 
<script type="text/javascript">
 
(function($){
 
window.gwmpnObj = function( args ) {
 
this.formId = args.formId;
this.formElem = jQuery('form#gform_' + this.formId);
this.currentPage = args.currentPage;
this.lastPage = args.lastPage;
this.labels = args.labels;
 
this.init = function() {
 
// if this form is ajax-enabled, we'll need to get the current page via JS
if( this.isAjax() )
this.currentPage = this.getCurrentPage();
 
if( !this.isLastPage() && !this.isLastPageReached() )
return;
 
var gwmpn = this;
var steps = $('form#gform_' + this.formId + ' .gf_step');
 
steps.each(function(){
 
var stepNumber = parseInt( $(this).find('span.gf_step_number').text() );
 
if( stepNumber != gwmpn.currentPage ) {
$(this).html( gwmpn.createPageLink( stepNumber, $(this).html() ) )
.addClass('gw-step-linked');
} else {
$(this).addClass('gw-step-current');
}
 
});
 
if( !this.isLastPage() )
this.addBackToLastPageButton();
 
$(document).on('click', '#gform_' + this.formId + ' a.gwmpn-page-link', function(event){
event.preventDefault();
 
var hrefArray = $(this).attr('href').split('#');
if( hrefArray.length >= 2 ) {
var pageNumber = hrefArray.pop();
gwmpn.postToPage( pageNumber );
}
 
});
 
}
 
this.createPageLink = function( stepNumber, HTML ) {
return '<a href="#' + stepNumber + '" class="gwmpn-page-link">' + HTML + '</a>';
}
 
this.postToPage = function(page) {
this.formElem.append('<input type="hidden" name="gw_page_change" value="1" />');
this.formElem.find('input[name="gform_target_page_number_' + this.formId + '"]').val(page);
this.formElem.submit();
}
 
this.addBackToLastPageButton = function() {
this.formElem.find('#gform_page_' + this.formId + '_' + this.currentPage + ' .gform_page_footer')
.append('<input type="button" onclick="gwmpn.postToPage(' + this.lastPage + ')" value="' + this.labels.lastPageButton + '" class="button gform_last_page_button">');
}
 
this.getCurrentPage = function() {
return this.formElem.find( 'input#gform_source_page_number_' + this.formId ).val();
}
 
this.isLastPage = function() {
return this.currentPage >= this.lastPage;
}
 
this.isLastPageReached = function() {
return this.formElem.find('input[name="gw_last_page_reached"]').val() == true;
}
 
this.isAjax = function() {
return this.formElem.attr('target') == 'gform_ajax_frame_' + this.formId;
}
 
this.init();
 
}
 
})(jQuery);
 
