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Submitted URL: https://redcapvwt.com/
Effective URL: https://vwtredcap.com/surveys/?s=3PEDEN9AHF3RFW9L
Submission: On November 26 via api from BE — Scanned from AU
Effective URL: https://vwtredcap.com/surveys/?s=3PEDEN9AHF3RFW9L
Submission: On November 26 via api from BE — Scanned from AU
Form analysis 1 forms found in the DOM
Name: form — POST /surveys/index.php?s=3PEDEN9AHF3RFW9L
<form action="/surveys/index.php?s=3PEDEN9AHF3RFW9L" enctype="multipart/form-data" target="_self" method="post" name="form" id="form"><input type="hidden" name="redcap_csrf_token" value="">
<div>
<script type="text/javascript">
if (typeof lang == 'undefined') {
var lang = {}
};
lang.global_143 = 'Checked';
lang.global_144 = 'Unchecked';
</script>
<script type="text/javascript">
var missing_data_replacement_js = '______';
var piping_receiver_class_field_js = '.piping_receiver.piperec-';
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<span id="maxchecked_tag_label" class="" style="display:none;z-index:1000;" data-rc-lang="data_entry_421">Cannot select choice! The maximum number of choices has been selected.</span><span id="matrix_rank_remove_label" class="opacity75"
style="display:none;" data-rc-lang="data_entry_203">Value removed!</span>
<div id="questiontable_loading" style="visibility: visible; display: none;">
<img alt="Loading..." src="/redcap_v14.5.4/Resources/images/progress_circle.gif"> <span data-rc-lang="data_entry_64">Loading...</span>
</div>
<script type="text/javascript">
setTimeout(function() {
document.getElementById('questiontable_loading').style.visibility = 'visible';
}, 750);
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<table role="presentation" class="form_border container-fluid" style="display: table;" id="questiontable">
<tbody class="formtbody">
<tr id="age-sh-tr" sq_id="{}" style="display: table-row;">
<td class="header toolbar" colspan="3">
<div data-mlm-field="age" data-mlm-type="header">
<div class="rich-text-field-label">
<p><span style="text-decoration: underline;">Section 1</span><br><span style="font-weight: normal;">We would like to know more about you.</span></p>
</div>
</div>
</td>
</tr>
<tr id="age-tr" sq_id="age">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="label-fl fl" id="label-age">
<div data-kind="field-label">
<div data-mlm-field="age" data-mlm-type="label">
<div class="rich-text-field-label">
<p><span style="font-weight: normal;">What is your age?</span></p>
</div>
</div>
</div>
</label></td>
<td class="data col-5"><span data-kind="field-value"><input name="age" value="" tabindex="-1" class="hiddenradio" aria-labelledby="label-age">
<div class="choicevert"><input type="radio" id="opt-age_1" tabindex="0" name="age___radio" aria-labelledby="label-age label-age-1" onclick="document.forms['form'].age.value=this.value;" value="1"> <label data-mlm-field="age"
data-mlm-type="enum" data-mlm-value="1" id="label-age-1" for="opt-age_1" class="mc">18 years or less</label></div>
<div class="choicevert"><input type="radio" id="opt-age_2" tabindex="0" name="age___radio" aria-labelledby="label-age label-age-2" onclick="document.forms['form'].age.value=this.value;" value="2"> <label data-mlm-field="age"
data-mlm-type="enum" data-mlm-value="2" id="label-age-2" for="opt-age_2" class="mc">19 - 25 years old</label></div>
<div class="choicevert"><input type="radio" id="opt-age_3" tabindex="0" name="age___radio" aria-labelledby="label-age label-age-3" onclick="document.forms['form'].age.value=this.value;" value="3"> <label data-mlm-field="age"
data-mlm-type="enum" data-mlm-value="3" id="label-age-3" for="opt-age_3" class="mc">26 - 35 years old</label></div>
<div class="choicevert"><input type="radio" id="opt-age_4" tabindex="0" name="age___radio" aria-labelledby="label-age label-age-4" onclick="document.forms['form'].age.value=this.value;" value="4"> <label data-mlm-field="age"
data-mlm-type="enum" data-mlm-value="4" id="label-age-4" for="opt-age_4" class="mc">36 - 45 years old</label></div>
<div class="choicevert"><input type="radio" id="opt-age_5" tabindex="0" name="age___radio" aria-labelledby="label-age label-age-5" onclick="document.forms['form'].age.value=this.value;" value="5"> <label data-mlm-field="age"
data-mlm-type="enum" data-mlm-value="5" id="label-age-5" for="opt-age_5" class="mc">Over 46 years old</label></div>
</span>
<div data-kind="reset-link" class="resetLinkParent d-print-none">
<a href="javascript:;" class="smalllink " tabindex="0" style="display:;" onclick="radioResetVal('age','form');return false;"><span data-rc-lang="form_renderer_20">reset</span></a></div>
<div id="age_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</td>
</tr>
<tr id="indigenous-tr" sq_id="indigenous">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="label-fl fl" id="label-indigenous">
<div data-kind="field-label">
<div data-mlm-field="indigenous" data-mlm-type="label">
<div class="rich-text-field-label">
<p><span style="font-weight: normal;">Are you of Aboriginal or Torres Strait Islander origin?</span></p>
</div>
</div>
</div>
</label></td>
<td class="data col-5"><span data-kind="field-value"><input name="indigenous" value="" tabindex="-1" class="hiddenradio" aria-labelledby="label-indigenous">
<div class="choicevert"><input type="radio" id="opt-indigenous_1" tabindex="0" name="indigenous___radio" aria-labelledby="label-indigenous label-indigenous-1" onclick="document.forms['form'].indigenous.value=this.value;" value="1">
<label data-mlm-field="indigenous" data-mlm-type="enum" data-mlm-value="1" id="label-indigenous-1" for="opt-indigenous_1" class="mc">No</label></div>
