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(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":29,"date":"2014-03-17T15:30:33","date_gmt":"2014-03-17T15:30:33","guid":{"rendered":"http:\/\/www.roche-forms.bg\/safety\/?page_id=29"},"modified":"2014-03-28T12:59:38","modified_gmt":"2014-03-28T12:59:38","slug":"%d1%84%d0%be%d1%80%d0%bc%d0%b0","status":"publish","type":"page","link":"https:\/\/www.roche-forms.bg\/safety\/?page_id=29","title":{"rendered":"\u0424\u043e\u0440\u043c\u0430 \u043f\u0430\u0446\u0438\u0435\u043d\u0442"},"content":{"rendered":"<p>\r\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework roche_wrapper' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_1' style='display:none'><div id='gf_1' 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-\u041f\u0430\u0446\u0438\u0435\u043d\u0442<\/h3>\r\n                            <p class='gform_description'><\/p>\r\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1' class='roche' action='\/safety\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F29#gf_1' data-formid='1' novalidate><div id='gf_page_steps_1' class='gf_page_steps'><div id='gf_step_1_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_1_2' class='gf_step gf_step_next gf_step_pending'><span class='gf_step_number'>2<\/span><span class='gf_step_label'>\u0414\u0430\u043d\u043d\u0438 \u0437\u0430 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430<\/span><\/div><div id='gf_step_1_3' class='gf_step gf_step_pending'><span class='gf_step_number'>3<\/span><span class='gf_step_label'>\u0414\u0430\u043d\u043d\u0438 \u0437\u0430 \u043f\u043e\u0434\u043e\u0437\u0438\u0440\u0430\u043d\u0438\u044f \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d \u043f\u0440\u043e\u0434\u0443\u043a\u0442<\/span><\/div><div id='gf_step_1_4' class='gf_step gf_step_pending'><span class='gf_step_number'>4<\/span><span class='gf_step_label'>\u0418\u0437\u043f\u043e\u043b\u0437\u0432\u0430\u043d\u0438 \u0441\u044a\u043f\u044a\u0442\u0441\u0442\u0432\u0430\u0449\u0438 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u0438 \u043f\u0440\u043e\u0434\u0443\u043a\u0442\u0438 <\/span><\/div><div id='gf_step_1_5' class='gf_step gf_step_pending'><span class='gf_step_number'>5<\/span><span class='gf_step_label'>\u041d\u0435\u0436\u0435\u043b\u0430\u043d\u043e \u0441\u044a\u0431\u0438\u0442\u0438\u0435(\u044f)\/\u0421\u043f\u0435\u0446\u0438\u0430\u043b\u043d\u0430 \u0441\u0438\u0442\u0443\u0430\u0446\u0438\u044f(\u0438)<\/span><\/div><div id='gf_step_1_6' class='gf_step gf_step_pending'><span class='gf_step_number'>6<\/span><span class='gf_step_label'>\u0418\u0437\u0432\u044a\u0440\u0448\u0435\u043d\u0438 \u043c\u0435\u0434.\/\u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u043d\u0438  \u0438\u0437\u0441\u043b\u0435\u0434\u0432\u0430\u043d\u0438\u044f<\/span><\/div><div id='gf_step_1_7' class='gf_step gf_step_pending'><span class='gf_step_number'>7<\/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_1_8' class='gf_step gf_step_last gf_step_pending'><span class='gf_step_number'>8<\/span><span class='gf_step_label'>\u0418\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f \u0437\u0430 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u0438 \u0433\u0440\u0435\u0448\u043a\u0438<\/span><\/div><\/div>\r\n                        <div class='gform-body gform_body'><div id='gform_page_1_1' class='gform_page ' data-js='page-field-id-1' >\r\n                                    <div class='gform_page_fields'><ul id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_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_1_11\" ><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\"><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. <\/p>\n\n<\/div><div class=\"clear\"><\/div><\/div><\/li><li id=\"field_1_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_1_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_1_1\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_1\" ><label class='gfield_label gform-field-label' for='input_1_1'>\u0418\u043c\u0435:<\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_1_1' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_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_1_2\" ><label class='gfield_label gform-field-label' for='input_1_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_1_2' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_20\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_20\" ><label class='gfield_label gform-field-label' for='input_1_20'>\u0414\u044a\u0440\u0436\u0430\u0432\u0430:<\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_1_20' type='text' value='' class='small'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_15\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_15\" ><label class='gfield_label gform-field-label' for='input_1_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_1_15' type='text' value='' class='small'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_135\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_135\" ><label class='gfield_label gform-field-label' for='input_1_135'>\u041d\u0430\u0441\u0435\u043b\u0435\u043d\u043e \u043c\u044f\u0441\u0442\u043e:<\/label><div class='ginput_container ginput_container_text'><input name='input_135' id='input_1_135' type='text' value='' class='small'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_14\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_14\" ><label class='gfield_label gform-field-label' for='input_1_14'>\u0410\u0434\u0440\u0435\u0441:<\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_1_14' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_137\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_137\" ><label class='gfield_label gform-field-label' for='input_1_137'>\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_137' id='input_1_137' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_19\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_19\" ><label class='gfield_label gform-field-label' for='input_1_19'>\u0424\u0430\u043a\u0441:<\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_1_19' type='text' value='' class='small'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_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_1_23\" ><\/li><li id=\"field_1_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_1_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_1_100'>\r\n\t\t\t<li class='gchoice gchoice_1_100_0'>\r\n\t\t\t\t<input name='input_100' type='radio' value='\u0414\u0430'  id='choice_1_100_0'    \/>\r\n\t\t\t\t<label for='choice_1_100_0' id='label_1_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_1_100_1'>\r\n\t\t\t\t<input name='input_100' type='radio' value='\u041d\u0435'  id='choice_1_100_1'    \/>\r\n\t\t\t\t<label for='choice_1_100_1' id='label_1_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_1_100'><div class=\"help\"  style=\"margin-top:-20px\" 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_1_3\" 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_1_3\" ><label class='gfield_label gform-field-label' >\u0423\u0432\u0435\u0434\u043e\u043c\u0435\u043d\u0438 \u043b\u0438 \u0441\u0430 \u0440\u0435\u0433\u0443\u043b\u0430\u0442\u043e\u0440\u043d\u0438\u0442\u0435 \u0432\u043b\u0430\u0441\u0442\u0438 \u0437\u0430 \u0442\u043e\u0432\u0430 \u0441\u044a\u0431\u0438\u0442\u0438\u0435? (\u0418\u0437\u043f\u044a\u043b\u043d\u0438\u0442\u0435\u043b\u043d\u0430 \u0430\u0433\u0435\u043d\u0446\u0438\u044f \u043f\u043e \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0430\u0442\u0430 \u0418\u0410\u041b)<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_1_3'>\r\n\t\t\t<li class='gchoice gchoice_1_3_0'>\r\n\t\t\t\t<input name='input_3' type='radio' value='\u0414\u0430'  id='choice_1_3_0'    \/>\r\n\t\t\t\t<label for='choice_1_3_0' id='label_1_3_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_1_3_1'>\r\n\t\t\t\t<input name='input_3' type='radio' value='\u041d\u0435'  id='choice_1_3_1'    \/>\r\n\t\t\t\t<label for='choice_1_3_1' id='label_1_3_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_1_151\" 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_1_151\" ><\/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_1_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_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \r\n                    <\/div>\r\n                <\/div>\r\n                <div id='gform_page_1_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_1_2' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_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_1_31\" ><div class=\"title_forms\">2. \u0414\u0430\u043d\u043d\u0438 \u0437\u0430 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430<\/div>\n<\/li><li id=\"field_1_159\" 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_1_159\" ><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 \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<\/div><div class=\"clear\"><\/div><\/li><li id=\"field_1_101\" 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_1_101\" ><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_1_103\" 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_1_103\" ><\/li><li id=\"field_1_111\" 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_1_111\" ><label class='gfield_label gform-field-label' >\u041a\u043e\u0439 \u0435 \u0438\u0437\u043f\u0438\u0442\u0430\u043b \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?<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_1_111'>\r\n\t\t\t<li class='gchoice gchoice_1_111_0'>\r\n\t\t\t\t<input name='input_111' type='radio' value='\u0412\u0438\u0435'  id='choice_1_111_0'    \/>\r\n\t\t\t\t<label for='choice_1_111_0' id='label_1_111_0' class='gform-field-label gform-field-label--type-inline'>\u0412\u0438\u0435<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_1_111_1'>\r\n\t\t\t\t<input name='input_111' type='radio' value='\u0412\u0430\u0448\u0435\u0442\u043e \u0434\u0435\u0442\u0435'  id='choice_1_111_1'    \/>\r\n\t\t\t\t<label for='choice_1_111_1' id='label_1_111_1' class='gform-field-label gform-field-label--type-inline'>\u0412\u0430\u0448\u0435\u0442\u043e \u0434\u0435\u0442\u0435<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_1_111_2'>\r\n\t\t\t\t<input name='input_111' type='radio' value='\u041d\u044f\u043a\u043e\u0439 \u0434\u0440\u0443\u0433'  id='choice_1_111_2'    \/>\r\n\t\t\t\t<label for='choice_1_111_2' id='label_1_111_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u044f\u043a\u043e\u0439 \u0434\u0440\u0443\u0433<\/label>\r\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_1_111'><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\">\u201e\u043d\u044f\u043a\u043e\u0439 \u0434\u0440\u0443\u0433\u201c \u043c\u043e\u0436\u0435 \u0434\u0430 \u0435 \u043d\u044f\u043a\u043e\u0439, \u0437\u0430 \u043a\u043e\u0439\u0442\u043e \u0412\u0438\u0435 \u0441\u0435 \u0433\u0440\u0438\u0436\u0438\u0442\u0435.