</script>
 
{"id":109,"date":"2014-04-01T19:43:54","date_gmt":"2014-04-01T19:43:54","guid":{"rendered":"http:\/\/www.roche-forms.bg\/safety\/?page_id=109"},"modified":"2014-04-01T19:44:34","modified_gmt":"2014-04-01T19:44:34","slug":"%d0%b4%d0%be%d0%ba%d0%bb%d0%b0%d0%b4%d0%b2%d0%b0%d0%b9-%d0%bd%d0%b5%d0%b6%d0%b5%d0%bb%d0%b0%d0%bd%d0%b0-%d0%bb%d0%b5%d0%ba%d0%b0%d1%80%d1%81%d1%82%d0%b2%d0%b5%d0%bd%d0%b0-%d1%80%d0%b5%d0%b0%d0%ba","status":"publish","type":"page","link":"https:\/\/www.roche-forms.bg\/safety\/?page_id=109","title":{"rendered":"\u0414\u043e\u043a\u043b\u0430\u0434\u0432\u0430\u0439 \u043d\u0435\u0436\u0435\u043b\u0430\u043d\u0430 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u0430 \u0440\u0435\u0430\u043a\u0446\u0438\u044f \u043f\u0440\u0438 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442"},"content":{"rendered":"<p>\r\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework roche1_wrapper' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_36' style='display:none'><div id='gf_36' class='gform_anchor' tabindex='-1'><\/div>\r\n                        <div class='gform_heading'>\r\n                            <h3 class=\"gform_title\">\u0414\u043e\u043a\u043b\u0430\u0434\u0432\u0430\u0439 \u043d\u0435\u0436\u0435\u043b\u0430\u043d\u0430 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u0430 \u0440\u0435\u0430\u043a\u0446\u0438\u044f \u043f\u0440\u0438 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442<\/h3>\r\n                            <p class='gform_description'><\/p>\r\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_36' class='roche1' action='\/safety\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F109#gf_36' data-formid='36' novalidate><div id='gf_page_steps_36' class='gf_page_steps'><div id='gf_step_36_1' class='gf_step gf_step_active gf_step_first'><span class='gf_step_number'>1<\/span><span class='gf_step_label'>\u0414\u0430\u043d\u043d\u0438 \u0437\u0430 \u0441\u044a\u043e\u0431\u0449\u0438\u0442\u0435\u043b\u044f<\/span><\/div><div id='gf_step_36_2' class='gf_step gf_step_next gf_step_pending'><span class='gf_step_number'>2<\/span><span class='gf_step_label'>\u0414\u0435\u0442\u0430\u0439\u043b\u0438 \u0437\u0430 \u0440\u043e\u0434\u0438\u0442\u0435\u043b\u0438\u0442\u0435<\/span><\/div><div id='gf_step_36_3' class='gf_step gf_step_pending'><span class='gf_step_number'>3<\/span><span class='gf_step_label'>\u041f\u0440\u043e\u0434\u0443\u043a\u0442\u043e\u0432\u0430 \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f<\/span><\/div><div id='gf_step_36_4' class='gf_step gf_step_pending'><span class='gf_step_number'>4<\/span><span class='gf_step_label'>\u041c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0430 \u0430\u043d\u0430\u043c\u043d\u0435\u0437\u0430 \u043d\u0430 \u043c\u0430\u0439\u043a\u0430\u0442\u0430 \u0438 \u0431\u0430\u0449\u0430\u0442\u0430<\/span><\/div><div id='gf_step_36_5' class='gf_step gf_step_pending'><span class='gf_step_number'>5<\/span><span class='gf_step_label'>\u041a\u043e\u043d\u0442\u0440\u0430\u0446\u0435\u043f\u0446\u0438\u044f<\/span><\/div><div id='gf_step_36_6' class='gf_step gf_step_pending'><span class='gf_step_number'>6<\/span><span class='gf_step_label'>\u0410\u043a\u0443\u0448\u0435\u0440\u0441\u043a\u0430 \u0430\u043d\u0430\u043c\u043d\u0435\u0437\u0430<\/span><\/div><div id='gf_step_36_7' class='gf_step gf_step_pending'><span class='gf_step_number'>7<\/span><span class='gf_step_label'>\u0418\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f \u0437\u0430 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u0442\u0430<\/span><\/div><div id='gf_step_36_8' class='gf_step gf_step_pending'><span class='gf_step_number'>8<\/span><span class='gf_step_label'>\u0418\u0437\u0445\u043e\u0434 \u043e\u0442 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u0442\u0430<\/span><\/div><div id='gf_step_36_9' class='gf_step gf_step_pending'><span class='gf_step_number'>9<\/span><span class='gf_step_label'>\u0418\u0437\u0432\u044a\u0440\u0448\u0435\u043d\u0438 \u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u043d\u0438 \u0442\u0435\u0441\u0442\u043e\u0432\u0435\/\u043f\u0440\u043e\u0446\u0435\u0434\u0443\u0440\u0438<\/span><\/div><div id='gf_step_36_10' class='gf_step gf_step_pending'><span class='gf_step_number'>10<\/span><span class='gf_step_label'>\u041d\u0430\u0447\u0438\u043d \u043d\u0430 \u0440\u0430\u0436\u0434\u0430\u043d\u0435<\/span><\/div><div id='gf_step_36_11' class='gf_step gf_step_pending'><span class='gf_step_number'>11<\/span><span class='gf_step_label'>\u0418\u0437\u0445\u043e\u0434 \u043e\u0442 \u0440\u0430\u0436\u0434\u0430\u043d\u0435\u0442\u043e<\/span><\/div><div id='gf_step_36_12' class='gf_step gf_step_pending'><span class='gf_step_number'>12<\/span><span class='gf_step_label'>\u0418\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f \u0437\u0430 \u0431\u0435\u0431\u0435\u0442\u043e<\/span><\/div><div id='gf_step_36_13' class='gf_step gf_step_pending'><span class='gf_step_number'>13<\/span><span class='gf_step_label'>\u041b\u0430\u0431. \u0438\/\u0438\u043b\u0438 \u043c\u0435\u0434. \u0442\u0435\u0441\u0442\u043e\u0432\u0435\/\u043f\u0440\u043e\u0446\u0435\u0434\u0443\u0440\u0438 \u043d\u0430 \u0434\u0435\u0442\u0435\u0442\u043e\/\u043f\u043b\u043e\u0434\u0430<\/span><\/div><div id='gf_step_36_14' class='gf_step gf_step_pending'><span class='gf_step_number'>14<\/span><span class='gf_step_label'>\u0414\u043e\u043f\u044a\u043b\u043d\u0438\u0442\u0435\u043b\u043d\u0430 \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f<\/span><\/div><div id='gf_step_36_15' class='gf_step gf_step_pending'><span class='gf_step_number'>15<\/span><span class='gf_step_label'>EU ISOTRETINOIN (Roaccutane) \u0414\u041e\u041f\u042a\u041b\u041d\u0418\u0422\u0415\u041b\u041d\u0410 \u0424\u041e\u0420\u041c\u0410 \u0417\u0410 \u0411\u0420\u0415\u041c\u0415\u041d\u041d\u041e\u0421\u0422<\/span><\/div><div id='gf_step_36_16' class='gf_step gf_step_last gf_step_pending'><span class='gf_step_number'>16<\/span><span class='gf_step_label'>MYCOPHENOLATE MOFETIL (Cellcept) \u0414\u041e\u041f\u042a\u041b\u041d\u0418\u0422\u0415\u041b\u041d\u0410 \u0424\u041e\u0420\u041c\u0410 \u0417\u0410 \u0411\u0420\u0415\u041c\u0415\u041d\u041d\u041e\u0421\u0422<\/span><\/div><\/div>\r\n                        <div class='gform-body gform_body'><div id='gform_page_36_1' class='gform_page steps' data-js='page-field-id-1' >\r\n                                    <div class='gform_page_fields'><ul id='gform_fields_36' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_36_11\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_11\" ><div class=\"title_forms\"><\/div>\n<div class=\"gfield grey\"><div class=\"left\" style=\"width:820px;text-align:justify\">\n<p>\u0412 \u0441\u0435\u043a\u0446\u0438\u0438 \u043e\u0442 1 \u2013 7 \u0438 14 \u0441\u0435 \u043f\u0440\u0435\u0434\u043e\u0441\u0442\u0430\u0432\u044f \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f \u0437\u0430 \u0440\u043e\u0434\u0438\u0442\u0435\u043b\u044f \u0438 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u0442\u0430.<\/p>\n<p>\u0412 \u0441\u0435\u043a\u0446\u0438\u0438 8 - 12 \u0438 14 \u0441\u0435 \u043f\u0440\u0435\u0434\u043e\u0441\u0442\u0430\u0432\u044f \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f \u0437\u0430 \u0434\u0435\u0442\u0435\u0442\u043e\/\u043f\u043b\u043e\u0434\u0430, \u043a\u044a\u0434\u0435\u0442\u043e \u0435 \u043f\u0440\u0438\u043b\u043e\u0436\u0438\u043c\u043e.<\/p>\n<p>\u0412 \u0441\u0435\u043a\u0446\u0438\u0438 15 - 16 \u0441\u0435 \u043f\u0440\u0435\u0434\u043e\u0441\u0442\u0430\u0432\u044f \u0434\u043e\u043f\u044a\u043b\u043d\u0438\u0442\u0435\u043b\u043d\u0430 \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f \u0437\u0430 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442 \u043f\u0440\u0438 \u0441\u043b\u0435\u0434\u043d\u0438\u0442\u0435 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u0438 \u043f\u0440\u043e\u0434\u0443\u043a\u0442\u0438: Isotretinoin (Roaccutane) \u0438 Mycophelonate Mofetil (CellCept).<\/p>\n\n<\/div><div class=\"clear\"><\/div><\/div><\/li><li id=\"field_36_183\" class=\"gfield gfield--type-html space_tab gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_183\" ><\/li><li id=\"field_36_182\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_182\" ><div class=\"title_forms\">1. \u0414\u0430\u043d\u043d\u0438 \u0437\u0430 \u0441\u044a\u043e\u0431\u0449\u0438\u0442\u0435\u043b\u044f<\/div>\n<div class=\"gfield grey\"><div class=\"left\" style=\"width:820px;text-align:justify\">\n<p>\u0429\u0435 \u0432\u0438 \u0431\u044a\u0434\u0435\u043c \u0431\u043b\u0430\u0433\u043e\u0434\u0430\u0440\u043d\u0438, \u0430\u043a\u043e \u043c\u043e\u0436\u0435\u0442\u0435 \u0434\u0430 \u043d\u0438 \u043f\u0440\u0435\u0434\u043e\u0441\u0442\u0430\u0432\u0438\u0442\u0435 \u0434\u0430\u043d\u043d\u0438\u0442\u0435 \u0441\u0438 \u0437\u0430 \u043a\u043e\u043d\u0442\u0430\u043a\u0442 \u043f\u043e-\u0434\u043e\u043b\u0443 \u0437\u0430 \u0434\u0430 \u043c\u043e\u0436\u0435\u043c \u0434\u0430 \u043f\u0440\u043e\u0441\u043b\u0435\u0434\u0438\u043c \u0441\u044a\u0431\u0438\u0442\u0438\u0435\u0442\u043e \u0438\/\u0438\u043b\u0438 \u0434\u0430 \u0441\u044a\u0431\u0435\u0440\u0435\u043c \u0434\u043e\u043f\u044a\u043b\u043d\u0438\u0442\u0435\u043b\u043d\u0430 \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f \u0437\u0430 \u0441\u044a\u043e\u0431\u0449\u0435\u043d\u0438\u0435\u0442\u043e, \u0430\u043a\u043e \u0435 \u043d\u0435\u043e\u0431\u0445\u043e\u0434\u0438\u043c\u043e. \n<\/p>\n\n<\/div><div class=\"clear\"><\/div><\/div><\/li><li id=\"field_36_96\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_96\" ><div class=\"gfield grey\"><div class=\"info\"><\/div><div class=\"left\" style=\"width:820px;text-align:justify\">\n\n\u041f\u043e\u043b\u0435\u0442\u0430\u0442\u0430, \u043a\u043e\u0438\u0442\u043e \u0437\u0430\u0434\u044a\u043b\u0436\u0438\u0442\u0435\u043b\u043d\u043e \u0442\u0440\u044f\u0431\u0432\u0430 \u0434\u0430 \u0441\u0435 \u043f\u043e\u043f\u044a\u043b\u043d\u044f\u0442, \u0441\u0430 \u043c\u0430\u0440\u043a\u0438\u0440\u0430\u043d\u0438 \u0441 \u0442\u043e\u0437\u0438 \u0441\u0438\u043c\u0432\u043e\u043b: <span class=\"gfield_required\">*<\/span>\n<\/div><div class=\"clear\"><\/div><\/li><li id=\"field_36_28\" class=\"gfield gfield--type-html space_tab gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_28\" ><\/li><li id=\"field_36_137\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_137\" ><div class=\"gfield grey\"><div class=\"left\" style=\"width:820px;text-align:justify\">\n\u041f\u043e\u043f\u044a\u043b\u043d\u0435\u0442\u0435 \u0441\u0430\u043c\u043e \u0430\u043a\u043e \u0441\u0442\u0435 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u043e \u043b\u0438\u0446\u0435:\n<\/div><div class=\"clear\"><\/div><\/li><li id=\"field_36_132\" class=\"gfield gfield--type-select field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_132\" ><label class='gfield_label gform-field-label' for='input_36_132'>\u041f\u0440\u043e\u0444\u0435\u0441\u0438\u044f\/\u0441\u043f\u0435\u0446\u0438\u0430\u043b\u043d\u043e\u0441\u0442:<\/label><div class='ginput_container ginput_container_select'><select name='input_132' id='input_36_132' class='medium gfield_select'     aria-invalid=\"false\" ><option value='\u041c\u043e\u043b\u044f, \u043f\u043e\u0441\u043e\u0447\u0435\u0442\u0435' >\u041c\u043e\u043b\u044f, \u043f\u043e\u0441\u043e\u0447\u0435\u0442\u0435<\/option><option value='\u0410\u043d\u0435\u0441\u0442\u0435\u0437\u0438\u043e\u043b\u043e\u0433\u0438\u044f \u0438 \u0438\u043d\u0442\u0435\u043d\u0437\u0438\u0432\u043d\u043e \u043b\u0435\u0447\u0435\u043d\u0438\u0435' >\u0410\u043d\u0435\u0441\u0442\u0435\u0437\u0438\u043e\u043b\u043e\u0433\u0438\u044f \u0438 \u0438\u043d\u0442\u0435\u043d\u0437\u0438\u0432\u043d\u043e \u043b\u0435\u0447\u0435\u043d\u0438\u0435<\/option><option value='\u0412\u044a\u0442\u0440\u0435\u0448\u043d\u0438 \u0431\u043e\u043b\u0435\u0441\u0442\u0438' >\u0412\u044a\u0442\u0440\u0435\u0448\u043d\u0438 \u0431\u043e\u043b\u0435\u0441\u0442\u0438<\/option><option value='\u0413\u0430\u0441\u0442\u0440\u043e\u0435\u043d\u0442\u0435\u0440\u043e\u043b\u043e\u0433\u0438\u044f' >\u0413\u0430\u0441\u0442\u0440\u043e\u0435\u043d\u0442\u0435\u0440\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u0413\u0435\u0440\u0438\u0430\u0442\u0440\u0438\u0447\u043d\u0430 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0430' >\u0413\u0435\u0440\u0438\u0430\u0442\u0440\u0438\u0447\u043d\u0430 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0430<\/option><option value='\u0414\u0435\u0442\u0441\u043a\u0430 \u043f\u0441\u0438\u0445\u0438\u0430\u0442\u0440\u0438\u044f' >\u0414\u0435\u0442\u0441\u043a\u0430 \u043f\u0441\u0438\u0445\u0438\u0430\u0442\u0440\u0438\u044f<\/option><option value='\u0414\u0435\u0442\u0441\u043a\u0438 \u0431\u043e\u043b\u0435\u0441\u0442\u0438 (\u041f\u0435\u0434\u0438\u0430\u0442\u0440\u0438\u044f)' >\u0414\u0435\u0442\u0441\u043a\u0438 \u0431\u043e\u043b\u0435\u0441\u0442\u0438 (\u041f\u0435\u0434\u0438\u0430\u0442\u0440\u0438\u044f)<\/option><option value='\u0415\u043d\u0434\u043e\u043a\u0440\u0438\u043d\u043e\u043b\u043e\u0433\u0438\u044f' >\u0415\u043d\u0434\u043e\u043a\u0440\u0438\u043d\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u0418\u043d\u0444\u0435\u043a\u0446\u0438\u043e\u0437\u043d\u0438 \u0431\u043e\u043b\u0435\u0441\u0442\u0438' >\u0418\u043d\u0444\u0435\u043a\u0446\u0438\u043e\u0437\u043d\u0438 \u0431\u043e\u043b\u0435\u0441\u0442\u0438<\/option><option value='\u041a\u0430\u0440\u0434\u0438\u043e\u043b\u043e\u0433\u0438\u044f' >\u041a\u0430\u0440\u0434\u0438\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u041a\u043b\u0438\u043d\u0438\u0447\u043d\u0430 \u0430\u043b\u0435\u0440\u0433\u043e\u043b\u043e\u0433\u0438\u044f' >\u041a\u043b\u0438\u043d\u0438\u0447\u043d\u0430 \u0430\u043b\u0435\u0440\u0433\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u041a\u043b\u0438\u043d\u0438\u0447\u043d\u0430 \u0444\u0430\u0440\u043c\u0430\u043a\u043e\u043b\u043e\u0433\u0438\u044f \u0438 \u0442\u0435\u0440\u0430\u043f\u0438\u044f' >\u041a\u043b\u0438\u043d\u0438\u0447\u043d\u0430 \u0444\u0430\u0440\u043c\u0430\u043a\u043e\u043b\u043e\u0433\u0438\u044f \u0438 \u0442\u0435\u0440\u0430\u043f\u0438\u044f<\/option><option value='\u041a\u043b\u0438\u043d\u0438\u0447\u043d\u0430 \u0445\u0435\u043c\u0430\u0442\u043e\u043b\u043e\u0433\u0438\u044f' >\u041a\u043b\u0438\u043d\u0438\u0447\u043d\u0430 \u0445\u0435\u043c\u0430\u0442\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u041a\u043e\u0436\u043d\u0438 \u0438 \u0432\u0435\u043d\u0435\u0440\u0438\u0447\u0435\u0441\u043a\u0438 \u0431\u043e\u043b\u0435\u0441\u0442\u0438' >\u041a\u043e\u0436\u043d\u0438 \u0438 \u0432\u0435\u043d\u0435\u0440\u0438\u0447\u0435\u0441\u043a\u0438 \u0431\u043e\u043b\u0435\u0441\u0442\u0438<\/option><option value='\u041b\u044a\u0447\u0435\u043b\u0435\u0447\u0435\u043d\u0438\u0435' >\u041b\u044a\u0447\u0435\u043b\u0435\u0447\u0435\u043d\u0438\u0435<\/option><option value='\u041d\u0435\u0432\u0440\u043e\u043b\u043e\u0433\u0438\u044f' >\u041d\u0435\u0432\u0440\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u041d\u0435\u0444\u0440\u043e\u043b\u043e\u0433\u0438\u044f' >\u041d\u0435\u0444\u0440\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u041e\u0431\u0449\u0430 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0430' >\u041e\u0431\u0449\u0430 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0430<\/option><option value='\u0411\u0435\u043b\u043e\u0434\u0440\u043e\u0431\u043d\u0438 \u0431\u043e\u043b\u0435\u0441\u0442\u0438' >\u0411\u0435\u043b\u043e\u0434\u0440\u043e\u0431\u043d\u0438 \u0431\u043e\u043b\u0435\u0441\u0442\u0438<\/option><option value='\u041f\u0441\u0438\u0445\u0438\u0430\u0442\u0440\u0438\u044f' >\u041f\u0441\u0438\u0445\u0438\u0430\u0442\u0440\u0438\u044f<\/option><option value='\u0420\u0435\u0432\u043c\u0430\u0442\u043e\u043b\u043e\u0433\u0438\u044f' >\u0420\u0435\u0432\u043c\u0430\u0442\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u0421\u043f\u0435\u0448\u043d\u0430 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0430' >\u0421\u043f\u0435\u0448\u043d\u0430 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0430<\/option><option value='\u0422\u0440\u0430\u043d\u0441\u0444\u0443\u0437\u0438\u043e\u043d\u043d\u0430 \u0445\u0435\u043c\u0430\u0442\u043e\u043b\u043e\u0433\u0438\u044f' >\u0422\u0440\u0430\u043d\u0441\u0444\u0443\u0437\u0438\u043e\u043d\u043d\u0430 \u0445\u0435\u043c\u0430\u0442\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u0424\u0438\u0437\u0438\u043a\u0430\u043b\u043d\u0430 \u0438 \u0440\u0435\u0445\u0430\u0431\u0438\u043b\u0438\u0442\u0430\u0446\u0438\u043e\u043d\u043d\u0430 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0430' >\u0424\u0438\u0437\u0438\u043a\u0430\u043b\u043d\u0430 \u0438 \u0440\u0435\u0445\u0430\u0431\u0438\u043b\u0438\u0442\u0430\u0446\u0438\u043e\u043d\u043d\u0430 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0430<\/option><option value='\u0410\u043a\u0443\u0448\u0435\u0440\u0441\u0442\u0432\u043e \u0438 \u0433\u0438\u043d\u0435\u043a\u043e\u043b\u043e\u0433\u0438\u044f' >\u0410\u043a\u0443\u0448\u0435\u0440\u0441\u0442\u0432\u043e \u0438 \u0433\u0438\u043d\u0435\u043a\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u0412\u0438\u0441\u0446\u0435\u0440\u0430\u043b\u043d\u0430 \u0445\u0438\u0440\u0443\u0440\u0433\u0438\u044f' >\u0412\u0438\u0441\u0446\u0435\u0440\u0430\u043b\u043d\u0430 \u0445\u0438\u0440\u0443\u0440\u0433\u0438\u044f<\/option><option value='\u0413\u0440\u044a\u0434\u043d\u0430 \u0445\u0438\u0440\u0443\u0440\u0433\u0438\u044f' >\u0413\u0440\u044a\u0434\u043d\u0430 \u0445\u0438\u0440\u0443\u0440\u0433\u0438\u044f<\/option><option value='\u0414\u0435\u0442\u0441\u043a\u0430 \u0445\u0438\u0440\u0443\u0440\u0433\u0438\u044f' >\u0414\u0435\u0442\u0441\u043a\u0430 \u0445\u0438\u0440\u0443\u0440\u0433\u0438\u044f<\/option><option value='\u041a\u0430\u0440\u0434\u0438\u043e\u0445\u0438\u0440\u0443\u0440\u0433\u0438\u044f' >\u041a\u0430\u0440\u0434\u0438\u043e\u0445\u0438\u0440\u0443\u0440\u0433\u0438\u044f<\/option><option value='\u041b\u0438\u0446\u0435\u0432\u043e-\u0447\u0435\u043b\u044e\u0441\u0442\u043d\u0430 \u0445\u0438\u0440\u0443\u0440\u0433\u0438\u044f' >\u041b\u0438\u0446\u0435\u0432\u043e-\u0447\u0435\u043b\u044e\u0441\u0442\u043d\u0430 \u0445\u0438\u0440\u0443\u0440\u0433\u0438\u044f<\/option><option value='\u041d\u0435\u0432\u0440\u043e\u0445\u0438\u0440\u0443\u0440\u0433\u0438\u044f' >\u041d\u0435\u0432\u0440\u043e\u0445\u0438\u0440\u0443\u0440\u0433\u0438\u044f<\/option><option value='\u041e\u0440\u0442\u043e\u043f\u0435\u0434\u0438\u044f \u0438 \u0442\u0440\u0430\u0432\u043c\u0430\u0442\u043e\u043b\u043e\u0433\u0438\u044f' >\u041e\u0440\u0442\u043e\u043f\u0435\u0434\u0438\u044f \u0438 \u0442\u0440\u0430\u0432\u043c\u0430\u0442\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u041e\u0447\u043d\u0438 \u0431\u043e\u043b\u0435\u0441\u0442\u0438' >\u041e\u0447\u043d\u0438 \u0431\u043e\u043b\u0435\u0441\u0442\u0438<\/option><option value='\u041f\u043b\u0430\u0441\u0442\u0438\u0447\u043d\u043e-\u0432\u044a\u0437\u0441\u0442\u0430\u043d\u043e\u0432\u0438\u0442\u0435\u043b\u043d\u0430 \u0445\u0438\u0440\u0443\u0440\u0433\u0438\u044f' >\u041f\u043b\u0430\u0441\u0442\u0438\u0447\u043d\u043e-\u0432\u044a\u0437\u0441\u0442\u0430\u043d\u043e\u0432\u0438\u0442\u0435\u043b\u043d\u0430 \u0445\u0438\u0440\u0443\u0440\u0433\u0438\u044f<\/option><option value='\u0421\u044a\u0434\u043e\u0432\u0430 \u0445\u0438\u0440\u0443\u0440\u0433\u0438\u044f' >\u0421\u044a\u0434\u043e\u0432\u0430 \u0445\u0438\u0440\u0443\u0440\u0433\u0438\u044f<\/option><option value='\u0423\u0440\u043e\u043b\u043e\u0433\u0438\u044f' >\u0423\u0440\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u0423\u0448\u043d\u043e-\u043d\u043e\u0441\u043d\u043e-\u0433\u044a\u0440\u043b\u0435\u043d\u0438 \u0431\u043e\u043b\u0435\u0441\u0442\u0438' >\u0423\u0448\u043d\u043e-\u043d\u043e\u0441\u043d\u043e-\u0433\u044a\u0440\u043b\u0435\u043d\u0438 \u0431\u043e\u043b\u0435\u0441\u0442\u0438<\/option><option value='\u0425\u0438\u0440\u0443\u0440\u0433\u0438\u044f' >\u0425\u0438\u0440\u0443\u0440\u0433\u0438\u044f<\/option><option value='\u041a\u043b\u0438\u043d\u0438\u0447\u043d\u0430 \u0438\u043c\u0443\u043d\u043e\u043b\u043e\u0433\u0438\u044f' >\u041a\u043b\u0438\u043d\u0438\u0447\u043d\u0430 \u0438\u043c\u0443\u043d\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u041a\u043b\u0438\u043d\u0438\u0447\u043d\u0430 \u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u0438\u044f' >\u041a\u043b\u0438\u043d\u0438\u0447\u043d\u0430 \u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u0438\u044f<\/option><option value='\u041c\u0438\u043a\u0440\u043e\u0431\u0438\u043e\u043b\u043e\u0433\u0438\u044f' >\u041c\u0438\u043a\u0440\u043e\u0431\u0438\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u041d\u0443\u043a\u043b\u0435\u0430\u0440\u043d\u0430 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0430' >\u041d\u0443\u043a\u043b\u0435\u0430\u0440\u043d\u0430 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0430<\/option><option value='\u041e\u0431\u0440\u0430\u0437\u043d\u0430 \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0430' >\u041e\u0431\u0440\u0430\u0437\u043d\u0430 \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0430<\/option><option value='\u041a\u043e\u043c\u0443\u043d\u0430\u043b\u043d\u0430 \u0445\u0438\u0433\u0438\u0435\u043d\u0430' >\u041a\u043e\u043c\u0443\u043d\u0430\u043b\u043d\u0430 \u0445\u0438\u0433\u0438\u0435\u043d\u0430<\/option><option value='\u0421\u043e\u0446\u0438\u0430\u043b\u043d\u0430 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0430 \u0438 \u0437\u0434\u0440\u0430\u0432\u0435\u043d \u043c\u0435\u043d\u0438\u0434\u0436\u043c\u044a\u043d\u0442' >\u0421\u043e\u0446\u0438\u0430\u043b\u043d\u0430 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0430 \u0438 \u0437\u0434\u0440\u0430\u0432\u0435\u043d \u043c\u0435\u043d\u0438\u0434\u0436\u043c\u044a\u043d\u0442<\/option><option value='\u0422\u0440\u0443\u0434\u043e\u0432\u0430 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0430' >\u0422\u0440\u0443\u0434\u043e\u0432\u0430 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0430<\/option><option value='\u0424\u0430\u0440\u043c\u0430\u043a\u043e\u043b\u043e\u0433\u0438\u044f' >\u0424\u0430\u0440\u043c\u0430\u043a\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u0414\u0435\u043d\u0442\u0430\u043b\u043d\u0430 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0430' >\u0414\u0435\u043d\u0442\u0430\u043b\u043d\u0430 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0430<\/option><option value='\u0424\u0430\u0440\u043c\u0430\u0446\u0438\u044f' >\u0424\u0430\u0440\u043c\u0430\u0446\u0438\u044f<\/option><option value='\u0410\u043d\u0433\u0438\u043e\u043b\u043e\u0433\u0438\u044f' >\u0410\u043d\u0433\u0438\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u0411\u043e\u043b\u043d\u0438\u0447\u043d\u0430 \u0445\u0438\u0433\u0438\u0435\u043d\u0430' >\u0411\u043e\u043b\u043d\u0438\u0447\u043d\u0430 \u0445\u0438\u0433\u0438\u0435\u043d\u0430<\/option><option value='\u0414\u0435\u0442\u0441\u043a\u0430 \u0433\u0430\u0441\u0442\u0440\u043e\u0435\u043d\u0442\u0435\u0440\u043e\u043b\u043e\u0433\u0438\u044f' >\u0414\u0435\u0442\u0441\u043a\u0430 \u0433\u0430\u0441\u0442\u0440\u043e\u0435\u043d\u0442\u0435\u0440\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u0414\u0435\u0442\u0441\u043a\u0430 \u0435\u043d\u0434\u043e\u043a\u0440\u0438\u043d\u043e\u043b\u043e\u0433\u0438\u044f \u0438 \u0431\u043e\u043b\u0435\u0441\u0442\u0438 \u043d\u0430 \u043e\u0431\u043c\u044f\u043d\u0430\u0442\u0430' >\u0414\u0435\u0442\u0441\u043a\u0430 \u0435\u043d\u0434\u043e\u043a\u0440\u0438\u043d\u043e\u043b\u043e\u0433\u0438\u044f \u0438 \u0431\u043e\u043b\u0435\u0441\u0442\u0438 \u043d\u0430 \u043e\u0431\u043c\u044f\u043d\u0430\u0442\u0430<\/option><option value='\u0414\u0435\u0442\u0441\u043a\u0430 \u043a\u0430\u0440\u0434\u0438\u043e\u043b\u043e\u0433\u0438\u044f' >\u0414\u0435\u0442\u0441\u043a\u0430 \u043a\u0430\u0440\u0434\u0438\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u0414\u0435\u0442\u0441\u043a\u0430 \u043a\u043b\u0438\u043d\u0438\u0447\u043d\u0430 \u0445\u0435\u043c\u0430\u0442\u043e\u043b\u043e\u0433\u0438\u044f \u0438 \u043e\u043d\u043a\u043e\u043b\u043e\u0433\u0438\u044f' >\u0414\u0435\u0442\u0441\u043a\u0430 \u043a\u043b\u0438\u043d\u0438\u0447\u043d\u0430 \u0445\u0435\u043c\u0430\u0442\u043e\u043b\u043e\u0433\u0438\u044f \u0438 \u043e\u043d\u043a\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u0414\u0435\u0442\u0441\u043a\u0430 \u043d\u0435\u0432\u0440\u043e\u043b\u043e\u0433\u0438\u044f' >\u0414\u0435\u0442\u0441\u043a\u0430 \u043d\u0435\u0432\u0440\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u0414\u0435\u0442\u0441\u043a\u0430 \u043d\u0435\u0444\u0440\u043e\u043b\u043e\u0433\u0438\u044f \u0438 \u0445\u0435\u043c\u043e\u0434\u0438\u0430\u043b\u0438\u0437\u0430' >\u0414\u0435\u0442\u0441\u043a\u0430 \u043d\u0435\u0444\u0440\u043e\u043b\u043e\u0433\u0438\u044f \u0438 \u0445\u0435\u043c\u043e\u0434\u0438\u0430\u043b\u0438\u0437\u0430<\/option><option value='\u0414\u0435\u0442\u0441\u043a\u0430 \u043f\u043d\u0435\u0432\u043c\u043e\u043b\u043e\u0433\u0438\u044f \u0438 \u0444\u0442\u0438\u0437\u0438\u0430\u0442\u0440\u0438\u044f' >\u0414\u0435\u0442\u0441\u043a\u0430 \u043f\u043d\u0435\u0432\u043c\u043e\u043b\u043e\u0433\u0438\u044f \u0438 \u0444\u0442\u0438\u0437\u0438\u0430\u0442\u0440\u0438\u044f<\/option><option value='\u0414\u0435\u0442\u0441\u043a\u0430 \u0440\u0435\u0432\u043c\u0430\u0442\u043e\u043b\u043e\u0433\u0438\u044f' >\u0414\u0435\u0442\u0441\u043a\u0430 \u0440\u0435\u0432\u043c\u0430\u0442\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u041a\u043b\u0438\u043d\u0438\u0447\u043d\u0430 \u0442\u043e\u043a\u0441\u0438\u043a\u043e\u043b\u043e\u0433\u0438\u044f' >\u041a\u043b\u0438\u043d\u0438\u0447\u043d\u0430 \u0442\u043e\u043a\u0441\u0438\u043a\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u041c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0430 \u043e\u043d\u043a\u043e\u043b\u043e\u0433\u0438\u044f' >\u041c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0430 \u043e\u043d\u043a\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u041c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0430 \u043f\u0430\u0440\u0430\u0437\u0438\u0442\u043e\u043b\u043e\u0433\u0438\u044f' >\u041c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0430 \u043f\u0430\u0440\u0430\u0437\u0438\u0442\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u041d\u0435\u043e\u043d\u0430\u0442\u043e\u043b\u043e\u0433\u0438\u044f' >\u041d\u0435\u043e\u043d\u0430\u0442\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u041e\u0442\u043e\u043d\u0435\u0432\u0440\u043e\u043b\u043e\u0433\u0438\u044f' >\u041e\u0442\u043e\u043d\u0435\u0432\u0440\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u0421\u043f\u043e\u0440\u0442\u043d\u0430 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0430' >\u0421\u043f\u043e\u0440\u0442\u043d\u0430 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0430<\/option><option value='\u0421\u044a\u0434\u0435\u0431\u043d\u0430 \u043f\u0441\u0438\u0445\u0438\u0430\u0442\u0440\u0438\u044f' >\u0421\u044a\u0434\u0435\u0431\u043d\u0430 \u043f\u0441\u0438\u0445\u0438\u0430\u0442\u0440\u0438\u044f<\/option><option value='\u0412\u0438\u0440\u0443\u0441\u043e\u043b\u043e\u0433\u0438\u044f' >\u0412\u0438\u0440\u0443\u0441\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u0415\u043f\u0438\u0434\u0435\u043c\u0438\u043e\u043b\u043e\u0433\u0438\u044f \u043d\u0430 \u0438\u043d\u0444\u0435\u043a\u0446\u0438\u043e\u0437\u043d\u0438\u0442\u0435 \u0431\u043e\u043b\u0435\u0441\u0442\u0438' >\u0415\u043f\u0438\u0434\u0435\u043c\u0438\u043e\u043b\u043e\u0433\u0438\u044f \u043d\u0430 \u0438\u043d\u0444\u0435\u043a\u0446\u0438\u043e\u0437\u043d\u0438\u0442\u0435 \u0431\u043e\u043b\u0435\u0441\u0442\u0438<\/option><option value='\u041f\u0430\u0442\u043e\u0444\u0438\u0437\u0438\u043e\u043b\u043e\u0433\u0438\u044f' >\u041f\u0430\u0442\u043e\u0444\u0438\u0437\u0438\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u0421\u044a\u0434\u0435\u0431\u043d\u0430 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0430' >\u0421\u044a\u0434\u0435\u0431\u043d\u0430 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0430<\/option><option value='\u0422\u043e\u043a\u0441\u0438\u043a\u043e\u043b\u043e\u0433\u0438\u044f' >\u0422\u043e\u043a\u0441\u0438\u043a\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u0418\u043a\u043e\u043d\u043e\u043c\u0438\u043a\u0430 \u043d\u0430 \u0437\u0434\u0440\u0430\u0432\u0435\u043e\u043f\u0430\u0437\u0432\u0430\u043d\u0435\u0442\u043e' >\u0418\u043a\u043e\u043d\u043e\u043c\u0438\u043a\u0430 \u043d\u0430 \u0437\u0434\u0440\u0430\u0432\u0435\u043e\u043f\u0430\u0437\u0432\u0430\u043d\u0435\u0442\u043e<\/option><option value='\u041c\u0435\u0434\u0438\u0446\u0438\u043d\u0430 \u043d\u0430 \u0431\u0435\u0434\u0441\u0442\u0432\u0435\u043d\u0438\u0442\u0435 \u0441\u0438\u0442\u0443\u0430\u0446\u0438\u0438' >\u041c\u0435\u0434\u0438\u0446\u0438\u043d\u0430 \u043d\u0430 \u0431\u0435\u0434\u0441\u0442\u0432\u0435\u043d\u0438\u0442\u0435 \u0441\u0438\u0442\u0443\u0430\u0446\u0438\u0438<\/option><option value='\u041e\u0431\u0449\u0430 \u0445\u0438\u0433\u0438\u0435\u043d\u0430' >\u041e\u0431\u0449\u0430 \u0445\u0438\u0433\u0438\u0435\u043d\u0430<\/option><option value='\u0420\u0430\u0434\u0438\u0430\u0446\u0438\u043e\u043d\u043d\u0430 \u0445\u0438\u0433\u0438\u0435\u043d\u0430' >\u0420\u0430\u0434\u0438\u0430\u0446\u0438\u043e\u043d\u043d\u0430 \u0445\u0438\u0433\u0438\u0435\u043d\u0430<\/option><option value='\u0420\u0430\u0434\u0438\u043e\u0431\u0438\u043e\u043b\u043e\u0433\u0438\u044f' >\u0420\u0430\u0434\u0438\u043e\u0431\u0438\u043e\u043b\u043e\u0433\u0438\u044f<\/option><option value='\u0425\u0438\u0433\u0438\u0435\u043d\u0430 \u043d\u0430 \u0434\u0435\u0442\u0441\u043a\u043e-\u044e\u043d\u043e\u0448\u0435\u0441\u043a\u0430\u0442\u0430 \u0432\u044a\u0437\u0440\u0430\u0441\u0442' >\u0425\u0438\u0433\u0438\u0435\u043d\u0430 \u043d\u0430 \u0434\u0435\u0442\u0441\u043a\u043e-\u044e\u043d\u043e\u0448\u0435\u0441\u043a\u0430\u0442\u0430 \u0432\u044a\u0437\u0440\u0430\u0441\u0442<\/option><option value='\u0425\u0440\u0430\u043d\u0435\u043d\u0435 \u0438 \u0434\u0438\u0435\u0442\u0435\u0442\u0438\u043a\u0430' >\u0425\u0440\u0430\u043d\u0435\u043d\u0435 \u0438 \u0434\u0438\u0435\u0442\u0435\u0442\u0438\u043a\u0430<\/option><option value='\u041c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0430 \u0441\u0435\u0441\u0442\u0440\u0430' >\u041c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0430 \u0441\u0435\u0441\u0442\u0440\u0430<\/option><option value='\u0414\u0440\u0443\u0433\u043e' >\u0414\u0440\u0443\u0433\u043e<\/option><\/select><\/div><\/li><li id=\"field_36_133\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_133\" ><label class='gfield_label gform-field-label' for='input_36_133'>\u041c\u043e\u043b\u044f, \u0443\u0442\u043e\u0447\u043d\u0435\u0442\u0435:<\/label><div class='ginput_container ginput_container_text'><input name='input_133' id='input_36_133' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_131\" class=\"gfield gfield--type-select field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_131\" ><label class='gfield_label gform-field-label' for='input_36_131'>\u0422\u0438\u0442\u043b\u0430:<\/label><div class='ginput_container ginput_container_select'><select name='input_131' id='input_36_131' class='small gfield_select'     aria-invalid=\"false\" ><option value='\u041c\u043e\u043b\u044f, \u043f\u043e\u0441\u043e\u0447\u0435\u0442\u0435' >\u041c\u043e\u043b\u044f, \u043f\u043e\u0441\u043e\u0447\u0435\u0442\u0435<\/option><option value='\u0414\u043e\u043a\u0442\u043e\u0440' >\u0414\u043e\u043a\u0442\u043e\u0440<\/option><option value='\u0414\u043e\u0446\u0435\u043d\u0442' >\u0414\u043e\u0446\u0435\u043d\u0442<\/option><option value='\u041f\u0440\u043e\u0444\u0435\u0441\u043e\u0440' >\u041f\u0440\u043e\u0444\u0435\u0441\u043e\u0440<\/option><\/select><\/div><\/li><li id=\"field_36_138\" class=\"gfield gfield--type-html space_tab gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_138\" ><\/li><li id=\"field_36_130\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_130\" ><label class='gfield_label gform-field-label' for='input_36_130'>\u0418\u043c\u0435:<\/label><div class='ginput_container ginput_container_text'><input name='input_130' id='input_36_130' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_2\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_2\" ><label class='gfield_label gform-field-label' for='input_36_2'>\u0424\u0430\u043c\u0438\u043b\u0438\u044f:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_36_2' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_20\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_20\" ><label class='gfield_label gform-field-label' for='input_36_20'>\u0414\u044a\u0440\u0436\u0430\u0432\u0430:<\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_36_20' type='text' value='' class='small'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_15\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_15\" ><label class='gfield_label gform-field-label' for='input_36_15'>\u041f\u043e\u0449\u0435\u043d\u0441\u043a\u0438 \u043a\u043e\u0434:<\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_36_15' type='text' value='' class='small'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_14\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_14\" ><label class='gfield_label gform-field-label' for='input_36_14'>\u041d\u0430\u0441\u0435\u043b\u0435\u043d\u043e \u043c\u044f\u0441\u0442\u043e:<\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_36_14' type='text' value='' class='small'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_185\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_185\" ><label class='gfield_label gform-field-label' for='input_36_185'>\u0410\u0434\u0440\u0435\u0441:<\/label><div class='ginput_container ginput_container_text'><input name='input_185' id='input_36_185' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_203\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_203\" ><label class='gfield_label gform-field-label' for='input_36_203'>\u041c\u043e\u043b\u044f, \u043f\u043e\u043f\u044a\u043b\u043d\u0435\u0442\u0435 \u0442\u0435\u043b\u0435\u0444\u043e\u043d \u0438\/\u0438\u043b\u0438 email:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_203' id='input_36_203' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_19\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_19\" ><label class='gfield_label gform-field-label' for='input_36_19'>\u0424\u0430\u043a\u0441:<\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_36_19' type='text' value='' class='small'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_23\" class=\"gfield gfield--type-html space_tab gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_23\" ><\/li><li id=\"field_36_100\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_100\" ><label class='gfield_label gform-field-label' >\u0414\u0435\u043a\u043b\u0430\u0440\u0438\u0440\u0430\u043c \u0441\u044a\u0433\u043b\u0430\u0441\u0438\u0435 \u0437\u0430 \u043e\u0431\u0440\u0430\u0431\u043e\u0442\u043a\u0430 \u043d\u0430 \u043b\u0438\u0447\u043d\u0438\u0442\u0435 \u043c\u0438 \u0434\u0430\u043d\u043d\u0438  \u043f\u0440\u0438 \u0441\u043f\u0430\u0437\u0432\u0430\u043d\u0435 \u043d\u0430 \u0440\u0430\u0437\u043f\u043e\u0440\u0435\u0434\u0431\u0438\u0442\u0435 \u043d\u0430 \u0417\u0430\u043a\u043e\u043d\u0430 \u0437\u0430 \u0437\u0430\u0449\u0438\u0442\u0430 \u043d\u0430 \u043b\u0438\u0447\u043d\u0438\u0442\u0435 \u0434\u0430\u043d\u043d\u0438.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_36_100'>\r\n\t\t\t<li class='gchoice gchoice_36_100_0'>\r\n\t\t\t\t<input name='input_100' type='radio' value='\u0414\u0430'  id='choice_36_100_0'    \/>\r\n\t\t\t\t<label for='choice_36_100_0' id='label_36_100_0' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_100_1'>\r\n\t\t\t\t<input name='input_100' type='radio' value='\u041d\u0435'  id='choice_36_100_1'    \/>\r\n\t\t\t\t<label for='choice_36_100_1' id='label_36_100_1' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_36_100'><div class=\"help\"  style=\"top:-10px\" onmouseover='jQuery(this).find(\".help_info\").css\n\n(\"display\",\"block\");' onmouseout='jQuery(this).find(\".help_info\").css\n\n(\"display\",\"none\");'>\n<div class=\"help_title\" >\u041f\u043e\u043c\u043e\u0449<\/div>\n<div class=\"clear\"><\/div>\n<div class=\"help_info\">\u0410\u043a\u043e \u0438\u0437\u0431\u0435\u0440\u0435\u0442\u0435 \"\u041d\u0435\" \u0442\u043e\u0432\u0430 \u043e\u0437\u043d\u0430\u0447\u0430\u0432\u0430, \u0447\u0435 \u0449\u0435 \u043e\u0441\u0442\u0430\u043d\u0435\u0442\u0435 \u0410\u043d\u043e\u043d\u0438\u043c\u0435\u043d \u0441\u044a\u0433\u043b\u0430\u0441\u043d\u043e \u0417\u0417\u041b\u0414.<\/div>\n<\/div><\/div><\/li><li id=\"field_36_201\" class=\"gfield gfield--type-html space_tab gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_201\" ><\/li><\/ul>\r\n                    <\/div>\r\n                    <div class='gform_page_footer top_label'>\r\n                         <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_next.png' id='gform_next_button_36_8' class='gform_next_button gform-theme-button button gform_image_button' alt='\u0421\u043b\u0435\u0434\u0432\u0430\u0449\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"2\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"2\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> \r\n                    <\/div>\r\n                <\/div>\r\n                <div id='gform_page_36_2' class='gform_page' data-js='page-field-id-8' style='display:none;'>\r\n                    <div class='gform_page_fields'>\r\n                        <ul id='gform_fields_36_2' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_36_31\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_31\" ><div class=\"title_forms\">2. \u0414\u0435\u0442\u0430\u0439\u043b\u0438 \u0437\u0430 \u0440\u043e\u0434\u0438\u0442\u0435\u043b\u0438\u0442\u0435<\/div>\n<div class=\"gfield grey\"><div class=\"left\" style=\"width:820px;text-align:justify\">\u0417\u0430\u0431\u0435\u043b\u0435\u0436\u043a\u0430: \u0410\u043a\u043e \u0440\u0430\u0437\u0440\u0435\u0448\u0430\u0432\u0430\u043d\u0435\u0442\u043e \u043d\u0430 \u043f\u043e\u0432\u0435\u0440\u0438\u0442\u0435\u043b\u043d\u043e\u0441\u0442\u0442\u0430 \u043d\u0430 \u0434\u0430\u043d\u043d\u0438\u0442\u0435 \u043f\u043e\u0437\u0432\u043e\u043b\u044f\u0432\u0430, \u043c\u043e\u043b\u044f, \u0434\u0430\u0439\u0442\u0435 \u043f\u043e\u043d\u0435 \u0435\u0434\u0438\u043d \u0438\u0434\u0435\u043d\u0442\u0438\u0444\u0438\u043a\u0430\u0442\u043e\u0440. \u041c\u043e\u043b\u044f, \u0443\u0432\u0435\u0440\u0435\u0442\u0435 \u0441\u0435, \u0447\u0435\n\u0432\u044a\u0437\u0440\u0430\u0441\u0442\u0442\u0430 \u0438\u043b\u0438 \u0432\u044a\u0437\u0440\u0430\u0441\u0442\u043e\u0432\u0430\u0442\u0430 \u0433\u0440\u0443\u043f\u0430 \u043d\u0430 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430 \u0441\u0435 \u0438\u0434\u0435\u043d\u0442\u0438\u0444\u0438\u0446\u0438\u0440\u0430\u0442, \u043a\u043e\u0433\u0430\u0442\u043e \u0435 \u0432\u044a\u0437\u043c\u043e\u0436\u043d\u043e.\n <\/p>\n<\/div><div class=\"clear\"><\/div><\/li><li id=\"field_36_102\" class=\"gfield gfield--type-html space_tab gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_102\" ><div class=\"gfield grey\"><div class=\"info\"><\/div><div class=\"left\" style=\"width:820px;text-align:justify\">\n\n\u041f\u043e\u043b\u0435\u0442\u0430\u0442\u0430, \u043a\u043e\u0438\u0442\u043e \u0437\u0430\u0434\u044a\u043b\u0436\u0438\u0442\u0435\u043b\u043d\u043e \u0442\u0440\u044f\u0431\u0432\u0430 \u0434\u0430 \u0441\u0435 \u043f\u043e\u043f\u044a\u043b\u043d\u044f\u0442, \u0441\u0430 \u043c\u0430\u0440\u043a\u0438\u0440\u0430\u043d\u0438 \u0441 \u0442\u043e\u0437\u0438 \u0441\u0438\u043c\u0432\u043e\u043b: <span class=\"gfield_required\">*<\/span>\n<\/div><div class=\"clear\"><\/div><\/li><li id=\"field_36_140\" class=\"gfield gfield--type-html space_tab gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_140\" ><\/li><li id=\"field_36_202\" class=\"gfield gfield--type-html err_html_class gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_202\" ><div class=\"bold\" style=\"padding-left:20px;padding:right:10px\"> \u041d\u0430\u0439-\u043c\u0430\u043b\u043a\u043e \u0435\u0434\u043d\u043e \u043e\u0442 \u043f\u043e\u043b\u0435\u0442\u0430\u0442\u0430, \u0442\u0440\u044f\u0431\u0432\u0430 \u0434\u0430 \u0431\u044a\u0434\u0435 \u043f\u043e\u043f\u044a\u043b\u043d\u0435\u043d\u043e, \u0437\u0430 \u0434\u0430 \u0431\u044a\u0434\u0435 \u0438\u0437\u043f\u0440\u0430\u0442\u0435\u043d\u043e \u0443\u0441\u043f\u0435\u0448\u043d\u043e \u0441\u044a\u043e\u0431\u0449\u0435\u043d\u0438\u0435\u0442\u043e: \u0438\u043d\u0438\u0446\u0438\u0430\u043b\u0438 \u043d\u0430 \u043c\u0430\u0439\u043a\u0430\u0442\u0430, \u0432\u044a\u0437\u0440\u0430\u0441\u0442 \u043f\u043e \u0432\u0440\u0435\u043c\u0435 \u043d\u0430 \u0437\u0430\u0447\u0435\u0432\u0430\u043d\u0435\u0442\u043e \u0438\u043b\u0438 \u0434\u0430\u0442\u0430 \u043d\u0430 \u0440\u0430\u0436\u0434\u0430\u043d\u0435.<span class=\"gfield_required\">*<\/span> <\/div><\/li><li id=\"field_36_208\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_208\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u0415\u043a\u0441\u043f\u043e\u043d\u0438\u0440\u0430\u043d\u0438 \u0440\u043e\u0434\u0438\u0442\u0435\u043b\u0438:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_208'><li class='gchoice gchoice_36_208_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_208.1' type='checkbox'  value='\u041c\u0430\u0439\u043a\u0430'  id='choice_36_208_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_208_1' id='label_36_208_1' class='gform-field-label gform-field-label--type-inline'>\u041c\u0430\u0439\u043a\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_208_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_208.2' type='checkbox'  value='\u0411\u0430\u0449\u0430'  id='choice_36_208_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_208_2' id='label_36_208_2' class='gform-field-label gform-field-label--type-inline'>\u0411\u0430\u0449\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_209\" class=\"gfield gfield--type-html space_tab gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_209\" ><\/li><li id=\"field_36_212\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_212\" ><span style=\"margin-left:30px;\"><strong>\u041c\u0430\u0439\u043a\u0430<\/strong><\/span><\/li><li id=\"field_36_9\" class=\"gfield gfield--type-text validate_at_least_one gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_9\" ><label class='gfield_label gform-field-label' for='input_36_9'>\u0418\u043d\u0438\u0446\u0438\u0430\u043b\u0438\/\u0418\u043c\u0435:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_36_9' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_216\" class=\"gfield gfield--type-text validate_at_least_one field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_216\" ><label class='gfield_label gform-field-label' for='input_36_216'>\u0414\u0430\u0442\u0430 \u043d\u0430 \u0440\u0430\u0436\u0434\u0430\u043d\u0435 (\u0434\u0435\u043d-\u043c\u0435\u0441\u0435\u0446-\u0433\u043e\u0434\u0438\u043d\u0430):<\/label><div class='ginput_container ginput_container_text'><input name='input_216' id='input_36_216' type='text' value='' class='small'    placeholder='\u0414\u0414\/\u041c\u041c\/\u0413\u0413\u0413\u0413'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_141\" class=\"gfield gfield--type-text validate_at_least_one field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_141\" ><label class='gfield_label gform-field-label' for='input_36_141'>\u0412\u044a\u0437\u0440\u0430\u0441\u0442 \u043f\u0440\u0438 \u0437\u0430\u0447\u0435\u0432\u0430\u043d\u0435:<\/label><div class='ginput_container ginput_container_text'><input name='input_141' id='input_36_141' type='text' value='' class='small'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_211\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_211\" ><label class='gfield_label gform-field-label' for='input_36_211'>\u0413\u043e\u0434\u0438\u043d\u0438<\/label><div class='ginput_container ginput_container_text'><input name='input_211' id='input_36_211' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_35\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_35\" ><label class='gfield_label gform-field-label' for='input_36_35'>\u0422\u0435\u0433\u043b\u043e (\u043a\u0433.)