Atlassian uses cookies to improve your browsing experience, perform analytics and research, and conduct advertising. Accept all cookies to indicate that you agree to our use of cookies on your device. Atlassian cookies and tracking notice, (opens new window)
Pour suivre vos demandes de manières plus fluides, nous vous invitons à vous connecter ou vous créer un compte via le bouton "Connexion" en haut à droite de cette page.
Renseignez ce formulaire pour obtenir un accès aux services numériques dédiés aux professionnels de santé.
Les champs obligatoires sont marqués d'un astérisque*
{"xsrfToken":"b6d45f4b5ed8702057ecdaa34d8b5b4b6a5d5cb3_lout","branding":{"id":"1","key":"support","name":"Assistance e-Santé Occitanie","portalBaseUrl":"/servicedesk/customer/portal/1","logoUrl":"/rest/servicedesk/1/customer/viewport-resources/portal-logo/1/2","theme":{"headerBGColor":"#ffffff","headerLinkColor":"#292929","headerLinkHoverColor":"#0091b0","headerLinkHoverBGColor":"#0091b0","headerBadgeColor":"#0091b0"}},"helpCenterBranding":{"logoUrl":"https://api.media.atlassian.com/file/f925c349-a269-42a8-a904-0250a8966b73/image/cdn?token=eyJhbGciOiJIUzI1NiJ9.eyJpc3MiOiI1YjEwNjQwOS01MDdhLTRkNWEtYjZhYS0yODIzNzE1NmM3ZjciLCJhY2Nlc3MiOnsidXJuOmZpbGVzdG9yZTpmaWxlOmY5MjVjMzQ5LWEyNjktNDJhOC1hOTA0LTAyNTBhODk2NmI3MyI6WyJyZWFkIl19LCJleHAiOjE3NzA5OTE2MzgsIm5iZiI6MTc3MDk5MTAzOH0.Dgx46fppskPV3CIxssSUwQFjxtRMynEnlDONLyUaDjk&client=5b106409-507a-4d5a-b6aa-28237156c7f7&mode=fit","logoId":"f925c349-a269-42a8-a904-0250a8966b73","isLogoAvailable":true,"helpCenterTitle":"Bienvenue sur l'assistance e-santé Occitanie","sharedPortalName":"Assistance e-santé Occitanie","userInitialAnnouncementHeader":"INFORMATION IMPORTANTE","userInitialAnnouncementMessageWiki":"<p>Pour suivre vos demandes de manières plus fluides, nous vous invitons à vous connecter ou vous créer un compte via le bouton \"Connexion\" en haut à droite de cette page.</p>\n<p>Merci de ne pas saisir dans cet espace d’échange des données de santé (définies à l’article 4-15 du RGPD)<br> Mentions Légales Jira Service Management :<br> <a href=\"https://www.atlassian.com/fr/legal/cloud-terms-of-service\" class=\"external-link\" rel=\"nofollow noreferrer\" target=\"_blank\" style=\"text-decoration: underline;\">https://www.atlassian.com/fr/legal/cloud-terms-of-service</a></p>","translations":{"en-US":{"localeDisplayName":"anglais (États-Unis)"},"fr-FR":{"helpCenterTitle":"Bienvenue sur l'assistance e-santé Occitanie","sharedPortalName":"Assistance e-santé Occitanie","announcementHeader":"INFORMATION IMPORTANTE","announcementMessage":"Pour suivre vos demandes de manières plus fluides, nous vous invitons à vous connecter ou vous créer un compte via le bouton \"Connexion\" en haut à droite de cette page.\n\nMerci de ne pas saisir dans cet espace d’échange des données de santé (définies à l’article 4-15 du RGPD)\nMentions Légales Jira Service Management :\nhttps://www.atlassian.com/fr/legal/cloud-terms-of-service","localeDisplayName":"français (France)"}},"canEditAnnouncement":false,"siteDefaultLanguageTag":"fr-FR","userLanguageTag":"fr-FR","portalThemeColor":"#005a9d","helpCenterTitleColor":"#ffffff","bannerMediaApiUrl":"https://api.media.atlassian.com/file/3a9164d5-0a3f-4c6f-8ca1-60146d9b433c/image/cdn?token=eyJhbGciOiJIUzI1NiJ9.eyJpc3MiOiI1YjEwNjQwOS01MDdhLTRkNWEtYjZhYS0yODIzNzE1NmM3ZjciLCJhY2Nlc3MiOnsidXJuOmZpbGVzdG9yZTpmaWxlOjNhOTE2NGQ1LTBhM2YtNGM2Zi04Y2ExLTYwMTQ2ZDliNDMzYyI6WyJyZWFkIl19LCJleHAiOjE3NzA5OTE2MzgsIm5iZiI6MTc3MDk5MTAzOH0.LrBYg_zipDSp9e9v8WyjdI92ImdfmMnkxzfTgmO4bzk&client=5b106409-507a-4d5a-b6aa-28237156c7f7&height=300&mode=fit","bannerMediaApiFileId":"3a9164d5-0a3f-4c6f-8ca1-60146d9b433c","useDefaultBanner":false,"isBannerAvailable":true,"topBarColor":"#ffffff","topBarTextColor":"#ffffff","hasTopBarBeenSplit":true},"portal":{"id":"1","key":"support","projectId":10000,"serviceDeskId":1,"name":"Assistance e-Santé Occitanie","description":"","portalBaseUrl":"/servicedesk/customer/portal/1","reqTypes":[{"id":"122","name":"Formulaire d'Inscription Portail d'Accès Services e-Santé","descriptionHtml":"","callToAction":"Formulaire d'Inscription Portail d'Accès Services e-Santé","introHtml":"<p>Renseignez ce formulaire pour obtenir un accès aux services numériques dédiés aux professionnels de santé.</p>","icon":10588,"iconUrl":"https://e-sante-occitanie.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10588","groups":[1],"key":""},{"id":"2","name":"Vous avez une demande de service ?","descriptionHtml":"<p>Vous pouvez nous poser vos question sur l'utilisation de nos outils ou sur nous faire une demande concernant l'aide à la connexion, la création de compte etc...</p>","callToAction":"Vous avez une demande de service ?","introHtml":"<p>Exemple : aide à l'utilisation de nos applications…,</p>","icon":11738,"iconUrl":"https://e-sante-occitanie.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/11738","groups":[1],"key":""},{"id":"1","name":"Vous rencontrez un dysfonctionnement sur nos services ?","descriptionHtml":"","callToAction":"Vous rencontrez un dysfonctionnement sur nos services ?","introHtml":"<p>Exemple : application indisponible, perte de certaines fonctionnalités</p>","icon":11739,"iconUrl":"https://e-sante-occitanie.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/11739","groups":[1],"key":""},{"id":"129","name":"Création de compte","descriptionHtml":"","callToAction":"Création de compte","introHtml":"","icon":10592,"iconUrl":"https://e-sante-occitanie.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10592","groups":[],"key":""},{"id":"103","name":"Demande par email","descriptionHtml":"","callToAction":"Demande par email","introHtml":"","icon":10492,"iconUrl":"https://e-sante-occitanie.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10492","groups":[],"key":""},{"id":"149","name":"Recette","descriptionHtml":"","callToAction":"Recette","introHtml":"<p>Utilisé pour les tickets Recette</p>","icon":10476,"iconUrl":"https://e-sante-occitanie.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10476","groups":[],"key":""},{"id":"174","name":"Supervision","descriptionHtml":"","callToAction":"Supervision","introHtml":"","icon":10490,"iconUrl":"https://e-sante-occitanie.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10490","groups":[],"key":""}],"reqGroups":[{"id":1,"name":"Information générale"}],"orderMapping":{"1":[2,1,122]},"kbs":{"kbEnabled":true,"kbLink":{"appLinkId":"2ccdd720-2de3-3499-afe7-b3fb112259b5","appLinkName":"System Confluence","appLinkUrl":"https://e-sante-occitanie.atlassian.net/wiki","spaceKey":"MSS","spaceName":"01 MSS Médimail V4","spaceUrl":"https://e-sante-occitanie.atlassian.net/wiki/spaces/MSS","isServer":false},"labels":[],"projectKey":"SUPPORT","serviceDeskId":1,"kbLinkDomainURLs":["https://e-sante-occitanie.atlassian.net"]},"createPermission":true,"portalAnnouncement":{"portalId":1,"canEditAnnouncement":false,"canAdministerProject":false,"portalProjectKey":"SUPPORT","userLanguageHeader":"INFORMATION IMPORTANTE","userLanguageMessageWiki":"<p>Pour suivre vos demandes de manières plus fluides, nous vous invitons à vous connecter ou vous créer un compte via le bouton \"Connexion\" en haut à droite de cette page.</p>\n<p>Merci de ne pas saisir dans cet espace d’échange des données de santé (définies à l’article 4-15 du RGPD)<br> Mentions Légales Jira Service Management :<br> <a href=\"https://www.atlassian.com/fr/legal/cloud-terms-of-service\" class=\"external-link\" rel=\"nofollow noreferrer\" target=\"_blank\" style=\"text-decoration: underline;\">https://www.atlassian.com/fr/legal/cloud-terms-of-service</a></p>","defaultLanguageHeader":"INFORMATION IMPORTANTE","defaultLanguageMessage":"Pour suivre vos demandes de manières plus fluides, nous vous invitons à vous connecter ou vous créer un compte via le bouton \"Connexion\" en haut à droite de cette page.\n\nMerci de ne pas saisir dans cet espace d’échange des données de santé (définies à l’article 4-15 du RGPD)\nMentions Légales Jira Service Management :\nhttps://www.atlassian.com/fr/legal/cloud-terms-of-service","defaultLanguageDisplayName":"français (France)","isUsingLanguageSupport":false,"translations":{}},"canViewCreateRequestForm":true,"isProjectSimplified":false,"mediaApiUploadInformation":{"token":"eyJhbGciOiJIUzI1NiJ9.eyJpc3MiOiI1YjEwNjQwOS01MDdhLTRkNWEtYjZhYS0yODIzNzE1NmM3ZjciLCJhY2Nlc3MiOnsidXJuOmZpbGVzdG9yZTp1cGxvYWQ6KiI6WyJyZWFkIiwiY3JlYXRlIiwidXBkYXRlIl0sInVybjpmaWxlc3RvcmU6Y29sbGVjdGlvbjp1cGxvYWQtcHJvamVjdC0xMDAwMCI6WyJyZWFkIiwiY3JlYXRlIiwidXBkYXRlIl0sInVybjpmaWxlc3RvcmU6Y2h1bms6KiI6WyJyZWFkIiwiY3JlYXRlIl19LCJleHAiOjE3NzA5OTIyMzgsIm5iZiI6MTc3MDk5MTAzOCwiYW5vbklkIjoiYW5vbi11c2VyIiwiaHR0cHM6Ly9pZC5hdGxhc3NpYW4uY29tL2FwcEFjY3JlZGl0ZWQiOmZhbHNlfQ.AcNZjtD1xTBeIAWPcsllVxhAwXrpDW8rMi5V0vHxzyk","targetCollection":"upload-project-10000","endpointUrl":"https://api.media.atlassian.com","clientId":"5b106409-507a-4d5a-b6aa-28237156c7f7","tokenDurationInMins":20},"categories":{"categoriesSupported":true,"categories":[]}},"reqCreate":{"id":122,"projectId":10000,"issueType":{"id":"10029","name":"Formulaire d'Inscription Portail d'Accès Services e-Santé"},"form":{"name":"Formulaire d'Inscription Portail d'Accès Services e-Santé","descriptionHtml":"","callToAction":"Formulaire d'Inscription Portail d'Accès Services e-Santé","intro":"<p>Renseignez ce formulaire pour obtenir un accès aux services numériques dédiés aux professionnels de santé.</p>","instructions":"","icon":10588,"iconUrl":"https://e-sante-occitanie.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10588","key":""},"fields":[{"fieldType":"text","fieldId":"email","fieldConfigId":"","label":"Envoyer la confirmation par e-mail à","description":"","descriptionHtml":"","required":true,"displayed":true,"presetValues":[]},{"fieldType":"multiselect","jiraFieldType":"components","fieldId":"components","fieldConfigId":"","label":"Composants","description":"","descriptionHtml":"","required":false,"displayed":false,"presetValues":[],"values":[{"value":"10161","label":"Autres","selected":false,"children":[]},{"value":"10204","label":"Cyber","selected":false,"children":[]},{"value":"10184","label":"DCC","selected":false,"children":[]},{"value":"10182","label":"GDR","selected":false,"children":[]},{"value":"10007","label":"Medimail","selected":false,"children":[]},{"value":"10009","label":"Portail Accès Services","selected":false,"children":[]},{"value":"10010","label":"ROR","selected":false,"children":[]},{"value":"10160","label":"SI URGENCES","selected":false,"children":[]},{"value":"10011","label":"SPICO","selected":false,"children":[]},{"value":"10006","label":"Téléo","selected":false,"children":[]},{"value":"10008","label":"ViaTrajectoire","selected":false,"children":[]}]},{"fieldType":"text","jiraFieldType":"summary","fieldId":"summary","fieldConfigId":"","label":"Résumé","description":"","descriptionHtml":"","required":true,"displayed":false,"presetValues":["Inscription Portail d'Accès Services e-Santé"]},{"fieldType":"text","jiraFieldType":"com.atlassian.jira.plugin.system.customfieldtypes:textfield","fieldId":"customfield_10315","fieldConfigId":"10419","label":"Identifiant Régional Utilisateur","description":"","descriptionHtml":"","required":false,"displayed":false,"presetValues":[]}],"userOrganisations":[],"canBrowseUsers":true,"requestCreateBaseUrl":"/servicedesk/customer/portal/1/create/122","requestValidateBaseUrl":"/servicedesk/customer/portal/1/validate/122","calendarParams":{"firstDay":1,"date":"2026-02-13T14:57:19+0100","useISO8601WeekNumbers":true,"dateIfFormat":"%e/%b/%y","dateTimeIfFormat":"%e/%b/%y %I:%M %p","timeFormat":"12"},"kbs":{"kbEnabled":true,"kbLink":{"appLinkId":"2ccdd720-2de3-3499-afe7-b3fb112259b5","appLinkName":"System Confluence","appLinkUrl":"https://e-sante-occitanie.atlassian.net/wiki","spaceKey":"MSS","spaceName":"01 MSS Médimail V4","spaceUrl":"https://e-sante-occitanie.atlassian.net/wiki/spaces/MSS","isServer":false},"labels":[],"projectKey":"SUPPORT","serviceDeskId":1,"kbLinkDomainURLs":["https://e-sante-occitanie.atlassian.net"]},"canRaiseOnBehalf":false,"canSignupCustomers":false,"canCreateAttachments":true,"attachmentRequiredField":false,"hasGroups":true,"canSubmitWithEmailAddress":true,"showRecaptcha":true,"siteKey":"6LePXLkdAAAAAF4gCNalrL1IvZcqbNbZf_Zakudd","mediaApiUploadInformation":{"token":"eyJhbGciOiJIUzI1NiJ9.eyJpc3MiOiI1YjEwNjQwOS01MDdhLTRkNWEtYjZhYS0yODIzNzE1NmM3ZjciLCJhY2Nlc3MiOnsidXJuOmZpbGVzdG9yZTp1cGxvYWQ6KiI6WyJyZWFkIiwiY3JlYXRlIiwidXBkYXRlIl0sInVybjpmaWxlc3RvcmU6Y29sbGVjdGlvbjp1cGxvYWQtcHJvamVjdC0xMDAwMCI6WyJyZWFkIiwiY3JlYXRlIiwidXBkYXRlIl0sInVybjpmaWxlc3RvcmU6Y2h1bms6KiI6WyJyZWFkIiwiY3JlYXRlIl19LCJleHAiOjE3NzA5OTIyMzksIm5iZiI6MTc3MDk5MTAzOSwiYW5vbklkIjoiYW5vbi11c2VyIiwiaHR0cHM6Ly9pZC5hdGxhc3NpYW4uY29tL2FwcEFjY3JlZGl0ZWQiOmZhbHNlfQ.ML1TWTUBvKTKq-4Zh93-DwDe3l3Ftn-9ka_sOt2roOU","targetCollection":"upload-project-10000","endpointUrl":"https://api.media.atlassian.com","clientId":"5b106409-507a-4d5a-b6aa-28237156c7f7","tokenDurationInMins":20},"hasProformaForm":true,"proformaTemplateForm":{"id":5359128234153951,"updated":"2026-02-12T08:38:16.935227182Z","publish":{"jira":{"newIssueIssueTypeIds":[],"newIssueRequestTypeIds":[122],"submitOnCreate":true,"validateOnCreate":true},"portal":{"portalRequestTypeIds":[122],"submitOnCreate":true,"validateOnCreate":true}},"design":{"settings":{"templateId":5359128234153951,"name":"Formulaire d'Inscription Portail d'Accès Services e-Santé","submit":{"lock":false,"pdf":false},"language":"fr","templateFormUuid":"28c0c76b-9c80-4d04-9ff1-d363cf04fe83"},"layout":[{"version":1,"type":"doc","content":[{"type":"heading","attrs":{"level":1,"localId":"d80221a7-8aa7-4053-9036-d6c1b44c8949"},"content":[{"type":"hardBreak"},{"type":"text","text":"Création d’un compte PASS (Point d’Accès aux Services de la e-Santé)"}]},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","attrs":{"localId":"d08fff6b-9f88-4d53-8e37-ae9ee4ab0d07"},"content":[{"type":"text","text":"Ce formulaire est spécifique pour la création de comptes "},{"type":"text","text":"SPICO, TéléO, Smurt@b et TUCS.","marks":[{"type":"strong"}]}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","attrs":{"localId":"c5b2a7cb-0531-4845-ae64-ab91e933c163"},"content":[{"type":"text","text":"Pour "},{"type":"text","text":"Medimail ","marks":[{"type":"strong"}]},{"type":"text","text":": "},{"type":"text","text":"Cliquez ici","marks":[{"type":"link","attrs":{"href":"https://medimail.mipih.fr/register/type-register"}}]},{"type":"text","text":" pour créer un compte"}]}]},{"type":"listItem","content":[{"type":"paragraph","attrs":{"localId":"263bbe8e-dc8a-443c-baa5-793c1f6042d2"},"content":[{"type":"text","text":"Pour "},{"type":"text","text":"DCC ","marks":[{"type":"strong"}]},{"type":"text","text":": "},{"type":"text","text":"Cliquez ici","marks":[{"type":"link","attrs":{"href":"https://portail.mediware.fr/Apps/WebObjects/Oncooc.woa"}}]},{"type":"text","text":" pour créer un compte"}]}]},{"type":"listItem","content":[{"type":"paragraph","attrs":{"localId":"7c8bb0f6-cd2b-4ce5-adda-9a1f8780e68c"},"content":[{"type":"text","text":"Pour "},{"type":"text","text":"ViaTrajectoire ","marks":[{"type":"strong"}]},{"type":"text","text":": Demandez à votre référent structure pour créer un compte. Si vous ne connaissez pas le nom de votre référent, vous pouvez en "},{"type":"text","text":"faire la demande à notre Centre de Services","marks":[{"type":"link","attrs":{"href":"https://e-sante-occitanie.atlassian.net/servicedesk/customer/portal/1/group/1/create/2"}}]}]}]}]}]},{"type":"paragraph","attrs":{"localId":"678d1045-b297-415d-98ca-9a41542fc1b3"},"content":[{"type":"text","text":"Afin de faciliter et d’accélérer votre inscription, nous vous invitons à lire et à compléter attentivement les informations ci-dessous, selon votre situation.","marks":[{"type":"strong"}]}]},{"type":"heading","attrs":{"level":1,"localId":"753976f0-5dea-4260-b6d9-be983cfa1fd6"},"content":[{"type":"text","text":"Demande d’accès aux services numériques","marks":[{"type":"strong"},{"type":"textColor","attrs":{"color":"#0747a6"}}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":480},"layout":"default","localId":"fd872d0a-efeb-4952-a033-5d6b672d9ad8"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":553},"layout":"default","localId":"db2acf7f-719e-4b9a-94d5-038603e4672d"}}]},{"version":1,"type":"doc","content":[{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"heading","attrs":{"level":3,"localId":"6adfd7d0-ded9-4e85-9ce8-0f318c0e72fb"},"content":[{"type":"text","text":"Informations SPICO"}]}]},{"type":"heading","attrs":{"level":4,"localId":"11beff1f-3d45-44e0-87f7-a2e8e28fea46"},"content":[{"type":"text","text":"Si vous souhaitez accéder aux patients pris en charge au sein de votre structure, nous vous invitons à lui demander de vous accorder une délégation."