<div class="choicevert"><input type="radio" id="opt-indigenous_2" tabindex="0" name="indigenous___radio" aria-labelledby="label-indigenous label-indigenous-2" onclick="document.forms['form'].indigenous.value=this.value;" value="2">
<label data-mlm-field="indigenous" data-mlm-type="enum" data-mlm-value="2" id="label-indigenous-2" for="opt-indigenous_2" class="mc">Yes; Aboriginal</label></div>
<div class="choicevert"><input type="radio" id="opt-indigenous_3" tabindex="0" name="indigenous___radio" aria-labelledby="label-indigenous label-indigenous-3" onclick="document.forms['form'].indigenous.value=this.value;" value="3">
<label data-mlm-field="indigenous" data-mlm-type="enum" data-mlm-value="3" id="label-indigenous-3" for="opt-indigenous_3" class="mc">Yes; Torres Strait Islander</label></div>
<div class="choicevert"><input type="radio" id="opt-indigenous_4" tabindex="0" name="indigenous___radio" aria-labelledby="label-indigenous label-indigenous-4" onclick="document.forms['form'].indigenous.value=this.value;" value="4">
<label data-mlm-field="indigenous" data-mlm-type="enum" data-mlm-value="4" id="label-indigenous-4" for="opt-indigenous_4" class="mc">Yes; Both Aboriginal and Torres Strait Islander</label></div>
<div class="choicevert"><input type="radio" id="opt-indigenous_5" tabindex="0" name="indigenous___radio" aria-labelledby="label-indigenous label-indigenous-5" onclick="document.forms['form'].indigenous.value=this.value;" value="5">
<label data-mlm-field="indigenous" data-mlm-type="enum" data-mlm-value="5" id="label-indigenous-5" for="opt-indigenous_5" class="mc">Prefer not to say</label></div>
</span>
<div data-kind="reset-link" class="resetLinkParent d-print-none">
<a href="javascript:;" class="smalllink " tabindex="0" style="display:;" onclick="radioResetVal('indigenous','form');return false;"><span data-rc-lang="form_renderer_20">reset</span></a></div>
<div id="indigenous_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</td>
</tr>
<tr id="gender-tr" sq_id="gender">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="label-fl fl" id="label-gender">
<div data-kind="field-label">
<div data-mlm-field="gender" data-mlm-type="label">
<div class="rich-text-field-label">
<p><span style="font-weight: normal;">How do you identify?</span></p>
</div>
</div>
</div>
</label></td>
<td class="data col-5"><span data-kind="field-value"><input name="gender" value="" tabindex="-1" class="hiddenradio" aria-labelledby="label-gender">
<div class="choicevert"><input type="radio" id="opt-gender_1" tabindex="0" name="gender___radio" aria-labelledby="label-gender label-gender-1" onclick="document.forms['form'].gender.value=this.value;" value="1"> <label
data-mlm-field="gender" data-mlm-type="enum" data-mlm-value="1" id="label-gender-1" for="opt-gender_1" class="mc">Woman/female</label></div>
<div class="choicevert"><input type="radio" id="opt-gender_2" tabindex="0" name="gender___radio" aria-labelledby="label-gender label-gender-2" onclick="document.forms['form'].gender.value=this.value;" value="2"> <label
data-mlm-field="gender" data-mlm-type="enum" data-mlm-value="2" id="label-gender-2" for="opt-gender_2" class="mc">Non-binary</label></div>
<div class="choicevert"><input type="radio" id="opt-gender_3" tabindex="0" name="gender___radio" aria-labelledby="label-gender label-gender-3" onclick="document.forms['form'].gender.value=this.value;" value="3"> <label
data-mlm-field="gender" data-mlm-type="enum" data-mlm-value="3" id="label-gender-3" for="opt-gender_3" class="mc">Other <span class="rc-field-embed" var="gender_other" req="0"><span data-kind="field-value"><input
autocomplete="new-password" aria-labelledby="label-gender_other" class="x-form-text x-form-field " type="text" name="gender_other" value="" tabindex="0" style="max-width: 380px; width: 95%;"></span>
<div id="gender_other_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</span></label></div>
</span>
<div data-kind="reset-link" class="resetLinkParent d-print-none">
<a href="javascript:;" class="smalllink " tabindex="0" style="display:;" onclick="radioResetVal('gender','form');return false;"><span data-rc-lang="form_renderer_20">reset</span></a></div>
<div id="gender_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</td>
</tr>
<tr class="hide row-field-embedded" id="gender_other-tr" sq_id="gender_other">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="label-fl fl" id="label-gender_other">
<div data-kind="field-label">
<div data-mlm-field="gender_other" data-mlm-type="label">
<div class="rich-text-field-label">
<p><span style="font-weight: normal;">Other</span></p>
</div>
</div>
</div>
</label></td>
<td class="data col-5">
</td>
</tr>
<tr id="disability-tr" sq_id="disability">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="label-fl fl" id="label-disability">
<div data-kind="field-label">
<div data-mlm-field="disability" data-mlm-type="label">
<div class="rich-text-field-label">
<p><span style="font-weight: normal;">How would you describe, if any, your disability or chronic condition at the time of your recent birth?</span><br><span style="font-weight: normal;">(Please select the options that apply to
you)</span></p>
</div>
</div>
</div>
</label></td>
<td class="data col-5">
<div style="overflow:hidden;">
<div data-kind="field-value">
<div class="choicevert" onclick=""><input type="checkbox" aria-labelledby="label-disability label-disability-1" tabindex="0" id="id-__chk__disability_RC_1" name="__chkn__disability" code="1"
onclick="checkboxClick('disability','1',this,event,0);"><input type="hidden" value="" name="__chk__disability_RC_1"> <label id="label-disability-1" class="mc" for="id-__chk__disability_RC_1" data-mlm-field="disability"
