{"id":13584,"date":"2023-01-18T12:39:16","date_gmt":"2023-01-18T20:39:16","guid":{"rendered":"https:\/\/www.lmvna.org\/?page_id=13584"},"modified":"2024-07-23T11:43:18","modified_gmt":"2024-07-23T18:43:18","slug":"youthgriefevaluation","status":"publish","type":"page","link":"https:\/\/www.lmvna.org\/es\/youthgriefevaluation\/","title":{"rendered":"Grief Youth\/Minor Evaluation Form"},"content":{"rendered":"<div     class=\"vc_row wpb_row section vc_row-fluid  grid_section\" style=' text-align:left;'><div class=\"section_inner clearfix\"><div class='section_inner_margin clearfix'><div class=\"wpb_column vc_column_container vc_col-sm-12\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"vc_empty_space\"   style=\"height: 60px\"><span class=\"vc_empty_space_inner\"><\/span><\/div>\n\t<div class=\"wpb_text_column wpb_content_element\">\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<h2 style=\"text-align: center;\">Youth Grief Evaluation Form<\/h2>\n\n\t\t<\/div> \n\t<\/div> <div class=\"vc_empty_space\"   style=\"height: 5px\"><span class=\"vc_empty_space_inner\"><\/span><\/div><div class=\"separator titleborder small left\" style=\"border-color: #92C1E9;border-width:11px;width:150px;margin-top:30px;margin-bottom:30px\"><\/div>\n<div class=\"vc_empty_space\"   style=\"height: 20px\"><span class=\"vc_empty_space_inner\"><\/span><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div     class=\"vc_row wpb_row section vc_row-fluid fullwidth\" style=' text-align:left;'><div class=\"full_section_inner clearfix\"><div class=\"wpb_column vc_column_container vc_col-sm-12\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"vc_empty_space\"   style=\"height: 35px\"><span class=\"vc_empty_space_inner\"><\/span><\/div>\n\t<div class=\"wpb_text_column wpb_content_element\">\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<p style=\"text-align: center;\"><script>\n                            if (window.qmn_quiz_data === undefined) {\n                                    window.qmn_quiz_data = new Object();\n                            }\n                    <\/script><script>window.qmn_quiz_data[\"9\"] = {\"quiz_id\":\"9\",\"quiz_name\":\"Minor Grief Evaluation\",\"disable_answer\":0,\"ajax_show_correct\":0,\"progress_bar\":\"0\",\"contact_info_location\":0,\"qpages\":{\"1\":{\"id\":\"1\",\"quizID\":\"9\",\"pagekey\":\"1Z1NJvRD\",\"hide_prevbtn\":\"0\"}},\"skip_validation_time_expire\":0,\"timer_limit_val\":0,\"disable_scroll_next_previous_click\":0,\"disable_scroll_on_result\":0,\"disable_first_page\":\"0\",\"enable_result_after_timer_end\":0,\"enable_quick_result_mc\":0,\"end_quiz_if_wrong\":0,\"form_disable_autofill\":0,\"disable_mathjax\":0,\"enable_quick_correct_answer_info\":0,\"quick_result_correct_answer_text\":\"Correct! You have selected correct answer.\",\"quick_result_wrong_answer_text\":\"Wrong! You have selected wrong answer.\",\"quiz_processing_message\":\"\",\"quiz_limit_choice\":\"Limit of choice is reached.\",\"not_allow_after_expired_time\":0,\"scheduled_time_end\":false,\"error_messages\":{\"email_error_text\":\"Not a valid e-mail address!\",\"number_error_text\":\"This field must be a number!\",\"incorrect_error_text\":\"The entered text is not correct!\",\"empty_error_text\":\"Please complete all required fields!\",\"url_error_text\":\"The entered URL is not valid!\",\"minlength_error_text\":\"Required atleast %minlength% characters.\",\"maxlength_error_text\":\"Maximum %maxlength% characters allowed.\",\"recaptcha_error_text\":\"ReCaptcha is missing\"},\"first_page\":false}\n                    <\/script><div class='qsm-quiz-container qsm-quiz-container-9 qmn_quiz_container mlw_qmn_quiz  quiz_theme_default'>\n\t\t\t\t\t\t\t\t<form name=\"quizForm9\" id=\"quizForm9\" action=\"\/es\/wp-json\/wp\/v2\/pages\/13584\" method=\"POST\" class=\"qsm-quiz-form qmn_quiz_form mlw_quiz_form\" novalidate enctype=\"multipart\/form-data\" data-trp-original-action=\"\/es\/wp-json\/wp\/v2\/pages\/13584\">\n\t\t\t\t<input type=\"hidden\" name=\"qsm_hidden_questions\" id=\"qsm_hidden_questions\" value=\"\">\n\t\t\t\t<input type=\"hidden\" name=\"qsm_nonce\" id=\"qsm_nonce_9\" value=\"2ca95797f0\">\n\t\t\t\t<input type=\"hidden\" name=\"qsm_unique_key\" id=\"qsm_unique_key_9\" value=\"6a0d4753c2a7f\">\n\t\t\t\t<div id=\"mlw_error_message\" class=\"qsm-error-message qmn_error_message_section\"><\/div>\n\t\t\t\t<span id=\"mlw_top_of_quiz\"><\/span>\n\t\t\t\t\t\t\t<section class=\"qsm-page\">\n\t\t\t\t\t\t\t\t<div class=\"quiz_section quiz_begin\">\n\t\t\t\t\t\t<div class='qsm-before-message mlw_qmn_message_before'>\n\t\t\t\t<p>Welcome to your Minor Grief Evaluation<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-3 question-section-id-182\" data-qid=\"182\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'><label class=\"qsm-question-title-label\" for=\"question182\">Su nombre <\/label><\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<input  type=\"text\" class=\"mlw_answer_open_text mlwRequiredText\" id=\"question182\" name=\"question182\"   placeholder=\"\" \/>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-3 question-section-id-184\" data-qid=\"184\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'><label class=\"qsm-question-title-label\" for=\"question184\">Therapist Name <\/label><\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<input  type=\"text\" class=\"mlw_answer_open_text mlwRequiredText\" id=\"question184\" name=\"question184\"   placeholder=\"\" \/>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-12 question-section-id-185\" data-qid=\"185\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'><label class=\"qsm-question-title-label\" for=\"question185\">Today&#039;s Date <\/label><\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<input type=\"date\" class=\"mlw_answer_date mlwRequiredDate\" name=\"question185\" id=\"question185\" value=\"\" \/>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0 question-section-id-159\" data-qid=\"159\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>1. Feeling confused about the death (asking a lot of why questions, disbelief, denial). <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question159-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question159\" id=\"question159_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question159_1\">\n\t\t\t\t\tNot at