a:21:{s:8:"langcode";s:2:"en";s:6:"status";s:4:"open";s:12:"dependencies";a:0:{}s:4:"open";N;s:5:"close";N;s:6:"weight";i:0;s:3:"uid";i:1;s:8:"template";b:0;s:7:"archive";b:0;s:2:"id";s:31:"mscu_ecf_2018_non_academic_mscu";s:5:"title";s:43:"MSCU – ECF – 2018 Non Academic Hospital";s:11:"description";s:0:"";s:8:"category";s:0:"";s:8:"elements";s:23389:"general_information:
  '#type': webform_wizard_page
  '#title': 'GENERAL INFORMATION'
  general_information1:
    '#type': webform_section
    '#title': 'GENERAL INFORMATION'
    name_of_the_organization:
      '#type': textfield
      '#title': 'NAME OF THE ORGANIZATION'
    country:
      '#type': select
      '#title': Country
      '#options': country_names
      '#options_display': side_by_side
    province_state:
      '#type': textfield
      '#title': Province/State
    indicate_the_type_of_organization:
      '#type': webform_radios_other
      '#title': 'INDICATE THE TYPE OF ORGANIZATION'
      '#options':
        HOSPITAL: HOSPITAL
        UNIVERSITY: UNIVERSITY
        'RESEARCH CENTRE': 'RESEARCH CENTRE'
        'HEALTHCARE ORGANIZATION': 'HEALTHCARE ORGANIZATION'
        'REGIONAL AUTHORITY': 'REGIONAL AUTHORITY'
      '#other__placeholder': 'Please specify'
    year:
      '#type': number
      '#title': Year
      '#min': 1945
      '#max': 2020
mscu_in_your_hospital:
  '#type': webform_wizard_page
  '#title': 'MSCU IN YOUR HOSPITAL'
  mscu_in_your_hospital1:
    '#type': webform_section
    '#title': 'EXPERIENCE OF THE MULTIPLE SCLEROSIS CARE UNIT (MSCU) IN YOUR HOSPITAL – ACTIVITY/YEAR'
    number_of_patients_of_ms_attended_in_one_yearn:
      '#type': radios
      '#title': 'Number of patients of MS attended in one year'
      '#options':
        '< 500': '< 500'
        500-1000: 500-1000
        1000-1500: 1000-1500
        1500-2000: 1500-2000
        '> 2000': '> 2000'
    processes_in_ms_patients_access_to_routinely_used_:
      '#type': webform_checkboxes_other
      '#title': 'Exams for MS Patients to assess the hospital'
      '#options':
        'Blood tests': 'Blood tests'
        'CSF studies (cerebrospinal fluid)': 'CSF studies (cerebrospinal fluid)'
        MRI: MRI
        'Evoked potentials (EP)': 'Evoked potentials (EP)'
        'OCT (optic coherence tomography)': 'OCT (optic coherence tomography)'
      '#other__option_label': 'Other ..'
      '#other__placeholder': 'Please specify'
    exams_routinely_performed_for_ms_patients_in_your_hospital:
      '#type': webform_checkboxes_other
      '#title': 'Exams routinely performed for MS Patients in your hospital'
      '#options':
        'CSF studies (cerebrospinal fluid)': 'CSF studies (cerebrospinal fluid)'
        MRI: MRI
        'Evoked potentials (EP)': 'Evoked potentials (EP)'
        'OCT (optic coherence tomography)': 'OCT (optic coherence tomography)'
      '#other__option_label': 'Other ..'