<\/div>\n<\/div><\/div><\/li><li id=\"field_1_136\" class=\"gfield gfield--type-html err_html_class gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_136\" ><div class=\"bold\"> \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 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430, \u043f\u043e\u043b \u043d\u0430 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430, \u0432\u044a\u0437\u0440\u0430\u0441\u0442 \u043d\u0430 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430 \u043f\u043e \u0432\u0440\u0435\u043c\u0435 \u043d\u0430 \u043d\u0435\u0436\u0435\u043b\u0430\u043d\u043e\u0442\u043e \u0441\u044a\u0431\u0438\u0442\u0438\u0435 \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_1_9\" 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_1_9\" ><label class='gfield_label gform-field-label' for='input_1_9'>\u0418\u043d\u0438\u0446\u0438\u0430\u043b\u0438 \u043d\u0430 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430:<\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_1_9' type='text' value='' class='small'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_104\" class=\"gfield gfield--type-radio gfield--type-choice validate_at_least_one field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_104\" ><label class='gfield_label gform-field-label' >\u041f\u043e\u043b:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_104'>\r\n\t\t\t<li class='gchoice gchoice_1_104_0'>\r\n\t\t\t\t<input name='input_104' type='radio' value='\u041c\u044a\u0436'  id='choice_1_104_0'    \/>\r\n\t\t\t\t<label for='choice_1_104_0' id='label_1_104_0' class='gform-field-label gform-field-label--type-inline'>\u041c\u044a\u0436<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_1_104_1'>\r\n\t\t\t\t<input name='input_104' type='radio' value='\u0416\u0435\u043d\u0430'  id='choice_1_104_1'    \/>\r\n\t\t\t\t<label for='choice_1_104_1' id='label_1_104_1' class='gform-field-label gform-field-label--type-inline'>\u0416\u0435\u043d\u0430<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_1_104_2'>\r\n\t\t\t\t<input name='input_104' type='radio' value='\u041d\u0435\u0438\u0437\u0432\u0435\u0441\u0442\u0435\u043d'  id='choice_1_104_2'    \/>\r\n\t\t\t\t<label for='choice_1_104_2' id='label_1_104_2' 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_1_138\" 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_1_138\" ><label class='gfield_label gform-field-label' for='input_1_138'>\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_138' id='input_1_138' type='text' value='' class='small'    placeholder='\u0414\u0414\/\u041c\u041c\/\u0413\u0413\u0413\u0413'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_128\" 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_1_128\" ><div style=\"margin-left:20px;font-weight:bold;display:block\">\u0438\u043b\u0438 \u0432\u044a\u0437\u0440\u0430\u0441\u0442<\/label><\/li><li id=\"field_1_125\" class=\"gfield gfield--type-text right_field field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_125\" ><label class='gfield_label gform-field-label' for='input_1_125'>\u0433\u043e\u0434\u0438\u043d\u0438<\/label><div class='ginput_container ginput_container_text'><input name='input_125' id='input_1_125' type='text' value='' class='small'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_126\" class=\"gfield gfield--type-text validate_at_least_one right_field field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_126\" ><label class='gfield_label gform-field-label' for='input_1_126'>\u043c\u0435\u0441\u0435\u0446\u0438<\/label><div class='ginput_container ginput_container_text'><input name='input_126' id='input_1_126' type='text' value='' class='small'  aria-describedby=\"gfield_description_1_126\"    aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_126'><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\">\u041e\u0442\u043d\u0430\u0441\u044f \u0441\u0435 \u0437\u0430 \u0431\u0435\u0431\u0435\u0442\u0430 \u0434\u043e 1 \u0433\u043e\u0434\u0438\u0448\u043d\u0430 \u0432\u044a\u0437\u0440\u0430\u0441\u0442.<\/div>\n<\/div><\/div><\/li><li id=\"field_1_127\" class=\"gfield gfield--type-text validate_at_least_one right_field field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_127\" ><label class='gfield_label gform-field-label' for='input_1_127'>\u0434\u043d\u0438<\/label><div class='ginput_container ginput_container_text'><input name='input_127' id='input_1_127' type='text' value='' class='small'  aria-describedby=\"gfield_description_1_127\"    aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_127'><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\">\u041e\u0442\u043d\u0430\u0441\u044f \u0441\u0435 \u0437\u0430 \u0431\u0435\u0431\u0435\u0442\u0430 \u043d\u0430 \u0432\u044a\u0437\u0440\u0430\u0441\u0442 \u0434\u043e 1 \u043c\u0435\u0441\u0435\u0446.<\/div>\n<\/div><\/div><\/li><li id=\"field_1_35\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_35\" ><label class='gfield_label gform-field-label' for='input_1_35'>\u0422\u0435\u0433\u043b\u043e (\u043a\u0433.)<\/label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_1_35' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_36\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_36\" ><label class='gfield_label gform-field-label' for='input_1_36'>\u0420\u044a\u0441\u0442 (\u0441\u043c.)<\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_1_36' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_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_1_113\" ><label class='gfield_label gform-field-label' >\u0415\u0442\u043d\u0438\u0447\u0435\u0441\u043a\u0430 \u043f\u0440\u0438\u043d\u0430\u0434\u043b\u0435\u0436\u043d\u043e\u0441\u0442:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_113'>\r\n\t\t\t<li class='gchoice gchoice_1_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_1_113_0'    \/>\r\n\t\t\t\t<label for='choice_1_113_0' id='label_1_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_1_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_1_113_1'    \/>\r\n\t\t\t\t<label for='choice_1_113_1' id='label_1_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_1_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_1_113_2'    \/>\r\n\t\t\t\t<label for='choice_1_113_2' id='label_1_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_1_113_3'>\r\n\t\t\t\t<input name='input_113' type='radio' value='\u0434\u0440\u0443\u0433\u043e'  id='choice_1_113_3'    \/>\r\n\t\t\t\t<label for='choice_1_113_3' id='label_1_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_1_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_1_114\" ><label class='gfield_label gform-field-label' for='input_1_114'>\u041c\u043e\u043b\u044f, \u043f\u043e\u0441\u043e\u0447\u0435\u0442\u0435:<\/label><div class='ginput_container ginput_container_text'><input name='input_114' id='input_1_114' type='text' value='' class='small'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_160\" 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_1_160\" ><div class=\"gfield grey\"><div class=\"left\" style=\"width:820px;text-align:justify\"><strong>\u041f\u0435\u0434\u0438\u0430\u0442\u0440\u0438\u0447\u043d\u0438 \u0441\u043b\u0443\u0447\u0430\u0438<\/strong><br><span>\u0417\u0430\u0431\u0435\u043b\u0435\u0436\u043a\u0430: \u0412 \u0441\u043b\u0443\u0447\u0430\u0439, \u0447\u0435 \u0434\u0430\u0442\u0430\u0442\u0430 \u043d\u0430 \u0440\u0430\u0436\u0434\u0430\u043d\u0435 \u043d\u0435 \u0435 \u0441\u044a\u043e\u0431\u0449\u0435\u043d\u0430, \u043e\u043f\u0438\u0442\u0430\u0439\u0442\u0435 \u0441\u0435\n\u0434\u0430 \u0440\u0430\u0437\u043f\u0440\u0435\u0434\u0435\u043b\u0438\u0442\u0435 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430 \u043a\u044a\u043c \u0435\u0434\u043d\u0430 \u043e\u0442 \u0432\u044a\u0437\u0440\u0430\u0441\u0442\u043e\u0432\u0438\u0442\u0435 \u0433\u0440\u0443\u043f\u0438, \u043f\u043e \u0432\u0440\u0435\u043c\u0435\u0442\u043e,\n\u043a\u043e\u0433\u0430\u0442\u043e \u0441\u0430 \u0431\u0438\u043b\u0438 \u043d\u0430\u0431\u043b\u044e\u0434\u0430\u0432\u0430\u043d\u0438 \u043d\u0430 \u043d\u0435\u0436\u0435\u043b\u0430\u043d\u0438\u0442\u0435 \u0441\u044a\u0431\u0438\u0442\u0438\u044f <\/span>\n<\/div><div class=\"clear\"><\/div><\/li><li id=\"field_1_161\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_161\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u0412\u044a\u0437\u0440\u0430\u0441\u0442 \u043f\u043e \u0432\u0440\u0435\u043c\u0435 \u043d\u0430 \u0441\u044a\u0431\u0438\u0442\u0438\u0435\u0442\u043e:<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_161'><li class='gchoice gchoice_1_161_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_161.1' type='checkbox'  value='\u041f\u0440\u0435\u0436\u0434\u0435\u0432\u0440\u0435\u043c\u0435\u043d\u043d\u043e \u0438 \u043d\u043e\u0432\u043e\u0440\u043e\u0434\u0435\u043d\u0438 \u043e\u0442 0 \u0434\u043e 27 \u0434\u043d\u0438'  id='choice_1_161_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_1_161_1' id='label_1_161_1' class='gform-field-label gform-field-label--type-inline'>\u041f\u0440\u0435\u0436\u0434\u0435\u0432\u0440\u0435\u043c\u0435\u043d\u043d\u043e \u0438 \u043d\u043e\u0432\u043e\u0440\u043e\u0434\u0435\u043d\u0438 \u043e\u0442 0 \u0434\u043e 27 \u0434\u043d\u0438<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_161_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_161.2' type='checkbox'  value='\u0411\u0435\u0431\u0435\u0442\u0430 (\u0438\u043b\u0438 \u043c\u0430\u043b\u043a\u0438 \u0434\u0435\u0446\u0430) \u043e\u0442 1 \u043c\u0435\u0441\u0435\u0446 \u0434\u043e 23 \u043c\u0435\u0441\u0435\u0446\u0430'  id='choice_1_161_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_1_161_2' id='label_1_161_2' class='gform-field-label gform-field-label--type-inline'>\u0411\u0435\u0431\u0435\u0442\u0430 (\u0438\u043b\u0438 \u043c\u0430\u043b\u043a\u0438 \u0434\u0435\u0446\u0430) \u043e\u0442 1 \u043c\u0435\u0441\u0435\u0446 \u0434\u043e 23 \u043c\u0435\u0441\u0435\u0446\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_161_3'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_161.3' type='checkbox'  value='\u0414\u0435\u0446\u0430 \u043e\u0442 2 \u0433\u043e\u0434\u0438\u043d\u0438 \u0434\u043e 11 \u0433\u043e\u0434\u0438\u043d\u0438'  id='choice_1_161_3'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_1_161_3' id='label_1_161_3' class='gform-field-label gform-field-label--type-inline'>\u0414\u0435\u0446\u0430 \u043e\u0442 2 \u0433\u043e\u0434\u0438\u043d\u0438 \u0434\u043e 11 \u0433\u043e\u0434\u0438\u043d\u0438<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_161_4'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_161.4' type='checkbox'  value='\u042e\u043d\u043e\u0448\u0438 \u043e\u0442 12 \u0434\u043e \u043f\u043e-\u043c\u0430\u043b\u043a\u043e \u043e\u0442 18 \u0433\u043e\u0434\u0438\u043d\u0438'  id='choice_1_161_4'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_1_161_4' id='label_1_161_4' class='gform-field-label gform-field-label--type-inline'>\u042e\u043d\u043e\u0448\u0438 \u043e\u0442 12 \u0434\u043e \u043f\u043e-\u043c\u0430\u043b\u043a\u043e \u043e\u0442 18 \u0433\u043e\u0434\u0438\u043d\u0438<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_162\" 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_1_162\" ><div style=\"margin-left:20px;font-weight:bold\">\u041d\u043e\u0432\u043e\u0440\u043e\u0434\u0435\u043d\u0438 \u0438 \u043a\u044a\u0440\u043c\u0430\u0447\u0435\u0442\u0430:<\/div><\/li><li id=\"field_1_163\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_163\" ><label class='gfield_label gform-field-label' for='input_1_163'>\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: \u0421\u0435\u0434\u043c\u0438\u0446\u0430(\u0438)<\/label><div class='ginput_container ginput_container_text'><input name='input_163' id='input_1_163' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_164\" 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_1_164\" ><div style=\"margin-left:20px;font-weight:bold\">\u0421\u044a\u0437\u0440\u044f\u0432\u0430\u043d\u0435 \u043d\u0430\n\u043f\u0435\u0434\u0438\u0430\u0442\u0440\u0438\u0447\u043d\u0438\u044f \u043f\u0430\u0446\u0438\u0435\u043d\u0442 \u0432\n\u043a\u043e\u043d\u0442\u0435\u043a\u0441\u0442\u0430 \u043d\u0430 \u0432\u044a\u0437\u0440\u0430\u0441\u0442\u0442\u0430:<\/div><\/li><li id=\"field_1_165\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_165\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u041f\u0440\u0435\u0436\u0434\u0435\u0432\u0440\u0435\u043c\u0435\u043d\u043d\u043e:<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_165'><li class='gchoice gchoice_1_165_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_165.1' type='checkbox'  value='\u041d\u0435'  id='choice_1_165_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_1_165_1' id='label_1_165_1' 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_1_165_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_165.2' type='checkbox'  value='\u0414\u0430'  id='choice_1_165_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_1_165_2' id='label_1_165_2' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_166\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_166\" ><label class='gfield_label gform-field-label' for='input_1_166'>\u0423\u0442\u043e\u0447\u043d\u0435\u0442\u0435<\/label><div class='ginput_container ginput_container_text'><input name='input_166' id='input_1_166' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_169\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_169\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u0417\u0430\u0431\u0430\u0432\u0435\u043d\u043e \u043f\u0443\u0431\u0435\u0440\u0442\u0435\u0442\u043d\u043e \u0440\u0430\u0437\u0432\u0438\u0442\u0438\u0435:<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_169'><li class='gchoice gchoice_1_169_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_169.1' type='checkbox'  value='\u041d\u0435'  id='choice_1_169_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_1_169_1' id='label_1_169_1' 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_1_169_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_169.2' type='checkbox'  value='\u0414\u0430'  id='choice_1_169_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_1_169_2' id='label_1_169_2' class='gform-field-label gform-field-label--type-inline'>\u0414\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_168\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_168\" ><label class='gfield_label gform-field-label' for='input_1_168'>\u0423\u0442\u043e\u0447\u043d\u0435\u0442\u0435<\/label><div class='ginput_container ginput_container_text'><input name='input_168' id='input_1_168' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_170\" 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_1_170\" ><div style=\"margin-left:20px;font-weight:bold\">\u0420\u0430\u0441\u0442\u0435\u0436: <\/div><\/li><li id=\"field_1_172\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_172\" ><label class='gfield_label gform-field-label' for='input_1_172'>\u041f\u0440\u043e\u0446\u0435\u043d\u0442\u043d\u043e \u043f\u043e-\u0434\u043e\u043b\u0443<\/label><div class='ginput_container ginput_container_text'><input name='input_172' id='input_1_172' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_171\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_171\" ><label class='gfield_label gform-field-label' for='input_1_171'>\u041f\u0440\u043e\u0446\u0435\u043d\u0442\u043d\u043e \u043f\u043e-\u0433\u043e\u0440\u0435<\/label><div class='ginput_container ginput_container_text'><input name='input_171' id='input_1_171' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_173\" 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_1_173\" ><div style=\"margin-left:20px;font-weight:bold\">\u041a\u043e\u0433\u043d\u0438\u0442\u0438\u0432\u043d\u043e \u0438 \u0434\u0432\u0438\u0433\u0430\u0442\u0435\u043b\u043d\u043e \u0440\u0430\u0437\u0432\u0438\u0442\u0438\u0435  <\/div><\/li><li id=\"field_1_167\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_167\" ><label class='gfield_label gform-field-label' for='input_1_167'>\u0423\u0442\u043e\u0447\u043d\u0435\u0442\u0435<\/label><div class='ginput_container ginput_container_text'><input name='input_167' id='input_1_167' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_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_1_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_1_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_1\").val(\"1\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"1\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_next.png' id='gform_next_button_1_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_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \r\n                    <\/div>\r\n                <\/div>\r\n                <div id='gform_page_1_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_1_3' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_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_1_39\" ><div class=\"title_forms\">3. \u0414\u0430\u043d\u043d\u0438 \u0437\u0430 \u043f\u043e\u0434\u043e\u0437\u0438\u0440\u0430\u043d\u0438\u044f \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d \u043f\u0440\u043e\u0434\u0443\u043a\u0442<\/div>\n<div class=\"gfield grey\"><div class=\"left\" style=\"width:820px\">\n<p>\u041f\u043e\u0434\u043e\u0437\u0438\u0440\u0430\u043d\u0438\u044f\u0442 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d \u043f\u0440\u043e\u0434\u0443\u043a\u0442 \u043c\u043e\u0436\u0435 \u0434\u0430 \u0431\u044a\u0434\u0435 \u0435\u0434\u0438\u043d\u0441\u0442\u0432\u0435\u043d\u043e \u0440\u0430\u0437\u0440\u0435\u0448\u0435\u043d \u0437\u0430 \u0443\u043f\u043e\u0442\u0440\u0435\u0431\u0430 \u043f\u0440\u043e\u0434\u0443\u043a\u0442 \u043d\u0430 \u0420\u043e\u0448 \u0411\u044a\u043b\u0433\u0430\u0440\u0438\u044f.<\/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 \u043f\u043e\u0434\u043e\u0437\u0438\u0440\u0430\u043d\u0438\u044f \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d \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 7 - \u0414\u043e\u043f\u044a\u043b\u043d\u0438\u0442\u0435\u043b\u043d\u0430 \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f <\/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 \u043f\u043e\u0434\u043e\u0437\u0438\u0440\u0430\u043d \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d \u043f\u0440\u043e\u0434\u0443\u043a\u0442.<\/p>\n<\/div><div class=\"clear\"><\/div><\/div><\/li><li id=\"field_1_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_1_99\" ><label class='gfield_label gform-field-label' for='input_1_99'>\u0414\u0430\u043d\u043d\u0438 \u0437\u0430 \u043f\u043e\u0434\u043e\u0437\u0438\u0440\u0430\u043d\u0438\u044f \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d \u043f\u0440\u043e\u0434\u0443\u043a\u0442<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-41\">\u041f\u043e\u0434\u043e\u0437\u0438\u0440\u0430\u043d\u043e \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u043e:<\/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: f41\">&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=\"1\" data-nestedformid=\"7\">\u0414\u043e\u0431\u0430\u0432\u0438<\/button>                        <input type=\"hidden\"                 name=\"input_99\"                 id=\"input_1_99\"                 data-bind=\"value: entryIds\"                value=\"\" \/>                    <\/div>                <\/li><li id=\"field_1_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_1_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 \u043f\u043e\u0434\u043e\u0437\u0438\u0440\u0430\u043d \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d \u043f\u0440\u043e\u0434\u0443\u043a\u0442.