{"id":6845,"date":"2025-11-04T15:23:31","date_gmt":"2025-11-04T20:23:31","guid":{"rendered":"https:\/\/periproxy.com\/?page_id=6845"},"modified":"2026-04-28T08:39:59","modified_gmt":"2026-04-28T13:39:59","slug":"delphi-mm-round-0","status":"publish","type":"page","link":"https:\/\/periproxy.com\/en\/delphi-mm-round-0\/","title":{"rendered":"Delphi MM &#8211; Round 0"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"6845\" class=\"elementor elementor-6845\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2acd1620 elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"2acd1620\" data-element_type=\"section\" data-e-type=\"section\" 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class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-2bb968c5\" data-id=\"2bb968c5\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7e0c595f elementor-widget elementor-widget-heading\" data-id=\"7e0c595f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Round 0<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-24718d5c elementor-section-stretched elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"24718d5c\" data-element_type=\"section\" data-e-type=\"section\" 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indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_195' id='gform_195'  action='\/en\/wp-json\/wp\/v2\/pages\/6845#gf_195' data-formid='195' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LfcVEokAAAAAGEsyVCmhFv4Q0tMXTKXOqoeR97w' data-tabindex='0'><input id=\"input_e42ee773ab1a9060fe9718be3ffddc7b\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_e42ee773ab1a9060fe9718be3ffddc7b\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_195_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_195' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_195_243\" class=\"gfield gfield--type-section gfield--input-type-section gsection no_number field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><h3 class=\"gsection_title\">Instructions<\/h3><\/div><div id=\"field_195_34\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><p style = \"color: #272c49; text-align: justify;\">This questionnaire is the first step of the Delphi consensus. The goal specifically is to gather your current perspective and experiences using chimeric antigen receptor T-cell (CAR-T) therapy and\/or bispecific antibodies (BsAb) for treating relapsed-refractory multiple myeloma (RRMM) in adults in an outpatient setting. The questions focus on the hospital set up required for administration of CAR-T and BsAb in an outpatient setting, the ideal patient profile, as well as the product risk profile for outpatient administration. We also seek to understand your opinion on the risks and benefits of providing these treatments in an outpatient setting.<\/p>\n<p style = \"color: #272c49; text-align: justify;\">This questionnaire includes three main sections: an initial section to confirm your eligibility, followed by sections focused on BsAb and CAR-T therapies. Depending on your clinical experience, you may be asked to complete one or both of the latter sections. The questionnaire consists of up to 52 questions and is expected to take approximately one hour to complete. Please respond based on your professional opinion and experience.<\/p>\n<p style = \"color: #272c49; text-align: justify;\">Your valuable input in this round will serve as the foundation for developing the statements that we will seek your consensus on in the next round.<\/p><\/div><div id=\"field_195_265\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h2 style=\"text-align:center;\">Confirmation of eligibility<\/h2><\/div><fieldset id=\"field_195_22\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >1. Which of the following best describes your role?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_195_22'>\n\t\t\t<div class='gchoice gchoice_195_22_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Physician'  id='choice_195_22_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_22_0' id='label_195_22_0' class='gform-field-label gform-field-label--type-inline'>Physician<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_22_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Nurse'  id='choice_195_22_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_22_1' id='label_195_22_1' class='gform-field-label gform-field-label--type-inline'>Nurse<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_22_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Pharmacist'  id='choice_195_22_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_22_2' id='label_195_22_2' class='gform-field-label gform-field-label--type-inline'>Pharmacist<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_195_24\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >2. In which province or territory are you currently practicing?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_195_24'>\n\t\t\t<div class='gchoice gchoice_195_24_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Alberta'  id='choice_195_24_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_24_0' id='label_195_24_0' class='gform-field-label gform-field-label--type-inline'>Alberta<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_24_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='British Colombia'  id='choice_195_24_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_24_1' id='label_195_24_1' class='gform-field-label gform-field-label--type-inline'>British Colombia<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_24_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Manitoba'  id='choice_195_24_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_24_2' id='label_195_24_2' class='gform-field-label gform-field-label--type-inline'>Manitoba<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_24_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='New Brunswick'  id='choice_195_24_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_24_3' id='label_195_24_3' class='gform-field-label gform-field-label--type-inline'>New Brunswick<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_24_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Newfoundland and Labrador'  id='choice_195_24_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_24_4' id='label_195_24_4' class='gform-field-label gform-field-label--type-inline'>Newfoundland and Labrador<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_24_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Nova Scotia'  id='choice_195_24_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_24_5' id='label_195_24_5' class='gform-field-label gform-field-label--type-inline'>Nova Scotia<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_24_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Ontario'  id='choice_195_24_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_24_6' id='label_195_24_6' class='gform-field-label gform-field-label--type-inline'>Ontario<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_24_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Prince Edward Island'  id='choice_195_24_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_24_7' id='label_195_24_7' class='gform-field-label gform-field-label--type-inline'>Prince Edward Island<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_24_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Quebec'  id='choice_195_24_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_24_8' id='label_195_24_8' class='gform-field-label gform-field-label--type-inline'>Quebec<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_24_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Saskatchewan'  id='choice_195_24_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_24_9' id='label_195_24_9' class='gform-field-label gform-field-label--type-inline'>Saskatchewan<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_24_10'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Yukon'  id='choice_195_24_10' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_24_10' id='label_195_24_10' class='gform-field-label gform-field-label--type-inline'>Yukon<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_24_11'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Northwest Territories'  id='choice_195_24_11' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_24_11' id='label_195_24_11' class='gform-field-label gform-field-label--type-inline'>Northwest Territories<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_24_12'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Nunavut'  id='choice_195_24_12' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_24_12' id='label_195_24_12' class='gform-field-label gform-field-label--type-inline'>Nunavut<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_195_37\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >3. Please check the therapies and their respective care settings where you have experience with infusion and\/or safety monitoring.