{"id":1069,"date":"2026-05-19T02:32:35","date_gmt":"2026-05-19T02:32:35","guid":{"rendered":"https:\/\/dymmedicalclinic.id\/in\/?page_id=1069"},"modified":"2026-05-19T03:07:10","modified_gmt":"2026-05-19T03:07:10","slug":"booking","status":"publish","type":"page","link":"https:\/\/dymmedicalclinic.id\/in\/mcu\/booking\/","title":{"rendered":"booking"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1068-o1\" lang=\"ja\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/in\/wp-json\/wp\/v2\/pages\/1069#wpcf7-f1068-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"1068\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.9.8\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"ja\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1068-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Jenis kelamin\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require\">\n\t\t\t<p>Wajib\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"sex\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"sex\" value=\"Laki-laki\" \/><span class=\"wpcf7-list-item-label\">Laki-laki<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"sex\" value=\"Perempuan\" \/><span class=\"wpcf7-list-item-label\">Perempuan<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"sex\" value=\"Lainnya\" \/><span class=\"wpcf7-list-item-label\">Lainnya<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Nama\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require\">\n\t\t\t<p>Wajib\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput hopeday_box\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"familyname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"YAMADA\" value=\"\" type=\"text\" name=\"familyname\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"firstname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"TARO\" value=\"\" type=\"text\" name=\"firstname\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Tanggal lahir\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require\">\n\t\t\t<p>Wajib\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput birthday_box\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"birth_year\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"birth_year\"><option value=\"Tahun\">Tahun<\/option><option value=\"1930\">1930<\/option><option value=\"1931\">1931<\/option><option value=\"1932\">1932<\/option><option value=\"1933\">1933<\/option><option value=\"1934\">1934<\/option><option value=\"1935\">1935<\/option><option value=\"1936\">1936<\/option><option value=\"1937\">1937<\/option><option value=\"1938\">1938<\/option><option value=\"1939\">1939<\/option><option value=\"1940\">1940<\/option><option value=\"1941\">1941<\/option><option value=\"1942\">1942<\/option><option value=\"1943\">1943<\/option><option value=\"1944\">1944<\/option><option value=\"1945\">1945<\/option><option value=\"1946\">1946<\/option><option value=\"1947\">1947<\/option><option value=\"1948\">1948<\/option><option value=\"1949\">1949<\/option><option value=\"1950\">1950<\/option><option value=\"1951\">1951<\/option><option value=\"1952\">1952<\/option><option value=\"1953\">1953<\/option><option value=\"1954\">1954<\/option><option value=\"1955\">1955<\/option><option value=\"1956\">1956<\/option><option value=\"1957\">1957<\/option><option value=\"1958\">1958<\/option><option value=\"1959\">1959<\/option><option value=\"1960\">1960<\/option><option value=\"1961\">1961<\/option><option value=\"1962\">1962<\/option><option value=\"1963\">1963<\/option><option value=\"1964\">1964<\/option><option value=\"1965\">1965<\/option><option value=\"1966\">1966<\/option><option value=\"1967\">1967<\/option><option value=\"1968\">1968<\/option><option value=\"1969\">1969<\/option><option value=\"1970\">1970<\/option><option value=\"1971\">1971<\/option><option value=\"1972\">1972<\/option><option value=\"1973\">1973<\/option><option value=\"1974\">1974<\/option><option value=\"1975\">1975<\/option><option value=\"1976\">1976<\/option><option value=\"1977\">1977<\/option><option value=\"1978\">1978<\/option><option value=\"1979\">1979<\/option><option value=\"1980\">1980<\/option><option value=\"1981\">1981<\/option><option value=\"1982\">1982<\/option><option value=\"1983\">1983<\/option><option value=\"1984\">1984<\/option><option value=\"1985\">1985<\/option><option value=\"1986\">1986<\/option><option value=\"1987\">1987<\/option><option value=\"1988\">1988<\/option><option value=\"1989\">1989<\/option><option value=\"1990\">1990<\/option><option value=\"1991\">1991<\/option><option value=\"1992\">1992<\/option><option value=\"1993\">1993<\/option><option value=\"1994\">1994<\/option><option value=\"1995\">1995<\/option><option value=\"1996\">1996<\/option><option value=\"1997\">1997<\/option><option value=\"1998\">1998<\/option><option value=\"1999\">1999<\/option><option value=\"2000\">2000<\/option><option value=\"2001\">2001<\/option><option value=\"2002\">2002<\/option><option value=\"2003\">2003<\/option><option value=\"2004\">2004<\/option><option value=\"2005\">2005<\/option><option value=\"2006\">2006<\/option><option value=\"2007\">2007<\/option><option value=\"2008\">2008<\/option><option value=\"2009\">2009<\/option><option value=\"2010\">2010<\/option><option value=\"2011\">2011<\/option><option value=\"2012\">2012<\/option><option value=\"2013\">2013<\/option><option value=\"2014\">2014<\/option><option value=\"2015\">2015<\/option><option value=\"2016\">2016<\/option><option value=\"2017\">2017<\/option><option value=\"2018\">2018<\/option><option value=\"2019\">2019<\/option><option value=\"2020\">2020<\/option><option value=\"2021\">2021<\/option><option value=\"2022\">2022<\/option><option value=\"2023\">2023<\/option><\/select><\/span><br \/>\n\/ <span class=\"wpcf7-form-control-wrap\" data-name=\"birth_month\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"birth_month\"><option value=\"Bulan\">Bulan<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><option value=\"5\">5<\/option><option value=\"6\">6<\/option><option value=\"7\">7<\/option><option value=\"8\">8<\/option><option value=\"9\">9<\/option><option value=\"10\">10<\/option><option value=\"11\">11<\/option><option value=\"12\">12<\/option><\/select><\/span><br \/>\n\/ <span class=\"wpcf7-form-control-wrap\" data-name=\"birth_day\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"birth_day\"><option value=\"Tanggal\">Tanggal<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><option value=\"5\">5<\/option><option value=\"6\">6<\/option><option value=\"7\">7<\/option><option value=\"8\">8<\/option><option value=\"9\">9<\/option><option value=\"10\">10<\/option><option value=\"11\">11<\/option><option value=\"12\">12<\/option><option value=\"13\">13<\/option><option value=\"14\">14<\/option><option value=\"15\">15<\/option><option value=\"16\">16<\/option><option value=\"17\">17<\/option><option value=\"18\">18<\/option><option value=\"19\">19<\/option><option value=\"20\">20<\/option><option value=\"21\">21<\/option><option value=\"22\">22<\/option><option value=\"23\">23<\/option><option value=\"24\">24<\/option><option value=\"25\">25<\/option><option value=\"26\">26<\/option><option value=\"27\">27<\/option><option value=\"28\">28<\/option><option value=\"29\">29<\/option><option value=\"30\">30<\/option><option value=\"31\">31<\/option><\/select><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Nomor telepon seluler\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require\">\n\t\t\t<p>Wajib\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"tel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"021-1111-2222\" value=\"\" type=\"text\" name=\"tel\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Alamat email\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require\">\n\t\t\t<p>Wajib\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"124@aaa.co.id\" value=\"\" type=\"email\" name=\"email\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Alamat email (konfirmasi)\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require\">\n\t\t\t<p>Wajib\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"email_confirm\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"124@aaa.co.id\" value=\"\" type=\"email\" name=\"email_confirm\" \/><\/span>\n\t\t<\/p>\n\t\t<div class=\"error-message\" id=\"email-error\">\n\t\t\t<p>Alamat email tidak sama.\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Tanggal dan waktu janji temu yang diinginkan\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require\">\n\t\t\t<p>Wajib\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput hopeday_box\">\n\t\t<div>\n\t\t\t<p>Pilihan pertama\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"kibou1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required hopeday\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u65e5\u4ed8\u3092\u9078\u629e\" value=\"\" type=\"text\" name=\"kibou1\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"kibou1-2\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"kibou1-2\"><option value=\"Pilih waktu\">Pilih waktu<\/option><option value=\"8:00\uff5e\">8:00\uff5e<\/option><option value=\"8:30\uff5e\">8:30\uff5e<\/option><option value=\"9:00\uff5e\">9:00\uff5e<\/option><option value=\"9:30\uff5e\">9:30\uff5e<\/option><option value=\"10:00\uff5e\">10:00\uff5e<\/option><option value=\"10:30\uff5e\">10:30\uff5e<\/option><option value=\"13:00\uff5e\">13:00\uff5e<\/option><\/select><\/span>\n\t\t<\/p>\n\t\t<div>\n\t\t\t<p>Pilihan kedua\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"kibou2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required hopeday\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u65e5\u4ed8\u3092\u9078\u629e\" value=\"\" type=\"text\" name=\"kibou2\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"kibou2-2\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"kibou2-2\"><option value=\"Pilih waktu\">Pilih waktu<\/option><option value=\"8:00\uff5e\">8:00\uff5e<\/option><option value=\"8:30\uff5e\">8:30\uff5e<\/option><option value=\"9:00\uff5e\">9:00\uff5e<\/option><option value=\"9:30\uff5e\">9:30\uff5e<\/option><option value=\"10:00\uff5e\">10:00\uff5e<\/option><option value=\"10:30\uff5e\">10:30\uff5e<\/option><option value=\"13:00\uff5e\">13:00\uff5e<\/option><\/select><\/span>\n\t\t<\/p>\n\t\t<p><br \/>\nPemeriksaan urine, feses, dan pemeriksaan ginekologi tidak dapat dilakukan saat menstruasi. Jika terdapat pemeriksaan tersebut pada paket, Anda mungkin diminta untuk kembali ke klinik untuk melakukan pemeriksaan atau pengumpulan sampel susulan di hari lain.\n\t\t<\/p>\n\t\t<p>Kami menyarankan pemeriksaan dilakukan mulai hari ke-4, dengan hari setelah menstruasi selesai dihitung sebagai hari ke-1.\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Paket\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require\">\n\t\t\t<p>Wajib\n\t\t\t<\/p>\n\t\t<\/div>\n <!-- <p class=\"chui_company\" style=\"color: #ff0000; font-size: 16px; padding: 5px;\" >\u203b2025\u5e745\u6708\u3088\u308a\u30d1\u30c3\u30b1\u30fc\u30b8\u5185\u5bb9\u3092\u4e00\u90e8\u5909\u66f4\u3044\u305f\u3057\u307e\u3057\u305f\u3002<\/p> -->\n\t<\/div>\n\t<div class=\"forminput brelement\">\n\t\t<div class=\"plan\" style=\"margin-bottom: 20px;\">\n\t\t\t<p>Silakan cek detail paket<a href=\"https:\/\/dymmedicalclinic.id\/wp-content\/uploads\/2025\/05\/DYM\u30d1\u30c3\u30b1\u30fc\u30b8_2025.pdf\" target=\"_blank\" style=\"color: #007bff; text-decoration: underline; font-weight: bold;\">di sini.