<\/div><\/li><li id=\"field_1_129\" 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_1_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_1_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_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_next.png' id='gform_next_button_1_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_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \r\n                    <\/div>\r\n                <\/div>\r\n                <div id='gform_page_1_4' 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_1_4' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_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_1_53\" ><div class=\"title_forms\">4. \u0418\u0437\u043f\u043e\u043b\u0437\u0432\u0430\u043d\u0438 \u0441\u044a\u043f\u044a\u0442\u0441\u0432\u0430\u0449\u0438 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u0438 \u043f\u0440\u043e\u0434\u0443\u043a\u0442\u0438 <\/div>\n<div class=\"gfield grey\"><div class=\"left\" style=\"width:820px\">\u0421\u044a\u043f\u044a\u0442\u0441\u0442\u0432\u0430\u0449\u0438 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u0438 \u043f\u0440\u043e\u0434\u0443\u043a\u0442\u0438 \u0441\u0430 \u0442\u0430\u043a\u0438\u0432\u0430, \u043f\u0440\u0438\u0435\u043c\u0430\u043d\u0438 \u0437\u0430 \u0434\u0440\u0443\u0433\u0438 \u0431\u043e\u043b\u0435\u0441\u0442\u043d\u0438 \u0441\u044a\u0441\u0442\u043e\u044f\u043d\u0438\u044f. <\/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  \u0441\u044a\u043f\u044a\u0442\u0441\u0442\u0432\u0430\u0449 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d \u043f\u0440\u043e\u0434\u0443\u043a\u0442.<\/p>\n<\/div><div class=\"clear\"><\/div><\/div><\/li><li id=\"field_1_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_1_115\" ><label class='gfield_label gform-field-label' for='input_1_115'>\u0418\u0437\u043f\u043e\u043b\u0437\u0432\u0430\u043d\u0438 \u0441\u044a\u043f\u044a\u0442\u0441\u0432\u0430\u0449\u0438 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u0438 \u043f\u0440\u043e\u0434\u0443\u043a\u0442\u0438<\/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-77\">\u0418\u043c\u0435 \u043d\u0430 \u0441\u044a\u043f\u044a\u0442\u0441\u0442\u0432\u0430\u0449 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d \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: f77\">&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=\"1\" data-nestedformid=\"13\">\u0414\u043e\u0431\u0430\u0432\u0438<\/button>                        <input type=\"hidden\"                 name=\"input_115\"                 id=\"input_1_115\"                 data-bind=\"value: entryIds\"                value=\"\" \/>                    <\/div>                <\/li><li id=\"field_1_130\" 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_1_130\" ><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 \u0441\u044a\u043f\u044a\u0442\u0441\u0442\u0432\u0430\u0449 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d \u043f\u0440\u043e\u0434\u0443\u043a\u0442 <\/div><\/li><li id=\"field_1_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_1_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_1_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_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_next.png' id='gform_next_button_1_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_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \r\n                    <\/div>\r\n                <\/div>\r\n                <div id='gform_page_1_5' 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_1_5' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_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_1_106\" ><div class=\"title_forms\">5. \u041d\u0435\u0436\u0435\u043b\u0430\u043d\u043e \u0441\u044a\u0431\u0438\u0442\u0438\u0435(\u044f)\/\u0421\u043f\u0435\u0446\u0438\u0430\u043b\u043d\u0430 \u0441\u0438\u0442\u0443\u0430\u0446\u0438\u044f(\u0438)<\/div>\n<div class=\"gfield grey\"><div class=\"left\" style=\"width:820px\">\u041d\u0435\u0436\u0435\u043b\u0430\u043d\u043e \u0441\u044a\u0431\u0438\u0442\u0438\u0435(\u044f)\/\u0421\u043f\u0435\u0446\u0438\u0430\u043b\u043d\u0430 \u0441\u0438\u0442\u0443\u0430\u0446\u0438\u044f(\u0438) \u043c\u043e\u0436\u0435 \u0434\u0430 \u0435 \u0441\u0438\u043c\u043f\u0442\u043e\u043c (\u043f\u0440\u043e\u043c\u044f\u043d\u0430 \u0432 \u0437\u0434\u0440\u0430\u0432\u043e\u0441\u043b\u043e\u0432\u043d\u043e\u0442\u043e \u0441\u044a\u0441\u0442\u043e\u044f\u043d\u0438\u0435, \u043a\u043e\u044f\u0442\u043e \u0447\u043e\u0432\u0435\u043a \u0437\u0430\u0431\u0435\u043b\u044f\u0437\u0432\u0430 \u0438 \u0441\u044a\u043e\u0431\u0449\u0430\u0432\u0430. \u041d\u0430\u043f\u0440. \u0431\u043e\u043b\u043a\u0430, \u0433\u0430\u0434\u0435\u043d\u0435, \u043f\u043e\u0432\u0440\u044a\u0449\u0430\u043d\u0435, \u0432\u0438\u0441\u043e\u043a\u0430 \u0442\u0435\u043b\u0435\u0441\u043d\u0430 \u0442\u0435\u043c\u043f\u0435\u0440\u0430\u0442\u0443\u0440\u0430, \u0442\u0440\u0435\u0441\u043a\u0430, \u043a\u0430\u0448\u043b\u0438\u0446\u0430, \u0434\u0440\u0443\u0433\u043e) \u0438\u043b\u0438 \u0434\u0438\u0430\u0433\u043d\u043e\u0437\u0430 (\u0443\u0441\u0442\u0430\u043d\u043e\u0432\u044f\u0432\u0430 \u0441\u0435 \u0441\u043b\u0435\u0434 \u0438\u0437\u0432\u044a\u0440\u0448\u0435\u043d \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0438 \u043f\u0440\u0435\u0433\u043b\u0435\u0434. \u041d\u0430\u043f\u0440. \u0430\u043d\u0435\u043c\u0438\u044f, \u043f\u043d\u0435\u0432\u043c\u043e\u043d\u0438\u044f, \u043e\u0441\u0442\u0435\u043e\u043f\u043e\u0440\u043e\u0437\u0430, \u0438\u043d\u0444\u0430\u0440\u043a\u0442, \u0434\u0440\u0443\u0433\u043e).<\/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 \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.<\/p>\n\n<\/div><div class=\"clear\"><\/div><\/div><\/li><li id=\"field_1_98\" 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_1_98\" ><label class='gfield_label gform-field-label' for='input_1_98'>\u041d\u0435\u0436\u0435\u043b\u0430\u043d\u043e \u0441\u044a\u0431\u0438\u0442\u0438\u0435(\u044f)\/\u0421\u043f\u0435\u0446\u0438\u0430\u043b\u043d\u0430 \u0441\u0438\u0442\u0443\u0430\u0446\u0438\u044f(\u0438)<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-78\">\u041d\u0435\u0436\u0435\u043b\u0430\u043d\u043e \u0441\u044a\u0431\u0438\u0442\u0438\u0435(\u044f)\/\u0421\u043f\u0435\u0446\u0438\u0430\u043b\u043d\u0430 \u0441\u0438\u0442\u0443\u0430\u0446\u0438\u044f(\u0438):<\/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=\"1\" data-nestedformid=\"10\">\u0414\u043e\u0431\u0430\u0432\u0438<\/button>                        <input type=\"hidden\"                 name=\"input_98\"                 id=\"input_1_98\"                 data-bind=\"value: entryIds\"                value=\"\" \/>                    <\/div>                <\/li><li id=\"field_1_131\" 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_1_131\" ><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 \u043d\u0435\u0436\u0435\u043b\u0430\u043d\u043e \u0441\u044a\u0431\u0438\u0442\u0438\u0435(\u044f)\/\u0441\u043f\u0435\u0446\u0438\u0430\u043b\u043d\u0430 \u0441\u0438\u0442\u0443\u0430\u0446\u0438\u044f(\u0438)<\/div><\/li><li id=\"field_1_132\" 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_1_132\" ><\/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_1_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_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_next.png' id='gform_next_button_1_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_1\").val(\"6\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"6\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \r\n                    <\/div>\r\n                <\/div>\r\n                <div id='gform_page_1_6' 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_1_6' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_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_1_83\" ><div class=\"title_forms\">6. \u0418\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>\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 \u0437\u0430 \u043e\u0446\u0435\u043d\u043a\u0430 \u043d\u0430 \u043d\u0435\u0436\u0435\u043b\u0430\u043d\u0430\u0442\u0430 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u0430 \u0440\u0435\u0430\u043a\u0446\u0438\u044f.<\/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_1_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_1_117\" ><label class='gfield_label gform-field-label' for='input_1_117'>\u0418\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:<\/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 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0438\/\u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440e\u043d \u0442\u0435\u0441\u0442. \u041c\u043e\u043b\u044f, \u043e\u043f\u0438\u0448\u0435\u0442\u0435 \u0432\u0438\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=\"1\" data-nestedformid=\"14\">\u0414\u043e\u0431\u0430\u0432\u0438<\/button>                        <input type=\"hidden\"                 name=\"input_117\"                 id=\"input_1_117\"                 data-bind=\"value: entryIds\"                value=\"\" \/>                    <\/div>                <\/li><li id=\"field_1_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_1_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_1_133\" 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_1_133\" ><\/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_1_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_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_next.png' id='gform_next_button_1_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_1\").val(\"7\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"7\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \r\n                    <\/div>\r\n                <\/div>\r\n                <div id='gform_page_1_7' 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_1_7' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_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_1_119\" ><div class=\"title_forms\">7. \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\">\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, \u043a\u043e\u044f\u0442\u043e \u0437\u043d\u0430\u0435\u0442\u0435.