      '#other__placeholder': 'Please specify'
other_activities_in_your_center1:
  '#type': webform_wizard_page
  '#title': 'OTHER ACTIVITIES IN YOUR CENTER'
  other_activities_carried_out_in_your_centre:
    '#type': webform_section
    '#title': 'Other activities carried out in your centre'
    teaching1:
      '#type': checkbox
      '#title': Teaching
    _of_overall_working_activity:
      '#type': number
      '#title': '% of overall working activity'
      '#states':
        invisible-slide:
          ':input[name="teaching1"]':
            unchecked: true
      '#min': 0
      '#max': 100
    continuous_medical_education:
      '#type': checkbox
      '#title': 'Continuous Medical Education'
    _of_overall_working_activity2:
      '#type': number
      '#title': '% of overall working activity'
      '#states':
        invisible-slide:
          ':input[name="continuous_medical_education"]':
            unchecked: true
      '#min': 0
      '#max': 100
    research:
      '#type': checkbox
      '#title': Research
    hours_years:
      '#type': number
      '#title': hours/year
      '#states':
        invisible-slide:
          ':input[name="research"]':
            unchecked: true
      '#min': 0
    publications:
      '#type': checkbox
      '#title': Publications
    number_of_publications_year:
      '#type': number
      '#title': 'Number of publications/year'
      '#states':
        invisible-slide:
          ':input[name="publications"]':
            unchecked: true
      '#min': 0
mscr_specific_equipments:
  '#type': webform_wizard_page
  '#title': 'MSCU SPECIFIC RESOURSES'
  mscr_specific_equipments1:
    '#type': webform_section
    '#title': 'MSCU SPECIFIC RESOURSES'
    specific_resources_of_the_mscu:
      '#type': webform_section
      '#title': 'HEALTH CARE PROFESSIONALS NEEDED FOR THE ADEGUATE ASSISTANCE OF MS PATIENTS'
      neurologists:
        '#type': checkbox
        '#title': Neurologists
      neurologists_1:
        '#type': number
        '#title': 'number of Neurologists '
        '#states':
          invisible-slide:
            ':input[name="neurologists"]':
              unchecked: true
        '#min': 0
      nurses1:
        '#type': checkbox
        '#title': Nurses
      nurses:
        '#type': number
        '#title': 'number of Nurses'
        '#states':
          invisible-slide:
            ':input[name="nurses1"]':
              unchecked: true
        '#min': 0
      physiotherapists11:
        '#type': checkbox
        '#title': Physiotherapists
      physiotherapists:
        '#type': number
        '#title': 'number of Physiotherapists'
        '#states':
          invisible-slide:
            ':input[name="physiotherapists11"]':
              unchecked: true
      others:
        '#type': checkbox
        '#title': Other
      specialty:
        '#type': textfield
        '#title': Specialty
        '#states':
          invisible-slide:
            ':input[name="others"]':
              unchecked: true
      number_of_specialty:
        '#type': number
        '#title': 'number of Specialty'
        '#states':
          invisible-slide:
            ':input[name="others"]':
              unchecked: true
      additional_health_care_professionals:
        '#type': checkboxes
        '#title': 'ADDITIONAL HEALTH CARE PROFESSIONALS'
        '#options':
          'OCCUPATIONAL THERAPIST ': 'OCCUPATIONAL THERAPIST '
          NEUROPSYCHOLOGIST: NEUROPSYCHOLOGIST
          'SPEECH THERAPIST    ': 'SPEECH THERAPIST    '
          'CLINICAL PSYCHOLOGISTS ': 'CLINICAL PSYCHOLOGISTS '
          'REHABILITATION NEUROLOGIST/PHYSICIAN ': 'REHABILITATION NEUROLOGIST/PHYSICIAN '
mscr_specific_equipments12:
  '#type': webform_wizard_page
