{"id":5226,"date":"2023-04-28T09:20:20","date_gmt":"2023-04-28T07:20:20","guid":{"rendered":"https:\/\/cpcms.fr\/2022\/?page_id=5226"},"modified":"2023-04-28T09:20:20","modified_gmt":"2023-04-28T07:20:20","slug":"fiche-informative","status":"publish","type":"page","link":"https:\/\/cpcms.fr\/2022\/fiche-informative\/","title":{"rendered":"Fiche Informative"},"content":{"rendered":"<p class=\"p1\"><div style=\"display:none\" class=\"fm-form-container fm-theme39\"><div id=\"fm-pages12\" class=\"fm-pages wdform_page_navigation \" show_title=\"\" show_numbers=\"1\" type=\"none\"><\/div><form name=\"form12\" action=\"\/2022\/wp-json\/wp\/v2\/pages\/5226\" method=\"post\" id=\"form12\" class=\"fm-form form12  \" enctype=\"multipart\/form-data\"><input type=\"hidden\" id=\"fm_page_id12\" value=\"5226\" name=\"fm_page_id12\" \/><input type=\"hidden\" id=\"fm_current_post_type12\" value=\"page\" name=\"fm_current_post_type12\" \/><input type=\"hidden\" id=\"counter12\" value=\"99\" name=\"counter12\" \/><input type=\"hidden\" id=\"Itemid12\" value=\"\" name=\"Itemid12\" \/><input type=\"hidden\" id=\"fm_shake12\" value=\"1\" name=\"fm_shake12\" \/><input type=\"text\" class=\"fm-hide\" id=\"fm_empty_field_validation12\" value=\"\" name=\"fm_empty_field_validation12\" data-value=\"bd736efb144d599cf463541431fbf5c4\" \/><div class=\"fm-header-bg\"><div class=\"fm-header \"><div class=\"fm-header-text\">          <div class=\"fm-header-title\">            Cr\u00e9ation de votre fiche informative          <\/div>          <div class=\"fm-header-description\">                      <\/div>        <\/div><\/div><\/div><div class=\"wdform-page-and-images fm-form-builder\"><div id=\"12form_view1\" class=\"wdform_page\" page_title=\"Untitled page\" next_title=\"Next\" next_type=\"text\" next_class=\"wdform-page-button\" next_checkable=\"true\" previous_title=\"Previous\" previous_type=\"text\" previous_class=\"wdform-page-button\" previous_checkable=\"false\"><div class=\"wdform_section\"><div class=\"wdform_column\"><div wdid=\"2\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_2_element12\" class=\"wdform-label\">D\u00e9nomination commerciale de l'officine <\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_2_element12\"                           name=\"wdform_2_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"10\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_10_element12\" class=\"wdform-label\">Adresse<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_10_element12\"                           name=\"wdform_10_element12\"                           value=\"\"                           title=\"B\u00e2timent ou lieu-dit\"                           placeholder=\"B\u00e2timent ou lieu-dit\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"11\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_text\" ><div class=\"wdform-label-section wd-width-30 wd-hidden  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_11_element12\" class=\"wdform-label\">Rue<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_11_element12\"                           name=\"wdform_11_element12\"                           value=\"\"                           title=\"Rue\"                           placeholder=\"Rue\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"12\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_text\" ><div class=\"wdform-label-section wd-width-30 wd-hidden  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_12_element12\" class=\"wdform-label\">Code Postal<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_12_element12\"                           name=\"wdform_12_element12\"                           value=\"\"                           title=\"Code Postal\"                           placeholder=\"Code Postal\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"13\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_text\" ><div class=\"wdform-label-section wd-width-30 wd-hidden  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_13_element12\" class=\"wdform-label\">Ville<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_13_element12\"                           name=\"wdform_13_element12\"                           value=\"\"                           title=\"Ville\"                           placeholder=\"Ville\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"22\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_own_select\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_own_select\" ><div class=\"wdform-label-section wd-width-100 wdform_select wd-flex-row\">    <label  for=\"wdform_22_element12\" class=\"wdform-label\">D\u00e9partement<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex wdform_select wd-flex-row wd-width-100\" ><select class=\"wd-width-100\" id=\"wdform_22_element12\" name=\"wdform_22_element12\" ><option value=\"Votre d\u00e9partement\" selected=\"selected\">Votre d\u00e9partement<\/option><option value=\"01 - Ain\" >01 - Ain<\/option><option value=\"02 - Aisne \" >02 - Aisne <\/option><option value=\"03 - Allier\" >03 - Allier<\/option><option value=\"04 - Alpes-de-Haute-Provence\" >04 - Alpes-de-Haute-Provence<\/option><option value=\"05 - Hautes-alpes\" >05 - Hautes-alpes<\/option><option value=\"06 - Alpes-maritimes\" >06 - Alpes-maritimes<\/option><option value=\"07 - Ard\u00e8che\" >07 - Ard\u00e8che<\/option><option value=\"08 - Ardennes\" >08 - Ardennes<\/option><option value=\"09 - Ari\u00e8ge\" >09 - Ari\u00e8ge<\/option><option value=\"10 - Aube\" >10 - Aube<\/option><option value=\"11 - Aude\" >11 - Aude<\/option><option value=\"12 - Aveyron\" >12 - Aveyron<\/option><option value=\"13 - Bouches-du-Rh\u00f4ne\" >13 - Bouches-du-Rh\u00f4ne<\/option><option value=\"14 - Calvados\" >14 - Calvados<\/option><option value=\"15 - Cantal\" >15 - Cantal<\/option><option value=\"16 - Charente\" >16 - Charente<\/option><option value=\"17 - Charente-maritime\" >17 - Charente-maritime<\/option><option value=\"18 - Cher\" >18 - Cher<\/option><option value=\"19 - Corr\u00e8ze\" >19 - Corr\u00e8ze<\/option><option value=\"2A - Corse-du-sud\" >2A - Corse-du-sud<\/option><option value=\"2B - Haute-Corse\" >2B - Haute-Corse<\/option><option value=\"21 - C\u00f4te-dOr\" >21 - C\u00f4te-d&#039;Or<\/option><option value=\"22 - C\u00f4tes-dArmor\" >22 - C\u00f4tes-d&#039;Armor<\/option><option value=\"23 - Creuse\" >23 - Creuse<\/option><option value=\"24 - Dordogne\" >24 - Dordogne<\/option><option value=\"25 - Doubs\" >25 - Doubs<\/option><option value=\"26 - Dr\u00f4me\" >26 - Dr\u00f4me<\/option><option value=\"27 - Eure\" >27 - Eure<\/option><option value=\"28 - Eure-et-loir\" >28 - Eure-et-loir<\/option><option value=\"29 - Finist\u00e8re\" >29 - Finist\u00e8re<\/option><option value=\"30 - Gard\" >30 - Gard<\/option><option value=\"31 - Haute-garonne\" >31 - Haute-garonne<\/option><option value=\"32 - Gers\" >32 - Gers<\/option><option value=\"33 - Gironde\" >33 - Gironde<\/option><option value=\"34 - H\u00e9rault\" >34 - H\u00e9rault<\/option><option value=\"35 - Ille-et-vilaine\" >35 - Ille-et-vilaine<\/option><option value=\"36 - Indre\" >36 - Indre<\/option><option value=\"37 - Indre-et-loire\" >37 - Indre-et-loire<\/option><option value=\"38 - Is\u00e8re\" >38 - Is\u00e8re<\/option><option value=\"39 - Jura\" >39 - Jura<\/option><option value=\"40 - Landes\" >40 - Landes<\/option><option value=\"41 - Loir-et-cher\" >41 - Loir-et-cher<\/option><option value=\"42 - Loire\" >42 - Loire<\/option><option value=\"43 - Haute-loire\" >43 - Haute-loire<\/option><option value=\"44 - Loire-atlantique\" >44 - Loire-atlantique<\/option><option value=\"45 - Loiret\" >45 - Loiret<\/option><option value=\"46 - Lot\" >46 - Lot<\/option><option value=\"47 - Lot-et-garonne\" >47 - Lot-et-garonne<\/option><option value=\"48 - Loz\u00e8re\" >48 - Loz\u00e8re<\/option><option value=\"49 - Maine-et-Loire\" >49 - Maine-et-Loire<\/option><option value=\"50 - Manche\" >50 - Manche<\/option><option value=\"51 - Marne\" >51 - Marne<\/option><option value=\"52 - Haute-Marne\" >52 - Haute-Marne<\/option><option value=\"53 - Mayenne\" >53 - Mayenne<\/option><option value=\"54 - Meurthe-et-Moselle\" >54 - Meurthe-et-Moselle<\/option><option value=\"55 - Meuse\" >55 - Meuse<\/option><option value=\"56 - Morbihan\" >56 - Morbihan<\/option><option value=\"57 - \tMoselle\" >57 - \tMoselle<\/option><option value=\"58 - \tNi\u00e8vre\" >58 - \tNi\u00e8vre<\/option><option value=\"59 - \tNord\" >59 - \tNord<\/option><option value=\"60 - Oise\" >60 - Oise<\/option><option value=\"61 - Orne\" >61 - Orne<\/option><option value=\"62 - Pas-de-Calais\" >62 - Pas-de-Calais<\/option><option value=\"63 - Puy-de-D\u00f4me\" >63 - Puy-de-D\u00f4me<\/option><option value=\"64 - Pyr\u00e9n\u00e9es-Atlantiques\" >64 - Pyr\u00e9n\u00e9es-Atlantiques<\/option><option value=\"65 - Hautes-Pyr\u00e9n\u00e9es\" >65 - Hautes-Pyr\u00e9n\u00e9es<\/option><option value=\"66 - Pyr\u00e9n\u00e9es-Orientales\" >66 - Pyr\u00e9n\u00e9es-Orientales<\/option><option value=\"67 - Bas-Rhin\" >67 - Bas-Rhin<\/option><option value=\"68 - Haut-Rhin\" >68 - Haut-Rhin<\/option><option value=\"69 - Rh\u00f4ne\" >69 - Rh\u00f4ne<\/option><option value=\"70 - Haute-Sa\u00f4ne\" >70 - Haute-Sa\u00f4ne<\/option><option value=\"71 - Sa\u00f4ne-et-Loire\" >71 - Sa\u00f4ne-et-Loire<\/option><option value=\"72 - Sarthe\" >72 - Sarthe<\/option><option value=\"73 - Savoie\" >73 - Savoie<\/option><option value=\"74 - Haute-Savoie\" >74 - Haute-Savoie<\/option><option value=\"75 - Paris\" >75 - Paris<\/option><option value=\"76 - Seine-Maritime\" >76 - Seine-Maritime<\/option><option value=\"77 - Seine-et-Marne\" >77 - Seine-et-Marne<\/option><option value=\"78 - Yvelines\" >78 - Yvelines<\/option><option value=\"79 - Deux-S\u00e8vres\" >79 - Deux-S\u00e8vres<\/option><option value=\"80 - Somme\" >80 - Somme<\/option><option value=\"81 - Tarn\" >81 - Tarn<\/option><option value=\"82 - Tarn-et-Garonne\" >82 - Tarn-et-Garonne<\/option><option value=\"83 - Var\" >83 - Var<\/option><option value=\"84 - Vaucluse\" >84 - Vaucluse<\/option><option value=\"85 - Vend\u00e9e\" >85 - Vend\u00e9e<\/option><option value=\"86 - Vienne\" >86 - Vienne<\/option><option value=\"87 - Haute-Vienne\" >87 - Haute-Vienne<\/option><option value=\"88 - Vosges\" >88 - Vosges<\/option><option value=\"89 - Yonne\" >89 - Yonne<\/option><option value=\"90 - Territoire-de-Belfort\" >90 - Territoire-de-Belfort<\/option><option value=\"91 - Essonne\" >91 - Essonne<\/option><option value=\"92 - Hauts-de-Seine\" >92 - Hauts-de-Seine<\/option><option value=\"93 - Seine-Saint-Denis\" >93 - Seine-Saint-Denis<\/option><option value=\"94 - Val-de-Marne\" >94 - Val-de-Marne<\/option><option value=\"95 - Val-dOise\" >95 - Val-d&#039;Oise<\/option><option value=\"971 - Guadeloupe\" >971 - Guadeloupe<\/option><option value=\"972 - Martinique\" >972 - Martinique<\/option><option value=\"973 - Guyane\" >973 - Guyane<\/option><option value=\"974 - La r\u00e9union\" >974 - La r\u00e9union<\/option><option value=\"976 - Mayotte\" >976 - Mayotte<\/option><\/select><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"15\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_text\" ><div class=\"wdform-label-section wd-width-30 wd-hidden  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_15_element12\" class=\"wdform-label\">T\u00e9l\u00e9phone fixe<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_15_element12\"                           name=\"wdform_15_element12\"                           value=\"\"                           title=\"T\u00e9l\u00e9phone fixe\"                           placeholder=\"T\u00e9l\u00e9phone fixe\"                                                       \/><\/div><\/div><\/div><div wdid=\"16\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_text\" ><div class=\"wdform-label-section wd-width-30 wd-hidden  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_16_element12\" class=\"wdform-label\">T\u00e9l\u00e9phone mobile<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_16_element12\"                           name=\"wdform_16_element12\"                           value=\"\"                           title=\"T\u00e9l\u00e9phone mobile\"                           placeholder=\"T\u00e9l\u00e9phone mobile\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"17\" class=\"wdform_row\"><div type=\"type_submitter_mail\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_submitter_mail\" ><div class=\"wdform-label-section wd-width-30 wd-hidden  wd-flex-row\">    <label  for=\"wdform_17_element12\" class=\"wdform-label\">Email<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-width-100\" ><input type=\"text\" class=\"wd-width-100\" id=\"wdform_17_element12\" name=\"wdform_17_element12\" value=\"\" title=\"Email\" placeholder=\"Email\"   onchange=\"wd_check_email('17', '12', 'Ceci n\\'est pas une adresse e-mail valide')\" \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"18\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_18_element12\" class=\"wdform-label\">Nom, pr\u00e9nom du pharmacien ma\u00eetre de stage<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_18_element12\"                           