data-mlm-type="enum" data-mlm-value="1">Chronic pelvic pain</label></div>
<div class="choicevert" onclick=""><input type="checkbox" aria-labelledby="label-disability label-disability-2" tabindex="0" id="id-__chk__disability_RC_2" name="__chkn__disability" code="2"
onclick="checkboxClick('disability','2',this,event,0);"><input type="hidden" value="" name="__chk__disability_RC_2"> <label id="label-disability-2" class="mc" for="id-__chk__disability_RC_2" data-mlm-field="disability"
data-mlm-type="enum" data-mlm-value="2">Polycystic ovary syndrome</label></div>
<div class="choicevert" onclick=""><input type="checkbox" aria-labelledby="label-disability label-disability-3" tabindex="0" id="id-__chk__disability_RC_3" name="__chkn__disability" code="3"
onclick="checkboxClick('disability','3',this,event,0);"><input type="hidden" value="" name="__chk__disability_RC_3"> <label id="label-disability-3" class="mc" for="id-__chk__disability_RC_3" data-mlm-field="disability"
data-mlm-type="enum" data-mlm-value="3">Endometriosis</label></div>
<div class="choicevert" onclick=""><input type="checkbox" aria-labelledby="label-disability label-disability-4" tabindex="0" id="id-__chk__disability_RC_4" name="__chkn__disability" code="4"
onclick="checkboxClick('disability','4',this,event,0);"><input type="hidden" value="" name="__chk__disability_RC_4"> <label id="label-disability-4" class="mc" for="id-__chk__disability_RC_4" data-mlm-field="disability"
data-mlm-type="enum" data-mlm-value="4">Attention deficit disorder</label></div>
<div class="choicevert" onclick=""><input type="checkbox" aria-labelledby="label-disability label-disability-5" tabindex="0" id="id-__chk__disability_RC_5" name="__chkn__disability" code="5"
onclick="checkboxClick('disability','5',this,event,0);"><input type="hidden" value="" name="__chk__disability_RC_5"> <label id="label-disability-5" class="mc" for="id-__chk__disability_RC_5" data-mlm-field="disability"
data-mlm-type="enum" data-mlm-value="5">Autism</label></div>
<div class="choicevert" onclick=""><input type="checkbox" aria-labelledby="label-disability label-disability-6" tabindex="0" id="id-__chk__disability_RC_6" name="__chkn__disability" code="6"
onclick="checkboxClick('disability','6',this,event,0);"><input type="hidden" value="" name="__chk__disability_RC_6"> <label id="label-disability-6" class="mc" for="id-__chk__disability_RC_6" data-mlm-field="disability"
data-mlm-type="enum" data-mlm-value="6">Blind or visually impaired</label></div>
<div class="choicevert" onclick=""><input type="checkbox" aria-labelledby="label-disability label-disability-7" tabindex="0" id="id-__chk__disability_RC_7" name="__chkn__disability" code="7"
onclick="checkboxClick('disability','7',this,event,0);"><input type="hidden" value="" name="__chk__disability_RC_7"> <label id="label-disability-7" class="mc" for="id-__chk__disability_RC_7" data-mlm-field="disability"
data-mlm-type="enum" data-mlm-value="7">Deaf or hard of hearing</label></div>
<div class="choicevert" onclick=""><input type="checkbox" aria-labelledby="label-disability label-disability-8" tabindex="0" id="id-__chk__disability_RC_8" name="__chkn__disability" code="8"
onclick="checkboxClick('disability','8',this,event,0);"><input type="hidden" value="" name="__chk__disability_RC_8"> <label id="label-disability-8" class="mc" for="id-__chk__disability_RC_8" data-mlm-field="disability"
data-mlm-type="enum" data-mlm-value="8">Learning disability</label></div>
<div class="choicevert" onclick=""><input type="checkbox" aria-labelledby="label-disability label-disability-9" tabindex="0" id="id-__chk__disability_RC_9" name="__chkn__disability" code="9"
onclick="checkboxClick('disability','9',this,event,0);"><input type="hidden" value="" name="__chk__disability_RC_9"> <label id="label-disability-9" class="mc" for="id-__chk__disability_RC_9" data-mlm-field="disability"
data-mlm-type="enum" data-mlm-value="9">Mental health condition</label></div>
<div class="choicevert" onclick=""><input type="checkbox" aria-labelledby="label-disability label-disability-10" tabindex="0" id="id-__chk__disability_RC_10" name="__chkn__disability" code="10"
onclick="checkboxClick('disability','10',this,event,0);"><input type="hidden" value="" name="__chk__disability_RC_10"> <label id="label-disability-10" class="mc" for="id-__chk__disability_RC_10" data-mlm-field="disability"
data-mlm-type="enum" data-mlm-value="10">Mobility-related disability</label></div>
<div class="choicevert" onclick=""><input type="checkbox" aria-labelledby="label-disability label-disability-11" tabindex="0" id="id-__chk__disability_RC_11" name="__chkn__disability" code="11"
onclick="checkboxClick('disability','11',this,event,0);"><input type="hidden" value="" name="__chk__disability_RC_11"> <label id="label-disability-11" class="mc" for="id-__chk__disability_RC_11" data-mlm-field="disability"
data-mlm-type="enum" data-mlm-value="11">Speech-related disability</label></div>
<div class="choicevert" onclick=""><input type="checkbox" aria-labelledby="label-disability label-disability-12" tabindex="0" id="id-__chk__disability_RC_12" name="__chkn__disability" code="12"
onclick="checkboxClick('disability','12',this,event,0);"><input type="hidden" value="" name="__chk__disability_RC_12"> <label id="label-disability-12" class="mc" for="id-__chk__disability_RC_12" data-mlm-field="disability"
data-mlm-type="enum" data-mlm-value="12">N/A</label></div>
<div class="choicevert" onclick=""><input type="checkbox" aria-labelledby="label-disability label-disability-13" tabindex="0" id="id-__chk__disability_RC_13" name="__chkn__disability" code="13"
