{"id":1519,"date":"2026-07-22T09:23:03","date_gmt":"2026-07-22T13:23:03","guid":{"rendered":"https:\/\/sourcewise.gomohealth.care\/enroll\/"},"modified":"2026-07-22T09:23:03","modified_gmt":"2026-07-22T13:23:03","slug":"enroll","status":"publish","type":"page","link":"https:\/\/sourcewise.gomohealth.care\/zh-hans\/enroll\/","title":{"rendered":"Enroll"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"background-color: rgba(255,255,255,0);background-position: center center;background-repeat: no-repeat;border-width: 0px 0px 0px 0px;border-color:#eae9e9;border-style:solid;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start\" style=\"max-width:1064.96px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 0px 0px 0px 0px;\"><script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_18' style='display:none'><div id='gf_18' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_18' id='gform_18'  action='\/zh-hans\/wp-json\/wp\/v2\/pages\/1519#gf_18' >\n                        <div class='gform_body gform-body'><ul id='gform_fields_18' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_18_1\"  class=\"gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_1\"><div class='ginput_container ginput_container_text'><input name='input_1' id='input_18_1' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/li><li id=\"field_18_2\"  class=\"gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_2\"><div class='ginput_container ginput_container_text'><input name='input_2' id='input_18_2' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='https:\/\/sourcewise.gomohealth.care\/zh-hans\/wp-json\/wp\/v2\/pages\/1519' \/><\/div><\/li><li id=\"field_18_3\"  class=\"gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_3\"><div class='ginput_container ginput_container_text'><input name='input_3' id='input_18_3' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/li><li id=\"field_18_50\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_18_50\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label' for='input_18_50' >ctreligible<\/label><div class='ginput_container ginput_container_number'><input name='input_50' id='input_18_50' type='text'    value='1' class='large'      aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_18_56\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_18_56\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label' for='input_18_56' >ctreligible2<\/label><div class='ginput_container ginput_container_number'><input name='input_56' id='input_18_56' type='text'    value='1' class='large'      aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_18_52\"  class=\"gfield gfield--width-full gfield_calculation field_sublabel_below field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_18_52\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label' for='input_18_52' >Zipcode_Eligibility<\/label><div class='ginput_container ginput_container_number'><input name='input_52' id='input_18_52' type='text'    value='' class='large'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_18_57\"  class=\"gfield gfield--width-full gfield_calculation field_sublabel_below field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_18_57\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label' for='input_18_57' >Zipcode_Eligibility_2<\/label><div class='ginput_container ginput_container_number'><input name='input_57' id='input_18_57' type='text'    value='' class='large'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_18_4\"  class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_4\"><p>\u7167\u987e\u60a8\u6240\u5173\u5fc3\u7684\u4eba\uff08\u4f8b\u5982\u5bb6\u4eba\u3001\u670b\u53cb\u6216\u90bb\u5c45\uff09\u53ef\u80fd\u4f1a\u8ba9\u60a8\u611f\u5230\u56f0\u96be\uff0c\u72ec\u81ea\u9762\u5bf9\u66f4\u662f\u4e0d\u5bb9\u6613\u3002\u6211\u4eec\u7684\u56e2\u961f\u968f\u65f6\u51c6\u5907\u5e2e\u52a9\u60a8\uff0c\u4e3a\u60a8\u6240\u7167\u987e\u7684\u4eba\u5bfb\u627e\u5207\u5b9e\u53ef\u884c\u7684\u7167\u62a4\u4e0e\u652f\u6301\u65b9\u6848\u3002\u8bf7\u586b\u5199\u4e0b\u65b9\u7684\u767b\u8bb0\u8868\uff0c\u63d0\u4f9b\u60a8\u672c\u4eba\u4ee5\u53ca\u60a8\u6240\u7167\u987e\u5bf9\u8c61\u7684\u76f8\u5173\u4fe1\u606f\u3002\u8fd9\u4e9b\u4fe1\u606f\u5c06\u5e2e\u52a9\u6211\u4eec\u4e86\u89e3\u5982\u4f55\u4e3a\u60a8\u63d0\u4f9b\u5e2e\u52a9\u3002\u5982\u679c\u60a8\u9700\u8981\u534f\u52a9\u586b\u5199\u6b64\u8868\u683c\uff0c\u8bf7\u81f4\u7535 (408) 320-3200\uff0c\u6309 1\u3002    <\/p>\n\n<p>\u5b8c\u6210\u6b64\u767b\u8bb0\u8868\u540e\uff0c\u60a8\u5c06\u52a0\u5165 Sourcewise MyPlan \u77ed\u4fe1\u670d\u52a1\uff0c\u5e76\u53ef\u4f7f\u7528\u5b9e\u65f6\u804a\u5929\u529f\u80fd\u3002\u60a8\u6bcf\u5468\u5c06\u6536\u5230 1 \u81f3 3 \u6761\u7531\u6211\u4eec\u56e2\u961f\u53d1\u9001\u7684\u77ed\u4fe1\uff0c\u5185\u5bb9\u5305\u62ec\u5b9e\u7528\u4fe1\u606f\u3001\u7167\u62a4\u5efa\u8bae\u548c\u6307\u5bfc\uff0c\u76f4\u63a5\u53d1\u9001\u5230\u60a8\u7684\u624b\u673a\u3002\u77ed\u4fe1\u5c06\u7531\u53f7\u7801 43386 \u53d1\u51fa\u3002\u5efa\u8bae\u60a8\u5c06\u6b64\u53f7\u7801\u4fdd\u5b58\u5230\u624b\u673a\u8054\u7cfb\u4eba\u4e2d\uff0c\u540d\u79f0\u8bbe\u4e3a\u201cSourcewise MyPlan\u201d\u3002\u60a8\u53ef\u4ee5\u5728\u6b64\u67e5\u770b\u670d\u52a1\u6761\u6b3e\u4e0e\u6761\u4ef6\uff1a<a href=\"https:\/\/sourcewise.gomohealth.care\/\">https:\/\/sourcewise.gomohealth.care\/terms\/<\/a>   <\/p>\n\n<p>\u9664\u4e86\u77ed\u4fe1\u670d\u52a1\u5916\uff0c\u60a8\u8fd8\u5c06\u83b7\u5f97 Sourcewise MyPlan \u7167\u62a4\u8005\u8d44\u6e90\u5e93\u7684\u4f7f\u7528\u6743\u9650\u3002\u8d44\u6e90\u5e93\u5c06\u6839\u636e\u60a8\u7684\u4e2a\u4eba\u9700\u6c42\u63d0\u4f9b\u5b9a\u5236\u5316\u8d44\u6e90\uff0c\u60a8\u4e5f\u53ef\u4ee5\u968f\u65f6\u901a\u8fc7\u77ed\u4fe1\u4e0e\u6211\u4eec\u7684\u56e2\u961f\u5b9e\u65f6\u6c9f\u901a\u3002\u60a8\u8fd8\u5c06\u6536\u5230\u6765\u81ea\u6211\u4eec\u804a\u5929\u670d\u52a1\u53f7\u7801 (833) 728-1403 \u7684\u6b22\u8fce\u77ed\u4fe1\uff0c\u5efa\u8bae\u60a8\u5c06\u6b64\u53f7\u7801\u4fdd\u5b58\u5230\u624b\u673a\u8054\u7cfb\u4eba\u4e2d\uff0c\u540d\u79f0\u8bbe\u4e3a\u201cSourcewise Chat\u201d\u3002 <\/p><\/li><li id=\"field_18_25\"  class=\"gfield gsection custom_section_style one mt_40 field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_25\"><h2 class=\"gsection_title\">\u8bf7\u82b1\u51e0\u5206\u949f\u65f6\u95f4\u56de\u7b54\u4ee5\u4e0b\u5173\u4e8e\u60a8\u672c\u4eba\u6216\u4eca\u5929\u6ce8\u518c\u7684\u4e3b\u8981\u7167\u62a4\u8005\u7684\u95ee\u9898\u3002\u6211\u4eec\u5e0c\u671b\u60a8\u4e86\u89e3\uff0c\u60a8\u5728\u672c\u9879\u76ee\u4e2d\u63d0\u4f9b\u548c\u63a5\u6536\u7684\u6240\u6709\u4fe1\u606f\u90fd\u5c06\u4e25\u683c\u4fdd\u5bc6\u3002\u60a8\u7684\u4fe1\u606f\u4e0d\u4f1a\u88ab\u5206\u4eab\uff0c\u4e5f\u4e0d\u4f1a\u7528\u4e8e\u4efb\u4f55\u5176\u4ed6\u7528\u9014\u3002  <\/h2><\/li><li id=\"field_18_5\"  class=\"gfield mt_25 gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_5\"><label class='gfield_label gfield_label_before_complex'  >\u7167\u62a4\u8005\u540d\u5b57<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_18_5'>\n                            \n                            <span id='input_18_5_3_container' class='name_first' >\n                                                    <input