all\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question159-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question159\" id=\"question159_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question159_2\">\n\t\t\t\t\tSomewhat\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question159-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question159\" id=\"question159_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question159_3\">\n\t\t\t\t\tQuite a bit\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question159-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question159\" id=\"question159_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question159_4\">\n\t\t\t\t\tOverwhelmingly\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question159_none\">Ninguna<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question159\" id=\"question159_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0 question-section-id-160\" data-qid=\"160\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>2. Feelings of depression (sadness, crying spells, fatigue, isolating). <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question160-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question160\" id=\"question160_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question160_1\">\n\t\t\t\t\tNot at all\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question160-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question160\" id=\"question160_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question160_2\">\n\t\t\t\t\tSomewhat\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question160-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question160\" id=\"question160_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question160_3\">\n\t\t\t\t\tQuite a bit\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question160-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question160\" id=\"question160_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question160_4\">\n\t\t\t\t\tOverwhelmingly\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question160_none\">Ninguna<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question160\" id=\"question160_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0 question-section-id-161\" data-qid=\"161\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>3. Feeling irritable, angry, frustrated or impatient. <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question161-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question161\" id=\"question161_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question161_1\">\n\t\t\t\t\tNot at all\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question161-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question161\" id=\"question161_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question161_2\">\n\t\t\t\t\tSomewhat\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question161-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question161\" id=\"question161_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question161_3\">\n\t\t\t\t\tQuite a bit\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question161-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question161\" id=\"question161_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question161_4\">\n\t\t\t\t\tOverwhelmingly\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question161_none\">Ninguna<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question161\" id=\"question161_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0 question-section-id-162\" data-qid=\"162\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>4. Feelings of guilt related to the death <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question162-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question162\" id=\"question162_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question162_1\">\n\t\t\t\t\tNot at all\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question162-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question162\" id=\"question162_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question162_2\">\n\t\t\t\t\tSomewhat\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question162-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question162\" id=\"question162_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question162_3\">\n\t\t\t\t\tQuite a bit\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question162-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question162\" id=\"question162_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question162_4\">\n\t\t\t\t\tOverwhelmingly\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question162_none\">Ninguna<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question162\" id=\"question162_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0 question-section-id-163\" data-qid=\"163\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>5. Feeling anxious about death of others or self (clingy, overprotective, dependent, worried someone else could die). <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question163-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question163\" id=\"question163_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question163_1\">\n\t\t\t\t\tNot at all\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question163-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question163\" id=\"question163_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question163_2\">\n\t\t\t\t\tSomewhat\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question163-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question163\" id=\"question163_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question163_3\">\n\t\t\t\t\tQuite a bit\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question163-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question163\" id=\"question163_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question163_4\">\n\t\t\t\t\tOverwhelmingly\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question163_none\">Ninguna<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question163\" id=\"question163_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0 question-section-id-164\" data-qid=\"164\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>6. Feeling nervous or unsafe since the