{"id":2995,"date":"2021-02-04T12:43:32","date_gmt":"2021-02-04T12:43:32","guid":{"rendered":"https:\/\/support.orthopedics.moveup.care\/signer-le-tele-accord\/"},"modified":"2021-02-10T14:00:15","modified_gmt":"2021-02-10T14:00:15","slug":"signer-le-tele-accord","status":"publish","type":"page","link":"https:\/\/support.orthopedics.moveup.care\/fr\/signer-le-tele-accord\/","title":{"rendered":"Signature de la convention sur la t\u00e9l\u00e9-r\u00e9\u00e9ducation"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_17' style='display:none'><div id='gf_17' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_17' id='gform_17'  action='\/fr\/wp-json\/wp\/v2\/pages\/2995#gf_17' ><div class='gf_invisible 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id='input_17_1_3_container' class='name_first' >\n                                                    <input type='text' name='input_1.3' id='input_17_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_17_1_3' >Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_17_1_6_container' class='name_last' >\n                                                    <input type='text' name='input_1.6' id='input_17_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_17_1_6' >Nom<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_17_2\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_2\"><label class='gfield_label' for='input_17_2' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_2' id='input_17_2' type='text' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_17_6\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_6\"><label class='gfield_label' for='input_17_6' >Votre num\u00e9ro INAMI<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_17_6' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li 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gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_17_23' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_17_20\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_20\"><label class='gfield_label gfield_label_before_complex'  >Adresse de votre cabinet, centre ou h\u00f4pital<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address' id='input_17_20' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1' id='input_17_20_1_container' >\n                                        <input type='text' name='input_20.1' id='input_17_20_1' value=''    aria-required='true'    \/>\n                                        <label for='input_17_20_1' id='input_17_20_1_label' >Adresse postale<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2' id='input_17_20_2_container' >\n                                        <input type='text' name='input_20.2' id='input_17_20_2' value=''     aria-required='false'   \/>\n                                        <label for='input_17_20_2' id='input_17_20_2_label' >Adresse ligne 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city' id='input_17_20_3_container' >\n                                    <input type='text' name='input_20.3' id='input_17_20_3' value=''    aria-required='true'    \/>\n                                    <label for='input_17_20_3' id='input_17_20_3_label' >Ville<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state' id='input_17_20_4_container' >\n                                        <input type='text' name='input_20.4' id='input_17_20_4' value=''      aria-required='true'    \/>\n                                        <label for='input_17_20_4' id='input_17_20_4_label' >\u00c9tat \/ Province \/ R\u00e9gion<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip' id='input_17_20_5_container' >\n                                    <input type='text' name='input_20.5' id='input_17_20_5' value=''    aria-required='true'    \/>\n                                    <label for='input_17_20_5' id='input_17_20_5_label' >ZIP \/ Code postal<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country' id='input_17_20_6_container' >\n                                        <select name='input_20.6' id='input_17_20_6'   aria-required='true'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Afrique du Sud' >Afrique du Sud<\/option><option value='Albanie' >Albanie<\/option><option value='Alg\u00e9rie' >Alg\u00e9rie<\/option><option value='Allemagne' >Allemagne<\/option><option value='Andorre' >Andorre<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctique' >Antarctique<\/option><option value='Antigua-et-Barbuda' >Antigua-et-Barbuda<\/option><option value='Arabie Saoudite' >Arabie Saoudite<\/option><option value='Argentine' >Argentine<\/option><option value='Arm\u00e9nie' >Arm\u00e9nie<\/option><option value='Aruba' >Aruba<\/option><option value='Australie' >Australie<\/option><option value='Autriche' >Autriche<\/option><option value='Azerba\u00efdjan' >Azerba\u00efdjan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahre\u00efn' >Bahre\u00efn<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Belarus' >Belarus<\/option><option