onclick="checkboxClick('disability','13',this,event,0);"><input type="hidden" value="" name="__chk__disability_RC_13"> <label id="label-disability-13" class="mc" for="id-__chk__disability_RC_13" data-mlm-field="disability"
data-mlm-type="enum" data-mlm-value="13">Other <span class="rc-field-embed" var="disability_other" req="0"><span data-kind="field-value"><input autocomplete="new-password" aria-labelledby="label-disability_other"
class="x-form-text x-form-field " type="text" name="disability_other" value="" tabindex="0" style="max-width: 380px; width: 95%;"></span>
<div id="disability_other_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</span></label></div>
</div>
</div>
<div class="space"></div>
<div id="disability_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</td>
</tr>
<tr class="hide row-field-embedded" id="disability_other-tr" sq_id="disability_other">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="label-fl fl" id="label-disability_other">
<div data-kind="field-label">
<div data-mlm-field="disability_other" data-mlm-type="label">
<div class="rich-text-field-label">
<p><span style="font-weight: normal;">Other</span></p>
</div>
</div>
</div>
</label></td>
<td class="data col-5">
</td>
</tr>
<tr id="country-tr" sq_id="country">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="label-fl fl" id="label-country">
<div data-kind="field-label">
<div data-mlm-field="country" data-mlm-type="label">
<div class="rich-text-field-label">
<p><span style="font-weight: normal;">What is your country of birth?</span></p>
</div>
</div>
</div>
</label></td>
<td class="data col-5"><span data-kind="field-value"><input name="country" value="" tabindex="-1" class="hiddenradio" aria-labelledby="label-country">
<div class="choicevert"><input type="radio" id="opt-country_1" tabindex="0" name="country___radio" aria-labelledby="label-country label-country-1" onclick="document.forms['form'].country.value=this.value;" value="1"> <label
data-mlm-field="country" data-mlm-type="enum" data-mlm-value="1" id="label-country-1" for="opt-country_1" class="mc">Australia</label></div>
<div class="choicevert"><input type="radio" id="opt-country_2" tabindex="0" name="country___radio" aria-labelledby="label-country label-country-2" onclick="document.forms['form'].country.value=this.value;" value="2"> <label
data-mlm-field="country" data-mlm-type="enum" data-mlm-value="2" id="label-country-2" for="opt-country_2" class="mc">New Zealand</label></div>
<div class="choicevert"><input type="radio" id="opt-country_3" tabindex="0" name="country___radio" aria-labelledby="label-country label-country-3" onclick="document.forms['form'].country.value=this.value;" value="3"> <label
data-mlm-field="country" data-mlm-type="enum" data-mlm-value="3" id="label-country-3" for="opt-country_3" class="mc">United Kingdom</label></div>
<div class="choicevert"><input type="radio" id="opt-country_4" tabindex="0" name="country___radio" aria-labelledby="label-country label-country-4" onclick="document.forms['form'].country.value=this.value;" value="4"> <label
data-mlm-field="country" data-mlm-type="enum" data-mlm-value="4" id="label-country-4" for="opt-country_4" class="mc">China</label></div>
<div class="choicevert"><input type="radio" id="opt-country_5" tabindex="0" name="country___radio" aria-labelledby="label-country label-country-5" onclick="document.forms['form'].country.value=this.value;" value="5"> <label
data-mlm-field="country" data-mlm-type="enum" data-mlm-value="5" id="label-country-5" for="opt-country_5" class="mc">India</label></div>
<div class="choicevert"><input type="radio" id="opt-country_6" tabindex="0" name="country___radio" aria-labelledby="label-country label-country-6" onclick="document.forms['form'].country.value=this.value;" value="6"> <label
data-mlm-field="country" data-mlm-type="enum" data-mlm-value="6" id="label-country-6" for="opt-country_6" class="mc">Other <span class="rc-field-embed" var="country_other" req="0"><span data-kind="field-value"><input
autocomplete="new-password" aria-labelledby="label-country_other" class="x-form-text x-form-field " type="text" name="country_other" value="" tabindex="0" style="max-width: 380px; width: 95%;"></span>
<div id="country_other_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</span></label></div>
</span>
<div data-kind="reset-link" class="resetLinkParent d-print-none">
<a href="javascript:;" class="smalllink " tabindex="0" style="display:;" onclick="radioResetVal('country','form');return false;"><span data-rc-lang="form_renderer_20">reset</span></a></div>
<div id="country_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</td>
</tr>
<tr class="hide row-field-embedded" id="country_other-tr" sq_id="country_other">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="label-fl fl" id="label-country_other">
<div data-kind="field-label">
<div data-mlm-field="country_other" data-mlm-type="label">
<div class="rich-text-field-label">
<p><span style="font-weight: normal;">Other</span></p>
</div>
</div>
</div>
</label></td>
<td class="data col-5">
</td>
</tr>
<tr id="language-tr" sq_id="language">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="label-fl fl" id="label-language">
<div data-kind="field-label">
<div data-mlm-field="language" data-mlm-type="label">
<div class="rich-text-field-label">
<p><span style="font-weight: normal;">What is your primary language used at home?</span></p>
</div>
</div>
</div>
</label></td>
<td class="data col-5"><span data-kind="field-value"><input name="language" value="" tabindex="-1" class="hiddenradio" aria-labelledby="label-language">