}]}]},{"version":1,"type":"doc","content":[]},{"version":1,"type":"doc","content":[{"type":"paragraph","content":[]},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"heading","attrs":{"level":3,"localId":"c1e91a19-c535-43a0-9850-e0f04aeba5a7"},"content":[{"type":"text","text":"Informations TUCS à renseigner"}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":554},"layout":"default","localId":"471927e3-310f-4163-97f4-d571c0341abb"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":510},"layout":"default","localId":"601ca754-9b92-4d70-b334-fcd1ec7600bd"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1382},"layout":"default","localId":"685aee9e-c1db-439d-bc2a-4ffe6dcbe939"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1384},"layout":"default","localId":"c0f4eab4-3a81-4248-8aa0-d7efc69fb0d6"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1385},"layout":"default","localId":"0c28eba7-24d7-42d4-a816-0294046003e9"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1386},"layout":"default","localId":"fa4681b8-0414-4784-becd-3524d916fc57"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1387},"layout":"default","localId":"9388e36e-d781-4141-ae80-60f1a1e8ff64"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1388},"layout":"default","localId":"76342398-5030-4aba-89c5-aae7c7a0e94a"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1389},"layout":"default","localId":"c371cdd2-7d96-47f4-aa6f-42fa89f6539b"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1390},"layout":"default","localId":"a582f742-c24d-47e9-b9da-9e991f5b35b9"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1391},"layout":"default","localId":"1020e0c0-1820-4d76-a9da-247015852ace"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1392},"layout":"default","localId":"9f257166-3efb-44b5-9a9f-146ae9531f34"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1393},"layout":"default","localId":"f6568d9a-5dff-443d-a930-95fb6fda0076"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1394},"layout":"default","localId":"271c4147-4cec-4e85-a94f-e7f46d7b386d"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":515},"layout":"default","localId":"9b009249-671f-432c-a625-907c694d0432"}}]},{"version":1,"type":"doc","content":[{"type":"paragraph","content":[]},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"heading","attrs":{"level":3,"localId":"c76b7d55-6721-4dc4-9136-c02af38eb347"},"content":[{"type":"text","text":"Informations Téléo à renseigner"}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1344},"layout":"default","localId":"90e11b3c-0975-480a-aa48-b1a9982c3fa3"}},{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1349},"layout":"default","localId":"139c8919-aa6e-4558-b824-0f18e7b5c423"}}]},{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1350},"layout":"default","localId":"c81877b2-4a18-4175-bf0f-fffc2851874d"}}]},{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1352},"layout":"default","localId":"9fd01f5d-ca40-4069-8277-04739138ce2d"}}]}]}]},{"version":1,"type":"doc","content":[{"type":"heading","attrs":{"level":1,"localId":"753976f0-5dea-4260-b6d9-be983cfa1fd6"},"content":[{"type":"hardBreak"},{"type":"text","text":"Informations personnelles","marks":[{"type":"strong"},{"type":"textColor","attrs":{"color":"#0747a6"}}]}]},{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1357},"layout":"default","localId":"2ac646da-23da-4a9c-8ea1-01a90e9d2472"}}]},{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1358},"layout":"default","localId":"6d840ba2-f79c-493c-b592-1a43fa119373"}}]},{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1366},"layout":"default","localId":"459236e9-590f-4db7-ae10-dd54bf5224f0"}}]}]},{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1368},"layout":"default","localId":"8a26573c-dfdf-47dd-acfd-a441db39ff46"}}]},{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1369},"layout":"default","localId":"6d4bd22e-4d53-4892-ad53-896a9fd46f6b"}}]},{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"paragraph","content":[]}]}]},{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":66.66},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1370},"layout":"default","localId":"c5fc324b-2c97-4065-8fe5-77b84e39dfb3"}}]},{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"paragraph","content":[]}]}]}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1217},"layout":"default","localId":"83976dc3-6906-4df5-8c05-9432a62ead4c"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":996},"layout":"default","localId":"cc97454d-64ce-4e31-8c9f-404547e043d6"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":998},"layout":"default","localId":"91283d24-8b60-46b2-a176-0f60a67bc0cc"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1000},"layout":"default","localId":"126547e1-ff4e-409c-bc3b-90d350ac086f"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1002},"layout":"default","localId":"f14e94ba-14b2-48a4-bd61-2f2bca70ecb8"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1004},"layout":"default","localId":"8e5a7e5e-9bae-47c1-bf04-2e889955112d"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1006},"layout":"default","localId":"38b261b0-08f8-482f-a3c0-63926cc0e93d"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1008},"layout":"default","localId":"c0458fd3-14ec-4d95-a015-7ddb70118629"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1010},"layout":"default","localId":"9f986385-4979-4d10-960d-1ccb33d55971"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1012},"layout":"default","localId":"4875e509-d956-42e4-b94c-328be1d74629"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1014},"layout":"default","localId":"bb8f8643-0c65-4c89-a5d3-a6701ee4854b"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1016},"layout":"default","localId":"2682c0d6-97a7-405e-927b-ce319faf864d"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1018},"layout":"default","localId":"c8a24189-69e2-4a70-b41d-4c7e0d9e7f47"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1020},"layout":"default","localId":"eb7b79f9-eaa3-4f7e-b1d7-19e378e32306"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1022},"layout":"default","localId":"79e5ef2c-9668-4a86-a00f-918abd410adb"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1024},"layout":"default","localId":"5e3da3c5-6208-4258-a5a1-8bb6892abf05"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1026},"layout":"default","localId":"65a8cf39-8f7b-47de-8423-b35c4909646b"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1028},"layout":"default","localId":"fdd3e6de-3e48-4479-85a6-fdbc0e6b14c9"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1030},"layout":"default","localId":"86c182a3-3496-4a72-947d-0a25e2a3a1bf"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1032},"layout":"default","localId":"fabf05ea-bbbd-449a-8479-5ef2671b5461"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1034},"layout":"default","localId":"6ab022ca-173b-4cc8-b034-4bef82d4a881"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1036},"layout":"default","localId":"9795b9db-0736-42b6-89d8-d3810c105f43"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1038},"layout":"default","localId":"4a482817-9c0e-4e60-85e1-eda1f335de27"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1040},"layout":"default","localId":"10013bb8-3078-4710-940f-8272f3b785af"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1042},"layout":"default","localId":"8e290217-2efc-417c-a1b7-cd2968679f67"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1044},"layout":"default","localId":"8378a009-3962-4d2b-9991-0c4f8b992fc7"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1046},"layout":"default","localId":"62f19c4d-e93e-4e6e-a256-fd24057bede0"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1048},"layout":"default","localId":"4e3f1985-7284-4ce4-af7b-bfc16c66573b"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1050},"layout":"default","localId":"51e0b39a-eeb2-44ef-85aa-2e69720aea1d"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1052},"layout":"default","localId":"7afc047c-c30d-496f-80ea-854f5a684736"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1054},"layout":"default","localId":"8ed1871a-5e24-4d7e-8f20-97579060ce8d"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1056},"layout":"default","localId":"80ae86cc-057f-4180-8903-725288125233"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1058},"layout":"default","localId":"d5dc7e9c-fdab-462f-97fe-b00c7ab7e62a"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1060},"layout":"default","localId":"5e219e44-522e-4e2c-865d-aab5385d8548"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1062},"layout":"default","localId":"85058167-5e88-45d1-84ca-7124bf2d1f2c"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1064},"layout":"default","localId":"6e02a894-c749-46f9-8acf-8581b79da769"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1066},"layout":"default","localId":"289ce5e4-61eb-4a2b-bb8e-ea8886169966"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1068},"layout":"default","localId":"be715a40-5931-4307-8ecf-936c33534986"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1070},"layout":"default","localId":"f1358794-7fef-4783-a084-1fae080cf856"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1072},"layout":"default","localId":"63947708-c14e-4fbc-a342-6f61d2d8a283"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1074},"layout":"default","localId":"0890c379-1253-4715-aa30-302c51b1e65b"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1076},"layout":"default","localId":"1f1df678-6e37-458a-b696-7515d3856f61"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1078},"layout":"default","localId":"6060393b-052e-476a-8414-e01ef76e3f09"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1080},"layout":"default","localId":"b40a2620-3064-4022-a590-8abd2ccaaffa"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1082},"layout":"default","localId":"520a8e07-e0b3-4d1b-9456-cbf477adc014"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1084},"layout":"default","localId":"9f77bb72-1ed0-46ab-8643-c0673ad77dca"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1086},"layout":"default","localId":"8239d723-e789-492f-aaba-b8a6aae246a4"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1088},"layout":"default","localId":"00229843-651f-4699-a856-24838b6c46b8"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1090},"layout":"default","localId":"99147514-7dc1-4f0e-82d6-bdbc04cb490a"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1092},"layout":"default","localId":"e1f94282-2d93-428f-a87c-01e759fc803d"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1094},"layout":"default","localId":"d10f1c2f-7e6f-4d08-93d7-9a02be0798f0"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1096},"layout":"default","localId":"0914a7a1-0d1f-44a5-9d30-30529fd08edd"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1098},"layout":"default","localId":"5f95a2c1-ffd1-460c-9997-8780af4f75d1"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1100},"layout":"default","localId":"1424433c-da0f-473e-8c88-9dc06b3c5026"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1102},"layout":"default","localId":"82e869b1-3811-45a8-b7e0-c555661dcea8"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1104},"layout":"default","localId":"72c88ad6-2cad-446a-b002-c45b25bcdc3f"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1106},"layout":"default","localId":"7290e2ea-46f1-44ac-818e-1ddb8a70670d"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1108},"layout":"default","localId":"173dfca1-2926-45e7-9066-71bbe5fe360a"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1110},"layout":"default","localId":"dff7a61f-6987-40a9-96d4-288e3530138a"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1112},"layout":"default","localId":"5e642542-5c06-4ff5-922a-6e79f51f66a5"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1114},"layout":"default","localId":"2723fd6a-4459-44b3-9241-68c23652f450"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1116},"layout":"default","localId":"564b189e-7911-435d-a979-e33123c4c80c"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1118},"layout":"default","localId":"fd93e23c-986f-4ca5-97b7-edf625d819a3"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1120},"layout":"default","localId":"f3cbd74e-fc35-4c58-b120-4496cc080426"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1122},"layout":"default","localId":"7df855ab-3d10-47be-a3f8-bc150b771ef5"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1124},"layout":"default","localId":"2f86e290-0a0f-48e5-b39c-5763be1d4556"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1126},"layout":"default","localId":"d8a30c4d-3064-45c2-b228-003cab384257"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1128},"layout":"default","localId":"51ae729c-afb5-4cde-b7f5-fb466fdde6e1"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1130},"layout":"default","localId":"0cd2ff8d-0c03-42c7-9e4f-5f938b0d3bf0"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1132},"layout":"default","localId":"4eefbfed-0ff7-4d58-95f3-78eac10afe75"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1134},"layout":"default","localId":"2021df4f-b48f-4569-aa76-56922e01dc7e"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1136},"layout":"default","localId":"4cbeb2a0-e073-4b45-ba8d-ecc90de66a14"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1138},"layout":"default","localId":"fd13edea-1791-47e2-8054-d26f2372a97a"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1140},"layout":"default","localId":"508b1771-abcb-40a1-b3b3-5ecf06953014"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1142},"layout":"default","localId":"37538843-97a5-4caf-b465-766249f29607"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1144},"layout":"default","localId":"572e9d10-2d25-470c-8c9f-91436e631f7f"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1146},"layout":"default","localId":"2541a15b-48c5-47ba-b980-f74ba2e37faa"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1148},"layout":"default","localId":"6b30f45d-6ae9-406f-9a93-d35f09049f25"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1150},"layout":"default","localId":"1753fed0-8f8c-410a-b86f-4f230e7292db"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1152},"layout":"default","localId":"e41e1ac5-d6ee-456f-84fe-4b552a4392ed"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1154},"layout":"default","localId":"b3b28d1f-912d-49df-ac3f-dd952c26e4f1"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1156},"layout":"default","localId":"935422a5-be0a-422d-b5c6-987c873d829e"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1158},"layout":"default","localId":"8e1ce744-cf32-4101-b7ac-d63e23bd6ba5"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1160},"layout":"default","localId":"892c96c8-9782-40f5-b3ae-ebd70f0e01cc"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1162},"layout":"default","localId":"5ecad855-fb06-4556-b3c4-8fea2ba042db"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1164},"layout":"default","localId":"aa8f27ff-e691-422d-ac4d-7d343ed25659"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1166},"layout":"default","localId":"4b3f410f-e5f9-4e2b-86c9-07e839a9e3b2"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1168},"layout":"default","localId":"7bc4d88b-ecee-4d9a-88f7-9c300be069cf"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1170},"layout":"default","localId":"37426cc7-1904-4f7f-bf03-60095b5ed88b"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1172},"layout":"default","localId":"e715f4dd-4eb8-4964-8e84-04c4a57d7909"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1174},"layout":"default","localId":"87969fe2-1b8c-4401-be53-3af3ce9aad4f"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1176},"layout":"default","localId":"ea002d92-91cc-41ae-8f57-ec8e543b6f8c"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1178},"layout":"default","localId":"4675d71f-a878-4297-9f72-3f81812584da"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1180},"layout":"default","localId":"e0a7e1db-3c74-48b3-909b-46ea514e44b6"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1182},"layout":"default","localId":"542b26b6-8841-4b4f-a0a1-9951bdd57e00"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1184},"layout":"default","localId":"cba4ba1d-bcff-4ed9-ae20-bb3172e7d076"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1186},"layout":"default","localId":"0dd6a00a-e49f-4005-9b65-a5b902f39ff5"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1188},"layout":"default","localId":"9d088f21-5926-4c49-bf7f-efef429d6aad"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1190},"layout":"default","localId":"9d5fb259-71bf-427d-8796-18c2e1bf59e4"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1192},"layout":"default","localId":"d59beb17-6027-4fc6-b115-9da2579caf94"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1194},"layout":"default","localId":"2c400bd9-8567-4e46-94a6-de4bfec050c5"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1196},"layout":"default","localId":"48fd301a-5227-447a-b1a7-89f2a04845dc"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1198},"layout":"default","localId":"21c4b1da-a49e-4bad-b7f7-e41c55f1ade8"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1200},"layout":"default","localId":"e258ba06-afa4-4877-ae6a-52b4df5ad9de"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1202},"layout":"default","localId":"72a99e49-ed94-479e-b3dc-4809ff3c53db"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1204},"layout":"default","localId":"7eda60c6-c041-4a03-8dcb-568df40a9e58"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1206},"layout":"default","localId":"a61c8522-3b80-41d0-b068-89d9e448ef57"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1208},"layout":"default","localId":"a826a117-d51b-4cb3-9c07-d10bd5b15af7"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1210},"layout":"default","localId":"5a53b71e-f658-40df-8509-2e6884d4cd22"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1212},"layout":"default","localId":"4cfd3727-88b8-4746-a8d7-be0b1f24bc18"}}]},{"version":1,"type":"doc","content":[{"type":"heading","attrs":{"level":1,"localId":"753976f0-5dea-4260-b6d9-be983cfa1fd6"},"content":[{"type":"hardBreak"},{"type":"text","text":"Informations d’authentification","marks":[{"type":"strong"},{"type":"textColor","attrs":{"color":"#0747a6"}}]}]},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","attrs":{"localId":"8272eea4-37b7-4e4c-a5b4-07430ecfbd74"},"content":[{"type":"text","text":"Les informations demandées ci-dessous seront exclusivement utilisées à des fins d’authentification au PASS."