type='text' name='input_5.3' id='input_18_5_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_18_5_3' >First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_18_5_6_container' class='name_last' >\n                                                    <input type='text' name='input_5.6' id='input_18_5_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_18_5_6' >Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_18_7\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_7\"><label class='gfield_label' for='input_18_7' >\u7535\u8bdd\u53f7\u7801<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_7' id='input_18_7' type='text' value='' class='medium'  placeholder='(555) 555-5555' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_9\"  class=\"gfield mt_25 gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_9\"><label class='gfield_label' for='input_18_9' >\u7167\u62a4\u8005\u7535\u5b50\u90ae\u7bb1\u5730\u5740<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_9' id='input_18_9' type='text' value='' class='medium'   placeholder='youremail@website.com' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_18_47\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_47\"><label class='gfield_label' for='input_18_47' >\u7167\u62a4\u8005\u5c45\u4f4f\u5730\u90ae\u653f\u7f16\u7801<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_18_47' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_18_54\"  class=\"gfield gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_18_54\">\u8bf7\u786e\u4fdd\u60a8\u8f93\u5165\u7684\u90ae\u653f\u7f16\u7801\u6709\u6548\u4ee5\u7ee7\u7eed\u3002<\/li><li id=\"field_18_55\"  class=\"gfield gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_55\">\u60a8\u6682\u4e0d\u7b26\u5408\u672c\u9879\u76ee\u53c2\u4e0e\u8d44\u683c\u3002\u8bf7\u70b9\u51fb\u201c\u63d0\u4ea4\u201d\u4ee5\u7ed3\u675f\u672c\u6b21\u95ee\u5377\u586b\u5199\u3002 <\/li><li id=\"field_18_13\"  class=\"gfield mt_25 custom_flex_style three gf_list_3col gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_18_13\"><label class='gfield_label gfield_label_before_complex'  >\u7167\u62a4\u8005\u65cf\u88d4<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_18_13'>\uff08\u8bf7\u52fe\u9009\u6240\u6709\u9002\u7528\u9879\uff09<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_18_13'><li class='gchoice gchoice_18_13_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.1' type='checkbox'  value='Alaska Native'  id='choice_18_13_1'   aria-describedby=\"gfield_description_18_13\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_18_13_1' id='label_18_13_1'>\u963f\u62c9\u65af\u52a0\u539f\u4f4f\u6c11<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_13_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.2' type='checkbox'  value='American Indian'  id='choice_18_13_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_13_2' id='label_18_13_2'>\u7f8e\u6d32\u5370\u7b2c\u5b89\u4eba<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_13_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.3' type='checkbox'  value='Asian'  id='choice_18_13_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_13_3' id='label_18_13_3'>\u4e9a\u88d4<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_13_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.4' type='checkbox'  value='Asian Indian'  id='choice_18_13_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_13_4' id='label_18_13_4'>\u5370\u5ea6\u88d4\u4e9a\u88d4<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_13_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.5' type='checkbox'  value='Cambodian'  id='choice_18_13_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_13_5' id='label_18_13_5'>\u67ec\u57d4\u5be8\u88d4<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_13_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.6' type='checkbox'  value='Chinese'  id='choice_18_13_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_13_6' id='label_18_13_6'>\u534e\u88d4<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_13_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.7' type='checkbox'  value='Filipino'  id='choice_18_13_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_13_7' id='label_18_13_7'>\u83f2\u5f8b\u5bbe\u88d4<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_13_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.8' type='checkbox'  value='Japanese'  id='choice_18_13_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_13_8' id='label_18_13_8'>\u65e5\u88d4<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_13_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.9' type='checkbox'  value='Korean'  id='choice_18_13_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_13_9' id='label_18_13_9'>\u97e9\u88d4<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_13_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.11' type='checkbox'  value='Laotian'  id='choice_18_13_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_13_11' id='label_18_13_11'>\u8001\u631d\u88d4<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_13_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.12' type='checkbox'  value='Vietnamese'  id='choice_18_13_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_13_12' id='label_18_13_12'>\u8d8a\u5357\u88d4<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_13_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.13' type='checkbox'  value='Other Asian'  id='choice_18_13_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_13_13' id='label_18_13_13'>\u5176\u4ed6\u4e9a\u88d4<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_13_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.14' type='checkbox'  value='Black or African American'  id='choice_18_13_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_13_14' id='label_18_13_14'>\u9ed1\u4eba\/\u975e\u88d4\u7f8e\u56fd\u4eba<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_13_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.15' type='checkbox'  value='Hispanic or Latino'  id='choice_18_13_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_13_15' id='label_18_13_15'>\u897f\u73ed\u7259\u88d4\/\u62c9\u4e01\u88d4<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_13_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.16' type='checkbox'  value='Native Hawaiian\/Other Pacific Islander'  id='choice_18_13_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_13_16' id='label_18_13_16'>\u590f\u5a01\u5937\u539f\u4f4f\u6c11\/\u5176\u4ed6\u592a\u5e73\u6d0b\u5c9b\u6c11<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_13_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.17' type='checkbox'  value='Guamanian'  id='choice_18_13_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_13_17' id='label_18_13_17'>\u5173\u5c9b\u88d4<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_13_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.18' type='checkbox'  value='Hawaiian'  id='choice_18_13_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_13_18' id='label_18_13_18'>\u590f\u5a01\u5937\u88d4<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_13_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.19' type='checkbox'  value='Samoan'  id='choice_18_13_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_13_19' id='label_18_13_19'>\u8428\u6469\u4e9a\u88d4<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_13_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.21' type='checkbox'  