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_195_37'><div class='gchoice gchoice_195_37_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.1' type='checkbox'  value='BsAbs'  id='choice_195_37_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_195_37_1' id='label_195_37_1' class='gform-field-label gform-field-label--type-inline'>BsAbs<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_195_37_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.2' type='checkbox'  value='CAR-T (Start at question 24)'  id='choice_195_37_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_195_37_2' id='label_195_37_2' class='gform-field-label gform-field-label--type-inline'>CAR-T (Start at question 24)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_195_212\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >BsAbs: In which setting(s) do you have experience with the step-up doses?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_195_212'><div class='gchoice gchoice_195_212_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_212.1' type='checkbox'  value='Inpatient'  id='choice_195_212_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_195_212_1' id='label_195_212_1' class='gform-field-label gform-field-label--type-inline'>Inpatient<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_195_212_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_212.2' type='checkbox'  value='Outpatient'  id='choice_195_212_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_195_212_2' id='label_195_212_2' class='gform-field-label gform-field-label--type-inline'>Outpatient<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_195_213\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >CAR-T:  In which setting(s) do you have experience with the infusion and safety monitoring?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_195_213'><div class='gchoice gchoice_195_213_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_213.1' type='checkbox'  value='Inpatient'  id='choice_195_213_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_195_213_1' id='label_195_213_1' class='gform-field-label gform-field-label--type-inline'>Inpatient<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_195_213_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_213.2' type='checkbox'  value='Outpatient'  id='choice_195_213_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_195_213_2' id='label_195_213_2' class='gform-field-label gform-field-label--type-inline'>Outpatient<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_195_41\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_bottom no_margin_top gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>4. How many patients per year do you treat or manage in an outpatient setting with the following therapies? Please provide an approximate number for each.<\/h4><\/div><div id=\"field_195_267\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third no_number hide-instructions gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_267'>a. BsAbs:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_267' id='input_195_267' type='number' step='any' min='1'  value='' class='large'    placeholder='Outpatients per year' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_195_267\" \/><div class='gfield_description instruction ' id='gfield_instruction_195_267'>Please enter a number greater than or equal to <strong>1<\/strong>.<\/div><\/div><\/div><div id=\"field_195_268\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third no_number hide-instructions gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_268'>b. CAR-T:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_268' id='input_195_268' type='number' step='any' min='1'  value='' class='large'    placeholder='Outpatients per year' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_195_268\" \/><div class='gfield_description instruction ' id='gfield_instruction_195_268'>Please enter a number greater than or equal to <strong>1<\/strong>.<\/div><\/div><\/div><fieldset id=\"field_195_43\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >5. Which of the following best represents the main centre in which you conduct clinical practice?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_195_43'>\n\t\t\t<div class='gchoice gchoice_195_43_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='Academic\/Teaching Hospital (affiliated with a medical school or university)'  id='choice_195_43_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_43_0' id='label_195_43_0' class='gform-field-label gform-field-label--type-inline'>Academic\/Teaching Hospital (affiliated with a medical school or university)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_43_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='Community Hospital'  id='choice_195_43_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_43_1' id='label_195_43_1' class='gform-field-label gform-field-label--type-inline'>Community Hospital<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_195_345' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> <button type='button'  id='gform_save_195_2_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  ><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> Save and Continue Later<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_195_2' class='gform_page' data-js='page-field-id-345' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_195_2' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_195_47\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 style=\"text-align:center;\">Bispecific antibody questionnaire<\/h2><\/div><div id=\"field_195_254\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Section 1: Institutional Requirements<\/h3><\/div><fieldset id=\"field_195_48\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >1. Does your institution have established protocols or guidelines for outpatient administration of BsAb step-up doses (e.g., eligibility, monitoring, logistics etc.)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_195_48'>\n\t\t\t<div class='gchoice gchoice_195_48_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='Yes'  id='choice_195_48_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_48_0' id='label_195_48_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_48_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='No'  id='choice_195_48_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_48_1' id='label_195_48_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_195_283\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_283'>Please describe briefly:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_283' id='input_195_283' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_284\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_284'>Please describe any alternatives currently used:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_284' id='input_195_284' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_51\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_51'>2. Please list key elements of an effective escalation pathway that supports timely and streamlined inpatient admission of patients receiving BsAb step-up doses outpatient.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_51' id='input_195_51' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_195_52\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >3. Is it essential to have a core multidisciplinary team overseeing both administration and safety monitoring when the step-up doses are delivered in an outpatient setting?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_195_52'>\n\t\t\t<div class='gchoice gchoice_195_52_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='Yes'  id='choice_195_52_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_52_0' id='label_195_52_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_52_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='No'  id='choice_195_52_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_52_1' id='label_195_52_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_195_271\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_top no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><\/br> <h4 style = \"text-align: justify;\">Please list all healthcare providers you believe should be included in this core team (e.g., physicians, specialists, nurses, pharmacists). <\/h4> <p style = \"text-align: justify; font-weight:400; color: #FFA500\"><i> For each healthcare provider, please specify the step they are involved (administration and\/or safety monitoring) <u>by marking an X in the appropriate column<\/u>. Please add a row for each healthcare provider by clicking the \u2018+\u2019 on the right.