<\/label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_36_35' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_36\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_36\" ><label class='gfield_label gform-field-label' for='input_36_36'>\u0412\u0438\u0441\u043e\u0447\u0438\u043d\u0430 (\u0441\u043c.)<\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_36_36' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_113\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_113\" ><label class='gfield_label gform-field-label' >\u0415\u0442\u043d\u0438\u0447\u0435\u0441\u043a\u0438 \u043f\u0440\u043e\u0438\u0437\u0445\u043e\u0434:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_36_113'>\r\n\t\t\t<li class='gchoice gchoice_36_113_0'>\r\n\t\t\t\t<input name='input_113' type='radio' value='\u043a\u0430\u0432\u043a\u0430\u0432\u0437\u043a\u0438'  id='choice_36_113_0'    \/>\r\n\t\t\t\t<label for='choice_36_113_0' id='label_36_113_0' class='gform-field-label gform-field-label--type-inline'>\u043a\u0430\u0432\u043a\u0430\u0432\u0437\u043a\u0438<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_113_1'>\r\n\t\t\t\t<input name='input_113' type='radio' value='\u0430\u0444\u0440\u0438\u043a\u0430\u043d\u0441\u043a\u0438'  id='choice_36_113_1'    \/>\r\n\t\t\t\t<label for='choice_36_113_1' id='label_36_113_1' class='gform-field-label gform-field-label--type-inline'>\u0430\u0444\u0440\u0438\u043a\u0430\u043d\u0441\u043a\u0438<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_113_2'>\r\n\t\t\t\t<input name='input_113' type='radio' value='\u0430\u0437\u0438\u0430\u0442\u0441\u043a\u0438'  id='choice_36_113_2'    \/>\r\n\t\t\t\t<label for='choice_36_113_2' id='label_36_113_2' class='gform-field-label gform-field-label--type-inline'>\u0430\u0437\u0438\u0430\u0442\u0441\u043a\u0438<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_113_3'>\r\n\t\t\t\t<input name='input_113' type='radio' value='\u0434\u0440\u0443\u0433\u043e'  id='choice_36_113_3'    \/>\r\n\t\t\t\t<label for='choice_36_113_3' id='label_36_113_3' class='gform-field-label gform-field-label--type-inline'>\u0434\u0440\u0443\u0433\u043e<\/label>\r\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_114\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_114\" ><label class='gfield_label gform-field-label' for='input_36_114'>\u0443\u0442\u043e\u0447\u043d\u0435\u0442\u0435:<\/label><div class='ginput_container ginput_container_text'><input name='input_114' id='input_36_114' type='text' value='' class='small'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_210\" class=\"gfield gfield--type-html space_tab gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_210\" ><\/li><li id=\"field_36_213\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_213\" ><spanspan style=\"margin-left:30px;\"><strong>\u0411\u0430\u0449\u0430 (\u0430\u043a\u043e \u0435 \u0435\u043a\u0441\u043f\u043e\u043d\u0438\u0440\u0430\u043d)<\/strong><\/span><\/li><li id=\"field_36_214\" class=\"gfield gfield--type-text validate_at_least_one gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_214\" ><label class='gfield_label gform-field-label' for='input_36_214'>\u0418\u043d\u0438\u0446\u0438\u0430\u043b\u0438\/\u0418\u043c\u0435:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_214' id='input_36_214' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_215\" class=\"gfield gfield--type-text validate_at_least_one field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_215\" ><label class='gfield_label gform-field-label' for='input_36_215'>\u0414\u0430\u0442\u0430 \u043d\u0430 \u0440\u0430\u0436\u0434\u0430\u043d\u0435 (\u0434\u0435\u043d-\u043c\u0435\u0441\u0435\u0446-\u0433\u043e\u0434\u0438\u043d\u0430):<\/label><div class='ginput_container ginput_container_text'><input name='input_215' id='input_36_215' type='text' value='' class='small'    placeholder='\u0414\u0414\/\u041c\u041c\/\u0413\u0413\u0413\u0413'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_217\" class=\"gfield gfield--type-text validate_at_least_one field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_217\" ><label class='gfield_label gform-field-label' for='input_36_217'>\u0412\u044a\u0437\u0440\u0430\u0441\u0442 \u043f\u0440\u0438 \u0437\u0430\u0447\u0435\u0432\u0430\u043d\u0435:<\/label><div class='ginput_container ginput_container_text'><input name='input_217' id='input_36_217' type='text' value='' class='small'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_218\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_218\" ><label class='gfield_label gform-field-label' for='input_36_218'>\u0413\u043e\u0434\u0438\u043d\u0438<\/label><div class='ginput_container ginput_container_text'><input name='input_218' id='input_36_218' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_219\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_219\" ><label class='gfield_label gform-field-label' for='input_36_219'>\u0422\u0435\u0433\u043b\u043e (\u043a\u0433.)<\/label><div class='ginput_container ginput_container_text'><input name='input_219' id='input_36_219' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_220\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_220\" ><label class='gfield_label gform-field-label' for='input_36_220'>\u0412\u0438\u0441\u043e\u0447\u0438\u043d\u0430 (\u0441\u043c.)<\/label><div class='ginput_container ginput_container_text'><input name='input_220' id='input_36_220' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_221\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_221\" ><label class='gfield_label gform-field-label' >\u0415\u0442\u043d\u0438\u0447\u0435\u0441\u043a\u0438 \u043f\u0440\u043e\u0438\u0437\u0445\u043e\u0434.:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_36_221'>\r\n\t\t\t<li class='gchoice gchoice_36_221_0'>\r\n\t\t\t\t<input name='input_221' type='radio' value='\u043a\u0430\u0432\u043a\u0430\u0432\u0437\u043a\u0438'  id='choice_36_221_0'    \/>\r\n\t\t\t\t<label for='choice_36_221_0' id='label_36_221_0' class='gform-field-label gform-field-label--type-inline'>\u043a\u0430\u0432\u043a\u0430\u0432\u0437\u043a\u0438<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_221_1'>\r\n\t\t\t\t<input name='input_221' type='radio' value='\u0430\u0444\u0440\u0438\u043a\u0430\u043d\u0441\u043a\u0438'  id='choice_36_221_1'    \/>\r\n\t\t\t\t<label for='choice_36_221_1' id='label_36_221_1' class='gform-field-label gform-field-label--type-inline'>\u0430\u0444\u0440\u0438\u043a\u0430\u043d\u0441\u043a\u0438<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_221_2'>\r\n\t\t\t\t<input name='input_221' type='radio' value='\u0430\u0437\u0438\u0430\u0442\u0441\u043a\u0438'  id='choice_36_221_2'    \/>\r\n\t\t\t\t<label for='choice_36_221_2' id='label_36_221_2' class='gform-field-label gform-field-label--type-inline'>\u0430\u0437\u0438\u0430\u0442\u0441\u043a\u0438<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_221_3'>\r\n\t\t\t\t<input name='input_221' type='radio' value='\u0434\u0440\u0443\u0433\u043e'  id='choice_36_221_3'    \/>\r\n\t\t\t\t<label for='choice_36_221_3' id='label_36_221_3' class='gform-field-label gform-field-label--type-inline'>\u0434\u0440\u0443\u0433\u043e<\/label>\r\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_222\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_222\" ><label class='gfield_label gform-field-label' for='input_36_222'>\u0443\u0442\u043e\u0447\u043d\u0435\u0442\u0435:<\/label><div class='ginput_container ginput_container_text'><input name='input_222' id='input_36_222' type='text' value='' class='small'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_72\" class=\"gfield gfield--type-html space_tab gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_72\" ><\/li><\/ul>\r\n                    <\/div>\r\n                    <div class='gform_page_footer top_label'>\r\n                        <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_prev.png' id='gform_previous_button_36_40' class='gform_previous_button gform-theme-button gform-theme-button--secondary button gform_image_button' alt='\u041f\u0440\u0435\u0434\u0438\u0448\u043d\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"1\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"1\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_next.png' id='gform_next_button_36_40' class='gform_next_button gform-theme-button button gform_image_button' alt='\u0421\u043b\u0435\u0434\u0432\u0430\u0449\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"3\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"3\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> \r\n                    <\/div>\r\n                <\/div>\r\n                <div id='gform_page_36_3' class='gform_page' data-js='page-field-id-40' style='display:none;'>\r\n                    <div class='gform_page_fields'>\r\n                        <ul id='gform_fields_36_3' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_36_39\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_39\" ><div class=\"title_forms\">3. \u0414\u0430\u043d\u043d\u0438 \u0437\u0430  \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u0438\u044f \u043f\u0440\u043e\u0434\u0443\u043a\u0442<\/div>\n<div class=\"gfield grey\"><div class=\"left\" style=\"width:820px\">\n<p>\u041f\u043e\u043d\u0435 \u0435\u0434\u0438\u043d \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d \u043f\u0440\u043e\u0434\u0443\u043a\u0442 \u043d\u0430 \u0420\u043e\u0448, \u0440\u0430\u0437\u0440\u0435\u0448\u0435\u043d \u0437\u0430 \u0443\u043f\u043e\u0442\u0440\u0435\u0431\u0430 \u0432 \u0411\u044a\u043b\u0433\u0430\u0440\u0438\u044f, \u0442\u0440\u044f\u0431\u0432\u0430 \u0434\u0430 \u0431\u044a\u0434\u0435 \u043f\u043e\u0441\u043e\u0447\u0435\u043d.<\/p>\n<p> A\u043a\u043e \u0437\u043d\u0430\u0435\u0442\u0435 \u0441\u0430\u043c\u043e \u0433\u0435\u043d\u0435\u0440\u0438\u0447\u043d\u043e\u0442\u043e \u043d\u0430\u0438\u043c\u0435\u043d\u043e\u0432\u0430\u043d\u0438\u0435 \u043d\u0430  \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u0438\u044f \u043f\u0440\u043e\u0434\u0443\u043a\u0442 \u0438 \u043d\u0435 \u0441\u0442\u0435 \u0441\u0438\u0433\u0443\u0440\u043d\u0438 \u0434\u0430\u043b\u0438 \u0435 \u043f\u0440o\u0434\u0443\u043a\u0442 \u043d\u0430 \u0420\u043e\u0448, \u043c\u043e\u043b\u044f \u0437\u0430\u0434\u044a\u043b\u0436\u0438\u0442\u0435\u043b\u043d\u043e \u043e\u0442\u0431\u0435\u043b\u0435\u0436\u0435\u0442\u0435 \u0442\u043e\u0432\u0430 \u0432 \u0441\u0435\u043a\u0446\u0438\u044f 13 - \u0414\u043e\u043f\u044a\u043b\u043d\u0438\u0442\u0435\u043b\u043d\u0430 \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f. <\/p>\n\n<p>K\u043b\u0438\u043a\u043d\u0435\u0442\u0435 \u0432\u044a\u0440\u0445\u0443 \u0431\u0443\u0442\u043e\u043d\u0430 \"\u0414\u043e\u0431\u0430\u0432\u0438\", \u0437\u0430 \u0434\u0430 \u0432\u044a\u0432\u0435\u0434\u0435\u0442\u0435 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d \u043f\u0440\u043e\u0434\u0443\u043a\u0442 \u043d\u0430 \u0420\u043e\u0448 \u0438\u043b\u0438 \u0434\u0440\u0443\u0433 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d \u043f\u0440\u043e\u0434\u0443\u043a\u0442.<\/p>\n<small style=\"font-size: 90%;\">\n(\u0412\u043f\u0438\u0448\u0435\u0442\u0435 \u0432\u0441\u0438\u0447\u043a\u0438 \u0440\u0435\u043b\u0435\u0432\u0430\u043d\u0442\u043d\u0438 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0430, \u043f\u0440\u0438\u0435\u043c\u0430\u043d\u0438 \u043f\u0440\u0435\u0434\u0438 (\u0434\u043e 24 \u043c\u0435\u0441\u0435\u0446\u0430 \u0437\u0430 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u043a\u0438\u0442\u0435, \u043b\u0435\u043a\u0443\u0432\u0430\u043d\u0438 \u0441 Erivedge\u00ae) \u0438 \u043f\u043e \u0432\u0440\u0435\u043c\u0435 \u043d\u0430 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u0442\u0430 \u0438\u043b\u0438, \u0430\u043a\u043e \u0435 \u0435\u043a\u0441\u043f\u043e\u043d\u0438\u0440\u0430\u043d \u0431\u0430\u0449\u0430\u0442\u0430, \u0432\u043f\u0438\u0448\u0435\u0442\u0435 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0430\u0442\u0430, \u043f\u0440\u0438\u0435\u043c\u0430\u043d\u0438 \u043f\u0440\u0435\u0434\u0438 \u0437\u0430\u0447\u0435\u0432\u0430\u043d\u0435\u0442\u043e \u0438\u043b\u0438 \u0434\u043e 2 \u043c\u0435\u0441\u0435\u0446\u0430 \u0441\u043b\u0435\u0434 \u043f\u043e\u0441\u043b\u0435\u0434\u043d\u0430\u0442\u0430 \u0434\u043e\u0437\u0430 \u043d\u0430 Erivedge\u00ae. \u0410\u043a\u043e \u0441\u0430 \u043f\u043e\u0432\u0435\u0447\u0435 \u043e\u0442 5, \u043f\u0440\u043e\u0434\u044a\u043b\u0436\u0435\u0442\u0435 \u0432 \u0441\u0435\u043a\u0446\u0438\u044f 13, \u0414\u043e\u043f\u044a\u043b\u043d\u0438\u0442\u0435\u043b\u043d\u0430 \u0438\u043d\u0444\u043e\u0440\u0446\u0438\u044f)\n<\/small>\n\n<\/div><div class=\"clear\"><\/div><\/div><\/li><li id=\"field_36_178\" class=\"gfield gfield--type-html space_tab gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_178\" ><div class=\"gfield grey\"><div class=\"info\"><\/div><div class=\"left\" style=\"width:820px;text-align:justify\">\n\n\u041f\u043e\u043b\u0435\u0442\u0430\u0442\u0430, \u043a\u043e\u0438\u0442\u043e \u0437\u0430\u0434\u044a\u043b\u0436\u0438\u0442\u0435\u043b\u043d\u043e \u0442\u0440\u044f\u0431\u0432\u0430 \u0434\u0430 \u0441\u0435 \u043f\u043e\u043f\u044a\u043b\u043d\u044f\u0442, \u0441\u0430 \u043c\u0430\u0440\u043a\u0438\u0440\u0430\u043d\u0438 \u0441 \u0442\u043e\u0437\u0438 \u0441\u0438\u043c\u0432\u043e\u043b: <span class=\"gfield_required\">*<\/span>\n<\/div><div class=\"clear\"><\/div><\/li><li id=\"field_36_99\" class=\"gfield gfield--type-form gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gform_form\"  data-field-class=\"gform_form\" data-js-reload=\"field_36_99\" ><label class='gfield_label gform-field-label' for='input_36_99'>\u041b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d \u043f\u0440\u043e\u0434\u0443\u043a\u0442 \u043d\u0430 \u0420\u043e\u0448:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>                <link href=\"https:\/\/ajax.googleapis.com\/ajax\/libs\/jqueryui\/1.10.3\/themes\/ui-lightness\/jquery-ui.css\" rel=\"stylesheet\" type=\"text\/css\" \/>        <style type=\"text\/css\">            .gpnf-nested-entries { border-top: 1px solid #f7f7f7; min-width: 50%; border-spacing: 0; border-collapse: separate; }            .gpnf-nested-entries th,            .gpnf-nested-entries td { border-bottom: 1px solid #f7f7f7; padding: 4px 8px; }            .gpnf-nested-entries th { background-color: #f7f7f7; border-color: #eee; }            .gpnf-no-entries td { text-align: center; padding: 10px 0; }            .gpnf-row-actions ul { }            .gpnf-row-actions li { display: inline; }        <\/style>        <div class=\"gpnf-nested-entries-container\">                        <table class=\"gpnf-nested-entries\">                <thead>                    <tr>                                                     <th class=\"gpnf-field-84\">\u041d\u0430\u0438\u043c\u0435\u043d\u043e\u0432\u0430\u043d\u0438\u0435 \u043d\u0430 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432e\u043d\u0438\u044f \u043f\u0440\u043e\u0434\u0443\u043a\u0442 \u043d\u0430 \u0420\u043e\u0448:<\/th>                                                <th class=\"gpnf-row-actions\">&nbsp;<\/th>                    <\/tr>                <\/thead>                <tbody data-bind=\"visible: entries().length > 0, foreach: entries\">                    <tr data-bind=\"attr: { 'data-entryid': id }\">                                                     <td class=\"gpnf-field\" data-bind=\"html: f84\">&nbsp;<\/td>                                                <td class=\"gpnf-row-actions\">                            <ul>                                <li><a href=\"#\" data-bind=\"click: $parent.editEntry\">\u0420\u0435\u0434\u0430\u043a\u0442\u0438\u0440\u0430\u0439<\/a><\/li>                                <li><a href=\"#\" data-bind=\"click: $parent.deleteEntry\">\u0418\u0437\u0442\u0440\u0438\u0439<\/a><\/li>                            <\/ul>                        <\/td>                    <\/tr>                <\/tbody>                <tbody data-bind=\"visible: entries().length <= 0\">                    <tr class=\"gpnf-no-entries\" data-bind=\"visible: entries().length <= 0\">                        <td colspan=\"2\"><\/td>                    <\/tr>                <\/tbody>            <\/table>                                    <button class=\"gpnf-add-entry\"  data-formid=\"36\" data-nestedformid=\"37\">\u0414\u043e\u0431\u0430\u0432\u0438<\/button>                        <input type=\"hidden\"                 name=\"input_99\"                 id=\"input_36_99\"                 data-bind=\"value: entryIds\"                value=\"\" \/>                    <\/div>                <\/li><li id=\"field_36_177\" class=\"gfield gfield--type-form field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gform_form\"  data-field-class=\"gform_form\" data-js-reload=\"field_36_177\" ><label class='gfield_label gform-field-label' for='input_36_177'>\u0414\u0440\u0443\u0433 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d \u043f\u0440\u043e\u0434\u0443\u043a\u0442:<\/label>                <link href=\"https:\/\/ajax.googleapis.com\/ajax\/libs\/jqueryui\/1.10.3\/themes\/ui-lightness\/jquery-ui.css\" rel=\"stylesheet\" type=\"text\/css\" \/>        <style type=\"text\/css\">            .gpnf-nested-entries { border-top: 1px solid #f7f7f7; min-width: 50%; border-spacing: 0; border-collapse: separate; }            .gpnf-nested-entries th,            .gpnf-nested-entries td { border-bottom: 1px solid #f7f7f7; padding: 4px 8px; }            .gpnf-nested-entries th { background-color: #f7f7f7; border-color: #eee; }            .gpnf-no-entries td { text-align: center; padding: 10px 0; }            .gpnf-row-actions ul { }            .gpnf-row-actions li { display: inline; }        <\/style>        <div class=\"gpnf-nested-entries-container\">                        <table class=\"gpnf-nested-entries\">                <thead>                    <tr>                                                     <th class=\"gpnf-field-87\">\u041d\u0430\u0438\u043c\u0435\u043d\u043e\u0432\u0430\u043d\u0438\u0435 \u043d\u0430 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u0438\u044f \u043f\u0440\u043e\u0434\u0443\u043a\u0442:<\/th>                                                <th class=\"gpnf-row-actions\">&nbsp;<\/th>                    <\/tr>                <\/thead>                <tbody data-bind=\"visible: entries().length > 0, foreach: entries\">                    <tr data-bind=\"attr: { 'data-entryid': id }\">                                                     <td class=\"gpnf-field\" data-bind=\"html: f87\">&nbsp;<\/td>                                                <td class=\"gpnf-row-actions\">                            <ul>                                <li><a href=\"#\" data-bind=\"click: $parent.editEntry\">\u0420\u0435\u0434\u0430\u043a\u0442\u0438\u0440\u0430\u0439<\/a><\/li>                                <li><a href=\"#\" data-bind=\"click: $parent.deleteEntry\">\u0418\u0437\u0442\u0440\u0438\u0439<\/a><\/li>                            <\/ul>                        <\/td>                    <\/tr>                <\/tbody>                <tbody data-bind=\"visible: entries().length <= 0\">                    <tr class=\"gpnf-no-entries\" data-bind=\"visible: entries().length <= 0\">                        <td colspan=\"2\"><\/td>                    <\/tr>                <\/tbody>            <\/table>                                    <button class=\"gpnf-add-entry\"  data-formid=\"36\" data-nestedformid=\"43\">\u0414\u043e\u0431\u0430\u0432\u0438<\/button>                        <input type=\"hidden\"                 name=\"input_177\"                 id=\"input_36_177\"                 data-bind=\"value: entryIds\"                value=\"\" \/>                    <\/div>                <\/li><li id=\"field_36_51\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_51\" ><div style=\"display:block;margin-left:20px;\">\u0410\u043a\u043e \u0435 \u043d\u0435\u043e\u0431\u0445\u043e\u0434\u0438\u043c\u043e \u043c\u043e\u0436\u0435 \u0434\u0430 \u0441\u0435 \u0432\u044a\u0432\u0435\u0434\u0435 \u043f\u043e\u0432\u0435\u0447\u0435 \u043e\u0442 \u0435\u0434\u0438\u043d \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d \u043f\u0440\u043e\u0434\u0443\u043a\u0442.<\/div><\/li><\/ul>\r\n                    <\/div>\r\n                    <div class='gform_page_footer top_label'>\r\n                        <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_prev.png' id='gform_previous_button_36_142' class='gform_previous_button gform-theme-button gform-theme-button--secondary button gform_image_button' alt='\u041f\u0440\u0435\u0434\u0438\u0448\u043d\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"2\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"2\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_next.png' id='gform_next_button_36_142' class='gform_next_button gform-theme-button button gform_image_button' alt='\u0421\u043b\u0435\u0434\u0432\u0430\u0449\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"4\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"4\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> \r\n                    <\/div>\r\n                <\/div>\r\n                <div id='gform_page_36_4' class='gform_page' data-js='page-field-id-142' style='display:none;'>\r\n                    <div class='gform_page_fields'>\r\n                        <ul id='gform_fields_36_4' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_36_143\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_143\" ><div class=\"title_forms\">4. \u041c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0430 \u0430\u043d\u0430\u043c\u043d\u0435\u0437\u0430 \u043d\u0430 \u043c\u0430\u0439\u043a\u0430\u0442\u0430 \u0438 \u0431\u0430\u0449\u0430\u0442\u0430<\/div>\n<div class=\"gfield grey\"><div class=\"left\" style=\"width:820px\"><\/div>\n<div class=\"clear\"><\/div><\/div><\/li><li id=\"field_36_225\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_225\" ><span style=\"margin-left:30px;\"><strong>\u041c\u0430\u0439\u043a\u0430<\/strong><\/span><\/li><li id=\"field_36_145\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_145\" ><label class='gfield_label gform-field-label' >\u0420\u0438\u0441\u043a\u043e\u0432\u0438 \u0444\u0430\u043a\u0442\u043e\u0440\u0438\/\u041c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0430 \u0430\u043d\u0430\u043c\u043d\u0435\u0437\u0430<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_36_145'>\r\n\t\t\t<li class='gchoice gchoice_36_145_0'>\r\n\t\t\t\t<input name='input_145' type='radio' value='\u041d\u0435 \u0435 \u0438\u0437\u0432\u0435\u0441\u0442\u043d\u043e'  id='choice_36_145_0'    \/>\r\n\t\t\t\t<label for='choice_36_145_0' id='label_36_145_0' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435 \u0435 \u0438\u0437\u0432\u0435\u0441\u0442\u043d\u043e<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_145_1'>\r\n\t\t\t\t<input name='input_145' type='radio' value='\u0410\u043b\u043a\u043e\u0445\u043e\u043b'  id='choice_36_145_1'    \/>\r\n\t\t\t\t<label for='choice_36_145_1' id='label_36_145_1' class='gform-field-label gform-field-label--type-inline'>\u0410\u043b\u043a\u043e\u0445\u043e\u043b<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_145_2'>\r\n\t\t\t\t<input name='input_145' type='radio' value='\u0410\u043b\u0435\u0440\u0433\u0438\u0438'  id='choice_36_145_2'    \/>\r\n\t\t\t\t<label for='choice_36_145_2' id='label_36_145_2' class='gform-field-label gform-field-label--type-inline'>\u0410\u043b\u0435\u0440\u0433\u0438\u0438<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_145_3'>\r\n\t\t\t\t<input name='input_145' type='radio' value='\u0414\u0438\u0430\u0431\u0435\u0442'  id='choice_36_145_3'    \/>\r\n\t\t\t\t<label for='choice_36_145_3' id='label_36_145_3' class='gform-field-label gform-field-label--type-inline'>\u0414\u0438\u0430\u0431\u0435\u0442<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_145_4'>\r\n\t\t\t\t<input name='input_145' type='radio' value='\u0418\u043d\u0444\u0435\u043a\u0446\u0438\u0438'  id='choice_36_145_4'    \/>\r\n\t\t\t\t<label for='choice_36_145_4' id='label_36_145_4' class='gform-field-label gform-field-label--type-inline'>\u0418\u043d\u0444\u0435\u043a\u0446\u0438\u0438<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_145_5'>\r\n\t\t\t\t<input name='input_145' type='radio' value='\u041f\u0443\u0448\u0435\u043d\u0435'  id='choice_36_145_5'    \/>\r\n\t\t\t\t<label for='choice_36_145_5' id='label_36_145_5' class='gform-field-label gform-field-label--type-inline'>\u041f\u0443\u0448\u0435\u043d\u0435<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_145_6'>\r\n\t\t\t\t<input name='input_145' type='radio' value='\u0417\u043b\u043e\u0443\u043f\u043e\u0442\u0440\u0435\u0431\u0430 \u0441 \u043d\u0430\u0440\u043a\u043e\u0442\u0438\u0446\u0438'  id='choice_36_145_6'    \/>\r\n\t\t\t\t<label for='choice_36_145_6' id='label_36_145_6' class='gform-field-label gform-field-label--type-inline'>\u0417\u043b\u043e\u0443\u043f\u043e\u0442\u0440\u0435\u0431\u0430 \u0441 \u043d\u0430\u0440\u043a\u043e\u0442\u0438\u0446\u0438<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_145_7'>\r\n\t\t\t\t<input name='input_145' type='radio' value='\u0414\u0440\u0443\u0433\u043e (\u0443\u0442\u043e\u0447\u043d\u0435\u0442\u0435):'  id='choice_36_145_7'    \/>\r\n\t\t\t\t<label for='choice_36_145_7' id='label_36_145_7' class='gform-field-label gform-field-label--type-inline'>\u0414\u0440\u0443\u0433\u043e (\u0443\u0442\u043e\u0447\u043d\u0435\u0442\u0435):<\/label>\r\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_228\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_228\" ><label class='gfield_label gform-field-label' for='input_36_228'>\u0443\u0442\u043e\u0447\u043d\u0435\u0442\u0435<\/label><div class='ginput_container ginput_container_text'><input name='input_228' id='input_36_228' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_265\" class=\"gfield gfield--type-html space_tab gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_265\" ><\/li><li id=\"field_36_226\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_226\" ><span style=\"margin-left:30px;\"><strong>\u0411\u0430\u0449\u0430<\/strong><\/span><\/li><li id=\"field_36_229\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_229\" ><label class='gfield_label gform-field-label' >\u0420\u0438\u0441\u043a\u043e\u0432\u0438 \u0444\u0430\u043a\u0442\u043e\u0440\u0438\/\u041c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0430 \u0430\u043d\u0430\u043c\u043d\u0435\u0437\u0430:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_36_229'>\r\n\t\t\t<li class='gchoice gchoice_36_229_0'>\r\n\t\t\t\t<input name='input_229' type='radio' value='\u041d\u0435 \u0435 \u0438\u0437\u0432\u0435\u0441\u0442\u043d\u043e'  id='choice_36_229_0'    \/>\r\n\t\t\t\t<label for='choice_36_229_0' id='label_36_229_0' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435 \u0435 \u0438\u0437\u0432\u0435\u0441\u0442\u043d\u043e<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_229_1'>\r\n\t\t\t\t<input name='input_229' type='radio' value='\u0410\u043b\u043a\u043e\u0445\u043e\u043b'  id='choice_36_229_1'    \/>\r\n\t\t\t\t<label for='choice_36_229_1' id='label_36_229_1' class='gform-field-label gform-field-label--type-inline'>\u0410\u043b\u043a\u043e\u0445\u043e\u043b<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_229_2'>\r\n\t\t\t\t<input name='input_229' type='radio' value='\u0410\u043b\u0435\u0440\u0433\u0438\u0438'  id='choice_36_229_2'    \/>\r\n\t\t\t\t<label for='choice_36_229_2' id='label_36_229_2' class='gform-field-label gform-field-label--type-inline'>\u0410\u043b\u0435\u0440\u0433\u0438\u0438<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_229_3'>\r\n\t\t\t\t<input name='input_229' type='radio' value='\u0414\u0438\u0430\u0431\u0435\u0442'  id='choice_36_229_3'    \/>\r\n\t\t\t\t<label for='choice_36_229_3' id='label_36_229_3' class='gform-field-label gform-field-label--type-inline'>\u0414\u0438\u0430\u0431\u0435\u0442<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_229_4'>\r\n\t\t\t\t<input name='input_229' type='radio' value='\u0418\u043d\u0444\u0435\u043a\u0446\u0438\u0438'  id='choice_36_229_4'    \/>\r\n\t\t\t\t<label for='choice_36_229_4' id='label_36_229_4' class='gform-field-label gform-field-label--type-inline'>\u0418\u043d\u0444\u0435\u043a\u0446\u0438\u0438<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_229_5'>\r\n\t\t\t\t<input name='input_229' type='radio' value='\u041f\u0443\u0448\u0435\u043d\u0435'  id='choice_36_229_5'    \/>\r\n\t\t\t\t<label for='choice_36_229_5' id='label_36_229_5' class='gform-field-label gform-field-label--type-inline'>\u041f\u0443\u0448\u0435\u043d\u0435<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_229_6'>\r\n\t\t\t\t<input name='input_229' type='radio' value='\u0417\u043b\u043e\u0443\u043f\u043e\u0442\u0440\u0435\u0431\u0430 \u0441 \u043d\u0430\u0440\u043a\u043e\u0442\u0438\u0446\u0438'  id='choice_36_229_6'    \/>\r\n\t\t\t\t<label for='choice_36_229_6' id='label_36_229_6' class='gform-field-label gform-field-label--type-inline'>\u0417\u043b\u043e\u0443\u043f\u043e\u0442\u0440\u0435\u0431\u0430 \u0441 \u043d\u0430\u0440\u043a\u043e\u0442\u0438\u0446\u0438<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_229_7'>\r\n\t\t\t\t<input name='input_229' type='radio' value='\u0414\u0440\u0443\u0433\u043e (\u0443\u0442\u043e\u0447\u043d\u0435\u0442\u0435):'  id='choice_36_229_7'    \/>\r\n\t\t\t\t<label for='choice_36_229_7' id='label_36_229_7' class='gform-field-label gform-field-label--type-inline'>\u0414\u0440\u0443\u0433\u043e (\u0443\u0442\u043e\u0447\u043d\u0435\u0442\u0435):<\/label>\r\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_230\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_230\" ><label class='gfield_label gform-field-label' for='input_36_230'>\u0443\u0442\u043e\u0447\u043d\u0435\u0442\u0435<\/label><div class='ginput_container ginput_container_text'><input name='input_230' id='input_36_230' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_129\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_129\" ><\/li><\/ul>\r\n                    <\/div>\r\n                    <div class='gform_page_footer top_label'>\r\n                        <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_prev.png' id='gform_previous_button_36_223' class='gform_previous_button gform-theme-button gform-theme-button--secondary button gform_image_button' alt='\u041f\u0440\u0435\u0434\u0438\u0448\u043d\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"3\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"3\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_next.png' id='gform_next_button_36_223' class='gform_next_button gform-theme-button button gform_image_button' alt='\u0421\u043b\u0435\u0434\u0432\u0430\u0449\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"5\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"5\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> \r\n                    <\/div>\r\n                <\/div>\r\n                <div id='gform_page_36_5' class='gform_page' data-js='page-field-id-223' style='display:none;'>\r\n                    <div class='gform_page_fields'>\r\n                        <ul id='gform_fields_36_5' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_36_224\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_224\" ><div class=\"title_forms\">5. \u041a\u043e\u043d\u0442\u0440\u0430\u0446\u0435\u043f\u0446\u0438\u044f<\/div>\n<div class=\"gfield grey\"><div class=\"left\" style=\"width:820px\"><\/div>\n<div class=\"clear\"><\/div><\/div><\/li><li id=\"field_36_144\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_144\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u041a\u043e\u043d\u0442\u0440\u0430\u0446\u0435\u043f\u0446\u0438\u044f (\u041c\u043e\u0436\u0435\u0442\u0435 \u0434\u0430 \u0438\u0437\u0431\u0435\u0440\u0435\u0442\u0435 \u043f\u043e\u0432\u0435\u0447\u0435 \u043e\u0442 \u0435\u0434\u043d\u0430)<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_144'><li class='gchoice gchoice_36_144_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_144.1' type='checkbox'  value='\u041a\u043e\u043d\u0442\u0440\u0430\u0446\u0435\u043f\u0442\u0438\u0432\u043d\u043e \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u043e'  id='choice_36_144_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_144_1' id='label_36_144_1' class='gform-field-label gform-field-label--type-inline'>\u041a\u043e\u043d\u0442\u0440\u0430\u0446\u0435\u043f\u0442\u0438\u0432\u043d\u043e \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u043e<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_144_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_144.2' type='checkbox'  value='\u041f\u0440\u0435\u0437\u0435\u0440\u0432\u0430\u0442\u0438\u0432'  id='choice_36_144_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_144_2' id='label_36_144_2' class='gform-field-label gform-field-label--type-inline'>\u041f\u0440\u0435\u0437\u0435\u0440\u0432\u0430\u0442\u0438\u0432<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_144_3'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_144.3' type='checkbox'  value='\u0414\u0438\u0430\u0444\u0440\u0430\u0433\u043c\u0430'  id='choice_36_144_3'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_144_3' id='label_36_144_3' class='gform-field-label gform-field-label--type-inline'>\u0414\u0438\u0430\u0444\u0440\u0430\u0433\u043c\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_144_4'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_144.4' type='checkbox'  value='\u0418\u043d\u0444\u0435\u0440\u0442\u0438\u043b\u0438\u0442\u0435\u0442 (\u0416\u0435\u043d\u0430)'  id='choice_36_144_4'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_144_4' id='label_36_144_4' class='gform-field-label gform-field-label--type-inline'>\u0418\u043d\u0444\u0435\u0440\u0442\u0438\u043b\u0438\u0442\u0435\u0442 (\u0416\u0435\u043d\u0430)<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_144_5'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_144.5' type='checkbox'  value='\u0418\u043d\u0444\u0435\u0440\u0442\u0438\u043b\u0438\u0442\u0435\u0442 (\u043c\u044a\u0436)'  id='choice_36_144_5'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_144_5' id='label_36_144_5' class='gform-field-label gform-field-label--type-inline'>\u0418\u043d\u0444\u0435\u0440\u0442\u0438\u043b\u0438\u0442\u0435\u0442 (\u043c\u044a\u0436)<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_144_6'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_144.6' type='checkbox'  value='\u0412\u044a\u0442\u0440\u0435\u043c\u0430\u0442\u043e\u0447\u043d\u043e \u0443\u0441\u0442\u0440\u043e\u0439\u0441\u0442\u0432\u043e (IUD)'  id='choice_36_144_6'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_144_6' id='label_36_144_6' class='gform-field-label gform-field-label--type-inline'>\u0412\u044a\u0442\u0440\u0435\u043c\u0430\u0442\u043e\u0447\u043d\u043e \u0443\u0441\u0442\u0440\u043e\u0439\u0441\u0442\u0432\u043e (IUD)<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_144_7'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_144.7' type='checkbox'  value='\u0420\u0438\u0442\u044a\u043c'  id='choice_36_144_7'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_144_7' id='label_36_144_7' class='gform-field-label gform-field-label--type-inline'>\u0420\u0438\u0442\u044a\u043c<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_144_8'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_144.8' type='checkbox'  value='\u0421\u043f\u0435\u0440\u043c\u0438\u0446\u0438\u0434'  id='choice_36_144_8'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_144_8' id='label_36_144_8' class='gform-field-label gform-field-label--type-inline'>\u0421\u043f\u0435\u0440\u043c\u0438\u0446\u0438\u0434<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_144_9'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_144.9' type='checkbox'  value='\u0425\u0438\u0440\u0443\u0440\u0433\u0438\u0447\u0435\u0441\u043a\u0430 \u0441\u0442\u0435\u0440\u0438\u043b\u0438\u0437\u0430\u0446\u0438\u044f (\u043c\u044a\u0436)'  id='choice_36_144_9'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_144_9' id='label_36_144_9' class='gform-field-label gform-field-label--type-inline'>\u0425\u0438\u0440\u0443\u0440\u0433\u0438\u0447\u0435\u0441\u043a\u0430 \u0441\u0442\u0435\u0440\u0438\u043b\u0438\u0437\u0430\u0446\u0438\u044f (\u043c\u044a\u0436)<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_144_11'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_144.11' type='checkbox'  value='\u0425\u0438\u0440\u0443\u0440\u0433\u0438\u0447\u0435\u0441\u043a\u0430 \u0441\u0442\u0435\u0440\u0438\u043b\u0438\u0437\u0430\u0446\u0438\u044f (\u0416\u0435\u043d\u0430)'  id='choice_36_144_11'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_144_11' id='label_36_144_11' class='gform-field-label gform-field-label--type-inline'>\u0425\u0438\u0440\u0443\u0440\u0433\u0438\u0447\u0435\u0441\u043a\u0430 \u0441\u0442\u0435\u0440\u0438\u043b\u0438\u0437\u0430\u0446\u0438\u044f (\u0416\u0435\u043d\u0430)<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_144_12'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_144.12' type='checkbox'  value='\u041d\u0435 \u0435 \u0438\u0437\u0432\u0435\u0441\u0442\u043d\u043e'  id='choice_36_144_12'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_144_12' id='label_36_144_12' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435 \u0435 \u0438\u0437\u0432\u0435\u0441\u0442\u043d\u043e<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_144_13'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_144.13' type='checkbox'  value='\u041f\u0440\u0435\u043a\u044a\u0441\u0432\u0430\u043d\u0435'  id='choice_36_144_13'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_144_13' id='label_36_144_13' class='gform-field-label gform-field-label--type-inline'>\u041f\u0440\u0435\u043a\u044a\u0441\u0432\u0430\u043d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_144_14'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_144.14' type='checkbox'  value='\u041d\u0438\u043a\u0430\u043a\u0432\u0430'  id='choice_36_144_14'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_144_14' id='label_36_144_14' class='gform-field-label gform-field-label--type-inline'>\u041d\u0438\u043a\u0430\u043a\u0432\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_227\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_227\" ><\/li><\/ul>\r\n                    <\/div>\r\n                    <div class='gform_page_footer top_label'>\r\n                        <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_prev.png' id='gform_previous_button_36_52' class='gform_previous_button gform-theme-button gform-theme-button--secondary button gform_image_button' alt='\u041f\u0440\u0435\u0434\u0438\u0448\u043d\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"4\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"4\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_next.png' id='gform_next_button_36_52' class='gform_next_button gform-theme-button button gform_image_button' alt='\u0421\u043b\u0435\u0434\u0432\u0430\u0449\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"6\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"6\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> \r\n                    <\/div>\r\n                <\/div>\r\n                <div id='gform_page_36_6' class='gform_page' data-js='page-field-id-52' style='display:none;'>\r\n                    <div class='gform_page_fields'>\r\n                        <ul id='gform_fields_36_6' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_36_53\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_53\" ><div class=\"title_forms\">6. \u0410\u043a\u0443\u0448\u0435\u0440\u0441\u043a\u0430 \u0430\u043d\u0430\u043c\u043d\u0435\u0437\u0430<\/div>\n<div class=\"gfield grey\"><div class=\"left\" style=\"width:820px\">K\u043b\u0438\u043a\u043d\u0435\u0442\u0435 \u0432\u044a\u0440\u0445\u0443 \u0431\u0443\u0442\u043e\u043d\u0430 \"\u0414\u043e\u0431\u0430\u0432\u0438\", \u0437\u0430 \u0434\u0430 \u0432\u044a\u0432\u0435\u0434\u0435\u0442\u0435 \u0434\u0430\u043d\u043d\u0438 \u0437\u0430 \u0430\u043a\u0443\u0448\u0435\u0440\u0441\u043a\u0430 \u0430\u043d\u0430\u043c\u043d\u0435\u0437\u0430.<\/p>\n<\/div><div class=\"clear\"><\/div><\/div><\/li><li id=\"field_36_115\" class=\"gfield gfield--type-form field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gform_form\"  data-field-class=\"gform_form\" data-js-reload=\"field_36_115\" ><label class='gfield_label gform-field-label' for='input_36_115'>\u0414\u0430\u043d\u043d\u0438 \u0437\u0430 \u0430\u043a\u0443\u0448\u0435\u0440\u0441\u043a\u0430 \u0430\u043d\u0430\u043c\u043d\u0435\u0437\u0430:<\/label>                <link href=\"https:\/\/ajax.googleapis.com\/ajax\/libs\/jqueryui\/1.10.3\/themes\/ui-lightness\/jquery-ui.css\" rel=\"stylesheet\" type=\"text\/css\" \/>        <style type=\"text\/css\">            .gpnf-nested-entries { border-top: 1px solid #f7f7f7; min-width: 50%; border-spacing: 0; border-collapse: separate; }            .gpnf-nested-entries th,            .gpnf-nested-entries td { border-bottom: 1px solid #f7f7f7; padding: 4px 8px; }            .gpnf-nested-entries th { background-color: #f7f7f7; border-color: #eee; }            .gpnf-no-entries td { text-align: center; padding: 10px 0; }            .gpnf-row-actions ul { }            .gpnf-row-actions li { display: inline; }        <\/style>        <div class=\"gpnf-nested-entries-container\">                        <table class=\"gpnf-nested-entries\">                <thead>                    <tr>                                                     <th class=\"gpnf-field-45\">\u041a\u043e\u044f \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442 \u0435 \u043f\u043e\u0434 \u0440\u0435\u0434:<\/th>                                                <th class=\"gpnf-row-actions\">&nbsp;<\/th>                    <\/tr>                <\/thead>                <tbody data-bind=\"visible: entries().length > 0, foreach: entries\">                    <tr data-bind=\"attr: { 'data-entryid': id }\">                                                     <td class=\"gpnf-field\" data-bind=\"html: f45\">&nbsp;<\/td>                                                <td class=\"gpnf-row-actions\">                            <ul>                                <li><a href=\"#\" data-bind=\"click: $parent.editEntry\">\u0420\u0435\u0434\u0430\u043a\u0442\u0438\u0440\u0430\u0439<\/a><\/li>                                <li><a href=\"#\" data-bind=\"click: $parent.deleteEntry\">\u0418\u0437\u0442\u0440\u0438\u0439<\/a><\/li>                            <\/ul>                        <\/td>                    <\/tr>                <\/tbody>                <tbody data-bind=\"visible: entries().length <= 0\">                    <tr class=\"gpnf-no-entries\" data-bind=\"visible: entries().length <= 0\">                        <td colspan=\"2\"><\/td>                    <\/tr>                <\/tbody>            <\/table>                                    <button class=\"gpnf-add-entry\"  data-formid=\"36\" data-nestedformid=\"38\">\u0414\u043e\u0431\u0430\u0432\u0438<\/button>                        <input type=\"hidden\"                 name=\"input_115\"                 id=\"input_36_115\"                 data-bind=\"value: entryIds\"                value=\"\" \/>                    <\/div>                <\/li><li id=\"field_36_134\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_134\" ><div style=\"display:block;margin-left:20px;\">\u0410\u043a\u043e \u0435 \u043d\u0435\u043e\u0431\u0445\u043e\u0434\u0438\u043c\u043e \u043c\u043e\u0436\u0435 \u0434\u0430 \u0441\u0435 \u0432\u044a\u0432\u0435\u0434\u0435 \u043f\u043e\u0432\u0435\u0447\u0435 \u043e\u0442 \u0435\u0434\u043d\u0430 \u0430\u043a\u0443\u0448\u0435\u0440\u0441\u043a\u0430 \u0430\u043d\u0430\u043c\u043d\u0435\u0437\u0430.