value='Other Pacific Islander'  id='choice_18_13_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_13_21' id='label_18_13_21'>\u5176\u4ed6\u592a\u5e73\u6d0b\u5c9b\u6c11<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_13_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.22' type='checkbox'  value='White'  id='choice_18_13_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_13_22' id='label_18_13_22'>\u767d\u4eba<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_13_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.23' type='checkbox'  value='Prefer not to disclose'  id='choice_18_13_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_13_23' id='label_18_13_23'>\u4e0d\u613f\u900f\u9732<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_44\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_44\"><label class='gfield_label'  >\u8bed\u8a00\u504f\u597d<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_44'>\n\t\t\t<li class='gchoice gchoice_18_44_0'>\n\t\t\t\t<input name='input_44' type='radio' value='English'  id='choice_18_44_0'    \/>\n\t\t\t\t<label for='choice_18_44_0' id='label_18_44_0'>\u82f1\u8bed<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_44_1'>\n\t\t\t\t<input name='input_44' type='radio' value='Spanish'  id='choice_18_44_1'    \/>\n\t\t\t\t<label for='choice_18_44_1' id='label_18_44_1'>\u897f\u73ed\u7259\u8bed<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_44_2'>\n\t\t\t\t<input name='input_44' type='radio' value='Mandarin'  id='choice_18_44_2'    \/>\n\t\t\t\t<label for='choice_18_44_2' id='label_18_44_2'>\u666e\u901a\u8bdd<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_41\"  class=\"gfield mt_25 custom_flex_style three gf_list_3col gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_41\"><label class='gfield_label'  >\u7167\u62a4\u8005\u5e74\u9f84<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_41'>\n\t\t\t<li class='gchoice gchoice_18_41_0'>\n\t\t\t\t<input name='input_41' type='radio' value='18-29'  id='choice_18_41_0'    \/>\n\t\t\t\t<label for='choice_18_41_0' id='label_18_41_0'>18-29<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_41_1'>\n\t\t\t\t<input name='input_41' type='radio' value='30-39'  id='choice_18_41_1'    \/>\n\t\t\t\t<label for='choice_18_41_1' id='label_18_41_1'>30-39<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_41_2'>\n\t\t\t\t<input name='input_41' type='radio' value='40-49'  id='choice_18_41_2'    \/>\n\t\t\t\t<label for='choice_18_41_2' id='label_18_41_2'>40-49<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_41_3'>\n\t\t\t\t<input name='input_41' type='radio' value='50-59'  id='choice_18_41_3'    \/>\n\t\t\t\t<label for='choice_18_41_3' id='label_18_41_3'>50-59<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_41_4'>\n\t\t\t\t<input name='input_41' type='radio' value='60-64'  id='choice_18_41_4'    \/>\n\t\t\t\t<label for='choice_18_41_4' id='label_18_41_4'>60-64<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_41_5'>\n\t\t\t\t<input name='input_41' type='radio' value='65-69'  id='choice_18_41_5'    \/>\n\t\t\t\t<label for='choice_18_41_5' id='label_18_41_5'>65-69<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_41_6'>\n\t\t\t\t<input name='input_41' type='radio' value='70-74'  id='choice_18_41_6'    \/>\n\t\t\t\t<label for='choice_18_41_6' id='label_18_41_6'>70-74<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_41_7'>\n\t\t\t\t<input name='input_41' type='radio' value='75-79'  id='choice_18_41_7'    \/>\n\t\t\t\t<label for='choice_18_41_7' id='label_18_41_7'>75-79<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_41_8'>\n\t\t\t\t<input name='input_41' type='radio' value='80-85'  id='choice_18_41_8'    \/>\n\t\t\t\t<label for='choice_18_41_8' id='label_18_41_8'>80-85<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_41_9'>\n\t\t\t\t<input name='input_41' type='radio' value='85+'  id='choice_18_41_9'    \/>\n\t\t\t\t<label for='choice_18_41_9' id='label_18_41_9'>85+<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_26\"  class=\"gfield gsection custom_section_style one mt_40 field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_26\"><h2 class=\"gsection_title\">\u8bf7\u63d0\u4f9b\u88ab\u7167\u62a4\u8005\u7684\u8865\u5145\u4fe1\u606f\u3002<\/h2><\/li><li id=\"field_18_15\"  class=\"gfield mt_25 gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_15\"><label class='gfield_label gfield_label_before_complex'  >\u88ab\u7167\u62a4\u8005\u540d\u5b57<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_18_15'>\n                            \n                            <span id='input_18_15_3_container' class='name_first' >\n                                                    <input type='text' name='input_15.3' id='input_18_15_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_18_15_3' >First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_18_15_6_container' class='name_last' >\n                                                    <input type='text' name='input_15.6' id='input_18_15_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_18_15_6' >Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_18_16\"  class=\"gfield mt_25 gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_16\"><label class='gfield_label'  >\u88ab\u7167\u62a4\u8005\u5e74\u9f84\u662f\u591a\u5c11\uff1f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_16'>\n\t\t\t<li class='gchoice gchoice_18_16_0'>\n\t\t\t\t<input name='input_16' type='radio' value='60 years old or older'  id='choice_18_16_0'    \/>\n\t\t\t\t<label for='choice_18_16_0' id='label_18_16_0'>60 \u5c81\u53ca\u4ee5\u4e0a<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_16_1'>\n\t\t\t\t<input name='input_16' type='radio' value='Less than 60 years old'  id='choice_18_16_1'    \/>\n\t\t\t\t<label for='choice_18_16_1' id='label_18_16_1'>\u672a\u6ee1 60 \u5c81<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_17\"  class=\"gfield mt_25 custom_flex_style three gf_list_3col gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_18_17\"><label class='gfield_label gfield_label_before_complex'  >\u88ab\u7167\u62a4\u8005\u88ab\u8bca\u65ad\u60a3\u6709\u4ee5\u4e0b\u54ea\u4e9b\u75be\u75c5\uff1f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_18_17'>\uff08\u8bf7\u52fe\u9009\u6240\u6709\u9002\u7528\u9879\uff09<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_18_17'><li class='gchoice gchoice_18_17_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.1' type='checkbox'  value='Alzheimer\u2019s disease'  id='choice_18_17_1'   aria-describedby=\"gfield_description_18_17\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_18_17_1' id='label_18_17_1'>\u963f\u5c14\u8328\u6d77\u9ed8\u75c5<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_17_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.2' type='checkbox'  value='Mild cognitive impairments'  id='choice_18_17_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_17_2' id='label_18_17_2'>\u8f7b\u5ea6\u8ba4\u77e5\u969c\u788d<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_17_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.3' type='checkbox'  value='Traumatic brain injury'  