<div class="choicevert"><input type="radio" id="opt-language_1" tabindex="0" name="language___radio" aria-labelledby="label-language label-language-1" onclick="document.forms['form'].language.value=this.value;" value="1"> <label
data-mlm-field="language" data-mlm-type="enum" data-mlm-value="1" id="label-language-1" for="opt-language_1" class="mc">English</label></div>
<div class="choicevert"><input type="radio" id="opt-language_2" tabindex="0" name="language___radio" aria-labelledby="label-language label-language-2" onclick="document.forms['form'].language.value=this.value;" value="2"> <label
data-mlm-field="language" data-mlm-type="enum" data-mlm-value="2" id="label-language-2" for="opt-language_2" class="mc">Mandarin</label></div>
<div class="choicevert"><input type="radio" id="opt-language_3" tabindex="0" name="language___radio" aria-labelledby="label-language label-language-3" onclick="document.forms['form'].language.value=this.value;" value="3"> <label
data-mlm-field="language" data-mlm-type="enum" data-mlm-value="3" id="label-language-3" for="opt-language_3" class="mc">Arabic</label></div>
<div class="choicevert"><input type="radio" id="opt-language_4" tabindex="0" name="language___radio" aria-labelledby="label-language label-language-4" onclick="document.forms['form'].language.value=this.value;" value="4"> <label
data-mlm-field="language" data-mlm-type="enum" data-mlm-value="4" id="label-language-4" for="opt-language_4" class="mc">Vietnamese</label></div>
<div class="choicevert"><input type="radio" id="opt-language_5" tabindex="0" name="language___radio" aria-labelledby="label-language label-language-5" onclick="document.forms['form'].language.value=this.value;" value="5"> <label
data-mlm-field="language" data-mlm-type="enum" data-mlm-value="5" id="label-language-5" for="opt-language_5" class="mc">Cantonese</label></div>
<div class="choicevert"><input type="radio" id="opt-language_6" tabindex="0" name="language___radio" aria-labelledby="label-language label-language-6" onclick="document.forms['form'].language.value=this.value;" value="6"> <label
data-mlm-field="language" data-mlm-type="enum" data-mlm-value="6" id="label-language-6" for="opt-language_6" class="mc">Other <span class="rc-field-embed" var="language_other" req="0"><span data-kind="field-value"><input
autocomplete="new-password" aria-labelledby="label-language_other" class="x-form-text x-form-field " type="text" name="language_other" value="" tabindex="0" style="max-width: 380px; width: 95%;"></span>
<div id="language_other_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</span></label></div>
</span>
<div data-kind="reset-link" class="resetLinkParent d-print-none">
<a href="javascript:;" class="smalllink " tabindex="0" style="display:;" onclick="radioResetVal('language','form');return false;"><span data-rc-lang="form_renderer_20">reset</span></a></div>
<div id="language_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</td>
</tr>
<tr class="hide row-field-embedded" id="language_other-tr" sq_id="language_other">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="label-fl fl" id="label-language_other">
<div data-kind="field-label">
<div data-mlm-field="language_other" data-mlm-type="label">
<div class="rich-text-field-label">
<p><span style="font-weight: normal;">Other</span></p>
</div>
</div>
</div>
</label></td>
<td class="data col-5">
</td>
</tr>
<tr id="religion-tr" sq_id="religion">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="label-fl fl" id="label-religion">
<div data-kind="field-label">
<div data-mlm-field="religion" data-mlm-type="label">
<div class="rich-text-field-label">
<p><span style="font-weight: normal;">What, if any, is your religious affiliation?</span></p>
</div>
</div>
</div>
</label></td>
<td class="data col-5"><span data-kind="field-value"><input name="religion" value="" tabindex="-1" class="hiddenradio" aria-labelledby="label-religion">
<div class="choicevert"><input type="radio" id="opt-religion_1" tabindex="0" name="religion___radio" aria-labelledby="label-religion label-religion-1" onclick="document.forms['form'].religion.value=this.value;" value="1"> <label
data-mlm-field="religion" data-mlm-type="enum" data-mlm-value="1" id="label-religion-1" for="opt-religion_1" class="mc">Christianity</label></div>
<div class="choicevert"><input type="radio" id="opt-religion_2" tabindex="0" name="religion___radio" aria-labelledby="label-religion label-religion-2" onclick="document.forms['form'].religion.value=this.value;" value="2"> <label
data-mlm-field="religion" data-mlm-type="enum" data-mlm-value="2" id="label-religion-2" for="opt-religion_2" class="mc">Buddhism</label></div>
<div class="choicevert"><input type="radio" id="opt-religion_3" tabindex="0" name="religion___radio" aria-labelledby="label-religion label-religion-3" onclick="document.forms['form'].religion.value=this.value;" value="3"> <label
data-mlm-field="religion" data-mlm-type="enum" data-mlm-value="3" id="label-religion-3" for="opt-religion_3" class="mc">Islam</label></div>
<div class="choicevert"><input type="radio" id="opt-religion_4" tabindex="0" name="religion___radio" aria-labelledby="label-religion label-religion-4" onclick="document.forms['form'].religion.value=this.value;" value="4"> <label
data-mlm-field="religion" data-mlm-type="enum" data-mlm-value="4" id="label-religion-4" for="opt-religion_4" class="mc">Judaism</label></div>
<div class="choicevert"><input type="radio" id="opt-religion_5" tabindex="0" name="religion___radio" aria-labelledby="label-religion label-religion-5" onclick="document.forms['form'].religion.value=this.value;" value="5"> <label