}]}]},{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":530},"layout":"default","localId":"32e86890-4a09-4836-9e65-fe19fdf3bac1"}}]},{"type":"layoutColumn","attrs":{"width":66.66},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":531},"layout":"default","localId":"54ea6ec5-8e9d-4c9c-8432-969a54635e1f"}}]}]},{"type":"heading","attrs":{"level":1,"localId":"753976f0-5dea-4260-b6d9-be983cfa1fd6"},"content":[{"type":"text","text":"Informations professionnelles","marks":[{"type":"strong"},{"type":"textColor","attrs":{"color":"#0747a6"}}]}]},{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1371},"layout":"default","localId":"04ed9d75-aa47-4681-ad5d-77e58ff8b566"}}]},{"type":"layoutColumn","attrs":{"width":66.66},"content":[{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","attrs":{"localId":"5bd05a3c-c223-4539-88c5-f1ac83e2eee3"},"content":[{"type":"text","text":"Retrouvez votre n° RPPS en allant sur "},{"type":"text","text":"https://annuaire.esante.gouv.fr/","marks":[{"type":"link","attrs":{"href":"https://annuaire.esante.gouv.fr/"}}]},{"type":"text","text":" "},{"type":"hardBreak"},{"type":"text","text":"→ ","marks":[{"type":"strong"}]},{"type":"text","text":"Puis choisir “"},{"type":"text","text":"Rechercher un professionnel”","marks":[{"type":"em"}]}]}]},{"type":"paragraph","content":[{"type":"text","text":" "}]}]}]}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1373},"layout":"default","localId":"e951cfd2-55ce-4532-bd7f-44164f46679b"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1374},"layout":"default","localId":"a0f30e6e-c340-4da2-a729-4e7f8c5d2228"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1376},"layout":"default","localId":"f19d7e3e-ce6d-4b8f-97aa-8dfc1667de6c"}}]},{"version":1,"type":"doc","content":[{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":66.66},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1329},"layout":"default","localId":"094c7ba7-2a6f-4f52-b1a2-d5728b3248d3"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1337},"layout":"default","localId":"3d3c09a2-d4a4-4700-8398-33276d407d6c"}}]},{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"paragraph","content":[]},{"type":"paragraph","content":[]},{"type":"paragraph","content":[]},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","attrs":{"localId":"cb5e67e5-04e2-4ccf-ac2b-03ed3e5f5c4b"},"content":[{"type":"text","text":"Retrouvez votre n° SIRET ou FINESS en allant sur "},{"type":"text","text":"https://annuaire.esante.gouv.fr/","marks":[{"type":"link","attrs":{"href":"https://annuaire.esante.gouv.fr/"}}]},{"type":"hardBreak"},{"type":"text","text":"→ ","marks":[{"type":"strong"}]},{"type":"text","text":"Puis choisir “"},{"type":"text","text":"Rechercher une structure”","marks":[{"type":"em"}]}]}]}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":545},"layout":"default","localId":"4f984c67-14f2-4ff1-a125-50ae13b533ee"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":496},"layout":"default","localId":"f9b2c652-97d6-4f03-8912-6a915a435483"}}]},{"version":1,"type":"doc","content":[]},{"version":1,"type":"doc","content":[{"type":"paragraph","attrs":{"localId":"c674080d-246e-4ccc-bbd9-a3e07a1f3969"},"content":[{"type":"text","text":"Au sein de votre structure :"}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":547},"layout":"default","localId":"4b4435bf-0180-4b7c-b247-c651ee6ef2fb"}},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","attrs":{"localId":"35584c6f-80db-4160-a7d2-42234e74252b"},"content":[{"type":"text","text":"Merci de renseigner les coordonnées d’une personne de votre service ou de votre établissement susceptible d’être contactée dans le cadre du traitement de votre demande de création de compte. Si vous n'avez pas de référent, merci d'indiquer les coordonnées du secrétariat de votre service ou de votre établissement."}]}]},{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1331},"layout":"default","localId":"e1bd36ae-152c-478c-8bcf-2086ad2dd383"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1333},"layout":"default","localId":"6e77793c-4f1e-4c0b-a713-0679e5cab4c0"}}]},{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1332},"layout":"default","localId":"ab800256-f93a-4af5-8c2c-537744e3d10e"}},{"type":"paragraph","content":[]}]},{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"paragraph","content":[]}]}]}]},{"version":1,"type":"doc","content":[{"type":"rule"},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","attrs":{"localId":"e7ac0cd6-e767-471f-b677-267295bd38e1"},"content":[{"type":"text","text":"Je comprends que la création des comptes n’est pas automatique, qu’elle implique un délai de traitement, et que je peux être contacté par le Centre de Services du GRADeS pour des raisons de sécurité liées aux informations que vous venez de renseigner."},{"type":"hardBreak"},{"type":"hardBreak"},{"type":"text","text":"Mentions légales Jira Service Management","marks":[{"type":"link","attrs":{"href":"https://www.atlassian.com/fr/legal/cloud-terms-of-service"}},{"type":"strong"},{"type":"underline"}]}]},{"type":"paragraph","attrs":{"localId":"76dae7e8-ea6c-4e0d-8d78-e2bd548c80c7"},"content":[{"type":"text","text":"Mentions légales PASS","marks":[{"type":"link","attrs":{"href":"https://pass.esante-occitanie.fr/AutoConnectSSO/Content/StaticPages/CharteLegale.html"}},{"type":"strong"},{"type":"underline"}]}]},{"type":"paragraph","attrs":{"localId":"7a015bfb-7734-4a45-8347-cb131c7508bc"},"content":[{"type":"text","text":"CGU PASS","marks":[{"type":"link","attrs":{"href":"https://pass.esante-occitanie.fr/AutoConnectSSO/Content/StaticPages/ConditionsGenerales.html"}},{"type":"strong"},{"type":"underline"}]}]},{"type":"paragraph","attrs":{"localId":"d003398e-d222-425f-b6e7-f5ec0c7a58f4"},"content":[{"type":"text","text":"Note RGPD","marks":[{"type":"link","attrs":{"href":"https://pass.esante-occitanie.fr/AutoConnectSSO/Content/StaticPages/Confidentialite.html"}},{"type":"strong"},{"type":"underline"}]}]}]}]}],"conditions":{"1310":{"i":{"co":{"cIds":{"1370":["92"]}}},"o":{"sIds":["111"]},"t":"sh"},"1379":{"i":{"co":{"cIds":{"480":["4"]}}},"o":{"sIds":["4"]},"t":"sh"},"1262":{"i":{"co":{"cIds":{"1370":["44"]}}},"o":{"sIds":["63"]},"t":"sh"},"1401":{"i":{"co":{"cIds":{"510":["10042"]}}},"o":{"sIds":["10"]},"t":"sh"},"1267":{"i":{"co":{"cIds":{"1370":["49"]}}},"o":{"sIds":["68"]},"t":"sh"},"1406":{"i":{"co":{"cIds":{"510":["10046"]}}},"o":{"sIds":["15"]},"t":"sh"},"1227":{"i":{"co":{"cIds":{"1370":["9"]}}},"o":{"sIds":["28"]},"t":"sh"},"541":{"i":{"co":{"cIds":{}},"operator":"OR","groups":[{"operator":"AND","checks":[{"fieldId":"496","type":"SOME_OF","constraint":["2"]}]}]},"o":{"sIds":["136"]},"t":"sh"},"1278":{"i":{"co":{"cIds":{"1370":["60"]}}},"o":{"sIds":["79"]},"t":"sh"},"1238":{"i":{"co":{"cIds":{"1370":["20"]}}},"o":{"sIds":["39"]},"t":"sh"},"519":{"i":{"co":{"cIds":{"480":["1"]}}},"o":{"sIds":["18"]},"t":"sh"},"1224":{"i":{"co":{"cIds":{"1370":["6"]}}},"o":{"sIds":["25"]},"t":"sh"},"1249":{"i":{"co":{"cIds":{"1370":["31"]}}},"o":{"sIds":["50"]},"t":"sh"},"1289":{"i":{"co":{"cIds":{"1370":["71"]}}},"o":{"sIds":["90"]},"t":"sh"},"1235":{"i":{"co":{"cIds":{"1370":["17"]}}},"o":{"sIds":["36"]},"t":"sh"},"1250":{"i":{"co":{"cIds":{"1370":["32"]}}},"o":{"sIds":["51"]},"t":"sh"},"1328":{"i":{"co":{"cIds":{"1370":["102"]}}},"o":{"sIds":["121"]},"t":"sh"},"1261":{"i":{"co":{"cIds":{"1370":["43"]}}},"o":{"sIds":["62"]},"t":"sh"},"1290":{"i":{"co":{"cIds":{"1370":["72"]}}},"o":{"sIds":["91"]},"t":"sh"},"1299":{"i":{"co":{"cIds":{"1370":["81"]}}},"o":{"sIds":["100"]},"t":"sh"},"1259":{"i":{"co":{"cIds":{"1370":["41"]}}},"o":{"sIds":["60"]},"t":"sh"},"1219":{"i":{"co":{"cIds":{"1370":["1"]}}},"o":{"sIds":["20"]},"t":"sh"},"1221":{"i":{"co":{"cIds":{"1370":["3"]}}},"o":{"sIds":["22"]},"t":"sh"},"1317":{"i":{"co":{"cIds":{"1370":["98"]}}},"o":{"sIds":["118"]},"t":"sh"},"504":{"i":{"co":{"cIds":{"480":["5"]}}},"o":{"sIds":["1"]},"t":"sh"},"1232":{"i":{"co":{"cIds":{"1370":["14"]}}},"o":{"sIds":["33"]},"t":"sh"},"1272":{"i":{"co":{"cIds":{"1370":["54"]}}},"o":{"sIds":["73"]},"t":"sh"},"1284":{"i":{"co":{"cIds":{"1370":["66"]}}},"o":{"sIds":["85"]},"t":"sh"},"1312":{"i":{"co":{"cIds":{"1370":["94"]}}},"o":{"sIds":["113"]},"t":"sh"},"1295":{"i":{"co":{"cIds":{"1370":["77"]}}},"o":{"sIds":["96"]},"t":"sh"},"1254":{"i":{"co":{"cIds":{"1370":["36"]}}},"o":{"sIds":["55"]},"t":"sh"},"1397":{"i":{"co":{"cIds":{"510":["10037"]}}},"o":{"sIds":["6"]},"t":"sh"},"1294":{"i":{"co":{"cIds":{"1370":["76"]}}},"o":{"sIds":["95"]},"t":"sh"},"1273":{"i":{"co":{"cIds":{"1370":["55"]}}},"o":{"sIds":["74"]},"t":"sh"},"1323":{"i":{"co":{"cIds":{"1370":["111"]}}},"o":{"sIds":["129"]},"t":"sh"},"1283":{"i":{"co":{"cIds":{"1370":["65"]}}},"o":{"sIds":["84"]},"t":"sh"},"1301":{"i":{"co":{"cIds":{"1370":["83"]}}},"o":{"sIds":["102"]},"t":"sh"},"1243":{"i":{"co":{"cIds":{"1370":["25"]}}},"o":{"sIds":["44"]},"t":"sh"},"1257":{"i":{"co":{"cIds":{"1370":["39"]}}},"o":{"sIds":["58"]},"t":"sh"},"1246":{"i":{"co":{"cIds":{"1370":["28"]}}},"o":{"sIds":["47"]},"t":"sh"},"1298":{"i":{"co":{"cIds":{"1370":["80"]}}},"o":{"sIds":["99"]},"t":"sh"},"1226":{"i":{"co":{"cIds":{"1370":["8"]}}},"o":{"sIds":["27"]},"t":"sh"},"1407":{"i":{"co":{"cIds":{"510":["10047"]}}},"o":{"sIds":["16"]},"t":"sh"},"1268":{"i":{"co":{"cIds":{"1370":["50"]}}},"o":{"sIds":["69"]},"t":"sh"},"1223":{"i":{"co":{"cIds":{"1370":["5"]}}},"o":{"sIds":["24"]},"t":"sh"},"1287":{"i":{"co":{"cIds":{"1370":["69"]}}},"o":{"sIds":["88"]},"t":"sh"},"1279":{"i":{"co":{"cIds":{"1370":["61"]}}},"o":{"sIds":["80"]},"t":"sh"},"1237":{"i":{"co":{"cIds":{"1370":["19"]}}},"o":{"sIds":["38"]},"t":"sh"},"1265":{"i":{"co":{"cIds":{"1370":["47"]}}},"o":{"sIds":["66"]},"t":"sh"},"1248":{"i":{"co":{"cIds":{"1370":["30"]}}},"o":{"sIds":["49"]},"t":"sh"},"1276":{"i":{"co":{"cIds":{"1370":["58"]}}},"o":{"sIds":["77"]},"t":"sh"},"1404":{"i":{"co":{"cIds":{"510":["10041"]}}},"o":{"sIds":["13"]},"t":"sh"},"1256":{"i":{"co":{"cIds":{"1370":["38"]}}},"o":{"sIds":["57"]},"t":"sh"},"1378":{"i":{"co":{"cIds":{"1371":["2"]}}},"o":{"sIds":["132"]},"t":"sh"},"1245":{"i":{"co":{"cIds":{"1370":["27"]}}},"o":{"sIds":["46"]},"t":"sh"},"1293":{"i":{"co":{"cIds":{"1370":["75"]}}},"o":{"sIds":["94"]},"t":"sh"},"1271":{"i":{"co":{"cIds":{"1370":["53"]}}},"o":{"sIds":["72"]},"t":"sh"},"1318":{"i":{"co":{"cIds":{"1370":["101"]}}},"o":{"sIds":["119"]},"t":"sh"},"1260":{"i":{"co":{"cIds":{"1370":["42"]}}},"o":{"sIds":["61"]},"t":"sh"},"1400":{"i":{"co":{"cIds":{"510":["10039"]}}},"o":{"sIds":["9"]},"t":"sh"},"1307":{"i":{"co":{"cIds":{"1370":["89"]}}},"o":{"sIds":["108"]},"t":"sh"},"511":{"i":{"co":{"cIds":{"480":["4"]}}},"o":{"sIds":["3"]},"t":"sh"},"1282":{"i":{"co":{"cIds":{"1370":["64"]}}},"o":{"sIds":["83"]},"t":"sh"},"1302":{"i":{"co":{"cIds":{"1370":["84"]}}},"o":{"sIds":["103"]},"t":"sh"},"1313":{"i":{"co":{"cIds":{"1370":["95"]}}},"o":{"sIds":["114"]},"t":"sh"},"1234":{"i":{"co":{"cIds":{"1370":["16"]}}},"o":{"sIds":["35"]},"t":"sh"},"1251":{"i":{"co":{"cIds":{"1370":["33"]}}},"o":{"sIds":["52"]},"t":"sh"},"1324":{"i":{"co":{"cIds":{"1370":["108"]}}},"o":{"sIds":["122"]},"t":"sh"},"1240":{"i":{"co":{"cIds":{"1370":["22"]}}},"o":{"sIds":["41"]},"t":"sh"},"1269":{"i":{"co":{"cIds":{"1370":["51"]}}},"o":{"sIds":["70"]},"t":"sh"},"1325":{"i":{"co":{"cIds":{"1370":["103"]}}},"o":{"sIds":["124"]},"t":"sh"},"1286":{"i":{"co":{"cIds":{"1370":["68"]}}},"o":{"sIds":["87"]},"t":"sh"},"1314":{"i":{"co":{"cIds":{"1370":["96"]}}},"o":{"sIds":["115"]},"t":"sh"},"1303":{"i":{"co":{"cIds":{"1370":["85"]}}},"o":{"sIds":["104"]},"t":"sh"},"1229":{"i":{"co":{"cIds":{"1370":["11"]}}},"o":{"sIds":["30"]},"t":"sh"},"1309":{"i":{"co":{"cIds":{"1370":["91"]}}},"o":{"sIds":["110"]},"t":"sh"},"1320":{"i":{"co":{"cIds":{"1370":["107"]}}},"o":{"sIds":["123"]},"t":"sh"},"1264":{"i":{"co":{"cIds":{"1370":["46"]}}},"o":{"sIds":["65"]},"t":"sh"},"1275":{"i":{"co":{"cIds":{"1370":["57"]}}},"o":{"sIds":["76"]},"t":"sh"},"1408":{"i":{"co":{"cIds":{"480":["4"]}}},"o":{"sIds":["17"]},"t":"sh"},"1304":{"i":{"co":{"cIds":{"1370":["86"]}}},"o":{"sIds":["105"]},"t":"sh"},"1244":{"i":{"co":{"cIds":{"1370":["26"]}}},"o":{"sIds":["45"]},"t":"sh"},"1315":{"i":{"co":{"cIds":{"1370":["97"]}}},"o":{"sIds":["116"]},"t":"sh"},"1281":{"i":{"co":{"cIds":{"1370":["63"]}}},"o":{"sIds":["82"]},"t":"sh"},"1321":{"i":{"co":{"cIds":{"1370":["105"]}}},"o":{"sIds":["125"]},"t":"sh"},"1241":{"i":{"co":{"cIds":{"1370":["23"]}}},"o":{"sIds":["42"]},"t":"sh"},"1230":{"i":{"co":{"cIds":{"1370":["12"]}}},"o":{"sIds":["31"]},"t":"sh"},"1255":{"i":{"co":{"cIds":{"1370":["37"]}}},"o":{"sIds":["56"]},"t":"sh"},"1270":{"i":{"co":{"cIds":{"1370":["52"]}}},"o":{"sIds":["71"]},"t":"sh"},"1297":{"i":{"co":{"cIds":{"1370":["79"]}}},"o":{"sIds":["98"]},"t":"sh"},"1233":{"i":{"co":{"cIds":{"1370":["15"]}}},"o":{"sIds":["34"]},"t":"sh"},"1405":{"i":{"co":{"cIds":{"510":["10045"]}}},"o":{"sIds":["14"]},"t":"sh"},"1399":{"i":{"co":{"cIds":{"510":["10040"]}}},"o":{"sIds":["8"]},"t":"sh"},"1292":{"i":{"co":{"cIds":{"1370":["74"]}}},"o":{"sIds":["93"]},"t":"sh"},"1252":{"i":{"co":{"cIds":{"1370":["34"]}}},"o":{"sIds":["53"]},"t":"sh"},"1326":{"i":{"co":{"cIds":{"1370":["104"]}}},"o":{"sIds":["126"]},"t":"sh"},"1403":{"i":{"co":{"cIds":{"510":["10044"]}}},"o":{"sIds":["12"]},"t":"sh"},"1222":{"i":{"co":{"cIds":{"1370":["4"]}}},"o":{"sIds":["23"]},"t":"sh"},"1319":{"i":{"co":{"cIds":{"1370":["99"]}}},"o":{"sIds":["120"]},"t":"sh"},"1274":{"i":{"co":{"cIds":{"1370":["56"]}}},"o":{"sIds":["75"]},"t":"sh"},"1377":{"i":{"co":{"cIds":{"1371":["1"]}}},"o":{"sIds":["131"]},"t":"sh"},"1228":{"i":{"co":{"cIds":{"1370":["10"]}}},"o":{"sIds":["29"]},"t":"sh"},"1277":{"i":{"co":{"cIds":{"1370":["59"]}}},"o":{"sIds":["78"]},"t":"sh"},"1266":{"i":{"co":{"cIds":{"1370":["48"]}}},"o":{"sIds":["67"]},"t":"sh"},"1239":{"i":{"co":{"cIds":{"1370":["21"]}}},"o":{"sIds":["40"]},"t":"sh"},"1263":{"i":{"co":{"cIds":{"1370":["45"]}}},"o":{"sIds":["64"]},"t":"sh"},"1306":{"i":{"co":{"cIds":{"1370":["88"]}}},"o":{"sIds":["107"]},"t":"sh"},"1225":{"i":{"co":{"cIds":{"1370":["7"]}}},"o":{"sIds":["26"]},"t":"sh"},"1236":{"i":{"co":{"cIds":{"1370":["18"]}}},"o":{"sIds":["37"]},"t":"sh"},"1308":{"i":{"co":{"cIds":{"1370":["90"]}}},"o":{"sIds":["109"]},"t":"sh"},"1288":{"i":{"co":{"cIds":{"1370":["70"]}}},"o":{"sIds":["89"]},"t":"sh"},"1285":{"i":{"co":{"cIds":{"1370":["67"]}}},"o":{"sIds":["86"]},"t":"sh"},"1316":{"i":{"co":{"cIds":{"1370":["100"]}}},"o":{"sIds":["117"]},"t":"sh"},"1253":{"i":{"co":{"cIds":{"1370":["35"]}}},"o":{"sIds":["54"]},"t":"sh"},"1327":{"i":{"co":{"cIds":{"1370":["106"]}}},"o":{"sIds":["127"]},"t":"sh"},"1322":{"i":{"co":{"cIds":{"1370":["109"]}}},"o":{"sIds":["128"]},"t":"sh"},"1231":{"i":{"co":{"cIds":{"1370":["13"]}}},"o":{"sIds":["32"]},"t":"sh"},"1220":{"i":{"co":{"cIds":{"1370":["2"]}}},"o":{"sIds":["21"]},"t":"sh"},"1296":{"i":{"co":{"cIds":{"1370":["78"]}}},"o":{"sIds":["97"]},"t":"sh"},"1247":{"i":{"co":{"cIds":{"1370":["29"]}}},"o":{"sIds":["48"]},"t":"sh"},"1311":{"i":{"co":{"cIds":{"1370":["93"]}}},"o":{"sIds":["112"]},"t":"sh"},"1398":{"i":{"co":{"cIds":{"510":["10038"]}}},"o":{"sIds":["7"]},"t":"sh"},"1242":{"i":{"co":{"cIds":{"1370":["24"]}}},"o":{"sIds":["43"]},"t":"sh"},"1402":{"i":{"co":{"cIds":{"510":["10043"]}}},"o":{"sIds":["11"]},"t":"sh"},"1258":{"i":{"co":{"cIds":{"1370":["40"]}}},"o":{"sIds":["59"]},"t":"sh"},"1305":{"i":{"co":{"cIds":{"1370":["87"]}}},"o":{"sIds":["106"]},"t":"sh"},"1280":{"i":{"co":{"cIds":{"1370":["62"]}}},"o":{"sIds":["81"]},"t":"sh"},"1291":{"i":{"co":{"cIds":{"1370":["73"]}}},"o":{"sIds":["92"]},"t":"sh"},"1396":{"i":{"co":{"cIds":{"510":["10036"]}}},"o":{"sIds":["5"]},"t":"sh"},"1300":{"i":{"co":{"cIds":{"1370":["82"]}}},"o":{"sIds":["101"]},"t":"sh"}},"sections":{"118":{"conditions":["1317"]},"131":{"name":"RPPS","conditions":["1377"]},"45":{"conditions":["1244"]},"98":{"conditions":["1297"]},"67":{"conditions":["1266"]},"120":{"conditions":["1319"]},"93":{"conditions":["1292"]},"113":{"conditions":["1312"]},"34":{"conditions":["1233"]},"12":{"name":"48","conditions":["1403"]},"66":{"conditions":["1265"]},"89":{"conditions":["1288"]},"51":{"conditions":["1250"]},"8":{"name":"31","conditions":["1399"]},"73":{"conditions":["1272"]},"78":{"conditions":["1277"]},"124":{"conditions":["1325"]},"84":{"conditions":["1283"]},"19":{"conditions":[]},"100":{"conditions":["1299"]},"23":{"conditions":["1222"]},"62":{"conditions":["1261"]},"135":{"name":"FIN LIBERAL","conditions":[]},"128":{"conditions":["1322"]},"4":{"name":"TUCS","conditions":["1379"]},"121":{"conditions":["1328"]},"88":{"conditions":["1287"]},"110":{"conditions":["1309"]},"77":{"conditions":["1276"]},"40":{"conditions":["1239"]},"15":{"name":"81","conditions":["1406"]},"132":{"name":"SANS RPPS","conditions":["1378"]},"11":{"name":"46","conditions":["1402"]},"104":{"conditions":["1303"]},"90":{"conditions":["1289"]},"9":{"name":"32","conditions":["1400"]},"44":{"conditions":["1243"]},"33":{"conditions":["1232"]},"117":{"conditions":["1316"]},"22":{"conditions":["1221"]},"56":{"conditions":["1255"]},"55":{"conditions":["1254"]},"26":{"conditions":["1225"]},"134":{"name":"LIBERAL","conditions":[]},"50":{"conditions":["1249"]},"123":{"conditions":["1320"]},"37":{"conditions":["1236"]},"68":{"conditions":["1267"]},"61":{"conditions":["1260"]},"107":{"conditions":["1306"]},"13":{"name":"65","conditions":["1404"]},"46":{"conditions":["1245"]},"99":{"conditions":["1298"]},"24":{"conditions":["1223"]},"94":{"conditions":["1293"]},"83":{"conditions":["1282"]},"35":{"conditions":["1234"]},"16":{"name":"82","conditions":["1407"]},"79":{"conditions":["1278"]},"5":{"name":"11","conditions":["1396"]},"103":{"conditions":["1302"]},"112":{"conditions":["1311"]},"72":{"conditions":["1271"]},"10":{"name":"34","conditions":["1401"]},"59":{"conditions":["1258"]},"87":{"conditions":["1286"]},"48":{"conditions":["1247"]},"76":{"conditions":["1275"]},"21":{"conditions":["1220"]},"116":{"conditions":["1315"]},"54":{"conditions":["1253"]},"43":{"conditions":["1242"]},"127":{"conditions":["1327"]},"65":{"conditions":["1264"]},"71":{"conditions":["1270"]},"57":{"conditions":["1256"]},"108":{"conditions":["1307"]},"32":{"conditions":["1231"]},"80":{"conditions":["1279"]},"106":{"conditions":["1305"]},"137":{"conditions":[]},"6":{"name":"12","conditions":["1397"]},"126":{"conditions":["1326"]},"36":{"conditions":["1235"]},"1":{"name":"SPICO","conditions":["504"]},"39":{"conditions":["1238"]},"82":{"conditions":["1281"]},"49":{"conditions":["1248"]},"17":{"conditions":["1408"]},"25":{"conditions":["1224"]},"60":{"conditions":["1259"]},"14":{"name":"66","conditions":["1405"]},"133":{"conditions":[]},"47":{"conditions":["1246"]},"122":{"conditions":["1324"]},"111":{"conditions":["1310"]},"102":{"conditions":["1301"]},"31":{"conditions":["1230"]},"95":{"conditions":["1294"]},"96":{"conditions":["1295"]},"69":{"conditions":["1268"]},"58":{"conditions":["1257"]},"64":{"conditions":["1263"]},"53":{"conditions":["1252"]},"42":{"conditions":["1241"]},"75":{"conditions":["1274"]},"115":{"conditions":["1314"]},"109":{"conditions":["1308"]},"20":{"conditions":["1219"]},"27":{"conditions":["1226"]},"70":{"conditions":["1269"]},"2":{"name":"","conditions":[]},"86":{"conditions":["1285"]},"38":{"conditions":["1237"]},"81":{"conditions":["1280"]},"92":{"conditions":["1291"]},"125":{"conditions":["1321"]},"18":{"name":"","conditions":["519"]},"101":{"conditions":["1300"]},"30":{"conditions":["1229"]},"7":{"name":"30","conditions":["1398"]},"97":{"conditions":["1296"]},"130":{"conditions":[]},"114":{"conditions":["1313"]},"129":{"conditions":["1323"]},"29":{"conditions":["1228"]},"41":{"conditions":["1240"]},"105":{"conditions":["1304"]},"63":{"conditions":["1262"]},"3":{"name":"TUCS","conditions":["511"]},"74":{"conditions":["1273"]},"91":{"conditions":["1290"]},"52":{"conditions":["1251"]},"85":{"conditions":["1284"]},"28":{"conditions":["1227"]},"119":{"conditions":["1318"]},"136":{"name":"NON