<\/div><\/li><li id=\"field_36_71\" class=\"gfield gfield--type-html space_tab gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_71\" ><\/li><\/ul>\r\n                    <\/div>\r\n                    <div class='gform_page_footer top_label'>\r\n                        <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_prev.png' id='gform_previous_button_36_73' class='gform_previous_button gform-theme-button gform-theme-button--secondary button gform_image_button' alt='\u041f\u0440\u0435\u0434\u0438\u0448\u043d\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"5\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"5\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_next.png' id='gform_next_button_36_73' class='gform_next_button gform-theme-button button gform_image_button' alt='\u0421\u043b\u0435\u0434\u0432\u0430\u0449\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"7\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"7\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> \r\n                    <\/div>\r\n                <\/div>\r\n                <div id='gform_page_36_7' class='gform_page' data-js='page-field-id-73' style='display:none;'>\r\n                    <div class='gform_page_fields'>\r\n                        <ul id='gform_fields_36_7' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_36_106\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_106\" ><div class=\"title_forms\">7. \u0418\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f \u0437\u0430 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u0442\u0430<\/div>\n<div class=\"gfield grey\"><div class=\"left\" style=\"width:820px\">\n\n<\/div><div class=\"clear\"><\/div><\/div><\/li><li id=\"field_36_205\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_205\" ><label class='gfield_label gform-field-label' for='input_36_205'>\u0414\u0430\u0442\u0430 \u043d\u0430 \u043f\u043e\u0441\u043b\u0435\u0434\u043d\u0430 \u043c\u0435\u043d\u0441\u0442\u0440\u0443\u0430\u0446\u0438\u044f:<\/label><div class='ginput_container ginput_container_text'><input name='input_205' id='input_36_205' type='text' value='' class='small'    placeholder='\u0414\u0414\/\u041c\u041c\/\u0413\u0413\u0413\u0413'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_206\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_206\" ><label class='gfield_label gform-field-label' for='input_36_206'>\u0414\u0430\u0442\u0430 \u043d\u0430 \u0437\u0430\u0447\u0435\u0432\u0430\u043d\u0435:<\/label><div class='ginput_container ginput_container_text'><input name='input_206' id='input_36_206' type='text' value='' class='small'    placeholder='\u0414\u0414\/\u041c\u041c\/\u0413\u0413\u0413\u0413'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_207\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_207\" ><label class='gfield_label gform-field-label' for='input_36_207'>\u0418\u0437\u0447\u0438\u0441\u043b\u0435\u043d\u0430 \u0434\u0430\u0442\u0430 \u043d\u0430 \u0440\u0430\u0436\u0434\u0430\u043d\u0435:<\/label><div class='ginput_container ginput_container_text'><input name='input_207' id='input_36_207' type='text' value='' class='small'    placeholder='\u0414\u0414\/\u041c\u041c\/\u0413\u0413\u0413\u0413'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_116\" class=\"gfield gfield--type-html space_tab gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_116\" ><\/li><\/ul>\r\n                    <\/div>\r\n                    <div class='gform_page_footer top_label'>\r\n                        <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_prev.png' id='gform_previous_button_36_154' class='gform_previous_button gform-theme-button gform-theme-button--secondary button gform_image_button' alt='\u041f\u0440\u0435\u0434\u0438\u0448\u043d\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"6\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"6\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_next.png' id='gform_next_button_36_154' class='gform_next_button gform-theme-button button gform_image_button' alt='\u0421\u043b\u0435\u0434\u0432\u0430\u0449\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"8\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"8\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> \r\n                    <\/div>\r\n                <\/div>\r\n                <div id='gform_page_36_8' class='gform_page' data-js='page-field-id-154' style='display:none;'>\r\n                    <div class='gform_page_fields'>\r\n                        <ul id='gform_fields_36_8' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_36_155\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_155\" ><div class=\"title_forms\">8. \u0418\u0437\u0445\u043e\u0434 \u043e\u0442 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u0442\u0430<\/div>\n<div class=\"gfield grey\"><div class=\"left\" style=\"width:820px\">\n\n<\/div><div class=\"clear\"><\/div><\/div><\/li><li id=\"field_36_157\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_157\" ><label class='gfield_label gform-field-label' >\u0418\u0437\u0445\u043e\u0434 \u043e\u0442 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u0442\u0430:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_36_157'>\r\n\t\t\t<li class='gchoice gchoice_36_157_0'>\r\n\t\t\t\t<input name='input_157' type='radio' value='\u041f\u0440\u043e\u0434\u044a\u043b\u0436\u0430\u0432\u0430'  id='choice_36_157_0'    \/>\r\n\t\t\t\t<label for='choice_36_157_0' id='label_36_157_0' class='gform-field-label gform-field-label--type-inline'>\u041f\u0440\u043e\u0434\u044a\u043b\u0436\u0430\u0432\u0430<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_157_1'>\r\n\t\t\t\t<input name='input_157' type='radio' value='\u0416\u0438\u0432\u043e\u0440\u043e\u0434\u0435\u043d\u043e'  id='choice_36_157_1'    \/>\r\n\t\t\t\t<label for='choice_36_157_1' id='label_36_157_1' class='gform-field-label gform-field-label--type-inline'>\u0416\u0438\u0432\u043e\u0440\u043e\u0434\u0435\u043d\u043e<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_157_2'>\r\n\t\t\t\t<input name='input_157' type='radio' value='\u0418\u0437\u0432\u044a\u043d\u043c\u0430\u0442\u043e\u0447\u043d\u0430 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442'  id='choice_36_157_2'    \/>\r\n\t\t\t\t<label for='choice_36_157_2' id='label_36_157_2' class='gform-field-label gform-field-label--type-inline'>\u0418\u0437\u0432\u044a\u043d\u043c\u0430\u0442\u043e\u0447\u043d\u0430 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_157_3'>\r\n\t\t\t\t<input name='input_157' type='radio' value='\u041c\u044a\u0440\u0442\u0432\u043e\u0440\u043e\u0434\u0435\u043d\u043e'  id='choice_36_157_3'    \/>\r\n\t\t\t\t<label for='choice_36_157_3' id='label_36_157_3' class='gform-field-label gform-field-label--type-inline'>\u041c\u044a\u0440\u0442\u0432\u043e\u0440\u043e\u0434\u0435\u043d\u043e<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_157_4'>\r\n\t\t\t\t<input name='input_157' type='radio' value='\u0421\u043f\u043e\u043d\u0442\u0430\u043d\u0435\u043d \u0430\u0431\u043e\u0440\u0442'  id='choice_36_157_4'    \/>\r\n\t\t\t\t<label for='choice_36_157_4' id='label_36_157_4' class='gform-field-label gform-field-label--type-inline'>\u0421\u043f\u043e\u043d\u0442\u0430\u043d\u0435\u043d \u0430\u0431\u043e\u0440\u0442<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_157_5'>\r\n\t\t\t\t<input name='input_157' type='radio' value='\u0422\u0435\u0440\u0430\u043f\u0435\u0432\u0442\u0438\u0447\u0435\u043d \u0430\u0431\u043e\u0440\u0442'  id='choice_36_157_5'    \/>\r\n\t\t\t\t<label for='choice_36_157_5' id='label_36_157_5' class='gform-field-label gform-field-label--type-inline'>\u0422\u0435\u0440\u0430\u043f\u0435\u0432\u0442\u0438\u0447\u0435\u043d \u0430\u0431\u043e\u0440\u0442<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_157_6'>\r\n\t\t\t\t<input name='input_157' type='radio' value='\u041d\u0435\u0438\u0437\u0432\u0435\u0441\u0442\u043d\u043e'  id='choice_36_157_6'    \/>\r\n\t\t\t\t<label for='choice_36_157_6' id='label_36_157_6' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435\u0438\u0437\u0432\u0435\u0441\u0442\u043d\u043e<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_157_7'>\r\n\t\t\t\t<input name='input_157' type='radio' value='\u041d\u0435 \u0435 \u043f\u0440\u043e\u0441\u043b\u0435\u0434\u0435\u043d\u043e'  id='choice_36_157_7'    \/>\r\n\t\t\t\t<label for='choice_36_157_7' id='label_36_157_7' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435 \u0435 \u043f\u0440\u043e\u0441\u043b\u0435\u0434\u0435\u043d\u043e<\/label>\r\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_179\" class=\"gfield gfield--type-post_custom_field gfield--input-type-date gfield--input-type-datedropdown field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_179\" ><label class='gfield_label gform-field-label' >\u041c\u043e\u043b\u044f, \u043f\u043e\u0441\u043e\u0447\u0435\u0442\u0435 \u0434\u0430\u0442\u0430:<\/label><div id='input_36_179' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\"><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_36_179_2_container'><select name='input_179[]' id='input_36_179_2'   aria-required='false'  ><option value=''>DD<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_36_179_1_container'><select name='input_179[]' id='input_36_179_1'   aria-required='false'  ><option value=''>MM<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_36_179_3_container'><select name='input_179[]' id='input_36_179_3'   aria-required='false'  ><option value=''>YYYY<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/div><\/li><li id=\"field_36_180\" class=\"gfield gfield--type-post_custom_field gfield--input-type-date gfield--input-type-datedropdown field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_180\" ><label class='gfield_label gform-field-label' >\u041c\u043e\u043b\u044f, \u043f\u043e\u0441\u043e\u0447\u0435\u0442\u0435 \u0434\u0430\u0442\u0430:<\/label><div id='input_36_180' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\"><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_36_180_2_container'><select name='input_180[]' id='input_36_180_2'   aria-required='false'  ><option value=''>DD<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_36_180_1_container'><select name='input_180[]' id='input_36_180_1'   aria-required='false'  ><option value=''>MM<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_36_180_3_container'><select name='input_180[]' id='input_36_180_3'   aria-required='false'  ><option value=''>YYYY<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/div><\/li><li id=\"field_36_156\" class=\"gfield gfield--type-html space_tab gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_156\" ><\/li><\/ul>\r\n                    <\/div>\r\n                    <div class='gform_page_footer top_label'>\r\n                        <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_prev.png' id='gform_previous_button_36_82' class='gform_previous_button gform-theme-button gform-theme-button--secondary button gform_image_button' alt='\u041f\u0440\u0435\u0434\u0438\u0448\u043d\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"7\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"7\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_next.png' id='gform_next_button_36_82' class='gform_next_button gform-theme-button button gform_image_button' alt='\u0421\u043b\u0435\u0434\u0432\u0430\u0449\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"9\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"9\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> \r\n                    <\/div>\r\n                <\/div>\r\n                <div id='gform_page_36_9' class='gform_page' data-js='page-field-id-82' style='display:none;'>\r\n                    <div class='gform_page_fields'>\r\n                        <ul id='gform_fields_36_9' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_36_83\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_83\" ><div class=\"title_forms\">9. \u0418\u0437\u0432\u044a\u0440\u0448\u0435\u043d\u0438 \u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u043d\u0438  \u0442\u0435\u0441\u0442\u043e\u0432\u0435\/\u043f\u0440\u043e\u0446\u0435\u0434\u0443\u0440\u0438 \u043f\u0440\u0435\u0434\u0438 \u0438 \u0441\u043b\u0435\u0434 \u0438\u0437\u0445\u043e\u0434\u0430<\/div>\n<div class=\"gfield grey\"><div class=\"left\" style=\"width:820px\">\u041c\u043e\u043b\u044f, \u0438\u0437\u043f\u043e\u043b\u0437\u0432\u0430\u0439\u0442\u0435 \u043f\u043e\u043b\u0435\u0442\u0430\u0442\u0430 \u043f\u043e-\u0434\u043e\u043b\u0443 \u0437\u0430 \u0434\u0430 \u043f\u0440\u0435\u0434\u043e\u0441\u0442\u0430\u0432\u0438\u0442\u0435 \u0432\u0441\u044f\u043a\u0430 \u0434\u043e\u0441\u0442\u044a\u043f\u043d\u0430 \u0434\u043e\u043f\u044a\u043b\u043d\u0438\u0442\u0435\u043b\u043d\u0430 \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f \u043e\u0442\u043d\u043e\u0441\u043d\u043e \u043d\u0430\u043f\u0440\u0430\u0432\u0435\u043d\u0438 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0438 \u0442\u0435\u0441\u0442\u043e\u0432\u0435 \u0438\/\u0438\u043b\u0438 \u043d\u0430\u043f\u0440\u0430\u0432\u0435\u043d\u0438 \u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u043d\u0438 \u0438\u0437\u0441\u043b\u0435\u0434\u0432\u0430\u043d\u0438\u044f \u043f\u0440\u0435\u0434\u0438 \u0438 \u0441\u043b\u0435\u0434 \u0438\u0437\u0445\u043e\u0434\u0430 \u043d\u0430 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u0442\u0430. <\/p>\n<p>K\u043b\u0438\u043a\u043d\u0435\u0442\u0435 \u0432\u044a\u0440\u0445\u0443 \u0431\u0443\u0442\u043e\u043d\u0430 \"\u0414\u043e\u0431\u0430\u0432\u0438\", \u0437\u0430 \u0434\u0430 \u0432\u044a\u0432\u0435\u0434\u0435\u0442\u0435 \u0438\u0437\u0432\u044a\u0440\u0448\u0435\u043d\u0438 \u043c\u0435\u0434\u0438\u0446\u0438\u0441\u043a\u0438\/\u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u043d\u0438  \u0438\u0437\u0441\u043b\u0435\u0434\u0432\u0430\u043d\u0438\u044f.<\/p>\n<\/div><div class=\"clear\"><\/div><\/div><\/li><li id=\"field_36_117\" class=\"gfield gfield--type-form field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gform_form\"  data-field-class=\"gform_form\" data-js-reload=\"field_36_117\" ><label class='gfield_label gform-field-label' for='input_36_117'>\u0418\u0437\u0432\u044a\u0440\u0448\u0435\u043d\u0438 \u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u043d\u0438  \u0442\u0435\u0441\u0442\u043e\u0432\u0435\/\u043f\u0440\u043e\u0446\u0435\u0434\u0443\u0440\u0438 \u043f\u0440\u0435\u0434\u0438 \u0438 \u0441\u043b\u0435\u0434 \u0438\u0437\u0445\u043e\u0434\u0430:<\/label>                <link href=\"https:\/\/ajax.googleapis.com\/ajax\/libs\/jqueryui\/1.10.3\/themes\/ui-lightness\/jquery-ui.css\" rel=\"stylesheet\" type=\"text\/css\" \/>        <style type=\"text\/css\">            .gpnf-nested-entries { border-top: 1px solid #f7f7f7; min-width: 50%; border-spacing: 0; border-collapse: separate; }            .gpnf-nested-entries th,            .gpnf-nested-entries td { border-bottom: 1px solid #f7f7f7; padding: 4px 8px; }            .gpnf-nested-entries th { background-color: #f7f7f7; border-color: #eee; }            .gpnf-no-entries td { text-align: center; padding: 10px 0; }            .gpnf-row-actions ul { }            .gpnf-row-actions li { display: inline; }        <\/style>        <div class=\"gpnf-nested-entries-container\">                        <table class=\"gpnf-nested-entries\">                <thead>                    <tr>                                                     <th class=\"gpnf-field-78\">\u0418\u0437\u0432\u044a\u0440\u0448\u0435\u043d \u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u0435\u043d \u0442\u0435\u0441\u0442\/\u043f\u0440\u043e\u0446\u0435\u0434\u0443\u0440\u0430 \u043f\u0440\u0435\u0434\u0438 \u0438 \u0441\u043b\u0435\u0434 \u0438\u0437\u0445\u043e\u0434\u0430:<\/th>                                                <th class=\"gpnf-row-actions\">&nbsp;<\/th>                    <\/tr>                <\/thead>                <tbody data-bind=\"visible: entries().length > 0, foreach: entries\">                    <tr data-bind=\"attr: { 'data-entryid': id }\">                                                     <td class=\"gpnf-field\" data-bind=\"html: f78\">&nbsp;<\/td>                                                <td class=\"gpnf-row-actions\">                            <ul>                                <li><a href=\"#\" data-bind=\"click: $parent.editEntry\">\u0420\u0435\u0434\u0430\u043a\u0442\u0438\u0440\u0430\u0439<\/a><\/li>                                <li><a href=\"#\" data-bind=\"click: $parent.deleteEntry\">\u0418\u0437\u0442\u0440\u0438\u0439<\/a><\/li>                            <\/ul>                        <\/td>                    <\/tr>                <\/tbody>                <tbody data-bind=\"visible: entries().length <= 0\">                    <tr class=\"gpnf-no-entries\" data-bind=\"visible: entries().length <= 0\">                        <td colspan=\"2\"><\/td>                    <\/tr>                <\/tbody>            <\/table>                                    <button class=\"gpnf-add-entry\"  data-formid=\"36\" data-nestedformid=\"39\">\u0414\u043e\u0431\u0430\u0432\u0438<\/button>                        <input type=\"hidden\"                 name=\"input_117\"                 id=\"input_36_117\"                 data-bind=\"value: entryIds\"                value=\"\" \/>                    <\/div>                <\/li><li id=\"field_36_118\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_118\" ><div style=\"display:block;margin-left:20px;\">\u0410\u043a\u043e \u0435 \u043d\u0435\u043e\u0431\u0445\u043e\u0434\u0438\u043c\u043e \u043c\u043e\u0436\u0435 \u0434\u0430 \u0441\u0435 \u0432\u044a\u0432\u0435\u0434\u0435 \u043f\u043e\u0432\u0435\u0447\u0435 \u043e\u0442 \u0435\u0434\u043d\u043e \u0438\u0437\u0432\u044a\u0440\u0448\u0435\u043d\u043e \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u043e\/\u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u043d\u043e \u0438\u0437\u0441\u043b\u0435\u0434\u0432\u0430\u043d\u0435.<\/div><\/li><li id=\"field_36_136\" class=\"gfield gfield--type-html space_tab gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_136\" ><\/li><\/ul>\r\n                    <\/div>\r\n                    <div class='gform_page_footer top_label'>\r\n                        <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_prev.png' id='gform_previous_button_36_120' class='gform_previous_button gform-theme-button gform-theme-button--secondary button gform_image_button' alt='\u041f\u0440\u0435\u0434\u0438\u0448\u043d\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"8\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"8\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_next.png' id='gform_next_button_36_120' class='gform_next_button gform-theme-button button gform_image_button' alt='\u0421\u043b\u0435\u0434\u0432\u0430\u0449\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"10\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"10\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> \r\n                    <\/div>\r\n                <\/div>\r\n                <div id='gform_page_36_10' class='gform_page' data-js='page-field-id-120' style='display:none;'>\r\n                    <div class='gform_page_fields'>\r\n                        <ul id='gform_fields_36_10' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_36_119\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_119\" ><div class=\"title_forms\">10. \u041d\u0430\u0447\u0438\u043d \u043d\u0430 \u0440\u0430\u0436\u0434\u0430\u043d\u0435<\/div>\n<div class=\"gfield grey\"><div class=\"left\" style=\"width:820px\"><\/li><li id=\"field_36_159\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_159\" ><label class='gfield_label gform-field-label' >\u041d\u0430\u0447\u0438\u043d \u043d\u0430 \u0440\u0430\u0436\u0434\u0430\u043d\u0435:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_36_159'>\r\n\t\t\t<li class='gchoice gchoice_36_159_0'>\r\n\t\t\t\t<input name='input_159' type='radio' value='\u0421\u043f\u043e\u043d\u0442\u0430\u043d\u043d\u043e \u0432\u0430\u0433\u0438\u043d\u0430\u043b\u043d\u043e \u0440\u0430\u0436\u0434\u0430\u043d\u0435'  id='choice_36_159_0'    \/>\r\n\t\t\t\t<label for='choice_36_159_0' id='label_36_159_0' class='gform-field-label gform-field-label--type-inline'>\u0421\u043f\u043e\u043d\u0442\u0430\u043d\u043d\u043e \u0432\u0430\u0433\u0438\u043d\u0430\u043b\u043d\u043e \u0440\u0430\u0436\u0434\u0430\u043d\u0435<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_159_1'>\r\n\t\t\t\t<input name='input_159' type='radio' value='\u0424\u043e\u0440\u0446\u0435\u043f\u0441\/\u0412\u0430\u043a\u0443\u0443\u043c (\u0438\u043d\u0441\u0442\u0440\u0443\u043c\u0435\u043d\u0442\u0430\u043b\u043d\u043e)'  id='choice_36_159_1'    \/>\r\n\t\t\t\t<label for='choice_36_159_1' id='label_36_159_1' class='gform-field-label gform-field-label--type-inline'>\u0424\u043e\u0440\u0446\u0435\u043f\u0441\/\u0412\u0430\u043a\u0443\u0443\u043c (\u0438\u043d\u0441\u0442\u0440\u0443\u043c\u0435\u043d\u0442\u0430\u043b\u043d\u043e)<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_159_2'>\r\n\t\t\t\t<input name='input_159' type='radio' value='\u0421\u0435\u043a\u0446\u0438\u043e (\u0446\u0435\u0437\u0430\u0440\u043e\u0432\u043e \u0441\u0435\u0447\u0435\u043d\u0438\u0435)'  id='choice_36_159_2'    \/>\r\n\t\t\t\t<label for='choice_36_159_2' id='label_36_159_2' class='gform-field-label gform-field-label--type-inline'>\u0421\u0435\u043a\u0446\u0438\u043e (\u0446\u0435\u0437\u0430\u0440\u043e\u0432\u043e \u0441\u0435\u0447\u0435\u043d\u0438\u0435)<\/label>\r\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_160\" class=\"gfield gfield--type-html space_tab gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_160\" ><\/li><\/ul>\r\n                    <\/div>\r\n                    <div class='gform_page_footer top_label'>\r\n                        <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_prev.png' id='gform_previous_button_36_161' class='gform_previous_button gform-theme-button gform-theme-button--secondary button gform_image_button' alt='\u041f\u0440\u0435\u0434\u0438\u0448\u043d\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"9\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"9\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_next.png' id='gform_next_button_36_161' class='gform_next_button gform-theme-button button gform_image_button' alt='\u0421\u043b\u0435\u0434\u0432\u0430\u0449\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"11\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"11\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> \r\n                    <\/div>\r\n                <\/div>\r\n                <div id='gform_page_36_11' class='gform_page' data-js='page-field-id-161' style='display:none;'>\r\n                    <div class='gform_page_fields'>\r\n                        <ul id='gform_fields_36_11' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_36_162\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_162\" ><div class=\"title_forms\">11. \u0418\u0437\u0445\u043e\u0434 \u043e\u0442 \u0440\u0430\u0436\u0434\u0430\u043d\u0435\u0442\u043e<\/div>\n<div class=\"gfield grey\"><div class=\"left\" style=\"width:820px;text-align:justify\">\n<\/div><div class=\"clear\"><\/div><\/div><\/li><li id=\"field_36_187\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_187\" ><label class='gfield_label gform-field-label' for='input_36_187'>\u0411\u0440\u043e\u0439 \u043f\u043b\u043e\u0434\/\u0431\u0435\u0431\u0435:<\/label><div class='ginput_container ginput_container_text'><input name='input_187' id='input_36_187' type='text' value='' class='small'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_196\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_196\" ><label class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_196'><li class='gchoice gchoice_36_196_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_196.1' type='checkbox'  value='\u043d\u043e\u0440\u043c\u0430\u043b\u043d\u043e'  id='choice_36_196_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_196_1' id='label_36_196_1' class='gform-field-label gform-field-label--type-inline'>\u043d\u043e\u0440\u043c\u0430\u043b\u043d\u043e<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_197\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_197\" ><label class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' >\u041f\u043e\u043c\u043e\u0449\n\n\u0412\u0440\u043e\u0434\u0435\u043d\u0438 \u0434\u0435\u0444\u0435\u043a\u0442\u0438\/\u0430\u043d\u043e\u043c\u0430\u043b\u0438\u0438 \u0438 \u0434\u0440\u0443\u0433\u0438 \u0441\u044a\u0431\u0438\u0442\u0438\u044f \u0441 \u043f\u043b\u043e\u0434\u0430\/\u0431\u0435\u0431\u0435\u0442\u043e<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_197'><li class='gchoice gchoice_36_197_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_197.1' type='checkbox'  value='\u0430\u043d\u043e\u0440\u043c\u0430\u043b\u043d\u043e'  id='choice_36_197_1'   aria-describedby=\"gfield_description_36_197\"\/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_197_1' id='label_36_197_1' class='gform-field-label gform-field-label--type-inline'>\u0430\u043d\u043e\u0440\u043c\u0430\u043b\u043d\u043e<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_36_197'><div class=\"help\" onmouseover='jQuery(this).find(\".help_info\").css(\"display\",\"block\");' onmouseout='jQuery(this).find(\".help_info\").css(\"display\",\"none\");'>\n<div class=\"help_title\" >\u041f\u043e\u043c\u043e\u0449<\/div>\n<div class=\"clear\"><\/div>\n<div class=\"help_info\">\u0412\u0440\u043e\u0434\u0435\u043d\u0438 \u0434\u0435\u0444\u0435\u043a\u0442\u0438\/\u0430\u043d\u043e\u043c\u0430\u043b\u0438\u0438 \u0438 \u0434\u0440\u0443\u0433\u0438 \u0441\u044a\u0431\u0438\u0442\u0438\u044f \u0441 \u043f\u043b\u043e\u0434\u0430\/\u0431\u0435\u0431\u0435\u0442\u043e<\/div>\n<\/div><\/div><\/li><li id=\"field_36_190\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_190\" ><label class='gfield_label gform-field-label' for='input_36_190'>\u041c\u043e\u043b\u044f, \u0443\u0442\u043e\u0447\u043d\u0435\u0442\u0435:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_190' id='input_36_190' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_198\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_198\" ><label class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_198'><li class='gchoice gchoice_36_198_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_198.1' type='checkbox'  value='\u043d\u0435\u0438\u0437\u0432\u0435\u0441\u0442\u043d\u043e'  id='choice_36_198_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_198_1' id='label_36_198_1' class='gform-field-label gform-field-label--type-inline'>\u043d\u0435\u0438\u0437\u0432\u0435\u0441\u0442\u043d\u043e<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_199\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_199\" ><label class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_199'><li class='gchoice gchoice_36_199_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_199.1' type='checkbox'  value='\u043c\u044a\u0440\u0442\u0432\u043e\u0440\u043e\u0434\u0435\u043d\u043e'  id='choice_36_199_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_199_1' id='label_36_199_1' class='gform-field-label gform-field-label--type-inline'>\u043c\u044a\u0440\u0442\u0432\u043e\u0440\u043e\u0434\u0435\u043d\u043e<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_193\" class=\"gfield gfield--type-post_custom_field gfield--input-type-date gfield--input-type-datedropdown gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_193\" ><label class='gfield_label gform-field-label' >\u0414\u0430\u0442\u0430:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_36_193' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\"><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_36_193_1_container'><select name='input_193[]' id='input_36_193_1'   aria-required='true'  ><option value=''>MM<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_36_193_2_container'><select name='input_193[]' id='input_36_193_2'   aria-required='true'  ><option value=''>DD<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_36_193_3_container'><select name='input_193[]' id='input_36_193_3'   aria-required='true'  ><option value=''>YYYY<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/div><\/li><li id=\"field_36_194\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_194\" ><label class='gfield_label gform-field-label' for='input_36_194'>\u041f\u0440\u0438\u0447\u0438\u043d\u0430 \u0437\u0430 \u0441\u043c\u044a\u0440\u0442\u0442\u0430:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_194' id='input_36_194' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_195\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_195\" ><label class='gfield_label gform-field-label' for='input_36_195'>\u0420\u0435\u0437\u0443\u043b\u0442\u0430\u0442\u0438 \u043e\u0442 \u0430\u0443\u0442\u043e\u043f\u0441\u0438\u044f\u0442\u0430:<\/label><div class='ginput_container ginput_container_text'><input name='input_195' id='input_36_195' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_200\" class=\"gfield gfield--type-html space_tab gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_200\" ><\/li><\/ul>\r\n                    <\/div>\r\n                    <div class='gform_page_footer top_label'>\r\n                        <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_prev.png' id='gform_previous_button_36_165' class='gform_previous_button gform-theme-button gform-theme-button--secondary button gform_image_button' alt='\u041f\u0440\u0435\u0434\u0438\u0448\u043d\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"10\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"10\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_next.png' id='gform_next_button_36_165' class='gform_next_button gform-theme-button button gform_image_button' alt='\u0421\u043b\u0435\u0434\u0432\u0430\u0449\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"12\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"12\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> \r\n                    <\/div>\r\n                <\/div>\r\n                <div id='gform_page_36_12' class='gform_page' data-js='page-field-id-165' style='display:none;'>\r\n                    <div class='gform_page_fields'>\r\n                        <ul id='gform_fields_36_12' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_36_166\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_166\" ><div class=\"title_forms\">12. \u0418\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f \u0437\u0430 \u0431\u0435\u0431\u0435\u0442\u043e<\/div>\n<div class=\"gfield grey\"><div class=\"left\" style=\"width:820px\">\n<p>K\u043b\u0438\u043a\u043d\u0435\u0442\u0435 \u0432\u044a\u0440\u0445\u0443 \u0431\u0443\u0442\u043e\u043d\u0430 \"\u0414\u043e\u0431\u0430\u0432\u0438\", \u0437\u0430 \u0434\u0430 \u0432\u044a\u0432\u0435\u0434\u0435\u0442\u0435 \u0434\u0430\u043d\u043d\u0438 \u0437\u0430 \u0431\u0435\u0431\u0435\u0442\u043e.<\/p>\n<\/div><div class=\"clear\"><\/div><\/div><\/li><li id=\"field_36_168\" class=\"gfield gfield--type-form field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gform_form\"  data-field-class=\"gform_form\" data-js-reload=\"field_36_168\" ><label class='gfield_label gform-field-label' for='input_36_168'>\u0418\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f \u0437\u0430 \u0431\u0435\u0431\u0435\u0442\u043e:<\/label>                <link href=\"https:\/\/ajax.googleapis.com\/ajax\/libs\/jqueryui\/1.10.3\/themes\/ui-lightness\/jquery-ui.css\" rel=\"stylesheet\" type=\"text\/css\" \/>        <style type=\"text\/css\">            .gpnf-nested-entries { border-top: 1px solid #f7f7f7; min-width: 50%; border-spacing: 0; border-collapse: separate; }            .gpnf-nested-entries th,            .gpnf-nested-entries td { border-bottom: 1px solid #f7f7f7; padding: 4px 8px; }            .gpnf-nested-entries th { background-color: #f7f7f7; border-color: #eee; }            .gpnf-no-entries td { text-align: center; padding: 10px 0; }            .gpnf-row-actions ul { }            .gpnf-row-actions li { display: inline; }        <\/style>        <div class=\"gpnf-nested-entries-container\">                        <table class=\"gpnf-nested-entries\">                <thead>                    <tr>                                                     <th class=\"gpnf-field-80\">\u041f\u043e\u043b:<\/th>                                                <th class=\"gpnf-row-actions\">&nbsp;<\/th>                    <\/tr>                <\/thead>                <tbody data-bind=\"visible: entries().length > 0, foreach: entries\">                    <tr data-bind=\"attr: { 'data-entryid': id }\">                                                     <td class=\"gpnf-field\" data-bind=\"html: f80\">&nbsp;<\/td>                                                <td class=\"gpnf-row-actions\">                            <ul>                                <li><a href=\"#\" data-bind=\"click: $parent.editEntry\">\u0420\u0435\u0434\u0430\u043a\u0442\u0438\u0440\u0430\u0439<\/a><\/li>                                <li><a href=\"#\" data-bind=\"click: $parent.deleteEntry\">\u0418\u0437\u0442\u0440\u0438\u0439<\/a><\/li>                            <\/ul>                        <\/td>                    <\/tr>                <\/tbody>                <tbody data-bind=\"visible: entries().length <= 0\">                    <tr class=\"gpnf-no-entries\" data-bind=\"visible: entries().length <= 0\">                        <td colspan=\"2\"><\/td>                    <\/tr>                <\/tbody>            <\/table>                                    <button class=\"gpnf-add-entry\"  data-formid=\"36\" data-nestedformid=\"41\">\u0414\u043e\u0431\u0430\u0432\u0438<\/button>                        <input type=\"hidden\"                 name=\"input_168\"                 id=\"input_36_168\"                 data-bind=\"value: entryIds\"                value=\"\" \/>                    <\/div>                <\/li><li id=\"field_36_167\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_167\" ><div style=\"display:block;margin-left:20px;\">\u0410\u043a\u043e \u0435 \u043d\u0435\u043e\u0431\u0445\u043e\u0434\u0438\u043c\u043e \u043c\u043e\u0436\u0435 \u0434\u0430 \u0441\u0435 \u0432\u044a\u0432\u0435\u0434\u044a\u0442 \u0434\u0430\u043d\u043d\u0438 \u0437\u0430 \u043f\u043e\u0432\u0435\u0447\u0435 \u043e\u0442 \u0435\u0434\u043d\u043e \u0431\u0435\u0431\u0435.<\/div><\/li><\/ul>\r\n                    <\/div>\r\n                    <div class='gform_page_footer top_label'>\r\n                        <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_prev.png' id='gform_previous_button_36_169' class='gform_previous_button gform-theme-button gform-theme-button--secondary button gform_image_button' alt='\u041f\u0440\u0435\u0434\u0438\u0448\u043d\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"11\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"11\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_next.png' id='gform_next_button_36_169' class='gform_next_button gform-theme-button button gform_image_button' alt='\u0421\u043b\u0435\u0434\u0432\u0430\u0449\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"13\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"13\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> \r\n                    <\/div>\r\n                <\/div>\r\n                <div id='gform_page_36_13' class='gform_page' data-js='page-field-id-169' style='display:none;'>\r\n                    <div class='gform_page_fields'>\r\n                        <ul id='gform_fields_36_13' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_36_170\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_170\" ><div class=\"title_forms\">13. \u041d\u0430\u043f\u0440\u0430\u0432\u0435\u043d\u0438 \u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u043d\u0438  \u0438\/\u0438\u043b\u0438 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0438 \u0442\u0435\u0441\u0442\u043e\u0432\u0435\/\u0438\u0437\u0441\u043b\u0435\u0434\u0432\u0430\u043d\u0438\u044f\/\u043f\u0440\u043e\u0446\u0435\u0434\u0443\u0440\u0438 \u043d\u0430 \u0431\u0435\u0431\u0435\u0442\u043e\/\u043f\u043b\u043e\u0434\u0430<\/div>\n<div class=\"gfield grey\"><div class=\"left\" style=\"width:820px\">\u041c\u043e\u043b\u044f, \u0438\u0437\u043f\u043e\u043b\u0437\u0432\u0430\u0439\u0442\u0435 \u043f\u043e\u043b\u0435\u0442\u0430\u0442\u0430 \u043f\u043e-\u0434\u043e\u043b\u0443 \u0437\u0430 \u0434\u0430 \u043f\u0440\u0435\u0434\u043e\u0441\u0442\u0430\u0432\u0438\u0442\u0435 \u0432\u0441\u044f\u043a\u0430 \u0434\u043e\u0441\u0442\u044a\u043f\u043d\u0430 \u0434\u043e\u043f\u044a\u043b\u043d\u0438\u0442\u0435\u043b\u043d\u0430 \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f \u043e\u0442\u043d\u043e\u0441\u043d\u043e \u043d\u0430\u043f\u0440\u0430\u0432\u0435\u043d\u0438 \u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u043d\u0438  \u0438\/\u0438\u043b\u0438 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0438 \u0442\u0435\u0441\u0442\u043e\u0432\u0435\/\u0438\u0437\u0441\u043b\u0435\u0434\u0432\u0430\u043d\u0438\u044f\/\u043f\u0440\u043e\u0446\u0435\u0434\u0443\u0440\u0438.<\/p>\n<p>K\u043b\u0438\u043a\u043d\u0435\u0442\u0435 \u0432\u044a\u0440\u0445\u0443 \u0431\u0443\u0442\u043e\u043d\u0430 \"\u0414\u043e\u0431\u0430\u0432\u0438\", \u0437\u0430 \u0434\u0430 \u0432\u044a\u0432\u0435\u0434\u0435\u0442\u0435 \u0438\u0437\u0432\u044a\u0440\u0448\u0435\u043d\u0438 \u043c\u0435\u0434\u0438\u0446\u0438\u0441\u043a\u0438\/\u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u043d\u0438  \u0438\u0437\u0441\u043b\u0435\u0434\u0432\u0430\u043d\u0438\u044f.<\/p>\n<\/div><div class=\"clear\"><\/div><\/div><\/li><li id=\"field_36_172\" class=\"gfield gfield--type-form field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gform_form\"  data-field-class=\"gform_form\" data-js-reload=\"field_36_172\" ><label class='gfield_label gform-field-label' for='input_36_172'>\u041d\u0430\u043f\u0440\u0430\u0432\u0435\u043d\u0438 \u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u043d\u0438  \u0438\/\u0438\u043b\u0438 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0438 \u0442\u0435\u0441\u0442\u043e\u0432\u0435\/\u0438\u0437\u0441\u043b\u0435\u0434\u0432\u0430\u043d\u0438\u044f\/\u043f\u0440\u043e\u0446\u0435\u0434\u0443\u0440\u0438 \u043d\u0430 \u0431\u0435\u0431\u0435\u0442\u043e\/\u043f\u043b\u043e\u0434\u0430:<\/label>                <link href=\"https:\/\/ajax.googleapis.com\/ajax\/libs\/jqueryui\/1.10.3\/themes\/ui-lightness\/jquery-ui.css\" rel=\"stylesheet\" type=\"text\/css\" \/>        <style type=\"text\/css\">            .gpnf-nested-entries { border-top: 1px solid #f7f7f7; min-width: 50%; border-spacing: 0; border-collapse: separate; }            .gpnf-nested-entries th,            .gpnf-nested-entries td { border-bottom: 1px solid #f7f7f7; padding: 4px 8px; }            .gpnf-nested-entries th { background-color: #f7f7f7; border-color: #eee; }            .gpnf-no-entries td { text-align: center; padding: 10px 0; }            .gpnf-row-actions ul { }            .gpnf-row-actions li { display: inline; }        <\/style>        <div class=\"gpnf-nested-entries-container\">                        <table class=\"gpnf-nested-entries\">                <thead>                    <tr>                                                     <th class=\"gpnf-field-78\">\u0418\u0437\u0432\u044a\u0440\u0448\u0435\u043d\u043e \u043c\u0435\u0434. \u0438\/\u0438\u043b\u0438 \u043b\u0430\u0431. \u0438\u0437\u0441\u043b\u0435\u0434\u0432\u0430\u043d\u0435 \u043d\u0430 \u0434\u0435\u0442\u0435\u0442\u043e\/\u043f\u043b\u043e\u0434\u0430:<\/th>                                                <th class=\"gpnf-row-actions\">&nbsp;<\/th>                    <\/tr>                <\/thead>                <tbody data-bind=\"visible: entries().length > 0, foreach: entries\">                    <tr data-bind=\"attr: { 'data-entryid': id }\">                                                     <td class=\"gpnf-field\" data-bind=\"html: f78\">&nbsp;<\/td>                                                <td class=\"gpnf-row-actions\">                            <ul>                                <li><a href=\"#\" data-bind=\"click: $parent.editEntry\">\u0420\u0435\u0434\u0430\u043a\u0442\u0438\u0440\u0430\u0439<\/a><\/li>                                <li><a href=\"#\" data-bind=\"click: $parent.deleteEntry\">\u0418\u0437\u0442\u0440\u0438\u0439<\/a><\/li>                            <\/ul>                        <\/td>                    <\/tr>                <\/tbody>                <tbody data-bind=\"visible: entries().length <= 0\">                    <tr class=\"gpnf-no-entries\" data-bind=\"visible: entries().length <= 0\">                        <td colspan=\"2\"><\/td>                    <\/tr>                <\/tbody>            <\/table>                                    <button class=\"gpnf-add-entry\"  data-formid=\"36\" data-nestedformid=\"42\">\u0414\u043e\u0431\u0430\u0432\u0438<\/button>                        <input type=\"hidden\"                 name=\"input_172\"                 id=\"input_36_172\"                 data-bind=\"value: entryIds\"                value=\"\" \/>                    <\/div>                <\/li><li id=\"field_36_171\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_171\" ><div style=\"display:block;margin-left:20px;\">\u0410\u043a\u043e \u0435 \u043d\u0435\u043e\u0431\u0445\u043e\u0434\u0438\u043c\u043e \u043c\u043e\u0436\u0435 \u0434\u0430 \u0441\u0435 \u0432\u044a\u0432\u0435\u0434\u044a\u0442 \u043f\u043e\u0432\u0435\u0447\u0435 \u043e\u0442 \u0435\u0434\u0438\u043d \u0438\u0437\u0432\u044a\u0440\u0448\u0435\u043d \u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u0435\u043d \u0442\u0435\u0441\u0442\/\u043f\u0440\u043e\u0446\u0435\u0434\u0443\u0440\u0430 \u043d\u0430 \u0434\u0435\u0442\u0435\u0442\u043e\/\u043f\u043b\u043e\u0434\u0430.