name=\"wdform_18_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"19\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_date_new\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_date_new\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row\">    <label  for=\"wdform_19_element12\" class=\"wdform-label\">Date de fin de l'agr\u00e9ment<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-width-100\" ><input class=\"wd-width-100\" autocomplete=\"off\" onchange=\"wd_validate(this)\" data-form-id=\"12\" data-wdid=\"19\" data-valid-type=\"date\" type=\"text\" id=\"wdform_19_element12\" value=\"\" name=\"wdform_19_element12\"   \/><span id=\"fm-calendar-19\" class=\"dashicons dashicons-calendar-alt wd-calendar-button wd-hidden\"><\/span><input type=\"hidden\" class=\"hidden_date\" data-format=\"dd\/mm\/yy\" data-min=\"\" data-max=\"\" id=\"wdform_19_button12\" value=\"\" \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"35\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_editor\" class=\"wdform-field\"><p><strong><span style=\"color: #339933;\">TOPOGRAPHIE DE L&#039;OFFICINE<\/span><\/strong><\/p><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"20\" class=\"wdform_row\"><div type=\"type_own_select\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_own_select\" ><div class=\"wdform-label-section wd-width-100 wdform_select wd-flex-row\">    <label  for=\"wdform_20_element12\" class=\"wdform-label\">Votre officine est-elle une pharmacie :<\/label><\/div><div class=\"wdform-element-section wd-flex wdform_select wd-flex-row wd-width-100\" ><select class=\"wd-width-100\" id=\"wdform_20_element12\" name=\"wdform_20_element12\" ><option value=\"\" selected=\"selected\"><\/option><option value=\"de centre-ville\" >de centre-ville<\/option><option value=\"de centre-commerciale\" >de centre-commerciale<\/option><option value=\"de quartier\" >de quartier<\/option><option value=\"en milieu rural\" >en milieu rural<\/option><\/select><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"21\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_21_element12\" class=\"wdform-label\">Indiquez, si vous le jugez utile, un ordre de grandeur de l\u2019activit\u00e9 de votre officine par le crit\u00e8re qui vous para\u00eet le plus pertinent. (par exemple, nombre de clients \/ jour, tranche de chiffre d\u2019affaire - &lt; 1,3 M\u20ac - &lt;2,6M\u20ac \u2026)<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_21_element12\"                           name=\"wdform_21_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"86\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_editor\" class=\"wdform-field\"><p><strong><span style=\"color: #339933;\">ASPECTS LOGISTIQUES DU STAGE<\/span><\/strong><\/p><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"23\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_23_element12\" class=\"wdform-label\">Distance entre la pharmacie et le point de desserte de transport en commun le plus proche (station de bus, m\u00e9tro\/RER, tramway, gare SNCF)<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_23_element12\"                           name=\"wdform_23_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"24\" class=\"wdform_row\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_radio\" ><div class=\"wdform-label-section wd-width-30  wd-flex-wrap wd-flex-row\">    <label  class=\"wdform-label\">Possibilit\u00e9 de proposer un moyen de transport (par exemple covoiturage ou autre)<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-row wd-width-70\" ><div class=\"wd-flex wd-flex-row\"><input type=\"hidden\" name=\"wdform_24_element12\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_24_element120\" name=\"wdform_24_element12\" value=\"Oui\" onclick=\"set_default(&quot;wdform_24&quot;,&quot;0&quot;,&quot;12&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_24_element120\"><span><\/span>Oui<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_24_element121\" name=\"wdform_24_element12\" value=\"Non\" onclick=\"set_default(&quot;wdform_24&quot;,&quot;1&quot;,&quot;12&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_24_element121\"><span><\/span>Non<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"25\" class=\"wdform_row\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio\" ><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-row\">    <label  class=\"wdform-label\">Existe-t-il des facilit\u00e9s d\u2019h\u00e9bergement ?<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-row wd-width-100\" ><div class=\"wd-flex wd-flex-row\"><input type=\"hidden\" name=\"wdform_25_element12\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_25_element120\" name=\"wdform_25_element12\" value=\"Oui\" onclick=\"set_default(&quot;wdform_25&quot;,&quot;0&quot;,&quot;12&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_25_element120\"><span><\/span>Oui<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_25_element121\" name=\"wdform_25_element12\" value=\"Non\" onclick=\"set_default(&quot;wdform_25&quot;,&quot;1&quot;,&quot;12&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_25_element121\"><span><\/span>Non<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"32\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_editor\" class=\"wdform-field\"><strong>Quels sont les jours et les horaires d\u2019ouverture ?<\/strong><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"26\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_text\" ><div class=\"wdform-label-section wd-width-30  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_26_element12\" class=\"wdform-label\">Lundi<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-70\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_26_element12\"                           name=\"wdform_26_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"27\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_text\" ><div class=\"wdform-label-section wd-width-30  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_27_element12\" class=\"wdform-label\">Mardi<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-70\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_27_element12\"                           name=\"wdform_27_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"28\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_text\" ><div class=\"wdform-label-section wd-width-30  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_28_element12\" class=\"wdform-label\">Mercredi<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-70\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_28_element12\"                           