<\/i> <\/p> <\/br> <\/div><fieldset id=\"field_195_242\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-full no_number no_margin_top field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Healthcare provider<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Administration (check if applicable)<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Safety Monitoring (check if applicable)<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_242_cell1 gform-grid-col' data-label='Healthcare provider'><input aria-invalid='false'   aria-label='Healthcare provider, Row 1' data-aria-label-template='Healthcare provider, Row {0}' type='text' name='input_242[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_242_cell2 gform-grid-col' data-label='Administration (check if applicable)'><input aria-invalid='false'   aria-label='Administration (check if applicable), Row 1' data-aria-label-template='Administration (check if applicable), Row {0}' type='text' name='input_242[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_242_cell3 gform-grid-col' data-label='Safety Monitoring (check if applicable)'><input aria-invalid='false'   aria-label='Safety Monitoring (check if applicable), Row 1' data-aria-label-template='Safety Monitoring (check if applicable), Row {0}' type='text' name='input_242[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type='button'  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_195_285\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_285'>Please explain briefly<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_285' id='input_195_285' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_195_55\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >4. Should patients have 24\/7 access to a care team (remotely or onsite) when receiving the step-up doses in an outpatient setting?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_195_55'>\n\t\t\t<div class='gchoice gchoice_195_55_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='Yes'  id='choice_195_55_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_55_0' id='label_195_55_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_55_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='No'  id='choice_195_55_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_55_1' id='label_195_55_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_195_220\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_top no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>Please address the following:<\/h4><\/br><\/div><div id=\"field_195_316\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top no_margin_bottom gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_316'>a. What duration of 24\/7 access (e.g., number of days post-injection) is necessary?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_316' id='input_195_316' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_317\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_317'>b. Should 24\/7 access be required for all patients, or only for those in specific risk categories? If the latter, please specify which risk categories.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_317' id='input_195_317' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_287\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_287'>Please specify the minimal level of access you believe is necessary to ensure patient safety:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_287' id='input_195_287' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_195_61\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >5. Do you have access to tools, such as those that support patient scheduling, staffing, or capacity forecasting, for optimal delivery of outpatient BsAbs?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_195_61'>\n\t\t\t<div class='gchoice gchoice_195_61_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Yes'  id='choice_195_61_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_61_0' id='label_195_61_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_61_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='No'  id='choice_195_61_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_61_1' id='label_195_61_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_195_288\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_288'>Please indicate which tools are currently implemented at your institution:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_288' id='input_195_288' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_289\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_289'>Please describe what tools would be valuable to have:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_289' id='input_195_289' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_195_58\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >6. Should access to reserved beds for inpatient admission be a minimum requirement to support outpatient BsAbs?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_195_58'>\n\t\t\t<div class='gchoice gchoice_195_58_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='Yes'  id='choice_195_58_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_58_0' id='label_195_58_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_58_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='No'  id='choice_195_58_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_58_1' id='label_195_58_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_195_85\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_top no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>Please address the following:<\/h4><\/br><\/div><div id=\"field_195_318\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top no_margin_bottom gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_318'>a. Where should the reserved beds be located (e.g., observation unit, emergency department)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_318' id='input_195_318' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_319\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_bottom gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_319'>b. The optimal duration (i.e., days, weeks) for which reserved beds should be made available.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_319' id='input_195_319' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_320\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_320'>c. What do you consider an optimal ratio of reserved beds to patients receiving or projected to receive BsAb step-up doses?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_320' id='input_195_320' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_290\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_290'>Please explain briefly:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_290' id='input_195_290' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_64\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_64'>7. For how long should patients be monitored at the outpatient setting on the day of administration following each step-up dose?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_64' id='input_195_64' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_65\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_65'>8. What is the recommended frequency of onsite safety follow-up at the outpatient center after each step-up dose?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_65' id='input_195_65' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_66\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_66'>9. What are the clinical parameters that should be evaluated as part of remote monitoring?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_66' id='input_195_66' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_223\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_223'>a. What tools can be used or are currently in use for remote monitoring at your institution?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_223' id='input_195_223' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_195_68\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >10. Which of the following medications, and the minimum number of doses, should be available in clinic when BsAbs step-up doses are administered in the outpatient setting? (Please check all that apply)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_195_68'><div class='gchoice gchoice_195_68_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_68.1' type='checkbox'  value='Tocilizumab'  id='choice_195_68_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_195_68_1' id='label_195_68_1' class='gform-field-label gform-field-label--type-inline'>Tocilizumab<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_195_68_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_68.2' type='checkbox'  value='Dexamethasone'  id='choice_195_68_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_195_68_2' id='label_195_68_2' class='gform-field-label gform-field-label--type-inline'>Dexamethasone<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_195_68_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_68.3' type='checkbox'  value='Others'  id='choice_195_68_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_195_68_3' id='label_195_68_3' class='gform-field-label gform-field-label--type-inline'>Others<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_195_166\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_166'>Tocilizumab minimum number of doses:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_166' id='input_195_166' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_195_167\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_167'>Dexamethasone minimum number of doses:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_167' id='input_195_167' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_195_69\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_69'>If others, please specify:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_69' id='input_195_69' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_195_70\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >11. Should the availability of medications for treatment of serious adverse events (AEs) be considered a minimum institutional requirement for administering the step-up doses in an outpatient setting?