value='Belgique' >Belgique<\/option><option value='Belize' >Belize<\/option><option value='Bermudes' >Bermudes<\/option><option value='Bhoutan' >Bhoutan<\/option><option value='Bolivie' >Bolivie<\/option><option value='Bonaire, Saint-Eustache et Saba ' >Bonaire, Saint-Eustache et Saba <\/option><option value='Bosnie-Herz\u00e9govine' >Bosnie-Herz\u00e9govine<\/option><option value='Botswana' >Botswana<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Br\u00e9sil' >Br\u00e9sil<\/option><option value='Bulgarie' >Bulgarie<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='B\u00e9nin' >B\u00e9nin<\/option><option value='Cambodge' >Cambodge<\/option><option value='Cameroun' >Cameroun<\/option><option value='Canada' >Canada<\/option><option value='Cap-Vert' >Cap-Vert<\/option><option value='Chili' >Chili<\/option><option value='Chine' >Chine<\/option><option value='Chypre' >Chypre<\/option><option value='Colombie' >Colombie<\/option><option value='Comores' >Comores<\/option><option value='Congo' >Congo<\/option><option value='Cor\u00e9e (R\u00e9publique de)' >Cor\u00e9e (R\u00e9publique de)<\/option><option value='Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)' >Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatie' >Croatie<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='C\u00f4te d\u2019Ivoire' >C\u00f4te d\u2019Ivoire<\/option><option value='Danemark' >Danemark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominique' >Dominique<\/option><option value='Espagne' >Espagne<\/option><option value='Estonie' >Estonie<\/option><option value='Eswatini' >Eswatini<\/option><option value='Fidji' >Fidji<\/option><option value='Finlande' >Finlande<\/option><option value='France' >France<\/option><option value='F\u00e9d\u00e9ration Russe' >F\u00e9d\u00e9ration Russe<\/option><option value='Gabon' >Gabon<\/option><option value='Gambie' >Gambie<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Grenade' >Grenade<\/option><option value='Groenland' >Groenland<\/option><option value='Gr\u00e8ce' >Gr\u00e8ce<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guin\u00e9e' >Guin\u00e9e<\/option><option value='Guin\u00e9e \u00e9quatoriale' >Guin\u00e9e \u00e9quatoriale<\/option><option value='Guin\u00e9e-Bissau' >Guin\u00e9e-Bissau<\/option><option value='Guyane' >Guyane<\/option><option value='Guyane' >Guyane<\/option><option value='G\u00e9orgie' >G\u00e9orgie<\/option><option value='G\u00e9orgie du Sud et \u00celes Sandwich du Sud' >G\u00e9orgie du Sud et \u00celes Sandwich du Sud<\/option><option value='Ha\u00efti' >Ha\u00efti<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hongrie' >Hongrie<\/option><option value='Inde' >Inde<\/option><option value='Indon\u00e9sie' >Indon\u00e9sie<\/option><option value='Irak' >Irak<\/option><option value='Iran' >Iran<\/option><option value='Irlande' >Irlande<\/option><option value='Islande' >Islande<\/option><option value='Isra\u00ebl' >Isra\u00ebl<\/option><option value='Italie' >Italie<\/option><option value='Jama\u00efque' >Jama\u00efque<\/option><option value='Japon' >Japon<\/option><option value='Jersey' >Jersey<\/option><option value='Jordanie' >Jordanie<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kirghizistan' >Kirghizistan<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kowe\u00eft' >Kowe\u00eft<\/option><option value='La Barbade' >La Barbade<\/option><option value='La R\u00e9union' >La R\u00e9union<\/option><option value='Lesotho' >Lesotho<\/option><option value='Lettonie' >Lettonie<\/option><option value='Liban' >Liban<\/option><option value='Liberia' >Liberia<\/option><option value='Libye' >Libye<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lituanie' >Lituanie<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Mac\u00e9doine du Nord' >Mac\u00e9doine du Nord<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malaisie' >Malaisie<\/option><option value='Malawi' >Malawi<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malte' >Malte<\/option><option value='Maroc' >Maroc<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritanie' >Mauritanie<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexique' >Mexique<\/option><option value='Micron\u00e9sie' >Micron\u00e9sie<\/option><option value='Moldavie' >Moldavie<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolie' >Mongolie<\/option><option value='Montserrat' >Montserrat<\/option><option value='Mont\u00e9n\u00e9gro' >Mont\u00e9n\u00e9gro<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibie' >Namibie<\/option><option value='Nauru' >Nauru<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nig\u00e9ria' >Nig\u00e9ria<\/option><option value='Niu\u00e9' >Niu\u00e9<\/option><option value='Norv\u00e8ge' >Norv\u00e8ge<\/option><option value='Nouvelle-Cal\u00e9donie' >Nouvelle-Cal\u00e9donie<\/option><option