<\/div><\/li><\/ul>\r\n                    <\/div>\r\n                    <div class='gform_page_footer top_label'>\r\n                        <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_prev.png' id='gform_previous_button_36_174' class='gform_previous_button gform-theme-button gform-theme-button--secondary button gform_image_button' alt='\u041f\u0440\u0435\u0434\u0438\u0448\u043d\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"12\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"12\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_next.png' id='gform_next_button_36_174' class='gform_next_button gform-theme-button button gform_image_button' alt='\u0421\u043b\u0435\u0434\u0432\u0430\u0449\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"14\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"14\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> \r\n                    <\/div>\r\n                <\/div>\r\n                <div id='gform_page_36_14' class='gform_page' data-js='page-field-id-174' style='display:none;'>\r\n                    <div class='gform_page_fields'>\r\n                        <ul id='gform_fields_36_14' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_36_173\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_173\" ><div class=\"title_forms\">14. \u0414\u043e\u043f\u044a\u043b\u043d\u0438\u0442\u0435\u043b\u043d\u0430 \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f<\/div>\n<div class=\"gfield grey\"><div class=\"left\" style=\"width:820px\">\n<\/div><div class=\"clear\"><\/div><\/div><\/li><li id=\"field_36_176\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_176\" ><label class='gfield_label gform-field-label' for='input_36_176'>\u041c\u043e\u043b\u044f, \u043f\u0440\u0435\u0434\u043e\u0441\u0442\u0430\u0432\u0435\u0442\u0435 \u0432\u0441\u044f\u043a\u0430 \u0434\u0440\u0443\u0433\u0430 \u043f\u043e\u043b\u0435\u0437\u043d\u0430 \u0438 \u0434\u043e\u0441\u0442\u044a\u043f\u043d\u0430 \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_176' id='input_36_176' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_36_181\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_181\" ><label class='gfield_label gform-field-label' >\u0412 \u0441\u043b\u0443\u0447\u0430\u0439, \u0447\u0435 \u0438\u043c\u0430\u043c\u0435 \u043d\u0443\u0436\u0434\u0430 \u043e\u0442 \u0434\u043e\u043f\u044a\u043b\u043d\u0438\u0442\u0435\u043b\u043d\u0430 \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f \u0438\u043b\u0438 \u0440\u0430\u0437\u044f\u0441\u043d\u0435\u043d\u0438\u0435 \u043f\u043e \u0432\u0430\u0448\u0435\u0442\u043e \u0441\u044a\u043e\u0431\u0449\u0435\u043d\u0438\u0435, \u0441\u044a\u0433\u043b\u0430\u0441\u043d\u0438 \u043b\u0438 \u0441\u0442\u0435 \u0434\u0430 \u0441\u0435 \u0441\u0432\u044a\u0440\u0436\u0435\u043c \u0441 \u0432\u0430\u0441:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_36_181'>\r\n\t\t\t<li class='gchoice gchoice_36_181_0'>\r\n\t\t\t\t<input name='input_181' type='radio' value='\u0414\u0430'  id='choice_36_181_0'    \/>\r\n\t\t\t\t<label for='choice_36_181_0' id='label_36_181_0' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_36_181_1'>\r\n\t\t\t\t<input name='input_181' type='radio' value='\u041d\u0435'  id='choice_36_181_1'    \/>\r\n\t\t\t\t<label for='choice_36_181_1' id='label_36_181_1' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_175\" class=\"gfield gfield--type-html space_tab gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_175\" ><\/li><\/ul>\r\n                    <\/div>\r\n                    <div class='gform_page_footer top_label'>\r\n                        <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_prev.png' id='gform_previous_button_36_231' class='gform_previous_button gform-theme-button gform-theme-button--secondary button gform_image_button' alt='\u041f\u0440\u0435\u0434\u0438\u0448\u043d\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"13\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"13\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_next.png' id='gform_next_button_36_231' class='gform_next_button gform-theme-button button gform_image_button' alt='\u0421\u043b\u0435\u0434\u0432\u0430\u0449\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"15\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"15\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> \r\n                    <\/div>\r\n                <\/div>\r\n                <div id='gform_page_36_15' class='gform_page' data-js='page-field-id-231' style='display:none;'>\r\n                    <div class='gform_page_fields'>\r\n                        <ul id='gform_fields_36_15' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_36_234\" class=\"gfield gfield--type-form field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gform_form\"  data-field-class=\"gform_form\" data-js-reload=\"field_36_234\" ><label class='gfield_label gform-field-label' for='input_36_234'>\u041f\u0420\u0415\u0414\u0418\u0428\u041d\u041e \u041b\u0415\u0427\u0415\u041d\u0418\u0415 \u041d\u0410 \u0410\u041a\u041d\u0415<\/label>                <link href=\"https:\/\/ajax.googleapis.com\/ajax\/libs\/jqueryui\/1.10.3\/themes\/ui-lightness\/jquery-ui.css\" rel=\"stylesheet\" type=\"text\/css\" \/>        <style type=\"text\/css\">            .gpnf-nested-entries { border-top: 1px solid #f7f7f7; min-width: 50%; border-spacing: 0; border-collapse: separate; }            .gpnf-nested-entries th,            .gpnf-nested-entries td { border-bottom: 1px solid #f7f7f7; padding: 4px 8px; }            .gpnf-nested-entries th { background-color: #f7f7f7; border-color: #eee; }            .gpnf-no-entries td { text-align: center; padding: 10px 0; }            .gpnf-row-actions ul { }            .gpnf-row-actions li { display: inline; }        <\/style>        <div class=\"gpnf-nested-entries-container\">                        <table class=\"gpnf-nested-entries\">                <thead>                    <tr>                                                     <th class=\"gpnf-field-1\">\u0418\u043c\u0435 \u043d\u0430 \u043f\u0440\u043e\u0434\u0443\u043a\u0442\u0430<\/th>                                                <th class=\"gpnf-row-actions\">&nbsp;<\/th>                    <\/tr>                <\/thead>                <tbody data-bind=\"visible: entries().length > 0, foreach: entries\">                    <tr data-bind=\"attr: { 'data-entryid': id }\">                                                     <td class=\"gpnf-field\" data-bind=\"html: f1\">&nbsp;<\/td>                                                <td class=\"gpnf-row-actions\">                            <ul>                                <li><a href=\"#\" data-bind=\"click: $parent.editEntry\">\u0420\u0435\u0434\u0430\u043a\u0442\u0438\u0440\u0430\u0439<\/a><\/li>                                <li><a href=\"#\" data-bind=\"click: $parent.deleteEntry\">\u0418\u0437\u0442\u0440\u0438\u0439<\/a><\/li>                            <\/ul>                        <\/td>                    <\/tr>                <\/tbody>                <tbody data-bind=\"visible: entries().length <= 0\">                    <tr class=\"gpnf-no-entries\" data-bind=\"visible: entries().length <= 0\">                        <td colspan=\"2\"><\/td>                    <\/tr>                <\/tbody>            <\/table>                                    <button class=\"gpnf-add-entry\"  data-formid=\"36\" data-nestedformid=\"56\">\u0414\u043e\u0431\u0430\u0432\u0438<\/button>                        <input type=\"hidden\"                 name=\"input_234\"                 id=\"input_36_234\"                 data-bind=\"value: entryIds\"                value=\"\" \/>                    <\/div>                <\/li><li id=\"field_36_235\" class=\"gfield gfield--type-html space_tab gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_235\" ><\/li><li id=\"field_36_236\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_236\" ><span style=\"margin-left:30px;\"><strong>\u041f\u0420\u041e\u0412\u0415\u0420\u041a\u0410 \u0417\u0410 \u041f\u0420\u0415\u0412\u0415\u041d\u0426\u0418\u042f \u041d\u0410 \u0411\u0420\u0415\u041c\u0415\u041d\u041d\u041e\u0421\u0422<\/strong><\/span><\/li><li id=\"field_36_237\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_237\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u0418\u0437\u0432\u044a\u0440\u0448\u0435\u043d\u0430 \u043b\u0438 \u0435 \u043a\u043e\u043d\u0441\u0443\u043b\u0442\u0430\u0446\u0438\u044f \u043e\u0442\u043d\u043e\u0441\u043d\u043e \u0440\u0438\u0441\u043a\u043e\u0432\u0435\u0442\u0435 \u043e\u0442 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442 \u043f\u043e \u0432\u0440\u0435\u043c\u0435 \u043d\u0430 \u0442\u0435\u0440\u0430\u043f\u0438\u044f\u0442\u0430 \u0441 Roaccutane \u0438 \u043c\u0435\u0442\u043e\u0434\u0438\u0442\u0435 \u043d\u0430 \u043a\u043e\u043d\u0442\u0440\u0430\u0446\u0435\u043f\u0446\u0438\u044f \u043f\u0440\u0435\u0434\u0438 \u0441\u0442\u0430\u0440\u0442\u0438\u0440\u0430\u043d\u0435 \u043f\u0440\u0438\u0435\u043c\u0430 \u043d\u0430 Roaccutane?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_237'><li class='gchoice gchoice_36_237_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_237.1' type='checkbox'  value='\u0418\u0437\u0432\u044a\u0440\u0448\u0435\u043d\u043e'  id='choice_36_237_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_237_1' id='label_36_237_1' class='gform-field-label gform-field-label--type-inline'>\u0418\u0437\u0432\u044a\u0440\u0448\u0435\u043d\u043e<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_237_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_237.2' type='checkbox'  value='\u041d\u0435 \u0435 \u0438\u0437\u0432\u044a\u0440\u0448\u0435\u043d\u043e'  id='choice_36_237_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_237_2' id='label_36_237_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435 \u0435 \u0438\u0437\u0432\u044a\u0440\u0448\u0435\u043d\u043e<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_238\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_238\" ><label class='gfield_label gform-field-label' for='input_36_238'>\u0418\u0437\u0432\u044a\u0440\u0448\u0435\u043d\u043e \u043e\u0442:<\/label><div class='ginput_container ginput_container_text'><input name='input_238' id='input_36_238' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_239\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_239\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u041f\u0430\u0446\u0438\u0435\u043d\u0442\u044a\u0442 \u0431\u0438\u043b \u043b\u0438 \u0435 \u043d\u0430 \u043a\u043e\u0442\u0440\u0430\u0446\u0435\u043f\u0446\u0438\u044f \u043f\u0440\u0438 \u0437\u0430\u043f\u043e\u0447\u0432\u0430\u043d\u0435 \u043d\u0430 \u043b\u0435\u0447\u0435\u043d\u0438\u0435\u0442\u043e \u0441 Roaccutane?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_239'><li class='gchoice gchoice_36_239_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_239.1' type='checkbox'  value='\u0414\u0430'  id='choice_36_239_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_239_1' id='label_36_239_1' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_239_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_239.2' type='checkbox'  value='\u041d\u0435'  id='choice_36_239_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_239_2' id='label_36_239_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_240\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_240\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Baseline \u0442\u0435\u0441\u0442 \u0437\u0430 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442 \u0437\u0430 \u043a\u043b\u0430\u0441\u0438\u0444\u0438\u0446\u0438\u0440\u0430\u043d\u0435 \u0437\u0430 \u0442\u0435\u0440\u0430\u043f\u0438\u044f \u0441 Roaccutane?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_240'><li class='gchoice gchoice_36_240_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_240.1' type='checkbox'  value='\u0414\u0430'  id='choice_36_240_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_240_1' id='label_36_240_1' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_240_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_240.2' type='checkbox'  value='\u041d\u0435'  id='choice_36_240_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_240_2' id='label_36_240_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_241\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_241\" ><label class='gfield_label gform-field-label' for='input_36_241'>\u0412\u0438\u0434:<\/label><div class='ginput_container ginput_container_text'><input name='input_241' id='input_36_241' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_242\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_242\" ><label class='gfield_label gform-field-label' for='input_36_242'>\u0414\u0430\u0442\u0430<\/label><div class='ginput_container ginput_container_date'>\r\n                            <input name='input_242' id='input_36_242' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_no_icon gdatepicker-no-icon'   placeholder='dd.mm.yyyy' aria-describedby=\"input_36_242_date_format\" aria-invalid=\"false\" \/>\r\n                            <span id='input_36_242_date_format' class='screen-reader-text'>DD dot MM dot YYYY<\/span>\r\n                        <\/div>\r\n                        <input type='hidden' id='gforms_calendar_icon_input_36_242' class='gform_hidden' value='https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_36_243\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_243\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u041f\u0440\u0430\u0432\u0435\u043d\u0438 \u043b\u0438 \u0441\u0430 \u043c\u0435\u0441\u0435\u0447\u043d\u0438 \u043a\u043e\u043d\u0442\u0440\u043e\u043b\u0438?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_243'><li class='gchoice gchoice_36_243_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_243.1' type='checkbox'  value='\u0414\u0430'  id='choice_36_243_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_243_1' id='label_36_243_1' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_243_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_243.2' type='checkbox'  value='\u041d\u0435'  id='choice_36_243_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_243_2' id='label_36_243_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_243_3'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_243.3' type='checkbox'  value='\u041d\u0435 \u0435 \u043f\u0440\u0438\u043b\u043e\u0436\u0438\u043c\u043e'  id='choice_36_243_3'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_243_3' id='label_36_243_3' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435 \u0435 \u043f\u0440\u0438\u043b\u043e\u0436\u0438\u043c\u043e<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_244\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_244\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u041f\u0440\u0430\u0432\u0435\u043d \u043b\u0438 \u0435 \u043a\u043e\u043d\u0442\u0440\u043e\u043b\u0435\u043d \u043c\u0435\u0441\u0435\u0447\u0435\u043d \u0442\u0435\u0441\u0442 \u0437\u0430 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_244'><li class='gchoice gchoice_36_244_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_244.1' type='checkbox'  value='\u0414\u0430'  id='choice_36_244_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_244_1' id='label_36_244_1' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_244_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_244.2' type='checkbox'  value='\u041d\u0435'  id='choice_36_244_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_244_2' id='label_36_244_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_244_3'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_244.3' type='checkbox'  value='\u041d\u0435 \u0435 \u043f\u0440\u0438\u043b\u043e\u0436\u0438\u043c\u043e'  id='choice_36_244_3'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_244_3' id='label_36_244_3' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435 \u0435 \u043f\u0440\u0438\u043b\u043e\u0436\u0438\u043c\u043e<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_245\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_245\" ><label class='gfield_label gform-field-label' for='input_36_245'>\u0412\u0438\u0434:<\/label><div class='ginput_container ginput_container_text'><input name='input_245' id='input_36_245' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_246\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_246\" ><label class='gfield_label gform-field-label' for='input_36_246'>\u0414\u0430\u0442\u0430<\/label><div class='ginput_container ginput_container_date'>\r\n                            <input name='input_246' id='input_36_246' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_no_icon gdatepicker-no-icon'   placeholder='dd.mm.yyyy' aria-describedby=\"input_36_246_date_format\" aria-invalid=\"false\" \/>\r\n                            <span id='input_36_246_date_format' class='screen-reader-text'>DD dot MM dot YYYY<\/span>\r\n                        <\/div>\r\n                        <input type='hidden' id='gforms_calendar_icon_input_36_246' class='gform_hidden' value='https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_36_247\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_247\" ><label class='gfield_label gform-field-label' for='input_36_247'>\u0420\u0435\u0437\u0443\u043b\u0442\u0430\u0442:<\/label><div class='ginput_container ginput_container_text'><input name='input_247' id='input_36_247' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_248\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_248\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u041d\u0430\u043f\u0440\u0430\u0432\u0435\u043d \u043b\u0438 \u0435 \u0442\u0435\u0441\u0442 \u0437\u0430 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442 5 \u0441\u0435\u0434\u043c\u0438\u0446\u0438 \u0441\u043b\u0435\u0434 \u043f\u0440\u0435\u043a\u0440\u0430\u0442\u044f\u0432\u0430\u043d\u0435 \u043d\u0430 \u0442\u0435\u0440\u0430\u043f\u0438\u044f\u0442\u0430 \u0441 Roaccutane?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_248'><li class='gchoice gchoice_36_248_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_248.1' type='checkbox'  value='\u0414\u0430'  id='choice_36_248_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_248_1' id='label_36_248_1' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_248_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_248.2' type='checkbox'  value='\u041d\u0435'  id='choice_36_248_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_248_2' id='label_36_248_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_248_3'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_248.3' type='checkbox'  value='\u041d\u0435 \u0435 \u043f\u0440\u0438\u043b\u043e\u0436\u0438\u043c\u043e'  id='choice_36_248_3'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_248_3' id='label_36_248_3' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435 \u0435 \u043f\u0440\u0438\u043b\u043e\u0436\u0438\u043c\u043e<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_249\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_249\" ><label class='gfield_label gform-field-label' for='input_36_249'>\u0412\u0438\u0434:<\/label><div class='ginput_container ginput_container_text'><input name='input_249' id='input_36_249' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_250\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_250\" ><label class='gfield_label gform-field-label' for='input_36_250'>\u0414\u0430\u0442\u0430<\/label><div class='ginput_container ginput_container_date'>\r\n                            <input name='input_250' id='input_36_250' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_no_icon gdatepicker-no-icon'   placeholder='dd.mm.yyyy' aria-describedby=\"input_36_250_date_format\" aria-invalid=\"false\" \/>\r\n                            <span id='input_36_250_date_format' class='screen-reader-text'>DD dot MM dot YYYY<\/span>\r\n                        <\/div>\r\n                        <input type='hidden' id='gforms_calendar_icon_input_36_250' class='gform_hidden' value='https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_36_251\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_251\" ><label class='gfield_label gform-field-label' for='input_36_251'>\u0420\u0435\u0437\u0443\u043b\u0442\u0430\u0442:<\/label><div class='ginput_container ginput_container_text'><input name='input_251' id='input_36_251' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_252\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_252\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u041f\u0430\u0446\u0438\u0435\u043d\u0442\u0430 \u0431\u0438\u043b \u043b\u0438 \u0435 \u043f\u0440\u0435\u0434\u0443\u043f\u0440\u0435\u0434\u0435\u043d \u0443\u0441\u0442\u043d\u043e \u0437\u0430 \u0440\u0438\u0441\u043a\u043e\u0432\u0435\u0442\u0435 \u043f\u0440\u0438 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_252'><li class='gchoice gchoice_36_252_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_252.1' type='checkbox'  value='\u0414\u0430'  id='choice_36_252_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_252_1' id='label_36_252_1' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_252_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_252.2' type='checkbox'  value='\u041d\u0435'  id='choice_36_252_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_252_2' id='label_36_252_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_253\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_253\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u041f\u0430\u0446\u0438\u0435\u043d\u0442\u044a\u0442 \u043f\u043e\u0434\u043f\u0438\u0441\u0430\u043b \u043b\u0438 \u0435 \u0444\u043e\u0440\u043c\u0443\u043b\u044f\u0440 \u0437\u0430 \u043f\u043e\u0442\u0432\u044a\u0440\u0436\u0434\u0435\u043d\u0438\u0435?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_253'><li class='gchoice gchoice_36_253_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_253.1' type='checkbox'  value='\u0414\u0430'  id='choice_36_253_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_253_1' id='label_36_253_1' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_253_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_253.2' type='checkbox'  value='\u041d\u0435'  id='choice_36_253_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_253_2' id='label_36_253_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_253_3'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_253.3' type='checkbox'  value='\u041d\u0435 \u0435 \u043f\u0440\u0438\u043b\u043e\u0436\u0438\u043c\u043e'  id='choice_36_253_3'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_253_3' id='label_36_253_3' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435 \u0435 \u043f\u0440\u0438\u043b\u043e\u0436\u0438\u043c\u043e<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_254\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_254\" ><label class='gfield_label gform-field-label' for='input_36_254'>\u0414\u0430\u0442\u0430<\/label><div class='ginput_container ginput_container_date'>\r\n                            <input name='input_254' id='input_36_254' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_no_icon gdatepicker-no-icon'   placeholder='dd.mm.yyyy' aria-describedby=\"input_36_254_date_format\" aria-invalid=\"false\" \/>\r\n                            <span id='input_36_254_date_format' class='screen-reader-text'>DD dot MM dot YYYY<\/span>\r\n                        <\/div>\r\n                        <input type='hidden' id='gforms_calendar_icon_input_36_254' class='gform_hidden' value='https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_36_255\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_255\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u041f\u0430\u0446\u0438\u0435\u043d\u0442\u044a\u0442 \u043f\u043e\u043b\u0443\u0447\u0438\u043b \u043b\u0438 \u0435 \u041f\u0430\u0446\u0438\u0435\u043d\u0442\u0441\u043a\u0430 \u0431\u0440\u043e\u0448\u0443\u0440\u0430 \u0437\u0430 \u043a\u043e\u043d\u0442\u0440\u0430\u0446\u0435\u043f\u0446\u0438\u044f?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_255'><li class='gchoice gchoice_36_255_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_255.1' type='checkbox'  value='\u0414\u0430'  id='choice_36_255_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_255_1' id='label_36_255_1' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_255_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_255.2' type='checkbox'  value='\u041d\u0435'  id='choice_36_255_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_255_2' id='label_36_255_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_256\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_256\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u041f\u0430\u0446\u0438\u0435\u043d\u0442\u044a\u0442 \u043f\u043e\u043b\u0443\u0447\u0438\u043b \u043b\u0438 \u0435 \u0411\u0440\u043e\u0448\u0443\u0440\u0430 \u0437\u0430 \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f \u043d\u0430 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_256'><li class='gchoice gchoice_36_256_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_256.1' type='checkbox'  value='\u0414\u0430'  id='choice_36_256_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_256_1' id='label_36_256_1' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_256_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_256.2' type='checkbox'  value='\u041d\u0435'  id='choice_36_256_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_256_2' id='label_36_256_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_257\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_257\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u041f\u0440\u0435\u0434\u043e\u0441\u0442\u0430\u0432\u0435\u043d\u0438 \u043b\u0438 \u0441\u0430 \u0434\u0440\u0443\u0433\u0438 \u043f\u0438\u0441\u043c\u0435\u043d\u043d\u0438 \u043c\u0430\u0442\u0435\u0440\u0438\u0430\u043b\u0438 \u043d\u0430 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_257'><li class='gchoice gchoice_36_257_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_257.1' type='checkbox'  value='\u0414\u0430'  id='choice_36_257_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_257_1' id='label_36_257_1' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_257_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_257.2' type='checkbox'  value='\u041d\u0435'  id='choice_36_257_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_257_2' id='label_36_257_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_258\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_258\" ><label class='gfield_label gform-field-label' for='input_36_258'>\u0423\u0442\u043e\u0447\u043d\u0435\u0442\u0435:<\/label><div class='ginput_container ginput_container_text'><input name='input_258' id='input_36_258' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_259\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_259\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u0418\u0437\u043f\u0438\u0441\u0430\u043d\u0430\u0442\u0430 \u0442\u0435\u0440\u0430\u043f\u0438\u044f \u0441 Roaccutane \u0431\u0438\u043b\u0430 \u043b\u0438 \u0435 \u043e\u0431\u0440\u0430\u0431\u043e\u0442\u0435\u043d\u0430 \u043f\u0440\u0430\u0432\u0438\u043b\u043d\u043e \u0441\u043f\u0440\u043e\u0440\u0435\u0434 \u043e\u0433\u0440\u0430\u043d\u0438\u0447\u0435\u043d\u0438\u044f\u0442\u0430 \u0437\u0430 \u043e\u0442\u043f\u0443\u0441\u043a\u0430\u043d\u0435?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_259'><li class='gchoice gchoice_36_259_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_259.1' type='checkbox'  value='\u0414\u0430'  id='choice_36_259_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_259_1' id='label_36_259_1' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_259_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_259.2' type='checkbox'  value='\u041d\u0435'  id='choice_36_259_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_259_2' id='label_36_259_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_260\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_260\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >30 \u0434\u043d\u0438 \u0434\u043e\u0441\u0442\u0430\u0432\u043a\u0430?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_260'><li class='gchoice gchoice_36_260_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_260.1' type='checkbox'  value='\u0414\u0430'  id='choice_36_260_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_260_1' id='label_36_260_1' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_260_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_260.2' type='checkbox'  value='\u041d\u0435'  id='choice_36_260_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_260_2' id='label_36_260_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_261\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_261\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >7 \u0434\u043d\u0438 \u0432\u0430\u043b\u0438\u0434\u043d\u043e\u0441\u0442 \u043d\u0430 \u043f\u0440\u0435\u0434\u043f\u0438\u0441\u0430\u043d\u0438\u0435\u0442\u043e?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_261'><li class='gchoice gchoice_36_261_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_261.1' type='checkbox'  value='\u0414\u0430'  id='choice_36_261_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_261_1' id='label_36_261_1' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_261_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_261.2' type='checkbox'  value='\u041d\u0435'  id='choice_36_261_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_261_2' id='label_36_261_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_262\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_262\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u041e\u0431\u0441\u044a\u0434\u0435\u043d\u0438 \u043b\u0438 \u0441\u0430 \u0441 \u043f\u0440\u0435\u0434\u043f\u0438\u0441\u0432\u0430\u0449\u0438\u044f \u043b\u0435\u043a\u0430\u0440 \u0438\u0437\u0431\u0440\u0430\u043d\u0438\u0442\u0435 \u043e\u0442 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430 \u043c\u0435\u0442\u043e\u0434\u0438 \u043d\u0430 \u043a\u043e\u043d\u0442\u0440\u0430\u0446\u0435\u043f\u0446\u0438\u044f?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_262'><li class='gchoice gchoice_36_262_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_262.1' type='checkbox'  value='\u0414\u0430'  id='choice_36_262_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_262_1' id='label_36_262_1' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_262_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_262.2' type='checkbox'  value='\u041d\u0435'  id='choice_36_262_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_262_2' id='label_36_262_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_263\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_263\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u0412\u0435\u0440\u0431\u0430\u043b\u0438\u0437\u0438\u0440\u0430\u043b \u043b\u0438 \u0435 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430 \u0440\u0430\u0437\u0431\u0438\u0440\u0430\u043d\u0435 \u0437\u0430 \u0440\u0438\u0441\u043a\u043e\u0432\u0435\u0442\u0435 \u043e\u0442 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442 \u0438 \u043c\u0435\u0442\u043e\u0434\u0438\u0442\u0435 \u0437\u0430 \u043a\u043e\u043d\u0442\u0440\u0430\u0446\u0435\u043f\u0446\u0438\u044f, \u043a\u043e\u0438\u0442\u043e \u0441\u0430 \u043c\u0443 \u0431\u0438\u043b\u0438 \u043f\u0440\u0435\u0434\u0441\u0442\u0430\u0432\u0435\u043d\u0438?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_263'><li class='gchoice gchoice_36_263_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_263.1' type='checkbox'  value='\u0414\u0430'  id='choice_36_263_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_263_1' id='label_36_263_1' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_263_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_263.2' type='checkbox'  value='\u041d\u0435'  id='choice_36_263_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_263_2' id='label_36_263_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_264\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_264\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u0411\u0438\u043b \u043b\u0438 \u0435 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430 \u043d\u0430 \u043a\u043e\u043d\u0442\u0440\u0430\u0446\u0435\u043f\u0446\u0438\u044f \u0435\u0434\u0438\u043d \u043c\u0435\u0441\u0435\u0446 \u0441\u043b\u0435\u0434 \u043f\u0440\u0435\u043a\u0440\u0430\u0442\u044f\u0432\u0430\u043d\u0435 \u0442\u0435\u0440\u0430\u043f\u0438\u044f\u0442\u0430 \u0441 Roaccutane?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_264'><li class='gchoice gchoice_36_264_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_264.1' type='checkbox'  value='\u0414\u0430'  id='choice_36_264_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_264_1' id='label_36_264_1' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_264_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_264.2' type='checkbox'  value='\u041d\u0435'  id='choice_36_264_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_264_2' id='label_36_264_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_232\" class=\"gfield gfield--type-html space_tab gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_232\" ><\/li><\/ul>\r\n                    <\/div>\r\n                    <div class='gform_page_footer top_label'>\r\n                        <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_prev.png' id='gform_previous_button_36_266' class='gform_previous_button gform-theme-button gform-theme-button--secondary button gform_image_button' alt='\u041f\u0440\u0435\u0434\u0438\u0448\u043d\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"14\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"14\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_next.png' id='gform_next_button_36_266' class='gform_next_button gform-theme-button button gform_image_button' alt='\u0421\u043b\u0435\u0434\u0432\u0430\u0449\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='jQuery(\"#gform_target_page_number_36\").val(\"16\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_36\").val(\"16\");  jQuery(\"#gform_36\").trigger(\"submit\",[true]); } ' \/> \r\n                    <\/div>\r\n                <\/div>\r\n                <div id='gform_page_36_16' class='gform_page' data-js='page-field-id-266' style='display:none;'>\r\n                    <div class='gform_page_fields'>\r\n                        <ul id='gform_fields_36_16' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_36_233\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_233\" ><div class=\"title_forms\">16. MYCOPHENOLATE MOFETIL (Cellcept) \u0414\u041e\u041f\u042a\u041b\u041d\u0418\u0422\u0415\u041b\u041d\u0410 \u0424\u041e\u0420\u041c\u0410 \u0417\u0410 \u0411\u0420\u0415\u041c\u0415\u041d\u041d\u041e\u0421\u0422<\/div>\n<div class=\"gfield grey\"><div class=\"left\" style=\"width:820px\">\u041a\u041e\u041d\u0422\u0420\u0410\u0426\u0415\u041f\u0426\u0418\u042f \u0418 \u0422\u0415\u0421\u0422\u041e\u0412\u0415 \u0417\u0410 \u0411\u0420\u0415\u041c\u0415\u041d\u041d\u041e\u0421\u0422\n<\/div><div class=\"clear\"><\/div><\/div><\/li><li id=\"field_36_268\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_268\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u0411\u0440\u043e\u0439 \u043d\u0430 \u043e\u0442\u0440\u0438\u0446\u0430\u0442\u0435\u043b\u043d\u0438\u0442\u0435 \u0442\u0435\u0441\u0442\u043e\u0432\u0435 \u0437\u0430 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442 \u043f\u043e\u043b\u0443\u0447\u0435\u043d\u0438 \u043f\u0440\u0435\u0434\u0438 \u043d\u0430\u0447\u0430\u043b\u043e\u0442\u043e \u043d\u0430 \u043b\u0435\u0447\u0435\u043d\u0438\u0435\u0442\u043e \u0441\u044a\u0441 Cellcept<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_268'><li class='gchoice gchoice_36_268_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_268.1' type='checkbox'  value='\u0415\u0434\u0438\u043d'  id='choice_36_268_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_268_1' id='label_36_268_1' class='gform-field-label gform-field-label--type-inline'>\u0415\u0434\u0438\u043d<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_268_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_268.2' type='checkbox'  value='\u0414\u0432\u0430'  id='choice_36_268_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_268_2' id='label_36_268_2' class='gform-field-label gform-field-label--type-inline'>\u0414\u0432\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_268_3'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_268.3' type='checkbox'  value='\u041d\u0438\u0442\u043e \u0435\u0434\u0438\u043d'  id='choice_36_268_3'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_268_3' id='label_36_268_3' class='gform-field-label gform-field-label--type-inline'>\u041d\u0438\u0442\u043e \u0435\u0434\u0438\u043d<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_269\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_269\" ><label class='gfield_label gform-field-label' for='input_36_269'>\u0414\u0430\u0442\u0430 \u043d\u0430 \u043e\u0442\u0440\u0438\u0446\u0430\u0442\u0435\u043b\u043d\u0438\u0442\u0435 \u0442\u0435\u0441\u0442\u043e\u0432\u0435 \u0437\u0430 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442:<\/label><div class='ginput_container ginput_container_date'>\r\n                            <input name='input_269' id='input_36_269' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_no_icon gdatepicker-no-icon'   placeholder='dd.mm.yyyy' aria-describedby=\"input_36_269_date_format\" aria-invalid=\"false\" \/>\r\n                            <span id='input_36_269_date_format' class='screen-reader-text'>DD dot MM dot YYYY<\/span>\r\n                        <\/div>\r\n                        <input type='hidden' id='gforms_calendar_icon_input_36_269' class='gform_hidden' value='https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_36_270\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_270\" ><label class='gfield_label gform-field-label' for='input_36_270'>\u0414\u0430\u0442\u0430 \u043d\u0430 \u043e\u0442\u0440\u0438\u0446\u0430\u0442\u0435\u043b\u043d\u0438\u0442\u0435 \u0442\u0435\u0441\u0442\u043e\u0432\u0435 \u0437\u0430 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442:<\/label><div class='ginput_container ginput_container_date'>\r\n                            <input name='input_270' id='input_36_270' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_no_icon gdatepicker-no-icon'   placeholder='dd.mm.yyyy' aria-describedby=\"input_36_270_date_format\" aria-invalid=\"false\" \/>\r\n                            <span id='input_36_270_date_format' class='screen-reader-text'>DD dot MM dot YYYY<\/span>\r\n                        <\/div>\r\n                        <input type='hidden' id='gforms_calendar_icon_input_36_270' class='gform_hidden' value='https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_36_271\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_271\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u041f\u043e\u0432\u0442\u0430\u0440\u044f\u043d\u0438 \u043b\u0438 \u0441\u0430 \u0442\u0435\u0441\u0442\u043e\u0432\u0435\u0442\u0435 \u0437\u0430 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442 \u043f\u043e \u0432\u0440\u0435\u043c\u0435 \u043d\u0430 \u0440\u0443\u0442\u0438\u043d\u043d\u0438\u0442\u0435 \u043a\u043e\u043d\u0442\u0440\u043e\u043b\u043d\u0438 \u043f\u0440\u0435\u0433\u043b\u0435\u0434\u0438:<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_271'><li class='gchoice gchoice_36_271_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_271.1' type='checkbox'  value='\u0414\u0430'  id='choice_36_271_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_271_1' id='label_36_271_1' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_271_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_271.2' type='checkbox'  value='\u041d\u0435'  id='choice_36_271_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_271_2' id='label_36_271_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_272\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_272\" ><label class='gfield_label gform-field-label' for='input_36_272'>\u0443\u0442\u043e\u0447\u043d\u0435\u0442\u0435 \u0447\u0435\u0441\u0442\u043e\u0442\u0430:<\/label><div class='ginput_container ginput_container_text'><input name='input_272' id='input_36_272' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_273\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_273\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u0411\u0438\u043b \u043b\u0438 \u0435 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430 \u043d\u0430 \u043a\u043e\u0442\u0440\u0430\u0446\u0435\u043f\u0446\u0438\u044f \u043f\u0440\u0438 \u0437\u0430\u043f\u043e\u0447\u0432\u0430\u043d\u0435 \u043d\u0430 \u043b\u0435\u0447\u0435\u043d\u0438\u0435\u0442\u043e \u0441\u044a\u0441 Cellcept?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_273'><li class='gchoice gchoice_36_273_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_273.1' type='checkbox'  value='\u0414\u0430'  id='choice_36_273_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_273_1' id='label_36_273_1' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_273_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_273.2' type='checkbox'  value='\u041d\u0435'  id='choice_36_273_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_273_2' id='label_36_273_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_274\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_274\" ><span style=\"margin-left:30px;\">\u0410\u043a\u043e \u0434\u0430, \u0443\u0432\u0435\u0440\u0435\u0442\u0435 \u0441\u0435, \u0447\u0435 \u0441\u0435\u043a\u0446\u0438\u044f 4 \u2013\n\u041c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0430 \u0430\u043d\u0430\u043c\u043d\u0435\u0437\u0430 \u043d\u0430 \u043c\u0430\u0439\u043a\u0430\u0442\u0430 \u0435\n\u043f\u043e\u043f\u044a\u043b\u043d\u0435\u043d\u0430<\/span><\/li><li id=\"field_36_275\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_275\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u0411\u0438\u043b \u043b\u0438 \u0435 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430 \u043d\u0430 \u043a\u043e\u0442\u0440\u0430\u0446\u0435\u043f\u0446\u0438\u044f \u043f\u043e \u0432\u0440\u0435\u043c\u0435 \u043d\u0430 \u043b\u0435\u0447\u0435\u043d\u0438\u0435\u0442\u043e \u0441\u044a\u0441 Cellcept?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_275'><li class='gchoice gchoice_36_275_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_275.1' type='checkbox'  value='\u0414\u0430'  id='choice_36_275_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_275_1' id='label_36_275_1' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_275_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_275.2' type='checkbox'  value='\u041d\u0435'  id='choice_36_275_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_275_2' id='label_36_275_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_276\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_276\" ><label class='gfield_label gform-field-label' for='input_36_276'>\u041d\u044f\u043a\u0430\u043a\u0432\u0430 \u043f\u0440\u043e\u043c\u044f\u043d\u0430 \u0432 \u043c\u0435\u0442\u043e\u0434\u0430?<\/label><div class='ginput_container ginput_container_text'><input name='input_276' id='input_36_276' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_277\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_277\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u0418\u0437\u043f\u043e\u043b\u0437\u0432\u0430\u043d\u0438 \u043b\u0438 \u0441\u0430 \u0435\u0434\u043d\u043e\u0432\u0440\u0435\u043c\u0435\u043d\u043d\u043e \u0434\u0432\u0435 \u0444\u043e\u0440\u043c\u0438 \u043d\u0430 \u043a\u043e\u043d\u0442\u0440\u0430\u0446\u0435\u043f\u0446\u0438\u044f \u043f\u043e \u0432\u0440\u0435\u043c\u0435 \u0438 \u0441\u043b\u0435\u0434 \u043f\u0440\u0435\u043a\u0440\u0430\u0442\u044f\u0432\u0430\u043d\u0435 \u043d\u0430 \u0442\u0435\u0440\u0430\u043f\u0438\u044f\u0442\u0430 \u0441\u044a\u0441 Cellcept?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_277'><li class='gchoice gchoice_36_277_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_277.1' type='checkbox'  value='\u0414\u0430'  id='choice_36_277_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_277_1' id='label_36_277_1' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_277_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_277.2' type='checkbox'  value='\u041d\u0435'  id='choice_36_277_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_277_2' id='label_36_277_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_278\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_278\" ><label class='gfield_label gform-field-label' for='input_36_278'>\u0423\u0442\u043e\u0447\u043d\u0435\u0442\u0435 \u0434\u0435\u0442\u0430\u0439\u043b\u0438:<\/label><div class='ginput_container ginput_container_text'><input name='input_278' id='input_36_278' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_279\" class=\"gfield gfield--type-html space_tab gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_279\" ><\/li><li id=\"field_36_280\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_280\" ><span style=\"margin-left:30px;\"><strong>\u0411\u0438\u043b \u043b\u0438 \u0435 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430 \u043d\u0430 \u043a\u043e\u043d\u0442\u0440\u0430\u0446\u0435\u043f\u0446\u0438\u044f?