data-mlm-field="religion" data-mlm-type="enum" data-mlm-value="5" id="label-religion-5" for="opt-religion_5" class="mc">Secular Beliefs, Other Spiritual Beliefs and/or No Religious Affiliation</label></div>
<div class="choicevert"><input type="radio" id="opt-religion_6" tabindex="0" name="religion___radio" aria-labelledby="label-religion label-religion-6" onclick="document.forms['form'].religion.value=this.value;" value="6"> <label
data-mlm-field="religion" data-mlm-type="enum" data-mlm-value="6" id="label-religion-6" for="opt-religion_6" class="mc">Other <span class="rc-field-embed" var="religion_other" req="0"><span data-kind="field-value"><input
autocomplete="new-password" aria-labelledby="label-religion_other" class="x-form-text x-form-field " type="text" name="religion_other" value="" tabindex="0" style="max-width: 380px; width: 95%;"></span>
<div id="religion_other_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</span></label></div>
</span>
<div data-kind="reset-link" class="resetLinkParent d-print-none">
<a href="javascript:;" class="smalllink " tabindex="0" style="display:;" onclick="radioResetVal('religion','form');return false;"><span data-rc-lang="form_renderer_20">reset</span></a></div>
<div id="religion_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</td>
</tr>
<tr class="hide row-field-embedded" id="religion_other-tr" sq_id="religion_other">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="label-fl fl" id="label-religion_other">
<div data-kind="field-label">
<div data-mlm-field="religion_other" data-mlm-type="label">
<div class="rich-text-field-label">
<p><span style="font-weight: normal;">Other</span></p>
</div>
</div>
</div>
</label></td>
<td class="data col-5">
</td>
</tr>
<tr id="relationship-tr" sq_id="relationship">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="label-fl fl" id="label-relationship">
<div data-kind="field-label">
<div data-mlm-field="relationship" data-mlm-type="label">
<div class="rich-text-field-label">
<p><span style="font-weight: normal;">What was your relationship status at the time of your recent birth?</span></p>
</div>
</div>
</div>
</label></td>
<td class="data col-5"><span data-kind="field-value"><input name="relationship" value="" tabindex="-1" class="hiddenradio" aria-labelledby="label-relationship">
<div class="choicevert"><input type="radio" id="opt-relationship_1" tabindex="0" name="relationship___radio" aria-labelledby="label-relationship label-relationship-1" onclick="document.forms['form'].relationship.value=this.value;"
value="1"> <label data-mlm-field="relationship" data-mlm-type="enum" data-mlm-value="1" id="label-relationship-1" for="opt-relationship_1" class="mc">Single</label></div>
<div class="choicevert"><input type="radio" id="opt-relationship_2" tabindex="0" name="relationship___radio" aria-labelledby="label-relationship label-relationship-2" onclick="document.forms['form'].relationship.value=this.value;"
value="2"> <label data-mlm-field="relationship" data-mlm-type="enum" data-mlm-value="2" id="label-relationship-2" for="opt-relationship_2" class="mc">Partnered (de facto or married)</label></div>
<div class="choicevert"><input type="radio" id="opt-relationship_3" tabindex="0" name="relationship___radio" aria-labelledby="label-relationship label-relationship-3" onclick="document.forms['form'].relationship.value=this.value;"
value="3"> <label data-mlm-field="relationship" data-mlm-type="enum" data-mlm-value="3" id="label-relationship-3" for="opt-relationship_3" class="mc">Separated or Divorced</label></div>
<div class="choicevert"><input type="radio" id="opt-relationship_4" tabindex="0" name="relationship___radio" aria-labelledby="label-relationship label-relationship-4" onclick="document.forms['form'].relationship.value=this.value;"
value="4"> <label data-mlm-field="relationship" data-mlm-type="enum" data-mlm-value="4" id="label-relationship-4" for="opt-relationship_4" class="mc">Widowed</label></div>
<div class="choicevert"><input type="radio" id="opt-relationship_5" tabindex="0" name="relationship___radio" aria-labelledby="label-relationship label-relationship-5" onclick="document.forms['form'].relationship.value=this.value;"
value="5"> <label data-mlm-field="relationship" data-mlm-type="enum" data-mlm-value="5" id="label-relationship-5" for="opt-relationship_5" class="mc">Other <span class="rc-field-embed" var="relationship_other" req="0"><span
data-kind="field-value"><input autocomplete="new-password" aria-labelledby="label-relationship_other" class="x-form-text x-form-field " type="text" name="relationship_other" value="" tabindex="0"
style="max-width: 380px; width: 95%;"></span>
<div id="relationship_other_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</span></label></div>
</span>
<div data-kind="reset-link" class="resetLinkParent d-print-none">
<a href="javascript:;" class="smalllink " tabindex="0" style="display:;" onclick="radioResetVal('relationship','form');return false;"><span data-rc-lang="form_renderer_20">reset</span></a></div>
<div id="relationship_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</td>
</tr>
<tr class="hide row-field-embedded" id="relationship_other-tr" sq_id="relationship_other">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="label-fl fl" id="label-relationship_other">
<div data-kind="field-label">
<div data-mlm-field="relationship_other" data-mlm-type="label">
<div class="rich-text-field-label">
<p><span style="font-weight: normal;">Other</span></p>
</div>
</div>
</div>
</label></td>
<td class="data col-5">
</td>
</tr>
<tr id="education-tr" sq_id="education">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="label-fl fl" id="label-education">