value='Nouvelle-Z\u00e9lande' >Nouvelle-Z\u00e9lande<\/option><option value='N\u00e9pal' >N\u00e9pal<\/option><option value='Oman' >Oman<\/option><option value='Ouganda' >Ouganda<\/option><option value='Ouzb\u00e9kistan' >Ouzb\u00e9kistan<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Panama' >Panama<\/option><option value='Papouasie-Nouvelle-Guin\u00e9e' >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value='Paraguay' >Paraguay<\/option><option value='Pays-Bas' >Pays-Bas<\/option><option value='Philippines' >Philippines<\/option><option value='Pologne' >Pologne<\/option><option value='Polyn\u00e9sie fran\u00e7aise' >Polyn\u00e9sie fran\u00e7aise<\/option><option value='Porto Rico' >Porto Rico<\/option><option value='Portugal' >Portugal<\/option><option value='P\u00e9rou' >P\u00e9rou<\/option><option value='Qatar' >Qatar<\/option><option value='Roumanie' >Roumanie<\/option><option value='Royaume-Uni' >Royaume-Uni<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9publique Dominicaine' >R\u00e9publique Dominicaine<\/option><option value='R\u00e9publique Tch\u00e8que' >R\u00e9publique Tch\u00e8que<\/option><option value='R\u00e9publique arabe syrienne' >R\u00e9publique arabe syrienne<\/option><option value='R\u00e9publique centrafricaine' >R\u00e9publique centrafricaine<\/option><option value='R\u00e9publique d\u00e9mocratique du Congo' >R\u00e9publique d\u00e9mocratique du Congo<\/option><option value='R\u00e9publique d\u00e9mocratique populaire du Laos' >R\u00e9publique d\u00e9mocratique populaire du Laos<\/option><option value='Sahara occidental' >Sahara occidental<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre et Miquelon' >Saint Pierre et Miquelon<\/option><option value='Saint-Christophe-et-Nevis' >Saint-Christophe-et-Nevis<\/option><option value='Saint-Marin' >Saint-Marin<\/option><option value='Saint-Si\u00e8ge' >Saint-Si\u00e8ge<\/option><option value='Saint-Vincent-et-les Grenadines' >Saint-Vincent-et-les Grenadines<\/option><option value='Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha' >Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha<\/option><option value='Sainte-Lucie' >Sainte-Lucie<\/option><option value='Salvador' >Salvador<\/option><option value='Samoa' >Samoa<\/option><option value='Samoa am\u00e9ricaines' >Samoa am\u00e9ricaines<\/option><option value='Sao Tom\u00e9 et Principe' >Sao Tom\u00e9 et Principe<\/option><option value='Serbie' >Serbie<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapour' >Singapour<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovaquie' >Slovaquie<\/option><option value='Slov\u00e9nie' >Slov\u00e9nie<\/option><option value='Somalie' >Somalie<\/option><option value='Soudan' >Soudan<\/option><option value='Soudan du Sud' >Soudan du Sud<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Suisse' >Suisse<\/option><option value='Suriname' >Suriname<\/option><option value='Su\u00e8de' >Su\u00e8de<\/option><option value='S\u00e9n\u00e9gal' >S\u00e9n\u00e9gal<\/option><option value='Tadjikistan' >Tadjikistan<\/option><option value='Tanzanie (R\u00e9publique-Unie de)' >Tanzanie (R\u00e9publique-Unie de)<\/option><option value='Ta\u00efwan' >Ta\u00efwan<\/option><option value='Tchad' >Tchad<\/option><option value='Terres Australes Fran\u00e7aises' >Terres Australes Fran\u00e7aises<\/option><option value='Territoire britannique de l\u2019oc\u00e9an Indien' >Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value='Tha\u00eflande' >Tha\u00eflande<\/option><option value='Timor oriental' >Timor oriental<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinit\u00e9 et Tobago' >Trinit\u00e9 et Tobago<\/option><option value='Tunisie' >Tunisie<\/option><option value='Turkm\u00e9nistan' >Turkm\u00e9nistan<\/option><option value='Turquie' >Turquie<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='Ukraine' >Ukraine<\/option><option value='Uruguay' >Uruguay<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Wallis et Futuna' >Wallis et Futuna<\/option><option value='Y\u00e9men' >Y\u00e9men<\/option><option value='Zambie' >Zambie<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c9gypte' >\u00c9gypte<\/option><option value='\u00c9mirats arabes unis' >\u00c9mirats arabes unis<\/option><option value='\u00c9quateur' >\u00c9quateur<\/option><option value='\u00c9rythr\u00e9e' >\u00c9rythr\u00e9e<\/option><option value='\u00c9tat palestinien' >\u00c9tat palestinien<\/option><option value='\u00c9tats-Unis' >\u00c9tats-Unis<\/option><option value='\u00c9thiopie' >\u00c9thiopie<\/option><option value='\u00cele Bouvet' >\u00cele Bouvet<\/option><option value='\u00cele Christmas' >\u00cele Christmas<\/option><option value='\u00cele Maurice' >\u00cele Maurice<\/option><option value='\u00cele Norfolk' >\u00cele Norfolk<\/option><option value='\u00cele de Man' >\u00cele de Man<\/option><option value='\u00celes Cayman' >\u00celes Cayman<\/option><option