name=\"wdform_28_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"29\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_text\" ><div class=\"wdform-label-section wd-width-30  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_29_element12\" class=\"wdform-label\">Jeudi<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-70\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_29_element12\"                           name=\"wdform_29_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"30\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_text\" ><div class=\"wdform-label-section wd-width-30  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_30_element12\" class=\"wdform-label\">Vendredi<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-70\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_30_element12\"                           name=\"wdform_30_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"31\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_text\" ><div class=\"wdform-label-section wd-width-30  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_31_element12\" class=\"wdform-label\">Samedi<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-70\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_31_element12\"                           name=\"wdform_31_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"33\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_text\" ><div class=\"wdform-label-section wd-width-30  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_33_element12\" class=\"wdform-label\">Dimanche<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-70\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_33_element12\"                           name=\"wdform_33_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"34\" class=\"wdform_row\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio\" ><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-row\">    <label  class=\"wdform-label\">Seriez-vous le cas \u00e9ch\u00e9ant favorable \u00e0 un stage de pratique professionnel partag\u00e9 pour permettre \u00e0 un \u00e9tudiant de d\u00e9couvrir deux officines diff\u00e9rentes (par exemple ville\/rurale) <\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-row wd-width-100\" ><div class=\"wd-flex wd-flex-row\"><input type=\"hidden\" name=\"wdform_34_element12\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_34_element120\" name=\"wdform_34_element12\" value=\"oui\" onclick=\"set_default(&quot;wdform_34&quot;,&quot;0&quot;,&quot;12&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_34_element120\"><span><\/span>oui<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_34_element121\" name=\"wdform_34_element12\" value=\"non\" onclick=\"set_default(&quot;wdform_34&quot;,&quot;1&quot;,&quot;12&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_34_element121\"><span><\/span>non<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"85\" class=\"wdform_row\"><div type=\"type_editor\" class=\"wdform-field\"><strong><span style=\"color: #339933;\">\u00c9QUIPE OFFICINALE & ORGANISATION DES COMPETENCES<\/span><\/strong><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"36\" class=\"wdform_row\"><div type=\"type_spinner\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_spinner\" ><div class=\"wdform-label-section wd-width-30  wd-flex-row\">    <label  for=\"wdform_36_element12\" class=\"wdform-label\">Nombre total de pharmaciens co-titulaires  :<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-width-70\" ><input                            name=\"wdform_36_element12\"                            id=\"wdform_36_element12\"                            class=\"wd-type-number\"                            onkeyup=\"wd_validate(this)\"                            data-valid-type=\"number\"                            data-form-id=\"12\"                            data-wdid=\"36\"                            style=\"width: 100px;\"                            value=\"\"                             \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"37\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_spinner\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_spinner\" ><div class=\"wdform-label-section wd-width-30  wd-flex-row\">    <label  for=\"wdform_37_element12\" class=\"wdform-label\">Nombre de pharmaciens adjoints (en ETP - \u00e9quivalent temps plein)  :<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-width-70\" ><input                            name=\"wdform_37_element12\"                            id=\"wdform_37_element12\"                            class=\"wd-type-number\"                            onkeyup=\"wd_validate(this)\"                            data-valid-type=\"number\"                            data-form-id=\"12\"                            data-wdid=\"37\"                            style=\"width: 60px;\"                            value=\"\"                             \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"38\" class=\"wdform_row\"><div type=\"type_spinner\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_spinner\" ><div class=\"wdform-label-section wd-width-30  wd-flex-row\">    <label  for=\"wdform_38_element12\" class=\"wdform-label\">Nombre de pr\u00e9parateurs dipl\u00f4m\u00e9s en ETP (ETP - \u00e9quivalent temps plein) :<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-width-70\" ><input                            name=\"wdform_38_element12\"                            id=\"wdform_38_element12\"                            class=\"wd-type-number\"                            onkeyup=\"wd_validate(this)\"                            data-valid-type=\"number\"                            data-form-id=\"12\"                            data-wdid=\"38\"                            style=\"width: 100px;\"                            value=\"\"                             \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"39\" class=\"wdform_row\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_radio\" ><div class=\"wdform-label-section wd-width-30  wd-flex-wrap wd-flex-row\">    <label  class=\"wdform-label\">Y-a-t-il d\u2019autres membres du personnel :<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-row wd-width-70\" ><div class=\"wd-flex wd-flex-row\"><input type=\"hidden\" name=\"wdform_39_element12\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_39_element120\" name=\"wdform_39_element12\" value=\"Oui\" onclick=\"set_default(&quot;wdform_39&quot;,&quot;0&quot;,&quot;12&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_39_element120\"><span><\/span>Oui<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_39_element121\" name=\"wdform_39_element12\" value=\"Non\" onclick=\"set_default(&quot;wdform_39&quot;,&quot;1&quot;,&quot;12&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_39_element121\"><span><\/span>Non<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"40\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_40_element12\" class=\"wdform-label\">Si oui, nombre et fonctions :<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_40_element12\"                           name=\"wdform_40_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"41\" class=\"wdform_row\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_radio\" ><div class=\"wdform-label-section wd-width-30  wd-flex-wrap wd-flex-row\">    <label  class=\"wdform-label\">Avez-vous accueilli des stagiaires dans les cinq ann\u00e9es pr\u00e9c\u00e9dentes ?