<\/a>\n\t\t\t<\/p>\n\t\t<\/div>\n <!-- <p style=\"padding: 16px 0 8px 0;\">\u3008\u7537\u6027\u5411\u3051\u3009<\/p> -->\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"plan\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"plan\" value=\"Paket Essential (Rp750,000)\" \/><span class=\"wpcf7-list-item-label\">Paket Essential (Rp750,000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"plan\" value=\"Paket Basic (Rp1,150,000)\" \/><span class=\"wpcf7-list-item-label\">Paket Basic (Rp1,150,000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"plan\" value=\"Paket Standard (Rp1,800,000)\" \/><span class=\"wpcf7-list-item-label\">Paket Standard (Rp1,800,000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"plan\" value=\"Paket Comprehensive (Rp2,700,000)\" \/><span class=\"wpcf7-list-item-label\">Paket Comprehensive (Rp2,700,000)<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"plan\" value=\"Paket Premium (Rp3,500,000)\" \/><span class=\"wpcf7-list-item-label\">Paket Premium (Rp3,500,000)<\/span><\/label><\/span><\/span><\/span><br \/>\n<!-- <p style=\"padding: 16px 0 8px 0;\">\u3008\u5973\u6027\u5411\u3051\u3009<\/p>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"plan\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"plan\" value=\"\u57fa\u790e\u30d7\u30e9\u30f3\uff08\u5973\u6027\uff09\uff08Rp1,800,000\uff09\" \/><span class=\"wpcf7-list-item-label\">\u57fa\u790e\u30d7\u30e9\u30f3\uff08\u5973\u6027\uff09\uff08Rp1,800,000\uff09<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"plan\" value=\"\u6a19\u6e96\u30d7\u30e9\u30f3A\uff08\u5973\u6027\uff09\uff08Rp4,000,000\uff09\" \/><span class=\"wpcf7-list-item-label\">\u6a19\u6e96\u30d7\u30e9\u30f3A\uff08\u5973\u6027\uff09\uff08Rp4,000,000\uff09<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"plan\" value=\"\u6a19\u6e96\u30d7\u30e9\u30f3B\uff08\u5973\u6027\uff09\uff08Rp4,700,000\uff09\" \/><span class=\"wpcf7-list-item-label\">\u6a19\u6e96\u30d7\u30e9\u30f3B\uff08\u5973\u6027\uff09\uff08Rp4,700,000\uff09<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"plan\" value=\"\u7dcf\u5408\u30d7\u30e9\u30f3A\uff08\u5973\u6027\uff09\uff08Rp5,400,000\uff09\" \/><span class=\"wpcf7-list-item-label\">\u7dcf\u5408\u30d7\u30e9\u30f3A\uff08\u5973\u6027\uff09\uff08Rp5,400,000\uff09<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"plan\" value=\"\u7dcf\u5408\u30d7\u30e9\u30f3B\uff08\u5973\u6027\uff09\uff08Rp6,400,000\uff09\" \/><span class=\"wpcf7-list-item-label\">\u7dcf\u5408\u30d7\u30e9\u30f3B\uff08\u5973\u6027\uff09\uff08Rp6,400,000\uff09<\/span><\/label><\/span><\/span><\/span>\n    <p style=\"padding: 16px 0 8px 0;\">\u3008\u305d\u306e\u4ed6\u3009<\/p>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"plan\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"plan\" value=\"\u4f1a\u793e\u6307\u5b9a\" \/><span class=\"wpcf7-list-item-label\">\u4f1a\u793e\u6307\u5b9a<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"plan\" value=\"\u305d\u306e\u4ed6\" \/><span class=\"wpcf7-list-item-label\">\u305d\u306e\u4ed6<\/span><\/label><\/span><\/span><\/span>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"plan2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"\u305d\u306e\u4ed6\u3092\u304a\u9078\u3073\u306e\u5834\u5408\u306b\u306f\u3053\u3061\u3089\u306b\u3054\u5165\u529b\u304f\u3060\u3055\u3044\u3002\" value=\"\" type=\"text\" name=\"plan2\" \/><\/span> -->\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Pemeriksaan tambahan\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require nini\">\n\t\t\t<p>Opsional\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput brelement option_dropdown_wrap\">\n\n <!-- <div class=\"category\">\u3010\u4eba\u6c17\u306e\u30aa\u30d7\u30b7\u30e7\u30f3\u691c\u67fb\u3011<\/div> -->\n\n <!-- <div class=\"option_dropdown\">\n      <button type=\"button\" class=\"category-mini option_toggle\">-\u8840\u6db2\u691c\u67fb<\/button>\n      <div class=\"option_menu\">\n        <span class=\"wpcf7-form-control-wrap\" data-name=\"option\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"option[]\" value=\"TSH\uff08Rp304.000\uff09\" \/><span class=\"wpcf7-list-item-label\">TSH\uff08Rp304.000\uff09<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Free T3\uff08Rp368.000\uff09\" \/><span class=\"wpcf7-list-item-label\">Free T3\uff08Rp368.000\uff09<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Free T4\uff08Rp288.000\uff09\" \/><span class=\"wpcf7-list-item-label\">Free T4\uff08Rp288.000\uff09<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"\u30d4\u30ed\u30ea\u83ccIgG\u6297\u4f53\uff08Rp1.054.000\uff09\" \/><span class=\"wpcf7-list-item-label\">\u30d4\u30ed\u30ea\u83ccIgG\u6297\u4f53\uff08Rp1.054.000\uff09<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"\u80c3\u90e8ABC\u691c\u67fb\uff08Rp1.716.000\uff09\" \/><span class=\"wpcf7-list-item-label\">\u80c3\u90e8ABC\u691c\u67fb\uff08Rp1.716.000\uff09<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"option[]\" value=\"\u30a2\u30c8\u30d4\u30fc\u7cfb\u30a2\u30ec\u30eb\u30ae\u30fc\u691c\u67fb\uff0854\u9805\u76ee\uff09\uff08Rp2.050.000\uff09\" \/><span class=\"wpcf7-list-item-label\">\u30a2\u30c8\u30d4\u30fc\u7cfb\u30a2\u30ec\u30eb\u30ae\u30fc\u691c\u67fb\uff0854\u9805\u76ee\uff09\uff08Rp2.050.000\uff09<\/span><\/label><\/span><\/span><\/span>\n      <\/div>\n    <\/div> -->\n\t\t<div class=\"option_dropdown\">\n\t\t\t<p><button type=\"button\" class=\"category-mini option_toggle\">-Pemeriksaan mata<\/button>\n\t\t\t<\/p>\n\t\t\t<div class=\"option_menu\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"option\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Tonometri (Rp150.000)\" \/><span class=\"wpcf7-list-item-label\">Tonometri (Rp150.