death. <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question164-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question164\" id=\"question164_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question164_1\">\n\t\t\t\t\tNot at all\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question164-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question164\" id=\"question164_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question164_2\">\n\t\t\t\t\tSomewhat\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question164-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question164\" id=\"question164_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question164_3\">\n\t\t\t\t\tQuite a bit\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question164-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question164\" id=\"question164_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question164_4\">\n\t\t\t\t\tOverwhelmingly\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question164_none\">Ninguna<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question164\" id=\"question164_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0 question-section-id-165\" data-qid=\"165\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>7. Acting younger than age (baby talk, needier, helpless). <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question165-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question165\" id=\"question165_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question165_1\">\n\t\t\t\t\tNot at all\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question165-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question165\" id=\"question165_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question165_2\">\n\t\t\t\t\tSomewhat\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question165-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question165\" id=\"question165_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question165_3\">\n\t\t\t\t\tQuite a bit\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question165-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question165\" id=\"question165_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question165_4\">\n\t\t\t\t\tOverwhelmingly\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question165_none\">Ninguna<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question165\" id=\"question165_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0 question-section-id-166\" data-qid=\"166\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>8. Difficulty concentrating, following through on a task, completing homework. <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question166-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question166\" id=\"question166_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question166_1\">\n\t\t\t\t\tNot at all\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question166-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question166\" id=\"question166_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question166_2\">\n\t\t\t\t\tSomewhat\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question166-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question166\" id=\"question166_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question166_3\">\n\t\t\t\t\tQuite a bit\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question166-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question166\" id=\"question166_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question166_4\">\n\t\t\t\t\tOverwhelmingly\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question166_none\">Ninguna<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question166\" id=\"question166_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0 question-section-id-167\" data-qid=\"167\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>9. Experiencing fears and\/or phobias since death. <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question167-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question167\" id=\"question167_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question167_1\">\n\t\t\t\t\tNot at all\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question167-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question167\" id=\"question167_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question167_2\">\n\t\t\t\t\tSomewhat\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question167-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question167\" id=\"question167_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question167_3\">\n\t\t\t\t\tQuite a bit\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question167-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question167\" id=\"question167_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question167_4\">\n\t\t\t\t\tOverwhelmingly\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question167_none\">Ninguna<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question167\" id=\"question167_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0 question-section-id-168\" data-qid=\"168\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>10. Unwilling to accept the loss, denial of the death. Refusal to talk about the death. <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question168-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question168\" id=\"question168_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question168_1\">\n\t\t\t\t\tNot at all\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question168-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question168\" id=\"question168_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question168_2\">\n\t\t\t\t\tSomewhat\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question168-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question168\" id=\"question168_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question168_3\">\n\t\t\t\t\tQuite a bit\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question168-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question168\" id=\"question168_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question168_4\">\n\t\t\t\t\tOverwhelmingly\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question168_none\">Ninguna<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question168\" id=\"question168_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0 