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_195_70'>\n\t\t\t<div class='gchoice gchoice_195_70_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='Yes'  id='choice_195_70_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_70_0' id='label_195_70_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_70_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='No'  id='choice_195_70_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_70_1' id='label_195_70_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_195_71\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Please select which drug should be available and indicate number of doses per patient: (please check all that apply)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_195_71'><div class='gchoice gchoice_195_71_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_71.1' type='checkbox'  value='Tocilizumab'  id='choice_195_71_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_195_71_1' id='label_195_71_1' class='gform-field-label gform-field-label--type-inline'>Tocilizumab<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_195_71_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_71.2' type='checkbox'  value='Dexamethasone'  id='choice_195_71_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_195_71_2' id='label_195_71_2' class='gform-field-label gform-field-label--type-inline'>Dexamethasone<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_195_71_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_71.3' type='checkbox'  value='Others'  id='choice_195_71_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_195_71_3' id='label_195_71_3' class='gform-field-label gform-field-label--type-inline'>Others<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_195_169\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_169'>Tocilizumab number of doses:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_169' id='input_195_169' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_195_170\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_170'>Dexamethasone number of doses:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_170' id='input_195_170' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_195_165\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_165'>Please specify the drug(s) and the number of doses:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_165' id='input_195_165' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_195_311\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_311'>Please explain briefly:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_311' id='input_195_311' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_324\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>12. Under what circumstances, if any, could dexamethasone be used as an alternative to tocilizumab for the management of CRS-related AEs in the outpatient setting? Please specify what clinical or logistical factors should be taken into consideration. <\/h4><\/br><\/div><div id=\"field_195_90\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_195_90'>AEs = Adverse events; CRS = cytokine release syndrome<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_90' id='input_195_90' class='textarea small'  aria-describedby=\"gfield_description_195_90\"   aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_195_90'>AEs = Adverse events; CRS = cytokine release syndrome<\/div><\/div><div id=\"field_195_89\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_89'>13. What minimal support should institutions provide to patients and caregivers to ensure safe and effective delivery of outpatient BsAbs?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_89' id='input_195_89' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_291\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>14. Please list what you consider to be the most significant institutional <u>benefits<\/u> of providing BsAbs step-up doses outpatient.<\/h4><\/br><\/div><div id=\"field_195_91\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_195_91'><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_91' id='input_195_91' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_292\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>15. Please list what you consider are the most significant institutional <u>hurdles<\/u> of providing BsAbs step-up doses outpatient.<\/h4><\/br><\/div><div id=\"field_195_92\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_195_92'><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_92' id='input_195_92' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_240\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_240'>a. What strategies can institutions implement to address these hurdles?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_240' id='input_195_240' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_195_346' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_195_346' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> <button type='button'  id='gform_save_195_3_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  ><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> Save and Continue Later<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_195_3' class='gform_page' data-js='page-field-id-346' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_195_3' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_195_93\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Section 2: Patient Eligibility Criteria<\/h3><\/div><div id=\"field_195_255\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>16. What are the <u>clinical criteria<\/u> that make a patient eligible for receiving BsAbs step-up doses in an outpatient setting (e.g., age, performance status, comorbidities)?<\/h4><\/br><\/div><div id=\"field_195_185\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_195_185'><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_185' id='input_195_185' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_256\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>17. What are the <u>non-clinical criteria<\/u> that make a patient suitable for receiving BsAbs step-up doses in an outpatient setting (e.g., access to caregiver, proximity to centre etc.)?<\/h4><\/br><\/div><div id=\"field_195_187\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_195_187'><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_187' id='input_195_187' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_257\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>18. What are the most significant <u>benefits<\/u> for patients receiving BsAbs step-up doses outpatient?<\/h4><\/br><\/div><div id=\"field_195_189\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_195_189'><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_189' id='input_195_189' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_258\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>19. What are the most significant <u>risks<\/u> to patients receiving BsAbs in outpatient setting and what strategies can be implemented to mitigate these risks?<\/h4><\/br><\/div><div id=\"field_195_191\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_195_191'><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_191' id='input_195_191' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_195_350' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_195_350' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> <button type='button'  id='gform_save_195_4_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  ><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> Save and Continue Later<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_195_4' class='gform_page' data-js='page-field-id-350' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_195_4' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_195_99\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Section 3: Product Risk Profile<\/h3><\/div><fieldset id=\"field_195_100\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >20. Is the product safety profile of BsAbs important in determining suitability for outpatient treatment?