id='choice_18_17_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_17_3' id='label_18_17_3'>\u521b\u4f24\u6027\u8111\u635f\u4f24<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_17_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.4' type='checkbox'  value='Vascular and mixed dementia'  id='choice_18_17_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_17_4' id='label_18_17_4'>\u8840\u7ba1\u6027\u75f4\u5446\u53ca\u6df7\u5408\u578b\u75f4\u5446<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_17_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.5' type='checkbox'  value='Parkinson\u2019s disease'  id='choice_18_17_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_17_5' id='label_18_17_5'>\u5e15\u91d1\u68ee\u75c5<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_17_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.6' type='checkbox'  value='Huntington\u2019s disease'  id='choice_18_17_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_17_6' id='label_18_17_6'>\u4ea8\u5ef7\u987f\u821e\u8e48\u75c7<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_17_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.7' type='checkbox'  value='Other'  id='choice_18_17_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_17_7' id='label_18_17_7'>\u5176\u4ed6<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_17_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.8' type='checkbox'  value='None'  id='choice_18_17_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_17_8' id='label_18_17_8'>\u65e0<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_45\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_45\"><label class='gfield_label' for='input_18_45' >\u60a8\u9009\u62e9\u4e86\u201c\u5176\u4ed6\u201d\uff0c\u8bf7\u8bf4\u660e<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_18_45' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_18_42\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_42\"><label class='gfield_label'  >\u88ab\u7167\u62a4\u8005\u662f\u5426\u4eab\u6709 Medi\u2011Cal\uff1f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_42'>\n\t\t\t<li class='gchoice gchoice_18_42_0'>\n\t\t\t\t<input name='input_42' type='radio' value='Yes'  id='choice_18_42_0'    \/>\n\t\t\t\t<label for='choice_18_42_0' id='label_18_42_0'>\u662f<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_42_1'>\n\t\t\t\t<input name='input_42' type='radio' value='No'  id='choice_18_42_1'    \/>\n\t\t\t\t<label for='choice_18_42_1' id='label_18_42_1'>\u5426<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_48\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_48\"><label class='gfield_label'  >\u5176 Medi-Cal \u627f\u4fdd\u673a\u6784\u4e3a Santa Clara Family Health Plan\u3001Kaiser \u8fd8\u662f Anthem\uff1f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_48'>\n\t\t\t<li class='gchoice gchoice_18_48_0'>\n\t\t\t\t<input name='input_48' type='radio' value='Santa Clara Family Health Plan'  id='choice_18_48_0'    \/>\n\t\t\t\t<label for='choice_18_48_0' id='label_18_48_0'>Santa Clara Family Health Plan<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_48_1'>\n\t\t\t\t<input name='input_48' type='radio' value='Kaiser'  id='choice_18_48_1'    \/>\n\t\t\t\t<label for='choice_18_48_1' id='label_18_48_1'>Kaiser<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_48_2'>\n\t\t\t\t<input name='input_48' type='radio' value='Anthem'  id='choice_18_48_2'    \/>\n\t\t\t\t<label for='choice_18_48_2' id='label_18_48_2'>Anthem<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_48_3'>\n\t\t\t\t<input name='input_48' type='radio' value='Not sure'  id='choice_18_48_3'    \/>\n\t\t\t\t<label for='choice_18_48_3' id='label_18_48_3'>\u4e0d\u6e05\u695a<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_48_4'>\n\t\t\t\t<input name='input_48' type='radio' value='None of the above'  id='choice_18_48_4'    \/>\n\t\t\t\t<label for='choice_18_48_4' id='label_18_48_4'>\u4ee5\u4e0a\u90fd\u4e0d\u662f<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_58\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_58\"><label class='gfield_label'  >\u7167\u62a4\u8005\u662f\u5426\u901a\u8fc7 Medi-Cal \u4eab\u53d7\u5c45\u5bb6\u652f\u6301\u670d\u52a1 (IHSS)\uff1f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_58'>\n\t\t\t<li class='gchoice gchoice_18_58_0'>\n\t\t\t\t<input name='input_58' type='radio' value='Yes'  id='choice_18_58_0'    \/>\n\t\t\t\t<label for='choice_18_58_0' id='label_18_58_0'>\u662f<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_58_1'>\n\t\t\t\t<input name='input_58' type='radio' value='No'  id='choice_18_58_1'    \/>\n\t\t\t\t<label for='choice_18_58_1' id='label_18_58_1'>\u5426<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_18\"  class=\"gfield mt_25 custom_flex_style three gf_list_3col gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_18_18\"><label class='gfield_label gfield_label_before_complex'  >\u88ab\u7167\u62a4\u8005\u5728\u4ee5\u4e0b\u4e8b\u9879\u4e2d\u662f\u5426\u9700\u8981\u534f\u52a9\uff1f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_18_18'>\uff08\u8bf7\u52fe\u9009\u6240\u6709\u9002\u7528\u9879\uff09<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_18_18'><li class='gchoice gchoice_18_18_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.1' type='checkbox'  value='Feeding'  id='choice_18_18_1'   aria-describedby=\"gfield_description_18_18\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_18_18_1' id='label_18_18_1'>\u8fdb\u98df<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_18_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.2' type='checkbox'  value='Dressing'  id='choice_18_18_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_18_2' id='label_18_18_2'>\u7a7f\u8863<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_18_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.3' type='checkbox'  value='Bathing'  id='choice_18_18_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_18_3' id='label_18_18_3'>\u6d17\u6fa1<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_18_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.4' type='checkbox'  value='Toileting'  id='choice_18_18_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_18_4' id='label_18_18_4'>\u5982\u5395<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_18_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.5' type='checkbox'  value='Transferring (i.e., in and out of a chair)'  id='choice_18_18_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_18_5' id='label_18_18_5'>\u79fb\u4f4d\uff08\u5982\u4e0a\u4e0b\u5ea7\u6905\uff09<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_18_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.6' type='checkbox'  value='Walking'  id='choice_18_18_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_18_6' id='label_18_18_6'>\u884c\u8d70<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_18_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.7' type='checkbox'  value='None'  id='choice_18_18_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_18_7' id='label_18_18_7'>\u65e0<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_19\"  class=\"gfield mt_25 gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_19\"><label class='gfield_label'  >\u5728\u8fc7\u53bb 3 \u4e2a\u6708\u4e2d\uff0c\u662f\u5426\u56e0\u65e0\u53ef\u9760\u51fa\u884c\u5de5\u5177\uff0c\u5bfc\u81f4\u88ab\u7167\u62a4\u8005\u65e0\u6cd5\u5c31\u533b\u3001\u8d74\u7ea6\u3001\u5de5\u4f5c\uff0c\u6216\u65e0\u6cd5\u8d2d\u7f6e\u751f\u6d3b\u5fc5\u9700\u54c1\uff1f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_19'>\n\t\t\t<li class='gchoice gchoice_18_19_0'>\n\t\t\t\t<input name='input_19' type='radio' value='Yes'  id='choice_18_19_0'    \/>\n\t\t\t\t<label for='choice_18_19_0' id='label_18_19_0'>\u662f<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_19_1'>\n\t\t\t\t<input name='input_19' type='radio' value='No'  id='choice_18_19_1'    \/>\n\t\t\t\t<label for='choice_18_19_1' id='label_18_19_1'>\u5426<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_20\"  class=\"gfield mt_25 gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_20\"><label class='gfield_label'  >\u5728\u8fc7\u53bb 3 \u4e2a\u6708\u4e2d\uff0c\u662f\u5426\u56e0\u5bb6\u4e2d\u98df\u7269\u4e0d\u8db3\u3001\u6ca1\u94b1\u91c7\u8d2d\uff0c\u5bfc\u81f4\u88ab\u7167\u62a4\u8005\u8fdb\u98df\u91cf\u4f4e\u4e8e\u6b63\u5e38\u6c34\u5e73\uff1f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_20'>\n\t\t\t<li class='gchoice gchoice_18_20_0'>\n\t\t\t\t<input name='input_20' type='radio' value='Yes'  id='choice_18_20_0'    \/>\n\t\t\t\t<label for='choice_18_20_0' id='label_18_20_0'>\u662f<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_20_1'>\n\t\t\t\t<input name='input_20' type='radio' value='\u5426'  id='choice_18_20_1'    \/>\n\t\t\t\t<label for='choice_18_20_1' id='label_18_20_1'>\u5426<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_21\"  class=\"gfield mt_25 gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_21\"><label class='gfield_label'  >\u5728\u8fc7\u53bb 3 \u4e2a\u6708\u4e2d\uff0c\u88ab\u7167\u62a4\u8005\u524d\u5f80\u6025\u8bca\u5ba4\u5c31\u8bca\u4f46\u672a\u4f4f\u9662\u7684\u6b21\u6570\u662f\u591a\u5c11\uff1f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_21'>\n\t\t\t<li class='gchoice gchoice_18_21_0'>\n\t\t\t\t<input name='input_21' type='radio' value='0'  id='choice_18_21_0'    \/>\n\t\t\t\t<label for='choice_18_21_0' id='label_18_21_0'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_21_1'>\n\t\t\t\t<input name='input_21' type='radio' value='1'  id='choice_18_21_1'    \/>\n\t\t\t\t<label for='choice_18_21_1' id='label_18_21_1'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_21_2'>\n\t\t\t\t<input name='input_21' type='radio' value='2'  id='choice_18_21_2'    \/>\n\t\t\t\t<label for='choice_18_21_2' id='label_18_21_2'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_21_3'>\n\t\t\t\t<input name='input_21' type='radio' value='3+'  id='choice_18_21_3'    \/>\n\t\t\t\t<label for='choice_18_21_3' id='label_18_21_3'>3+<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_22\"  class=\"gfield mt_25 gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_22\"><label class='gfield_label'  >\u5728\u8fc7\u53bb 3 \u4e2a\u6708\u4e2d\uff0c\u88ab\u7167\u62a4\u8005\u4f4f\u9662\uff08\u5728\u533b\u9662\u8fc7\u591c\u6216\u66f4\u957f\u65f6\u95f4\uff09\u7684\u6b21\u6570\u662f\u591a\u5c11\uff1f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_22'>\n\t\t\t<li class='gchoice gchoice_18_22_0'>\n\t\t\t\t<input name='input_22' type='radio' value='0'  id='choice_18_22_0'    \/>\n\t\t\t\t<label for='choice_18_22_0' id='label_18_22_0'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_22_1'>\n\t\t\t\t<input name='input_22' type='radio' value='1'  id='choice_18_22_1'    \/>\n\t\t\t\t<label for='choice_18_22_1' id='label_18_22_1'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_22_2'>\n\t\t\t\t<input name='input_22' type='radio' value='2'  id='choice_18_22_2'    \/>\n\t\t\t\t<label for='choice_18_22_2' id='label_18_22_2'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_22_3'>\n\t\t\t\t<input name='input_22' type='radio' value='3+'  id='choice_18_22_3'    \/>\n\t\t\t\t<label for='choice_18_22_3' id='label_18_22_3'>3+<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_23\"  class=\"gfield mt_25 gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_23\"><label class='gfield_label' for='input_18_23' >\u60a8\u7684\u7167\u62a4\u5bf9\u8c61\u603b\u5171\u5728\u533b\u9662\u4f4f\u4e86\u591a\u5c11\u665a\uff1f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_23' id='input_18_23' class='small gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>- \u9009\u62e9 -<\/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><option value='32' >32<\/option><option value='33' >33<\/option><option value='34' >34<\/option><option value='35' >35<\/option><option value='36' >36<\/option><option value='37' >37<\/option><option value='38' >38<\/option><option value='39' >39<\/option><option value='40' >40<\/option><option value='41' >41<\/option><option value='42' >42<\/option><option value='43' >43<\/option><option value='44' >44<\/option><option value='45' >45<\/option><option value='46' >46<\/option><option value='47' >47<\/option><option value='48' >48<\/option><option value='49' >49<\/option><option value='50' >50<\/option><option value='51' >51<\/option><option value='52' >52<\/option><option value='53' >53<\/option><option value='54' >54<\/option><option value='55' >55<\/option><option value='56' >56<\/option><option value='57' >57<\/option><option value='58' >58<\/option><option value='59' >59<\/option><option value='60' >60<\/option><option value='61' >61<\/option><option value='62' >62<\/option><option value='63' >63<\/option><option value='64' >64<\/option><option value='65' >65<\/option><option value='66' >66<\/option><option value='67' >67<\/option><option value='68' >68<\/option><option value='69' >69<\/option><option value='70' >70<\/option><option value='71' >71<\/option><option value='72' >72<\/option><option value='73' >73<\/option><option value='74' >74<\/option><option value='75' >75<\/option><option value='76' >76<\/option><option value='77' >77<\/option><option value='78' >78<\/option><option value='79' >79<\/option><option value='80' >80<\/option><option value='81' >81<\/option><option value='82' >82<\/option><option value='83' >83<\/option><option value='84' >84<\/option><option value='85' >85<\/option><option value='86' >86<\/option><option value='87' >87<\/option><option value='88' >88<\/option><option value='89' >89<\/option><option value='90' >90<\/option><option value='91' >91<\/option><option value='92' >92<\/option><option value='93' >93<\/option><option value='94' >94<\/option><option value='95' >95<\/option><option value='96' >96<\/option><option value='97' >97<\/option><option value='98' >98<\/option><option value='99' >99<\/option><\/select><\/div><\/li><li id=\"field_18_27\"  class=\"gfield gsection custom_section_style one mt_40 field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_27\"><h2 class=\"gsection_title\">\u4e3a\u4e86\u66f4\u597d\u5730\u5e2e\u52a9\u60a8\uff0c\u8bf7\u8c08\u8c08\u60a8\u4f5c\u4e3a\u7167\u62a4\u8005\u7684\u8eab\u5fc3\u611f\u53d7<\/h2><\/li><li id=\"field_18_28\"  class=\"gfield gf_list_inline radio_btns_inline_style_one mt_25 custom_rating_style gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_18_28\"><label class='gfield_label'  >\u8bf7\u6309\u7167 1-10 \u5206\u4e3a\u60a8\u7684\u538b\u529b\u7a0b\u5ea6\u6253\u5206\u3002<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_18_28'>\uff08<span style=\"color:#24a061;font-weight: 700\">1 \u5206\uff1d\u65e0\u538b\u529b<\/span>\uff0c<span