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Foto fundus (Rp350.000)\uff09\" \/><span class=\"wpcf7-list-item-label\">Foto fundus (Rp350.000)\uff09<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"option_dropdown\">\n\t\t\t<p><button type=\"button\" class=\"category-mini option_toggle\">-Lainnya<\/button>\n\t\t\t<\/p>\n\t\t\t<div class=\"option_menu\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"option\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Pemeriksaan fungsi paru (Spirometri) (Rp250.000)\" \/><span class=\"wpcf7-list-item-label\">Pemeriksaan fungsi paru (Spirometri) (Rp250.000)<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"category\">\n\t\t\t<p>Pemeriksaan darah\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"option_dropdown\">\n\t\t\t<p><button type=\"button\" class=\"category-mini option_toggle\">-Anemia<\/button>\n\t\t\t<\/p>\n\t\t\t<div class=\"option_menu\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"option\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Zat besi serum (Rp325.000)\" \/><span class=\"wpcf7-list-item-label\">Zat besi serum (Rp325.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Ferritin (Rp564.000)\" \/><span class=\"wpcf7-list-item-label\">Ferritin (Rp564.000)<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"option_dropdown\">\n\t\t\t<p><button type=\"button\" class=\"category-mini option_toggle\">-Rematik<\/button>\n\t\t\t<\/p>\n\t\t\t<div class=\"option_menu\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"option\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Faktor reumatoid (kualitatif) (Rp172.000)\" \/><span class=\"wpcf7-list-item-label\">Faktor reumatoid (kualitatif) (Rp172.000)<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"option_dropdown\">\n\t\t\t<p><button type=\"button\" class=\"category-mini option_toggle\">-Fungsi pankreas<\/button>\n\t\t\t<\/p>\n\t\t\t<div class=\"option_menu\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"option\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Amilase (Rp270.000)\" \/><span class=\"wpcf7-list-item-label\">Amilase (Rp270.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Laktat dehidrogenase (LDH) (Rp293.000)\" \/><span class=\"wpcf7-list-item-label\">Laktat dehidrogenase (LDH) (Rp293.000)<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"option_dropdown\">\n\t\t\t<p><button type=\"button\" class=\"category-mini option_toggle\">-Metabolisme gula<\/button>\n\t\t\t<\/p>\n\t\t\t<div class=\"option_menu\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"option\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"option[]\" value=\"HbA1c (Rp228.000)\" \/><span class=\"wpcf7-list-item-label\">HbA1c (Rp228.000)<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"option_dropdown\">\n\t\t\t<p><button type=\"button\" class=\"category-mini option_toggle\">-Tiroid<\/button>\n\t\t\t<\/p>\n\t\t\t<div class=\"option_menu\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"option\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Hormon tiroid (Rp304.000)\" \/><span class=\"wpcf7-list-item-label\">Hormon tiroid (Rp304.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Free T3\uff08Rp368.000\uff09\" \/><span class=\"wpcf7-list-item-label\">Free T3\uff08Rp368.000\uff09<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Free T4\uff08Rp288.000\uff09\" \/><span class=\"wpcf7-list-item-label\">Free T4\uff08Rp288.000\uff09<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"option_dropdown\">\n\t\t\t<p><button type=\"button\" class=\"category-mini option_toggle\">-Hormon wanita<\/button>\n\t\t\t<\/p>\n\t\t\t<div class=\"option_menu\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"option\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"option[]\" value=\"FSH: hormon perangsang folikel (Rp639.000)\" \/><span class=\"wpcf7-list-item-label\">FSH: hormon perangsang folikel (Rp639.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Estradiol (Rp745.000)\" \/><span class=\"wpcf7-list-item-label\">Estradiol (Rp745.000)<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"option_dropdown\">\n\t\t\t<p><button type=\"button\" class=\"category-mini option_toggle\">-Hormon pria<\/button>\n\t\t\t<\/p>\n\t\t\t<div class=\"option_menu\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"option\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Testosteron (Rp698.000)\" \/><span class=\"wpcf7-list-item-label\">Testosteron (Rp698.000)<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"option_dropdown\">\n\t\t\t<p><button type=\"button\" class=\"category-mini option_toggle\">-Penanda tumor<\/button>\n\t\t\t<\/p>\n\t\t\t<div class=\"option_menu\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"option\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"option[]\" value=\"AFP: penanda tumor hati (Rp495.000)\" \/><span class=\"wpcf7-list-item-label\">AFP: penanda tumor hati (Rp495.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"CEA: penanda tumor usus besar (Rp378.000)\" \/><span class=\"wpcf7-list-item-label\">CEA: penanda tumor usus besar (Rp378.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"CA19-9: penanda tumor pankreas (Rp460.000)\" \/><span class=\"wpcf7-list-item-label\">CA19-9: penanda tumor pankreas (Rp460.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"PSA: penanda tumor prostat (pria) (Rp405.000)\" \/><span class=\"wpcf7-list-item-label\">PSA: penanda tumor prostat (pria) (Rp405.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"CA125: penanda tumor ovarium (wanita) (Rp489.000)\" \/><span class=\"wpcf7-list-item-label\">CA125: penanda tumor ovarium (wanita) (Rp489.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"CA15-3: penanda tumor payudara (wanita) (Rp470.000)\" \/><span class=\"wpcf7-list-item-label\">CA15-3: penanda tumor payudara (wanita) (Rp470.