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_195_100'>\n\t\t\t<div class='gchoice gchoice_195_100_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_100' type='radio' value='Yes'  id='choice_195_100_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_100_0' id='label_195_100_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_100_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_100' type='radio' value='No'  id='choice_195_100_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_100_1' id='label_195_100_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_195_293\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_293'>Please explain briefly:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_293' id='input_195_293' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_294\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_294'>Please explain briefly:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_294' id='input_195_294' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_195_102\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >21. Are the timing and predictability of AEs onset important in determining product suitability for outpatient treatment?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_195_102'>\n\t\t\t<div class='gchoice gchoice_195_102_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_102' type='radio' value='Yes'  id='choice_195_102_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_102_0' id='label_195_102_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_102_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_102' type='radio' value='No'  id='choice_195_102_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_102_1' id='label_195_102_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_195_295\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_295'>Please explain briefly:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_295' id='input_195_295' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_296\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_296'>Please explain briefly:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_296' id='input_195_296' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_224\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>22. Please provide information on outpatient and inpatient management of AEs.<\/h4><\/div><div id=\"field_195_341\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4 style = \"text-align: justify;\">a. Indicate the AE types and the maximum acceptable severity\/grade for outpatient management (e.g. CRS up to Grade 1, ICANs up to Grade 2, infections): <\/h4> <p style = \"text-align: justify; font-weight:400; color: #FFA500\"><i> Please add a row for each AE by clicking the \u2018+\u2019 on the right.<\/i> <\/p><\/div><fieldset id=\"field_195_342\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-full no_number no_margin_top no_margin_bottom gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' >ICANS = immune effector cell-associated neurotoxicity syndrome<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Adverse Event<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Severity grade<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_342_cell1 gform-grid-col' data-label='Adverse Event'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_195_342\" aria-label='Adverse Event, Row 1' data-aria-label-template='Adverse Event, Row {0}' type='text' name='input_342[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_342_cell2 gform-grid-col' data-label='Severity grade'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_195_342\" aria-label='Severity grade, Row 1' data-aria-label-template='Severity grade, Row {0}' type='text' name='input_342[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type='button'  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><div class='gfield_description' id='gfield_description_195_342'>ICANS = immune effector cell-associated neurotoxicity syndrome<\/div><\/fieldset><div id=\"field_195_343\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_bottom gfield_html gfield_html_formatted field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><\/br> <h4 style = \"text-align: justify;\">b. Indicate the AEs and severity levels you believe require inpatient care: <\/h4> <p style = \"text-align: justify; font-weight:400; color: #FFA500\"><i> Please add a row for each AE by clicking the \u2018+\u2019 on the right.<\/i> <\/p><\/div><fieldset id=\"field_195_344\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Adverse event<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Severity grade<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_344_cell1 gform-grid-col' data-label='Adverse event'><input aria-invalid='false' aria-required=\"true\"  aria-label='Adverse event, Row 1' data-aria-label-template='Adverse event, Row {0}' type='text' name='input_344[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_344_cell2 gform-grid-col' data-label='Severity grade'><input aria-invalid='false' aria-required=\"true\"  aria-label='Severity grade, Row 1' data-aria-label-template='Severity grade, Row {0}' type='text' name='input_344[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type='button'  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_195_105\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_105'>23. Beyond AEs and toxicity, what product characteristics do you consider most important when assessing suitability for outpatient administration?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_105' id='input_195_105' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_195_347' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_195_347' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> <button type='button'  id='gform_save_195_5_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  ><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> Save and Continue Later<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_195_5' class='gform_page' data-js='page-field-id-347' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_195_5' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_195_107\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 style=\"text-align:center;\">CAR-T Questionnaire<\/h2><\/div><div id=\"field_195_108\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Section 4. Institutional Requirements<\/h3><\/div><fieldset id=\"field_195_109\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >24. Does your institution have established protocols or guidelines for the delivery of CAR-T cell therapy in an outpatient setting (e.g., eligibility, monitoring, logistics etc.)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_195_109'>\n\t\t\t<div class='gchoice gchoice_195_109_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_109' type='radio' value='Yes'  id='choice_195_109_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_109_0' id='label_195_109_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_109_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_109' type='radio' value='No'  id='choice_195_109_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_109_1' id='label_195_109_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_195_297\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_297'>Please describe briefly:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_297' id='input_195_297' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_298\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_298'>Please describe any alternatives currently used:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_298' id='input_195_298' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_113\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_113'>25. Please list key elements of an effective escalation pathway that supports timely and streamlined inpatient admission of patients receiving CAR-T cell therapy outpatient, when needed.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_113' id='input_195_113' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_195_114\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >26. Is it essential to have a core multidisciplinary team overseeing both infusion and safety monitoring when CAR-T cell therapy is administered in an outpatient setting?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_195_114'>\n\t\t\t<div class='gchoice gchoice_195_114_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_114' type='radio' value='Yes'  id='choice_195_114_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_114_0' id='label_195_114_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_114_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_114' type='radio' value='No'  id='choice_195_114_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_114_1' id='label_195_114_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_195_272\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_top no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><\/br> <h4 style = \"text-align: justify;\">Please list all healthcare providers you believe should be included in this core team (e.g., physicians, specialists, nurses, pharmacists). <\/h4> <p style = \"text-align: justify; font-weight:400; color: #FFA500\"><i> For each healthcare provider, please specify the step they are involved (administration and\/or safety monitoring) <u>by marking an X in the appropriate column<\/u>. Please add a row for each healthcare provider by clicking the \u2018+\u2019 on the right.