LIBERAL","conditions":["541"]}},"questions":{"1150":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10527","questionKey":""},"1182":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10543","questionKey":""},"1394":{"type":"cd","label":"Sélectionnez votre établissement","description":"","validation":{"rq":true},"jiraField":"customfield_10699","questionKey":"Nom de votre établissement-1-1-1-1-1-1-1-1-1-1-1-1"},"1389":{"type":"cd","label":"Sélectionnez votre établissement","description":"","validation":{"rq":true},"jiraField":"customfield_10700","questionKey":"Nom de votre établissement-1-1-1-1-1-1-1"},"515":{"type":"ts","label":"Numéro de carte CPE/CPA","description":"A renseigner uniquement si vous n'avez pas d'identifiant national.","validation":{"rq":false,"mxc":40},"choices":[],"questionKey":""},"1210":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10559","questionKey":""},"1390":{"type":"cd","label":"Sélectionnez votre établissement","description":"","validation":{"rq":true},"jiraField":"customfield_10933","questionKey":"Nom de votre établissement-1-1-1-1-1-1-1-1"},"1086":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10495","questionKey":""},"1108":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10506","questionKey":""},"1172":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10538","questionKey":""},"1198":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10558","questionKey":""},"1208":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10556","questionKey":""},"1329":{"type":"tl","label":"Nom de votre structure d'exercice","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"1082":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10493","questionKey":""},"1104":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10504","questionKey":""},"1176":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10540","questionKey":""},"1042":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10473","questionKey":""},"1006":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10456","questionKey":""},"1060":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10482","questionKey":""},"1160":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10532","questionKey":""},"1194":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10551","questionKey":""},"1020":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10463","questionKey":""},"1202":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10553","questionKey":""},"1012":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10459","questionKey":""},"1078":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10491","questionKey":""},"1080":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10492","questionKey":""},"1134":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10519","questionKey":""},"1126":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10515","questionKey":""},"1154":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10529","questionKey":""},"1120":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10512","questionKey":""},"1112":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10508","questionKey":""},"1118":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10511","questionKey":""},"1373":{"type":"ts","label":"Votre n° RPPS","description":"Composé de 11 chiffres.","validation":{"rq":true,"mnc":11,"mxc":11},"choices":[],"questionKey":"Identifiant National (Adeli/RPPS)"},"1156":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10530","questionKey":""},"1192":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10550","questionKey":""},"1142":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10523","questionKey":""},"1384":{"type":"cd","label":"Sélectionnez votre établissement","description":"","validation":{"rq":true},"jiraField":"customfield_10697","questionKey":"Nom de votre établissement-1-1"},"1068":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10486","questionKey":""},"1028":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10467","questionKey":""},"1350":{"type":"ts","label":"Autre service (ou communauté TéléO si vous la connaissez)","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"1132":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10518","questionKey":""},"1148":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10526","questionKey":""},"1391":{"type":"cd","label":"Sélectionnez votre établissement","description":"","validation":{"rq":true},"jiraField":"customfield_10698","questionKey":"Nom de votre établissement-1-1-1-1-1-1-1-1-1"},"1164":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10534","questionKey":""},"553":{"type":"tl","label":"Précisez votre besoin","description":"Merci de préciser votre besoin métier ou toute autre information complémentaire.","validation":{"rq":false},"choices":[],"questionKey":""},"1186":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10547","questionKey":""},"1178":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10541","questionKey":""},"545":{"type":"tl","label":"Adresse de votre structure d'exercice","description":"Par ex : 10 rue des Trente-six ponts, 31400 Toulouse","validation":{"rq":true,"mnc":10},"choices":[],"questionKey":""},"480":{"type":"cm","label":"Cochez les services numériques auxquels vous voulez avoir accès :","description":"","validation":{"rq":true},"choices":[{"id":"5","label":"SPICO (Outil de coordination des parcours de soins complexes)","other":false},{"id":"1","label":"TéléO (Plateforme de transfert d’imagerie et de téléexpertise)","other":false},{"id":"3","label":"Smurt@b (Outil de recueil et transmission lors de prise en charge SMUR)","other":false},{"id":"4","label":"TUCS (Outil de visibilité des patients régulés par le centre 15)","other":false}],"questionKey":"Pour l'usage de quelle application avez-vous besoin d'un compte PASS ?"},"1036":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10470","questionKey":""},"1114":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10509","questionKey":""},"1046":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10475","questionKey":""},"1074":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10489","questionKey":""},"1034":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10546","questionKey":""},"1066":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10485","questionKey":""},"1136":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10520","questionKey":""},"1092":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10498","questionKey":""},"1052":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10478","questionKey":""},"1204":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10555","questionKey":""},"1170":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10537","questionKey":""},"996":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10450","questionKey":""},"530":{"type":"ts","label":"N° de téléphone","description":"Utilisé pour la réception des codes SMS OTP.","validation":{"rq":true,"rgx":{"p":"^(0|\\+33)[1-9]([-. ]?[0-9]{2}){4}$","m":"Le n° de téléphone saisi est invalide."}},"choices":[],"questionKey":""},"1158":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10531","questionKey":""},"1002":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10454","questionKey":""},"1070":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10487","questionKey":""},"1030":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10468","questionKey":""},"1212":{"type":"cl","label":"Pays de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10560","questionKey":""},"1110":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10507","questionKey":""},"1096":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10500","questionKey":""},"1056":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10480","questionKey":""},"1024":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10465","questionKey":""},"1331":{"type":"ts","label":"Nom et prénom du contact","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"1018":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10462","questionKey":""},"1152":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10528","questionKey":""},"1058":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10481","questionKey":""},"1128":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10516","questionKey":""},"510":{"type":"cd","label":"Sélectionnez votre département","description":"","validation":{"rq":true},"jiraField":"customfield_10061","questionKey":""},"1376":{"type":"cd","label":"Profession à rôle (sans RPPS)","description":"Si vous ne trouvez pas votre profession, vous avez certainement un n° RPPS. Rendez-vous sur annuaire.sante.fr pour le retrouver.","validation":{"rq":true},"jiraField":"customfield_10319","questionKey":"Role"},"1048":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10476","questionKey":""},"1168":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10536","questionKey":""},"1088":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10496","questionKey":""},"1371":{"type":"cs","label":"Avez-vous un numéro RPPS ?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Oui","other":false},{"id":"2","label":"Non","other":false}],"questionKey":""},"1146":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10525","questionKey":""},"1196":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10552","questionKey":""},"1122":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10513","questionKey":""},"554":{"type":"cs","label":"Type de compte TUCS","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Référent TUCS","other":false},{"id":"2","label":"Utilisateur TUCS","other":false}],"questionKey":""},"1106":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10505","questionKey":""},"1174":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10539","questionKey":""},"1062":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10483","questionKey":""},"1022":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10464","questionKey":""},"1138":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10521","questionKey":""},"1392":{"type":"cd","label":"Sélectionnez votre établissement","description":"","validation":{"rq":true},"jiraField":"customfield_10653","questionKey":"Nom de votre établissement-1-1-1-1-1-1-1-1-1-1"},"1368":{"type":"ts","label":"Prénom","description":"","validation":{"rq":true,"rgx":{"p":"^(?=.{2,50}$)[A-Za-zÀ-ÖØ-öø-ÿ]+(?:[ '-][A-Za-zÀ-ÖØ-öø-ÿ]+)*$","m":"Le format de saisie est invalide."}},"choices":[],"questionKey":"Prénom de naissance"},"1040":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10472","questionKey":""},"1357":{"type":"cd","label":"Civilité","description":"","validation":{"rq":true},"choices":[{"id":"3","label":"- Aucun(e)","other":false},{"id":"2","label":"M.","other":false},{"id":"1","label":"Mme","other":false}],"defaultAnswer":{"choices":["3"]},"questionKey":""},"1076":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10490","questionKey":""},"1014":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10460","questionKey":""},"1358":{"type":"ts","label":"Nom de naissance","description":"","validation":{"rq":true,"rgx":{"p":"^(?=.{2,50}$)[A-Za-zÀ-ÖØ-öø-ÿ]+(?:[ '-][A-Za-zÀ-ÖØ-öø-ÿ]+)*$","m":"Le format de saisie est invalide."}},"choices":[],"questionKey":"Nom de naissance"},"1010":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10458","questionKey":""},"1200":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10557","questionKey":""},"1190":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10549","questionKey":""},"1388":{"type":"cd","label":"Sélectionnez votre établissement","description":"","validation":{"rq":true},"jiraField":"customfield_10694","questionKey":"Nom de votre établissement-1-1-1-1-1-1"},"1332":{"type":"te","label":"Adresse email du contact","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"1084":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10494","questionKey":""},"1044":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10474","questionKey":""},"1100":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10502","questionKey":""},"1370":{"type":"cd","label":"Votre département ou pays de naissance","description":"Si vous n'êtes pas né en France, choisissez \"Je suis né.e à l'étranger\".","validation":{"rq":true},"choices":[{"id":"1","label":"01","other":false},{"id":"2","label":"02","other":false},{"id":"3","label":"03","other":false},{"id":"4","label":"04","other":false},{"id":"5","label":"05","other":false},{"id":"6","label":"06","other":false},{"id":"7","label":"07","other":false},{"id":"8","label":"08","other":false},{"id":"9","label":"09","other":false},{"id":"10","label":"10","other":false},{"id":"11","label":"11","other":false},{"id":"12","label":"12","other":false},{"id":"13","label":"13","other":false},{"id":"14","label":"14","other":false},{"id":"15","label":"15","other":false},{"id":"16","label":"16","other":false},{"id":"17","label":"17","other":false},{"id":"18","label":"18","other":false},{"id":"19","label":"19","other":false},{"id":"20","label":"2A","other":false},{"id":"21","label":"2B","other":false},{"id":"22","label":"21","other":false},{"id":"23","label":"22","other":false},{"id":"24","label":"23","other":false},{"id":"25","label":"24","other":false},{"id":"26","label":"25","other":false},{"id":"27","label":"26","other":false},{"id":"28","label":"27","other":false},{"id":"29","label":"28","other":false},{"id":"30","label":"29","other":false},{"id":"31","label":"30","other":false},{"id":"32","label":"31","other":false},{"id":"33","label":"32","other":false},{"id":"34","label":"33","other":false},{"id":"35","label":"34","other":false},{"id":"36","label":"35","other":false},{"id":"37","label":"36","other":false},{"id":"38","label":"37","other":false},{"id":"39","label":"38","other":false},{"id":"40","label":"39","other":false},{"id":"41","label":"40","other":false},{"id":"42","label":"41","other":false},{"id":"43","label":"42","other":false},{"id":"44","label":"43","other":false},{"id":"45","label":"44","other":false},{"id":"46","label":"45","other":false},{"id":"47","label":"46","other":false},{"id":"48","label":"47","other":false},{"id":"49","label":"48","other":false},{"id":"50","label":"49","other":false},{"id":"51","label":"50","other":false},{"id":"52","label":"51","other":false},{"id":"53","label":"52","other":false},{"id":"54","label":"53","other":false},{"id":"55","label":"54","other":false},{"id":"56","label":"55","other":false},{"id":"57","label":"56","other":false},{"id":"58","label":"57","other":false},{"id":"59","label":"58","other":false},{"id":"60","label":"59","other":false},{"id":"61","label":"60","other":false},{"id":"62","label":"61","other":false},{"id":"63","label":"62","other":false},{"id":"64","label":"63","other":false},{"id":"65","label":"64","other":false},{"id":"66","label":"65","other":false},{"id":"67","label":"66","other":false},{"id":"68","label":"67","other":false},{"id":"69","label":"68","other":false},{"id":"70","label":"69","other":false},{"id":"71","label":"70","other":false},{"id":"72","label":"71","other":false},{"id":"73","label":"72","other":false},{"id":"74","label":"73","other":false},{"id":"75","label":"74","other":false},{"id":"76","label":"75","other":false},{"id":"77","label":"76","other":false},{"id":"78","label":"77","other":false},{"id":"79","label":"78","other":false},{"id":"80","label":"79","other":false},{"id":"81","label":"80","other":false},{"id":"82","label":"81","other":false},{"id":"83","label":"82","other":false},{"id":"84","label":"83","other":false},{"id":"85","label":"84","other":false},{"id":"86","label":"85","other":false},{"id":"87","label":"86","other":false},{"id":"88","label":"87","other":false},{"id":"89","label":"88","other":false},{"id":"90","label":"89","other":false},{"id":"91","label":"90","other":false},{"id":"92","label":"91","other":false},{"id":"93","label":"92","other":false},{"id":"94","label":"93","other":false},{"id":"95","label":"94","other":false},{"id":"96","label":"95","other":false},{"id":"97","label":"971","other":false},{"id":"98","label":"973","other":false},{"id":"99","label":"975","other":false},{"id":"100","label":"972","other":false},{"id":"101","label":"974","other":false},{"id":"102","label":"976","other":false},{"id":"103","label":"984","other":false},{"id":"104","label":"987","other":false},{"id":"105","label":"986","other":false},{"id":"106","label":"988","other":false},{"id":"107","label":"978","other":false},{"id":"108","label":"977","other":false},{"id":"109","label":"989","other":false},{"id":"111","label":"Je suis né.e à l'étranger","other":false}],"questionKey":""},"998":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10452","questionKey":""},"531":{"type":"te","label":"Adresse email","description":"Les adresses emails génériques (ex : secretariat@structure.fr) ne sont pas autorisées.","validation":{"rq":true},"jiraField":"customfield_10039","questionKey":""},"1102":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10503","questionKey":""},"1386":{"type":"cd","label":"Sélectionnez votre établissement","description":"","validation":{"rq":true},"jiraField":"customfield_10692","questionKey":"Nom de votre établissement-1-1-1-1"},"1337":{"type":"tl","label":"SIRET ou FINESS de ma structure d'exercice","description":"La saisie de ce champ n’est pas obligatoire mais est fortement recommandée pour garantir le traitement optimal de votre demande. Veuillez vous référer à l'encart ci-contre pour retrouver le n° SIRET ou FINESS de votre structure d'exercice.","validation":{"rq":false,"rgx":{"p":"^(\\d{10}|\\d{9}|\\d{14}|\\d{15}|RG000000000)$","m":"Le format de la valeur saisie est invalide."