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Antigen SCC: penanda tumor karsinoma sel skuamosa (Rp980.000)\" \/><span class=\"wpcf7-list-item-label\">Antigen SCC: penanda tumor karsinoma sel skuamosa (Rp980.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"option[]\" value=\"CYFRA21-1: penanda tumor paru (Rp873.000)\" \/><span class=\"wpcf7-list-item-label\">CYFRA21-1: penanda tumor paru (Rp873.000)<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"option_dropdown\">\n\t\t\t<p><button type=\"button\" class=\"category-mini option_toggle\">-Penyakit infeksi<\/button>\n\t\t\t<\/p>\n\t\t\t<div class=\"option_menu\">\n <!-- \u524d\u534a -->\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"option\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Anti HAV IgG (Rp900,000)\" \/><span class=\"wpcf7-list-item-label\">Anti HAV IgG (Rp900,000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"HBsAg (Kualitatif) (Rp70.000)\" \/><span class=\"wpcf7-list-item-label\">HBsAg (Kualitatif) (Rp70.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Anti HBsAg (Kualitatif) (Rp83.000)\" \/><span class=\"wpcf7-list-item-label\">Anti HBsAg (Kualitatif) (Rp83.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Anti HCV (Kualitatif) (Rp260.000)\" \/><span class=\"wpcf7-list-item-label\">Anti HCV (Kualitatif) (Rp260.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Tes sifilis (RPR\/VDRL) (Rp153.000)\" \/><span class=\"wpcf7-list-item-label\">Tes sifilis (RPR\/VDRL) (Rp153.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Tes sifilis (TPHA) (Rp123.000)\" \/><span class=\"wpcf7-list-item-label\">Tes sifilis (TPHA) (Rp123.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Anti HIV (1 metode) (Rp350,000)\" \/><span class=\"wpcf7-list-item-label\">Anti HIV (1 metode) (Rp350,000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Tes HPV (Rp1.179.000)\" \/><span class=\"wpcf7-list-item-label\">Tes HPV (Rp1.179.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Tes PCR IMS\/PMS (12 item) (Rp2.250.000)\" \/><span class=\"wpcf7-list-item-label\">Tes PCR IMS\/PMS (12 item) (Rp2.250.000)<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<div class=\"option_note\">\n\t\t\t\t\t<p>\u30fb\u5358\u7d14\u30d8\u30eb\u30da\u30b9\u30a6\u30a4\u30eb\u30b91\u578b\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p>\u30fb\u5358\u7d14\u30d8\u30eb\u30da\u30b9\u30a6\u30a4\u30eb\u30b92\u578b\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p>\u30fb\u6dcb\u83cc\uff08\u30ca\u30a4\u30bb\u30ea\u30a2\u30fb\u30b4\u30ce\u30ec\u30a2\uff09\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p>\u30fb\u30af\u30e9\u30df\u30b8\u30a2\u30fb\u30c8\u30e9\u30b3\u30de\u30c1\u30b9\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p>\u30fb\u30de\u30a4\u30b3\u30d7\u30e9\u30ba\u30de\u30fb\u30b8\u30a7\u30cb\u30bf\u30ea\u30a6\u30e0\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p>\u30fb\u30de\u30a4\u30b3\u30d7\u30e9\u30ba\u30de\u30fb\u30db\u30df\u30cb\u30b9\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p>\u30fb\u30c8\u30ea\u30b3\u30e2\u30ca\u30b9\u30fb\u30d0\u30b8\u30ca\u30ea\u30b9\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p>\u30fb\u30a6\u30ec\u30a2\u30d7\u30e9\u30ba\u30de\uff08\u30a6\u30ec\u30a2\u30ea\u30c1\u30ab\u30e0\uff0f\u30d1\u30eb\u30d0\u30e0\uff09\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p>\u30fb\u30d8\u30e2\u30d5\u30a3\u30eb\u30b9\u30fb\u30c7\u30e5\u30af\u30ec\u30a4\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p>\u30fb\u6885\u6bd2\u30c8\u30ec\u30dd\u30cd\u30fc\u30de\uff08\u30c8\u30ec\u30dd\u30cd\u30fc\u30de\u30fb\u30d1\u30ea\u30c0\u30e0\uff09\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"option\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Anti Rubella IgG (Rp556.000)\" \/><span class=\"wpcf7-list-item-label\">Anti Rubella IgG (Rp556.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Anti Measles IgG (Rp655,000)\" \/><span class=\"wpcf7-list-item-label\">Anti Measles IgG (Rp655,000)<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\n <!-- <div class=\"option_dropdown\">\n      <button type=\"button\" class=\"category-mini option_toggle\">-\u80c3\u304c\u3093\u30ea\u30b9\u30af\u691c\u67fb<\/button>\n      <div class=\"option_menu\">\n        <span class=\"wpcf7-form-control-wrap\" data-name=\"option\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"option[]\" value=\"\u30d4\u30ed\u30ea\u83ccIgG\u6297\u4f53\uff08Rp1.054.000\uff09\" \/><span class=\"wpcf7-list-item-label\">\u30d4\u30ed\u30ea\u83ccIgG\u6297\u4f53\uff08Rp1.054.000\uff09<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"option[]\" value=\"\u80c3\u90e8ABC\u691c\u67fb\uff08Rp1.716.000\uff09\" \/><span class=\"wpcf7-list-item-label\">\u80c3\u90e8ABC\u691c\u67fb\uff08Rp1.716.000\uff09<\/span><\/label><\/span><\/span><\/span>\n      <\/div>\n    <\/div> -->\n\t\t<div class=\"option_dropdown\">\n\t\t\t<p><button type=\"button\" class=\"category-mini option_toggle\">-Pemeriksaan alergi<\/button>\n\t\t\t<\/p>\n\t\t\t<div class=\"option_menu\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"option\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Pemeriksaan alergi makanan (20 item) (Rp2.470.000)\" \/><span class=\"wpcf7-list-item-label\">Pemeriksaan alergi makanan (20 item) (Rp2.470.000)<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\n\n <!