<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-row wd-width-70\" ><div class=\"wd-flex wd-flex-row\"><input type=\"hidden\" name=\"wdform_41_element12\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_41_element120\" name=\"wdform_41_element12\" value=\"oui\" onclick=\"set_default(&quot;wdform_41&quot;,&quot;0&quot;,&quot;12&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_41_element120\"><span><\/span>oui<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_41_element121\" name=\"wdform_41_element12\" value=\"non\" onclick=\"set_default(&quot;wdform_41&quot;,&quot;1&quot;,&quot;12&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_41_element121\"><span><\/span>non<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"43\" class=\"wdform_row\"><div type=\"type_editor\" class=\"wdform-field\"><strong><font color=\"#339933\">D\u00c9L\u00c9GATION DE MISSION A UN PHARMACIEN ADJOINT MA\u00ceTRE DE STAGE<\/font><\/strong><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"83\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_radio\" ><div class=\"wdform-label-section wd-width-30  wd-flex-wrap wd-flex-row\">    <label  class=\"wdform-label\">Envisagez-vous ce type de d\u00e9l\u00e9gation ?<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-row wd-width-70\" ><div class=\"wd-flex wd-flex-row\"><input type=\"hidden\" name=\"wdform_83_element12\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_83_element120\" name=\"wdform_83_element12\" value=\"oui\" onclick=\"set_default(&quot;wdform_83&quot;,&quot;0&quot;,&quot;12&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_83_element120\"><span><\/span>oui<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_83_element121\" name=\"wdform_83_element12\" value=\"non\" onclick=\"set_default(&quot;wdform_83&quot;,&quot;1&quot;,&quot;12&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_83_element121\"><span><\/span>non<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"49\" class=\"wdform_row\"><div type=\"type_editor\" class=\"wdform-field\"><strong><font color=\"#339933\">ACTIVIT\u00c9S DE L\u2019OFFICINE<\/font><\/strong><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"50\" class=\"wdform_row\"><div type=\"type_own_select\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_own_select\" ><div class=\"wdform-label-section wd-width-100 wdform_select wd-flex-row\">    <label  for=\"wdform_50_element12\" class=\"wdform-label\">Votre pharmacie est-elle engag\u00e9e dans une d\u00e9marche de la qualit\u00e9 ?<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex wdform_select wd-flex-row wd-width-100\" style=\"max-width: 50px;\"><select class=\"wd-width-100\" id=\"wdform_50_element12\" name=\"wdform_50_element12\" ><option value=\"\" selected=\"selected\"><\/option><option value=\"oui\" >oui<\/option><option value=\"non\" >non<\/option><\/select><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"87\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100 undefined wd-flex-row wd-align-items-center\">    <label  for=\"wdform_87_element12\" class=\"wdform-label\">Si oui, avec quel support (DQO, QMS Pharma, autre - pr\u00e9cisez)<\/label><\/div><div class=\"wdform-element-section wd-flex undefined wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_87_element12\"                           name=\"wdform_87_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"88\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100 undefined wd-flex-row wd-align-items-center\">    <label  for=\"wdform_88_element12\" class=\"wdform-label\">Parmi toutes les nouvelles missions* (loi HPST, Convention\u2026) quelles sont celles que vous avez ou allez mettre en place dans votre exercice officinal&nbsp;?<\/label><\/div><div class=\"wdform-element-section wd-flex undefined wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_88_element12\"                           name=\"wdform_88_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"89\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100 undefined wd-flex-row wd-align-items-center\">    <label  for=\"wdform_89_element12\" class=\"wdform-label\">\u2022 Participez-vous \u00e0 une structure de coordination des soins dans un cadre d\u2019inter-professionnalit\u00e9&nbsp;(CPTS, SISA, autres) ?<\/label><\/div><div class=\"wdform-element-section wd-flex undefined wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_89_element12\"                           name=\"wdform_89_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"91\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_own_select\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_own_select\" ><div class=\"wdform-label-section wd-width-100 wdform_select wd-flex-row\">    <label  for=\"wdform_91_element12\" class=\"wdform-label\">\u2022 Participez-vous&nbsp;\u00e0 d\u2019autres r\u00e9seaux, d\u2019autres organisations (Conseil de l\u2019Ordre, URPS, syndicats professionnels\u2026), ou associations. <\/label><\/div><div class=\"wdform-element-section wd-flex wdform_select wd-flex-row wd-width-100\" style=\"max-width: 50px;\"><select class=\"wd-width-100\" id=\"wdform_91_element12\" name=\"wdform_91_element12\" ><option value=\"\" selected=\"selected\"><\/option><option value=\"oui\" >oui<\/option><option value=\"non\" >non<\/option><\/select><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"92\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100 undefined wd-flex-row wd-align-items-center\">    <label  for=\"wdform_92_element12\" class=\"wdform-label\">\u2022 Si oui, lesquels&nbsp;? <\/label><\/div><div class=\"wdform-element-section wd-flex undefined wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_92_element12\"                           name=\"wdform_92_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"93\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_own_select\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_own_select\" ><div class=\"wdform-label-section wd-width-100 wdform_select wd-flex-row\">    <label  for=\"wdform_93_element12\" class=\"wdform-label\">Avez-vous des activit\u00e9s d\u2019enseignement\/formation (\u00e9tudiants en pharmacie, apprentis, DEUST pr\u00e9parateur) ?