}},\"numero_licencia\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true},\"numeric\":{\"value\":true,\"message\":\"This field must contain numeric value\",\"global_message\":\"This field must contain numeric value\",\"global\":true},\"min\":{\"value\":\"\",\"message\":\"Validation fails for minimum value\",\"global_message\":\"Validation fails for minimum value\",\"global\":true},\"max\":{\"value\":\"\",\"message\":\"Validation fails for maximum value\",\"global_message\":\"Validation fails for maximum value\",\"global\":true},\"digits\":{\"value\":\"\",\"message\":\"Validation fails for limited digits\",\"global_message\":\"Validation fails for limited digits\",\"global\":true}},\"expiracion_licencia\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"file-upload\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true},\"max_file_size\":{\"value\":null,\"message\":\"Validation fails for maximum file size\",\"global_message\":\"Validation fails for maximum file size\",\"global\":true},\"max_file_count\":{\"value\":1,\"message\":\"Validation fails for maximum file count\",\"global_message\":\"Validation fails for maximum file count\",\"global\":true},\"allowed_file_types\":{\"value\":[\"jpg|jpeg|gif|png|bmp\",\"pdf\",\"doc|ppt|pps|xls|mdb|docx|xlsx|pptx|odt|odp|ods|odg|odc|odb|odf|rtf|txt\",\"zip|gz|gzip|rar|7z\",\"csv\"],\"message\":\"Invalid file type\",\"global_message\":\"Invalid file type\",\"global\":true}},\"input_radio_10\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"input_text_37\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"This field is 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                           <\/script>\n            <\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-8974bce e-flex e-con-boxed sc_layouts_column_icons_position_left e-con e-parent\" data-id=\"8974bce\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-fded4db sc_fly_static elementor-widget elementor-widget-heading\" data-id=\"fded4db\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">\u00bfNecesitas ayuda?<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-876902c sc_fly_static elementor-widget elementor-widget-text-editor\" data-id=\"876902c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Llama al\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-951888f elementor-align-center sc_fly_static elementor-widget elementor-widget-button\" data-id=\"951888f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"tel:7879937763\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">(787) 993-7763<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"e-con-gap-no elementor-element elementor-element-4315e5a e-con-full e-flex sc_layouts_column_icons_position_left e-con e-parent\" data-id=\"4315e5a\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-753e702 e-flex e-con-boxed sc_layouts_column_icons_position_left e-con e-parent\" data-id=\"753e702\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div data-animation-type=\"block\" class=\"elementor-element elementor-element-f443f20 animation_type_block sc_fly_static elementor-invisible elementor-widget elementor-widget-heading\" data-id=\"f443f20\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;ta_fadeinup&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h6 class=\"elementor-heading-title elementor-size-default\">Menos tr\u00e1mites. M\u00e1s claridad.<\/h6>\t\t\t\t<\/div>\n\t\t\t\t<div data-animation-type=\"block\" class=\"elementor-element elementor-element-54e42ac elementor-widget__width-initial animation_type_block sc_fly_static elementor-invisible elementor-widget elementor-widget-heading\" data-id=\"54e42ac\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;ta_fadeinup&quot;,&quot;_animation_delay&quot;:100}\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Gestione su cobertura con apoyo experto.<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div data-animation-type=\"block\" class=\"elementor-element elementor-element-605f5c3 animation_type_block sc_fly_static elementor-invisible elementor-widget elementor-widget-button\" data-id=\"605f5c3\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;ta_fadeinup&quot;,&quot;_animation_delay&quot;:150}\" data-widget_type=\"button.default\">\n\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/resolvegeneralagency.com\/contactanos\/\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Cont\u00e1ctanos<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Page (post) title REsolve General Agency Cotizaci\u00f3n Aliados de la Salud Esta solicitud es&hellip;<\/p>","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"iawp_total_views":289,"footnotes":""},"class_list":["post-2689","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/resolvegeneralagency.com\/en\/wp-json\/wp\/v2\/pages\/2689","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/resolvegeneralagency.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/resolvegeneralagency.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/resolvegeneralagency.com\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/resolvegeneralagency.com\/en\/wp-json\/wp\/v2\/comments?post=2689"}],"version-history":[{"count":132,"href":"https:\/\/resolvegeneralagency.com\/en\/wp-json\/wp\/v2\/pages\/2689\/revisions"}],"predecessor-version":[{"id":5281,"href":"https:\/\/resolvegeneralagency.com\/en\/wp-json\/wp\/v2\/pages\/2689\/revisions\/5281"}],"wp:attachment":[{"href":"https:\/\/resolvegeneralagency.com\/en\/wp-json\/wp\/v2\/media?parent=2689"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}