-- <div class=\"option_dropdown option_dropdown_category\">\n      <button type=\"button\" class=\"category option_toggle option_toggle_category\">\u3010\u773c\u79d1\u691c\u67fb\u3011<\/button>\n      <div class=\"option_menu\">\n        <span class=\"wpcf7-form-control-wrap\" data-name=\"option\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"option[]\" value=\"\u773c\u5727\u691c\u67fb\uff08Rp150.000\uff09\" \/><span class=\"wpcf7-list-item-label\">\u773c\u5727\u691c\u67fb\uff08Rp150.000\uff09<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"option[]\" value=\"\u773c\u5e95\u691c\u67fb\uff08Rp350.000\uff09\" \/><span class=\"wpcf7-list-item-label\">\u773c\u5e95\u691c\u67fb\uff08Rp350.000\uff09<\/span><\/label><\/span><\/span><\/span>\n      <\/div>\n    <\/div> -->\n\t\t<div class=\"option_dropdown option_dropdown_category\">\n\t\t\t<p><button type=\"button\" class=\"category option_toggle option_toggle_category\">Pemeriksaan pencitraan<\/button>\n\t\t\t<\/p>\n\t\t\t<div class=\"option_menu\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"option\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"option[]\" value=\"USG abdomen lengkap (Rp750.000)\" \/><span class=\"wpcf7-list-item-label\">USG abdomen lengkap (Rp750.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"USG abdomen atas (Rp550.000)\" \/><span class=\"wpcf7-list-item-label\">USG abdomen atas (Rp550.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"USG abdomen bawah (Rp450.000)\" \/><span class=\"wpcf7-list-item-label\">USG abdomen bawah (Rp450.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"USG tiroid (Rp450.000)\" \/><span class=\"wpcf7-list-item-label\">USG tiroid (Rp450.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"USG payudara (Rp450.000)\" \/><span class=\"wpcf7-list-item-label\">USG payudara (Rp450.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Fluoroskopi (tes barium) (Rp1.200.000)\" \/><span class=\"wpcf7-list-item-label\">Fluoroskopi (tes barium) (Rp1.200.000)<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"option_dropdown option_dropdown_category\">\n\t\t\t<p><button type=\"button\" class=\"category option_toggle option_toggle_category\">Pemeriksaan ginekologi<\/button>\n\t\t\t<\/p>\n\t\t\t<div class=\"option_menu\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"option\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Sitologi kanker serviks (metode Pap smear) (Rp260.000)\" \/><span class=\"wpcf7-list-item-label\">Sitologi kanker serviks (metode Pap smear) (Rp260.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Sitologi kanker serviks (metode ThinPrep) (Rp887.000)\" \/><span class=\"wpcf7-list-item-label\">Sitologi kanker serviks (metode ThinPrep) (Rp887.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"\u2f26\u5bae\u9838\u304c\u3093\u7d30\u80de\u8a3a\uff08\u30d1\u30c3\u30d7\u30b9\u30e1\u30a2\u6cd5\u2192\u30b7\u30f3\u30d7\u30ec\u30c3\u30d7\u6cd5\u3078\u306e\u5909\u66f4\uff09\uff08Rp627.000\uff09\" \/><span class=\"wpcf7-list-item-label\">\u2f26\u5bae\u9838\u304c\u3093\u7d30\u80de\u8a3a\uff08\u30d1\u30c3\u30d7\u30b9\u30e1\u30a2\u6cd5\u2192\u30b7\u30f3\u30d7\u30ec\u30c3\u30d7\u6cd5\u3078\u306e\u5909\u66f4\uff09\uff08Rp627.000\uff09<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"USG payudara (Rp450.000)\" \/><span class=\"wpcf7-list-item-label\">USG payudara (Rp450.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"CA125: penanda tumor ovarium (wanita) (Rp489.000)\" \/><span class=\"wpcf7-list-item-label\">CA125: penanda tumor ovarium (wanita) (Rp489.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"option[]\" value=\"CA15-3: penanda tumor payudara (wanita) (Rp470.000)\" \/><span class=\"wpcf7-list-item-label\">CA15-3: penanda tumor payudara (wanita) (Rp470.000)<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"option_dropdown option_dropdown_category\">\n\t\t\t<p><button type=\"button\" class=\"category option_toggle option_toggle_category\">Vaksinasi<\/button>\n\t\t\t<\/p>\n\t\t\t<div class=\"option_menu\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"option\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Vaksin Hepatitis A (dewasa) (Rp700.000)\" \/><span class=\"wpcf7-list-item-label\">Vaksin Hepatitis A (dewasa) (Rp700.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Vaksin Hepatitis B (dewasa) (Rp510.000)\" \/><span class=\"wpcf7-list-item-label\">Vaksin Hepatitis B (dewasa) (Rp510.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Vaksin Hepatitis A dan B (Rp850.000)\" \/><span class=\"wpcf7-list-item-label\">Vaksin Hepatitis A dan B (Rp850.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Vaksin tetanus (Rp250.000)\" \/><span class=\"wpcf7-list-item-label\">Vaksin tetanus (Rp250.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Vaksin rabies (Rp670.000)\" \/><span class=\"wpcf7-list-item-label\">Vaksin rabies (Rp670.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Vaksin Japanese encephalitis (Rp710.000)\" \/><span class=\"wpcf7-list-item-label\">Vaksin Japanese encephalitis (Rp710.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Vaksin influenza (Rp400.000)\" \/><span class=\"wpcf7-list-item-label\">Vaksin influenza (Rp400.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Vaksin DBD (Rp700.000)\" \/><span class=\"wpcf7-list-item-label\">Vaksin DBD (Rp700.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Vaksin tifoid (Rp600.000)\" \/><span class=\"wpcf7-list-item-label\">Vaksin tifoid (Rp600.000)<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\n <!