value='\u00celes Cocos' >\u00celes Cocos<\/option><option value='\u00celes Cook' >\u00celes Cook<\/option><option value='\u00celes Falkland' >\u00celes Falkland<\/option><option value='\u00celes F\u00e9ro\u00e9' >\u00celes F\u00e9ro\u00e9<\/option><option value='\u00celes Heard et McDonald' >\u00celes Heard et McDonald<\/option><option value='\u00celes Mariannes du Nord' >\u00celes Mariannes du Nord<\/option><option value='\u00celes Marshall' >\u00celes Marshall<\/option><option value='\u00celes Pitcairn' >\u00celes Pitcairn<\/option><option value='\u00celes Salomon' >\u00celes Salomon<\/option><option value='\u00celes Turques et Ca\u00efques' >\u00celes Turques et Ca\u00efques<\/option><option value='\u00celes Vierges am\u00e9ricaines' >\u00celes Vierges am\u00e9ricaines<\/option><option value='\u00celes Vierges britanniques' >\u00celes Vierges britanniques<\/option><option value='\u00celes de Svalbard et Jan Mayen' >\u00celes de Svalbard et Jan Mayen<\/option><option value='\u00celes mineures am\u00e9ricaines' >\u00celes mineures am\u00e9ricaines<\/option><option value='\u00celes \u00c5land' >\u00celes \u00c5land<\/option><\/select>\n                                        <label for='input_17_20_6' id='input_17_20_6_label' >Pays<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_17_27\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_27\"><label class='gfield_label' for='input_17_27' >Votre num\u00e9ro de compte IBAN pour les paiements<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_27' id='input_17_27' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_17_28\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_28\"><label class='gfield_label' for='input_17_28' >Num\u00e9ro de soci\u00e9t\u00e9 (BCE)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_17_28' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_17_24\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_24\"><label class='gfield_label'  >Nous souhaitons afficher les informations et l&#039;adresse de votre cabinet ou de votre organisation sur notre site web et sur une carte Google. Donnez-vous votre consentement?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_17_24'>\n\t\t\t<li class='gchoice gchoice_17_24_0'>\n\t\t\t\t<input name='input_24' type='radio' value='Oui'  id='choice_17_24_0'    \/>\n\t\t\t\t<label for='choice_17_24_0' id='label_17_24_0'>Oui<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_17_24_1'>\n\t\t\t\t<input name='input_24' type='radio' value='Non'  id='choice_17_24_1'    \/>\n\t\t\t\t<label for='choice_17_24_1' id='label_17_24_1'>Non<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_17_4\"  class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_4\">Pour \u00eatre autoris\u00e9 \u00e0 attester les pseudocodes de la convention, vous devez \u00eatre num\u00e9riquement en accord <a href=\"https:\/\/www.riziv.fgov.be\/SiteCollectionDocuments\/overeenkomst_mob_medische_toepassing_revalidatie_heup_knie.pdf\" target=\"_blank\">avec la t\u00e9l\u00e9 convention<\/a>. Chaque semaine, nous devons envoyer \u00e0 l'INAMI une liste des kin\u00e9sith\u00e9rapeutes qui ont accept\u00e9 la convention et qui ont <a href=\"https:\/\/moveup.talentlms.com\/\" target=\"_blank\">suivi l'e-learning (formation en ligne) de moveUP<\/a>.\n<\/li><li id=\"field_17_5\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_5\"><label class='gfield_label'  >Avez-vous d\u00e9j\u00e0 termin\u00e9 l&#039;e-learning?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_17_5'>\n\t\t\t<li class='gchoice gchoice_17_5_0'>\n\t\t\t\t<input name='input_5' type='radio' value='Oui'  id='choice_17_5_0'    \/>\n\t\t\t\t<label for='choice_17_5_0' id='label_17_5_0'>Oui<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_17_5_1'>\n\t\t\t\t<input name='input_5' type='radio' value='Non'  id='choice_17_5_1'    \/>\n\t\t\t\t<label for='choice_17_5_1' id='label_17_5_1'>Non<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_17_8\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_8\"><label class='gfield_label' for='input_17_8' >Sur une \u00e9chelle de 1 \u00e0 10 : Qu&#039;avez-vous pens\u00e9 du cours ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_8' id='input_17_8' type='text'    value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_17_9\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_9\"><label class='gfield_label' for='input_17_9' >Pouvez-vous nous donner quelques suggestions pour am\u00e9liorer l&#039;e-learning ?