}},"choices":[],"questionKey":"SIRET/FINESS de ma structure d'exercice"},"1038":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10471","questionKey":""},"1344":{"type":"ts","label":"Nom de votre établissement","description":"","validation":{"rq":true},"choices":[],"questionKey":"Etablissement Téléo"},"1349":{"type":"ts","label":"Nom de votre service (ou de la communauté TéléO si vous la connaissez)","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"1008":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10457","questionKey":""},"1217":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10451","questionKey":""},"1369":{"type":"ts","label":"Date de naissance (Exemple : 14/02/1990)","description":"","validation":{"rq":true,"rgx":{"p":"^(0[1-9]|[12][0-9]|3[01])/(0[1-9]|1[0-2])/\\d{4}$","m":"La date saisie est invalide."}},"choices":[],"questionKey":"Date de naissance"},"1162":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10533","questionKey":""},"1098":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10501","questionKey":""},"1366":{"type":"ts","label":"Nom d'usage (nom d'exercice)","description":"","validation":{"rq":true,"rgx":{"p":"^(?=.{2,50}$)[A-Za-zÀ-ÖØ-öø-ÿ]+(?:[ '-][A-Za-zÀ-ÖØ-öø-ÿ]+)*$","m":"Le format de saisie est invalide."}},"choices":[],"questionKey":"nom-1"},"496":{"type":"cs","label":"Exercez-vous en libéral ?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Oui","other":false},{"id":"2","label":"Non","other":false}],"questionKey":""},"1188":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10548","questionKey":""},"1116":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10510","questionKey":""},"1016":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10461","questionKey":""},"1124":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10514","questionKey":""},"1166":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10535","questionKey":""},"547":{"type":"tl","label":"Nom de votre service d'exercice","description":"Nom du service dans lequel vous évoluez au sein de l'établissement.","validation":{"rq":true},"choices":[],"questionKey":""},"1072":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10488","questionKey":""},"1094":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10499","questionKey":""},"1054":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10479","questionKey":""},"1026":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10466","questionKey":""},"1352":{"type":"ts","label":"Autre service (ou communauté TéléO si vous la connaissez)","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"1184":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10544","questionKey":""},"1130":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10517","questionKey":""},"1144":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10524","questionKey":""},"1000":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10453","questionKey":""},"1032":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10545","questionKey":""},"1064":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10484","questionKey":""},"1090":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10497","questionKey":""},"1374":{"type":"cd","label":"Profession RPPS","description":"Si vous êtes infirmer, vous êtes dans l'obligation de renseigner votre RPPS comme identifiant national.","validation":{"rq":true},"jiraField":"customfield_10562","defaultAnswer":{"choices":["181930"]},"questionKey":"profession"},"1050":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10477","questionKey":""},"1385":{"type":"cd","label":"Sélectionnez votre établissement","description":"","validation":{"rq":true},"jiraField":"customfield_10733","questionKey":"Nom de votre établissement-1-1-1"},"1206":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10554","questionKey":""},"1333":{"type":"ts","label":"N° téléphone du contact","description":"","validation":{"rq":true,"rgx":{"p":"^(0|\\+33)[1-9]([-. ]?[0-9]{2}){4}$","m":"Le n° de téléphone saisi est invalide."}},"choices":[],"questionKey":""},"1382":{"type":"cd","label":"Sélectionnez votre établissement","description":"","validation":{"rq":true},"jiraField":"customfield_10900","questionKey":"Nom de votre établissement-1"},"1180":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10542","questionKey":""},"1140":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10522","questionKey":""},"1004":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10455","questionKey":""},"1387":{"type":"cd","label":"Sélectionnez votre établissement","description":"","validation":{"rq":true},"jiraField":"customfield_10696","questionKey":"Nom de votre établissement-1-1-1-1-1"},"1393":{"type":"cd","label":"Sélectionnez votre établissement","description":"","validation":{"rq":true},"jiraField":"customfield_10695","questionKey":"Nom de votre établissement-1-1-1-1-1-1-1-1-1-1-1"}}},"uuid":"28c0c76b-9c80-4d04-9ff1-d363cf04fe83"},"proforma":{"formExists":true,"formValid":true,"formTemplateData":{"id":5359128234153951,"updated":"2026-02-12T08:38:16.935227182Z","publish":{"jira":{"newIssueIssueTypeIds":[],"newIssueRequestTypeIds":[122],"submitOnCreate":true,"validateOnCreate":true},"portal":{"portalRequestTypeIds":[122],"submitOnCreate":true,"validateOnCreate":true}},"design":{"settings":{"templateId":5359128234153951,"name":"Formulaire d'Inscription Portail d'Accès Services e-Santé","submit":{"lock":false,"pdf":false},"language":"fr","templateFormUuid":"28c0c76b-9c80-4d04-9ff1-d363cf04fe83"},"layout":[{"version":1,"type":"doc","content":[{"type":"heading","attrs":{"level":1,"localId":"d80221a7-8aa7-4053-9036-d6c1b44c8949"},"content":[{"type":"hardBreak"},{"type":"text","text":"Création d’un compte PASS (Point d’Accès aux Services de la e-Santé)"}]},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","attrs":{"localId":"d08fff6b-9f88-4d53-8e37-ae9ee4ab0d07"},"content":[{"type":"text","text":"Ce formulaire est spécifique pour la création de comptes "},{"type":"text","text":"SPICO, TéléO, Smurt@b et TUCS.","marks":[{"type":"strong"}]}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","attrs":{"localId":"c5b2a7cb-0531-4845-ae64-ab91e933c163"},"content":[{"type":"text","text":"Pour "},{"type":"text","text":"Medimail ","marks":[{"type":"strong"}]},{"type":"text","text":": "},{"type":"text","text":"Cliquez ici","marks":[{"type":"link","attrs":{"href":"https://medimail.mipih.fr/register/type-register"}}]},{"type":"text","text":" pour créer un compte"}]}]},{"type":"listItem","content":[{"type":"paragraph","attrs":{"localId":"263bbe8e-dc8a-443c-baa5-793c1f6042d2"},"content":[{"type":"text","text":"Pour "},{"type":"text","text":"DCC ","marks":[{"type":"strong"}]},{"type":"text","text":": "},{"type":"text","text":"Cliquez ici","marks":[{"type":"link","attrs":{"href":"https://portail.mediware.fr/Apps/WebObjects/Oncooc.woa"}}]},{"type":"text","text":" pour créer un compte"}]}]},{"type":"listItem","content":[{"type":"paragraph","attrs":{"localId":"7c8bb0f6-cd2b-4ce5-adda-9a1f8780e68c"},"content":[{"type":"text","text":"Pour "},{"type":"text","text":"ViaTrajectoire ","marks":[{"type":"strong"}]},{"type":"text","text":": Demandez à votre référent structure pour créer un compte. Si vous ne connaissez pas le nom de votre référent, vous pouvez en "},{"type":"text","text":"faire la demande à notre Centre de Services","marks":[{"type":"link","attrs":{"href":"https://e-sante-occitanie.atlassian.net/servicedesk/customer/portal/1/group/1/create/2"}}]}]}]}]}]},{"type":"paragraph","attrs":{"localId":"678d1045-b297-415d-98ca-9a41542fc1b3"},"content":[{"type":"text","text":"Afin de faciliter et d’accélérer votre inscription, nous vous invitons à lire et à compléter attentivement les informations ci-dessous, selon votre situation.","marks":[{"type":"strong"}]}]},{"type":"heading","attrs":{"level":1,"localId":"753976f0-5dea-4260-b6d9-be983cfa1fd6"},"content":[{"type":"text","text":"Demande d’accès aux services numériques","marks":[{"type":"strong"},{"type":"textColor","attrs":{"color":"#0747a6"}}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":480},"layout":"default","localId":"fd872d0a-efeb-4952-a033-5d6b672d9ad8"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":553},"layout":"default","localId":"db2acf7f-719e-4b9a-94d5-038603e4672d"}}]},{"version":1,"type":"doc","content":[{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"heading","attrs":{"level":3,"localId":"6adfd7d0-ded9-4e85-9ce8-0f318c0e72fb"},"content":[{"type":"text","text":"Informations SPICO"}]}]},{"type":"heading","attrs":{"level":4,"localId":"11beff1f-3d45-44e0-87f7-a2e8e28fea46"},"content":[{"type":"text","text":"Si vous souhaitez accéder aux patients pris en charge au sein de votre structure, nous vous invitons à lui demander de vous accorder une délégation."}]}]},{"version":1,"type":"doc","content":[]},{"version":1,"type":"doc","content":[{"type":"paragraph","content":[]},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"heading","attrs":{"level":3,"localId":"c1e91a19-c535-43a0-9850-e0f04aeba5a7"},"content":[{"type":"text","text":"Informations TUCS à renseigner"}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":554},"layout":"default","localId":"471927e3-310f-4163-97f4-d571c0341abb"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":510},"layout":"default","localId":"601ca754-9b92-4d70-b334-fcd1ec7600bd"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1382},"layout":"default","localId":"685aee9e-c1db-439d-bc2a-4ffe6dcbe939"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1384},"layout":"default","localId":"c0f4eab4-3a81-4248-8aa0-d7efc69fb0d6"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1385},"layout":"default","localId":"0c28eba7-24d7-42d4-a816-0294046003e9"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1386},"layout":"default","localId":"fa4681b8-0414-4784-becd-3524d916fc57"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1387},"layout":"default","localId":"9388e36e-d781-4141-ae80-60f1a1e8ff64"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1388},"layout":"default","localId":"76342398-5030-4aba-89c5-aae7c7a0e94a"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1389},"layout":"default","localId":"c371cdd2-7d96-47f4-aa6f-42fa89f6539b"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1390},"layout":"default","localId":"a582f742-c24d-47e9-b9da-9e991f5b35b9"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1391},"layout":"default","localId":"1020e0c0-1820-4d76-a9da-247015852ace"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1392},"layout":"default","localId":"9f257166-3efb-44b5-9a9f-146ae9531f34"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1393},"layout":"default","localId":"f6568d9a-5dff-443d-a930-95fb6fda0076"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1394},"layout":"default","localId":"271c4147-4cec-4e85-a94f-e7f46d7b386d"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":515},"layout":"default","localId":"9b009249-671f-432c-a625-907c694d0432"}}]},{"version":1,"type":"doc","content":[{"type":"paragraph","content":[]},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"heading","attrs":{"level":3,"localId":"c76b7d55-6721-4dc4-9136-c02af38eb347"},"content":[{"type":"text","text":"Informations Téléo à renseigner"}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1344},"layout":"default","localId":"90e11b3c-0975-480a-aa48-b1a9982c3fa3"}},{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1349},"layout":"default","localId":"139c8919-aa6e-4558-b824-0f18e7b5c423"}}]},{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1350},"layout":"default","localId":"c81877b2-4a18-4175-bf0f-fffc2851874d"}}]},{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1352},"layout":"default","localId":"9fd01f5d-ca40-4069-8277-04739138ce2d"}}]}]}]},{"version":1,"type":"doc","content":[{"type":"heading","attrs":{"level":1,"localId":"753976f0-5dea-4260-b6d9-be983cfa1fd6"},"content":[{"type":"hardBreak"},{"type":"text","text":"Informations personnelles","marks":[{"type":"strong"},{"type":"textColor","attrs":{"color":"#0747a6"}}]}]},{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1357},"layout":"default","localId":"2ac646da-23da-4a9c-8ea1-01a90e9d2472"}}]},{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1358},"layout":"default","localId":"6d840ba2-f79c-493c-b592-1a43fa119373"}}]},{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1366},"layout":"default","localId":"459236e9-590f-4db7-ae10-dd54bf5224f0"}}]}]},{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1368},"layout":"default","localId":"8a26573c-dfdf-47dd-acfd-a441db39ff46"}}]},{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1369},"layout":"default","localId":"6d4bd22e-4d53-4892-ad53-896a9fd46f6b"}}]},{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"paragraph","content":[]}]}]},{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":66.66},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1370},"layout":"default","localId":"c5fc324b-2c97-4065-8fe5-77b84e39dfb3"}}]},{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"paragraph","content":[]}]}]}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1217},"layout":"default","localId":"83976dc3-6906-4df5-8c05-9432a62ead4c"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":996},"layout":"default","localId":"cc97454d-64ce-4e31-8c9f-404547e043d6"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":998},"layout":"default","localId":"91283d24-8b60-46b2-a176-0f60a67bc0cc"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1000},"layout":"default","localId":"126547e1-ff4e-409c-bc3b-90d350ac086f"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1002},"layout":"default","localId":"f14e94ba-14b2-48a4-bd61-2f2bca70ecb8"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1004},"layout":"default","localId":"8e5a7e5e-9bae-47c1-bf04-2e889955112d"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1006},"layout":"default","localId":"38b261b0-08f8-482f-a3c0-63926cc0e93d"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1008},"layout":"default","localId":"c0458fd3-14ec-4d95-a015-7ddb70118629"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1010},"layout":"default","localId":"9f986385-4979-4d10-960d-1ccb33d55971"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1012},"layout":"default","localId":"4875e509-d956-42e4-b94c-328be1d74629"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1014},"layout":"default","localId":"bb8f8643-0c65-4c89-a5d3-a6701ee4854b"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1016},"layout":"default","localId":"2682c0d6-97a7-405e-927b-ce319faf864d"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1018},"layout":"default","localId":"c8a24189-69e2-4a70-b41d-4c7e0d9e7f47"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1020},"layout":"default","localId":"eb7b79f9-eaa3-4f7e-b1d7-19e378e32306"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1022},"layout":"default","localId":"79e5ef2c-9668-4a86-a00f-918abd410adb"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1024},"layout":"default","localId":"5e3da3c5-6208-4258-a5a1-8bb6892abf05"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1026},"layout":"default","localId":"65a8cf39-8f7b-47de-8423-b35c4909646b"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1028},"layout":"default","localId":"fdd3e6de-3e48-4479-85a6-fdbc0e6b14c9"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1030},"layout":"default","localId":"86c182a3-3496-4a72-947d-0a25e2a3a1bf"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1032},"layout":"default","localId":"fabf05ea-bbbd-449a-8479-5ef2671b5461"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1034},"layout":"default","localId":"6ab022ca-173b-4cc8-b034-4bef82d4a881"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1036},"layout":"default","localId":"9795b9db-0736-42b6-89d8-d3810c105f43"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1038},"layout":"default","localId":"4a482817-9c0e-4e60-85e1-eda1f335de27"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1040},"layout":"default","localId":"10013bb8-3078-4710-940f-8272f3b785af"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1042},"layout":"default","localId":"8e290217-2efc-417c-a1b7-cd2968679f67"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1044},"layout":"default","localId":"8378a009-3962-4d2b-9991-0c4f8b992fc7"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1046},"layout":"default","localId":"62f19c4d-e93e-4e6e-a256-fd24057bede0"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1048},"layout":"default","localId":"4e3f1985-7284-4ce4-af7b-bfc16c66573b"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1050},"layout":"default","localId":"51e0b39a-eeb2-44ef-85aa-2e69720aea1d"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1052},"layout":"default","localId":"7afc047c-c30d-496f-80ea-854f5a684736"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1054},"layout":"default","localId":"8ed1871a-5e24-4d7e-8f20-97579060ce8d"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1056},"layout":"default","localId":"80ae86cc-057f-4180-8903-725288125233"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1058},"layout":"default","localId":"d5dc7e9c-fdab-462f-97fe-b00c7ab7e62a"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1060},"layout":"default","localId":"5e219e44-522e-4e2c-865d-aab5385d8548"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1062},"layout":"default","localId":"85058167-5e88-45d1-84ca-7124bf2d1f2c"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1064},"layout":"default","localId":"6e02a894-c749-46f9-8acf-8581b79da769"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1066},"layout":"default","localId":"289ce5e4-61eb-4a2b-bb8e-ea8886169966"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1068},"layout":"default","localId":"be715a40-5931-4307-8ecf-936c33534986"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1070},"layout":"default","localId":"f1358794-7fef-4783-a084-1fae080cf856"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1072},"layout":"default","localId":"63