  '#title': 'MSCR SPECIFIC EQUIPMENT'
  mscr_specific_equipments11:
    '#type': webform_section
    '#title': 'MSCR SPECIFIC EQUIPMENT'
    day_hospital_integrated_in_the_mscu_or_available_at_the_centre:
      '#type': select
      '#title': 'DAY HOSPITAL INTEGRATED IN THE MSCU OR AVAILABLE AT THE CENTRE'
      '#options': yes_no
    area_for_extraction_and_manipulation_of_body_fluids_blood_csf_:
      '#type': select
      '#title': 'AREA FOR EXTRACTION AND MANIPULATION OF BODY FLUIDS (BLOOD, CSF)'
      '#options': yes_no
    area_of_outpatient_assistance:
      '#type': select
      '#title': 'AREA OF OUTPATIENT ASSISTANCE'
      '#options': yes_no
    system_of_communications_with_patients:
      '#type': webform_checkboxes_other
      '#title': 'System of communications with patients'
      '#options':
        Telephone: Telephone
        'Mobile (SMS)': 'Mobile (SMS)'
        E-mail: E-mail
        'Web page': 'Web page'
other_hospital_units_services:
  '#type': webform_wizard_page
  '#title': 'OTHER HOSPITAL UNITS_SERVICES'
  other_hospital_units_services1:
    '#type': webform_section
    '#title': 'RESOURCES OF OTHER UNITS OR SERVICES APART FROM THE MSCU, NECESSARY FOR THE ADEQUATE PROVISION OF CARE FOR MS PATIENTS '
    resources_of_other_units_or_services_apart_from_the_mscu_necessa:
      '#type': checkboxes
      '#title': 'Resources of other units or services apart from the MSCU, necessary for the adequate provision of care for MS patients'
      '#options':
        'Service/Unit of Neuroradiology with MRI 1.5 tesla or more': 'Service/Unit of Neuroradiology with MRI 1.5 tesla or more'
        'Service/Unit of Neurophysiology, with the possibility to perform EP (visual, brainstem, somatosensory and motor)': 'Service/Unit of Neurophysiology, with the possibility to perform EP (visual, brainstem, somatosensory and motor)'
        'Service/Unit of Nuclear Medicine, with SPECT or PET available, needed in some cases for differential diagnosis': 'Service/Unit of Nuclear Medicine, with SPECT or PET available, needed in some cases for differential diagnosis'
        'Service/Unit of Immunology that can perform IgG oligoclonal bands': 'Service/Unit of Immunology that can perform IgG oligoclonal bands'
        'Service/Unit of Immunology that can perform Neurofilament Light in blood (Simoa)': 'Service/Unit of Immunology that can perform Neurofilament Light in blood (Simoa)'
        'Service/Unit of Rehabilitation with experience in the management of MS patients': 'Service/Unit of Rehabilitation with experience in the management of MS patients'
        'Service/Unit of Ophthalmology, able to perform OCT and with experience in the management of MS patients': 'Service/Unit of Ophthalmology, able to perform OCT and with experience in the management of MS patients'
        'Service/Unit of Urology, with experience in the management of MS patients': 'Service/Unit of Urology, with experience in the management of MS patients'
        'Service/Unit of Genetics, with possibility for banking of DNA/RNA samples': 'Service/Unit of Genetics, with possibility for banking of DNA/RNA samples'
        'Availability of a Haematology Unit for autologous hematopoietic stem cell transplantation (aHSCT) ': 'Availability of a Haematology Unit for autologous hematopoietic stem cell transplantation (aHSCT) '
mscu_kpis:
  '#type': webform_wizard_page
  '#title': 'Indicators of processes and clinical results of the MSCU/year'
  mscu_kpis1:
    '#type': webform_section
    '#title': 'Indicators of processes and clinical results of the MSCU/year'
    number_of_treatments_administered_in_the_day_hospital_outpatient:
      '#type': number
      '#title': 'NUMBER OF TREATMENTS ADMINISTERED IN THE DAY HOSPITAL/OUTPATIENT CLINIC.'