<div data-kind="field-label">
<div data-mlm-field="education" data-mlm-type="label">
<div class="rich-text-field-label">
<p><span style="font-weight: normal;">What is your highest completed level of education?</span></p>
</div>
</div>
</div>
</label></td>
<td class="data col-5"><span data-kind="field-value"><input name="education" value="" tabindex="-1" class="hiddenradio" aria-labelledby="label-education">
<div class="choicevert"><input type="radio" id="opt-education_1" tabindex="0" name="education___radio" aria-labelledby="label-education label-education-1" onclick="document.forms['form'].education.value=this.value;" value="1"> <label
data-mlm-field="education" data-mlm-type="enum" data-mlm-value="1" id="label-education-1" for="opt-education_1" class="mc">Year 12 or lower</label></div>
<div class="choicevert"><input type="radio" id="opt-education_2" tabindex="0" name="education___radio" aria-labelledby="label-education label-education-2" onclick="document.forms['form'].education.value=this.value;" value="2"> <label
data-mlm-field="education" data-mlm-type="enum" data-mlm-value="2" id="label-education-2" for="opt-education_2" class="mc">Technical college (TAFE) or diploma</label></div>
<div class="choicevert"><input type="radio" id="opt-education_3" tabindex="0" name="education___radio" aria-labelledby="label-education label-education-3" onclick="document.forms['form'].education.value=this.value;" value="3"> <label
data-mlm-field="education" data-mlm-type="enum" data-mlm-value="3" id="label-education-3" for="opt-education_3" class="mc">Undergraduate degree</label></div>
<div class="choicevert"><input type="radio" id="opt-education_4" tabindex="0" name="education___radio" aria-labelledby="label-education label-education-4" onclick="document.forms['form'].education.value=this.value;" value="4"> <label
data-mlm-field="education" data-mlm-type="enum" data-mlm-value="4" id="label-education-4" for="opt-education_4" class="mc">Postgraduate degree</label></div>
<div class="choicevert"><input type="radio" id="opt-education_5" tabindex="0" name="education___radio" aria-labelledby="label-education label-education-5" onclick="document.forms['form'].education.value=this.value;" value="5"> <label
data-mlm-field="education" data-mlm-type="enum" data-mlm-value="5" id="label-education-5" for="opt-education_5" class="mc">Other <span class="rc-field-embed" var="education_other" req="0"><span data-kind="field-value"><input
autocomplete="new-password" aria-labelledby="label-education_other" class="x-form-text x-form-field " type="text" name="education_other" value="" tabindex="0" style="max-width: 380px; width: 95%;"></span>
<div id="education_other_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</span></label></div>
</span>
<div data-kind="reset-link" class="resetLinkParent d-print-none">
<a href="javascript:;" class="smalllink " tabindex="0" style="display:;" onclick="radioResetVal('education','form');return false;"><span data-rc-lang="form_renderer_20">reset</span></a></div>
<div id="education_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</td>
</tr>
<tr class="hide row-field-embedded" id="education_other-tr" sq_id="education_other">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="label-fl fl" id="label-education_other">
<div data-kind="field-label">
<div data-mlm-field="education_other" data-mlm-type="label">
<div class="rich-text-field-label">
<p><span style="font-weight: normal;">Other</span></p>
</div>
</div>
</div>
</label></td>
<td class="data col-5">
</td>
</tr>
<input type="hidden" name="submit-action" id="submit-action" value="<span data-rc-lang="data_entry_206">Save Record</span>">
<input type="hidden" name="__start_time__" id="__start_time__" value="2024-11-26 07:14:03">
<input type="hidden" name="__start_time_hash__" id="__start_time__" value="ql2G/J1bNiYLP0HHm5mzWUDz5zuDoqMGdrstI1/ehVqR9FbJQK5aNK6PIyPGSsoj">
<input type="hidden" name="record_id" id="record_id" value="1">
<input type="hidden" name="__page__" value="1">
<input type="hidden" name="__page_hash__" value="a52466538bd39431a633d3179d99b342">
<input type="hidden" name="__response_hash__" value="">
<input type="hidden" name="maternity_care_complete" value="">
<tr class="surveysubmit">
<td class="labelrc col-12" style="padding:5px;" colspan="3">
<table cellspacing="0">
<tbody>
<tr>
<td colspan="2" style="text-align:center;padding:15px 0;">
<button name="submit-btn-saverecord" tabindex="0" class="jqbutton nowrap ui-button ui-corner-all ui-widget" style="color:#800000;min-width:140px;"
onclick="$(this).button("disable");dataEntrySubmit(this);return false;"><span data-rc-lang="data_entry_536">Next Page >></span></button>
</td>
</tr>
<tr>
<td colspan="2" style="text-align:center;padding: 1px 0 10px;">
<button name="submit-btn-savereturnlater" tabindex="0" class="jqbutton ui-button ui-corner-all ui-widget" onclick="$(this).button("disable");dataEntrySubmit(this);return false;"><span data-rc-lang="data_entry_215">Save
& Return Later</span></button>
</td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table>
</div><input type="hidden" name="external-modules-temporary-record-id" value="external-modules-temporary-record-id-1732605243-1135932367">
</form>Text Content