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_9' id='input_17_9' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_17_3\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_3\"><label class='gfield_label'  >Signez num\u00e9riquement la convention sur la t\u00e9l\u00e9r\u00e9\u00e9ducation mentionn\u00e9e ci-dessus :<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_17_3'>\n\t\t\t<li class='gchoice gchoice_17_3_0'>\n\t\t\t\t<input name='input_3' type='radio' value='J&#039;ai lu la t\u00e9l\u00e9-convention, je l&#039;accepte et je la signe'  id='choice_17_3_0'    \/>\n\t\t\t\t<label for='choice_17_3_0' id='label_17_3_0'>J'ai lu la t\u00e9l\u00e9-convention, je l'accepte et je la signe<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_17_10\"  class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_10\">Vous ne pouvez signer la convention que si vous avez suivi le cours d'apprentissage en ligne. Veuillez revenir une fois que vous avez termin\u00e9 l'apprentissage en ligne.<\/li><li id=\"field_17_13\"  class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_13\"><h2 class=\"gsection_title\">Administration li\u00e9e \u00e0 la convention<\/h2><\/li><li id=\"field_17_14\"  class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_14\">Une <a href=\"https:\/\/support.orthopedics.moveup.care\/fr\/knowledge-base\/gestion-administration-financiere-et-autre-durant-letude-de-tele-reeducation\/\" target=\"_blank\">gestion administrative<\/a> est li\u00e9e \u00e0 la convention. <\/li><li id=\"field_17_19\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_19\"><label class='gfield_label'  >Voulez-vous \u00e9galement faire des s\u00e9ances physiques pour les patients qui sont suivis de mani\u00e8re digitale par b.Clinic et qui vivent dans votre quartier?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_17_19'>\n\t\t\t<li class='gchoice gchoice_17_19_0'>\n\t\t\t\t<input name='input_19' type='radio' value='Oui'  id='choice_17_19_0'    \/>\n\t\t\t\t<label for='choice_17_19_0' id='label_17_19_0'>Oui<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_17_19_1'>\n\t\t\t\t<input name='input_19' type='radio' value='Non'  id='choice_17_19_1'    \/>\n\t\t\t\t<label for='choice_17_19_1' id='label_17_19_1'>Non<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_17_15\"  class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_15\">Le forfait F2 peut seulement \u00eatre attest\u00e9 en combinaison avec le forfait F1 et F3. Le forfait F2 est destin\u00e9 \u00e0 moveUP. moveUP vous enverra une facture \u00e0 la fin du mois pour le forfait F2. <a href=\"https:\/\/support.orthopedics.moveup.care\/knowledge-base\/convention-study-pseudocodes\/\" target=\"_blank\">Cliquez ici pour un aper\u00e7u des pseudocodes<\/a><\/li><li id=\"field_17_16\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_16\"><label class='gfield_label'  >Je d\u00e9clare que je vais attester des codes du forfait F2 pour moveUP quand je fais l&#039;attestation pour les codes des forfaits F1 et F3\/4. I will invoice the patient, moveUP will send me an invoice for the F2 amounts I received.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_17_16'>\n\t\t\t<li class='gchoice gchoice_17_16_0'>\n\t\t\t\t<input name='input_16' type='radio' value='J\u2019ai lu ceci et compris'  id='choice_17_16_0'    \/>\n\t\t\t\t<label for='choice_17_16_0' id='label_17_16_0'>J\u2019ai lu ceci et compris<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_17_11\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_11\"><label class='gfield_label' for='input_17_11' >Remarque facultative<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_11' id='input_17_11' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><\/ul><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_17' class='gform_button button' value='Envoyer'  onclick='if(window[\"gf_submitting_17\"]){return false;}  window[\"gf_submitting_17\"]=true;  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_17\"]){return false;} window[\"gf_submitting_17\"]=true;  jQuery(\"#gform_17\").trigger(\"submit\",[true]); }' \/> <input type='hidden' name='gform_ajax' value='form_id=17&amp;title=&amp;description=&amp;tabindex=0' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_17' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='17' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_17' value='WyJbXSIsIjFjMGI3OTk0MzgxOTk5MzgwZmFiZDY5ODk3YmFiN2UzIl0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_17' id='gform_target_page_number_17' value='0' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_17' id='gform_source_page_number_17' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div>\n                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_17' id='gform_ajax_frame_17' title='Cette iframe contient la logique n\u00e9cessaire pour manipuler Gravity Forms avec Ajax.'><\/iframe>\n                <script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 17, 'https:\/\/support.orthopedics.moveup.care\/wp-content\/plugins\/gravityforms\/images\/spinner.svg' );jQuery('#gform_ajax_frame_17').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_17');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_17').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! 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