      '#min': 0
    number_of_treated_exacerbations_relapses_:
      '#type': number
      '#title': 'NUMBER OF TREATED EXACERBATIONS (RELAPSES)'
      '#min': 0
    number_and_severity_of_adverse_events_who_scale_qualitative_vari:
      '#type': number
      '#title': 'NUMBER AND SEVERITY OF ADVERSE EVENTS. WHO SCALE: QUANTITATIVE VARIABLE (NUMBER OF CASES)'
      '#min': 0
    umber_and_severity_of_adverse:
      '#type': number
      '#title': "NUMBER AND SEVERITY OF ADVERSE EVENTS. WHO SCALE:  QUALITATIVE VARIABLE (SEVERITY).\_"
      '#min': 0
    use_of_disability_progression_expanded_disability_status_scale_e:
      '#type': checkbox
      '#title': 'USE OF DISABILITY PROGRESSION, EXPANDED DISABILITY STATUS SCALE (EDSS)'
      '#attributes':
        class:
          - veryStrong
      '#label_attributes':
        class:
          - veryStrong
    assessment_of_degree_of_satisfaction_of_users:
      '#type': checkbox
      '#title': 'ASSESSMENT OF DEGREE OF SATISFACTION OF USERS'
      '#label_attributes':
        class:
          - veryStrong
    amministrative_data:
      '#type': checkbox
      '#title': 'ADMINISTRATIVE DATA'
      '#label_attributes':
        class:
          - veryStrong
    cost_questionnaire:
      '#type': checkbox
      '#title': 'COST QUESTIONNAIRE'
      '#label_attributes':
        class:
          - veryStrong
mscu_registry:
  '#type': webform_wizard_page
  '#title': 'MSCU REGISTRY'
  mscu_registry1:
    '#type': webform_section
    '#title': 'MSCU REGISTRY'
    does_mscu_have_a_registry_of_patients_with_multiple_sclerosis_:
      '#type': select
      '#title': 'DOES MSCU HAVE A REGISTRY OF PATIENTS WITH MULTIPLE SCLEROSIS?'
      '#options': yes_no
    please_tick_which_of_the_following_data_are_recorded_in_the_mscu:
      '#type': label
      '#title': 'PLEASE TICK WHICH OF THE FOLLOWING DATA ARE RECORDED IN THE MSCU REGISTRY'
      '#states':
        invisible-slide:
          ':input[name="does_mscu_have_a_registry_of_patients_with_multiple_sclerosis_"]':
            '!value': 'Yes'
    minimal_data_set_requirement:
      '#type': checkboxes
      '#title': 'MINIMAL DATA SET REQUIREMENT'
      '#options':
        'NUMBER OF PATIENT IDENTIFICATION': 'NUMBER OF PATIENT IDENTIFICATION'
        'DATE OF BIRTH': 'DATE OF BIRTH'
        SEX: SEX
        'AUTONOMOUS COMMUNITY-STATE -PROVINCE OF RESIDENCE': 'AUTONOMOUS COMMUNITY-STATE -PROVINCE OF RESIDENCE'
        'DATE OF DIAGNOSIS AND DATE OF EXACERBATIONS (RELAPSES) ': 'DATE OF DIAGNOSIS AND DATE OF EXACERBATIONS (RELAPSES) '
        'OTHER DIAGNOSIS (ICD-9-MC)': 'OTHER DIAGNOSIS (ICD-9-MC)'
        'DIAGNOSTIC PROCEDURES USED IN THE PATIENT (ICD-9-MC) TYPES OF PROCEDURES AND DATE OF SAME ': 'DIAGNOSTIC PROCEDURES USED IN THE PATIENT (ICD-9-MC) TYPES OF PROCEDURES AND DATE OF SAME '
      '#states':
        invisible-slide:
          ':input[name="does_mscu_have_a_registry_of_patients_with_multiple_sclerosis_"]':
            '!value': 'Yes'
    clinical_assessment:
      '#type': webform_checkboxes_other
      '#title': 'CLINICAL ASSESSMENT'
      '#options':
        EDSS: EDSS
        MSFC: MSFC
      '#other__placeholder': 'Please Specify'
      '#states':