<\/label><\/div><div class=\"wdform-element-section wd-flex wdform_select wd-flex-row wd-width-100\" style=\"max-width: 50px;\"><select class=\"wd-width-100\" id=\"wdform_93_element12\" name=\"wdform_93_element12\" ><option value=\"\" selected=\"selected\"><\/option><option value=\"oui\" >oui<\/option><option value=\"non\" >non<\/option><\/select><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"94\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100 undefined wd-flex-row wd-align-items-center\">    <label  for=\"wdform_94_element12\" class=\"wdform-label\">\u2022 Si oui, lesquels&nbsp;?<\/label><\/div><div class=\"wdform-element-section wd-flex undefined wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_94_element12\"                           name=\"wdform_94_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"96\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_own_select\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_own_select\" ><div class=\"wdform-label-section wd-width-100 wdform_select wd-flex-row\">    <label  for=\"wdform_96_element12\" class=\"wdform-label\">\u2022 Avez-vous une activit\u00e9 au titre de l\u2019HAD ? <\/label><\/div><div class=\"wdform-element-section wd-flex wdform_select wd-flex-row wd-width-100\" style=\"max-width: 50px;\"><select class=\"wd-width-100\" id=\"wdform_96_element12\" name=\"wdform_96_element12\" ><option value=\"\" selected=\"selected\"><\/option><option value=\"oui\" >oui<\/option><option value=\"non\" >non<\/option><\/select><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"97\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_own_select\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_own_select\" ><div class=\"wdform-label-section wd-width-100 wdform_select wd-flex-row\">    <label  for=\"wdform_97_element12\" class=\"wdform-label\">\u2022 Avez-vous une activit\u00e9 en relation avec un EHPAD ou une maison de retraite ? <\/label><\/div><div class=\"wdform-element-section wd-flex wdform_select wd-flex-row wd-width-100\" style=\"max-width: 50px;\"><select class=\"wd-width-100\" id=\"wdform_97_element12\" name=\"wdform_97_element12\" ><option value=\"\" selected=\"selected\"><\/option><option value=\"oui\" >oui<\/option><option value=\"non\" >non<\/option><\/select><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"98\" class=\"wdform_row\"><div type=\"type_own_select\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_own_select\" ><div class=\"wdform-label-section wd-width-100 wdform_select wd-flex-row\">    <label  for=\"wdform_98_element12\" class=\"wdform-label\">Si oui pratiquez-vous la PDA&nbsp;? <\/label><\/div><div class=\"wdform-element-section wd-flex wdform_select wd-flex-row wd-width-100\" style=\"max-width: 50px;\"><select class=\"wd-width-100\" id=\"wdform_98_element12\" name=\"wdform_98_element12\" ><option value=\"\" selected=\"selected\"><\/option><option value=\"oui\" >oui<\/option><option value=\"non\" >non<\/option><\/select><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"62\" class=\"wdform_row\"><div type=\"type_checkbox\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_checkbox\" ><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Quelles sont les activit\u00e9s sp\u00e9cialis\u00e9es de votre officine ?<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_62_element12\" value=\"\" \/><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_62_element120\" name=\"wdform_62_element120\" value=\"Orthop\u00e9die\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_62_element120\"><span><\/span>Orthop\u00e9die<\/label><\/div><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_62_element121\" name=\"wdform_62_element121\" value=\"Hom\u00e9opathie\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_62_element121\"><span><\/span>Hom\u00e9opathie<\/label><\/div><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_62_element122\" name=\"wdform_62_element122\" value=\"Maintien \u00e0 domicile\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_62_element122\"><span><\/span>Maintien \u00e0 domicile<\/label><\/div><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_62_element123\" name=\"wdform_62_element123\" value=\"Pharmacie v\u00e9t\u00e9rinaire\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_62_element123\"><span><\/span>Pharmacie v\u00e9t\u00e9rinaire<\/label><\/div><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_62_element124\" name=\"wdform_62_element124\" value=\"Di\u00e9t\u00e9tique et nutrition\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_62_element124\"><span><\/span>Di\u00e9t\u00e9tique et nutrition<\/label><\/div><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_62_element125\" name=\"wdform_62_element125\" value=\"Audioproth\u00e8se\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_62_element125\"><span><\/span>Audioproth\u00e8se<\/label><\/div><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_62_element126\" name=\"wdform_62_element126\" value=\"Optique\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_62_element126\"><span><\/span>Optique<\/label><\/div><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_62_element127\" name=\"wdform_62_element127\" value=\"Autres\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_62_element127\"><span><\/span>Autres<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"64\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_text\" ><div class=\"wdform-label-section wd-width-30  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_64_element12\" class=\"wdform-label\">Autres, si oui, pr\u00e9cisez<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-70\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_64_element12\"                           name=\"wdform_64_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"65\" class=\"wdform_row\"><div type=\"type_editor\" class=\"wdform-field\"><p><span style=\"margin: 0px; padding: 0px; border: 0px; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-alternates: inherit; font-weight: 600; font-stretch: inherit; font-size: 14px; line-height: inherit; font-family: \"Segoe UI\"; font-optical-sizing: inherit; font-kerning: inherit; font-feature-settings: inherit; font-variation-settings: inherit; vertical-align: baseline; color: rgb(51, 51, 51);\"><font color=\"#339933\">DOMAINES PARTICULIERS ET SPECIFIQUES DE COMPETENCES DU MA\u00ceTRE DE STAGE<\/font><\/span><\/p><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"66\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_radio\" ><div class=\"wdform-label-section wd-width-30  wd-flex-wrap wd-flex-row\">    <label  class=\"wdform-label\">Etes-vous titulaire d\u2019un DU, DIU\u2026<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-row wd-width-70\" ><div class=\"wd-flex wd-flex-row\"><input type=\"hidden\" name=\"wdform_66_element12\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_66_element120\" name=\"wdform_66_element12\" value=\"Oui\" onclick=\"set_default(&quot;wdform_66&quot;,&quot;0&quot;,&quot;12&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_66_element120\"><span><\/span>Oui<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_66_element121\" name=\"wdform_66_element12\" value=\"Non\" onclick=\"set_default(&quot;wdform_66&quot;,&quot;1&quot;,&quot;12&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_66_element121\"><span><\/span>Non<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"67\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_text\" ><div class=\"wdform-label-section wd-width-30  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_67_element12\" class=\"wdform-label\">\u2022 Si oui, lequel (lesquels) ?<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-70\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_67_element12\"                           name=\"wdform_67_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"68\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_radio\" ><div class=\"wdform-label-section wd-width-30  wd-flex-wrap wd-flex-row\">    <label  class=\"wdform-label\">Avez-vous suivi une ou plusieurs formations sp\u00e9cifiques non dipl\u00f4mantes ?<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-row wd-width-70\" ><div class=\"wd-flex wd-flex-row\"><input type=\"hidden\" name=\"wdform_68_element12\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_68_element120\" name=\"wdform_68_element12\" value=\"Oui\" onclick=\"set_default(&quot;wdform_68&quot;,&quot;0&quot;,&quot;12&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_68_element120\"><span><\/span>Oui<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_68_element121\" name=\"wdform_68_element12\" value=\"Non\" onclick=\"set_default(&quot;wdform_68&quot;,&quot;1&quot;,&quot;12&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_68_element121\"><span><\/span>Non<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"69\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_text\" ><div class=\"wdform-label-section wd-width-30  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_69_element12\" class=\"wdform-label\">\u2022 Si oui, laquelle (lesquelles) ?<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-70\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_69_element12\"                           name=\"wdform_69_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"70\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_70_element12\" class=\"wdform-label\">Y-a-t-il des domaines d\u2019int\u00e9r\u00eats particuliers ou de comp\u00e9tences sp\u00e9cifiques que vous avez d\u00e9velopp\u00e9s dans le cadre de l\u2019exercice de votre activit\u00e9 officinale :<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_70_element12\"                           name=\"wdform_70_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"71\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_71_element12\" class=\"wdform-label\">R\u00e9sumez en quelques lignes les points forts de votre parcours professionnel<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_71_element12\"                           name=\"wdform_71_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"72\" class=\"wdform_row\"><div type=\"type_editor\" class=\"wdform-field\"><p><span style=\"margin: 0px; padding: 0px; border: 0px; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-alternates: inherit; font-weight: 600; font-stretch: inherit; font-size: 14px; line-height: inherit; font-family: \"Segoe UI\"; font-optical-sizing: inherit; font-kerning: inherit; font-feature-settings: inherit; font-variation-settings: inherit; vertical-align: baseline; color: rgb(51, 51, 51);\"><span color=\"#339933\" data-mce-style=\"color: #339933;\" style=\"margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline; color: rgb(51, 153, 51);\">D\u00c9VELOPPEMENT PROFESSIONNEL CONTINU ET AUTRES FORMATIONS<\/span><\/span><\/p><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"73\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_73_element12\" class=\"wdform-label\">Pouvez-vous expliciter bri\u00e8vement, les axes de formation que vous avez retenus comme strat\u00e9giques pour vous et pour votre \u00e9quipe et ceux que vous projetez pour l\u2019avenir ?<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_73_element12\"                           name=\"wdform_73_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"74\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_radio\" ><div class=\"wdform-label-section wd-width-30  wd-flex-wrap wd-flex-row\">    <label  class=\"wdform-label\">Envisagez-vous d\u2019y associer un \u00e9tudiant stagiaire ?<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-row wd-width-70\" ><div class=\"wd-flex wd-flex-row\"><input type=\"hidden\" name=\"wdform_74_element12\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_74_element120\" name=\"wdform_74_element12\" value=\"Oui\" onclick=\"set_default(&quot;wdform_74&quot;,&quot;0&quot;,&quot;12&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_74_element120\"><span><\/span>Oui<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_74_element121\" name=\"wdform_74_element12\" value=\"Non\" onclick=\"set_default(&quot;wdform_74&quot;,&quot;1&quot;,&quot;12&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_74_element121\"><span><\/span>Non<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"77\" class=\"wdform_row\"><div type=\"type_editor\" class=\"wdform-field\"><p><span style=\"margin: 0px; padding: 0px; border: 0px; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-alternates: inherit; font-weight: 600; font-stretch: inherit; font-size: 14px; line-height: inherit; font-family: \"Segoe UI\"; font-optical-sizing: inherit; font-kerning: inherit; font-feature-settings: inherit; font-variation-settings: inherit; vertical-align: baseline; color: rgb(51, 51, 51);\"><font color=\"#339933\">MOTIVATION DU MA\u00ceTRE DE STAGE \u2013 ATTENTES DU MA\u00ceTRE DE STAGE<\/font><\/span><\/p><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"78\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_78_element12\" class=\"wdform-label\">Les raisons qui vous ont conduit \u00e0 vous impliquer comme ma\u00eetre de stage&nbsp;:<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_78_element12\"                           name=\"wdform_78_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"79\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_text\" ><div class=\"wdform-label-section wd-width-30 undefined wd-flex-row wd-align-items-center\">    <label  for=\"wdform_79_element12\" class=\"wdform-label\">Vos attentes pour l\u2019implication de votre \u00e9tudiant stagiaire&nbsp;:<\/label><\/div><div class=\"wdform-element-section wd-flex undefined wd-flex-row wd-align-items-center wd-width-70\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_79_element12\"                           name=\"wdform_79_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"84\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_text\" ><div class=\"wdform-label-section wd-width-30 undefined wd-flex-row wd-align-items-center\">    <label  for=\"wdform_84_element12\" class=\"wdform-label\">En conclusion, r\u00e9sumez en quelques lignes les points forts de votre parcours professionnel&nbsp;:<\/label><\/div><div class=\"wdform-element-section wd-flex undefined wd-flex-row wd-align-items-center wd-width-70\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_84_element12\"                           name=\"wdform_84_element12\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"80\" class=\"wdform_row\"><div type=\"type_editor\" class=\"wdform-field\"><p style=\"margin: 0px 0px 1.5em; padding: 0px; border: 0px; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-alternates: inherit; font-stretch: inherit; font-size: 14px; line-height: 21px; font-family: \"Segoe UI\"; font-optical-sizing: inherit; font-kerning: inherit; font-feature-settings: inherit; font-variation-settings: inherit; vertical-align: baseline; color: rgb(102, 102, 102);\">Les champs\u00a0accompagn\u00e9s d&#039;un\u00a0ast\u00e9risque<span data-mce-style=\"color: #ff0000;\" style=\"margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline; color: rgb(255, 0, 0);\">*<\/span>\u00a0sont obligatoires.<br>Mise \u00e0 jour le 6 octobre 2016<br><br><span style=\"margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-variant: inherit; font-weight: 600; font-stretch: inherit; font-size: inherit; line-height: inherit; font-family: inherit; font-optical-sizing: inherit; font-kerning: inherit; font-feature-settings: inherit; font-variation-settings: inherit; vertical-align: baseline;\">Donn\u00e9es personnelles<\/span><br><\/p><p style=\"margin: 0px 0px 1.5em; padding: 0px; border: 0px; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-alternates: inherit; font-stretch: inherit; line-height: 21px; font-optical-sizing: inherit; font-kerning: inherit; font-feature-settings: inherit; font-variation-settings: inherit; vertical-align: baseline;\"><font color=\"#666666\" face=\"Segoe UI\"><span style=\"font-size: 14px;\">Les informations recueillies \u00e0 partir de ce formulaire font l&#039;objet d&#039;un traitement informatique destin\u00e9 au Coll\u00e8ge des pharmaciens conseillers et ma\u00eetres de stage.\u2028Pour la finalit\u00e9 suivante : Aider les \u00e9tudiants dans leur choix d&#039;un pharmacien ma\u00eetre de stage par la mise en ligne d&#039;une fiche informative.\u2028\u2028<\/span><\/font><\/p><p style=\"margin: 0px 0px 1.5em; padding: 0px; border: 0px; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-alternates: inherit; font-stretch: inherit; line-height: 21px; font-optical-sizing: inherit; font-kerning: inherit; font-feature-settings: inherit; font-variation-settings: inherit; vertical-align: baseline;\"><font color=\"#666666\" face=\"Segoe UI\"><span style=\"font-size: 14px;\">Les \u00e9l\u00e9ments renseign\u00e9s non conformes \u00e0 l&#039;\u00e9thique de la profession et aux valeurs du Coll\u00e8ge ne seront pas retenus.<\/span><\/font><\/p><p style=\"margin: 0px 0px 1.5em; padding: 0px; border: 0px; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-alternates: inherit; font-stretch: inherit; line-height: 21px; font-optical-sizing: inherit; font-kerning: inherit; font-feature-settings: inherit; font-variation-settings: inherit; vertical-align: baseline;\"><font color=\"#666666\" face=\"Segoe UI\"><span style=\"font-size: 14px;\">Il est pr\u00e9cis\u00e9 les points suivants :<br><\/span><\/font><span style=\"font-size: 14px; color: rgb(102, 102, 102); font-family: \"Segoe UI\";\">1 \u2013 La r\u00e9daction de la fiche est sous la seule responsabilit\u00e9 du d\u00e9clarant,<br><\/span><font color=\"#666666\" face=\"Segoe UI\"><span style=\"font-size: 14px;\">2 \u2013 L\u2019enregistrement de la fiche informative se fait apr\u00e8s mod\u00e9ration du Coll\u00e8ge,<br><\/span><\/font><font color=\"#666666\" face=\"Segoe UI\"><span style=\"font-size: 14px;\">3 \u2013 Il est recommand\u00e9 de suivre les attentes du Coll\u00e8ge.<\/span><\/font><\/p><p style=\"margin: 0px 0px 1.5em; padding: 0px; border: 0px; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-alternates: inherit; font-stretch: inherit; line-height: 21px; font-optical-sizing: inherit; font-kerning: inherit; font-feature-settings: inherit; font-variation-settings: inherit; vertical-align: baseline;\"><\/p><p style=\"margin: 0px 0px 1.5em; padding: 0px; border: 0px; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-alternates: inherit; font-stretch: inherit; font-size: 14px; line-height: 21px; font-family: \"Segoe UI\"; font-optical-sizing: inherit; font-kerning: inherit; font-feature-settings: inherit; font-variation-settings: inherit; vertical-align: baseline; color: rgb(102, 102, 102);\"><span style=\"margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-variant: inherit; font-weight: 600; font-stretch: inherit; font-size: inherit; line-height: inherit; font-family: inherit; font-optical-sizing: inherit; font-kerning: inherit; font-feature-settings: inherit; font-variation-settings: inherit; vertical-align: baseline; color: rgb(51, 51, 51);\">Votre fiche sera sur le site du Coll\u00e8ge dans les 72 heures suivant votre envoi<\/span><br><br>Si vous rencontrez un probl\u00e8me pour renseigner la fiche, contactez- nous \u00e0 l&#039;adresse\u00a0<a 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