<\/i> <\/p> <\/br> <\/div><fieldset id=\"field_195_259\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-full no_number no_margin_top field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Healthcare provider<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Administration (check if applicable)<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Safety Monitoring (check if applicable)<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_259_cell1 gform-grid-col' data-label='Healthcare provider'><input aria-invalid='false'   aria-label='Healthcare provider, Row 1' data-aria-label-template='Healthcare provider, Row {0}' type='text' name='input_259[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_259_cell2 gform-grid-col' data-label='Administration (check if applicable)'><input aria-invalid='false'   aria-label='Administration (check if applicable), Row 1' data-aria-label-template='Administration (check if applicable), Row {0}' type='text' name='input_259[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_259_cell3 gform-grid-col' data-label='Safety Monitoring (check if applicable)'><input aria-invalid='false'   aria-label='Safety Monitoring (check if applicable), Row 1' data-aria-label-template='Safety Monitoring (check if applicable), Row {0}' type='text' name='input_259[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type='button'  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_195_299\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_299'>Please explain briefly:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_299' id='input_195_299' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_195_117\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >27. Should patients have 24\/7 access to a care team (remotely or onsite) when receiving CAR-T cell therapy in an outpatient setting?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_195_117'>\n\t\t\t<div class='gchoice gchoice_195_117_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_117' type='radio' value='Yes'  id='choice_195_117_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_117_0' id='label_195_117_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_117_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_117' type='radio' value='No'  id='choice_195_117_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_117_1' id='label_195_117_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_195_119\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_top no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>Please address the following:<\/h4><\/br><\/div><div id=\"field_195_326\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top no_margin_bottom gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_326'>a. What duration of 24\/7 access (e.g., number of days post-infusion) is necessary?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_326' id='input_195_326' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_328\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_328'>b. Should 24\/7 access be required for all patients, or only for those in specific risk categories? If the latter, please specify which risk categories.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_328' id='input_195_328' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_300\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_300'>Please specify the minimal level of access you believe is necessary to ensure patient safety.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_300' id='input_195_300' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_195_125\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >28. Do you have access to tools, such as those that support patient scheduling, staffing, or capacity forecasting, for optimal delivery of CAR-T cell therapy outpatient?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_195_125'>\n\t\t\t<div class='gchoice gchoice_195_125_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_125' type='radio' value='Yes'  id='choice_195_125_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_125_0' id='label_195_125_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_125_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_125' type='radio' value='No'  id='choice_195_125_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_125_1' id='label_195_125_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_195_301\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_301'>Please indicate which tools are currently implemented at your institution.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_301' id='input_195_301' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_302\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_302'>Please describe what tools would be valuable to have.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_302' id='input_195_302' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_195_121\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >29. Should access to reserved beds for inpatient admission be a minimum requirement to support outpatient CAR-T cell therapy?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_195_121'>\n\t\t\t<div class='gchoice gchoice_195_121_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_121' type='radio' value='Yes'  id='choice_195_121_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_121_0' id='label_195_121_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_121_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_121' type='radio' value='No'  id='choice_195_121_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_121_1' id='label_195_121_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_195_122\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_top no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>Please address the following:<\/h4><\/br><\/div><div id=\"field_195_329\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top no_margin_bottom gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_329'>a. Where should the reserved beds be located (e.g., observation unit, nearby inpatient unit, emergency department)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_329' id='input_195_329' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_330\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_bottom gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_330'>b. The optimal duration (i.e., days, weeks) for which reserved beds should be made available.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_330' id='input_195_330' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_331\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_331'>c. What do you consider an optimal ratio of reserved beds to patients receiving or projected to receive CAR-T therapy?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_331' id='input_195_331' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_280\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_top no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><\/div><div id=\"field_195_303\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_303'>Please explain briefly:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_303' id='input_195_303' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_128\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_128'>30. For how long should patients be monitored at the outpatient setting on the day of infusion?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_128' id='input_195_128' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_129\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_129'>31. What is the recommended frequency of onsite safety follow-up at the outpatient center post-infusion?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_129' id='input_195_129' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_130\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_130'>32. What are the clinical parameters that should be evaluated as part of remote monitoring?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_130' id='input_195_130' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_236\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_236'>a. What tools can be used or are currently in use for remote monitoring at your institution?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_236' id='input_195_236' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_195_131\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >33. Is there a role for pre-emptive inpatient admission following outpatient delivery of CAR-T cell therapy?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_195_131'>\n\t\t\t<div class='gchoice gchoice_195_131_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_131' type='radio' value='Yes'  id='choice_195_131_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_131_0' id='label_195_131_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_131_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_131' type='radio' value='No'  id='choice_195_131_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_131_1' id='label_195_131_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_195_132\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_top no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>Please address the following:<\/h4><\/br><\/div><div id=\"field_195_332\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top no_margin_bottom gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_332'>a. Under what circumstances should pre-emptive inpatient admission be considered?