947708-c14e-4fbc-a342-6f61d2d8a283"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1074},"layout":"default","localId":"0890c379-1253-4715-aa30-302c51b1e65b"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1076},"layout":"default","localId":"1f1df678-6e37-458a-b696-7515d3856f61"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1078},"layout":"default","localId":"6060393b-052e-476a-8414-e01ef76e3f09"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1080},"layout":"default","localId":"b40a2620-3064-4022-a590-8abd2ccaaffa"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1082},"layout":"default","localId":"520a8e07-e0b3-4d1b-9456-cbf477adc014"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1084},"layout":"default","localId":"9f77bb72-1ed0-46ab-8643-c0673ad77dca"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1086},"layout":"default","localId":"8239d723-e789-492f-aaba-b8a6aae246a4"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1088},"layout":"default","localId":"00229843-651f-4699-a856-24838b6c46b8"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1090},"layout":"default","localId":"99147514-7dc1-4f0e-82d6-bdbc04cb490a"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1092},"layout":"default","localId":"e1f94282-2d93-428f-a87c-01e759fc803d"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1094},"layout":"default","localId":"d10f1c2f-7e6f-4d08-93d7-9a02be0798f0"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1096},"layout":"default","localId":"0914a7a1-0d1f-44a5-9d30-30529fd08edd"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1098},"layout":"default","localId":"5f95a2c1-ffd1-460c-9997-8780af4f75d1"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1100},"layout":"default","localId":"1424433c-da0f-473e-8c88-9dc06b3c5026"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1102},"layout":"default","localId":"82e869b1-3811-45a8-b7e0-c555661dcea8"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1104},"layout":"default","localId":"72c88ad6-2cad-446a-b002-c45b25bcdc3f"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1106},"layout":"default","localId":"7290e2ea-46f1-44ac-818e-1ddb8a70670d"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1108},"layout":"default","localId":"173dfca1-2926-45e7-9066-71bbe5fe360a"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1110},"layout":"default","localId":"dff7a61f-6987-40a9-96d4-288e3530138a"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1112},"layout":"default","localId":"5e642542-5c06-4ff5-922a-6e79f51f66a5"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1114},"layout":"default","localId":"2723fd6a-4459-44b3-9241-68c23652f450"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1116},"layout":"default","localId":"564b189e-7911-435d-a979-e33123c4c80c"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1118},"layout":"default","localId":"fd93e23c-986f-4ca5-97b7-edf625d819a3"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1120},"layout":"default","localId":"f3cbd74e-fc35-4c58-b120-4496cc080426"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1122},"layout":"default","localId":"7df855ab-3d10-47be-a3f8-bc150b771ef5"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1124},"layout":"default","localId":"2f86e290-0a0f-48e5-b39c-5763be1d4556"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1126},"layout":"default","localId":"d8a30c4d-3064-45c2-b228-003cab384257"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1128},"layout":"default","localId":"51ae729c-afb5-4cde-b7f5-fb466fdde6e1"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1130},"layout":"default","localId":"0cd2ff8d-0c03-42c7-9e4f-5f938b0d3bf0"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1132},"layout":"default","localId":"4eefbfed-0ff7-4d58-95f3-78eac10afe75"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1134},"layout":"default","localId":"2021df4f-b48f-4569-aa76-56922e01dc7e"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1136},"layout":"default","localId":"4cbeb2a0-e073-4b45-ba8d-ecc90de66a14"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1138},"layout":"default","localId":"fd13edea-1791-47e2-8054-d26f2372a97a"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1140},"layout":"default","localId":"508b1771-abcb-40a1-b3b3-5ecf06953014"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1142},"layout":"default","localId":"37538843-97a5-4caf-b465-766249f29607"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1144},"layout":"default","localId":"572e9d10-2d25-470c-8c9f-91436e631f7f"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1146},"layout":"default","localId":"2541a15b-48c5-47ba-b980-f74ba2e37faa"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1148},"layout":"default","localId":"6b30f45d-6ae9-406f-9a93-d35f09049f25"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1150},"layout":"default","localId":"1753fed0-8f8c-410a-b86f-4f230e7292db"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1152},"layout":"default","localId":"e41e1ac5-d6ee-456f-84fe-4b552a4392ed"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1154},"layout":"default","localId":"b3b28d1f-912d-49df-ac3f-dd952c26e4f1"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1156},"layout":"default","localId":"935422a5-be0a-422d-b5c6-987c873d829e"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1158},"layout":"default","localId":"8e1ce744-cf32-4101-b7ac-d63e23bd6ba5"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1160},"layout":"default","localId":"892c96c8-9782-40f5-b3ae-ebd70f0e01cc"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1162},"layout":"default","localId":"5ecad855-fb06-4556-b3c4-8fea2ba042db"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1164},"layout":"default","localId":"aa8f27ff-e691-422d-ac4d-7d343ed25659"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1166},"layout":"default","localId":"4b3f410f-e5f9-4e2b-86c9-07e839a9e3b2"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1168},"layout":"default","localId":"7bc4d88b-ecee-4d9a-88f7-9c300be069cf"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1170},"layout":"default","localId":"37426cc7-1904-4f7f-bf03-60095b5ed88b"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1172},"layout":"default","localId":"e715f4dd-4eb8-4964-8e84-04c4a57d7909"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1174},"layout":"default","localId":"87969fe2-1b8c-4401-be53-3af3ce9aad4f"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1176},"layout":"default","localId":"ea002d92-91cc-41ae-8f57-ec8e543b6f8c"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1178},"layout":"default","localId":"4675d71f-a878-4297-9f72-3f81812584da"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1180},"layout":"default","localId":"e0a7e1db-3c74-48b3-909b-46ea514e44b6"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1182},"layout":"default","localId":"542b26b6-8841-4b4f-a0a1-9951bdd57e00"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1184},"layout":"default","localId":"cba4ba1d-bcff-4ed9-ae20-bb3172e7d076"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1186},"layout":"default","localId":"0dd6a00a-e49f-4005-9b65-a5b902f39ff5"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1188},"layout":"default","localId":"9d088f21-5926-4c49-bf7f-efef429d6aad"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1190},"layout":"default","localId":"9d5fb259-71bf-427d-8796-18c2e1bf59e4"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1192},"layout":"default","localId":"d59beb17-6027-4fc6-b115-9da2579caf94"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1194},"layout":"default","localId":"2c400bd9-8567-4e46-94a6-de4bfec050c5"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1196},"layout":"default","localId":"48fd301a-5227-447a-b1a7-89f2a04845dc"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1198},"layout":"default","localId":"21c4b1da-a49e-4bad-b7f7-e41c55f1ade8"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1200},"layout":"default","localId":"e258ba06-afa4-4877-ae6a-52b4df5ad9de"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1202},"layout":"default","localId":"72a99e49-ed94-479e-b3dc-4809ff3c53db"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1204},"layout":"default","localId":"7eda60c6-c041-4a03-8dcb-568df40a9e58"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1206},"layout":"default","localId":"a61c8522-3b80-41d0-b068-89d9e448ef57"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1208},"layout":"default","localId":"a826a117-d51b-4cb3-9c07-d10bd5b15af7"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1210},"layout":"default","localId":"5a53b71e-f658-40df-8509-2e6884d4cd22"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1212},"layout":"default","localId":"4cfd3727-88b8-4746-a8d7-be0b1f24bc18"}}]},{"version":1,"type":"doc","content":[{"type":"heading","attrs":{"level":1,"localId":"753976f0-5dea-4260-b6d9-be983cfa1fd6"},"content":[{"type":"hardBreak"},{"type":"text","text":"Informations d’authentification","marks":[{"type":"strong"},{"type":"textColor","attrs":{"color":"#0747a6"}}]}]},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","attrs":{"localId":"8272eea4-37b7-4e4c-a5b4-07430ecfbd74"},"content":[{"type":"text","text":"Les informations demandées ci-dessous seront exclusivement utilisées à des fins d’authentification au PASS."}]}]},{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":530},"layout":"default","localId":"32e86890-4a09-4836-9e65-fe19fdf3bac1"}}]},{"type":"layoutColumn","attrs":{"width":66.66},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":531},"layout":"default","localId":"54ea6ec5-8e9d-4c9c-8432-969a54635e1f"}}]}]},{"type":"heading","attrs":{"level":1,"localId":"753976f0-5dea-4260-b6d9-be983cfa1fd6"},"content":[{"type":"text","text":"Informations professionnelles","marks":[{"type":"strong"},{"type":"textColor","attrs":{"color":"#0747a6"}}]}]},{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1371},"layout":"default","localId":"04ed9d75-aa47-4681-ad5d-77e58ff8b566"}}]},{"type":"layoutColumn","attrs":{"width":66.66},"content":[{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","attrs":{"localId":"5bd05a3c-c223-4539-88c5-f1ac83e2eee3"},"content":[{"type":"text","text":"Retrouvez votre n° RPPS en allant sur "},{"type":"text","text":"https://annuaire.esante.gouv.fr/","marks":[{"type":"link","attrs":{"href":"https://annuaire.esante.gouv.fr/"}}]},{"type":"text","text":" "},{"type":"hardBreak"},{"type":"text","text":"→ ","marks":[{"type":"strong"}]},{"type":"text","text":"Puis choisir “"},{"type":"text","text":"Rechercher un professionnel”","marks":[{"type":"em"}]}]}]},{"type":"paragraph","content":[{"type":"text","text":" "}]}]}]}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1373},"layout":"default","localId":"e951cfd2-55ce-4532-bd7f-44164f46679b"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1374},"layout":"default","localId":"a0f30e6e-c340-4da2-a729-4e7f8c5d2228"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1376},"layout":"default","localId":"f19d7e3e-ce6d-4b8f-97aa-8dfc1667de6c"}}]},{"version":1,"type":"doc","content":[{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":66.66},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1329},"layout":"default","localId":"094c7ba7-2a6f-4f52-b1a2-d5728b3248d3"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1337},"layout":"default","localId":"3d3c09a2-d4a4-4700-8398-33276d407d6c"}}]},{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"paragraph","content":[]},{"type":"paragraph","content":[]},{"type":"paragraph","content":[]},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","attrs":{"localId":"cb5e67e5-04e2-4ccf-ac2b-03ed3e5f5c4b"},"content":[{"type":"text","text":"Retrouvez votre n° SIRET ou FINESS en allant sur "},{"type":"text","text":"https://annuaire.esante.gouv.fr/","marks":[{"type":"link","attrs":{"href":"https://annuaire.esante.gouv.fr/"}}]},{"type":"hardBreak"},{"type":"text","text":"→ ","marks":[{"type":"strong"}]},{"type":"text","text":"Puis choisir “"},{"type":"text","text":"Rechercher une structure”","marks":[{"type":"em"}]}]}]}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":545},"layout":"default","localId":"4f984c67-14f2-4ff1-a125-50ae13b533ee"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":496},"layout":"default","localId":"f9b2c652-97d6-4f03-8912-6a915a435483"}}]},{"version":1,"type":"doc","content":[]},{"version":1,"type":"doc","content":[{"type":"paragraph","attrs":{"localId":"c674080d-246e-4ccc-bbd9-a3e07a1f3969"},"content":[{"type":"text","text":"Au sein de votre structure :"}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":547},"layout":"default","localId":"4b4435bf-0180-4b7c-b247-c651ee6ef2fb"}},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","attrs":{"localId":"35584c6f-80db-4160-a7d2-42234e74252b"},"content":[{"type":"text","text":"Merci de renseigner les coordonnées d’une personne de votre service ou de votre établissement susceptible d’être contactée dans le cadre du traitement de votre demande de création de compte. Si vous n'avez pas de référent, merci d'indiquer les coordonnées du secrétariat de votre service ou de votre établissement."}]}]},{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1331},"layout":"default","localId":"e1bd36ae-152c-478c-8bcf-2086ad2dd383"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1333},"layout":"default","localId":"6e77793c-4f1e-4c0b-a713-0679e5cab4c0"}}]},{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1332},"layout":"default","localId":"ab800256-f93a-4af5-8c2c-537744e3d10e"}},{"type":"paragraph","content":[]}]},{"type":"layoutColumn","attrs":{"width":33.33},"content":[{"type":"paragraph","content":[]}]}]}]},{"version":1,"type":"doc","content":[{"type":"rule"},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","attrs":{"localId":"e7ac0cd6-e767-471f-b677-267295bd38e1"},"content":[{"type":"text","text":"Je comprends que la création des comptes n’est pas automatique, qu’elle implique un délai de traitement, et que je peux être contacté par le Centre de Services du GRADeS pour des raisons de sécurité liées aux informations que vous venez de renseigner."},{"type":"hardBreak"},{"type":"hardBreak"},{"type":"text","text":"Mentions légales Jira Service Management","marks":[{"type":"link","attrs":{"href":"https://www.atlassian.com/fr/legal/cloud-terms-of-service"}},{"type":"strong"},{"type":"underline"}]}]},{"type":"paragraph","attrs":{"localId":"76dae7e8-ea6c-4e0d-8d78-e2bd548c80c7"},"content":[{"type":"text","text":"Mentions légales PASS","marks":[{"type":"link","attrs":{"href":"https://pass.esante-occitanie.fr/AutoConnectSSO/Content/StaticPages/CharteLegale.html"}},{"type":"strong"},{"type":"underline"}]}]},{"type":"paragraph","attrs":{"localId":"7a015bfb-7734-4a45-8347-cb131c7508bc"},"content":[{"type":"text","text":"CGU PASS","marks":[{"type":"link","attrs":{"href":"https://pass.esante-occitanie.fr/AutoConnectSSO/Content/StaticPages/ConditionsGenerales.html"}},{"type":"strong"},{"type":"underline"}]}]},{"type":"paragraph","attrs":{"localId":"d003398e-d222-425f-b6e7-f5ec0c7a58f4"},"content":[{"type":"text","text":"Note RGPD","marks":[{"type":"link","attrs":{"href":"https://pass.esante-occitanie.fr/AutoConnectSSO/Content/StaticPages/Confidentialite.html"}},{"type":"strong"},{"type":"underline"}]}]}]}]}],"conditions":{"1310":{"i":{"co":{"cIds":{"1370":["92"]}}},"o":{"sIds":["111"]},"t":"sh"},"1379":{"i":{"co":{"cIds":{"480":["4"]}}},"o":{"sIds":["4"]},"t":"sh"},"1262":{"i":{"co":{"cIds":{"1370":["44"]}}},"o":{"sIds":["63"]},"t":"sh"},"1401":{"i":{"co":{"cIds":{"510":["10042"]}}},"o":{"sIds":["10"]},"t":"sh"},"1267":{"i":{"co":{"cIds":{"1370":["49"]}}},"o":{"sIds":["68"]},"t":"sh"},"1406":{"i":{"co":{"cIds":{"510":["10046"]}}},"o":{"sIds":["15"]},"t":"sh"},"1227":{"i":{"co":{"cIds":{"1370":["9"]}}},"o":{"sIds":["28"]},"t":"sh"},"541":{"i":{"co":{"cIds":{}},"operator":"OR","groups":[{"operator":"AND","checks":[{"fieldId":"496","type":"SOME_OF","constraint":["2"]}]}]},"o":{"sIds":["136"]},"t":"sh"},"1278":{"i":{"co":{"cIds":{"1370":["60"]}}},"o":{"sIds":["79"]},"t":"sh"},"1238":{"i":{"co":{"cIds":{"1370":["20"]}}},"o":{"sIds":["39"]},"t":"sh"},"519":{"i":{"co":{"cIds":{"480":["1"]}}},"o":{"sIds":["18"]},"t":"sh"},"1224":{"i":{"co":{"cIds":{"1370":["6"]}}},"o":{"sIds":["25"]},"t":"sh"},"1249":{"i":{"co":{"cIds":{"1370":["31"]}}},"o":{"sIds":["50"]},"t":"sh"},"1289":{"i":{"co":{"cIds":{"1370":["71"]}}},"o":{"sIds":["90"]},"t":"sh"},"1235":{"i":{"co":{"cIds":{"1370":["17"]}}},"o":{"sIds":["36"]},"t":"sh"},"1250":{"i":{"co":{"cIds":{"1370":["32"]}}},"o":{"sIds":["51"]},"t":"sh"},"1328":{"i":{"co":{"cIds":{"1370":["102"]}}},"o":{"sIds":["121"]},"t":"sh"},"1261":{"i":{"co":{"cIds":{"1370":["43"]}}},"o":{"sIds":["62"]},"t":"sh"},"1290":{"i":{"co":{"cIds":{"1370":["72"]}}},"o":{"sIds":["91"]},"t":"sh"},"1299":{"i":{"co":{"cIds":{"1370":["81"]}}},"o":{"sIds":["100"]},"t":"sh"},"1259":{"i":{"co":{"cIds":{"1370":["41"]}}},"o":{"sIds":["60"]},"t":"sh"},"1219":{"i":{"co":{"cIds":{"1370":["1"]}}},"o":{"sIds":["20"]},"t":"sh"},"1221":{"i":{"co":{"cIds":{"1370":["3"]}}},"o":{"sIds":["22"]},"t":"sh"},"1317":{"i":{"co":{"cIds":{"1370":["98"]}}},"o":{"sIds":["118"]},"t":"sh"},"504":{"i":{"co":{"cIds":{"480":["5"]}}},"o":{"sIds":["1"]},"t":"sh"},"1232":{"i":{"co":{"cIds":{"1370":["14"]}}},"o":{"sIds":["33"]},"t":"sh"},"1272":{"i":{"co":{"cIds":{"1370":["54"]}}},"o":{"sIds":["73"]},"t":"sh"},"1284":{"i":{"co":{"cIds":{"1370":["66"]}}},"o":{"sIds":["85"]},"t":"sh"},"1312":{"i":{"co":{"cIds":{"1370":["94"]}}},"o":{"sIds":["113"]},"t":"sh"},"1295":{"i":{"co":{"cIds":{"1370":["77"]}}},"o":{"sIds":["96"]},"t":"sh"},"1254":{"i":{"co":{"cIds":{"1370":["36"]}}},"o":{"sIds":["55"]},"t":"sh"},"1397":{"i":{"co":{"cIds":{"510":["10037"]}}},"o":{"sIds":["6"]},"t":"sh"},"1294":{"i":{"co":{"cIds":{"1370":["76"]}}},"o":{"sIds":["95"]},"t":"sh"},"1273":{"i":{"co":{"cIds":{"1370":["55"]}}},"o":{"sIds":["74"]},"t":"sh"},"1323":{"i":{"co":{"cIds":{"1370":["111"]}}},"o":{"sIds":["129"]},"t":"sh"},"1283":{"i":{"co":{"cIds":{"1370":["65"]}}},"o":{"sIds":["84"]},"t":"sh"},"1301":{"i":{"co":{"cIds":{"1370":["83"]}}},"o":{"sIds":["102"]},"t":"sh"},"1243":{"i":{"co":{"cIds":{"1370":["25"]}