style=\"color:#cd3c27;font-weight: 700\">10 \u5206\uff1d\u538b\u529b\u6781\u5927<\/span>\uff09<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_28'>\n\t\t\t<li class='gchoice gchoice_18_28_0'>\n\t\t\t\t<input name='input_28' type='radio' value='1'  id='choice_18_28_0'    \/>\n\t\t\t\t<label for='choice_18_28_0' id='label_18_28_0'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_28_1'>\n\t\t\t\t<input name='input_28' type='radio' value='2'  id='choice_18_28_1'    \/>\n\t\t\t\t<label for='choice_18_28_1' id='label_18_28_1'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_28_2'>\n\t\t\t\t<input name='input_28' type='radio' value='3'  id='choice_18_28_2'    \/>\n\t\t\t\t<label for='choice_18_28_2' id='label_18_28_2'>3<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_28_3'>\n\t\t\t\t<input name='input_28' type='radio' value='4'  id='choice_18_28_3'    \/>\n\t\t\t\t<label for='choice_18_28_3' id='label_18_28_3'>4<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_28_4'>\n\t\t\t\t<input name='input_28' type='radio' value='5'  id='choice_18_28_4'    \/>\n\t\t\t\t<label for='choice_18_28_4' id='label_18_28_4'>5<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_28_5'>\n\t\t\t\t<input name='input_28' type='radio' value='6'  id='choice_18_28_5'    \/>\n\t\t\t\t<label for='choice_18_28_5' id='label_18_28_5'>6<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_28_6'>\n\t\t\t\t<input name='input_28' type='radio' value='7'  id='choice_18_28_6'    \/>\n\t\t\t\t<label for='choice_18_28_6' id='label_18_28_6'>7<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_28_7'>\n\t\t\t\t<input name='input_28' type='radio' value='8'  id='choice_18_28_7'    \/>\n\t\t\t\t<label for='choice_18_28_7' id='label_18_28_7'>8<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_28_8'>\n\t\t\t\t<input name='input_28' type='radio' value='9'  id='choice_18_28_8'    \/>\n\t\t\t\t<label for='choice_18_28_8' id='label_18_28_8'>9<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_28_9'>\n\t\t\t\t<input name='input_28' type='radio' value='10'  id='choice_18_28_9'    \/>\n\t\t\t\t<label for='choice_18_28_9' id='label_18_28_9'>10<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_43\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_43\"><label class='gfield_label'  >\u4f5c\u4e3a\u4e3b\u8981\u7167\u62a4\u8005\uff0c\u60a8\u7684\u538b\u529b\u6765\u6e90\u662f\u4ec0\u4e48\uff1f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_43'>\n\t\t\t<li class='gchoice gchoice_18_43_0'>\n\t\t\t\t<input name='input_43' type='radio' value='Caregiving responsibilities'  id='choice_18_43_0'    \/>\n\t\t\t\t<label for='choice_18_43_0' id='label_18_43_0'>\u7167\u62a4\u8d23\u4efb<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_43_1'>\n\t\t\t\t<input name='input_43' type='radio' value='Something other than caregiving'  id='choice_18_43_1'    \/>\n\t\t\t\t<label for='choice_18_43_1' id='label_18_43_1'>\u7167\u62a4\u4ee5\u5916\u7684\u5176\u4ed6\u4e8b\u60c5<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_43_2'>\n\t\t\t\t<input name='input_43' type='radio' value='Both'  id='choice_18_43_2'    \/>\n\t\t\t\t<label for='choice_18_43_2' id='label_18_43_2'>\u4e24\u8005\u7686\u6709<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_37\"  class=\"gfield gsection custom_section_style one mt_40 field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_37\"><h2 class=\"gsection_title\">\u8fc7\u53bb 2 \u5468\uff0c\u60a8\u51fa\u73b0\u4ee5\u4e0b\u56f0\u6270\u7684\u9891\u7387\u5982\u4f55\uff1f<\/h2><\/li><li id=\"field_18_38\"  class=\"gfield mt_25 gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_18_38\"><label class='gfield_label'  >\u505a\u4e8b\u63d0\u4e0d\u8d77\u5174\u8da3\u3001\u611f\u53d7\u4e0d\u5230\u6109\u60a6<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_38'>\n\t\t\t<li class='gchoice gchoice_18_38_0'>\n\t\t\t\t<input name='input_38' type='radio' value='0'  id='choice_18_38_0'    \/>\n\t\t\t\t<label for='choice_18_38_0' id='label_18_38_0'>\u5b8c\u5168\u6ca1\u6709<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_38_1'>\n\t\t\t\t<input name='input_38' type='radio' value='1'  id='choice_18_38_1'    \/>\n\t\t\t\t<label for='choice_18_38_1' id='label_18_38_1'>\u6570\u65e5\u5b58\u5728<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_38_2'>\n\t\t\t\t<input name='input_38' type='radio' value='2'  id='choice_18_38_2'    \/>\n\t\t\t\t<label for='choice_18_38_2' id='label_18_38_2'>\u8d85\u534a\u6570\u65f6\u65e5\u5b58\u5728<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_38_3'>\n\t\t\t\t<input name='input_38' type='radio' value='3'  id='choice_18_38_3'    \/>\n\t\t\t\t<label for='choice_18_38_3' id='label_18_38_3'>\u51e0\u4e4e\u6bcf\u65e5\u5982\u6b64<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_39\"  class=\"gfield mt_25 gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_18_39\"><label class='gfield_label'  >\u60c5\u7eea\u4f4e\u843d\u3001\u6291\u90c1\u6216\u611f\u5230\u65e0\u671b<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_39'>\n\t\t\t<li class='gchoice gchoice_18_39_0'>\n\t\t\t\t<input name='input_39' type='radio' value='0'  id='choice_18_39_0'    \/>\n\t\t\t\t<label for='choice_18_39_0' id='label_18_39_0'>\u5b8c\u5168\u6ca1\u6709<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_39_1'>\n\t\t\t\t<input name='input_39' type='radio' value='1'  id='choice_18_39_1'    \/>\n\t\t\t\t<label for='choice_18_39_1' id='label_18_39_1'>\u6570\u65e5\u5b58\u5728<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_39_2'>\n\t\t\t\t<input name='input_39' type='radio' value='2'  id='choice_18_39_2'    \/>\n\t\t\t\t<label for='choice_18_39_2' id='label_18_39_2'>\u8d85\u534a\u6570\u65f6\u65e5\u5b58\u5728<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_39_3'>\n\t\t\t\t<input name='input_39' type='radio' value='3'  id='choice_18_39_3'    \/>\n\t\t\t\t<label for='choice_18_39_3' id='label_18_39_3'>\u51e0\u4e4e\u6bcf\u65e5\u5982\u6b64<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_29\"  class=\"gfield gfield--width-full mt_25 gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_18_29\"><label class='gfield_label'  >\u60a8\u662f\u5426\u9700\u8981\u6682\u65f6\u8131\u79bb\u7167\u62a4\u5de5\u4f5c\u6216\u83b7\u5f97\u5598\u606f\u7167\u62a4\u670d\u52a1\uff1f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_29'>\n\t\t\t<li class='gchoice gchoice_18_29_0'>\n\t\t\t\t<input name='input_29' type='radio' value='Yes'  id='choice_18_29_0'    \/>\n\t\t\t\t<label for='choice_18_29_0' id='label_18_29_0'>\u662f<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_29_1'>\n\t\t\t\t<input name='input_29' type='radio' value='No'  id='choice_18_29_1'    \/>\n\t\t\t\t<label for='choice_18_29_1' id='label_18_29_1'>\u5426<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_30\"  class=\"gfield gfield--width-full mt_25 field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_18_30\"><label class='gfield_label'  >\u60a8\u76ee\u524d\u662f\u5426\u5df2\u4ed8\u8d39\u8bf7\u4eba\u534f\u52a9\u7167\u6599\uff1f<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_30'>\n\t\t\t<li class='gchoice gchoice_18_30_0'>\n\t\t\t\t<input name='input_30' type='radio' value='Yes'  id='choice_18_30_0'    \/>\n\t\t\t\t<label for='choice_18_30_0' id='label_18_30_0'>\u662f<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_30_1'>\n\t\t\t\t<input