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_332' id='input_195_332' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_333\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_333'>b. What factors determine the optimal timing for pre-emptive admission?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_333' id='input_195_333' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_304\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_top no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><\/div><div id=\"field_195_305\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_305'>Please explain briefly:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_305' id='input_195_305' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_195_135\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >34. Which of the following medications, and the minimum number of doses, should be available in clinic when CAR-T cell therapy is administered in the outpatient setting? (Please check all that apply)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_195_135'><div class='gchoice gchoice_195_135_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_135.1' type='checkbox'  value='Tocilizumab'  id='choice_195_135_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_195_135_1' id='label_195_135_1' class='gform-field-label gform-field-label--type-inline'>Tocilizumab<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_195_135_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_135.2' type='checkbox'  value='Dexamethasone'  id='choice_195_135_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_195_135_2' id='label_195_135_2' class='gform-field-label gform-field-label--type-inline'>Dexamethasone<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_195_135_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_135.3' type='checkbox'  value='Others'  id='choice_195_135_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_195_135_3' id='label_195_135_3' class='gform-field-label gform-field-label--type-inline'>Others<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_195_136\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_136'>Tocilizumab minimum number of doses:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_136' id='input_195_136' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_195_137\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_137'>Dexamethasone minimum number of doses:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_137' id='input_195_137' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_195_138\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_138'>If others, please specify:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_138' id='input_195_138' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_195_139\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >35. Should the availability of medications for treatment of serious adverse events (AEs) be considered a minimum institutional requirement for administering CAR-T cell therapy in an outpatient setting?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_195_139'>\n\t\t\t<div class='gchoice gchoice_195_139_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_139' type='radio' value='Yes'  id='choice_195_139_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_139_0' id='label_195_139_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_139_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_139' type='radio' value='No'  id='choice_195_139_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_139_1' id='label_195_139_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_195_140\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full no_margin_top no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Please select which drug should be available and indicate number of doses per patient: (Please check all that apply)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_195_140'><div class='gchoice gchoice_195_140_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_140.1' type='checkbox'  value='Tocilizumab'  id='choice_195_140_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_195_140_1' id='label_195_140_1' class='gform-field-label gform-field-label--type-inline'>Tocilizumab<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_195_140_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_140.2' type='checkbox'  value='Dexamethasone'  id='choice_195_140_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_195_140_2' id='label_195_140_2' class='gform-field-label gform-field-label--type-inline'>Dexamethasone<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_195_140_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_140.3' type='checkbox'  value='Others'  id='choice_195_140_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_195_140_3' id='label_195_140_3' class='gform-field-label gform-field-label--type-inline'>Others<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_195_141\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_141'>Tocilizumab number of doses:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_141' id='input_195_141' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_195_142\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_142'>Dexamethasone number of doses:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_142' id='input_195_142' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_195_143\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_143'>Please specify the drug(s) and the number of doses:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_143' id='input_195_143' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_195_306\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_306'>Please explain briefly:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_306' id='input_195_306' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_325\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>36. Under what circumstances, if any, could dexamethasone be used as an alternative to tocilizumab for the management of CRS-related AEs when CAR-T cell therapy is administered in the outpatient setting? Please specify what clinical or logistical factors should be taken into consideration.<\/h4><\/div><div id=\"field_195_145\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_195_145'>AEs = adverse events; CRS = cytokine release syndrome<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_145' id='input_195_145' class='textarea small'  aria-describedby=\"gfield_description_195_145\"   aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_195_145'>AEs = adverse events; CRS = cytokine release syndrome<\/div><\/div><div id=\"field_195_146\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_146'>37. What minimal support should institutions provide to patients and caregivers to ensure safe and effective delivery of outpatient CAR-T therapy?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_146' id='input_195_146' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_312\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>38. What are the most significant institutional <u>benefits<\/u> of providing CAR-T cell therapy outpatient?<\/h4><\/br><\/div><div id=\"field_195_147\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_195_147'><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_147' id='input_195_147' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_315\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>39. What are the most significant institutional <u>hurdles<\/u> to providing CAR-T cell therapy outpatient?<\/h4><\/br><\/div><div id=\"field_195_148\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_195_148'><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_148' id='input_195_148' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_314\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_314'>a. What strategies can institutions implement to address these hurdles?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_314' id='input_195_314' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_195_348' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_195_348' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> <button type='button'  id='gform_save_195_6_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  ><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> Save and Continue Later<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_195_6' class='gform_page' data-js='page-field-id-348' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_195_6' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_195_149\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Section 5. Patient Eligibility Criteria<\/h3><\/div><div id=\"field_195_260\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>40. What are the <u>clinical criteria<\/u> that make a patient eligible for receiving CAR-T cell therapy in an outpatient setting (e.g., age, performance status, comorbidities)?