<\/p>\n<\/li><li id=\"field_1_158\" 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_1_158\" ><div class=\"gfield grey\"><div class=\"left\" style=\"width:820px;text-align:justify\">\u0417\u0430\u0431\u0435\u043b\u0435\u0436\u043a\u0430: \u041f\u0440\u0435\u0434\u043e\u0441\u0442\u0430\u0432\u0435\u0442\u0435 \u043e\u043f\u0438\u0441\u0430\u043d\u0438\u0435 \u043d\u0430 \u043d\u0435\u0436\u0435\u043b\u0430\u043d\u043e \u0441\u044a\u0431\u0438\u0442\u0438\u0435 (\u044f), \u0441\u044a\u043f\u044a\u0442\u0441\u0442\u0432\u0430\u0449\u0438 \u0441\u044a\u0441\u0442\u043e\u044f\u043d\u0438\u044f \u0438 \u0441\u044a\u043e\u0442\u0432\u0435\u0442\u043d\u0430\u0442\u0430 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0430 \u0438\u0441\u0442\u043e\u0440\u0438\u044f (\u0432\u043a\u043b\u044e\u0447\u0438\u0442\u0435\u043b\u043d\u043e \u043d\u0430\u0447\u0430\u043b\u043d\u0430 \u0438 \u043a\u0440\u0430\u0439\u043d\u0430 \u0434\u0430\u0442\u0430, \u0430\u043a\u043e \u0435 \u043f\u0440\u0438\u043b\u043e\u0436\u0438\u043c\u043e), \u043a\u043b\u0438\u043d\u0438\u0447\u043d\u043e \u043f\u0440\u043e\u0442\u0438\u0447\u0430\u043d\u0435, \u043f\u0440\u0438\u0447\u0438\u043d\u043d\u043e-\u0441\u043b\u0435\u0434\u0441\u0442\u0432\u0435\u043d\u0430\u0442\u0430 \u0432\u0440\u044a\u0437\u043a\u0430 (\u0430\u043a\u043e \u0441\u0430 \u043d\u0435\u0438\u0437\u0432\u0435\u0441\u0442\u043d\u0438), \u043b\u0435\u0447\u0435\u043d\u0438\u0435 \u043d\u0430 \u043d\u0435\u0436\u0435\u043b\u0430\u043d\u043e \u0441\u044a\u0431\u0438\u0442\u0438\u0435 (\u044f) \u0438 \u0438\u0437\u0445\u043e\u0434. \u041f\u0440\u0438 \u043f\u0435\u0434\u0438\u0430\u0442\u0440\u0438\u0447\u043d\u0438 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0438, \u043f\u043e\u043c\u0438\u0441\u043b\u0435\u0442\u0435 \u0437\u0430 \u0441\u043b\u0435\u0434\u043d\u0430\u0442\u0430 \u0432\u0430\u0436\u043d\u0430 \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f: \u0424\u0430\u0440\u043c\u0430\u0446\u0435\u0432\u0442\u0438\u0447\u043d\u0430 \u0444\u043e\u0440\u043c\u0430 \u0438 \u0441\u0438\u043b\u0430 \u043d\u0430 \u043f\u0440\u043e\u0434\u0443\u043a\u0442\u0430. \u0414\u043e\u0437\u0438\u0440\u043e\u0432\u043a\u0430, \u043f\u0440\u0435\u0434\u043f\u0438\u0441\u0430\u043d\u0430 \u0438 \/ \u0438\u043b\u0438 \u043f\u0440\u0438\u043b\u0430\u0433\u0430\u043d\u0430 (\u0432\u043a\u043b\u044e\u0447\u0438\u0442\u0435\u043b\u043d\u043e \u0435\u0434\u0438\u043d\u0438\u0447\u043d\u0430 \/ \u0434\u043d\u0435\u0432\u043d\u0430 \u0438 \/ \u0438\u043b\u0438 \u043e\u0431\u0449\u0430 \u0434\u043e\u0437\u0430, \u043a\u0430\u043a\u0442\u043e \u0438 \u0441\u0445\u0435\u043c\u0430 \u043d\u0430 \u0434\u043e\u0437\u0438\u0440\u0430\u043d\u0435). \u041f\u0440\u043e\u0434\u044a\u043b\u0436\u0438\u0442\u0435\u043b\u043d\u043e\u0441\u0442 \u0438 \u043e\u0431\u0441\u0442\u043e\u044f\u0442\u0435\u043b\u0441\u0442\u0432\u0430 \u043d\u0430 \u0435\u043a\u0441\u043f\u043e\u0437\u0438\u0446\u0438\u044f \u043d\u0430 \u043f\u0440\u043e\u0434\u0443\u043a\u0442\u0430. \u041c\u0435\u0442\u043e\u0434, \u0438\u0437\u043f\u043e\u043b\u0437\u0432\u0430\u043d \u0437\u0430 \u043e\u043f\u0440\u0435\u0434\u0435\u043b\u044f\u043d\u0435 \u043d\u0430 \u0434\u043e\u0437\u0430\u0442\u0430. \u0421\u043f\u0430\u0437\u0432\u0430\u043d\u0435 \u043d\u0430 \u043b\u0435\u0447\u0435\u043d\u0438\u0435\u0442\u043e. \u0418\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f \u0437\u0430 \u0435\u043a\u0441\u043f\u043e\u0437\u0438\u0446\u0438\u044f \u043d\u0430 \u043c\u0430\u0439\u043a\u0430\u0442\u0430 \u0438 \u0431\u0430\u0449\u0430\u0442\u0430 \u043f\u043e \u0432\u0440\u0435\u043c\u0435 \u043d\u0430 \u0437\u0430\u0431\u0440\u0435\u043c\u0435\u043d\u044f\u0432\u0430\u043d\u0435 \u0438\u043b\u0438 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442, \u043a\u0430\u043a\u0442\u043e \u0438 \u0435\u043a\u0441\u043f\u043e\u0437\u0438\u0446\u0438\u044f \u043d\u0430 \u043d\u043e\u0432\u043e\u0440\u043e\u0434\u0435\u043d\u043e\u0442\u043e \/ \u043a\u044a\u0440\u043c\u0430\u0447\u0435\u0442\u043e \u0447\u0440\u0435\u0437 \u043a\u044a\u0440\u043c\u0435\u043d\u0435.\n<\/div><div class=\"clear\"><\/div><\/li><li id=\"field_1_121\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_121\" ><label class='gfield_label gform-field-label' for='input_1_121'>\u041c\u043e\u043b\u044f, \u043e\u043f\u0438\u0448\u0435\u0442\u0435 \u0441\u044a\u0431\u0438\u0442\u0438\u0435\u0442\u043e\/\u044f\u0442\u0430 \u0441\u044a\u0441 \u0441\u0432\u043e\u0438 \u0434\u0443\u043c\u0438 \u0438 \u0432\u0441\u044f\u043a\u0430 \u0434\u0440\u0443\u0433\u0430 \u043f\u043e\u043b\u0435\u0437\u043d\u0430 \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f (\u0435\u0434\u043d\u043e\u0432\u0440\u0435\u043c\u0435\u043d\u043d\u0438 \u043e\u0431\u0441\u0442\u043e\u044f\u0442\u0435\u043b\u0441\u0442\u0432\u0430, \u0438\u0437\u0432\u0435\u0441\u0442\u043d\u0438 \u0430\u043b\u0435\u0440\u0433\u0438\u0438, \u0442\u044e\u0442\u044e\u043d\u043e\u043f\u0443\u0448\u0435\u043d\u0435, \u0437\u043b\u043e\u0443\u043f\u043e\u0442\u0440\u0435\u0431\u0430 \u0441 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u0438 \u043f\u0440\u043e\u0434\u0443\u043a\u0442\u0438, \u0430\u043b\u043a\u043e\u0445\u043e\u043b, \u043d\u0430\u0440\u043a\u043e\u0442\u0438\u0446\u0438 \u0438 \u0434\u0440\u0443\u0433\u0438).<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_121' id='input_1_121' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_122\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_122\" ><label class='gfield_label gform-field-label' >\u0421\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\u0448\u0438\u044f \u043b\u0438\u0447\u0435\u043d \u043b\u0435\u043a\u0430\u0440 \u0432\u044a\u0432 \u0432\u0440\u044a\u0437\u043a\u0430 \u0441 \u0432\u0430\u0448\u0435\u0442\u043e \u0441\u044a\u043e\u0431\u0449\u0435\u043d\u0438\u0435.<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_122'>\r\n\t\t\t<li class='gchoice gchoice_1_122_0'>\r\n\t\t\t\t<input name='input_122' type='radio' value='\u0414\u0430'  id='choice_1_122_0'    \/>\r\n\t\t\t\t<label for='choice_1_122_0' id='label_1_122_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_1_122_1'>\r\n\t\t\t\t<input name='input_122' type='radio' value='\u041d\u0435'  id='choice_1_122_1'    \/>\r\n\t\t\t\t<label for='choice_1_122_1' id='label_1_122_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_1_123\" 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_1_123\" ><label class='gfield_label gform-field-label' for='input_1_123'>M\u043e\u043b\u044f, \u043f\u043e\u0441\u043e\u0447\u0435\u0442\u0435 \u0434\u0430\u043d\u043d\u0438 \u0437\u0430 \u043a\u043e\u043d\u0442\u0430\u043a\u0442 \u0441 \u0432\u0430\u0448\u0438\u044f \u043b\u0438\u0447\u0435\u043d \u043b\u0435\u043a\u0430\u0440 (\u0418\u043c\u0435, \u0424\u0430\u043c\u0438\u043b\u0438\u044f, \u0442\u0435\u043b\u0435\u0444\u043e\u043d \u0437\u0430 \u0432\u0440\u044a\u0437\u043a\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_123' id='input_1_123' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_124\" 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_1_124\" ><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_1_124'>\r\n\t\t\t<li class='gchoice gchoice_1_124_0'>\r\n\t\t\t\t<input name='input_124' type='radio' value='\u0414\u0430'  id='choice_1_124_0'    \/>\r\n\t\t\t\t<label for='choice_1_124_0' id='label_1_124_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_1_124_1'>\r\n\t\t\t\t<input name='input_124' type='radio' value='\u041d\u0435'  id='choice_1_124_1'    \/>\r\n\t\t\t\t<label for='choice_1_124_1' id='label_1_124_1' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t<\/li><\/ul><\/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_1_139' 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_1\").val(\"6\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"6\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='image' src='https:\/\/www.roche-forms.bg\/safety\/images\/btn_next.png' id='gform_next_button_1_139' 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_1\").val(\"8\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"8\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \r\n                    <\/div>\r\n                <\/div>\r\n                <div id='gform_page_1_8' class='gform_page' data-js='page-field-id-139' style='display:none;'>\r\n                    <div class='gform_page_fields'>\r\n                        <ul id='gform_fields_1_8' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_140\" 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_1_140\" >\n<div class=\"title_forms\">8. \u0418\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f \u0437\u0430 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u0438 \u0433\u0440\u0435\u0448\u043a\u0438<\/div>\n<div class=\"gfield grey\"><div class=\"left\" style=\"width:820px\">\u041c\u043e\u043b\u044f, \u043f\u043e\u043f\u044a\u043b\u043d\u0435\u0442\u0435 \u0432\u0441\u0438\u0447\u043a\u0438 \u0441\u044a\u043e\u0431\u0449\u0435\u043d\u0438\u044f \u0437\u0430 \u0443\u0441\u0442\u0430\u043d\u043e\u0432\u0435\u043d\u0430 \u0438\u043b\u0438 \u043f\u043e\u0442\u0432\u044a\u0440\u0434\u0435\u043d\u0430 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u0430 \u0433\u0440\u0435\u0448\u043a\u0430. \u0410\u043a\u043e \u0434\u0440\u0443\u0433\u0430 \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f \u0441\u0435 \u0441\u0447\u0438\u0442\u0430 \u0437\u0430 \u0440\u0435\u043b\u0435\u0432\u0430\u043d\u0442\u043d\u0430, \u043c\u043e\u043b\u044f, \u043f\u0440\u0435\u0434\u043e\u0441\u0442\u0430\u0432\u0435\u0442\u0435 \u044f \u0432 \u0440\u0430\u0437\u0434\u0435\u043b 7.<\/p><\/div><\/div><\/li><li id=\"field_1_141\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_141\" ><label class='gfield_label gform-field-label' for='input_1_141'>\u041a\u0440\u0430\u0442\u043a\u043e \u043e\u043f\u0438\u0441\u0430\u043d\u0438\u0435 \u043d\u0430 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u0430\u0442\u0430 \u0433\u0440\u0435\u0448\u043a\u0430:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_141' id='input_1_141' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_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_1_28\" ><\/li><li id=\"field_1_142\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_142\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u041c\u044f\u0441\u0442\u043e, \u043d\u0430 \u043a\u043e\u0435\u0442\u043e \u043f\u044a\u0440\u0432\u043e \u0441\u0435 \u0435 \u043f\u043e\u044f\u0432\u0438\u043b\u0430 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u0430\u0442\u0430 \u0433\u0440\u0435\u0448\u043a\u0430:<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_142'><li class='gchoice gchoice_1_142_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.1' type='checkbox'  value='\u0421\u044a\u0445\u0440\u0430\u043d\u0435\u043d\u0438\u0435'  id='choice_1_142_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_1_142_1' id='label_1_142_1' class='gform-field-label gform-field-label--type-inline'>\u0421\u044a\u0445\u0440\u0430\u043d\u0435\u043d\u0438\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_142_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.2' type='checkbox'  value='\u041f\u0440\u0435\u0434\u043f\u0438\u0441\u0432\u0430\u043d\u0435'  