<\/strong><\/span><\/li><li id=\"field_36_282\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_282\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >6 \u0441\u0435\u0434\u043c\u0438\u0446\u0438 \u0441\u043b\u0435\u0434 \u043f\u0440\u0435\u043a\u0440\u0430\u0442\u044f\u0432\u0430\u043d\u0435 \u043d\u0430 \u043b\u0435\u0447\u0435\u043d\u0438\u0435\u0442\u043e \u0441\u044a\u0441 CellCept \u043f\u0440\u0438 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u0438, \u0438\u0437\u043b\u043e\u0436\u0435\u043d\u0438 \u043d\u0430 \u043c\u0430\u0439\u0447\u0438\u043d\u0441\u0442\u0432\u043e?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_282'><li class='gchoice gchoice_36_282_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_282.1' type='checkbox'  value='\u0414\u0430'  id='choice_36_282_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_282_1' id='label_36_282_1' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_282_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_282.2' type='checkbox'  value='\u041d\u0435'  id='choice_36_282_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_282_2' id='label_36_282_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_281\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_281\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >90 \u0441\u043b\u0435\u0434 \u043f\u0440\u0435\u043a\u0440\u0430\u0442\u044f\u0432\u0430\u043d\u0435 \u043d\u0430 \u043b\u0435\u0447\u0435\u043d\u0438\u0435\u0442\u043e \u0441\u044a\u0441 Cellcept \u043f\u0440\u0438 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u0438, \u0438\u0437\u043b\u043e\u0436\u0435\u043d\u0438 \u043d\u0430 \u0431\u0430\u0449\u0438\u043d\u0441\u0442\u0432\u043e (\u043f\u0440\u0438\u043b\u043e\u0436\u0438\u043c \u0438 \u0437\u0430 \u0434\u0432\u0430\u043c\u0430\u0442\u0430 \u043c\u0430\u0439\u043a\u0430 \u0438 \u0431\u0430\u0449\u0430)?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_36_281'><li class='gchoice gchoice_36_281_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_281.1' type='checkbox'  value='\u0414\u0430'  id='choice_36_281_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_281_1' id='label_36_281_1' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_36_281_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_281.2' type='checkbox'  value='\u041d\u0435'  id='choice_36_281_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_36_281_2' id='label_36_281_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_36_283\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_283\" ><label class='gfield_label gform-field-label' for='input_36_283'>\u041d\u044f\u043a\u0430\u043a\u0432\u0430 \u043f\u0440\u043e\u043c\u044f\u043d\u0430 \u0432 \u043c\u0435\u0442\u043e\u0434\u0430?<\/label><div class='ginput_container ginput_container_text'><input name='input_283' id='input_36_283' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_36_284\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_284\" ><label class='gfield_label gform-field-label' for='input_36_284'>\u041f\u0440\u0435\u0434\u043e\u0441\u0442\u0430\u0432\u0435\u0442\u0435 \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f \u0437\u0430 \u043d\u0435\u0443\u0441\u043f\u0435\u0448\u043d\u0430 \u043a\u043e\u043d\u0442\u0440\u0430\u0446\u0435\u043f\u0446\u0438\u044f \u043f\u043e \u0432\u0440\u0435\u043c\u0435\/\u0441\u043b\u0435\u0434 \u0442\u0435\u0440\u0430\u043f\u0438\u044f\u0442\u0430 \u0441\u044a\u0441 Cellcept:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_284' id='input_36_284' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_36_285\" class=\"gfield gfield--type-html space_tab gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_36_285\" ><\/li><\/ul><\/div>\r\n        <div class='gform_page_footer top_label'><input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_prev.png' id='gform_previous_button_36' class='gform_previous_button gform-theme-button gform-theme-button--secondary button gform_image_button' alt='\u041f\u0440\u0435\u0434\u0438\u0448\u043d\u0430 \u0441\u0442\u0440\u0430\u043d\u0438\u0446\u0430'  onclick='if(window[\"gf_submitting_36\"]){return false;}  if( !jQuery(\"#gform_36\")[0].checkValidity || jQuery(\"#gform_36\")[0].checkValidity()){window[\"gf_submitting_36\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_36\"]){return false;} if( !jQuery(\"#gform_36\")[0].checkValidity || jQuery(\"#gform_36\")[0].checkValidity()){window[\"gf_submitting_36\"]=true;}  jQuery(\"#gform_36\").trigger(\"submit\",[true]); }' \/> <input type='submit' id='gform_submit_button_36' class='gform_button button' value='\u0414\u043e\u0431\u0430\u0432\u0438'  onclick='if(window[\"gf_submitting_36\"]){return false;}  if( !jQuery(\"#gform_36\")[0].checkValidity || jQuery(\"#gform_36\")[0].checkValidity()){window[\"gf_submitting_36\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_36\"]){return false;} if( !jQuery(\"#gform_36\")[0].checkValidity || jQuery(\"#gform_36\")[0].checkValidity()){window[\"gf_submitting_36\"]=true;}  jQuery(\"#gform_36\").trigger(\"submit\",[true]); }' \/> \r\n            <input type='hidden' class='gform_hidden' name='is_submit_36' value='1' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='36' \/>\r\n            \r\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\r\n            <input type='hidden' class='gform_hidden' name='state_36' value='WyJbXSIsIjc3NmM1ZTkyNmUzZDg2ZDhhYjEwOGNiNDViZjVmOWRjIl0=' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_36' id='gform_target_page_number_36' value='2' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_36' id='gform_source_page_number_36' value='1' \/>\r\n            <input type='hidden' name='gform_field_values' value='' \/>\r\n            \r\n        <\/div>\r\n                        <\/div><\/div>\r\n                        <\/form>\r\n                        <\/div><script type=\"text\/javascript\"> gform.initializeOnLoaded( function() {gformInitSpinner( 36, 'https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_36').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_36');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_36').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_36').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_36').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_36').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_36').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_36').val();gformInitSpinner( 36, 'https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [36, current_page]);window['gf_submitting_36'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_36').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_36').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [36]);window['gf_submitting_36'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_36').text());}, 50);}else{jQuery('#gform_36').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gform_post_render', [36, current_page]);gform.utils.trigger({ event: 'gform\/postRender', native: false, data: { formId: 36, currentPage: current_page } });} );} ); <\/script><link rel='stylesheet' id='gforms_reset_css-css'  href='https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/legacy\/css\/formreset.min.css?ver=2.8.0' type='text\/css' media='all' \/>\n<link rel='stylesheet' id='gforms_formsmain_css-css'  href='https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/legacy\/css\/formsmain.min.css?ver=2.8.0' type='text\/css' media='all' \/>\n<link rel='stylesheet' id='gforms_ready_class_css-css'  href='https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/legacy\/css\/readyclass.min.css?ver=2.8.0' type='text\/css' media='all' \/>\n<link rel='stylesheet' id='gforms_browsers_css-css'  href='https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/legacy\/css\/browsers.min.css?ver=2.8.0' type='text\/css' media='all' \/>\n<script type='text\/javascript' src='https:\/\/www.roche-forms.bg\/safety\/wp-includes\/js\/dist\/vendor\/wp-polyfill.min.js?ver=7.4.4' id='wp-polyfill-js'><\/script>\n<script type='text\/javascript' id='wp-polyfill-js-after'>\n( 'fetch' in window ) || document.write( '<script src=\"https:\/\/www.roche-forms.bg\/safety\/wp-includes\/js\/dist\/vendor\/wp-polyfill-fetch.min.js?ver=3.0.0\"><\/scr' + 'ipt>' );( document.contains ) || document.write( '<script src=\"https:\/\/www.roche-forms.bg\/safety\/wp-includes\/js\/dist\/vendor\/wp-polyfill-node-contains.min.js?ver=3.42.0\"><\/scr' + 'ipt>' );( window.DOMRect ) || document.write( '<script src=\"https:\/\/www.roche-forms.bg\/safety\/wp-includes\/js\/dist\/vendor\/wp-polyfill-dom-rect.min.js?ver=3.42.0\"><\/scr' + 'ipt>' );( window.URL && window.URL.prototype && window.URLSearchParams ) || document.write( '<script src=\"https:\/\/www.roche-forms.bg\/safety\/wp-includes\/js\/dist\/vendor\/wp-polyfill-url.min.js?ver=3.6.4\"><\/scr' + 'ipt>' );( window.FormData && window.FormData.prototype.keys ) || document.write( '<script src=\"https:\/\/www.roche-forms.bg\/safety\/wp-includes\/js\/dist\/vendor\/wp-polyfill-formdata.min.js?ver=3.0.12\"><\/scr' + 'ipt>' );( Element.prototype.matches && Element.prototype.closest ) || document.write( '<script src=\"https:\/\/www.roche-forms.bg\/safety\/wp-includes\/js\/dist\/vendor\/wp-polyfill-element-closest.min.js?ver=2.0.2\"><\/scr' + 'ipt>' );\n<\/script>\n<script type='text\/javascript' src='https:\/\/www.roche-forms.bg\/safety\/wp-includes\/js\/dist\/dom-ready.min.js?ver=93db39f6fe07a70cb9217310bec0a531' id='wp-dom-ready-js'><\/script>\n<script type='text\/javascript' src='https:\/\/www.roche-forms.bg\/safety\/wp-includes\/js\/dist\/i18n.min.js?ver=4ab02c8fd541b8cfb8952fe260d21f16' id='wp-i18n-js'><\/script>\n<script type='text\/javascript' id='wp-a11y-js-translations'>\n( function( domain, translations ) {\n\tvar localeData = translations.locale_data[ domain ] || translations.locale_data.messages;\n\tlocaleData[\"\"].domain = domain;\n\twp.i18n.setLocaleData( localeData, domain );\n} )( \"default\", { \"locale_data\": { \"messages\": { \"\": {} } } } );\n<\/script>\n<script type='text\/javascript' src='https:\/\/www.roche-forms.bg\/safety\/wp-includes\/js\/dist\/a11y.min.js?ver=f23e5b9c6e4214e0ec04d318a7c9f898' id='wp-a11y-js'><\/script>\n<script type='text\/javascript' src='https:\/\/www.roche-forms.bg\/safety\/wp-includes\/js\/jquery\/jquery.js?ver=1.12.4-wp' id='jquery-core-js'><\/script>\n<script type='text\/javascript' defer='defer' src='https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/js\/jquery.json.min.js?ver=2.8.0' id='gform_json-js'><\/script>\n<script type='text\/javascript' id='gform_gravityforms-js-extra'>\n\/* <![CDATA[ *\/\nvar gf_global = {\"gf_currency_config\":{\"name\":\"\\u0415\\u0432\\u0440\\u043e\",\"symbol_left\":\"\",\"symbol_right\":\"&#8364;\",\"symbol_padding\":\" \",\"thousand_separator\":\".\",\"decimal_separator\":\",\",\"decimals\":2,\"code\":\"EUR\"},\"base_url\":\"https:\\\/\\\/www.roche-forms.bg\\\/safety\\\/wp-content\\\/plugins\\\/gravityforms\",\"number_formats\":[],\"spinnerUrl\":\"https:\\\/\\\/www.roche-forms.bg\\\/safety\\\/wp-content\\\/plugins\\\/gravityforms\\\/images\\\/spinner.svg\",\"version_hash\":\"ddf6120d15e71cfa3035b9b71fb7a8f1\",\"strings\":{\"newRowAdded\":\"New row added.\",\"rowRemoved\":\"Row removed\",\"formSaved\":\"The form has been saved.  The content contains the link to return and complete the form.\"}};\nvar gf_global = {\"gf_currency_config\":{\"name\":\"\\u0415\\u0432\\u0440\\u043e\",\"symbol_left\":\"\",\"symbol_right\":\"&#8364;\",\"symbol_padding\":\" \",\"thousand_separator\":\".\",\"decimal_separator\":\",\",\"decimals\":2,\"code\":\"EUR\"},\"base_url\":\"https:\\\/\\\/www.roche-forms.bg\\\/safety\\\/wp-content\\\/plugins\\\/gravityforms\",\"number_formats\":[],\"spinnerUrl\":\"https:\\\/\\\/www.roche-forms.bg\\\/safety\\\/wp-content\\\/plugins\\\/gravityforms\\\/images\\\/spinner.svg\",\"version_hash\":\"ddf6120d15e71cfa3035b9b71fb7a8f1\",\"strings\":{\"newRowAdded\":\"New row added.\",\"rowRemoved\":\"Row removed\",\"formSaved\":\"The form has been saved.  The content contains the link to return and complete the form.\"}};\n\/* ]]> *\/\n<\/script>\n<script type='text\/javascript' defer='defer' src='https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/js\/gravityforms.min.js?ver=2.8.0' id='gform_gravityforms-js'><\/script>\n<script type='text\/javascript' id='gform_conditional_logic-js-extra'>\n\/* <![CDATA[ *\/\nvar gf_legacy = {\"is_legacy\":\"1\"};\nvar gf_legacy = {\"is_legacy\":\"1\"};\n\/* ]]> *\/\n<\/script>\n<script type='text\/javascript' defer='defer' src='https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/js\/conditional_logic.min.js?ver=2.8.0' id='gform_conditional_logic-js'><\/script>\n<script type='text\/javascript' defer='defer' src='https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/js\/placeholders.jquery.min.js?ver=2.8.0' id='gform_placeholder-js'><\/script>\n            \r\n            <div class=\"gpnf-nested-form gpnf-nested-form-36-99\" style=\"display:none;\">\r\n                <script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\r\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework gform_legacy_markup_wrapper gform-theme--no-framework popup_form_wrapper' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_37' style='display:none'><style>#gform_wrapper_37[data-form-index=\"0\"].gform-theme,[data-parent-form=\"37_0\"]{--gf-color-primary: #204ce5;--gf-color-primary-rgb: 32, 76, 229;--gf-color-primary-contrast: #fff;--gf-color-primary-contrast-rgb: 255, 255, 255;--gf-color-primary-darker: #001AB3;--gf-color-primary-lighter: #527EFF;--gf-color-secondary: #fff;--gf-color-secondary-rgb: 255, 255, 255;--gf-color-secondary-contrast: #112337;--gf-color-secondary-contrast-rgb: 17, 35, 55;--gf-color-secondary-darker: #F5F5F5;--gf-color-secondary-lighter: #FFFFFF;--gf-color-out-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-out-ctrl-light-rgb: 17, 35, 55;--gf-color-out-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-out-ctrl-light-lighter: #F5F5F5;--gf-color-out-ctrl-dark: #585e6a;--gf-color-out-ctrl-dark-rgb: 88, 94, 106;--gf-color-out-ctrl-dark-darker: #112337;--gf-color-out-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-color-in-ctrl: #fff;--gf-color-in-ctrl-rgb: 255, 255, 255;--gf-color-in-ctrl-contrast: #112337;--gf-color-in-ctrl-contrast-rgb: 17, 35, 55;--gf-color-in-ctrl-darker: #F5F5F5;--gf-color-in-ctrl-lighter: #FFFFFF;--gf-color-in-ctrl-primary: #204ce5;--gf-color-in-ctrl-primary-rgb: 32, 76, 229;--gf-color-in-ctrl-primary-contrast: #fff;--gf-color-in-ctrl-primary-contrast-rgb: 255, 255, 255;--gf-color-in-ctrl-primary-darker: #001AB3;--gf-color-in-ctrl-primary-lighter: #527EFF;--gf-color-in-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-in-ctrl-light-rgb: 17, 35, 55;--gf-color-in-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-in-ctrl-light-lighter: #F5F5F5;--gf-color-in-ctrl-dark: #585e6a;--gf-color-in-ctrl-dark-rgb: 88, 94, 106;--gf-color-in-ctrl-dark-darker: #112337;--gf-color-in-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-radius: 3px;--gf-font-size-secondary: 14px;--gf-font-size-tertiary: 13px;--gf-icon-ctrl-number: url(\"data:image\/svg+xml,%3Csvg width='8' height='14' viewBox='0 0 8 14' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M4 0C4.26522 5.96046e-08 4.51957 0.105357 4.70711 0.292893L7.70711 3.29289C8.09763 3.68342 8.09763 4.31658 7.70711 4.70711C7.31658 5.09763 6.68342 5.09763 6.29289 4.70711L4 2.41421L1.70711 4.70711C1.31658 5.09763 0.683417 5.09763 0.292893 4.70711C-0.0976311 4.31658 -0.097631 3.68342 0.292893 3.29289L3.29289 0.292893C3.48043 0.105357 3.73478 0 4 0ZM0.292893 9.29289C0.683417 8.90237 1.31658 8.90237 1.70711 9.29289L4 11.5858L6.29289 9.29289C6.68342 8.90237 7.31658 8.90237 7.70711 9.29289C8.09763 9.68342 8.09763 10.3166 7.70711 10.7071L4.70711 13.7071C4.31658 14.0976 3.68342 14.0976 3.29289 13.7071L0.292893 10.7071C-0.0976311 10.3166 -0.0976311 9.68342 0.292893 9.29289Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-select: url(\"data:image\/svg+xml,%3Csvg width='10' height='6' viewBox='0 0 10 6' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M0.292893 0.292893C0.683417 -0.097631 1.31658 -0.097631 1.70711 0.292893L5 3.58579L8.29289 0.292893C8.68342 -0.0976311 9.31658 -0.0976311 9.70711 0.292893C10.0976 0.683417 10.0976 1.31658 9.70711 1.70711L5.70711 5.70711C5.31658 6.09763 4.68342 6.09763 4.29289 5.70711L0.292893 1.70711C-0.0976311 1.31658 -0.0976311 0.683418 0.292893 0.292893Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-search: url(\"data:image\/svg+xml,%3Csvg version='1.1' xmlns='http:\/\/www.w3.org\/2000\/svg' width='640' height='640'%3E%3Cpath d='M256 128c-70.692 0-128 57.308-128 128 0 70.691 57.308 128 128 128 70.691 0 128-57.309 128-128 0-70.692-57.309-128-128-128zM64 256c0-106.039 85.961-192 192-192s192 85.961 192 192c0 41.466-13.146 79.863-35.498 111.248l154.125 154.125c12.496 12.496 12.496 32.758 0 45.254s-32.758 12.496-45.254 0L367.248 412.502C335.862 434.854 297.467 448 256 448c-106.039 0-192-85.962-192-192z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-label-space-y-secondary: var(--gf-label-space-y-md-secondary);--gf-ctrl-border-color: #686e77;--gf-ctrl-size: var(--gf-ctrl-size-md);--gf-ctrl-label-color-primary: #112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style>\r\n                        <div class='gform_heading'>\r\n                            <p class='gform_description'><\/p>\r\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_37' id='gform_37' class='popup_form' action='\/safety\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F109' data-formid='37' novalidate><input type=\"hidden\" name=\"gpnf_parent_form_id\" value=\"36\" \/><input type=\"hidden\" value=\"1\" id=\"gpnf_is_valid_37\" \/><input id=\"gw_last_page_reached\" name=\"gw_last_page_reached\" value=\"1\" type=\"hidden\" \/>\r\n                        <div class='gform-body gform_body'><ul id='gform_fields_37' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_37_84\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_37_84\" ><label class='gfield_label gform-field-label' for='input_37_84'>\u041d\u0430\u0438\u043c\u0435\u043d\u043e\u0432\u0430\u043d\u0438\u0435 \u043d\u0430 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432e\u043d\u0438\u044f \u043f\u0440\u043e\u0434\u0443\u043a\u0442 \u043d\u0430 \u0420\u043e\u0448:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_84' id='input_37_84' class='medium gfield_select' tabindex='99999'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>\u041c\u043e\u043b\u044f, \u043f\u043e\u0441\u043e\u0447\u0435\u0442\u0435:<\/option><option value='Alecensa (Alectinib )' >Alecensa (Alectinib )<\/option><option value='Avastin (Bevacizumab)' >Avastin (Bevacizumab)<\/option><option value='CellCept (Mycophenolate mofetil)' >CellCept (Mycophenolate mofetil)<\/option><option value='Copegus (Ribavirin)' >Copegus (Ribavirin)<\/option><option value='Cotellic (Cobimetinib)' >Cotellic (Cobimetinib)<\/option><option value='Cymevene (Ganciclovir)' >Cymevene (Ganciclovir)<\/option><option value='Dormicum (Midazolam)' >Dormicum (Midazolam)<\/option><option value='Erivedge (Vismodegib)' >Erivedge (Vismodegib)<\/option><option value='Esbriet (Pirfenidone)' >Esbriet (Pirfenidone)<\/option><option value='Gazyvaro (Obinutuzumab)' >Gazyvaro (Obinutuzumab)<\/option><option value='Hemlibra (Emicizumab)' >Hemlibra (Emicizumab)<\/option><option value='Herceptin (Trastuzumab)' >Herceptin (Trastuzumab)<\/option><option value='Invirase (Saquinavir)' >Invirase (Saquinavir)<\/option><option value='Kadcyla (Trastuzumab emtansine)' >Kadcyla (Trastuzumab emtansine)<\/option><option value='Konakion (Phytomenadione)' >Konakion (Phytomenadione)<\/option><option value='Lexotan (Bromazepam)' >Lexotan (Bromazepam)<\/option><option value='Mabthera (Rituximab)' >Mabthera (Rituximab)<\/option><option value='Madopar (Levodopa\/Benserazide)' >Madopar (Levodopa\/Benserazide)<\/option><option value='Mircera (Methoxy polyethylene glycol-epoetin beta)' >Mircera (Methoxy polyethylene glycol-epoetin beta)<\/option><option value='NeoRecormon (Epoetin beta)' >NeoRecormon (Epoetin beta)<\/option><option value='Ocrevus (Ocrelizumab )' >Ocrevus (Ocrelizumab )<\/option><option value='Pegasys (Peginterferon alfa-2a)' >Pegasys (Peginterferon alfa-2a)<\/option><option value='Perjeta (Pertuzumab)' >Perjeta (Pertuzumab)<\/option><option value='Pulmozyme (Dornase alfa)' >Pulmozyme (Dornase alfa)<\/option><option value='Rivotril (Clonazepam)' >Rivotril (Clonazepam)<\/option><option value='Roaccutan\u0435 (Isotretinoin)' >Roaccutan\u0435 (Isotretinoin)<\/option><option value='RoActemra (Tocilizumab)' >RoActemra (Tocilizumab)<\/option><option value='Rocaltrol (Calcitriol)' >Rocaltrol (Calcitriol)<\/option><option value='Roferon-A (Interferon alfa-2a)' >Roferon-A (Interferon alfa-2a)<\/option><option value='Tamiflu (Oseltamivir)' >Tamiflu (Oseltamivir)<\/option><option value='Tarceva (Erlotinib)' >Tarceva (Erlotinib)<\/option><option value='Tecentriq (Atezolizomab)' >Tecentriq (Atezolizomab)<\/option><option value='Valcyte (Valganciclovir)' >Valcyte (Valganciclovir)<\/option><option value='Xeloda (Capecitabine)' >Xeloda (Capecitabine)<\/option><option value='Zelboraf (Vemurafenib)' >Zelboraf (Vemurafenib)<\/option><option value='\u041d\u0435\u0438\u0437\u0432\u0435\u0441\u0442\u0435\u043d' >\u041d\u0435\u0438\u0437\u0432\u0435\u0441\u0442\u0435\u043d<\/option><\/select><\/div><\/li><li id=\"field_37_80\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_37_80\" ><label class='gfield_label gform-field-label' >\u041a\u043e\u0439 \u0435 \u043f\u0440\u0438\u0435\u043c\u0430\u043b \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u043e\u0442\u043e:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_37_80'>\r\n\t\t\t<li class='gchoice gchoice_37_80_0'>\r\n\t\t\t\t<input name='input_80' type='radio' value='\u0411\u0430\u0449\u0430'  id='choice_37_80_0' tabindex='100000'   \/>\r\n\t\t\t\t<label for='choice_37_80_0' id='label_37_80_0' class='gform-field-label gform-field-label--type-inline'>\u0411\u0430\u0449\u0430<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_37_80_1'>\r\n\t\t\t\t<input name='input_80' type='radio' value='\u041c\u0430\u0439\u043a\u0430'  id='choice_37_80_1' tabindex='100001'   \/>\r\n\t\t\t\t<label for='choice_37_80_1' id='label_37_80_1' class='gform-field-label gform-field-label--type-inline'>\u041c\u0430\u0439\u043a\u0430<\/label>\r\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_37_85\" class=\"gfield gfield--type-post_custom_field gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_37_85\" ><label class='gfield_label gform-field-label' >\u0412\u0440\u0435\u043c\u0435 \u043d\u0430 \u0435\u043a\u0441\u043f\u043e\u0437\u0438\u0446\u0438\u044f:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_37_85'>\r\n\t\t\t<li class='gchoice gchoice_37_85_0'>\r\n\t\t\t\t<input name='input_85' type='radio' value='\u041f\u0440\u0435\u0434\u0438 \u0437\u0430\u0447\u0435\u0432\u0430\u043d\u0435'  id='choice_37_85_0' tabindex='100002'   \/>\r\n\t\t\t\t<label for='choice_37_85_0' id='label_37_85_0' class='gform-field-label gform-field-label--type-inline'>\u041f\u0440\u0435\u0434\u0438 \u0437\u0430\u0447\u0435\u0432\u0430\u043d\u0435<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_37_85_1'>\r\n\t\t\t\t<input name='input_85' type='radio' value='\u0421\u043b\u0435\u0434 \u0440\u0430\u0436\u0434\u0430\u043d\u0435'  id='choice_37_85_1' tabindex='100003'   \/>\r\n\t\t\t\t<label for='choice_37_85_1' id='label_37_85_1' class='gform-field-label gform-field-label--type-inline'>\u0421\u043b\u0435\u0434 \u0440\u0430\u0436\u0434\u0430\u043d\u0435<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_37_85_2'>\r\n\t\t\t\t<input name='input_85' type='radio' value='\u041f\u043e \u0432\u0440\u0435\u043c\u0435 \u043d\u0430 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u0442\u0430'  id='choice_37_85_2' tabindex='100004'   \/>\r\n\t\t\t\t<label for='choice_37_85_2' id='label_37_85_2' class='gform-field-label gform-field-label--type-inline'>\u041f\u043e \u0432\u0440\u0435\u043c\u0435 \u043d\u0430 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u0442\u0430<\/label>\r\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_37_74\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_37_74\" ><label class='gfield_label gform-field-label' for='input_37_74'>Mo\u043b\u044f, \u0443\u0442\u043e\u0447\u043d\u0435\u0442\u0435 \u043c\u0435\u0441\u0435\u0446\u0430 \u043e\u0442 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u0442\u0430:<\/label><div class='ginput_container ginput_container_text'><input name='input_74' id='input_37_74' type='text' value='' class='small'   tabindex='100005'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_37_86\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_37_86\" ><label class='gfield_label gform-field-label' for='input_37_86'>\u0414\u0430\u0442\u0430 \u043d\u0430 \u0437\u0430\u043f\u043e\u0447\u0432\u0430\u043d\u0435:<\/label><div class='ginput_container ginput_container_text'><input name='input_86' id='input_37_86' type='text' value='' class='small'   tabindex='100006' placeholder='\u0414\u0414\/\u041c\u041c\/\u0413\u0413\u0413\u0413'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_37_87\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_37_87\" ><label class='gfield_label gform-field-label' for='input_37_87'>\u0414\u0430\u0442\u0430 \u043d\u0430 \u043f\u0440\u0438\u043a\u043b\u044e\u0447\u0432\u0430\u043d\u0435:<\/label><div class='ginput_container ginput_container_text'><input name='input_87' id='input_37_87' type='text' value='' class='small'   tabindex='100007' placeholder='\u0414\u0414\/\u041c\u041c\/\u0413\u0413\u0413\u0413'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_37_82\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_37_82\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u0438\u043b\u0438 \u043d\u0435 \u0435 \u0441\u043f\u0440\u044f\u043d\u043e:<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_37_82'><li class='gchoice gchoice_37_82_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_82.1' type='checkbox'  value='\u043f\u0440\u0438\u0435\u043c\u044a\u0442 \u043f\u0440\u043e\u0434\u044a\u043b\u0436\u0430\u0432\u0430 \u0438 \u0434\u043e \u043c\u043e\u043c\u0435\u043d\u0442\u0430'  id='choice_37_82_1' tabindex='100008'  \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_37_82_1' id='label_37_82_1' class='gform-field-label gform-field-label--type-inline'>\u043f\u0440\u0438\u0435\u043c\u044a\u0442 \u043f\u0440\u043e\u0434\u044a\u043b\u0436\u0430\u0432\u0430 \u0438 \u0434\u043e \u043c\u043e\u043c\u0435\u043d\u0442\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_37_79\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_37_79\" ><label class='gfield_label gform-field-label' for='input_37_79'>\u0414\u043e\u0437\u0430:<\/label><div class='ginput_container ginput_container_text'><input name='input_79' id='input_37_79' type='text' value='' class='medium'  aria-describedby=\"gfield_description_37_79\" tabindex='100009'   aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_37_79'><div class=\"help\" onmouseover='jQuery(this).find(\".help_info\").css\n\n(\"display\",\"block\");' onmouseout='jQuery(this).find(\".help_info\").css\n\n(\"display\",\"none\");'>\n<div class=\"help_title\" >\u041f\u043e\u043c\u043e\u0449<\/div>\n<div class=\"clear\"><\/div>\n<div class=\"help_info\">\u043f\u0440. 15mg\/kg \u0432\u0435\u0434\u043d\u044a\u0436 \u0441\u0435\u0434\u043c\u0438\u0447\u043d\u043e \u0438\u043b\u0438 3mg \u0434\u0432\u0430 \u043f\u044a\u0442\u0438 \u0434\u043d\u0435\u0432\u043d\u043e \u0438\u043b\u0438 3mg \u0432\u0435\u0434\u043d\u044a\u0436 \u0432\u0435\u0447\u0435\u0440<\/div>\n<\/div><\/div><\/li><li id=\"field_37_81\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_37_81\" ><label class='gfield_label gform-field-label' >\u041d\u0430\u0447\u0438\u043d \u043d\u0430 \u043f\u0440\u0438\u043b\u043e\u0436\u0435\u043d\u0438\u0435:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_37_81'>\r\n\t\t\t<li class='gchoice gchoice_37_81_0'>\r\n\t\t\t\t<input name='input_81' type='radio' value='\u043f\u043e\u0434\u043a\u043e\u0436\u043d\u043e'  id='choice_37_81_0' tabindex='100010'   \/>\r\n\t\t\t\t<label for='choice_37_81_0' id='label_37_81_0' class='gform-field-label gform-field-label--type-inline'>\u043f\u043e\u0434\u043a\u043e\u0436\u043d\u043e<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_37_81_1'>\r\n\t\t\t\t<input name='input_81' type='radio' value='\u0432\u0435\u043d\u043e\u0437\u043d\u043e'  id='choice_37_81_1' tabindex='100011'   \/>\r\n\t\t\t\t<label for='choice_37_81_1' id='label_37_81_1' class='gform-field-label gform-field-label--type-inline'>\u0432\u0435\u043d\u043e\u0437\u043d\u043e<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_37_81_2'>\r\n\t\t\t\t<input name='input_81' type='radio' value='\u043f\u043e\u0434\u043a\u043e\u0436\u043d\u0430 \u0438\u043d\u0436\u0435\u043a\u0446\u0438\u044f'  id='choice_37_81_2' tabindex='100012'   \/>\r\n\t\t\t\t<label for='choice_37_81_2' id='label_37_81_2' class='gform-field-label gform-field-label--type-inline'>\u043f\u043e\u0434\u043a\u043e\u0436\u043d\u0430 \u0438\u043d\u0436\u0435\u043a\u0446\u0438\u044f<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_37_81_3'>\r\n\t\t\t\t<input name='input_81' type='radio' value='\u043f\u0440\u0435\u0437 \u0443\u0441\u0442\u0430\u0442\u0430'  id='choice_37_81_3' tabindex='100013'   \/>\r\n\t\t\t\t<label for='choice_37_81_3' id='label_37_81_3' class='gform-field-label gform-field-label--type-inline'>\u043f\u0440\u0435\u0437 \u0443\u0441\u0442\u0430\u0442\u0430<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_37_81_4'>\r\n\t\t\t\t<input name='input_81' type='radio' value='\u0434\u0440\u0443\u0433\u043e'  id='choice_37_81_4' tabindex='100014'   \/>\r\n\t\t\t\t<label for='choice_37_81_4' id='label_37_81_4' class='gform-field-label gform-field-label--type-inline'>\u0434\u0440\u0443\u0433\u043e<\/label>\r\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_37_83\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_37_83\" ><label class='gfield_label gform-field-label' for='input_37_83'>Mo\u043b\u044f, \u0443\u0442\u043e\u0447\u043d\u0435\u0442\u0435:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_83' id='input_37_83' type='text' value='' class='small'   tabindex='100015'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_37_77\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_37_77\" ><label class='gfield_label gform-field-label' for='input_37_77'>\u041f\u0440\u0438\u0447\u0438\u043d\u0430 \u0437\u0430 \u043f\u0440\u0438\u0435\u043c\u0430\u043d\u0435 \u043d\u0430 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u043e\u0442\u043e:<\/label><div class='ginput_container ginput_container_text'><input name='input_77' id='input_37_77' type='text' value='' class='medium'  aria-describedby=\"gfield_description_37_77\" tabindex='100016'   aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_37_77'><div class=\"help\"  onmouseover='jQuery(this).find(\".help_info\").css\n\n(\"display\",\"block\");' onmouseout='jQuery(this).find(\".help_info\").css\n\n(\"display\",\"none\");'>\n<div class=\"help_title\" >\u041f\u043e\u043c\u043e\u0449<\/div>\n<div class=\"clear\"><\/div>\n<div class=\"help_info\">\u041f\u043e\u043a\u0430\u0437\u0430\u043d\u0438\u0435, \u0437\u0430 \u043a\u043e\u0435\u0442\u043e \u0435 \u043f\u0440\u0435\u0434\u043f\u0438\u0441\u0430\u043d\u043e \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u043e\u0442\u043e.<\/div>\n<\/div><\/div><\/li><li id=\"field_37_75\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_37_75\" ><label class='gfield_label gform-field-label' for='input_37_75'>\u041f\u0430\u0440\u0442\u0438\u0434\u0435\u043d \u043d\u043e\u043c\u0435\u0440:<\/label><div class='ginput_container ginput_container_text'><input name='input_75' id='input_37_75' type='text' value='' class='small'   tabindex='100017'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_37_76\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_37_76\" ><label class='gfield_label gform-field-label' for='input_37_76'>\u0421\u0440\u043e\u043a \u043d\u0430 \u0433\u043e\u0434\u043d\u043e\u0441\u0442:<\/label><div class='ginput_container ginput_container_text'><input name='input_76' id='input_37_76' type='text' value='' class='small'   tabindex='100018'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_37_78\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_37_78\" ><div class=\"text\">\u041d\u0430\u0442\u0438\u0441\u043d\u0438 \u0431\u0443\u0442\u043e\u043d\u0430 \u041f\u0440\u043e\u0434\u044a\u043b\u0436\u0438, \u0437\u0430 \u0434\u0430 \u0441\u0435 \u0432\u044a\u0440\u043d\u0435\u0448 \u043a\u044a\u043c \u0432\u044a\u043f\u0440\u043e\u0441\u0438\u0442\u0435 \u0438\u043b\u0438 \u0437\u0430 \u0434\u0430 \u0434\u043e\u0431\u0430\u0432\u0438\u0448 \u043e\u0449\u0435 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u0438 \u043f\u0440\u043e\u0434\u0443\u043a\u0442\u0438.<\/div><\/li><\/ul><\/div>\r\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_37' class='gform_button button' value='\u041f\u0440\u043e\u0434\u044a\u043b\u0436\u0438' tabindex='100019' onclick='if(window[\"gf_submitting_37\"]){return false;}  if( !jQuery(\"#gform_37\")[0].checkValidity || jQuery(\"#gform_37\")[0].checkValidity()){window[\"gf_submitting_37\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_37\"]){return false;} if( !jQuery(\"#gform_37\")[0].checkValidity || jQuery(\"#gform_37\")[0].checkValidity()){window[\"gf_submitting_37\"]=true;}  jQuery(\"#gform_37\").trigger(\"submit\",[true]); }' \/> <input type='hidden' name='gform_ajax' value='form_id=37&amp;title=&amp;description=1&amp;tabindex=99999&amp;theme=data-form-theme=&#039;legacy&#039;' \/>\r\n            <input type='hidden' class='gform_hidden' name='is_submit_37' value='1' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='37' \/>\r\n            \r\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\r\n            <input type='hidden' class='gform_hidden' name='state_37' value='WyJbXSIsIjc3NmM1ZTkyNmUzZDg2ZDhhYjEwOGNiNDViZjVmOWRjIl0=' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_37' id='gform_target_page_number_37' value='0' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_37' id='gform_source_page_number_37' value='1' \/>\r\n            <input type='hidden' name='gform_field_values' value='' \/>\r\n            \r\n        <\/div>\r\n                        <\/form>\r\n                        <\/div>\r\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_37' id='gform_ajax_frame_37' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\r\n\t\t                <script type=\"text\/javascript\"> gform.initializeOnLoaded( function() {gformInitSpinner( 37, 'https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_37').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_37');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_37').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_37').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_37').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_37').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/  }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_37').val();gformInitSpinner( 37, 'https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [37, current_page]);window['gf_submitting_37'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_37').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [37]);window['gf_submitting_37'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_37').text());}, 50);}else{jQuery('#gform_37').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gpnf_post_render', [37, current_page]);gform.utils.trigger({ event: 'gform\/postRender', native: false, data: { formId: 37, currentPage: current_page } });} );} ); <\/script>            <\/div>\r\n            \r\n            <div class=\"gpnf-edit-form gpnf-edit-form-36-99\" style=\"display:none;\">\r\n                <!-- Loaded dynamically via AJAX -->\r\n            <\/div>\r\n            \r\n                    \r\n            <div class=\"gpnf-nested-form gpnf-nested-form-36-177\" style=\"display:none;\">\r\n                \r\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework gform_legacy_markup_wrapper gform-theme--no-framework popup_form_wrapper' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_43' style='display:none'><style>#gform_wrapper_43[data-form-index=\"0\"].gform-theme,[data-parent-form=\"43_0\"]{--gf-color-primary: #204ce5;--gf-color-primary-rgb: 32, 76, 229;--gf-color-primary-contrast: #fff;--gf-color-primary-contrast-rgb: 255, 255, 255;--gf-color-primary-darker: #001AB3;--gf-color-primary-lighter: #527EFF;--gf-color-secondary: #fff;--gf-color-secondary-rgb: 255, 255, 255;--gf-color-secondary-contrast: #112337;--gf-color-secondary-contrast-rgb: 17, 35, 55;--gf-color-secondary-darker: #F5F5F5;--gf-color-secondary-lighter: #FFFFFF;--gf-color-out-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-out-ctrl-light-rgb: 17, 35, 55;--gf-color-out-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-out-ctrl-light-lighter: #F5F5F5;--gf-color-out-ctrl-dark: #585e6a;--gf-color-out-ctrl-dark-rgb: 88, 94, 106;--gf-color-out-ctrl-dark-darker: #112337;--gf-color-out-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-color-in-ctrl: #fff;--gf-color-in-ctrl-rgb: 255, 255, 255;--gf-color-in-ctrl-contrast: #112337;--gf-color-in-ctrl-contrast-rgb: 17, 35, 55;--gf-color-in-ctrl-darker: #F5F5F5;--gf-color-in-ctrl-lighter: #FFFFFF;--gf-color-in-ctrl-primary: #204ce5;--gf-color-in-ctrl-primary-rgb: 32, 76, 229;--gf-color-in-ctrl-primary-contrast: #fff;--gf-color-in-ctrl-primary-contrast-rgb: 255, 255, 255;--gf-color-in-ctrl-primary-darker: #001AB3;--gf-color-in-ctrl-primary-lighter: #527EFF;--gf-color-in-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-in-ctrl-light-rgb: 17, 35, 55;--gf-color-in-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-in-ctrl-light-lighter: #F5F5F5;--gf-color-in-ctrl-dark: #585e6a;--gf-color-in-ctrl-dark-rgb: 88, 94, 106;--gf-color-in-ctrl-dark-darker: #112337;--gf-color-in-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-radius: 3px;--gf-font-size-secondary: 14px;--gf-font-size-tertiary: 13px;--gf-icon-ctrl-number: url(\"data:image\/svg+xml,%3Csvg width='8' height='14' viewBox='0 0 8 14' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M4 0C4.26522 5.96046e-08 4.51957 0.105357 4.70711 0.292893L7.70711 3.29289C8.09763 3.68342 8.09763 4.31658 7.70711 4.70711C7.31658 5.09763 6.68342 5.09763 6.29289 4.70711L4 2.41421L1.70711 4.70711C1.31658 5.09763 0.683417 5.09763 0.292893 4.70711C-0.0976311 4.31658 -0.097631 3.68342 0.292893 3.29289L3.29289 0.292893C3.48043 0.105357 3.73478 0 4 0ZM0.292893 9.29289C0.683417 8.90237 1.31658 8.90237 1.70711 9.29289L4 11.5858L6.29289 9.29289C6.68342 8.90237 7.31658 8.90237 7.70711 9.29289C8.09763 9.68342 8.09763 10.3166 7.70711 10.7071L4.70711 13.7071C4.31658 14.0976 3.68342 14.0976 3.29289 13.7071L0.292893 10.7071C-0.0976311 10.3166 -0.0976311 9.68342 0.292893 9.29289Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-select: url(\"data:image\/svg+xml,%3Csvg width='10' height='6' viewBox='0 0 10 6' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M0.292893 0.292893C0.683417 -0.097631 1.31658 -0.097631 1.70711 0.292893L5 3.58579L8.29289 0.292893C8.68342 -0.0976311 9.31658 -0.0976311 9.70711 0.292893C10.0976 0.683417 10.0976 1.31658 9.70711 1.70711L5.70711 5.70711C5.31658 6.09763 4.68342 6.09763 4.29289 5.70711L0.292893 1.70711C-0.0976311 1.31658 -0.0976311 0.683418 0.292893 0.292893Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-search: url(\"data:image\/svg+xml,%3Csvg version='1.1' xmlns='http:\/\/www.w3.org\/2000\/svg' width='640' height='640'%3E%3Cpath d='M256 128c-70.692 0-128 57.308-128 128 0 70.691 57.308 128 128 128 70.691 0 128-57.309 128-128 0-70.692-57.309-128-128-128zM64 256c0-106.039 85.961-192 192-192s192 85.961 192 192c0 41.466-13.146 79.863-35.498 111.248l154.125 154.125c12.496 12.496 12.496 32.758 0 45.254s-32.758 12.496-45.254 0L367.248 412.502C335.862 434.854 297.467 448 256 448c-106.039 0-192-85.962-192-192z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-label-space-y-secondary: var(--gf-label-space-y-md-secondary);--gf-ctrl-border-color: #686e77;--gf-ctrl-size: var(--gf-ctrl-size-md);--gf-ctrl-label-color-primary: #112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style>\r\n                        <div class='gform_heading'>\r\n                            <p class='gform_description'><\/p>\r\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_43' id='gform_43' class='popup_form' action='\/safety\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F109' data-formid='43' novalidate><input type=\"hidden\" name=\"gpnf_parent_form_id\" value=\"36\" \/><input type=\"hidden\" value=\"1\" id=\"gpnf_is_valid_43\" \/><input id=\"gw_last_page_reached\" name=\"gw_last_page_reached\" value=\"1\" type=\"hidden\" \/>\r\n                        <div class='gform-body gform_body'><ul id='gform_fields_43' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_43_86\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_43_86\" ><div class=\"gfield grey\"><div class=\"left\" style=\"width:820px;text-align:justify\">\n\u0410\u043a\u043e \u0435 \u0435\u043a\u0441\u043f\u043e\u0440\u043d\u0438\u0440\u0430\u043d\u0430 \u043c\u0430\u0439\u043a\u0430\u0442\u0430, \u0434\u0430 \u0441\u0435 \u0432\u043f\u0438\u0448\u0430\u0442 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0430\u0442\u0430, \u043f\u0440\u0438\u0435\u043c\u0430\u043d\u0438 \u043e\u0442 \u043d\u0435\u044f \u043f\u0440\u0435\u0434\u0438 \u0438 \u043f\u043e \u0432\u0440\u0435\u043c\u0435 \u043d\u0430 \u0431\u0440\u0435\u043c\u0435\u043d\u043e\u0441\u0442\u0442\u0430. \u0410\u043a\u043e \u0435 \u0435\u043a\u0441\u043f\u043e\u043d\u0438\u0440\u0430\u043d \u0431\u0430\u0449\u0430\u0442\u0430, \u0434\u0430 \u0441\u0435 \u0432\u043f\u0438\u0448\u0430\u0442 \u0441\u0430\u043c\u043e \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0430\u0442\u0430 \u043f\u0440\u0438\u0435\u043c\u0430\u043d\u0438 \u043e\u0442 \u043c\u0430\u0439\u043a\u0430\u0442\u0430 \u043f\u0440\u0435\u0434\u0438 \u0437\u0430\u0447\u0435\u0432\u0430\u043d\u0435\u0442\u043e.