        invisible-slide:
          ':input[name="does_mscu_have_a_registry_of_patients_with_multiple_sclerosis_"]':
            '!value': 'Yes'
    patient_reported_outcome_assessment:
      '#type': webform_checkboxes_other
      '#title': 'PATIENT REPORTED OUTCOME ASSESSMENT'
      '#options':
        'QoL MEASURE': 'QoL MEASURE'
        'FATIGUE: MODIFIED FATIGUE IMPACT SCALE OR OTHER': 'FATIGUE: MODIFIED FATIGUE IMPACT SCALE OR OTHER'
        'ANXIETY/DEPRESSION: HOSPITAL ANXIETY AND DEPRESSION SCALE ': 'ANXIETY/DEPRESSION: HOSPITAL ANXIETY AND DEPRESSION SCALE '
      '#other__placeholder': 'Please Specify'
      '#states':
        invisible-slide:
          ':input[name="does_mscu_have_a_registry_of_patients_with_multiple_sclerosis_"]':
            '!value': 'Yes'
    blood_tests:
      '#type': checkboxes
      '#title': 'BLOOD TESTS'
      '#options':
        'IMMUNOLOGY SEROLOGICAL PROFILE': 'IMMUNOLOGY SEROLOGICAL PROFILE'
        NfL: NfL
        AQ4A: AQ4A
      '#other__placeholder': 'Please Specify'
      '#states':
        invisible-slide:
          ':input[name="does_mscu_have_a_registry_of_patients_with_multiple_sclerosis_"]':
            '!value': 'Yes'
    csf_studies_cerebrospinal_fluid_:
      '#type': checkboxes
      '#title': 'CSF STUDIES (CEREBROSPINAL FLUID)'
      '#options':
        'IT Synthesis of IgG': 'IT Synthesis of IgG'
        'IgG OB': 'IgG OB'
        'IgM OB': 'IgM OB'
      '#other__placeholder': 'Please Specify'
      '#states':
        invisible-slide:
          ':input[name="does_mscu_have_a_registry_of_patients_with_multiple_sclerosis_"]':
            '!value': 'Yes'
    evoked_potentials_ep_:
      '#type': checkboxes
      '#title': 'Evoked potentials (EP)'
      '#options':
        'Visual EP': 'Visual EP'
        'Auditory EP': 'Auditory EP'
        'Somatosensory EP': 'Somatosensory EP'
        'Motor EP': 'Motor EP'
      '#other__placeholder': 'Please Specify'
      '#states':
        invisible-slide:
          ':input[name="does_mscu_have_a_registry_of_patients_with_multiple_sclerosis_"]':
            '!value': 'Yes'
    hospital_admissions:
      '#type': webform_checkboxes_other
      '#title': 'HOSPITAL ADMISSIONS'
      '#options':
        'DATE OF HOSPITALIZATION': 'DATE OF HOSPITALIZATION'
        'DATE HOSPITAL DISCHARGE': 'DATE HOSPITAL DISCHARGE'
        'TYPE OF HOSPITALIZATION': 'TYPE OF HOSPITALIZATION'
        URGENT: URGENT
        PROGRAMMED: PROGRAMMED
      '#other__placeholder': 'Please Specify'
      '#states':
        invisible-slide:
          ':input[name="does_mscu_have_a_registry_of_patients_with_multiple_sclerosis_"]':
            '!value': 'Yes'
    type_of_hospital_discharge_:
      '#type': webform_checkboxes_other
      '#title': 'TYPE OF HOSPITAL DISCHARGE '
      '#options':
        Home: Home
        'Transfer to another hospital': 'Transfer to another hospital'
        'Voluntary discharge': 'Voluntary discharge'
        'Transfer to another sanitary facility ': 'Transfer to another sanitary facility '
        Death: Death
        'Service responsible of discharge. ': 'Service responsible of discharge. '
        'Principal diagnosis (ICD-9-MC)': 'Principal diagnosis (ICD-9-MC)'