id='choice_1_142_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_1_142_2' id='label_1_142_2' class='gform-field-label gform-field-label--type-inline'>\u041f\u0440\u0435\u0434\u043f\u0438\u0441\u0432\u0430\u043d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_142_3'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.3' type='checkbox'  value='\u0420\u0430\u0437\u043f\u0440\u043e\u0441\u0442\u0440\u0430\u043d\u0435\u043d\u0438\u0435'  id='choice_1_142_3'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_1_142_3' id='label_1_142_3' class='gform-field-label gform-field-label--type-inline'>\u0420\u0430\u0437\u043f\u0440\u043e\u0441\u0442\u0440\u0430\u043d\u0435\u043d\u0438\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_142_4'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.4' type='checkbox'  value='\u041f\u043e\u0434\u0433\u043e\u0442\u043e\u0432\u043a\u0430 \u0437\u0430 \u043f\u0440\u0438\u043b\u043e\u0436\u0435\u043d\u0438\u0435'  id='choice_1_142_4'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_1_142_4' id='label_1_142_4' class='gform-field-label gform-field-label--type-inline'>\u041f\u043e\u0434\u0433\u043e\u0442\u043e\u0432\u043a\u0430 \u0437\u0430 \u043f\u0440\u0438\u043b\u043e\u0436\u0435\u043d\u0438\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_142_5'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.5' type='checkbox'  value='\u041f\u0440\u0438\u043b\u043e\u0436\u0435\u043d\u0438\u0435'  id='choice_1_142_5'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_1_142_5' id='label_1_142_5' class='gform-field-label gform-field-label--type-inline'>\u041f\u0440\u0438\u043b\u043e\u0436\u0435\u043d\u0438\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_142_6'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.6' type='checkbox'  value='\u041d\u0430\u0431\u043b\u044e\u0434\u0435\u043d\u0438\u0435 \u043d\u0430 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0430\u0442\u0430'  id='choice_1_142_6'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_1_142_6' id='label_1_142_6' class='gform-field-label gform-field-label--type-inline'>\u041d\u0430\u0431\u043b\u044e\u0434\u0435\u043d\u0438\u0435 \u043d\u0430 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0430\u0442\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_153\" 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_1_153\" ><\/li><li id=\"field_1_143\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_143\" ><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 \u0438\u0437\u043b\u043e\u0436\u0435\u043d \u043d\u0430 \u0433\u0440\u0435\u0448\u043a\u0430\u0442\u0430?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_143'><li class='gchoice gchoice_1_143_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_143.1' type='checkbox'  value='\u0414\u0430'  id='choice_1_143_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_1_143_1' id='label_1_143_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_1_143_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_143.2' type='checkbox'  value='\u041d\u0435'  id='choice_1_143_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_1_143_2' id='label_1_143_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_1_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_1_144\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u0413\u0440\u0435\u0448\u043a\u0430\u0442\u0430 \u0438\u043c\u0430\u043b\u0430 \u043b\u0438 \u0435 \u043d\u044f\u043a\u0430\u043a\u0432\u0438 \u043a\u043b\u0438\u043d\u0438\u0447\u043d\u0438 \u043f\u043e\u0441\u043b\u0435\u0434\u0438\u0446\u0438?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_144'><li class='gchoice gchoice_1_144_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_144.1' type='checkbox'  value='\u0414\u0430'  id='choice_1_144_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_1_144_1' id='label_1_144_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_1_144_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_144.2' type='checkbox'  value='\u041d\u0435'  id='choice_1_144_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_1_144_2' id='label_1_144_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_1_157\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_157\" ><label class='gfield_label gform-field-label' for='input_1_157'>\u0410\u043a\u043e \u043e\u0442\u0433\u043e\u0432\u043e\u0440\u044a\u0442 \u0435 &quot;\u0414\u0430&quot;, \u043c\u043e\u043b\u044f \u043f\u043e\u0441\u043e\u0447\u0435\u0442\u0435 \u0441\u0432\u044a\u0440\u0437\u0430\u043d\u0438\u0442\u0435 \u0441 \u0442\u043e\u0432\u0430 \u043d\u0435\u0436\u0435\u043b\u0430\u043d\u0438 \u0441\u044a\u0431\u0438\u0442\u0438\u044f (\u043a\u0430\u043a\u0442\u043e \u0435 \u043e\u043f\u0438\u0441\u0430\u043d\u043e \u0432 \u0441\u0435\u043a\u0446\u0438\u044f 5) \u043f\u043e- \u0434\u043e\u043b\u0443<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_157' id='input_1_157' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_145\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_145\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u041c\u044f\u0441\u0442\u043e, \u043a\u044a\u0434\u0435\u0442\u043e \u0435 \u0431\u0438\u043b\u0430 \u0443\u0441\u0442\u0430\u043d\u043e\u0432\u0435\u043d\u0430 \u0433\u0440\u0435\u0448\u043a\u0430\u0442\u0430:<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_145'><li class='gchoice gchoice_1_145_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_145.1' type='checkbox'  value='\u0421\u044a\u0445\u0440\u0430\u043d\u0435\u043d\u0438\u0435'  id='choice_1_145_1'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_1_145_1' id='label_1_145_1' class='gform-field-label gform-field-label--type-inline'>\u0421\u044a\u0445\u0440\u0430\u043d\u0435\u043d\u0438\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_145_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_145.2' type='checkbox'  value='\u041f\u0440\u0435\u0434\u043f\u0438\u0441\u0432\u0430\u043d\u0435'  id='choice_1_145_2'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_1_145_2' id='label_1_145_2' class='gform-field-label gform-field-label--type-inline'>\u041f\u0440\u0435\u0434\u043f\u0438\u0441\u0432\u0430\u043d\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_145_3'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_145.3' type='checkbox'  value='\u0420\u0430\u0437\u043f\u0440\u043e\u0441\u0442\u0440\u0430\u043d\u0435\u043d\u0438\u0435'  id='choice_1_145_3'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_1_145_3' id='label_1_145_3' class='gform-field-label gform-field-label--type-inline'>\u0420\u0430\u0437\u043f\u0440\u043e\u0441\u0442\u0440\u0430\u043d\u0435\u043d\u0438\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_145_4'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_145.4' type='checkbox'  value='\u041f\u043e\u0434\u0433\u043e\u0442\u043e\u0432\u043a\u0430 \u0437\u0430 \u043f\u0440\u0438\u043b\u043e\u0436\u0435\u043d\u0438\u0435'  id='choice_1_145_4'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_1_145_4' id='label_1_145_4' class='gform-field-label gform-field-label--type-inline'>\u041f\u043e\u0434\u0433\u043e\u0442\u043e\u0432\u043a\u0430 \u0437\u0430 \u043f\u0440\u0438\u043b\u043e\u0436\u0435\u043d\u0438\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_145_5'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_145.5' type='checkbox'  value='\u041f\u0440\u0438\u043b\u043e\u0436\u0435\u043d\u0438\u0435'  id='choice_1_145_5'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_1_145_5' id='label_1_145_5' class='gform-field-label gform-field-label--type-inline'>\u041f\u0440\u0438\u043b\u043e\u0436\u0435\u043d\u0438\u0435<\/label>\r\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_145_6'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_145.6' type='checkbox'  value='\u041d\u0430\u0431\u043b\u044e\u0434\u0435\u043d\u0438\u0435 \u043d\u0430 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0430\u0442\u0430'  id='choice_1_145_6'   \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_1_145_6' id='label_1_145_6' class='gform-field-label gform-field-label--type-inline'>\u041d\u0430\u0431\u043b\u044e\u0434\u0435\u043d\u0438\u0435 \u043d\u0430 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0430\u0442\u0430<\/label>\r\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_146\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_146\" ><label class='gfield_label gform-field-label' for='input_1_146'>\u041c\u043e\u043b\u044f, \u043e\u043f\u0438\u0448\u0435\u0442\u0435 \u043f\u043e\u0442\u0435\u043d\u0446\u0438\u0430\u043b\u043d\u0430\u0442\u0430 \u0432\u0440\u0435\u0434\u0430, \u043a\u043e\u044f\u0442\u043e \u043c\u043e\u0436\u0435 \u0434\u0430 \u0435 \u043d\u0430\u0441\u0442\u044a\u043f\u0438\u043b\u0430, \u0430\u043a\u043e \u0433\u0440\u0435\u0448\u043a\u0430\u0442\u0430 \u0435 \u0434\u043e\u0441\u0442\u0438\u0433\u043d\u0430\u043b\u0430 \u0434\u043e \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_146' id='input_1_146' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_152\" 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_1_152\" ><\/li><li id=\"field_1_147\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_147\" ><label class='gfield_label gform-field-label' 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#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_7' id='gform_7'  action='\/safety\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F29' data-formid='7' novalidate><input type=\"hidden\" name=\"gpnf_parent_form_id\" value=\"1\" \/><input type=\"hidden\" value=\"1\" id=\"gpnf_is_valid_7\" \/><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_7' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_7_41\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_7_41\" ><label class='gfield_label gform-field-label' for='input_7_41'>\u041f\u043e\u0434\u043e\u0437\u0438\u0440\u0430\u043d\u043e \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u043e:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_41' id='input_7_41' 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\u0435\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\u043d\u043e' >\u041d\u0435\u0438\u0437\u0432\u0435\u0441\u0442\u043d\u043e<\/option><\/select><\/div><\/li><li id=\"field_7_79\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_7_79\" ><label class='gfield_label gform-field-label' for='input_7_79'>\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_79' id='input_7_79' type='text' value='' class='small'   