<\/p>\n<\/div><div class=\"clear\"><\/div><\/li><li id=\"field_43_87\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_43_87\" ><label class='gfield_label gform-field-label' for='input_43_87'>\u041d\u0430\u0438\u043c\u0435\u043d\u043e\u0432\u0430\u043d\u0438\u0435 \u043d\u0430 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u0438\u044f \u043f\u0440\u043e\u0434\u0443\u043a\u0442:<\/label><div class='ginput_container ginput_container_text'><input name='input_87' id='input_43_87' type='text' value='' class='medium'   tabindex='99999'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_43_89\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_43_89\" ><label class='gfield_label gform-field-label' for='input_43_89'>\u0414\u0430\u0442\u0430 \u043d\u0430 \u0437\u0430\u043f\u043e\u0447\u0432\u0430\u043d\u0435:<\/label><div class='ginput_container ginput_container_text'><input name='input_89' id='input_43_89' type='text' value='' class='small'   tabindex='100000' placeholder='\u0414\u0414\/\u041c\u041c\/\u0413\u0413\u0413\u0413'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_43_90\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_43_90\" ><label class='gfield_label gform-field-label' for='input_43_90'>\u0414\u0430\u0442\u0430 \u043d\u0430 \u043f\u0440\u0438\u043a\u043b\u044e\u0447\u0432\u0430\u043d\u0435:<\/label><div class='ginput_container ginput_container_text'><input name='input_90' id='input_43_90' type='text' value='' class='small'   tabindex='100001' placeholder='\u0414\u0414\/\u041c\u041c\/\u0413\u0413\u0413\u0413'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_43_82\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_43_82\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u0438\u043b\u0438 \u043d\u0435 \u0435 \u0441\u043f\u0440\u044f\u043d\u043e:<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_43_82'><li class='gchoice gchoice_43_82_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_82.1' type='checkbox'  value='\u043f\u0440\u0438\u0435\u043c\u0430 \u043f\u0440\u043e\u0434\u044a\u043b\u0436\u0430\u0432\u0430 \u0438 \u0434\u043e \u043c\u043e\u043c\u0435\u043d\u0442\u0430'  id='choice_43_82_1' tabindex='100002'  \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_43_82_1' id='label_43_82_1' class='gform-field-label gform-field-label--type-inline'>\u043f\u0440\u0438\u0435\u043c\u0430 \u043f\u0440\u043e\u0434\u044a\u043b\u0436\u0430\u0432\u0430 \u0438 \u0434\u043e \u043c\u043e\u043c\u0435\u043d\u0442\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_43_79\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_43_79\" ><label class='gfield_label gform-field-label' for='input_43_79'>\u0414\u043e\u0437\u0430:<\/label><div class='ginput_container ginput_container_text'><input name='input_79' id='input_43_79' type='text' value='' class='medium'  aria-describedby=\"gfield_description_43_79\" tabindex='100003'   aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_43_79'><div class=\"help\" onmouseover='jQuery(this).find(\".help_info\").css\n\n(\"display\",\"block\");' onmouseout='jQuery(this).find(\".help_info\").css\n\n(\"display\",\"none\");'>\n<div class=\"help_title\" >\u041f\u043e\u043c\u043e\u0449<\/div>\n<div class=\"clear\"><\/div>\n<div class=\"help_info\">\u043f\u0440. 15mg\/kg \u0432\u0435\u0434\u043d\u044a\u0436 \u0441\u0435\u0434\u043c\u0438\u0447\u043d\u043e \u0438\u043b\u0438 3mg \u0434\u0432\u0430 \u043f\u044a\u0442\u0438 \u0434\u043d\u0435\u0432\u043d\u043e \u0438\u043b\u0438 3mg \u0432\u0435\u0434\u043d\u044a\u0436 \u0432\u0435\u0447\u0435\u0440<\/div>\n<\/div><\/div><\/li><li id=\"field_43_81\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_43_81\" ><label class='gfield_label gform-field-label' >\u041d\u0430\u0447\u0438\u043d \u043d\u0430 \u043f\u0440\u0438\u043b\u043e\u0436\u0435\u043d\u0438\u0435:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_43_81'>\r\n\t\t\t<li class='gchoice gchoice_43_81_0'>\r\n\t\t\t\t<input name='input_81' type='radio' value='\u043f\u043e\u0434\u043a\u043e\u0436\u043d\u043e'  id='choice_43_81_0' tabindex='100004'   \/>\r\n\t\t\t\t<label for='choice_43_81_0' id='label_43_81_0' class='gform-field-label gform-field-label--type-inline'>\u043f\u043e\u0434\u043a\u043e\u0436\u043d\u043e<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_43_81_1'>\r\n\t\t\t\t<input name='input_81' type='radio' value='\u0432\u0435\u043d\u043e\u0437\u043d\u043e'  id='choice_43_81_1' tabindex='100005'   \/>\r\n\t\t\t\t<label for='choice_43_81_1' id='label_43_81_1' class='gform-field-label gform-field-label--type-inline'>\u0432\u0435\u043d\u043e\u0437\u043d\u043e<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_43_81_2'>\r\n\t\t\t\t<input name='input_81' type='radio' value='\u043f\u043e\u0434\u043a\u043e\u0436\u043d\u0430 \u0438\u043d\u0436\u0435\u043a\u0446\u0438\u044f'  id='choice_43_81_2' tabindex='100006'   \/>\r\n\t\t\t\t<label for='choice_43_81_2' id='label_43_81_2' class='gform-field-label gform-field-label--type-inline'>\u043f\u043e\u0434\u043a\u043e\u0436\u043d\u0430 \u0438\u043d\u0436\u0435\u043a\u0446\u0438\u044f<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_43_81_3'>\r\n\t\t\t\t<input name='input_81' type='radio' value='\u043f\u0440\u0435\u0437 \u0443\u0441\u0442\u0430\u0442\u0430'  id='choice_43_81_3' tabindex='100007'   \/>\r\n\t\t\t\t<label for='choice_43_81_3' id='label_43_81_3' class='gform-field-label gform-field-label--type-inline'>\u043f\u0440\u0435\u0437 \u0443\u0441\u0442\u0430\u0442\u0430<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_43_81_4'>\r\n\t\t\t\t<input name='input_81' type='radio' value='\u0434\u0440\u0443\u0433\u043e'  id='choice_43_81_4' tabindex='100008'   \/>\r\n\t\t\t\t<label for='choice_43_81_4' id='label_43_81_4' class='gform-field-label gform-field-label--type-inline'>\u0434\u0440\u0443\u0433\u043e<\/label>\r\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_43_83\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_43_83\" ><label class='gfield_label gform-field-label' for='input_43_83'>Mo\u043b\u044f, \u0443\u0442\u043e\u0447\u043d\u0435\u0442\u0435:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_83' id='input_43_83' type='text' value='' class='small'   tabindex='100009'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_43_77\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_43_77\" ><label class='gfield_label gform-field-label' for='input_43_77'>\u041f\u0440\u0438\u0447\u0438\u043d\u0430 \u0437\u0430 \u043f\u0440\u0438\u0435\u043c\u0430\u043d\u0435 \u043d\u0430 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u043e\u0442\u043e:<\/label><div class='ginput_container ginput_container_text'><input name='input_77' id='input_43_77' type='text' value='' class='medium'  aria-describedby=\"gfield_description_43_77\" tabindex='100010'   aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_43_77'><div class=\"help\"  onmouseover='jQuery(this).find(\".help_info\").css\n\n(\"display\",\"block\");' onmouseout='jQuery(this).find(\".help_info\").css\n\n(\"display\",\"none\");'>\n<div class=\"help_title\" >\u041f\u043e\u043c\u043e\u0449<\/div>\n<div class=\"clear\"><\/div>\n<div class=\"help_info\">\u041f\u043e\u043a\u0430\u0437\u0430\u043d\u0438\u0435, \u0437\u0430 \u043a\u043e\u0435\u0442\u043e \u0412\u0438 \u0435 \u043f\u0440\u0435\u0434\u043f\u0438\u0441\u0430\u043d\u043e \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u043e\u0442\u043e.<\/div>\n<\/div><\/div><\/li><li id=\"field_43_75\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_43_75\" ><label class='gfield_label gform-field-label' for='input_43_75'>\u041f\u0430\u0440\u0442\u0438\u0434\u0435\u043d \u043d\u043e\u043c\u0435\u0440:<\/label><div class='ginput_container ginput_container_text'><input name='input_75' id='input_43_75' type='text' value='' class='small'   tabindex='100011'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_43_76\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_43_76\" ><label class='gfield_label gform-field-label' for='input_43_76'>\u0421\u0440\u043e\u043a \u043d\u0430 \u0433\u043e\u0434\u043d\u043e\u0441\u0442:<\/label><div class='ginput_container ginput_container_text'><input name='input_76' id='input_43_76' type='text' value='' class='small'   tabindex='100012'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_43_88\" class=\"gfield gfield--type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_43_88\" ><div class='ginput_container ginput_container_text'><input name='input_88' id='input_43_88' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='hidden safety field' \/><\/div><\/li><li id=\"field_43_78\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_43_78\" ><div class=\"text\">\u041d\u0430\u0442\u0438\u0441\u043d\u0438 \u0431\u0443\u0442\u043e\u043d\u0430 \u041f\u0440\u043e\u0434\u044a\u043b\u0436\u0438, \u0437\u0430 \u0434\u0430 \u0441\u0435 \u0432\u044a\u0440\u043d\u0435\u0448 \u043a\u044a\u043c \u0432\u044a\u043f\u0440\u043e\u0441\u0438\u0442\u0435 \u0438\u043b\u0438 \u0437\u0430 \u0434\u0430 \u0434\u043e\u0431\u0430\u0432\u0438\u0448 \u043e\u0449\u0435 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u0438 \u043f\u0440\u043e\u0434\u0443\u043a\u0442\u0438.<\/div><\/li><\/ul><\/div>\r\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_43' class='gform_button button' value='\u041f\u0440\u043e\u0434\u044a\u043b\u0436\u0438' tabindex='100013' onclick='if(window[\"gf_submitting_43\"]){return false;}  if( !jQuery(\"#gform_43\")[0].checkValidity || jQuery(\"#gform_43\")[0].checkValidity()){window[\"gf_submitting_43\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_43\"]){return false;} if( !jQuery(\"#gform_43\")[0].checkValidity || jQuery(\"#gform_43\")[0].checkValidity()){window[\"gf_submitting_43\"]=true;}  jQuery(\"#gform_43\").trigger(\"submit\",[true]); }' \/> <input type='hidden' name='gform_ajax' value='form_id=43&amp;title=&amp;description=1&amp;tabindex=99999&amp;theme=data-form-theme=&#039;legacy&#039;' \/>\r\n            <input type='hidden' class='gform_hidden' name='is_submit_43' value='1' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='43' \/>\r\n            \r\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\r\n            <input type='hidden' class='gform_hidden' name='state_43' value='WyJbXSIsIjc3NmM1ZTkyNmUzZDg2ZDhhYjEwOGNiNDViZjVmOWRjIl0=' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_43' id='gform_target_page_number_43' value='0' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_43' id='gform_source_page_number_43' value='1' \/>\r\n            <input type='hidden' name='gform_field_values' value='' \/>\r\n            \r\n        <\/div>\r\n                        <\/form>\r\n                        <\/div>\r\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_43' id='gform_ajax_frame_43' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\r\n\t\t                <script type=\"text\/javascript\"> gform.initializeOnLoaded( function() {gformInitSpinner( 43, 'https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_43').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_43');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_43').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_43').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_43').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_43').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/  }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_43').val();gformInitSpinner( 43, 'https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [43, current_page]);window['gf_submitting_43'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_43').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [43]);window['gf_submitting_43'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_43').text());}, 50);}else{jQuery('#gform_43').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gpnf_post_render', [43, current_page]);gform.utils.trigger({ event: 'gform\/postRender', native: false, data: { formId: 43, currentPage: current_page } });} );} ); <\/script>            <\/div>\r\n            \r\n            <div class=\"gpnf-edit-form gpnf-edit-form-36-177\" style=\"display:none;\">\r\n                <!-- Loaded dynamically via AJAX -->\r\n            <\/div>\r\n            \r\n                    \r\n            <div class=\"gpnf-nested-form gpnf-nested-form-36-115\" style=\"display:none;\">\r\n                \r\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework gform_legacy_markup_wrapper gform-theme--no-framework popup_form_wrapper' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_38' ><style>#gform_wrapper_38[data-form-index=\"0\"].gform-theme,[data-parent-form=\"38_0\"]{--gf-color-primary: #204ce5;--gf-color-primary-rgb: 32, 76, 229;--gf-color-primary-contrast: #fff;--gf-color-primary-contrast-rgb: 255, 255, 255;--gf-color-primary-darker: #001AB3;--gf-color-primary-lighter: #527EFF;--gf-color-secondary: #fff;--gf-color-secondary-rgb: 255, 255, 255;--gf-color-secondary-contrast: #112337;--gf-color-secondary-contrast-rgb: 17, 35, 55;--gf-color-secondary-darker: #F5F5F5;--gf-color-secondary-lighter: #FFFFFF;--gf-color-out-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-out-ctrl-light-rgb: 17, 35, 55;--gf-color-out-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-out-ctrl-light-lighter: #F5F5F5;--gf-color-out-ctrl-dark: #585e6a;--gf-color-out-ctrl-dark-rgb: 88, 94, 106;--gf-color-out-ctrl-dark-darker: #112337;--gf-color-out-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-color-in-ctrl: #fff;--gf-color-in-ctrl-rgb: 255, 255, 255;--gf-color-in-ctrl-contrast: #112337;--gf-color-in-ctrl-contrast-rgb: 17, 35, 55;--gf-color-in-ctrl-darker: #F5F5F5;--gf-color-in-ctrl-lighter: #FFFFFF;--gf-color-in-ctrl-primary: #204ce5;--gf-color-in-ctrl-primary-rgb: 32, 76, 229;--gf-color-in-ctrl-primary-contrast: #fff;--gf-color-in-ctrl-primary-contrast-rgb: 255, 255, 255;--gf-color-in-ctrl-primary-darker: #001AB3;--gf-color-in-ctrl-primary-lighter: #527EFF;--gf-color-in-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-in-ctrl-light-rgb: 17, 35, 55;--gf-color-in-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-in-ctrl-light-lighter: #F5F5F5;--gf-color-in-ctrl-dark: #585e6a;--gf-color-in-ctrl-dark-rgb: 88, 94, 106;--gf-color-in-ctrl-dark-darker: #112337;--gf-color-in-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-radius: 3px;--gf-font-size-secondary: 14px;--gf-font-size-tertiary: 13px;--gf-icon-ctrl-number: url(\"data:image\/svg+xml,%3Csvg width='8' height='14' viewBox='0 0 8 14' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M4 0C4.26522 5.96046e-08 4.51957 0.105357 4.70711 0.292893L7.70711 3.29289C8.09763 3.68342 8.09763 4.31658 7.70711 4.70711C7.31658 5.09763 6.68342 5.09763 6.29289 4.70711L4 2.41421L1.70711 4.70711C1.31658 5.09763 0.683417 5.09763 0.292893 4.70711C-0.0976311 4.31658 -0.097631 3.68342 0.292893 3.29289L3.29289 0.292893C3.48043 0.105357 3.73478 0 4 0ZM0.292893 9.29289C0.683417 8.90237 1.31658 8.90237 1.70711 9.29289L4 11.5858L6.29289 9.29289C6.68342 8.90237 7.31658 8.90237 7.70711 9.29289C8.09763 9.68342 8.09763 10.3166 7.70711 10.7071L4.70711 13.7071C4.31658 14.0976 3.68342 14.0976 3.29289 13.7071L0.292893 10.7071C-0.0976311 10.3166 -0.0976311 9.68342 0.292893 9.29289Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-select: url(\"data:image\/svg+xml,%3Csvg width='10' height='6' viewBox='0 0 10 6' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M0.292893 0.292893C0.683417 -0.097631 1.31658 -0.097631 1.70711 0.292893L5 3.58579L8.29289 0.292893C8.68342 -0.0976311 9.31658 -0.0976311 9.70711 0.292893C10.0976 0.683417 10.0976 1.31658 9.70711 1.70711L5.70711 5.70711C5.31658 6.09763 4.68342 6.09763 4.29289 5.70711L0.292893 1.70711C-0.0976311 1.31658 -0.0976311 0.683418 0.292893 0.292893Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-search: url(\"data:image\/svg+xml,%3Csvg version='1.1' xmlns='http:\/\/www.w3.org\/2000\/svg' width='640' height='640'%3E%3Cpath d='M256 128c-70.692 0-128 57.308-128 128 0 70.691 57.308 128 128 128 70.691 0 128-57.309 128-128 0-70.692-57.309-128-128-128zM64 256c0-106.039 85.961-192 192-192s192 85.961 192 192c0 41.466-13.146 79.863-35.498 111.248l154.125 154.125c12.496 12.496 12.496 32.758 0 45.254s-32.758 12.496-45.254 0L367.248 412.502C335.862 434.854 297.467 448 256 448c-106.039 0-192-85.962-192-192z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-label-space-y-secondary: var(--gf-label-space-y-md-secondary);--gf-ctrl-border-color: #686e77;--gf-ctrl-size: var(--gf-ctrl-size-md);--gf-ctrl-label-color-primary: #112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style>\r\n                        <div class='gform_heading'>\r\n                            <p class='gform_description'><\/p>\r\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_38' id='gform_38' class='popup_form' action='\/safety\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F109' data-formid='38' novalidate><input type=\"hidden\" name=\"gpnf_parent_form_id\" value=\"36\" \/><input type=\"hidden\" value=\"1\" id=\"gpnf_is_valid_38\" \/><input id=\"gw_last_page_reached\" name=\"gw_last_page_reached\" value=\"1\" type=\"hidden\" \/>\r\n                        <div class='gform-body gform_body'><ul id='gform_fields_38' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_38_45\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_38_45\" ><label class='gfield_label gform-field-label' for='input_38_45'>\u041a\u043e\u044f \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442 \u0435 \u043f\u043e\u0434 \u0440\u0435\u0434:<\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_38_45' type='text' value='' class='small'  aria-describedby=\"gfield_description_38_45\" tabindex='99999'   aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_38_45'><div class=\"help\" onmouseover='jQuery(this).find(\".help_info\").css(\"display\",\"block\");' onmouseout='jQuery(this).find(\".help_info\").css(\"display\",\"none\");'>\n<div class=\"help_title\" >\u041f\u043e\u043c\u043e\u0449<\/div>\n<div class=\"clear\"><\/div>\n<div class=\"help_info\">\u041d\u0430\u043f\u0440.: \u043f\u044a\u0440\u0432\u0430, \u0432\u0442\u043e\u0440\u0430, \u0442\u0440\u0435\u0442\u0430 \u0438 \u0442.\u043d <\/div>\n<\/div><\/div><\/li><li id=\"field_38_80\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_38_80\" ><label class='gfield_label gform-field-label' >\u0418\u0437\u0445\u043e\u0434 \u043e\u0442 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u0430:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_38_80'>\r\n\t\t\t<li class='gchoice gchoice_38_80_0'>\r\n\t\t\t\t<input name='input_80' type='radio' value='\u0416\u0438\u0432\u043e\u0440\u043e\u0434\u0435\u043d\u043e (\u043f\u0440\u0435\u0436\u0434\u0435\u0432\u0440\u0435\u043c\u0435\u043d\u043d\u043e\/ \u043d\u043e\u0440\u043c\u0430\u043b\u043d\u043e)'  id='choice_38_80_0' tabindex='100000'   \/>\r\n\t\t\t\t<label for='choice_38_80_0' id='label_38_80_0' class='gform-field-label gform-field-label--type-inline'>\u0416\u0438\u0432\u043e\u0440\u043e\u0434\u0435\u043d\u043e (\u043f\u0440\u0435\u0436\u0434\u0435\u0432\u0440\u0435\u043c\u0435\u043d\u043d\u043e\/ \u043d\u043e\u0440\u043c\u0430\u043b\u043d\u043e)<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_38_80_1'>\r\n\t\t\t\t<input name='input_80' type='radio' value='\u0418\u0437\u0432\u044a\u043d\u043c\u0430\u0442\u043e\u0447\u043d\u0430 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442'  id='choice_38_80_1' tabindex='100001'   \/>\r\n\t\t\t\t<label for='choice_38_80_1' id='label_38_80_1' class='gform-field-label gform-field-label--type-inline'>\u0418\u0437\u0432\u044a\u043d\u043c\u0430\u0442\u043e\u0447\u043d\u0430 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_38_80_2'>\r\n\t\t\t\t<input name='input_80' type='radio' value='\u0421\u043f\u043e\u043d\u0442\u0430\u043d\u0435\u043d \u0430\u0431\u043e\u0440\u0442'  id='choice_38_80_2' tabindex='100002'   \/>\r\n\t\t\t\t<label for='choice_38_80_2' id='label_38_80_2' class='gform-field-label gform-field-label--type-inline'>\u0421\u043f\u043e\u043d\u0442\u0430\u043d\u0435\u043d \u0430\u0431\u043e\u0440\u0442<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_38_80_3'>\r\n\t\t\t\t<input name='input_80' type='radio' value='\u0422\u0435\u0440\u0430\u043f\u0435\u0432\u0442\u0438\u0447\u0435\u043d \u0430\u0431\u043e\u0440\u0442'  id='choice_38_80_3' tabindex='100003'   \/>\r\n\t\t\t\t<label for='choice_38_80_3' id='label_38_80_3' class='gform-field-label gform-field-label--type-inline'>\u0422\u0435\u0440\u0430\u043f\u0435\u0432\u0442\u0438\u0447\u0435\u043d \u0430\u0431\u043e\u0440\u0442<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_38_80_4'>\r\n\t\t\t\t<input name='input_80' type='radio' value='\u041c\u044a\u0440\u0442\u0432\u043e\u0440\u043e\u0434\u0435\u043d\u043e'  id='choice_38_80_4' tabindex='100004'   \/>\r\n\t\t\t\t<label for='choice_38_80_4' id='label_38_80_4' class='gform-field-label gform-field-label--type-inline'>\u041c\u044a\u0440\u0442\u0432\u043e\u0440\u043e\u0434\u0435\u043d\u043e<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_38_80_5'>\r\n\t\t\t\t<input name='input_80' type='radio' value='\u041d\u0435\u0438\u0437\u0432\u0435\u0441\u0442\u0435\u043d'  id='choice_38_80_5' tabindex='100005'   \/>\r\n\t\t\t\t<label for='choice_38_80_5' id='label_38_80_5' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435\u0438\u0437\u0432\u0435\u0441\u0442\u0435\u043d<\/label>\r\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_38_81\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_38_81\" ><label class='gfield_label gform-field-label' >\u0421\u044a\u0441\u0442\u043e\u044f\u043d\u0438\u0435 \u043d\u0430 \u043f\u043b\u043e\u0434\u0430:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_38_81'>\r\n\t\t\t<li class='gchoice gchoice_38_81_0'>\r\n\t\t\t\t<input name='input_81' type='radio' value='\u041d\u043e\u0440\u043c\u0430\u043b\u043d\u043e'  id='choice_38_81_0' tabindex='100006'   \/>\r\n\t\t\t\t<label for='choice_38_81_0' id='label_38_81_0' class='gform-field-label gform-field-label--type-inline'>\u041d\u043e\u0440\u043c\u0430\u043b\u043d\u043e<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_38_81_1'>\r\n\t\t\t\t<input name='input_81' type='radio' value='\u0420\u043e\u0434\u0435\u043d\u043e \u0441 \u0434\u0435\u0444\u0435\u043a\u0442\u0438'  id='choice_38_81_1' tabindex='100007'   \/>\r\n\t\t\t\t<label for='choice_38_81_1' id='label_38_81_1' class='gform-field-label gform-field-label--type-inline'>\u0420\u043e\u0434\u0435\u043d\u043e \u0441 \u0434\u0435\u0444\u0435\u043a\u0442\u0438<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_38_81_2'>\r\n\t\t\t\t<input name='input_81' type='radio' value='\u041c\u044a\u0440\u0442\u0432\u043e'  id='choice_38_81_2' tabindex='100008'   \/>\r\n\t\t\t\t<label for='choice_38_81_2' id='label_38_81_2' class='gform-field-label gform-field-label--type-inline'>\u041c\u044a\u0440\u0442\u0432\u043e<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_38_81_3'>\r\n\t\t\t\t<input name='input_81' type='radio' value='\u041d\u0435\u0438\u0437\u0432\u0435\u0441\u0442\u043d\u043e'  id='choice_38_81_3' tabindex='100009'   \/>\r\n\t\t\t\t<label for='choice_38_81_3' id='label_38_81_3' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435\u0438\u0437\u0432\u0435\u0441\u0442\u043d\u043e<\/label>\r\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_38_82\" class=\"gfield gfield--type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_38_82\" ><div class='ginput_container ginput_container_text'><input name='input_82' id='input_38_82' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='hidden safety field' \/><\/div><\/li><li id=\"field_38_78\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_38_78\" ><div class=\"text\">\u041d\u0430\u0442\u0438\u0441\u043d\u0438 \u0431\u0443\u0442\u043e\u043d\u0430 \u041f\u0440\u043e\u0434\u044a\u043b\u0436\u0438, \u0437\u0430 \u0434\u0430 \u0441\u0435 \u0432\u044a\u0440\u043d\u0435\u0448 \u043a\u044a\u043c \u0432\u044a\u043f\u0440\u043e\u0441\u0438\u0442\u0435 \u0438\u043b\u0438 \u0437\u0430 \u0434\u0430 \u0434\u043e\u0431\u0430\u0432\u0438\u0448 \u043f\u0440\u0435\u0434\u0445\u043e\u0434\u043d\u0438 \u0431\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442.<\/div><\/li><\/ul><\/div>\r\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_38' class='gform_button button' value='\u041f\u0440\u043e\u0434\u044a\u043b\u0436\u0438' tabindex='100010' onclick='if(window[\"gf_submitting_38\"]){return false;}  if( !jQuery(\"#gform_38\")[0].checkValidity || jQuery(\"#gform_38\")[0].checkValidity()){window[\"gf_submitting_38\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_38\"]){return false;} if( !jQuery(\"#gform_38\")[0].checkValidity || jQuery(\"#gform_38\")[0].checkValidity()){window[\"gf_submitting_38\"]=true;}  jQuery(\"#gform_38\").trigger(\"submit\",[true]); }' \/> <input type='hidden' name='gform_ajax' value='form_id=38&amp;title=&amp;description=1&amp;tabindex=99999&amp;theme=data-form-theme=&#039;legacy&#039;' \/>\r\n            <input type='hidden' class='gform_hidden' name='is_submit_38' value='1' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='38' \/>\r\n            \r\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\r\n            <input type='hidden' class='gform_hidden' name='state_38' value='WyJbXSIsIjc3NmM1ZTkyNmUzZDg2ZDhhYjEwOGNiNDViZjVmOWRjIl0=' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_38' id='gform_target_page_number_38' value='0' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_38' id='gform_source_page_number_38' value='1' \/>\r\n            <input type='hidden' name='gform_field_values' value='' \/>\r\n            \r\n        <\/div>\r\n                        <\/form>\r\n                        <\/div>\r\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_38' id='gform_ajax_frame_38' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\r\n\t\t                <script type=\"text\/javascript\"> gform.initializeOnLoaded( function() {gformInitSpinner( 38, 'https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_38').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_38');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_38').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_38').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_38').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_38').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/  }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_38').val();gformInitSpinner( 38, 'https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [38, current_page]);window['gf_submitting_38'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_38').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [38]);window['gf_submitting_38'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_38').text());}, 50);}else{jQuery('#gform_38').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gpnf_post_render', [38, current_page]);gform.utils.trigger({ event: 'gform\/postRender', native: false, data: { formId: 38, currentPage: current_page } });} );} ); <\/script>            <\/div>\r\n            \r\n            <div class=\"gpnf-edit-form gpnf-edit-form-36-115\" style=\"display:none;\">\r\n                <!-- Loaded dynamically via AJAX -->\r\n            <\/div>\r\n            \r\n        <script type='text\/javascript' src='https:\/\/www.roche-forms.bg\/safety\/wp-includes\/js\/plupload\/moxie.min.js?ver=1.3.5' id='moxiejs-js'><\/script>\n<script type='text\/javascript' src='https:\/\/www.roche-forms.bg\/safety\/wp-includes\/js\/plupload\/plupload.min.js?ver=2.1.9' id='plupload-js'><\/script>\n            \r\n            <div class=\"gpnf-nested-form gpnf-nested-form-36-117\" style=\"display:none;\">\r\n                \r\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_39' ><style>#gform_wrapper_39[data-form-index=\"0\"].gform-theme,[data-parent-form=\"39_0\"]{--gf-color-primary: #204ce5;--gf-color-primary-rgb: 32, 76, 229;--gf-color-primary-contrast: #fff;--gf-color-primary-contrast-rgb: 255, 255, 255;--gf-color-primary-darker: #001AB3;--gf-color-primary-lighter: #527EFF;--gf-color-secondary: #fff;--gf-color-secondary-rgb: 255, 255, 255;--gf-color-secondary-contrast: #112337;--gf-color-secondary-contrast-rgb: 17, 35, 55;--gf-color-secondary-darker: #F5F5F5;--gf-color-secondary-lighter: #FFFFFF;--gf-color-out-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-out-ctrl-light-rgb: 17, 35, 55;--gf-color-out-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-out-ctrl-light-lighter: #F5F5F5;--gf-color-out-ctrl-dark: #585e6a;--gf-color-out-ctrl-dark-rgb: 88, 94, 106;--gf-color-out-ctrl-dark-darker: #112337;--gf-color-out-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-color-in-ctrl: #fff;--gf-color-in-ctrl-rgb: 255, 255, 255;--gf-color-in-ctrl-contrast: #112337;--gf-color-in-ctrl-contrast-rgb: 17, 35, 55;--gf-color-in-ctrl-darker: #F5F5F5;--gf-color-in-ctrl-lighter: #FFFFFF;--gf-color-in-ctrl-primary: #204ce5;--gf-color-in-ctrl-primary-rgb: 32, 76, 229;--gf-color-in-ctrl-primary-contrast: #fff;--gf-color-in-ctrl-primary-contrast-rgb: 255, 255, 255;--gf-color-in-ctrl-primary-darker: #001AB3;--gf-color-in-ctrl-primary-lighter: #527EFF;--gf-color-in-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-in-ctrl-light-rgb: 17, 35, 55;--gf-color-in-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-in-ctrl-light-lighter: #F5F5F5;--gf-color-in-ctrl-dark: #585e6a;--gf-color-in-ctrl-dark-rgb: 88, 94, 106;--gf-color-in-ctrl-dark-darker: #112337;--gf-color-in-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-radius: 3px;--gf-font-size-secondary: 14px;--gf-font-size-tertiary: 13px;--gf-icon-ctrl-number: url(\"data:image\/svg+xml,%3Csvg width='8' height='14' viewBox='0 0 8 14' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M4 0C4.26522 5.96046e-08 4.51957 0.105357 4.70711 0.292893L7.70711 3.29289C8.09763 3.68342 8.09763 4.31658 7.70711 4.70711C7.31658 5.09763 6.68342 5.09763 6.29289 4.70711L4 2.41421L1.70711 4.70711C1.31658 5.09763 0.683417 5.09763 0.292893 4.70711C-0.0976311 4.31658 -0.097631 3.68342 0.292893 3.29289L3.29289 0.292893C3.48043 0.105357 3.73478 0 4 0ZM0.292893 9.29289C0.683417 8.90237 1.31658 8.90237 1.70711 9.29289L4 11.5858L6.29289 9.29289C6.68342 8.90237 7.31658 8.90237 7.70711 9.29289C8.09763 9.68342 8.09763 10.3166 7.70711 10.7071L4.70711 13.7071C4.31658 14.0976 3.68342 14.0976 3.29289 13.7071L0.292893 10.7071C-0.0976311 10.3166 -0.0976311 9.68342 0.292893 9.29289Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-select: url(\"data:image\/svg+xml,%3Csvg width='10' height='6' viewBox='0 0 10 6' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M0.292893 0.292893C0.683417 -0.097631 1.31658 -0.097631 1.70711 0.292893L5 3.58579L8.29289 0.292893C8.68342 -0.0976311 9.31658 -0.0976311 9.70711 0.292893C10.0976 0.683417 10.0976 1.31658 9.70711 1.70711L5.70711 5.70711C5.31658 6.09763 4.68342 6.09763 4.29289 5.70711L0.292893 1.70711C-0.0976311 1.31658 -0.0976311 0.683418 0.292893 0.292893Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-search: url(\"data:image\/svg+xml,%3Csvg version='1.1' xmlns='http:\/\/www.w3.org\/2000\/svg' width='640' height='640'%3E%3Cpath d='M256 128c-70.692 0-128 57.308-128 128 0 70.691 57.308 128 128 128 70.691 0 128-57.309 128-128 0-70.692-57.309-128-128-128zM64 256c0-106.039 85.961-192 192-192s192 85.961 192 192c0 41.466-13.146 79.863-35.498 111.248l154.125 154.125c12.496 12.496 12.496 32.758 0 45.254s-32.758 12.496-45.254 0L367.248 412.502C335.862 434.854 297.467 448 256 448c-106.039 0-192-85.962-192-192z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-label-space-y-secondary: var(--gf-label-space-y-md-secondary);--gf-ctrl-border-color: #686e77;--gf-ctrl-size: var(--gf-ctrl-size-md);--gf-ctrl-label-color-primary: #112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style>\r\n                        <div class='gform_heading'>\r\n                            <p class='gform_description'><\/p>\r\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_39' id='gform_39'  action='\/safety\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F109' data-formid='39' novalidate><input type=\"hidden\" name=\"gpnf_parent_form_id\" value=\"36\" \/><input type=\"hidden\" value=\"1\" id=\"gpnf_is_valid_39\" \/><input id=\"gw_last_page_reached\" name=\"gw_last_page_reached\" value=\"1\" type=\"hidden\" \/>\r\n                        <div class='gform-body gform_body'><ul id='gform_fields_39' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_39_39\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_39_39\" ><\/li><li id=\"field_39_78\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_39_78\" ><label class='gfield_label gform-field-label' for='input_39_78'>\u0418\u0437\u0432\u044a\u0440\u0448\u0435\u043d \u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u0435\u043d \u0442\u0435\u0441\u0442\/\u043f\u0440\u043e\u0446\u0435\u0434\u0443\u0440\u0430 \u043f\u0440\u0435\u0434\u0438 \u0438 \u0441\u043b\u0435\u0434 \u0438\u0437\u0445\u043e\u0434\u0430:<\/label><div class='ginput_container ginput_container_text'><input name='input_78' id='input_39_78' type='text' value='' class='small'  aria-describedby=\"gfield_description_39_78\" tabindex='99999'   aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_39_78'><div class=\"help\" onmouseover='jQuery(this).find(\".help_info\").css\n\n(\"display\",\"block\");' onmouseout='jQuery(this).find(\".help_info\").css\n\n(\"display\",\"none\");'>\n<div class=\"help_title\" >\u041f\u043e\u043c\u043e\u0449<\/div>\n<div class=\"clear\"><\/div>\n<div class=\"help_info\">\u041d\u0430\u043f\u0440. \u041f\u041a\u041a, \u0445\u0435\u043c\u043e\u0433\u043b\u043e\u0431\u0438\u043d, \u0445\u043e\u043b\u0435\u0441\u0442\u0435\u0440\u043e\u043b, \u043a\u0440\u044a\u0432\u043d\u043e-\u0437\u0430\u0445\u0430\u0440\u0435\u043d \u043f\u0440\u043e\u0444\u0438\u043b, \u0435\u0445\u043e\u0433\u0440\u0430\u0444\u0438\u044f, \u0430\u043c\u043d\u0438\u043e\u0446\u0435\u043d\u0442\u0435\u0437\u0430, \u0415\u041a\u0413 \u0438 \u0434\u0440. <\/div>\n<\/div>\n<\/div><\/li><li id=\"field_39_86\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_39_86\" ><label class='gfield_label gform-field-label' for='input_39_86'>\u0414\u0430\u0442\u0430 \u043d\u0430 \u0438\u0437\u0432\u044a\u0440\u0448\u0432\u0430\u043d\u0435 \u043d\u0430 \u0442\u0435\u0441\u0442\u043e\u0432\u0435\u0442\u0435:<\/label><div class='ginput_container ginput_container_text'><input name='input_86' id='input_39_86' type='text' value='' class='small'   tabindex='100000' placeholder='\u0414\u0414\/\u041c\u041c\/\u0413\u0413\u0413\u0413'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_39_84\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_39_84\" ><label class='gfield_label gform-field-label' for='input_39_84'>\u0420\u0435\u0437\u0443\u043b\u0442\u0430\u0442 \u043e\u0442 \u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u043d\u0438\u0442\u0435\/\u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0438 \u0438\u0437\u0441\u043b\u0435\u0434\u0432\u0430\u043d\u0438\u044f (\u0432\u043a\u043b\u044e\u0447\u0438\u0442\u0435\u043b\u043d\u043e \u0435\u0434\u0438\u043d\u0438\u0446\u0438, \u0430\u043a\u043e \u0435 \u043f\u0440\u0438\u043b\u043e\u0436\u0438\u043c\u043e):<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_84' id='input_39_84' class='textarea medium' tabindex='100001'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_39_81\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_39_81\" ><label class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_39_81'><li class='gchoice gchoice_39_81_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.1' type='checkbox'  value='\u0420\u0435\u0437\u0443\u043b\u0442\u0430\u0442\u044a\u0442 \u043d\u0435 \u0435 \u0433\u043e\u0442\u043e\u0432 \u0438 \u0441\u0435 \u043e\u0447\u0430\u043a\u0432\u0430'  id='choice_39_81_1' tabindex='100002'  \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_39_81_1' id='label_39_81_1' class='gform-field-label gform-field-label--type-inline'>\u0420\u0435\u0437\u0443\u043b\u0442\u0430\u0442\u044a\u0442 \u043d\u0435 \u0435 \u0433\u043e\u0442\u043e\u0432 \u0438 \u0441\u0435 \u043e\u0447\u0430\u043a\u0432\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_39_83\" class=\"gfield gfield--type-fileupload field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_39_83\" ><label class='gfield_label gform-field-label' for='gform_browse_button_39_83'>\u041c\u043e\u0436\u0435 \u0434\u0430 \u0438\u0437\u043f\u043e\u043b\u0437\u0432\u0430\u0442\u0435 \u0431\u0443\u0442\u043e\u043d\u0430 &quot;\u041f\u0440\u0438\u043a\u0430\u0447\u0438 \u0444\u0430\u0439\u043b&quot;, \u0437\u0430 \u0434\u0430 \u043f\u0440\u0438\u043a\u0430\u0447\u0438\u0442\u0435 \u0438 \u0438\u0437\u043f\u0440\u0430\u0442\u0438\u0442\u0435 \u043d\u0430\u043b\u0438\u0447\u043d\u0438\u0442\u0435 \u0440\u0435\u0437\u0443\u043b\u0442\u0430\u0442\u0438, \u0438\u0437\u0441\u043b\u0435\u0434\u0432\u0430\u043d\u0438\u044f \u0438\u043b\u0438 \u0442\u0435\u0441\u0442\u043e\u0432\u0435.<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_39_83' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_39_83&quot;,&quot;container&quot;:&quot;gform_multifile_upload_39_83&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_39_83&quot;,&quot;filelist&quot;:&quot;gform_preview_39_83&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/www.roche-forms.bg\\\/safety\\\/?gf_page=dd29975bf9fae22&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/www.roche-forms.bg\\\/safety\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/www.roche-forms.bg\\\/safety\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;\\u0420\\u0430\\u0437\\u0440\\u0435\\u0448\\u0435\\u043d\\u0438 \\u0444\\u0430\\u0439\\u043b\\u043e\\u0432\\u0435&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;2097152b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:39,&quot;field_id&quot;:83},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_39_83&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\r\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_39_83' class='gform_drop_area gform-theme-field-control'>\r\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>\u041f\u0443\u0441\u043d\u0438 \u0444\u0430\u0439\u043b\u043e\u0432\u0435\u0442\u0435 \u0442\u0443\u043a \u0438\u043b\u0438 <\/span>\r\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_39_83' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_39_83 gfield_description_39_83\" tabindex='100003' >\u0418\u0437\u0431\u0435\u0440\u0438 \u0444\u0430\u0439\u043b\u043e\u0432\u0435<\/button>\r\n\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_39_83'>Max. file size: 2 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_39_83'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_39_83' class='ginput_preview_list'><\/div><div class='gfield_description' id='gfield_description_39_83'>M\u043e\u0436\u0435 \u0434\u0430 \u043f\u0440\u0438\u043a\u0430\u0447\u0438\u0442\u0435 \u043f\u043e\u0432\u0435\u0447\u0435 \u043e\u0442 1 \u0444\u0430\u0439\u043b. \u0420\u0430\u0437\u0440\u0435\u0448\u0435\u043d\u0438\u0442\u0435 \u0444\u043e\u0440\u043c\u0430\u0442\u0438 \u0441\u0430 jpg, gif, png, pdf.<\/div><\/li><li id=\"field_39_85\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_39_85\" ><div class=\"text\"> \u041d\u0430\u0442\u0438\u0441\u043d\u0438 \u0431\u0443\u0442\u043e\u043d\u0430 \u041f\u0440\u043e\u0434\u044a\u043b\u0436\u0438, \u0437\u0430 \u0434\u0430 \u0441\u0435 \u0432\u044a\u0440\u043d\u0435\u0448 \u043a\u044a\u043c \u0432\u044a\u043f\u0440\u043e\u0441\u0438\u0442\u0435 \u0438\u043b\u0438 \u0437\u0430 \u0434\u0430 \u0434\u043e\u0431\u0430\u0432\u0438\u0448 \u043e\u0449\u0435 \u0438\u0437\u0432\u044a\u0440\u0448\u0435\u043d\u0438 \u043c\u0435\u0434\u0438\u0446\u0438\u0441\u043a\u0438 \/ \u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u043d\u0438 \u0438\u0437\u0441\u043b\u0435\u0434\u0432\u0430\u043d\u0438\u044f.<\/div><\/li><\/ul><\/div>\r\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_39' class='gform_button button' value='\u041f\u0440\u043e\u0434\u044a\u043b\u0436\u0438' tabindex='100004' onclick='if(window[\"gf_submitting_39\"]){return false;}  if( !jQuery(\"#gform_39\")[0].checkValidity || jQuery(\"#gform_39\")[0].checkValidity()){window[\"gf_submitting_39\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_39\"]){return false;} if( !jQuery(\"#gform_39\")[0].checkValidity || jQuery(\"#gform_39\")[0].checkValidity()){window[\"gf_submitting_39\"]=true;}  jQuery(\"#gform_39\").trigger(\"submit\",[true]); }' \/> <input type='hidden' name='gform_ajax' value='form_id=39&amp;title=&amp;description=1&amp;tabindex=99999&amp;theme=data-form-theme=&#039;legacy&#039;' \/>\r\n            <input type='hidden' class='gform_hidden' name='is_submit_39' value='1' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='39' \/>\r\n            \r\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\r\n            <input type='hidden' class='gform_hidden' name='state_39' value='WyJbXSIsIjc3NmM1ZTkyNmUzZDg2ZDhhYjEwOGNiNDViZjVmOWRjIl0=' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_39' id='gform_target_page_number_39' value='0' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_39' id='gform_source_page_number_39' value='1' \/>\r\n            <input type='hidden' name='gform_field_values' value='' \/>\r\n            <input type='hidden' name='gform_uploaded_files' id='gform_uploaded_files_39' value='' \/>\r\n        <\/div>\r\n                        <\/form>\r\n                        <\/div>\r\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_39' id='gform_ajax_frame_39' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\r\n\t\t                <script type=\"text\/javascript\"> gform.initializeOnLoaded( function() {gformInitSpinner( 39, 'https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_39').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_39');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_39').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_39').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_39').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_39').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/  }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_39').val();gformInitSpinner( 39, 'https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [39, current_page]);window['gf_submitting_39'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_39').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [39]);window['gf_submitting_39'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_39').text());}, 50);}else{jQuery('#gform_39').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gpnf_post_render', [39, current_page]);gform.utils.trigger({ event: 'gform\/postRender', native: false, data: { formId: 39, currentPage: current_page } });} );} ); <\/script>            <\/div>\r\n            \r\n            <div class=\"gpnf-edit-form gpnf-edit-form-36-117\" style=\"display:none;\">\r\n                <!