question-section-id-169\" data-qid=\"169\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>11. Experiencing the following physical symptoms since the death: headaches, stomach aches, body pains, etc. <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question169-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question169\" id=\"question169_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question169_1\">\n\t\t\t\t\tNot at all\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question169-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question169\" id=\"question169_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question169_2\">\n\t\t\t\t\tSomewhat\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question169-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question169\" id=\"question169_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question169_3\">\n\t\t\t\t\tQuite a bit\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question169-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question169\" id=\"question169_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question169_4\">\n\t\t\t\t\tOverwhelmingly\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question169_none\">Ninguna<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question169\" id=\"question169_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0 question-section-id-170\" data-qid=\"170\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>12. Experiencing a loss or increase of appetite since the death. (Disinterested in food or can\u2019t seem to get enough.) <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question170-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question170\" id=\"question170_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question170_1\">\n\t\t\t\t\tNot at all\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question170-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question170\" id=\"question170_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question170_2\">\n\t\t\t\t\tSomewhat\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question170-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question170\" id=\"question170_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question170_3\">\n\t\t\t\t\tQuite a bit\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question170-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question170\" id=\"question170_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question170_4\">\n\t\t\t\t\tOverwhelmingly\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question170_none\">Ninguna<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question170\" id=\"question170_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0 question-section-id-171\" data-qid=\"171\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>13. Experience sleep disturbances such as inability to sleep through the night, nightmares, bedwetting, sleeping at odd times, fear of sleeping alone. <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question171-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question171\" id=\"question171_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question171_1\">\n\t\t\t\t\tNot at all\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question171-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question171\" id=\"question171_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question171_2\">\n\t\t\t\t\tSomewhat\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question171-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question171\" id=\"question171_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question171_3\">\n\t\t\t\t\tQuite a bit\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question171-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question171\" id=\"question171_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question171_4\">\n\t\t\t\t\tOverwhelmingly\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question171_none\">Ninguna<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question171\" id=\"question171_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0 question-section-id-172\" data-qid=\"172\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>14. Onset of stuttering. <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question172-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question172\" id=\"question172_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question172_1\">\n\t\t\t\t\tNot at all\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question172-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question172\" id=\"question172_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question172_2\">\n\t\t\t\t\tSomewhat\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question172-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question172\" id=\"question172_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question172_3\">\n\t\t\t\t\tQuite a bit\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question172-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question172\" id=\"question172_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question172_4\">\n\t\t\t\t\tOverwhelmingly\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question172_none\">Ninguna<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question172\" id=\"question172_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0 question-section-id-173\" data-qid=\"173\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>15. Increase number of accidents, injuries. <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question173-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question173\" id=\"question173_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question173_1\">\n\t\t\t\t\tNot at all\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question173-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question173\" id=\"question173_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question173_2\">\n\t\t\t\t\tSomewhat\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question173-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question173\" id=\"question173_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question173_3\">\n\t\t\t\t\tQuite