-- <div class=\"option_dropdown option_dropdown_category\">\n      <button type=\"button\" class=\"category option_toggle option_toggle_category\">\u3010\u305d\u306e\u4ed6\u3011<\/button>\n      <div class=\"option_menu\">\n        <span class=\"wpcf7-form-control-wrap\" data-name=\"option\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"option[]\" value=\"Pemeriksaan fungsi paru (Spirometri) (Rp250.000)\" \/><span class=\"wpcf7-list-item-label\">Pemeriksaan fungsi paru (Spirometri) (Rp250.000)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"\u4fbf\u6f5c\u8840\u691c\u67fb\uff081\u56de\u6cd5\uff09\uff08Rp126.000\uff09\" \/><span class=\"wpcf7-list-item-label\">\u4fbf\u6f5c\u8840\u691c\u67fb\uff081\u56de\u6cd5\uff09\uff08Rp126.000\uff09<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"\u4fbf\u6f5c\u8840\u691c\u67fb\uff082\u56de\u6cd5\uff09\uff08Rp210.000\uff09\" \/><span class=\"wpcf7-list-item-label\">\u4fbf\u6f5c\u8840\u691c\u67fb\uff082\u56de\u6cd5\uff09\uff08Rp210.000\uff09<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"option[]\" value=\"\u4fbf\u6f5c\u8840\u691c\u67fb\uff081\u56de\u6cd5\u304b\u30892\u56de\u6cd5\u306b\u5909\u66f4\uff09\uff08Rp84.000\uff09\" \/><span class=\"wpcf7-list-item-label\">\u4fbf\u6f5c\u8840\u691c\u67fb\uff081\u56de\u6cd5\u304b\u30892\u56de\u6cd5\u306b\u5909\u66f4\uff09\uff08Rp84.000\uff09<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"option[]\" value=\"\u5bc4\u2f63\u2f8d\u691c\u67fb\uff08Rp110.500\uff09\" \/><span class=\"wpcf7-list-item-label\">\u5bc4\u2f63\u2f8d\u691c\u67fb\uff08Rp110.500\uff09<\/span><\/label><\/span><\/span><\/span>\n      <\/div>\n    <\/div> -->\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Riwayat kunjungan di klinik kami\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require\">\n\t\t\t<p>Wajib\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"history\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"history\" value=\"Tidak ada\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Tidak ada<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"history\" value=\"Ada (mencakup seluruh riwayat kunjungan, termasuk rawat jalan)\" \/><span class=\"wpcf7-list-item-label\">Ada (mencakup seluruh riwayat kunjungan, termasuk rawat jalan)<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Metode pembayaran (biaya paket)\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require\">\n\t\t\t<p>Wajib\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"payment\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"payment\"><option value=\"Silakan pilih\">Silakan pilih<\/option><option value=\"Bayar pada hari pemeriksaan\">Bayar pada hari pemeriksaan<\/option><option value=\"Tagihan perusahaan\">Tagihan perusahaan<\/option><\/select><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Metode pembayaran (pemeriksaan tambahan)\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require nini\">\n\t\t\t<p>Opsional\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"payment2\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"payment2\"><option value=\"Silakan pilih\">Silakan pilih<\/option><option value=\"Bayar pada hari pemeriksaan\">Bayar pada hari pemeriksaan<\/option><option value=\"Tagihan perusahaan\">Tagihan perusahaan<\/option><\/select><\/span>\n\t\t<\/p>\n\t\t<p><br \/>\n[ADD REMARK]\n\t\t<\/p>\n\t\t<p>Kami melayani sistem pembayaran melalui asuransi. Mohon hubungi kami terlebih dahulu guna memverifikasi cakupan asuransi Anda.\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Nama perusahaan\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require nini\">\n\t\t\t<p>Opsional\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"company\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"company\" \/><\/span>\n\t\t<\/p>\n\t\t<p class=\"chui_company\">Wajib diisi jika ditagihkan perusahaan.\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Alamat perusahaan\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require nini\">\n\t\t\t<p>Opsional\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"company_address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"company_address\" \/><\/span>\n\t\t<\/p>\n\t\t<p class=\"chui_company\">Wajib diisi jika ditagihkan perusahaan.\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Nama PIC akuntan Indonesia\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require nini\">\n\t\t\t<p>Opsional\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"keiri_name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"keiri_name\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Nomor telepon PIC akuntan Indonesia\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require nini\">\n\t\t\t<p>Opsional\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"keiri_tel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"021-1111-2222\" value=\"\" type=\"text\" name=\"keiri_tel\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Alamat email PIC akuntan Indonesia\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require nini\">\n\t\t\t<p>Opsional\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"keiri_mail\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" placeholder=\"124@aaa.co.id\" value=\"\" type=\"email\" name=\"keiri_mail\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<!-- <div class=\"formpart\">\n  <div class=\"formname\">\n    <div class=\"name\">\u63a1\u8840\u3067\u306e\u3075\u3089\u3064\u304d<\/div>\n    <div class=\"require nini\">\u4efb\u610f<\/div>\n  <\/div>\n  <div class=\"forminput\">\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"blood\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"blood[]\" value=\"\u3042\u308b(\u8a3a\u7642\u30d9\u30c3\u30c9\u3067\u306e\u63a1\u8840\u3092\u5e0c\u671b)\" \/><span class=\"wpcf7-list-item-label\">\u3042\u308b(\u8a3a\u7642\u30d9\u30c3\u30c9\u3067\u306e\u63a1\u8840\u3092\u5e0c\u671b)<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n<\/div>\n<div class=\"formpart\">\n  <div class=\"formname\">\n    <div class=\"name\">\u691c\u67fb\u30ad\u30c3\u30c8\u306e\u53d7\u3051\u53d6\u308a\u65b9\u6cd5<\/div>\n    <div class=\"require\">\u5fc5\u9808<\/div>\n  <\/div>\n  <div class=\"forminput brelement\">\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"method\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"method\" value=\"\u691c\u4fbf\u691c\u67fb\u306a\u3057\" \/><span