tabindex='100000' placeholder='\u0414\u0414\/\u041c\u041c\/\u0413\u0413\u0413\u0413'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_7_80\" class=\"gfield gfield--type-text \u0414\u0430\u0442\u0430 \u043d\u0430 \u0437\u0430\u043f\u043e\u0447\u0432\u0430\u043d\u0435: field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_7_80\" ><label class='gfield_label gform-field-label' for='input_7_80'>\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_80' id='input_7_80' type='text' value='' class='small'   tabindex='100001' placeholder='\u0414\u0414\/\u041c\u041c\/\u0413\u0413\u0413\u0413'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_7_45\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_7_45\" ><label class='gfield_label gform-field-label' for='input_7_45'>\u0414\u043e\u0437\u0430:<\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_7_45' type='text' value='' class='medium'  aria-describedby=\"gfield_description_7_45\" tabindex='100002'   aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_7_45'><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_7_73\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_7_73\" ><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_7_73'>\r\n\t\t\t<li class='gchoice gchoice_7_73_0'>\r\n\t\t\t\t<input name='input_73' type='radio' value='\u043f\u043e\u0434\u043a\u043e\u0436\u043d\u043e'  id='choice_7_73_0' tabindex='100003'   \/>\r\n\t\t\t\t<label for='choice_7_73_0' id='label_7_73_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_7_73_1'>\r\n\t\t\t\t<input name='input_73' type='radio' value='\u0432\u0435\u043d\u043e\u0437\u043d\u043e'  id='choice_7_73_1' tabindex='100004'   \/>\r\n\t\t\t\t<label for='choice_7_73_1' id='label_7_73_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_7_73_2'>\r\n\t\t\t\t<input name='input_73' type='radio' value='\u043f\u043e\u0434\u043a\u043e\u0436\u043d\u0430 \u0438\u043d\u0436\u0435\u043a\u0446\u0438\u044f'  id='choice_7_73_2' tabindex='100005'   \/>\r\n\t\t\t\t<label for='choice_7_73_2' id='label_7_73_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_7_73_3'>\r\n\t\t\t\t<input name='input_73' type='radio' value='\u043f\u0440\u0435\u0437 \u0443\u0441\u0442\u0430\u0442\u0430'  id='choice_7_73_3' tabindex='100006'   \/>\r\n\t\t\t\t<label for='choice_7_73_3' id='label_7_73_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_7_73_4'>\r\n\t\t\t\t<input name='input_73' type='radio' value='\u0434\u0440\u0443\u0433\u043e'  id='choice_7_73_4' tabindex='100007'   \/>\r\n\t\t\t\t<label for='choice_7_73_4' id='label_7_73_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_7_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_7_74\" ><label class='gfield_label gform-field-label' for='input_7_74'>Mo\u043b\u044f, \u0443\u0442\u043e\u0447\u043d\u0435\u0442\u0435:<\/label><div class='ginput_container ginput_container_text'><input name='input_74' id='input_7_74' type='text' value='' class='small'   tabindex='100008'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_7_77\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_7_77\" ><label class='gfield_label gform-field-label' for='input_7_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_7_77' type='text' value='' class='medium'  aria-describedby=\"gfield_description_7_77\" tabindex='100009'   aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_7_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_7_75\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_7_75\" ><label class='gfield_label gform-field-label' for='input_7_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_7_75' type='text' value='' class='small'   tabindex='100010'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_7_76\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_7_76\" ><label class='gfield_label gform-field-label' for='input_7_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_7_76' type='text' value='' class='small'   tabindex='100011'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_7_70\" 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_7_70\" ><\/li><li id=\"field_7_71\" 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_7_71\" ><\/li><li id=\"field_7_72\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_7_72\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u041f\u0440\u0435\u0443\u0441\u0442\u0430\u043d\u043e\u0432\u0435\u043d\u0430 \u043b\u0438 \u0435 \u0442\u0435\u0440\u0430\u043f\u0438\u044f\u0442\u0430 \u0441 \u043e\u0441\u043d\u043e\u0432\u043d\u043e\u0442\u043e \u043f\u043e\u0434\u043e\u0437\u0438\u0440\u0430\u043d\u043e \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u043e \u043f\u043e\u0440\u0430\u0434\u0438 \u043d\u0435\u0436\u0435\u043b\u0430\u043d\u0430 \u0440\u0435\u0430\u043a\u0446\u0438\u044f?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_7_72'><li class='gchoice gchoice_7_72_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_72.1' type='checkbox'  value='\u0414\u0430'  id='choice_7_72_1' tabindex='100012'  \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_7_72_1' id='label_7_72_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_7_72_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_72.2' type='checkbox'  value='\u041d\u0435'  id='choice_7_72_2' tabindex='100013'  \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_7_72_2' id='label_7_72_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_7_66\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_7_66\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u0410\u043a\u043e &quot;\u0434\u0430&quot;, \u0438\u0437\u043b\u0435\u043a\u0443\u0432\u0430\u043d\u0430 \u043b\u0438 \u0435 \u043d\u0435\u0436\u0435\u043b\u0430\u043d\u0430\u0442\u0430 \u0440\u0435\u0430\u043a\u0446\u0438\u044f?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_7_66'><li class='gchoice gchoice_7_66_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_66.1' type='checkbox'  value='\u0414\u0430'  id='choice_7_66_1' tabindex='100014'  \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_7_66_1' id='label_7_66_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_7_66_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_66.2' type='checkbox'  value='\u041d\u0435'  id='choice_7_66_2' tabindex='100015'  \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_7_66_2' id='label_7_66_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_7_67\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_7_67\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u0418\u0437\u043f\u043e\u043b\u0437\u0432\u0430\u043d\u043e \u043b\u0438 \u0435 \u043f\u043e\u0432\u0442\u043e\u0440\u043d\u043e \u043e\u0441\u043d\u043e\u0432\u043d\u043e\u0442\u043e \u043f\u043e\u0434\u043e\u0437\u0438\u0440\u0430\u043d\u043e \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u043e?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_7_67'><li class='gchoice gchoice_7_67_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.1' type='checkbox'  value='\u0414\u0430'  id='choice_7_67_1' tabindex='100016'  \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_7_67_1' id='label_7_67_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_7_67_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.2' type='checkbox'  value='\u041d\u0435'  id='choice_7_67_2' tabindex='100017'  \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_7_67_2' id='label_7_67_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_7_67_3'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.3' type='checkbox'  value='\u041d\u0435 \u0435 \u0438\u0437\u0432\u0435\u0441\u0442\u043d\u043e'  id='choice_7_67_3' tabindex='100018'  \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_7_67_3' id='label_7_67_3' 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><\/ul><\/div><\/li><li id=\"field_7_68\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_7_68\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u0410\u043a\u043e &quot;\u0434\u0430&quot;,  \u043f\u043e\u044f\u0432\u0438\u043b\u0430 \u043b\u0438 \u0441\u0435 \u0435 \u043e\u0442\u043d\u043e\u0432\u043e \u043d\u0435\u0436\u0435\u043b\u0430\u043d\u0430\u0442\u0430 \u0440\u0435\u0430\u043a\u0446\u0438\u044f?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_7_68'><li class='gchoice gchoice_7_68_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_68.1' type='checkbox'  value='\u0414\u0430'  id='choice_7_68_1' tabindex='100019'  \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_7_68_1' id='label_7_68_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_7_68_2'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_68.2' type='checkbox'  value='\u041d\u0435'  id='choice_7_68_2' tabindex='100020'  \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_7_68_2' id='label_7_68_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_7_68_3'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_68.3' type='checkbox'  value='\u041d\u0435 \u0435 \u0438\u0437\u0432\u0435\u0441\u0442\u043d\u043e'  id='choice_7_68_3' tabindex='100021'  \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_7_68_3' id='label_7_68_3' 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><\/ul><\/div><\/li><li id=\"field_7_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_7_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 \u043f\u043e\u0434\u043e\u0437\u0438\u0440\u0430\u043d\u0438 \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_7' class='gform_button button' value='\u041f\u0440\u043e\u0434\u044a\u043b\u0436\u0438' tabindex='100022' onclick='if(window[\"gf_submitting_7\"]){return false;}  if( !jQuery(\"#gform_7\")[0].checkValidity || jQuery(\"#gform_7\")[0].checkValidity()){window[\"gf_submitting_7\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_7\"]){return false;} if( !jQuery(\"#gform_7\")[0].checkValidity || jQuery(\"#gform_7\")[0].checkValidity()){window[\"gf_submitting_7\"]=true;}  jQuery(\"#gform_7\").trigger(\"submit\",[true]); }' \/> <input type='hidden' name='gform_ajax' value='form_id=7&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_7' value='1' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='7' \/>\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_7' value='WyJbXSIsIjc3NmM1ZTkyNmUzZDg2ZDhhYjEwOGNiNDViZjVmOWRjIl0=' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_7' id='gform_target_page_number_7' value='0' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_7' id='gform_source_page_number_7' 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_7' id='gform_ajax_frame_7' 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( 7, 'https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_7').