a bit\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question173-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question173\" id=\"question173_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question173_4\">\n\t\t\t\t\tOverwhelmingly\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question173_none\">Ninguna<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question173\" id=\"question173_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0 question-section-id-174\" data-qid=\"174\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>16. Increase in risky behaviors (truancy, fighting, alcohol\/drug use, staying out late, driving fast, change in peer group). <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question174-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question174\" id=\"question174_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question174_1\">\n\t\t\t\t\tNot at all\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question174-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question174\" id=\"question174_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question174_2\">\n\t\t\t\t\tSomewhat\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question174-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question174\" id=\"question174_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question174_3\">\n\t\t\t\t\tQuite a bit\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question174-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question174\" id=\"question174_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question174_4\">\n\t\t\t\t\tOverwhelmingly\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question174_none\">Ninguna<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question174\" id=\"question174_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0 question-section-id-175\" data-qid=\"175\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>17. Social withdrawal and disinterest in normal activities. Avoiding friends. (Increase in television watching or gaming.) <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question175-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question175\" id=\"question175_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question175_1\">\n\t\t\t\t\tNot at all\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question175-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question175\" id=\"question175_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question175_2\">\n\t\t\t\t\tSomewhat\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question175-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question175\" id=\"question175_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question175_3\">\n\t\t\t\t\tQuite a bit\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question175-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question175\" id=\"question175_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question175_4\">\n\t\t\t\t\tOverwhelmingly\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question175_none\">Ninguna<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question175\" id=\"question175_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0 question-section-id-176\" data-qid=\"176\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>18. Problems at school. (Teacher(s) have voiced concerns, doesn\u2019t want to go to school, drop in performance, issues with peer group)&gt; <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question176-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question176\" id=\"question176_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question176_1\">\n\t\t\t\t\tNot at all\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question176-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question176\" id=\"question176_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question176_2\">\n\t\t\t\t\tSomewhat\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question176-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question176\" id=\"question176_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question176_3\">\n\t\t\t\t\tQuite a bit\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question176-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question176\" id=\"question176_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question176_4\">\n\t\t\t\t\tOverwhelmingly\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question176_none\">Ninguna<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question176\" id=\"question176_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0 question-section-id-177\" data-qid=\"177\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>19. Increase in acting out behaviors (bullying, hitting, tantrums, screaming, aggressive, breaking\/throwing things) <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question177-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question177\" id=\"question177_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question177_1\">\n\t\t\t\t\tNot at all\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question177-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question177\" id=\"question177_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question177_2\">\n\t\t\t\t\tSomewhat\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question177-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question177\" id=\"question177_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question177_3\">\n\t\t\t\t\tQuite a bit\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question177-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question177\" id=\"question177_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question177_4\">\n\t\t\t\t\tOverwhelmingly\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question177_none\">Ninguna<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question177\" id=\"question177_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0 question-section-id-178\" data-qid=\"178\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>20. Problems at home. <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question178-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question178\" id=\"question178_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question178_1\">\n\t\t\t\t\tNot