class=\"wpcf7-list-item-label\">\u691c\u4fbf\u691c\u67fb\u306a\u3057<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"method\" value=\"\u3054\u81ea\u5b85\u306b\u90f5\u9001\u5e0c\u671b\" \/><span class=\"wpcf7-list-item-label\">\u3054\u81ea\u5b85\u306b\u90f5\u9001\u5e0c\u671b<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"method\" value=\"\u3054\u52e4\u52d9\u5148\u306b\u90f5\u9001\u5e0c\u671b\" \/><span class=\"wpcf7-list-item-label\">\u3054\u52e4\u52d9\u5148\u306b\u90f5\u9001\u5e0c\u671b<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n<\/div>\n<div class=\"formpart\">\n  <div class=\"formname\">\n    <div class=\"name\">\u4f4f\u6240(\u691c\u67fb\u30ad\u30c3\u30c8\u9001\u4ed8\u5148)<\/div>\n    <div class=\"require\">\u5fc5\u9808<\/div>\n  <\/div>\n  <div class=\"forminput\">\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"address_kit\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u306a\u3057\u306e\u5834\u5408\u306f\u306a\u3057\u3068\u3054\u8a18\u5165\u304f\u3060\u3055\u3044\u3002\" value=\"\" type=\"text\" name=\"address_kit\" \/><\/span>\n  <\/div>\n<\/div>\n<div class=\"formpart\">\n  <div class=\"formname\">\n    <div class=\"name\">\u3054\u53d7\u8a3a\u306e\u304d\u3063\u304b\u3051<\/div>\n    <div class=\"require\">\u5fc5\u9808<\/div>\n  <\/div>\n  <div class=\"forminput brelement\">\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"kikkake\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"kikkake\" value=\"\u30db\u30fc\u30e0\u30da\u30fc\u30b8\u3084\u30a4\u30f3\u30bf\u30fc\u30cd\u30c3\u30c8\u691c\u7d22\" \/><span class=\"wpcf7-list-item-label\">\u30db\u30fc\u30e0\u30da\u30fc\u30b8\u3084\u30a4\u30f3\u30bf\u30fc\u30cd\u30c3\u30c8\u691c\u7d22<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"kikkake\" value=\"\u4f1a\u793e\u304b\u3089\u306e\u7d39\u4ecb\" \/><span class=\"wpcf7-list-item-label\">\u4f1a\u793e\u304b\u3089\u306e\u7d39\u4ecb<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"kikkake\" value=\"\u30d5\u30ea\u30fc\u30da\u30fc\u30d1\u30fc\" \/><span class=\"wpcf7-list-item-label\">\u30d5\u30ea\u30fc\u30da\u30fc\u30d1\u30fc<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"kikkake\" value=\"\u304a\u77e5\u308a\u5408\u3044\u304b\u3089\u306e\u3054\u7d39\u4ecb\" \/><span class=\"wpcf7-list-item-label\">\u304a\u77e5\u308a\u5408\u3044\u304b\u3089\u306e\u3054\u7d39\u4ecb<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"kikkake\" value=\"\u9662\u5185\u63b2\u793a\u7269\" \/><span class=\"wpcf7-list-item-label\">\u9662\u5185\u63b2\u793a\u7269<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"kikkake\" value=\"\u6628\u5e74\u5ea6\u304b\u3089\u306e\u7d99\u7d9a\u5229\u7528\" \/><span class=\"wpcf7-list-item-label\">\u6628\u5e74\u5ea6\u304b\u3089\u306e\u7d99\u7d9a\u5229\u7528<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"kikkake\" value=\"\u305d\u306e\u4ed6\" \/><span class=\"wpcf7-list-item-label\">\u305d\u306e\u4ed6<\/span><\/label><\/span><\/span><\/span>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"kikkake2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"\u305d\u306e\u4ed6\u306e\u5834\u5408\u306f\u3053\u3061\u3089\u306b\u3054\u5165\u529b\u304f\u3060\u3055\u3044\u3002\" value=\"\" type=\"text\" name=\"kikkake2\" \/><\/span>\n  <\/div>\n<\/div> -->\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Catatan\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require nini\">\n\t\t\t<p>Opsional\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"others\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"\u3054\u8cea\u554f\u30fb\u3054\u8981\u671b\u306a\u3069\u304c\u3054\u3056\u3044\u307e\u3057\u305f\u3089\u8a18\u5165\u304f\u3060\u3055\u3044\" name=\"others\"><\/textarea><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"policy\">\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"agree\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"agree\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">Saya menyetujui<a href=\"https:\/\/dymmedicalclinic.id\/privacypolicy\/\" target=\"_blank\">Kebijakan Privasi<\/a><\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<div class=\"submit\">\n\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"submit\" \/><br \/>\n<input type=\"hidden\" name=\"_cf7msm_multistep_tag\" class=\"wpcf7-form-control wpcf7-multistep cf7msm-multistep\" value=\"{&quot;first_step&quot;:1,&quot;next_url&quot;:&quot;\\\/mcu\\\/booking-confirm\\\/&quot;}\" \/><input type=\"hidden\" name=\"cf7msm-no-ss\" value=\"\" \/>\n\t<\/p>\n<\/div>\n<style>\n .option_note {\n margin: 6px 0 10px 28px;\n font-size: 15px;\n color: #555;\n line-height: 1.7;\n }\n<\/style><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":3,"featured_media":0,"parent":445,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"pages\/booking.php","meta":{"footnotes":""},"acf":[],"_links":{"self":[{"href":"https:\/\/dymmedicalclinic.id\/in\/wp-json\/wp\/v2\/pages\/1069"}],"collection":[{"href":"https:\/\/dymmedicalclinic.id\/in\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dymmedicalclinic.id\/in\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dymmedicalclinic.id\/in\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/dymmedicalclinic.id\/in\/wp-json\/wp\/v2\/comments?post=1069"}],"version-history":[{"count":1,"href":"https:\/\/dymmedicalclinic.id\/in\/wp-json\/wp\/v2\/pages\/1069\/revisions"}],"predecessor-version":[{"id":1070,"href":"https:\/\/dymmedicalclinic.id\/in\/wp-json\/wp\/v2\/pages\/1069\/revisions\/1070"}],"up":[{"embeddable":true,"href":"https:\/\/dymmedicalclinic.id\/in\/wp-json\/wp\/v2\/pages\/445"}],"wp:attachment":[{"href":"https:\/\/dymmedicalclinic.id\/in\/wp-json\/wp\/v2\/media?parent=1069"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}