name='input_30' type='radio' value='\u5426'  id='choice_18_30_1'    \/>\n\t\t\t\t<label for='choice_18_30_1' id='label_18_30_1'>\u5426<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_31\"  class=\"gfield gfield--width-full mt_25 field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_18_31\"><label class='gfield_label'  >\u534f\u52a9\u60a8\u7167\u6599\u7684\u4eba\u5458\u662f\u5426\u96b6\u5c5e\u4e8e\u673a\u6784\uff1f<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_31'>\n\t\t\t<li class='gchoice gchoice_18_31_0'>\n\t\t\t\t<input name='input_31' type='radio' value='Yes'  id='choice_18_31_0'    \/>\n\t\t\t\t<label for='choice_18_31_0' id='label_18_31_0'>\u662f<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_31_1'>\n\t\t\t\t<input name='input_31' type='radio' value='No'  id='choice_18_31_1'    \/>\n\t\t\t\t<label for='choice_18_31_1' id='label_18_31_1'>\u5426<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_33\"  class=\"gfield gfield--width-full mt_25 field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_33\"><label class='gfield_label' for='input_18_33' >\u8be5\u673a\u6784\u7684\u540d\u79f0\u662f\u4ec0\u4e48\uff1f<\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_18_33' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_18_35\"  class=\"gfield gfield--width-full mt_25 field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_35\"><label class='gfield_label' for='input_18_35' >\u8be5\u673a\u6784\u7684\u8054\u7cfb\u7535\u8bdd\u662f\u591a\u5c11\uff1f<\/label><div class='ginput_container ginput_container_phone'><input name='input_35' id='input_18_35' type='text' value='' class='medium'  placeholder='(555) 555-5555'  aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_46\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_18_46\"><label class='gfield_label'  >\u60a8\u662f\u5426\u9700\u8981 Medicare \u76f8\u5173\u534f\u52a9\uff0c\u6216\u5bf9 Medi-Cal \u53c2\u4fdd\u8d44\u683c\u6709\u7591\u95ee\uff1f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_46'>\n\t\t\t<li class='gchoice gchoice_18_46_0'>\n\t\t\t\t<input name='input_46' type='radio' value='Yes'  id='choice_18_46_0'    \/>\n\t\t\t\t<label for='choice_18_46_0' id='label_18_46_0'>\u662f<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_46_1'>\n\t\t\t\t<input name='input_46' type='radio' value='No'  id='choice_18_46_1'    \/>\n\t\t\t\t<label for='choice_18_46_1' id='label_18_46_1'>\u5426<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_40\"  class=\"gfield mt_25 field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_18_40\"><label class='gfield_label' for='input_18_40' >\u60a8\u662f\u5426\u8fd8\u6709\u5176\u4ed6\u4e8b\u5b9c\u5e0c\u671b\u4e0e\u6211\u4eec\u6c9f\u901a\uff1f<\/label><div class='gfield_description' id='gfield_description_18_40'>\u5982\u6709\uff0c\u8bf7\u5728\u6b64\u586b\u5199<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_40' id='input_18_40' class='textarea medium'  aria-describedby=\"gfield_description_18_40\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_49\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_18_49\"><label class='gfield_label gfield_label_before_complex'  >\u6761\u6b3e\u4e0e\u6761\u4ef6<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_18_49'><p>\u6839\u636e\u300a\u7535\u8bdd\u6d88\u8d39\u8005\u4fdd\u62a4\u6cd5\u300b\uff08Telephone Consumer Protection Act\uff0c\u5728\u901a\u8fc7\u624b\u673a\u4e0e\u60a8\u8054\u7cfb\u4e4b\u524d\uff0c\u6211\u4eec\u901a\u5e38\u9700\u8981\u83b7\u5f97\u60a8\u7684\u540c\u610f\u3002\u6ce8\u518c\u53c2\u52a0\u672c\u9879\u76ee\u5373\u8868\u793a\u60a8\u540c\u610f GoMo Health \u4f7f\u7528\u77ed\u4fe1\u53f7\u7801 43386 \u5411\u60a8\u6ce8\u518c\u65f6\u63d0\u4f9b\u7684\u624b\u673a\u53f7\u7801\u53d1\u9001\u77ed\u4fe1\u3002\u60a8\u6bcf\u5468\u6700\u591a\u53ef\u80fd\u6536\u5230 12 \u6761\u77ed\u4fe1\u3002\u8bf7\u6ce8\u610f\uff0c\u6839\u636e\u60a8\u7684\u624b\u673a\u5957\u9910\uff0c\u60a8\u7684\u79fb\u52a8\u901a\u4fe1\u670d\u52a1\u63d0\u4f9b\u5546\u53ef\u80fd\u4f1a\u6536\u53d6\u77ed\u4fe1\u548c\u6570\u636e\u8d39\u7528\u3002\u60a8\u540c\u65f6\u786e\u8ba4\uff0c\u60a8\u662f\u6240\u63d0\u4f9b\u624b\u673a\u53f7\u7801\u7684\u65e0\u7ebf\u670d\u52a1\u7528\u6237\u6216\u6240\u6709\u8005\uff0c\u5e76\u6709\u6743\u63d0\u4f9b\u6b64\u9879\u540c\u610f\u3002 <br\/>\u5982\u9700\u5e2e\u52a9\uff0c\u8bf7\u53d1\u9001 HELP \u81f3 43386\u3002\u60a8\u53ef\u968f\u65f6\u53d1\u9001 STOP \u6216 STOPALL \u81f3 43386 \u9000\u51fa\u77ed\u4fe1\u670d\u52a1\u3002\u5982\u9700\u53d6\u6d88\u7535\u5b50\u90ae\u4ef6\u8ba2\u9605\uff0c\u8bf7\u70b9\u51fb\u60a8\u6536\u5230\u7684\u4efb\u4f55\u7535\u5b50\u90ae\u4ef6\u5e95\u90e8\u7684\u201cunsubscribe\uff08\u53d6\u6d88\u8ba2\u9605\uff09\u201d\u94fe\u63a5\u3002 <br\/>\u6761\u6b3e\u4e0e\u6761\u4ef6\u8bf7\u53c2\u9605\uff1a<a href=\"https:\/\/sourcewise.gomohealth.care\/zh-hans\/\">https:\/\/sourcewise.gomohealth.care\/<\/a>\u3002 <br\/>GoMo Health \u9690\u79c1\u653f\u7b56\u8bf7\u53c2\u9605\uff1a <a href=\"https:\/\/gomohealth.com\/privacy\/\">https:\/\/gomohealth.com\/privacy<\/a>\/\u3002         <\/p><\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_18_49'><li class='gchoice gchoice_18_49_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.1' type='checkbox'  value='I have fully read and agreed to the terms and conditions of this program.'  id='choice_18_49_1'   aria-describedby=\"gfield_description_18_49\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_18_49_1' id='label_18_49_1'>\u6211\u5df2\u5b8c\u6574\u9605\u8bfb\u5e76\u540c\u610f\u672c\u9879\u76ee\u7684\u6761\u6b3e\u4e0e\u6761\u4ef6\u3002<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_49_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.2' type='checkbox'  value='I have completed the enrollment form, provided electronic consent to enroll, and I grant permission to GoMo Health to contact my cell phone via text message from the phone number 43386.'  id='choice_18_49_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_49_2' id='label_18_49_2'>\u6211\u5df2\u5b8c\u6210\u6ce8\u518c\u8868\uff0c\u5df2\u63d0\u4f9b\u7535\u5b50\u540c\u610f\u53c2\u52a0\u672c\u9879\u76ee\uff0c\u5e76\u6388\u6743 GoMo Health \u4f7f\u7528\u77ed\u4fe1\u53f7\u7801 43386 \u5411\u6211\u7684\u624b\u673a\u53d1\u9001\u77ed\u4fe1\u3002<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><\/ul><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_18' class='gform_button button' value='\u63d0\u4ea4'  onclick='if(window[\"gf_submitting_18\"]){return false;}  window[\"gf_submitting_18\"]=true;  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_18\"]){return false;} window[\"gf_submitting_18\"]=true;  jQuery(\"#gform_18\").trigger(\"submit\",[true]); }' \/> <input type='hidden' name='gform_ajax' value='form_id=18&amp;title=&amp;description=&amp;tabindex=0' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_18' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='18' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_18' value='WyJ7XCI0NFwiOltcIjVhZTAwYzVmOTU4MWUwN2I3MDY2YzA2NmY3ZWZhNzQyXCIsXCIyNjQyZDVkZWVjNWM5NWFlMjU4ZWQ4MzE3ODc5MTUxOFwiLFwiN2Q4MDZkMzEzMzNjZGM4MTAyZmE0MDFlNDMyMzg1MmRcIl0sXCI0NlwiOltcIjdhOWIzMDAzZWU4NWYyYjMyZTM0NjgzNWY2Nzk3MTM1XCIsXCJiZTI4MGVlN2NmMDBjYzdmZTg5OGE4NzU5ZGUwZTUwMVwiXX0iLCIzYzMzZGI1NGE0NDA3ZTdmNTJhOWMxZDA5YTNlNGIyMiJd' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_18' id='gform_target_page_number_18' value='0' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_18' id='gform_source_page_number_18' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <p style=\"display: none !important;\"><label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"176\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><\/form>\n                        <\/div>\n                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_18' id='gform_ajax_frame_18' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n                <script type=\"text\/javascript\">\ngform.initializeOnLoaded( function() {gformInitSpinner( 18, '\/wp-content\/plugins\/gravityforms\/images\/spinner.svg' );jQuery('#gform_ajax_frame_18').