at all\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question178-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question178\" id=\"question178_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question178_2\">\n\t\t\t\t\tSomewhat\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question178-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question178\" id=\"question178_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question178_3\">\n\t\t\t\t\tQuite a bit\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question178-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question178\" id=\"question178_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question178_4\">\n\t\t\t\t\tOverwhelmingly\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question178_none\">Ninguna<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question178\" id=\"question178_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0 question-section-id-179\" data-qid=\"179\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>21. Defiant, disrespectful, oppositional behavior. <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question179-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question179\" id=\"question179_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question179_1\">\n\t\t\t\t\tNot at all\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question179-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question179\" id=\"question179_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question179_2\">\n\t\t\t\t\tSomewhat\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question179-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question179\" id=\"question179_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question179_3\">\n\t\t\t\t\tQuite a bit\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question179-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input' name=\"question179\" id=\"question179_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question179_4\">\n\t\t\t\t\tOverwhelmingly\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question179_none\">Ninguna<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question179\" id=\"question179_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-3 question-section-id-180\" data-qid=\"180\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'><label class=\"qsm-question-title-label\" for=\"question180\">22. What is the most significant issue for you\/minor at this time? <\/label><\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<input  type=\"text\" class=\"mlw_answer_open_text\" id=\"question180\" name=\"question180\"   placeholder=\"\" \/>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-3 question-section-id-181\" data-qid=\"181\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'><label class=\"qsm-question-title-label\" for=\"question181\">23. Please feel free to add more information here: <\/label><\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<input  type=\"text\" class=\"mlw_answer_open_text\" id=\"question181\" name=\"question181\"   placeholder=\"\" \/>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/section>\n\t\t\t\t\t<input type=\"hidden\" name=\"qmn_question_list\" value=\"182Q184Q185Q159Q160Q161Q162Q163Q164Q165Q166Q167Q168Q169Q170Q171Q172Q173Q174Q175Q176Q177Q178Q179Q180Q181Q\" \/>\n\t\t\t\t\t\t\t<div id=\"mlw_error_message_bottom\" class=\"qsm-error-message qmn_error_message_section\"><\/div>\n\t\t\t\t\t<input type=\"hidden\" name=\"qmn_all_questions_count\" id=\"qmn_all_questions_count\" value=\"26\" \/>\n\t\t\t\t\t<input type=\"hidden\" name=\"total_questions\" id=\"total_questions\" value=\"26\" \/>\n\t\t\t\t\t<input type=\"hidden\" name=\"timer\" id=\"timer\" value=\"0\" \/>\n\t\t\t\t\t<input type=\"hidden\" name=\"timer_ms\" id=\"timer_ms\" value=\"0\"\/>\n\t\t\t\t\t<input type=\"hidden\" class=\"qmn_quiz_id\" name=\"qmn_quiz_id\" id=\"qmn_quiz_id\" value=\"9\" \/>\n\t\t\t\t\t<input type='hidden' name='complete_quiz' value='confirmation' \/>\n\t\t\t\t\t\t\t\t\t<input type=\"hidden\" name=\"trp-form-language\" value=\"es\"\/><\/form>\n\t\t<\/div>\n\t\t<div style=\"display: none;\" class=\"qsm-popup qsm-popup-slide\" id=\"modal-4\" aria-hidden=\"false\"><div class=\"qsm-popup__overlay\" tabindex=\"-1\" data-micromodal-close=\"\"><div class=\"qsm-popup__container qmn_quiz_container\" role=\"dialog\" aria-modal=\"true\"><div class=\"qsm-popup__content\"><img decoding=\"async\" src=\"https:\/\/www.lmvna.org\/wp-content\/plugins\/quiz-master-next\/assets\/clock.png\" alt=\"clock.png\"\/><p class=\"qsm-time-up-text\"> Time's up<\/p><\/div><footer class=\"qsm-popup__footer\"><button class=\"qsm-popup-secondary-button qmn_btn\" data-micromodal-close=\"\" aria-label=\"Close this dialog window\" onclick=\"location.reload();\">Cancelar<\/button><\/footer><\/div><\/div><\/div>\n\n\t\t<\/div> \n\t<\/div> <div class=\"vc_empty_space\"   style=\"height: 70px\"><span class=\"vc_empty_space_inner\"><\/span><\/div><\/div><\/div><\/div><\/div><\/div>","protected":false},"excerpt":{"rendered":"Welcome to your Minor Grief Evaluation Your Name Therapist Name Today&#039;s Date 1. Feeling confused about the death (asking a lot of why questions, disbelief, denial). Not at all Somewhat Quite a bit Overwhelmingly Ninguna 2. Feelings of depression (sadness, crying spells, fatigue, isolating). Not...","protected":false},"author":6,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"full_width.php","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-13584","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.lmvna.org\/es\/wp-json\/wp\/v2\/pages\/13584"}],"collection":[{"href":"https:\/\/www.lmvna.org\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.lmvna.org\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.lmvna.org\/es\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/www.lmvna.org\/es\/wp-json\/wp\/v2\/comments?post=13584"}],"version-history":[{"count":8,"href":"https:\/\/www.lmvna.org\/es\/wp-json\/wp\/v2\/pages\/13584\/revisions"}],"predecessor-version":[{"id":17460,"href":"https:\/\/www.lmvna.org\/es\/wp-json\/wp\/v2\/pages\/13584\/revisions\/17460"}],"wp:attachment":[{"href":"https:\/\/www.lmvna.org\/es\/wp-json\/wp\/v2\/media?parent=13584"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}