        'Other diagnosis (ICD-9-MC)': 'Other diagnosis (ICD-9-MC)'
      '#other__placeholder': 'Please Specify'
      '#states':
        invisible-slide:
          ':input[name="does_mscu_have_a_registry_of_patients_with_multiple_sclerosis_"]':
            '!value': 'Yes'
    mri:
      '#type': checkbox
      '#title': MRI
      '#states':
        invisible-slide:
          ':input[name="does_mscu_have_a_registry_of_patients_with_multiple_sclerosis_"]':
            '!value': 'Yes'
    oct_optic_coherence_tomography_:
      '#type': checkbox
      '#title': 'OCT (optic coherence tomography)'
      '#states':
        invisible-slide:
          ':input[name="does_mscu_have_a_registry_of_patients_with_multiple_sclerosis_"]':
            '!value': 'Yes'
    x_ray:
      '#type': checkbox
      '#title': X-Ray
      '#states':
        invisible-slide:
          ':input[name="does_mscu_have_a_registry_of_patients_with_multiple_sclerosis_"]':
            '!value': 'Yes'
  please_tick_which_of_the_following_data2:
    '#type': webform_section
    '#title': 'PLEASE TICK WHICH OF THE FOLLOWING DATA ARE RECORDED IN THE MSCU REGISTRY FOR OUTPATIENT VISITS?'
    date_of_visit:
      '#type': checkbox
      '#title': 'DATE OF VISIT'
      '#states':
        invisible-slide:
          ':input[name="does_mscu_have_a_registry_of_patients_with_multiple_sclerosis_"]':
            '!value': 'Yes'
    type_of_visit:
      '#type': webform_checkboxes_other
      '#title': 'TYPE OF VISIT'
      '#options':
        URGENT: URGENT
        PROGRAMMED: PROGRAMMED
      '#other__placeholder': 'Please Specify'
      '#states':
        invisible-slide:
          ':input[name="does_mscu_have_a_registry_of_patients_with_multiple_sclerosis_"]':
            '!value': 'Yes'
    reason_for_visit:
      '#type': webform_checkboxes_other
      '#title': 'REASON FOR VISIT'
      '#options':
        DIAGNOSTIC: DIAGNOSTIC
        RELAPSE: RELAPSE
        'INITIATION OR MONITORING OF DISEASE MODIFYING THERAPY': 'INITIATION OR MONITORING OF DISEASE MODIFYING THERAPY'
      '#other__placeholder': 'Please Specify'
      '#states':
        invisible-slide:
          ':input[name="does_mscu_have_a_registry_of_patients_with_multiple_sclerosis_"]':
            '!value': 'Yes'
    clinical_assessment2:
      '#type': webform_checkboxes_other
      '#title': 'CLINICAL ASSESSMENT'
      '#options':
        EDSS: EDSS
        MSFC: MSFC
      '#other__placeholder': 'Please Specify'
      '#states':
        invisible-slide:
          ':input[name="does_mscu_have_a_registry_of_patients_with_multiple_sclerosis_"]':
            '!value': 'Yes'
    patient_reported_outcome_assessment2:
      '#type': webform_checkboxes_other
      '#title': 'PATIENT REPORTED OUTCOME ASSESSMENT'
      '#options':
        'QoL MEASURE': 'QoL MEASURE'
        'FATIGUE: MODIFIED FATIGUE IMPACT SCALE OR OTHER': 'FATIGUE: MODIFIED FATIGUE IMPACT SCALE OR OTHER'
        'ANXIETY/DEPRESSION: HOSPITAL ANXIETY AND DEPRESSION SCALE ': 'ANXIETY/DEPRESSION: HOSPITAL ANXIETY AND DEPRESSION SCALE '
      '#other__placeholder': 'Please Specify'
      '#states':
        invisible-slide:
          ':input[name="does_mscu_have_a_registry_of_patients_with_multiple_sclerosis_"]':