The code block below illustrates how one might use # and // as comments in your logic and calculations. # Text can be put here to explain what the logic/calculation does and why. if ([field1] = '1' and [field2] > 7, // This comment can explain what the next line does. [score] * [factor], // Return '0' if the condition is False. 0 ) Working … 0% means 50% means 100% means This value you provided is not a number. Please try again. This value you provided is not an integer. Please try again. The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again. The value you provided must be within the suggested range The value you provided is outside the suggested range This value is admissible, but you may wish to double check it. The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19). This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now. This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now. This field must be a valid email address (like joe@user.com). Please re-enter it now. The value you provided could not be validated because it does not follow the expected format. Please try again. Required format: htVyC9tHmVFBa6bEINbPgHvnyhsnm7dHaUdYh57INB3dBxPfLcPLXsLgPiCr47ecJpg4tXcigntjUJKMQ9v4Ch8fYECGoCchdCtR9bajy974fGxV5n5 HELP SHAPE THE FUTURE OF MATERNITY CARE IN AUSTRALIA Returning? Returning? Begin where you left off. If you have already completed part of the survey, you may continue where you left off. All you need is the return code given to you previously. Click the link below to begin entering your return code and continue the survey. Continue the survey A A A The Victorian Women's Trust has been engaging with many people around the issue of maternity care in Victoria. We are interested in lived experiences of birthing and the challenges faced. We are keen to hear from those who have given birth within the last 10 years. We understand that reflecting on your birth experience may not necessarily be positive but if we are to be part of the solution in improving maternity care in Australia, we need to ensure that honest and real life experience is the cornerstone. With your participation, this survey will provide us with a sense of the next steps and actions we may take. *Please note that this survey typically takes 15-20 minutes to complete, so we encourage you to relax and take your time to respond to each question carefully.* If you require any assistance or support after completing this survey, please reach out to the following helplines: PANDA (Perinatal Anxiety & Depression Australia): Call: 1300 726 306 Monday to Friday: 9 am - 7.30 pm, Saturday: 9 am - 4 pm (AEST/AEDT) 1800 RESPECT: Available 24/7: Call 1800 737 732, text 0458 737 732 or chat online. Lifeline: Available 24/7: Call 13 11 14, text 0477 13 11 14 or chat online. Acknowledgement of Participants The Victorian Women's Trust acknowledges the courage and efforts of the respondents who have come forward to participate in this survey. We understand that everyone's experience is unique, and your input is invaluable in shaping our advocacy efforts to improve maternity care services. We sincerely thank you for taking the time to take part in the survey and we value your response. Acknowledgement of Country The Victorian Women's Trust acknowledges the Wurundjeri People of the Kulin Nation, who are the Traditional Custodians of the land on which we stand. We pay respect to Elders both past and present and extend that respect to the Aboriginal and Torres Strait Islander peoples participating in this survey. Inclusivity Statement The Victorian Women's Trust supports women, girls and gender-diverse people. In recognition of our support, we affirm our respect for all birthing experiences. Confidentiality Statement Your participation in this survey is voluntary. Names and personal identifiers are not essential. All responses will be kept strictly confidential and will only be viewed by the researchers. We have two Interns working with us on this project. If you have any queries about the survey, please contact: Monae Scott-Coutts: monae@vwt.org.au Devini Raj Kumar: devini@vwt.org.au If you would like to stay informed on the survey results, please visit our website or follow the Victorian Women's Trust on Instagram at @vicwomenstrust Cannot select choice! The maximum number of choices has been selected.Value removed! Loading... Section 1 We would like to know more about you. What is your age? 18 years or less 19 - 25 years old 26 - 35 years old 36 - 45 years old Over 46 years old reset Are you of Aboriginal or Torres Strait Islander origin? No Yes; Aboriginal Yes; Torres Strait Islander Yes; Both Aboriginal and Torres Strait Islander Prefer not to say reset How do you identify? Woman/female Non-binary Other reset Other How would you describe, if any, your disability or chronic condition at the time of your recent birth? (Please select the options that apply to you) Chronic pelvic pain Polycystic ovary syndrome Endometriosis Attention deficit disorder Autism Blind or visually impaired Deaf or hard of hearing Learning disability Mental health condition Mobility-related disability Speech-related disability N/A Other Other What is your country of birth? Australia New Zealand United Kingdom China India Other reset Other What is your primary language used at home? English Mandarin Arabic Vietnamese Cantonese Other reset Other What, if any, is your religious affiliation? Christianity Buddhism Islam Judaism Secular Beliefs, Other Spiritual Beliefs and/or No Religious Affiliation Other reset Other What was your relationship status at the time of your recent birth? Single Partnered (de facto or married) Separated or Divorced Widowed Other reset Other What is your highest completed level of education? Year 12 or lower Technical college (TAFE) or diploma Undergraduate degree Postgraduate degree Other reset Other Next Page >> Save & Return Later YOU HAVE SELECTED AN OPTION THAT TRIGGERS THIS SURVEY TO END RIGHT NOW. To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button. Powered by REDCap