}},"o":{"sIds":["44"]},"t":"sh"},"1257":{"i":{"co":{"cIds":{"1370":["39"]}}},"o":{"sIds":["58"]},"t":"sh"},"1246":{"i":{"co":{"cIds":{"1370":["28"]}}},"o":{"sIds":["47"]},"t":"sh"},"1298":{"i":{"co":{"cIds":{"1370":["80"]}}},"o":{"sIds":["99"]},"t":"sh"},"1226":{"i":{"co":{"cIds":{"1370":["8"]}}},"o":{"sIds":["27"]},"t":"sh"},"1407":{"i":{"co":{"cIds":{"510":["10047"]}}},"o":{"sIds":["16"]},"t":"sh"},"1268":{"i":{"co":{"cIds":{"1370":["50"]}}},"o":{"sIds":["69"]},"t":"sh"},"1223":{"i":{"co":{"cIds":{"1370":["5"]}}},"o":{"sIds":["24"]},"t":"sh"},"1287":{"i":{"co":{"cIds":{"1370":["69"]}}},"o":{"sIds":["88"]},"t":"sh"},"1279":{"i":{"co":{"cIds":{"1370":["61"]}}},"o":{"sIds":["80"]},"t":"sh"},"1237":{"i":{"co":{"cIds":{"1370":["19"]}}},"o":{"sIds":["38"]},"t":"sh"},"1265":{"i":{"co":{"cIds":{"1370":["47"]}}},"o":{"sIds":["66"]},"t":"sh"},"1248":{"i":{"co":{"cIds":{"1370":["30"]}}},"o":{"sIds":["49"]},"t":"sh"},"1276":{"i":{"co":{"cIds":{"1370":["58"]}}},"o":{"sIds":["77"]},"t":"sh"},"1404":{"i":{"co":{"cIds":{"510":["10041"]}}},"o":{"sIds":["13"]},"t":"sh"},"1256":{"i":{"co":{"cIds":{"1370":["38"]}}},"o":{"sIds":["57"]},"t":"sh"},"1378":{"i":{"co":{"cIds":{"1371":["2"]}}},"o":{"sIds":["132"]},"t":"sh"},"1245":{"i":{"co":{"cIds":{"1370":["27"]}}},"o":{"sIds":["46"]},"t":"sh"},"1293":{"i":{"co":{"cIds":{"1370":["75"]}}},"o":{"sIds":["94"]},"t":"sh"},"1271":{"i":{"co":{"cIds":{"1370":["53"]}}},"o":{"sIds":["72"]},"t":"sh"},"1318":{"i":{"co":{"cIds":{"1370":["101"]}}},"o":{"sIds":["119"]},"t":"sh"},"1260":{"i":{"co":{"cIds":{"1370":["42"]}}},"o":{"sIds":["61"]},"t":"sh"},"1400":{"i":{"co":{"cIds":{"510":["10039"]}}},"o":{"sIds":["9"]},"t":"sh"},"1307":{"i":{"co":{"cIds":{"1370":["89"]}}},"o":{"sIds":["108"]},"t":"sh"},"511":{"i":{"co":{"cIds":{"480":["4"]}}},"o":{"sIds":["3"]},"t":"sh"},"1282":{"i":{"co":{"cIds":{"1370":["64"]}}},"o":{"sIds":["83"]},"t":"sh"},"1302":{"i":{"co":{"cIds":{"1370":["84"]}}},"o":{"sIds":["103"]},"t":"sh"},"1313":{"i":{"co":{"cIds":{"1370":["95"]}}},"o":{"sIds":["114"]},"t":"sh"},"1234":{"i":{"co":{"cIds":{"1370":["16"]}}},"o":{"sIds":["35"]},"t":"sh"},"1251":{"i":{"co":{"cIds":{"1370":["33"]}}},"o":{"sIds":["52"]},"t":"sh"},"1324":{"i":{"co":{"cIds":{"1370":["108"]}}},"o":{"sIds":["122"]},"t":"sh"},"1240":{"i":{"co":{"cIds":{"1370":["22"]}}},"o":{"sIds":["41"]},"t":"sh"},"1269":{"i":{"co":{"cIds":{"1370":["51"]}}},"o":{"sIds":["70"]},"t":"sh"},"1325":{"i":{"co":{"cIds":{"1370":["103"]}}},"o":{"sIds":["124"]},"t":"sh"},"1286":{"i":{"co":{"cIds":{"1370":["68"]}}},"o":{"sIds":["87"]},"t":"sh"},"1314":{"i":{"co":{"cIds":{"1370":["96"]}}},"o":{"sIds":["115"]},"t":"sh"},"1303":{"i":{"co":{"cIds":{"1370":["85"]}}},"o":{"sIds":["104"]},"t":"sh"},"1229":{"i":{"co":{"cIds":{"1370":["11"]}}},"o":{"sIds":["30"]},"t":"sh"},"1309":{"i":{"co":{"cIds":{"1370":["91"]}}},"o":{"sIds":["110"]},"t":"sh"},"1320":{"i":{"co":{"cIds":{"1370":["107"]}}},"o":{"sIds":["123"]},"t":"sh"},"1264":{"i":{"co":{"cIds":{"1370":["46"]}}},"o":{"sIds":["65"]},"t":"sh"},"1275":{"i":{"co":{"cIds":{"1370":["57"]}}},"o":{"sIds":["76"]},"t":"sh"},"1408":{"i":{"co":{"cIds":{"480":["4"]}}},"o":{"sIds":["17"]},"t":"sh"},"1304":{"i":{"co":{"cIds":{"1370":["86"]}}},"o":{"sIds":["105"]},"t":"sh"},"1244":{"i":{"co":{"cIds":{"1370":["26"]}}},"o":{"sIds":["45"]},"t":"sh"},"1315":{"i":{"co":{"cIds":{"1370":["97"]}}},"o":{"sIds":["116"]},"t":"sh"},"1281":{"i":{"co":{"cIds":{"1370":["63"]}}},"o":{"sIds":["82"]},"t":"sh"},"1321":{"i":{"co":{"cIds":{"1370":["105"]}}},"o":{"sIds":["125"]},"t":"sh"},"1241":{"i":{"co":{"cIds":{"1370":["23"]}}},"o":{"sIds":["42"]},"t":"sh"},"1230":{"i":{"co":{"cIds":{"1370":["12"]}}},"o":{"sIds":["31"]},"t":"sh"},"1255":{"i":{"co":{"cIds":{"1370":["37"]}}},"o":{"sIds":["56"]},"t":"sh"},"1270":{"i":{"co":{"cIds":{"1370":["52"]}}},"o":{"sIds":["71"]},"t":"sh"},"1297":{"i":{"co":{"cIds":{"1370":["79"]}}},"o":{"sIds":["98"]},"t":"sh"},"1233":{"i":{"co":{"cIds":{"1370":["15"]}}},"o":{"sIds":["34"]},"t":"sh"},"1405":{"i":{"co":{"cIds":{"510":["10045"]}}},"o":{"sIds":["14"]},"t":"sh"},"1399":{"i":{"co":{"cIds":{"510":["10040"]}}},"o":{"sIds":["8"]},"t":"sh"},"1292":{"i":{"co":{"cIds":{"1370":["74"]}}},"o":{"sIds":["93"]},"t":"sh"},"1252":{"i":{"co":{"cIds":{"1370":["34"]}}},"o":{"sIds":["53"]},"t":"sh"},"1326":{"i":{"co":{"cIds":{"1370":["104"]}}},"o":{"sIds":["126"]},"t":"sh"},"1403":{"i":{"co":{"cIds":{"510":["10044"]}}},"o":{"sIds":["12"]},"t":"sh"},"1222":{"i":{"co":{"cIds":{"1370":["4"]}}},"o":{"sIds":["23"]},"t":"sh"},"1319":{"i":{"co":{"cIds":{"1370":["99"]}}},"o":{"sIds":["120"]},"t":"sh"},"1274":{"i":{"co":{"cIds":{"1370":["56"]}}},"o":{"sIds":["75"]},"t":"sh"},"1377":{"i":{"co":{"cIds":{"1371":["1"]}}},"o":{"sIds":["131"]},"t":"sh"},"1228":{"i":{"co":{"cIds":{"1370":["10"]}}},"o":{"sIds":["29"]},"t":"sh"},"1277":{"i":{"co":{"cIds":{"1370":["59"]}}},"o":{"sIds":["78"]},"t":"sh"},"1266":{"i":{"co":{"cIds":{"1370":["48"]}}},"o":{"sIds":["67"]},"t":"sh"},"1239":{"i":{"co":{"cIds":{"1370":["21"]}}},"o":{"sIds":["40"]},"t":"sh"},"1263":{"i":{"co":{"cIds":{"1370":["45"]}}},"o":{"sIds":["64"]},"t":"sh"},"1306":{"i":{"co":{"cIds":{"1370":["88"]}}},"o":{"sIds":["107"]},"t":"sh"},"1225":{"i":{"co":{"cIds":{"1370":["7"]}}},"o":{"sIds":["26"]},"t":"sh"},"1236":{"i":{"co":{"cIds":{"1370":["18"]}}},"o":{"sIds":["37"]},"t":"sh"},"1308":{"i":{"co":{"cIds":{"1370":["90"]}}},"o":{"sIds":["109"]},"t":"sh"},"1288":{"i":{"co":{"cIds":{"1370":["70"]}}},"o":{"sIds":["89"]},"t":"sh"},"1285":{"i":{"co":{"cIds":{"1370":["67"]}}},"o":{"sIds":["86"]},"t":"sh"},"1316":{"i":{"co":{"cIds":{"1370":["100"]}}},"o":{"sIds":["117"]},"t":"sh"},"1253":{"i":{"co":{"cIds":{"1370":["35"]}}},"o":{"sIds":["54"]},"t":"sh"},"1327":{"i":{"co":{"cIds":{"1370":["106"]}}},"o":{"sIds":["127"]},"t":"sh"},"1322":{"i":{"co":{"cIds":{"1370":["109"]}}},"o":{"sIds":["128"]},"t":"sh"},"1231":{"i":{"co":{"cIds":{"1370":["13"]}}},"o":{"sIds":["32"]},"t":"sh"},"1220":{"i":{"co":{"cIds":{"1370":["2"]}}},"o":{"sIds":["21"]},"t":"sh"},"1296":{"i":{"co":{"cIds":{"1370":["78"]}}},"o":{"sIds":["97"]},"t":"sh"},"1247":{"i":{"co":{"cIds":{"1370":["29"]}}},"o":{"sIds":["48"]},"t":"sh"},"1311":{"i":{"co":{"cIds":{"1370":["93"]}}},"o":{"sIds":["112"]},"t":"sh"},"1398":{"i":{"co":{"cIds":{"510":["10038"]}}},"o":{"sIds":["7"]},"t":"sh"},"1242":{"i":{"co":{"cIds":{"1370":["24"]}}},"o":{"sIds":["43"]},"t":"sh"},"1402":{"i":{"co":{"cIds":{"510":["10043"]}}},"o":{"sIds":["11"]},"t":"sh"},"1258":{"i":{"co":{"cIds":{"1370":["40"]}}},"o":{"sIds":["59"]},"t":"sh"},"1305":{"i":{"co":{"cIds":{"1370":["87"]}}},"o":{"sIds":["106"]},"t":"sh"},"1280":{"i":{"co":{"cIds":{"1370":["62"]}}},"o":{"sIds":["81"]},"t":"sh"},"1291":{"i":{"co":{"cIds":{"1370":["73"]}}},"o":{"sIds":["92"]},"t":"sh"},"1396":{"i":{"co":{"cIds":{"510":["10036"]}}},"o":{"sIds":["5"]},"t":"sh"},"1300":{"i":{"co":{"cIds":{"1370":["82"]}}},"o":{"sIds":["101"]},"t":"sh"}},"sections":{"118":{"conditions":["1317"]},"131":{"name":"RPPS","conditions":["1377"]},"45":{"conditions":["1244"]},"98":{"conditions":["1297"]},"67":{"conditions":["1266"]},"120":{"conditions":["1319"]},"93":{"conditions":["1292"]},"113":{"conditions":["1312"]},"34":{"conditions":["1233"]},"12":{"name":"48","conditions":["1403"]},"66":{"conditions":["1265"]},"89":{"conditions":["1288"]},"51":{"conditions":["1250"]},"8":{"name":"31","conditions":["1399"]},"73":{"conditions":["1272"]},"78":{"conditions":["1277"]},"124":{"conditions":["1325"]},"84":{"conditions":["1283"]},"19":{"conditions":[]},"100":{"conditions":["1299"]},"23":{"conditions":["1222"]},"62":{"conditions":["1261"]},"135":{"name":"FIN LIBERAL","conditions":[]},"128":{"conditions":["1322"]},"4":{"name":"TUCS","conditions":["1379"]},"121":{"conditions":["1328"]},"88":{"conditions":["1287"]},"110":{"conditions":["1309"]},"77":{"conditions":["1276"]},"40":{"conditions":["1239"]},"15":{"name":"81","conditions":["1406"]},"132":{"name":"SANS RPPS","conditions":["1378"]},"11":{"name":"46","conditions":["1402"]},"104":{"conditions":["1303"]},"90":{"conditions":["1289"]},"9":{"name":"32","conditions":["1400"]},"44":{"conditions":["1243"]},"33":{"conditions":["1232"]},"117":{"conditions":["1316"]},"22":{"conditions":["1221"]},"56":{"conditions":["1255"]},"55":{"conditions":["1254"]},"26":{"conditions":["1225"]},"134":{"name":"LIBERAL","conditions":[]},"50":{"conditions":["1249"]},"123":{"conditions":["1320"]},"37":{"conditions":["1236"]},"68":{"conditions":["1267"]},"61":{"conditions":["1260"]},"107":{"conditions":["1306"]},"13":{"name":"65","conditions":["1404"]},"46":{"conditions":["1245"]},"99":{"conditions":["1298"]},"24":{"conditions":["1223"]},"94":{"conditions":["1293"]},"83":{"conditions":["1282"]},"35":{"conditions":["1234"]},"16":{"name":"82","conditions":["1407"]},"79":{"conditions":["1278"]},"5":{"name":"11","conditions":["1396"]},"103":{"conditions":["1302"]},"112":{"conditions":["1311"]},"72":{"conditions":["1271"]},"10":{"name":"34","conditions":["1401"]},"59":{"conditions":["1258"]},"87":{"conditions":["1286"]},"48":{"conditions":["1247"]},"76":{"conditions":["1275"]},"21":{"conditions":["1220"]},"116":{"conditions":["1315"]},"54":{"conditions":["1253"]},"43":{"conditions":["1242"]},"127":{"conditions":["1327"]},"65":{"conditions":["1264"]},"71":{"conditions":["1270"]},"57":{"conditions":["1256"]},"108":{"conditions":["1307"]},"32":{"conditions":["1231"]},"80":{"conditions":["1279"]},"106":{"conditions":["1305"]},"137":{"conditions":[]},"6":{"name":"12","conditions":["1397"]},"126":{"conditions":["1326"]},"36":{"conditions":["1235"]},"1":{"name":"SPICO","conditions":["504"]},"39":{"conditions":["1238"]},"82":{"conditions":["1281"]},"49":{"conditions":["1248"]},"17":{"conditions":["1408"]},"25":{"conditions":["1224"]},"60":{"conditions":["1259"]},"14":{"name":"66","conditions":["1405"]},"133":{"conditions":[]},"47":{"conditions":["1246"]},"122":{"conditions":["1324"]},"111":{"conditions":["1310"]},"102":{"conditions":["1301"]},"31":{"conditions":["1230"]},"95":{"conditions":["1294"]},"96":{"conditions":["1295"]},"69":{"conditions":["1268"]},"58":{"conditions":["1257"]},"64":{"conditions":["1263"]},"53":{"conditions":["1252"]},"42":{"conditions":["1241"]},"75":{"conditions":["1274"]},"115":{"conditions":["1314"]},"109":{"conditions":["1308"]},"20":{"conditions":["1219"]},"27":{"conditions":["1226"]},"70":{"conditions":["1269"]},"2":{"name":"","conditions":[]},"86":{"conditions":["1285"]},"38":{"conditions":["1237"]},"81":{"conditions":["1280"]},"92":{"conditions":["1291"]},"125":{"conditions":["1321"]},"18":{"name":"","conditions":["519"]},"101":{"conditions":["1300"]},"30":{"conditions":["1229"]},"7":{"name":"30","conditions":["1398"]},"97":{"conditions":["1296"]},"130":{"conditions":[]},"114":{"conditions":["1313"]},"129":{"conditions":["1323"]},"29":{"conditions":["1228"]},"41":{"conditions":["1240"]},"105":{"conditions":["1304"]},"63":{"conditions":["1262"]},"3":{"name":"TUCS","conditions":["511"]},"74":{"conditions":["1273"]},"91":{"conditions":["1290"]},"52":{"conditions":["1251"]},"85":{"conditions":["1284"]},"28":{"conditions":["1227"]},"119":{"conditions":["1318"]},"136":{"name":"NON LIBERAL","conditions":["541"]}},"questions":{"1150":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10527","questionKey":""},"1182":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10543","questionKey":""},"1394":{"type":"cd","label":"Sélectionnez votre établissement","description":"","validation":{"rq":true},"jiraField":"customfield_10699","questionKey":"Nom de votre établissement-1-1-1-1-1-1-1-1-1-1-1-1"},"1389":{"type":"cd","label":"Sélectionnez votre établissement","description":"","validation":{"rq":true},"jiraField":"customfield_10700","questionKey":"Nom de votre établissement-1-1-1-1-1-1-1"},"515":{"type":"ts","label":"Numéro de carte CPE/CPA","description":"A renseigner uniquement si vous n'avez pas d'identifiant national.","validation":{"rq":false,"mxc":40},"choices":[],"questionKey":""},"1210":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10559","questionKey":""},"1390":{"type":"cd","label":"Sélectionnez votre établissement","description":"","validation":{"rq":true},"jiraField":"customfield_10933","questionKey":"Nom de votre établissement-1-1-1-1-1-1-1-1"},"1086":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10495","questionKey":""},"1108":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10506","questionKey":""},"1172":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10538","questionKey":""},"1198":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10558","questionKey":""},"1208":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10556","questionKey":""},"1329":{"type":"tl","label":"Nom de votre structure d'exercice","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"1082":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10493","questionKey":""},"1104":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10504","questionKey":""},"1176":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10540","questionKey":""},"1042":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10473","questionKey":""},"1006":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10456","questionKey":""},"1060":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10482","questionKey":""},"1160":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10532","questionKey":""},"1194":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10551","questionKey":""},"1020":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10463","questionKey":""},"1202":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10553","questionKey":""},"1012":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10459","questionKey":""},"1078":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10491","questionKey":""},"1080":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10492","questionKey":""},"1134":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10519","questionKey":""},"1126":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10515","questionKey":""},"1154":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10529","questionKey":""},"1120":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10512","questionKey":""},"1112":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10508","questionKey":""},"1118":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10511","questionKey":""},"1373":{"type":"ts","label":"Votre n° RPPS","description":"Composé de 11 chiffres.","validation":{"rq":true,"mnc":11,"mxc":11},"choices":[],"questionKey":"Identifiant National (Adeli/RPPS)"},"1156":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10530","questionKey":""},"1192":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10550","questionKey":""},"1142":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10523","questionKey":""},"1384":{"type":"cd","label":"Sélectionnez votre établissement","description":"","validation":{"rq":true},"jiraField":"customfield_10697","questionKey":"Nom de votre établissement-1-1"},"1068":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10486","questionKey":""},"1028":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10467","questionKey":""},"1350":{"type":"ts","label":"Autre service (ou communauté TéléO si vous la connaissez)","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"1132":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10518","questionKey":""},"1148":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10526","questionKey":""},"1391":{"type":"cd","label":"Sélectionnez votre établissement","description":"","validation":{"rq":true},"jiraField":"customfield_10698","questionKey":"Nom de votre établissement-1-1-1-1-1-1-1-1-1"},"1164":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10534","questionKey":""},"553":{"type":"tl","label":"Précisez votre besoin","description":"Merci de préciser votre besoin métier ou toute autre information complémentaire.","validation":{"rq":false},"choices":[],"questionKey":""},"1186":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10547","questionKey":""},"1178":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10541","questionKey":""},"545":{"type":"tl","label":"Adresse de votre structure d'exercice","description":"Par ex : 10 rue des Trente-six ponts, 31400 Toulouse","validation":{"rq":true,"mnc":10},"choices":[],"questionKey":""},"480":{"type":"cm","label":"Cochez les services numériques auxquels vous voulez avoir accès :","description":"","validation":{"rq":true},"choices":[{"id":"5","label":"SPICO (Outil de coordination des parcours de soins complexes)","other":false},{"id":"1","label":"TéléO (Plateforme de transfert d’imagerie et de téléexpertise)","other":false},{"id":"3","label":"Smurt@b (Outil de recueil et transmission lors de prise en charge SMUR)","other":false},{"id":"4","label":"TUCS (Outil de visibilité des patients régulés par le centre 15)","other":false}],"questionKey":"Pour l'usage de quelle application avez-vous besoin d'un compte PASS ?"},"1036":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10470","questionKey":""},"1114":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10509","questionKey":""},"1046":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10475","questionKey":""},"1074":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10489","questionKey":""},"1034":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10546","questionKey":""},"1066":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10485","questionKey":""},"1136":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10520","questionKey":""},"1092":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10498","questionKey":""},"1052":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10478","questionKey":""},"1204":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10555","questionKey":""},"1170":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10537","questionKey":""},"996":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10450","questionKey":""},"530":{"type":"ts","label":"N° de téléphone","description":"Utilisé pour la réception des codes SMS OTP.","validation":{"rq":true,"rgx":{"p":"^(0|\\+33)[1-9]([-. ]?[0-9]{2}){4}$","m":"Le n° de téléphone saisi est invalide."