-- Loaded dynamically via AJAX -->\r\n            <\/div>\r\n            \r\n                    \r\n            <div class=\"gpnf-nested-form gpnf-nested-form-36-168\" style=\"display:none;\">\r\n                \r\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_41' style='display:none'><style>#gform_wrapper_41[data-form-index=\"0\"].gform-theme,[data-parent-form=\"41_0\"]{--gf-color-primary: #204ce5;--gf-color-primary-rgb: 32, 76, 229;--gf-color-primary-contrast: #fff;--gf-color-primary-contrast-rgb: 255, 255, 255;--gf-color-primary-darker: #001AB3;--gf-color-primary-lighter: #527EFF;--gf-color-secondary: #fff;--gf-color-secondary-rgb: 255, 255, 255;--gf-color-secondary-contrast: #112337;--gf-color-secondary-contrast-rgb: 17, 35, 55;--gf-color-secondary-darker: #F5F5F5;--gf-color-secondary-lighter: #FFFFFF;--gf-color-out-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-out-ctrl-light-rgb: 17, 35, 55;--gf-color-out-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-out-ctrl-light-lighter: #F5F5F5;--gf-color-out-ctrl-dark: #585e6a;--gf-color-out-ctrl-dark-rgb: 88, 94, 106;--gf-color-out-ctrl-dark-darker: #112337;--gf-color-out-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-color-in-ctrl: #fff;--gf-color-in-ctrl-rgb: 255, 255, 255;--gf-color-in-ctrl-contrast: #112337;--gf-color-in-ctrl-contrast-rgb: 17, 35, 55;--gf-color-in-ctrl-darker: #F5F5F5;--gf-color-in-ctrl-lighter: #FFFFFF;--gf-color-in-ctrl-primary: #204ce5;--gf-color-in-ctrl-primary-rgb: 32, 76, 229;--gf-color-in-ctrl-primary-contrast: #fff;--gf-color-in-ctrl-primary-contrast-rgb: 255, 255, 255;--gf-color-in-ctrl-primary-darker: #001AB3;--gf-color-in-ctrl-primary-lighter: #527EFF;--gf-color-in-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-in-ctrl-light-rgb: 17, 35, 55;--gf-color-in-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-in-ctrl-light-lighter: #F5F5F5;--gf-color-in-ctrl-dark: #585e6a;--gf-color-in-ctrl-dark-rgb: 88, 94, 106;--gf-color-in-ctrl-dark-darker: #112337;--gf-color-in-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-radius: 3px;--gf-font-size-secondary: 14px;--gf-font-size-tertiary: 13px;--gf-icon-ctrl-number: url(\"data:image\/svg+xml,%3Csvg width='8' height='14' viewBox='0 0 8 14' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M4 0C4.26522 5.96046e-08 4.51957 0.105357 4.70711 0.292893L7.70711 3.29289C8.09763 3.68342 8.09763 4.31658 7.70711 4.70711C7.31658 5.09763 6.68342 5.09763 6.29289 4.70711L4 2.41421L1.70711 4.70711C1.31658 5.09763 0.683417 5.09763 0.292893 4.70711C-0.0976311 4.31658 -0.097631 3.68342 0.292893 3.29289L3.29289 0.292893C3.48043 0.105357 3.73478 0 4 0ZM0.292893 9.29289C0.683417 8.90237 1.31658 8.90237 1.70711 9.29289L4 11.5858L6.29289 9.29289C6.68342 8.90237 7.31658 8.90237 7.70711 9.29289C8.09763 9.68342 8.09763 10.3166 7.70711 10.7071L4.70711 13.7071C4.31658 14.0976 3.68342 14.0976 3.29289 13.7071L0.292893 10.7071C-0.0976311 10.3166 -0.0976311 9.68342 0.292893 9.29289Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-select: url(\"data:image\/svg+xml,%3Csvg width='10' height='6' viewBox='0 0 10 6' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M0.292893 0.292893C0.683417 -0.097631 1.31658 -0.097631 1.70711 0.292893L5 3.58579L8.29289 0.292893C8.68342 -0.0976311 9.31658 -0.0976311 9.70711 0.292893C10.0976 0.683417 10.0976 1.31658 9.70711 1.70711L5.70711 5.70711C5.31658 6.09763 4.68342 6.09763 4.29289 5.70711L0.292893 1.70711C-0.0976311 1.31658 -0.0976311 0.683418 0.292893 0.292893Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-search: url(\"data:image\/svg+xml,%3Csvg version='1.1' xmlns='http:\/\/www.w3.org\/2000\/svg' width='640' height='640'%3E%3Cpath d='M256 128c-70.692 0-128 57.308-128 128 0 70.691 57.308 128 128 128 70.691 0 128-57.309 128-128 0-70.692-57.309-128-128-128zM64 256c0-106.039 85.961-192 192-192s192 85.961 192 192c0 41.466-13.146 79.863-35.498 111.248l154.125 154.125c12.496 12.496 12.496 32.758 0 45.254s-32.758 12.496-45.254 0L367.248 412.502C335.862 434.854 297.467 448 256 448c-106.039 0-192-85.962-192-192z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-label-space-y-secondary: var(--gf-label-space-y-md-secondary);--gf-ctrl-border-color: #686e77;--gf-ctrl-size: var(--gf-ctrl-size-md);--gf-ctrl-label-color-primary: #112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style>\r\n                        <div class='gform_heading'>\r\n                            <p class='gform_description'><\/p>\r\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_41' id='gform_41'  action='\/safety\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F109' data-formid='41' novalidate><input type=\"hidden\" name=\"gpnf_parent_form_id\" value=\"36\" \/><input type=\"hidden\" value=\"1\" id=\"gpnf_is_valid_41\" \/><input id=\"gw_last_page_reached\" name=\"gw_last_page_reached\" value=\"1\" type=\"hidden\" \/>\r\n                        <div class='gform-body gform_body'><ul id='gform_fields_41' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_41_80\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_41_80\" ><label class='gfield_label gform-field-label' >\u041f\u043e\u043b:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_41_80'>\r\n\t\t\t<li class='gchoice gchoice_41_80_0'>\r\n\t\t\t\t<input name='input_80' type='radio' value='\u041c\u043e\u043c\u0447\u0435'  id='choice_41_80_0' tabindex='99999'   \/>\r\n\t\t\t\t<label for='choice_41_80_0' id='label_41_80_0' class='gform-field-label gform-field-label--type-inline'>\u041c\u043e\u043c\u0447\u0435<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_41_80_1'>\r\n\t\t\t\t<input name='input_80' type='radio' value='\u041c\u043e\u043c\u0438\u0447\u0435'  id='choice_41_80_1' tabindex='100000'   \/>\r\n\t\t\t\t<label for='choice_41_80_1' id='label_41_80_1' class='gform-field-label gform-field-label--type-inline'>\u041c\u043e\u043c\u0438\u0447\u0435<\/label>\r\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_41_45\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_41_45\" ><label class='gfield_label gform-field-label' for='input_41_45'>\u0422\u0435\u0433\u043b\u043e: (kg)<\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_41_45' type='text' value='' class='small'   tabindex='100001'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_41_83\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_41_83\" ><label class='gfield_label gform-field-label' for='input_41_83'>\u0414\u044a\u043b\u0436\u0438\u043d\u0430: (\u0441\u043c)<\/label><div class='ginput_container ginput_container_text'><input name='input_83' id='input_41_83' type='text' value='' class='small'   tabindex='100002'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_41_84\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_41_84\" ><label class='gfield_label gform-field-label' for='input_41_84'>\u041e\u0431\u0438\u043a\u043e\u043b\u043a\u0430 \u043d\u0430 \u0433\u043b\u0430\u0432\u0430\u0442\u0430: (\u0441\u043c)<\/label><div class='ginput_container ginput_container_text'><input name='input_84' id='input_41_84' type='text' value='' class='small'   tabindex='100003'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_41_85\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_41_85\" ><label class='gfield_label gform-field-label' for='input_41_85'>\u0413\u0435\u0441\u0442\u0430\u0446\u0438\u043e\u043d\u043d\u0430 \u0432\u044a\u0437\u0440\u0430\u0441\u0442 \u043f\u0440\u0438 \u0440\u0430\u0436\u0434\u0430\u043d\u0435\/\u0430\u0431\u043e\u0440\u0442 (\u0441\u0435\u0434\u043c\u0438\u0446\u0438)<\/label><div class='ginput_container ginput_container_text'><input name='input_85' id='input_41_85' type='text' value='' class='small'   tabindex='100004'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_41_87\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_41_87\" ><div style=\"margin-left:20px;font-weight:bold;display:block\">\u0422\u043e\u0447\u043a\u0438 \u043f\u043e Apagar<r\/label><\/li><li id=\"field_41_86\" class=\"gfield gfield--type-text right_field field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_41_86\" ><label class='gfield_label gform-field-label' for='input_41_86'>1 \u043c\u0438\u043d\u0443\u0442\u0430<\/label><div class='ginput_container ginput_container_text'><input name='input_86' id='input_41_86' type='text' value='' class='medium'   tabindex='100005'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_41_88\" class=\"gfield gfield--type-text right_field field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_41_88\" ><label class='gfield_label gform-field-label' for='input_41_88'>5 \u043c\u0438\u043d\u0443\u0442\u0438<\/label><div class='ginput_container ginput_container_text'><input name='input_88' id='input_41_88' type='text' value='' class='medium'   tabindex='100006'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_41_89\" class=\"gfield gfield--type-text right_field field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_41_89\" ><label class='gfield_label gform-field-label' for='input_41_89'>10 \u043c\u0438\u043d\u0443\u0442\u0438<\/label><div class='ginput_container ginput_container_text'><input name='input_89' id='input_41_89' type='text' value='' class='medium'   tabindex='100007'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_41_82\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_41_82\" ><label class='gfield_label gform-field-label' >\u0418\u043c\u0430 \u043b\u0438 \u043d\u0435\u0449\u043e \u043d\u0435\u043e\u0431\u0438\u0447\u0430\u0439\u043d\u043e \u043e\u0442\u043d\u043e\u0441\u043d\u043e \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u0442\u0430 \u0438\u043b\u0438 \u0438\u0437\u0445\u043e\u0434\u0430 \u043e\u0442 \u043d\u0435\u044f?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_41_82'>\r\n\t\t\t<li class='gchoice gchoice_41_82_0'>\r\n\t\t\t\t<input name='input_82' type='radio' value='\u0414\u0430'  id='choice_41_82_0' tabindex='100008'   \/>\r\n\t\t\t\t<label for='choice_41_82_0' id='label_41_82_0' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_41_82_1'>\r\n\t\t\t\t<input name='input_82' type='radio' value='\u041d\u0435'  id='choice_41_82_1' tabindex='100009'   \/>\r\n\t\t\t\t<label for='choice_41_82_1' id='label_41_82_1' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_41_90\" class=\"gfield gfield--type-post_custom_field gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_41_90\" ><label class='gfield_label gform-field-label' for='input_41_90'>\u041c\u043e\u043b\u044f, \u0443\u0442\u043e\u0447\u043d\u0435\u0442\u0435:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_90' id='input_41_90' class='textarea small' tabindex='100010'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_41_93\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_41_93\" ><div style=\"margin-left:20px;font-weight:bold;display:block\">\u0414\u0430\u043d\u043d\u0438 \u0437\u0430 \u043f\u0435\u0434\u0438\u0430\u0442\u044a\u0440 (\u0430\u043a\u043e \u0435 \u043a\u043e\u043d\u0441\u0443\u043b\u0442\u0438\u0440\u0430\u043d):<r\/label><\/li><li id=\"field_41_101\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_41_101\" ><label class='gfield_label gform-field-label' for='input_41_101'>\u0418\u043c\u0435:<\/label><div class='ginput_container ginput_container_text'><input name='input_101' id='input_41_101' type='text' value='' class='medium'   tabindex='100011'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_41_95\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_41_95\" ><label class='gfield_label gform-field-label' for='input_41_95'>\u0410\u0434\u0440\u0435\u0441:<\/label><div class='ginput_container ginput_container_text'><input name='input_95' id='input_41_95' type='text' value='' class='large'   tabindex='100012'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_41_97\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_41_97\" ><label class='gfield_label gform-field-label' for='input_41_97'>\u0422\u0435\u043b\u0435\u0444\u043e\u043d:<\/label><div class='ginput_container ginput_container_text'><input name='input_97' id='input_41_97' type='text' value='' class='medium'   tabindex='100013'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_41_99\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_41_99\" ><label class='gfield_label gform-field-label' for='input_41_99'>\u0424\u0430\u043a\u0441:<\/label><div class='ginput_container ginput_container_text'><input name='input_99' id='input_41_99' type='text' value='' class='medium'   tabindex='100014'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_41_98\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_41_98\" ><label class='gfield_label gform-field-label' for='input_41_98'>E-mail:<\/label><div class='ginput_container ginput_container_text'><input name='input_98' id='input_41_98' type='text' value='' class='medium'   tabindex='100015'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_41_103\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_41_103\" ><label class='gfield_label gform-field-label' for='input_41_103'>\u0414\u0430\u0442\u0430 \u043d\u0430 \u043f\u0440\u0435\u0433\u043b\u0435\u0434 \u043d\u0430 \u0434\u0435\u0442\u0435\u0442\u043e:<\/label><div class='ginput_container ginput_container_text'><input name='input_103' id='input_41_103' type='text' value='' class='small'   tabindex='100016' placeholder='\u0414\u0414\/\u041c\u041c\/\u0413\u0413\u0413\u0413'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_41_92\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_41_92\" ><label class='gfield_label gform-field-label' for='input_41_92'>\u041d\u0430\u0445\u043e\u0434\u043a\u0430:<\/label><div class='ginput_container ginput_container_text'><input name='input_92' id='input_41_92' type='text' value='' class='large'   tabindex='100017'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_41_102\" class=\"gfield gfield--type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_41_102\" ><div class='ginput_container ginput_container_text'><input name='input_102' id='input_41_102' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='hidden safety field' \/><\/div><\/li><li id=\"field_41_78\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_41_78\" ><div class=\"text\">\u041d\u0430\u0442\u0438\u0441\u043d\u0438 \u0431\u0443\u0442\u043e\u043d\u0430 \u041f\u0440\u043e\u0434\u044a\u043b\u0436\u0438, \u0437\u0430 \u0434\u0430 \u0441\u0435 \u0432\u044a\u0440\u043d\u0435\u0448 \u043a\u044a\u043c \u0432\u044a\u043f\u0440\u043e\u0441\u0438\u0442\u0435 \u0438\u043b\u0438 \u0437\u0430 \u0434\u0430 \u0434\u043e\u0431\u0430\u0432\u0438\u0448 \u043e\u0449\u0435 \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f.<\/div><\/li><\/ul><\/div>\r\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_41' class='gform_button button' value='\u041f\u0440\u043e\u0434\u044a\u043b\u0436\u0438' tabindex='100018' onclick='if(window[\"gf_submitting_41\"]){return false;}  if( !jQuery(\"#gform_41\")[0].checkValidity || jQuery(\"#gform_41\")[0].checkValidity()){window[\"gf_submitting_41\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_41\"]){return false;} if( !jQuery(\"#gform_41\")[0].checkValidity || jQuery(\"#gform_41\")[0].checkValidity()){window[\"gf_submitting_41\"]=true;}  jQuery(\"#gform_41\").trigger(\"submit\",[true]); }' \/> <input type='hidden' name='gform_ajax' value='form_id=41&amp;title=&amp;description=1&amp;tabindex=99999&amp;theme=data-form-theme=&#039;legacy&#039;' \/>\r\n            <input type='hidden' class='gform_hidden' name='is_submit_41' value='1' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='41' \/>\r\n            \r\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\r\n            <input type='hidden' class='gform_hidden' name='state_41' value='WyJbXSIsIjc3NmM1ZTkyNmUzZDg2ZDhhYjEwOGNiNDViZjVmOWRjIl0=' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_41' id='gform_target_page_number_41' value='0' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_41' id='gform_source_page_number_41' value='1' \/>\r\n            <input type='hidden' name='gform_field_values' value='' \/>\r\n            \r\n        <\/div>\r\n                        <\/form>\r\n                        <\/div>\r\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_41' id='gform_ajax_frame_41' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\r\n\t\t                <script type=\"text\/javascript\"> gform.initializeOnLoaded( function() {gformInitSpinner( 41, 'https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_41').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_41');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_41').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_41').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_41').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_41').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/  }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_41').val();gformInitSpinner( 41, 'https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [41, current_page]);window['gf_submitting_41'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_41').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [41]);window['gf_submitting_41'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_41').text());}, 50);}else{jQuery('#gform_41').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gpnf_post_render', [41, current_page]);gform.utils.trigger({ event: 'gform\/postRender', native: false, data: { formId: 41, currentPage: current_page } });} );} ); <\/script>            <\/div>\r\n            \r\n            <div class=\"gpnf-edit-form gpnf-edit-form-36-168\" style=\"display:none;\">\r\n                <!-- Loaded dynamically via AJAX -->\r\n            <\/div>\r\n            \r\n                    \r\n            <div class=\"gpnf-nested-form gpnf-nested-form-36-172\" style=\"display:none;\">\r\n                \r\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework gform_legacy_markup_wrapper gform-theme--no-framework popup_form_wrapper' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_42' ><style>#gform_wrapper_42[data-form-index=\"0\"].gform-theme,[data-parent-form=\"42_0\"]{--gf-color-primary: #204ce5;--gf-color-primary-rgb: 32, 76, 229;--gf-color-primary-contrast: #fff;--gf-color-primary-contrast-rgb: 255, 255, 255;--gf-color-primary-darker: #001AB3;--gf-color-primary-lighter: #527EFF;--gf-color-secondary: #fff;--gf-color-secondary-rgb: 255, 255, 255;--gf-color-secondary-contrast: #112337;--gf-color-secondary-contrast-rgb: 17, 35, 55;--gf-color-secondary-darker: #F5F5F5;--gf-color-secondary-lighter: #FFFFFF;--gf-color-out-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-out-ctrl-light-rgb: 17, 35, 55;--gf-color-out-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-out-ctrl-light-lighter: #F5F5F5;--gf-color-out-ctrl-dark: #585e6a;--gf-color-out-ctrl-dark-rgb: 88, 94, 106;--gf-color-out-ctrl-dark-darker: #112337;--gf-color-out-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-color-in-ctrl: #fff;--gf-color-in-ctrl-rgb: 255, 255, 255;--gf-color-in-ctrl-contrast: #112337;--gf-color-in-ctrl-contrast-rgb: 17, 35, 55;--gf-color-in-ctrl-darker: #F5F5F5;--gf-color-in-ctrl-lighter: #FFFFFF;--gf-color-in-ctrl-primary: #204ce5;--gf-color-in-ctrl-primary-rgb: 32, 76, 229;--gf-color-in-ctrl-primary-contrast: #fff;--gf-color-in-ctrl-primary-contrast-rgb: 255, 255, 255;--gf-color-in-ctrl-primary-darker: #001AB3;--gf-color-in-ctrl-primary-lighter: #527EFF;--gf-color-in-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-in-ctrl-light-rgb: 17, 35, 55;--gf-color-in-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-in-ctrl-light-lighter: #F5F5F5;--gf-color-in-ctrl-dark: #585e6a;--gf-color-in-ctrl-dark-rgb: 88, 94, 106;--gf-color-in-ctrl-dark-darker: #112337;--gf-color-in-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-radius: 3px;--gf-font-size-secondary: 14px;--gf-font-size-tertiary: 13px;--gf-icon-ctrl-number: url(\"data:image\/svg+xml,%3Csvg width='8' height='14' viewBox='0 0 8 14' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M4 0C4.26522 5.96046e-08 4.51957 0.105357 4.70711 0.292893L7.70711 3.29289C8.09763 3.68342 8.09763 4.31658 7.70711 4.70711C7.31658 5.09763 6.68342 5.09763 6.29289 4.70711L4 2.41421L1.70711 4.70711C1.31658 5.09763 0.683417 5.09763 0.292893 4.70711C-0.0976311 4.31658 -0.097631 3.68342 0.292893 3.29289L3.29289 0.292893C3.48043 0.105357 3.73478 0 4 0ZM0.292893 9.29289C0.683417 8.90237 1.31658 8.90237 1.70711 9.29289L4 11.5858L6.29289 9.29289C6.68342 8.90237 7.31658 8.90237 7.70711 9.29289C8.09763 9.68342 8.09763 10.3166 7.70711 10.7071L4.70711 13.7071C4.31658 14.0976 3.68342 14.0976 3.29289 13.7071L0.292893 10.7071C-0.0976311 10.3166 -0.0976311 9.68342 0.292893 9.29289Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-select: url(\"data:image\/svg+xml,%3Csvg width='10' height='6' viewBox='0 0 10 6' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M0.292893 0.292893C0.683417 -0.097631 1.31658 -0.097631 1.70711 0.292893L5 3.58579L8.29289 0.292893C8.68342 -0.0976311 9.31658 -0.0976311 9.70711 0.292893C10.0976 0.683417 10.0976 1.31658 9.70711 1.70711L5.70711 5.70711C5.31658 6.09763 4.68342 6.09763 4.29289 5.70711L0.292893 1.70711C-0.0976311 1.31658 -0.0976311 0.683418 0.292893 0.292893Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-search: url(\"data:image\/svg+xml,%3Csvg version='1.1' xmlns='http:\/\/www.w3.org\/2000\/svg' width='640' height='640'%3E%3Cpath d='M256 128c-70.692 0-128 57.308-128 128 0 70.691 57.308 128 128 128 70.691 0 128-57.309 128-128 0-70.692-57.309-128-128-128zM64 256c0-106.039 85.961-192 192-192s192 85.961 192 192c0 41.466-13.146 79.863-35.498 111.248l154.125 154.125c12.496 12.496 12.496 32.758 0 45.254s-32.758 12.496-45.254 0L367.248 412.502C335.862 434.854 297.467 448 256 448c-106.039 0-192-85.962-192-192z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-label-space-y-secondary: var(--gf-label-space-y-md-secondary);--gf-ctrl-border-color: #686e77;--gf-ctrl-size: var(--gf-ctrl-size-md);--gf-ctrl-label-color-primary: #112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style>\r\n                        <div class='gform_heading'>\r\n                            <p class='gform_description'><\/p>\r\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_42' id='gform_42' class='popup_form' action='\/safety\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F109' data-formid='42' novalidate><input type=\"hidden\" name=\"gpnf_parent_form_id\" value=\"36\" \/><input type=\"hidden\" value=\"1\" id=\"gpnf_is_valid_42\" \/><input id=\"gw_last_page_reached\" name=\"gw_last_page_reached\" value=\"1\" type=\"hidden\" \/>\r\n                        <div class='gform-body gform_body'><ul id='gform_fields_42' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_42_39\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_42_39\" ><\/li><li id=\"field_42_78\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_42_78\" ><label class='gfield_label gform-field-label' for='input_42_78'>\u0418\u0437\u0432\u044a\u0440\u0448\u0435\u043d\u043e \u043c\u0435\u0434. \u0438\/\u0438\u043b\u0438 \u043b\u0430\u0431. \u0438\u0437\u0441\u043b\u0435\u0434\u0432\u0430\u043d\u0435 \u043d\u0430 \u0434\u0435\u0442\u0435\u0442\u043e\/\u043f\u043b\u043e\u0434\u0430:<\/label><div class='ginput_container ginput_container_text'><input name='input_78' id='input_42_78' type='text' value='' class='small'  aria-describedby=\"gfield_description_42_78\" tabindex='99999'   aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_42_78'><div class=\"help\" onmouseover='jQuery(this).find(\".help_info\").css\n\n(\"display\",\"block\");' onmouseout='jQuery(this).find(\".help_info\").css\n\n(\"display\",\"none\");'>\n<div class=\"help_title\" >\u041f\u043e\u043c\u043e\u0449<\/div>\n<div class=\"clear\"><\/div>\n<div class=\"help_info\">\u041d\u0430\u043f\u0440. \u041f\u041a\u041a, \u0443\u0440\u0438\u043d\u0430, \u0435\u0445\u043e\u0433\u0440\u0430\u0444\u0438\u044f \u0438 \u0434\u0440. <\/div>\n<\/div>\n<\/div><\/li><li id=\"field_42_87\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_42_87\" ><label class='gfield_label gform-field-label' for='input_42_87'>\u0414\u0430\u0442\u0430 \u043d\u0430 \u0438\u0437\u0432\u044a\u0440\u0448\u0432\u0430\u043d\u0435 \u043d\u0430 \u0442\u0435\u0441\u0442\u043e\u0432\u0435\u0442\u0435:<\/label><div class='ginput_container ginput_container_text'><input name='input_87' id='input_42_87' type='text' value='' class='small'   tabindex='100000' placeholder='\u0414\u0414\/\u041c\u041c\/\u0413\u0413\u0413\u0413'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_42_84\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_42_84\" ><label class='gfield_label gform-field-label' for='input_42_84'>\u0420\u0435\u0437\u0443\u043b\u0442\u0430\u0442 \u043e\u0442 \u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u043d\u0438\u0442\u0435\/\u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0438 \u0438\u0437\u0441\u043b\u0435\u0434\u0432\u0430\u043d\u0438\u044f (\u0432\u043a\u043b\u044e\u0447\u0438\u0442\u0435\u043b\u043d\u043e \u0435\u0434\u0438\u043d\u0438\u0446\u0438, \u0430\u043a\u043e \u0435 \u043f\u0440\u0438\u043b\u043e\u0436\u0438\u043c\u043e):<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_84' id='input_42_84' class='textarea medium' tabindex='100001'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_42_81\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_42_81\" ><label class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_42_81'><li class='gchoice gchoice_42_81_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.1' type='checkbox'  value='\u0420\u0435\u0437\u0443\u043b\u0442\u0430\u0442\u044a\u0442 \u043d\u0435 \u0435 \u0433\u043e\u0442\u043e\u0432 \u0438 \u0441\u0435 \u043e\u0447\u0430\u043a\u0432\u0430'  id='choice_42_81_1' tabindex='100002'  \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_42_81_1' id='label_42_81_1' class='gform-field-label gform-field-label--type-inline'>\u0420\u0435\u0437\u0443\u043b\u0442\u0430\u0442\u044a\u0442 \u043d\u0435 \u0435 \u0433\u043e\u0442\u043e\u0432 \u0438 \u0441\u0435 \u043e\u0447\u0430\u043a\u0432\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_42_83\" class=\"gfield gfield--type-fileupload field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_42_83\" ><label class='gfield_label gform-field-label' for='gform_browse_button_42_83'>\u041c\u043e\u0436\u0435 \u0434\u0430 \u0438\u0437\u043f\u043e\u043b\u0437\u0432\u0430\u0442\u0435 \u0431\u0443\u0442\u043e\u043d\u0430 &quot;\u041f\u0440\u0438\u043a\u0430\u0447\u0438 \u0444\u0430\u0439\u043b&quot;, \u0437\u0430 \u0434\u0430 \u043f\u0440\u0438\u043a\u0430\u0447\u0438\u0442\u0435 \u0438 \u0438\u0437\u043f\u0440\u0430\u0442\u0438\u0442\u0435 \u043d\u0430\u043b\u0438\u0447\u043d\u0438\u0442\u0435 \u0440\u0435\u0437\u0443\u043b\u0442\u0430\u0442\u0438, \u0438\u0437\u0441\u043b\u0435\u0434\u0432\u0430\u043d\u0438\u044f \u0438\u043b\u0438 \u0442\u0435\u0441\u0442\u043e\u0432\u0435.<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_42_83' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_42_83&quot;,&quot;container&quot;:&quot;gform_multifile_upload_42_83&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_42_83&quot;,&quot;filelist&quot;:&quot;gform_preview_42_83&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/www.roche-forms.bg\\\/safety\\\/?gf_page=dd29975bf9fae22&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/www.roche-forms.bg\\\/safety\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/www.roche-forms.bg\\\/safety\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;\\u0420\\u0430\\u0437\\u0440\\u0435\\u0448\\u0435\\u043d\\u0438 \\u0444\\u0430\\u0439\\u043b\\u043e\\u0432\\u0435&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;2097152b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:42,&quot;field_id&quot;:83},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_42_83&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\r\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_42_83' class='gform_drop_area gform-theme-field-control'>\r\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>\u041f\u0443\u0441\u043d\u0438 \u0444\u0430\u0439\u043b\u043e\u0432\u0435\u0442\u0435 \u0442\u0443\u043a \u0438\u043b\u0438 <\/span>\r\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_42_83' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_42_83 gfield_description_42_83\" tabindex='100003' >\u0418\u0437\u0431\u0435\u0440\u0438 \u0444\u0430\u0439\u043b\u043e\u0432\u0435<\/button>\r\n\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_42_83'>Max. file size: 2 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_42_83'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_42_83' class='ginput_preview_list'><\/div><div class='gfield_description' id='gfield_description_42_83'>M\u043e\u0436\u0435 \u0434\u0430 \u043f\u0440\u0438\u043a\u0430\u0447\u0438\u0442\u0435 \u043f\u043e\u0432\u0435\u0447\u0435 \u043e\u0442 1 \u0444\u0430\u0439\u043b. \u0420\u0430\u0437\u0440\u0435\u0448\u0435\u043d\u0438\u0442\u0435 \u0444\u043e\u0440\u043c\u0430\u0442\u0438 \u0441\u0430 jpg, gif, png, pdf.<\/div><\/li><li id=\"field_42_86\" class=\"gfield gfield--type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_42_86\" ><div class='ginput_container ginput_container_text'><input name='input_86' id='input_42_86' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='hidden safety field' \/><\/div><\/li><li id=\"field_42_85\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_42_85\" ><div class=\"text\"> \u041d\u0430\u0442\u0438\u0441\u043d\u0438 \u0431\u0443\u0442\u043e\u043d\u0430 \u041f\u0440\u043e\u0434\u044a\u043b\u0436\u0438, \u0437\u0430 \u0434\u0430 \u0441\u0435 \u0432\u044a\u0440\u043d\u0435\u0448 \u043a\u044a\u043c \u0432\u044a\u043f\u0440\u043e\u0441\u0438\u0442\u0435 \u0438\u043b\u0438 \u0437\u0430 \u0434\u0430 \u0434\u043e\u0431\u0430\u0432\u0438\u0448 \u043e\u0449\u0435 \u0438\u0437\u0432\u044a\u0440\u0448\u0435\u043d\u0438 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0438 \/ \u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u043d\u0438 \u0438\u0437\u0441\u043b\u0435\u0434\u0432\u0430\u043d\u0438\u044f.<\/div><\/li><\/ul><\/div>\r\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_42' class='gform_button button' value='\u041f\u0440\u043e\u0434\u044a\u043b\u0436\u0438' tabindex='100004' onclick='if(window[\"gf_submitting_42\"]){return false;}  if( !jQuery(\"#gform_42\")[0].checkValidity || jQuery(\"#gform_42\")[0].checkValidity()){window[\"gf_submitting_42\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_42\"]){return false;} if( !jQuery(\"#gform_42\")[0].checkValidity || jQuery(\"#gform_42\")[0].checkValidity()){window[\"gf_submitting_42\"]=true;}  jQuery(\"#gform_42\").trigger(\"submit\",[true]); }' \/> <input type='hidden' name='gform_ajax' value='form_id=42&amp;title=&amp;description=1&amp;tabindex=99999&amp;theme=data-form-theme=&#039;legacy&#039;' \/>\r\n            <input type='hidden' class='gform_hidden' name='is_submit_42' value='1' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='42' \/>\r\n            \r\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\r\n            <input type='hidden' class='gform_hidden' name='state_42' value='WyJbXSIsIjc3NmM1ZTkyNmUzZDg2ZDhhYjEwOGNiNDViZjVmOWRjIl0=' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_42' id='gform_target_page_number_42' value='0' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_42' id='gform_source_page_number_42' value='1' \/>\r\n            <input type='hidden' name='gform_field_values' value='' \/>\r\n            <input type='hidden' name='gform_uploaded_files' id='gform_uploaded_files_42' value='' \/>\r\n        <\/div>\r\n                        <\/form>\r\n                        <\/div>\r\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_42' id='gform_ajax_frame_42' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\r\n\t\t                <script type=\"text\/javascript\"> gform.initializeOnLoaded( function() {gformInitSpinner( 42, 'https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_42').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_42');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_42').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_42').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_42').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_42').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/  }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_42').val();gformInitSpinner( 42, 'https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [42, current_page]);window['gf_submitting_42'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_42').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [42]);window['gf_submitting_42'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_42').text());}, 50);}else{jQuery('#gform_42').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gpnf_post_render', [42, current_page]);gform.utils.trigger({ event: 'gform\/postRender', native: false, data: { formId: 42, currentPage: current_page } });} );} ); <\/script>            <\/div>\r\n            \r\n            <div class=\"gpnf-edit-form gpnf-edit-form-36-172\" style=\"display:none;\">\r\n                <!-- Loaded dynamically via AJAX -->\r\n            <\/div>\r\n            \r\n        <link rel='stylesheet' id='gforms_datepicker_css-css'  href='https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/legacy\/css\/datepicker.min.css?ver=2.8.0' type='text\/css' media='all' \/>\n<script type='text\/javascript' src='https:\/\/www.roche-forms.bg\/safety\/wp-includes\/js\/jquery\/ui\/core.min.js?ver=1.11.4' id='jquery-ui-core-js'><\/script>\n<script type='text\/javascript' src='https:\/\/www.roche-forms.bg\/safety\/wp-includes\/js\/jquery\/ui\/datepicker.min.js?ver=1.11.4' id='jquery-ui-datepicker-js'><\/script>\n<script type='text\/javascript' defer='defer' src='https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/js\/datepicker-legacy.min.js?ver=2.8.0' id='gform_datepicker_legacy-js'><\/script>\n<script type='text\/javascript' defer='defer' src='https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/js\/datepicker.min.js?ver=2.8.0' id='gform_datepicker_init-js'><\/script>\n            \r\n            <div class=\"gpnf-nested-form gpnf-nested-form-36-234\" style=\"display:none;\">\r\n                \r\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_56' ><style>#gform_wrapper_56[data-form-index=\"0\"].gform-theme,[data-parent-form=\"56_0\"]{--gf-color-primary: #204ce5;--gf-color-primary-rgb: 32, 76, 229;--gf-color-primary-contrast: #fff;--gf-color-primary-contrast-rgb: 255, 255, 255;--gf-color-primary-darker: #001AB3;--gf-color-primary-lighter: #527EFF;--gf-color-secondary: #fff;--gf-color-secondary-rgb: 255, 255, 255;--gf-color-secondary-contrast: #112337;--gf-color-secondary-contrast-rgb: 17, 35, 55;--gf-color-secondary-darker: #F5F5F5;--gf-color-secondary-lighter: #FFFFFF;--gf-color-out-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-out-ctrl-light-rgb: 17, 35, 55;--gf-color-out-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-out-ctrl-light-lighter: #F5F5F5;--gf-color-out-ctrl-dark: #585e6a;--gf-color-out-ctrl-dark-rgb: 88, 94, 106;--gf-color-out-ctrl-dark-darker: #112337;--gf-color-out-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-color-in-ctrl: #fff;--gf-color-in-ctrl-rgb: 255, 255, 255;--gf-color-in-ctrl-contrast: #112337;--gf-color-in-ctrl-contrast-rgb: 17, 35, 55;--gf-color-in-ctrl-darker: #F5F5F5;--gf-color-in-ctrl-lighter: #FFFFFF;--gf-color-in-ctrl-primary: #204ce5;--gf-color-in-ctrl-primary-rgb: 32, 76, 229;--gf-color-in-ctrl-primary-contrast: #fff;--gf-color-in-ctrl-primary-contrast-rgb: 255, 255, 255;--gf-color-in-ctrl-primary-darker: #001AB3;--gf-color-in-ctrl-primary-lighter: #527EFF;--gf-color-in-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-in-ctrl-light-rgb: 17, 35, 55;--gf-color-in-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-in-ctrl-light-lighter: #F5F5F5;--gf-color-in-ctrl-dark: #585e6a;--gf-color-in-ctrl-dark-rgb: 88, 94, 106;--gf-color-in-ctrl-dark-darker: #112337;--gf-color-in-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-radius: 3px;--gf-font-size-secondary: 14px;--gf-font-size-tertiary: 13px;--gf-icon-ctrl-number: url(\"data:image\/svg+xml,%3Csvg width='8' height='14' viewBox='0 0 8 14' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M4 0C4.26522 5.96046e-08 4.51957 0.105357 4.70711 0.292893L7.70711 3.29289C8.09763 3.68342 8.09763 4.31658 7.70711 4.70711C7.31658 5.09763 6.68342 5.09763 6.29289 4.70711L4 2.41421L1.70711 4.70711C1.31658 5.09763 0.683417 5.09763 0.292893 4.70711C-0.0976311 4.31658 -0.097631 3.68342 0.292893 3.29289L3.29289 0.292893C3.48043 0.105357 3.73478 0 4 0ZM0.292893 9.29289C0.683417 8.90237 1.31658 8.90237 1.70711 9.29289L4 11.5858L6.29289 9.29289C6.68342 8.90237 7.31658 8.90237 7.70711 9.29289C8.09763 9.68342 8.09763 10.3166 7.70711 10.7071L4.70711 13.7071C4.31658 14.0976 3.68342 14.0976 3.29289 13.7071L0.292893 10.7071C-0.0976311 10.3166 -0.0976311 9.68342 0.292893 9.29289Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-select: url(\"data:image\/svg+xml,%3Csvg width='10' height='6' viewBox='0 0 10 6' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M0.292893 0.292893C0.683417 -0.097631 1.31658 -0.097631 1.70711 0.292893L5 3.58579L8.29289 0.292893C8.68342 -0.0976311 9.31658 -0.0976311 9.70711 0.292893C10.0976 0.683417 10.0976 1.31658 9.70711 1.70711L5.70711 5.70711C5.31658 6.09763 4.68342 6.09763 4.29289 5.70711L0.292893 1.70711C-0.0976311 1.31658 -0.0976311 0.683418 0.292893 0.292893Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-search: url(\"data:image\/svg+xml,%3Csvg version='1.1' xmlns='http:\/\/www.w3.org\/2000\/svg' width='640' height='640'%3E%3Cpath d='M256 128c-70.692 0-128 57.308-128 128 0 70.691 57.308 128 128 128 70.691 0 128-57.309 128-128 0-70.692-57.309-128-128-128zM64 256c0-106.039 85.961-192 192-192s192 85.961 192 192c0 41.466-13.146 79.863-35.498 111.248l154.125 154.125c12.496 12.496 12.496 32.758 0 45.254s-32.758 12.496-45.254 0L367.248 412.502C335.862 434.854 297.467 448 256 448c-106.039 0-192-85.962-192-192z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-label-space-y-secondary: var(--gf-label-space-y-md-secondary);--gf-ctrl-border-color: #686e77;--gf-ctrl-size: var(--gf-ctrl-size-md);--gf-ctrl-label-color-primary: #112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style>\r\n                        <div class='gform_heading'>\r\n                            <p class='gform_description'><\/p>\r\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_56' id='gform_56'  action='\/safety\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F109' data-formid='56' novalidate><input type=\"hidden\" name=\"gpnf_parent_form_id\" value=\"36\" \/><input type=\"hidden\" value=\"1\" id=\"gpnf_is_valid_56\" \/><input id=\"gw_last_page_reached\" name=\"gw_last_page_reached\" value=\"1\" type=\"hidden\" \/>\r\n                        <div class='gform-body gform_body'><ul id='gform_fields_56' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_56_1\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_56_1\" ><label class='gfield_label gform-field-label' for='input_56_1'>\u0418\u043c\u0435 \u043d\u0430 \u043f\u0440\u043e\u0434\u0443\u043a\u0442\u0430<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_56_1' type='text' value='' class='medium'  aria-describedby=\"gfield_description_56_1\" tabindex='99999'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_56_1'>(\u0434\u043e\u043a\u043b\u0430\u0434\u0432\u0430\u0439\u0442\u0435\n\u0442\u044a\u0440\u0433\u043e\u0432\u0441\u043a\u043e\u0442\u043e \u0438\u043c\u0435\n\u0430\u043a\u043e \u0435 \u0432\u044a\u0437\u043c\u043e\u0436\u043d\u043e)<\/div><\/li><li id=\"field_56_2\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_56_2\" ><label class='gfield_label gform-field-label' for='input_56_2'>\u041f\u0430\u0440\u0442\u0438\u0434\u0435\u043d \u043d\u043e\u043c\u0435\u0440<\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_56_2' type='text' value='' class='medium'   tabindex='100000'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_56_3\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_56_3\" ><label class='gfield_label gform-field-label' for='input_56_3'>\u041f\u0440\u043e\u0438\u0437\u0432\u043e\u0434\u0438\u0442\u0435\u043b<\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_56_3' type='text' value='' class='medium'   tabindex='100001'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_56_4\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_56_4\" ><label class='gfield_label gform-field-label' for='input_56_4'>\u0414\u0430\u0442\u0430 \u043d\u0430 \u0437\u0430\u043f\u043e\u0447\u0432\u0430\u043d\u0435<\/label><div class='ginput_container ginput_container_date'>\r\n                            <input name='input_4' id='input_56_4' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_no_icon gdatepicker-no-icon' tabindex='100002'  placeholder='dd.mm.yyyy' aria-describedby=\"input_56_4_date_format\" aria-invalid=\"false\" \/>\r\n                            <span id='input_56_4_date_format' class='screen-reader-text'>DD dot MM dot YYYY<\/span>\r\n                        <\/div>\r\n                        <input type='hidden' id='gforms_calendar_icon_input_56_4' class='gform_hidden' value='https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_56_5\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_56_5\" ><label class='gfield_label gform-field-label' for='input_56_5'>\u0414\u0430\u0442\u0430 \u043d\u0430 \u0441\u043f\u0438\u0440\u0430\u043d\u0435<\/label><div class='ginput_container ginput_container_date'>\r\n                            <input name='input_5' id='input_56_5' type='text' value='' class='datepicker gform-datepicker dmy_dot datepicker_no_icon gdatepicker-no-icon' tabindex='100003'  placeholder='dd.mm.yyyy' aria-describedby=\"input_56_5_date_format\" aria-invalid=\"false\" \/>\r\n                            <span id='input_56_5_date_format' class='screen-reader-text'>DD dot MM dot YYYY<\/span>\r\n                        <\/div>\r\n                        <input type='hidden' id='gforms_calendar_icon_input_56_5' class='gform_hidden' value='https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_56_6\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_56_6\" ><label class='gfield_label gform-field-label' for='input_56_6'>\u041d\u0430\u0447\u0438\u043d \u043d\u0430 \u043f\u0440\u0438\u043b\u043e\u0436\u0435\u043d\u0438\u0435<\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_56_6' type='text' value='' class='medium'   tabindex='100004'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_56_7\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_56_7\" ><label class='gfield_label gform-field-label' for='input_56_7'>\u041a\u043e\u043d\u0446\u0435\u043d\u0442\u0440\u0430\u0446\u0438\u044f, \u0444\u043e\u0440\u043c\u0430 \u0438 \u0434\u043e\u0437\u0430<\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_56_7' type='text' value='' class='medium'   tabindex='100005'   aria-invalid=\"false\"   \/> <\/div><\/li><\/ul><\/div>\r\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_56' class='gform_button button' value='\u0414\u043e\u0431\u0430\u0432\u0438' tabindex='100006' onclick='if(window[\"gf_submitting_56\"]){return false;}  if( !jQuery(\"#gform_56\")[0].checkValidity || jQuery(\"#gform_56\")[0].checkValidity()){window[\"gf_submitting_56\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_56\"]){return false;} if( !jQuery(\"#gform_56\")[0].checkValidity || jQuery(\"#gform_56\")[0].checkValidity()){window[\"gf_submitting_56\"]=true;}  jQuery(\"#gform_56\").trigger(\"submit\",[true]); }' \/> <input type='hidden' name='gform_ajax' value='form_id=56&amp;title=&amp;description=1&amp;tabindex=99999&amp;theme=data-form-theme=&#039;legacy&#039;' \/>\r\n            <input type='hidden' class='gform_hidden' name='is_submit_56' value='1' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='56' \/>\r\n            \r\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\r\n            <input type='hidden' class='gform_hidden' name='state_56' value='WyJbXSIsIjc3NmM1ZTkyNmUzZDg2ZDhhYjEwOGNiNDViZjVmOWRjIl0=' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_56' id='gform_target_page_number_56' value='0' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_56' id='gform_source_page_number_56' value='1' \/>\r\n            <input type='hidden' name='gform_field_values' value='' \/>\r\n            \r\n        <\/div>\r\n                        <\/form>\r\n                        <\/div>\r\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_56' id='gform_ajax_frame_56' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\r\n\t\t                <script type=\"text\/javascript\"> gform.initializeOnLoaded( function() {gformInitSpinner( 56, 'https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_56').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_56');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_56').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_56').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_56').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_56').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/  }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_56').val();gformInitSpinner( 56, 'https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [56, current_page]);window['gf_submitting_56'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_56').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [56]);window['gf_submitting_56'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_56').text());}, 50);}else{jQuery('#gform_56').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gpnf_post_render', [56, current_page]);gform.utils.trigger({ event: 'gform\/postRender', native: false, data: { formId: 56, currentPage: current_page } });} );} ); <\/script>            <\/div>\r\n            \r\n            <div class=\"gpnf-edit-form gpnf-edit-form-36-234\" style=\"display:none;\">\r\n                <!-- Loaded dynamically via AJAX -->\r\n            <\/div>\r\n            \r\n        <\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"onecolumn-page.php","meta":[],"_links":{"self":[{"href":"https:\/\/www.roche-forms.bg\/safety\/index.php?rest_route=\/wp\/v2\/pages\/109"}],"collection":[{"href":"https:\/\/www.roche-forms.bg\/safety\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.roche-forms.bg\/safety\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.roche-forms.bg\/safety\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.roche-forms.bg\/safety\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=109"}],"version-history":[{"count":0,"href":"https:\/\/www.roche-forms.bg\/safety\/index.php?rest_route=\/wp\/v2\/pages\/109\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.roche-forms.bg\/safety\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=109"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}