            '!value': 'Yes'
    blood_tests2:
      '#type': checkboxes
      '#title': 'BLOOD TESTS'
      '#options':
        'IMMUNOLOGY SEROLOGICAL PROFILE': 'IMMUNOLOGY SEROLOGICAL PROFILE'
        NfL: NfL
        AQ4A: AQ4A
      '#other__placeholder': 'Please Specify'
      '#states':
        invisible-slide:
          ':input[name="does_mscu_have_a_registry_of_patients_with_multiple_sclerosis_"]':
            '!value': 'Yes'
    csf_studies_cerebrospinal_fluid_2:
      '#type': checkboxes
      '#title': 'CSF STUDIES (CEREBROSPINAL FLUID)'
      '#options':
        'IT Synthesis of IgG': 'IT Synthesis of IgG'
        'IgG OB': 'IgG OB'
        'IgM OB': 'IgM OB'
      '#other__placeholder': 'Please Specify'
      '#states':
        invisible-slide:
          ':input[name="does_mscu_have_a_registry_of_patients_with_multiple_sclerosis_"]':
            '!value': 'Yes'
    mri2:
      '#type': checkbox
      '#title': MRI
      '#states':
        invisible-slide:
          ':input[name="does_mscu_have_a_registry_of_patients_with_multiple_sclerosis_"]':
            '!value': 'Yes'
    oct_optic_coherence_tomography_2:
      '#type': checkbox
      '#title': 'OCT (optic coherence tomography)'
      '#states':
        invisible-slide:
          ':input[name="does_mscu_have_a_registry_of_patients_with_multiple_sclerosis_"]':
            '!value': 'Yes'
treatments_available:
  '#type': webform_wizard_page
  '#title': 'TREATMENTS AVAILABLE'
  treatments_available1:
    '#type': webform_section
    '#title': 'TREATMENTS AVAILABLE'
    immunomodulator_treatment:
      '#type': webform_checkboxes_other
      '#title': 'IMMUNOMODULATOR TREATMENT'
      '#options':
        Betaseron: Betaseron
        Extavia: Extavia
        Avonex: Avonex
        Copaxone: Copaxone
        'Generic Glatiramer': 'Generic Glatiramer'
        'Rebif® (interferon beta-1a)': 'Rebif® (interferon beta-1a)'
        'Plegridy® (PEG-Interferon)': 'Plegridy® (PEG-Interferon)'
    immunosuppressant_treatment:
      '#type': webform_checkboxes_other
      '#title': 'IMMUNOSUPPRESSANT TREATMENT'
      '#options':
        'Aubagi® (teriflunmide)': 'Aubagi® (teriflunmide)'
        'Tecfidera® (dimethyl fumarate)': 'Tecfidera® (dimethyl fumarate)'
        'Tysabri® (natalizumab)': 'Tysabri® (natalizumab)'
        'Gilenya® (finglimd)': 'Gilenya® (finglimd)'
        'Lemtrada® (alemtuzumab)': 'Lemtrada® (alemtuzumab)'
        'Nvantrne® (mitxantrne) ': 'Nvantrne® (mitxantrne) '
        'Mavenclad® (cladribine)': 'Mavenclad® (cladribine)'
        'crevus® (crelizumab)': 'crevus® (crelizumab)'
        Rituximab: Rituximab
        Azathiprine: Azathiprine
        Methtrexate: Methtrexate
        Cyclphsphamide: Cyclphsphamide
    autologous_hematopoietic_stem_cell_transplantation_asct_:
      '#type': select
      '#title': 'AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION (ASCT)'
      '#options': yes_no
    other_therapeutic_procedures:
      '#type': checkbox
      '#title': 'OTHER THERAPEUTIC PROCEDURES'
    please_specify:
      '#type': textarea
      '#title': 'PLEASE SPECIFY'
      '#states':
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