}},"choices":[],"questionKey":""},"1158":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10531","questionKey":""},"1002":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10454","questionKey":""},"1070":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10487","questionKey":""},"1030":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10468","questionKey":""},"1212":{"type":"cl","label":"Pays de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10560","questionKey":""},"1110":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10507","questionKey":""},"1096":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10500","questionKey":""},"1056":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10480","questionKey":""},"1024":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10465","questionKey":""},"1331":{"type":"ts","label":"Nom et prénom du contact","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"1018":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10462","questionKey":""},"1152":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10528","questionKey":""},"1058":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10481","questionKey":""},"1128":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10516","questionKey":""},"510":{"type":"cd","label":"Sélectionnez votre département","description":"","validation":{"rq":true},"jiraField":"customfield_10061","questionKey":""},"1376":{"type":"cd","label":"Profession à rôle (sans RPPS)","description":"Si vous ne trouvez pas votre profession, vous avez certainement un n° RPPS. Rendez-vous sur annuaire.sante.fr pour le retrouver.","validation":{"rq":true},"jiraField":"customfield_10319","questionKey":"Role"},"1048":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10476","questionKey":""},"1168":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10536","questionKey":""},"1088":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10496","questionKey":""},"1371":{"type":"cs","label":"Avez-vous un numéro RPPS ?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Oui","other":false},{"id":"2","label":"Non","other":false}],"questionKey":""},"1146":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10525","questionKey":""},"1196":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10552","questionKey":""},"1122":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10513","questionKey":""},"554":{"type":"cs","label":"Type de compte TUCS","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Référent TUCS","other":false},{"id":"2","label":"Utilisateur TUCS","other":false}],"questionKey":""},"1106":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10505","questionKey":""},"1174":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10539","questionKey":""},"1062":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10483","questionKey":""},"1022":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10464","questionKey":""},"1138":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10521","questionKey":""},"1392":{"type":"cd","label":"Sélectionnez votre établissement","description":"","validation":{"rq":true},"jiraField":"customfield_10653","questionKey":"Nom de votre établissement-1-1-1-1-1-1-1-1-1-1"},"1368":{"type":"ts","label":"Prénom","description":"","validation":{"rq":true,"rgx":{"p":"^(?=.{2,50}$)[A-Za-zÀ-ÖØ-öø-ÿ]+(?:[ '-][A-Za-zÀ-ÖØ-öø-ÿ]+)*$","m":"Le format de saisie est invalide."}},"choices":[],"questionKey":"Prénom de naissance"},"1040":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10472","questionKey":""},"1357":{"type":"cd","label":"Civilité","description":"","validation":{"rq":true},"choices":[{"id":"3","label":"- Aucun(e)","other":false},{"id":"2","label":"M.","other":false},{"id":"1","label":"Mme","other":false}],"defaultAnswer":{"choices":["3"]},"questionKey":""},"1076":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10490","questionKey":""},"1014":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10460","questionKey":""},"1358":{"type":"ts","label":"Nom de naissance","description":"","validation":{"rq":true,"rgx":{"p":"^(?=.{2,50}$)[A-Za-zÀ-ÖØ-öø-ÿ]+(?:[ '-][A-Za-zÀ-ÖØ-öø-ÿ]+)*$","m":"Le format de saisie est invalide."}},"choices":[],"questionKey":"Nom de naissance"},"1010":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10458","questionKey":""},"1200":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10557","questionKey":""},"1190":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10549","questionKey":""},"1388":{"type":"cd","label":"Sélectionnez votre établissement","description":"","validation":{"rq":true},"jiraField":"customfield_10694","questionKey":"Nom de votre établissement-1-1-1-1-1-1"},"1332":{"type":"te","label":"Adresse email du contact","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"1084":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10494","questionKey":""},"1044":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10474","questionKey":""},"1100":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10502","questionKey":""},"1370":{"type":"cd","label":"Votre département ou pays de naissance","description":"Si vous n'êtes pas né en France, choisissez \"Je suis né.e à l'étranger\".","validation":{"rq":true},"choices":[{"id":"1","label":"01","other":false},{"id":"2","label":"02","other":false},{"id":"3","label":"03","other":false},{"id":"4","label":"04","other":false},{"id":"5","label":"05","other":false},{"id":"6","label":"06","other":false},{"id":"7","label":"07","other":false},{"id":"8","label":"08","other":false},{"id":"9","label":"09","other":false},{"id":"10","label":"10","other":false},{"id":"11","label":"11","other":false},{"id":"12","label":"12","other":false},{"id":"13","label":"13","other":false},{"id":"14","label":"14","other":false},{"id":"15","label":"15","other":false},{"id":"16","label":"16","other":false},{"id":"17","label":"17","other":false},{"id":"18","label":"18","other":false},{"id":"19","label":"19","other":false},{"id":"20","label":"2A","other":false},{"id":"21","label":"2B","other":false},{"id":"22","label":"21","other":false},{"id":"23","label":"22","other":false},{"id":"24","label":"23","other":false},{"id":"25","label":"24","other":false},{"id":"26","label":"25","other":false},{"id":"27","label":"26","other":false},{"id":"28","label":"27","other":false},{"id":"29","label":"28","other":false},{"id":"30","label":"29","other":false},{"id":"31","label":"30","other":false},{"id":"32","label":"31","other":false},{"id":"33","label":"32","other":false},{"id":"34","label":"33","other":false},{"id":"35","label":"34","other":false},{"id":"36","label":"35","other":false},{"id":"37","label":"36","other":false},{"id":"38","label":"37","other":false},{"id":"39","label":"38","other":false},{"id":"40","label":"39","other":false},{"id":"41","label":"40","other":false},{"id":"42","label":"41","other":false},{"id":"43","label":"42","other":false},{"id":"44","label":"43","other":false},{"id":"45","label":"44","other":false},{"id":"46","label":"45","other":false},{"id":"47","label":"46","other":false},{"id":"48","label":"47","other":false},{"id":"49","label":"48","other":false},{"id":"50","label":"49","other":false},{"id":"51","label":"50","other":false},{"id":"52","label":"51","other":false},{"id":"53","label":"52","other":false},{"id":"54","label":"53","other":false},{"id":"55","label":"54","other":false},{"id":"56","label":"55","other":false},{"id":"57","label":"56","other":false},{"id":"58","label":"57","other":false},{"id":"59","label":"58","other":false},{"id":"60","label":"59","other":false},{"id":"61","label":"60","other":false},{"id":"62","label":"61","other":false},{"id":"63","label":"62","other":false},{"id":"64","label":"63","other":false},{"id":"65","label":"64","other":false},{"id":"66","label":"65","other":false},{"id":"67","label":"66","other":false},{"id":"68","label":"67","other":false},{"id":"69","label":"68","other":false},{"id":"70","label":"69","other":false},{"id":"71","label":"70","other":false},{"id":"72","label":"71","other":false},{"id":"73","label":"72","other":false},{"id":"74","label":"73","other":false},{"id":"75","label":"74","other":false},{"id":"76","label":"75","other":false},{"id":"77","label":"76","other":false},{"id":"78","label":"77","other":false},{"id":"79","label":"78","other":false},{"id":"80","label":"79","other":false},{"id":"81","label":"80","other":false},{"id":"82","label":"81","other":false},{"id":"83","label":"82","other":false},{"id":"84","label":"83","other":false},{"id":"85","label":"84","other":false},{"id":"86","label":"85","other":false},{"id":"87","label":"86","other":false},{"id":"88","label":"87","other":false},{"id":"89","label":"88","other":false},{"id":"90","label":"89","other":false},{"id":"91","label":"90","other":false},{"id":"92","label":"91","other":false},{"id":"93","label":"92","other":false},{"id":"94","label":"93","other":false},{"id":"95","label":"94","other":false},{"id":"96","label":"95","other":false},{"id":"97","label":"971","other":false},{"id":"98","label":"973","other":false},{"id":"99","label":"975","other":false},{"id":"100","label":"972","other":false},{"id":"101","label":"974","other":false},{"id":"102","label":"976","other":false},{"id":"103","label":"984","other":false},{"id":"104","label":"987","other":false},{"id":"105","label":"986","other":false},{"id":"106","label":"988","other":false},{"id":"107","label":"978","other":false},{"id":"108","label":"977","other":false},{"id":"109","label":"989","other":false},{"id":"111","label":"Je suis né.e à l'étranger","other":false}],"questionKey":""},"998":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10452","questionKey":""},"531":{"type":"te","label":"Adresse email","description":"Les adresses emails génériques (ex : secretariat@structure.fr) ne sont pas autorisées.","validation":{"rq":true},"jiraField":"customfield_10039","questionKey":""},"1102":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10503","questionKey":""},"1386":{"type":"cd","label":"Sélectionnez votre établissement","description":"","validation":{"rq":true},"jiraField":"customfield_10692","questionKey":"Nom de votre établissement-1-1-1-1"},"1337":{"type":"tl","label":"SIRET ou FINESS de ma structure d'exercice","description":"La saisie de ce champ n’est pas obligatoire mais est fortement recommandée pour garantir le traitement optimal de votre demande. Veuillez vous référer à l'encart ci-contre pour retrouver le n° SIRET ou FINESS de votre structure d'exercice.","validation":{"rq":false,"rgx":{"p":"^(\\d{10}|\\d{9}|\\d{14}|\\d{15}|RG000000000)$","m":"Le format de la valeur saisie est invalide."}},"choices":[],"questionKey":"SIRET/FINESS de ma structure d'exercice"},"1038":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10471","questionKey":""},"1344":{"type":"ts","label":"Nom de votre établissement","description":"","validation":{"rq":true},"choices":[],"questionKey":"Etablissement Téléo"},"1349":{"type":"ts","label":"Nom de votre service (ou de la communauté TéléO si vous la connaissez)","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"1008":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10457","questionKey":""},"1217":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10451","questionKey":""},"1369":{"type":"ts","label":"Date de naissance (Exemple : 14/02/1990)","description":"","validation":{"rq":true,"rgx":{"p":"^(0[1-9]|[12][0-9]|3[01])/(0[1-9]|1[0-2])/\\d{4}$","m":"La date saisie est invalide."}},"choices":[],"questionKey":"Date de naissance"},"1162":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10533","questionKey":""},"1098":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10501","questionKey":""},"1366":{"type":"ts","label":"Nom d'usage (nom d'exercice)","description":"","validation":{"rq":true,"rgx":{"p":"^(?=.{2,50}$)[A-Za-zÀ-ÖØ-öø-ÿ]+(?:[ '-][A-Za-zÀ-ÖØ-öø-ÿ]+)*$","m":"Le format de saisie est invalide."}},"choices":[],"questionKey":"nom-1"},"496":{"type":"cs","label":"Exercez-vous en libéral ?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Oui","other":false},{"id":"2","label":"Non","other":false}],"questionKey":""},"1188":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10548","questionKey":""},"1116":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10510","questionKey":""},"1016":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10461","questionKey":""},"1124":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10514","questionKey":""},"1166":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10535","questionKey":""},"547":{"type":"tl","label":"Nom de votre service d'exercice","description":"Nom du service dans lequel vous évoluez au sein de l'établissement.","validation":{"rq":true},"choices":[],"questionKey":""},"1072":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10488","questionKey":""},"1094":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10499","questionKey":""},"1054":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10479","questionKey":""},"1026":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10466","questionKey":""},"1352":{"type":"ts","label":"Autre service (ou communauté TéléO si vous la connaissez)","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"1184":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10544","questionKey":""},"1130":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10517","questionKey":""},"1144":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10524","questionKey":""},"1000":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10453","questionKey":""},"1032":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10545","questionKey":""},"1064":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10484","questionKey":""},"1090":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10497","questionKey":""},"1374":{"type":"cd","label":"Profession RPPS","description":"Si vous êtes infirmer, vous êtes dans l'obligation de renseigner votre RPPS comme identifiant national.","validation":{"rq":true},"jiraField":"customfield_10562","defaultAnswer":{"choices":["181930"]},"questionKey":"profession"},"1050":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10477","questionKey":""},"1385":{"type":"cd","label":"Sélectionnez votre établissement","description":"","validation":{"rq":true},"jiraField":"customfield_10733","questionKey":"Nom de votre établissement-1-1-1"},"1206":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10554","questionKey":""},"1333":{"type":"ts","label":"N° téléphone du contact","description":"","validation":{"rq":true,"rgx":{"p":"^(0|\\+33)[1-9]([-. ]?[0-9]{2}){4}$","m":"Le n° de téléphone saisi est invalide."}},"choices":[],"questionKey":""},"1382":{"type":"cd","label":"Sélectionnez votre établissement","description":"","validation":{"rq":true},"jiraField":"customfield_10900","questionKey":"Nom de votre établissement-1"},"1180":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10542","questionKey":""},"1140":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10522","questionKey":""},"1004":{"type":"cl","label":"Commune de naissance","description":"","validation":{"rq":true,"mns":1,"mxs":1},"jiraField":"customfield_10455","questionKey":""},"1387":{"type":"cd","label":"Sélectionnez votre établissement","description":"","validation":{"rq":true},"jiraField":"customfield_10696","questionKey":"Nom de votre établissement-1-1-1-1-1"},"1393":{"type":"cd","label":"Sélectionnez votre établissement","description":"","validation":{"rq":true},"jiraField":"customfield_10695","questionKey":"Nom de votre établissement-1-1-1-1-1-1-1-1-1-1-1"}}},"uuid":"28c0c76b-9c80-4d04-9ff1-d363cf04fe83"},"linkedJiraFields":["customfield_10470","customfield_10471","customfield_10472","customfield_10473","customfield_10474","customfield_10475","customfield_10476","customfield_10477","customfield_10510","customfield_10500","customfield_10467","customfield_10468","customfield_10501","customfield_10502","customfield_10503","customfield_10900","customfield_10504","customfield_10505","customfield_10506","customfield_10507","customfield_10508","customfield_10509","customfield_10061","customfield_10460","customfield_10461","customfield_10462","customfield_10463","customfield_10464","customfield_10465","customfield_10466","customfield_10456","customfield_10698","customfield_10457","customfield_10699","customfield_10733","customfield_10458","customfield_10459","customfield_10450","customfield_10692","customfield_10451","customfield_10694","customfield_10452","customfield_10453","customfield_10695","customfield_10454","customfield_10696","customfield_10697","customfield_10455","customfield_10560","customfield_10562","customfield_10555","customfield_10039","customfield_10556","customfield_10557","customfield_10558","customfield_10559","customfield_10319","customfield_10550","customfield_10551","customfield_10552","customfield_10553","customfield_10554","customfield_10544","customfield_10545","customfield_10546","customfield_10700","customfield_10547","customfield_10548","customfield_10549","customfield_10540","customfield_10541","customfield_10542","customfield_10543","customfield_10533","customfield_10534","customfield_10535","customfield_10536","customfield_10933","customfield_10537","customfield_10538","customfield_10539","customfield_10490","customfield_10491","customfield_10492","customfield_10493","customfield_10494","customfield_10495","customfield_10496","customfield_10497","customfield_10530","customfield_10498","customfield_10531","customfield_10532","customfield_10499","customfield_10653","customfield_10489","customfield_10522","customfield_10523","customfield_10524","customfield_10525","customfield_10526","customfield_10527","customfield_10528","customfield_10529","customfield_10480","customfield_10481","customfield_10482","customfield_10483","customfield_10484","customfield_10485","customfield_10486","customfield_10487","customfield_10520","customfield_10521","customfield_10488","customfield_10511","customfield_10478","customfield_10512","customfield_10479","customfield_10513","customfield_10514","customfield_10515","customfield_10516","customfield_10517","customfield_10518","customfield_10519"]},"key":""},"portalWebFragments":{"headerPanels":[],"subheaderPanels":[],"footerPanels":[],"pagePanels":{"propertyPanels":[],"legacyPropertyPanels":[]}}}