<\/h4> <\/br><\/div><div id=\"field_195_151\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_195_151'><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_151' id='input_195_151' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_261\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>41. What are the <u>non-clinical criteria<\/u> that make a patient suitable for receiving CAR-T cell therapy in an outpatient setting (e.g., access to caregiver, proximity to centre, etc.)?<\/h4><\/br><\/div><div id=\"field_195_150\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_195_150'><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_150' id='input_195_150' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_262\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>42. What are the most significant <u>benefits<\/u> to patients receiving CAR-T cell therapy outpatient?<\/h4><\/br><\/div><div id=\"field_195_152\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_195_152'><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_152' id='input_195_152' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_263\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>43. What are the most significant <u>risks<\/u> to patients receiving CAR-T cell therapy outpatient?<\/h4><\/br><\/div><div id=\"field_195_153\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_195_153'><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_153' id='input_195_153' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_264\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_264'>a. What strategies can be implemented to mitigate these risks?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_264' id='input_195_264' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_195_349' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_195_349' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> <button type='button'  id='gform_save_195_7_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  ><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> Save and Continue Later<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_195_7' class='gform_page' data-js='page-field-id-349' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_195_7' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_195_155\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Section 6. Product Risk Profile<\/h3><\/div><fieldset id=\"field_195_156\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >44. Is the product safety profile of CAR-T cell therapy important in determining suitability for outpatient treatment?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_195_156'>\n\t\t\t<div class='gchoice gchoice_195_156_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_156' type='radio' value='Yes'  id='choice_195_156_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_156_0' id='label_195_156_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_156_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_156' type='radio' value='No'  id='choice_195_156_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_156_1' id='label_195_156_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_195_307\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_307'>Please explain briefly:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_307' id='input_195_307' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_308\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_308'>Please explain briefly:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_308' id='input_195_308' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_195_158\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >45. Are the timing and predictability of AE onset important in determining product suitability for outpatient treatment?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_195_158'>\n\t\t\t<div class='gchoice gchoice_195_158_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_158' type='radio' value='Yes'  id='choice_195_158_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_158_0' id='label_195_158_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_195_158_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_158' type='radio' value='No'  id='choice_195_158_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_195_158_1' id='label_195_158_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_195_310\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_310'>Please explain briefly:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_310' id='input_195_310' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_309\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_309'>Please explain briefly:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_309' id='input_195_309' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><div id=\"field_195_160\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>46. Please provide information on outpatient and inpatient management of AEs.<\/h4><\/div><div id=\"field_195_338\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_bottom gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4 style = \"text-align: justify;\">a. Indicate the AE types and the maximum acceptable severity\/grade for outpatient management (e.g. CRS up to Grade 1, ICANs up to Grade 2, infections): <\/h4> <p style = \"text-align: justify; font-weight:400; color: #FFA500\"><i> Please add a row for each AE by clicking the \u2018+\u2019 on the right.<\/i> <\/p><\/div><fieldset id=\"field_195_337\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-full no_number no_margin_top no_margin_bottom gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' >ICANS = immune effector cell-associated neurotoxicity syndrome<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Adverse Event<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Severity grade<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_337_cell1 gform-grid-col' data-label='Adverse Event'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_195_337\" aria-label='Adverse Event, Row 1' data-aria-label-template='Adverse Event, Row {0}' type='text' name='input_337[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_337_cell2 gform-grid-col' data-label='Severity grade'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_195_337\" aria-label='Severity grade, Row 1' data-aria-label-template='Severity grade, Row {0}' type='text' name='input_337[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type='button'  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><div class='gfield_description' id='gfield_description_195_337'>ICANS = immune effector cell-associated neurotoxicity syndrome<\/div><\/fieldset><div id=\"field_195_339\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number no_margin_bottom gfield_html gfield_html_formatted field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><\/br> <h4 style = \"text-align: justify;\">b. Indicate the AEs and severity levels you believe require inpatient care: <\/h4> <p style = \"text-align: justify; font-weight:400; color: #FFA500\"><i> Please add a row for each AE by clicking the \u2018+\u2019 on the right.<\/i> <\/p><\/div><fieldset id=\"field_195_340\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-full no_number no_margin_top gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Adverse event<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Severity grade<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_340_cell1 gform-grid-col' data-label='Adverse event'><input aria-invalid='false' aria-required=\"true\"  aria-label='Adverse event, Row 1' data-aria-label-template='Adverse event, Row {0}' type='text' name='input_340[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_340_cell2 gform-grid-col' data-label='Severity grade'><input aria-invalid='false' aria-required=\"true\"  aria-label='Severity grade, Row 1' data-aria-label-template='Severity grade, Row {0}' type='text' name='input_340[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type='button'  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_195_162\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full no_number gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_195_162'>47. Beyond AEs and toxicity, what product characteristics do you consider most important when assessing suitability for outpatient administration of CAR-T cell therapy?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_162' id='input_195_162' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='7' cols='50'><\/textarea><\/div><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_195' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='submit' id='gform_submit_button_195' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> <button type='button'  id='gform_save_195_footer_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  ><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> Save and Continue Later<\/button><input type='hidden' name='gform_ajax' value='form_id=195&amp;title=&amp;description=&amp;tabindex=0&amp;theme=gravity-theme&amp;hash=2bce87036df8a884f9e9ebb8f02a7b2f' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_195' value='iframe' \/>\n            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