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_18');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_18').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_18').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_18').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_18').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_18').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_18').val();gformInitSpinner( 18, '\/wp-content\/plugins\/gravityforms\/images\/spinner.svg' );jQuery(document).trigger('gform_page_loaded', [18, current_page]);window['gf_submitting_18'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_18').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_18').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [18]);window['gf_submitting_18'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_18').text());}, 50);}else{jQuery('#gform_18').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gform_post_render', [18, current_page]);} );} );\n<\/script>\n<\/div><style type=\"text\/css\">.fusion-body .fusion-builder-column-0{width:100% !important;margin-top : 0px;margin-bottom : 20px;}.fusion-builder-column-0 > .fusion-column-wrapper {padding-top : 0px !important;padding-right : 0px !important;margin-right : 1.92%;padding-bottom : 0px !important;padding-left : 0px !important;margin-left : 1.92%;}@media only screen and (max-width:1024px) {.fusion-body .fusion-builder-column-0{width:100% !important;order : 0;}.fusion-builder-column-0 > .fusion-column-wrapper {margin-right : 1.92%;margin-left : 1.92%;}}@media only screen and (max-width:640px) {.fusion-body .fusion-builder-column-0{width:100% !important;order : 0;}.fusion-builder-column-0 > .fusion-column-wrapper {margin-right : 1.92%;margin-left : 1.92%;}}<\/style><\/div><\/div><style type=\"text\/css\">.fusion-body .fusion-flex-container.fusion-builder-row-1{ padding-top : 0px;margin-top : 30px;padding-right : 0px;padding-bottom : 0px;margin-bottom : 30px;padding-left : 0px;}<\/style><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"inline_featured_image":false},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v19.10 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Enroll | Sourcewise<\/title>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"zh_CN\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Enroll | Sourcewise\" \/>\n<meta property=\"og:url\" content=\"https:\/\/sourcewise.gomohealth.care\/zh-hans\/enroll\/\" \/>\n<meta property=\"og:site_name\" content=\"Sourcewise\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"\u9884\u8ba1\u9605\u8bfb\u65f6\u95f4\" \/>\n\t<meta name=\"twitter:data1\" content=\"3\u5206\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/sourcewise.gomohealth.care\/zh-hans\/enroll\/\",\"url\":\"https:\/\/sourcewise.gomohealth.care\/zh-hans\/enroll\/\",\"name\":\"Enroll | Sourcewise\",\"isPartOf\":{\"@id\":\"https:\/\/sourcewise.gomohealth.care\/zh-hans\/#website\"},\"datePublished\":\"2026-07-22T13:23:03+00:00\",\"dateModified\":\"2026-07-22T13:23:03+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/sourcewise.gomohealth.care\/zh-hans\/enroll\/#breadcrumb\"},\"inLanguage\":\"zh-CN\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/sourcewise.gomohealth.care\/zh-hans\/enroll\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/sourcewise.gomohealth.care\/zh-hans\/enroll\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/sourcewise.gomohealth.care\/zh-hans\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Enroll\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/sourcewise.gomohealth.care\/zh-hans\/#website\",\"url\":\"https:\/\/sourcewise.gomohealth.care\/zh-hans\/\",\"name\":\"Sourcewise\",\"description\":\"Driven to advance targeted therapies where significant medical needs persist.\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/sourcewise.gomohealth.care\/zh-hans\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"zh-CN\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Enroll | Sourcewise","robots":{"index":"noindex","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"og_locale":"zh_CN","og_type":"article","og_title":"Enroll | Sourcewise","og_url":"https:\/\/sourcewise.gomohealth.care\/zh-hans\/enroll\/","og_site_name":"Sourcewise","twitter_card":"summary_large_image","twitter_misc":{"\u9884\u8ba1\u9605\u8bfb\u65f6\u95f4":"3\u5206"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/sourcewise.gomohealth.care\/zh-hans\/enroll\/","url":"https:\/\/sourcewise.gomohealth.care\/zh-hans\/enroll\/","name":"Enroll | Sourcewise","isPartOf":{"@id":"https:\/\/sourcewise.gomohealth.care\/zh-hans\/#website"},"datePublished":"2026-07-22T13:23:03+00:00","dateModified":"2026-07-22T13:23:03+00:00","breadcrumb":{"@id":"https:\/\/sourcewise.gomohealth.care\/zh-hans\/enroll\/#breadcrumb"},"inLanguage":"zh-CN","potentialAction":[{"@type":"ReadAction","target":["https:\/\/sourcewise.gomohealth.care\/zh-hans\/enroll\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/sourcewise.gomohealth.care\/zh-hans\/enroll\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/sourcewise.gomohealth.care\/zh-hans\/"},{"@type":"ListItem","position":2,"name":"Enroll"}]},{"@type":"WebSite","@id":"https:\/\/sourcewise.gomohealth.care\/zh-hans\/#website","url":"https:\/\/sourcewise.gomohealth.care\/zh-hans\/","name":"Sourcewise","description":"Driven to advance targeted therapies where significant medical needs persist.","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/sourcewise.gomohealth.care\/zh-hans\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"zh-CN"}]}},"_links":{"self":[{"href":"https:\/\/sourcewise.gomohealth.care\/zh-hans\/wp-json\/wp\/v2\/pages\/1519"}],"collection":[{"href":"https:\/\/sourcewise.gomohealth.care\/zh-hans\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/sourcewise.gomohealth.care\/zh-hans\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/sourcewise.gomohealth.care\/zh-hans\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/sourcewise.gomohealth.care\/zh-hans\/wp-json\/wp\/v2\/comments?post=1519"}],"version-history":[{"count":1,"href":"https:\/\/sourcewise.gomohealth.care\/zh-hans\/wp-json\/wp\/v2\/pages\/1519\/revisions"}],"predecessor-version":[{"id":1520,"href":"https:\/\/sourcewise.gomohealth.care\/zh-hans\/wp-json\/wp\/v2\/pages\/1519\/revisions\/1520"}],"wp:attachment":[{"href":"https:\/\/sourcewise.gomohealth.care\/zh-hans\/wp-json\/wp\/v2\/media?parent=1519"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}