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_7');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_7').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_7').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_7').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_7').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_7').val();gformInitSpinner( 7, 'https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [7, current_page]);window['gf_submitting_7'] = 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_7').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [7]);window['gf_submitting_7'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_7').text());}, 50);}else{jQuery('#gform_7').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gpnf_post_render', [7, current_page]);gform.utils.trigger({ event: 'gform\/postRender', native: false, data: { formId: 7, currentPage: current_page } });} );} ); <\/script>            <\/div>\r\n            \r\n            <div class=\"gpnf-edit-form gpnf-edit-form-1-99\" 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-1-115\" 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' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_13' style='display:none'><style>#gform_wrapper_13[data-form-index=\"0\"].gform-theme,[data-parent-form=\"13_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, 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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_13' id='gform_13'  action='\/safety\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F29' data-formid='13' novalidate><input type=\"hidden\" name=\"gpnf_parent_form_id\" value=\"1\" \/><input type=\"hidden\" value=\"1\" id=\"gpnf_is_valid_13\" \/><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_13' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_13_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_13_39\" ><\/li><li id=\"field_13_77\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_77\" ><label class='gfield_label gform-field-label' for='input_13_77'>\u0418\u043c\u0435 \u043d\u0430 \u0441\u044a\u043f\u044a\u0442\u0441\u0442\u0432\u0430\u0449 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d \u043f\u0440\u043e\u0434\u0443\u043a\u0442:<\/label><div class='ginput_container ginput_container_text'><input name='input_77' id='input_13_77' type='text' value='' class='medium'  aria-describedby=\"gfield_description_13_77\" tabindex='99999'   aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_13_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\">\u041b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0430 \u043f\u0440\u0438\u0435\u043c\u0430\u043d\u0438 \u0437\u0430 \u0441\u044a\u0449\u043e\u0442\u043e \u0438\u043b\u0438 \u0434\u0440\u0443\u0433\u0438 \u043f\u043e\u043a\u0430\u0437\u0430\u043d\u0438\u044f (\u0431\u043e\u043b\u0435\u0441\u0442\u043d\u0438 \u0441\u044a\u0441\u0442\u043e\u044f\u043d\u0438\u044f).\u0422\u043e\u0432\u0430 \u043d\u0435 \u0441\u0430 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u0438 \u043f\u0440\u043e\u0434\u0443\u043a\u0442\u0438 \u0438\u0437\u043f\u043e\u043b\u0437\u0432\u0430\u043d\u0438 \u0432 \u043f\u043e\u0441\u043b\u0435\u0434\u0441\u0442\u0432\u0438\u0435 \u0437\u0430 \u043e\u0432\u043b\u0430\u0434\u044f\u0432\u0430\u043d\u0435 \u043d\u0430 \u043d\u0435\u0436\u0435\u043b\u0430\u043d\u0430\u0442\u0430 \u0440\u0435\u0430\u043a\u0446\u0438\u044f.<\/div>\n<\/div><\/div><\/li><li id=\"field_13_82\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_82\" ><label class='gfield_label gform-field-label' for='input_13_82'>\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_82' id='input_13_82' type='text' value='' class='small'   tabindex='100000' placeholder='\u0414\u0414\/\u041c\u041c\/\u0413\u0413\u0413\u0413'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_13_83\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_83\" ><label class='gfield_label gform-field-label' for='input_13_83'>\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_83' id='input_13_83' type='text' value='' class='small'   tabindex='100001' placeholder='\u0414\u0414\/\u041c\u041c\/\u0413\u0413\u0413\u0413'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_13_78\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_78\" ><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_13_78'><li class='gchoice gchoice_13_78_1'>\r\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.1' 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_13_78_1' tabindex='100002'  \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_13_78_1' id='label_13_78_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_13_45\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_45\" ><label class='gfield_label gform-field-label' for='input_13_45'>\u0414\u043e\u0437\u0430:<\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_13_45' type='text' value='' class='medium'  aria-describedby=\"gfield_description_13_45\" tabindex='100003'   aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_13_45'><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_13_73\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_73\" ><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_13_73'>\r\n\t\t\t<li class='gchoice gchoice_13_73_0'>\r\n\t\t\t\t<input name='input_73' type='radio' value='\u043f\u043e\u0434\u043a\u043e\u0436\u043d\u043e'  id='choice_13_73_0' tabindex='100004'   \/>\r\n\t\t\t\t<label for='choice_13_73_0' id='label_13_73_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_13_73_1'>\r\n\t\t\t\t<input name='input_73' type='radio' value='\u0432\u0435\u043d\u043e\u0437\u043d\u043e'  id='choice_13_73_1' tabindex='100005'   \/>\r\n\t\t\t\t<label for='choice_13_73_1' id='label_13_73_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_13_73_2'>\r\n\t\t\t\t<input name='input_73' type='radio' value='\u043f\u0440\u0435\u0437 \u0443\u0441\u0442\u0430\u0442\u0430'  id='choice_13_73_2' tabindex='100006'   \/>\r\n\t\t\t\t<label for='choice_13_73_2' id='label_13_73_2' 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_13_73_3'>\r\n\t\t\t\t<input name='input_73' type='radio' value='\u0432\u044a\u0442\u0440\u0435\u043e\u0447\u043d\u043e'  id='choice_13_73_3' tabindex='100007'   \/>\r\n\t\t\t\t<label for='choice_13_73_3' id='label_13_73_3' class='gform-field-label gform-field-label--type-inline'>\u0432\u044a\u0442\u0440\u0435\u043e\u0447\u043d\u043e<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_13_73_4'>\r\n\t\t\t\t<input name='input_73' type='radio' value='\u0432\u0430\u0433\u0438\u043d\u0430\u043b\u043d\u043e'  id='choice_13_73_4' tabindex='100008'   \/>\r\n\t\t\t\t<label for='choice_13_73_4' id='label_13_73_4' class='gform-field-label gform-field-label--type-inline'>\u0432\u0430\u0433\u0438\u043d\u0430\u043b\u043d\u043e<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_13_73_5'>\r\n\t\t\t\t<input name='input_73' type='radio' value='\u043c\u0443\u0441\u043a\u0443\u043b\u043d\u043e'  id='choice_13_73_5' tabindex='100009'   \/>\r\n\t\t\t\t<label for='choice_13_73_5' id='label_13_73_5' class='gform-field-label gform-field-label--type-inline'>\u043c\u0443\u0441\u043a\u0443\u043b\u043d\u043e<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_13_73_6'>\r\n\t\t\t\t<input name='input_73' type='radio' value='\u0440\u0435\u043a\u0442\u0430\u043b\u043d\u043e'  id='choice_13_73_6' tabindex='100010'   \/>\r\n\t\t\t\t<label for='choice_13_73_6' id='label_13_73_6' class='gform-field-label gform-field-label--type-inline'>\u0440\u0435\u043a\u0442\u0430\u043b\u043d\u043e<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_13_73_7'>\r\n\t\t\t\t<input name='input_73' type='radio' value='\u0432\u044a\u043d\u0448\u043d\u043e (\u0437\u0430 \u043c\u0430\u0437\u0430\u043d\u0435)'  id='choice_13_73_7' tabindex='100011'   \/>\r\n\t\t\t\t<label for='choice_13_73_7' id='label_13_73_7' class='gform-field-label gform-field-label--type-inline'>\u0432\u044a\u043d\u0448\u043d\u043e (\u0437\u0430 \u043c\u0430\u0437\u0430\u043d\u0435)<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_13_73_8'>\r\n\t\t\t\t<input name='input_73' type='radio' value='\u0434\u0440\u0443\u0433\u043e'  id='choice_13_73_8' tabindex='100012'   \/>\r\n\t\t\t\t<label for='choice_13_73_8' id='label_13_73_8' 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_13_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_13_74\" ><label class='gfield_label gform-field-label' for='input_13_74'>Mo\u043b\u044f, \u0443\u0442\u043e\u0447\u043d\u0435\u0442\u0435:<\/label><div class='ginput_container ginput_container_text'><input name='input_74' id='input_13_74' type='text' value='' class='small'   tabindex='100013'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_13_79\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_79\" ><label class='gfield_label gform-field-label' for='input_13_79'>\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_79' id='input_13_79' type='text' value='' class='medium'  aria-describedby=\"gfield_description_13_79\" tabindex='100014'   aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_13_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\">\u041f\u043e\u043a\u0430\u0437\u0430\u043d\u0438\u0435 (\u0431\u043e\u043b\u0435\u0441\u0442\u043d\u043e \u0441\u044a\u0441\u0442\u043e\u044f\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_13_81\" class=\"gfield gfield--type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_81\" ><div class='ginput_container ginput_container_text'><input name='input_81' id='input_13_81' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='hidden safety field' \/><\/div><\/li><li id=\"field_13_80\" 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_13_80\" ><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 \u043f\u043e\u0434\u043e\u0437\u0438\u0440\u0430\u043d\u0438 \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_13' class='gform_button button' value='\u041f\u0440\u043e\u0434\u044a\u043b\u0436\u0438' tabindex='100015' onclick='if(window[\"gf_submitting_13\"]){return false;}  if( !jQuery(\"#gform_13\")[0].checkValidity || jQuery(\"#gform_13\")[0].checkValidity()){window[\"gf_submitting_13\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_13\"]){return false;} if( !jQuery(\"#gform_13\")[0].checkValidity || jQuery(\"#gform_13\")[0].checkValidity()){window[\"gf_submitting_13\"]=true;}  jQuery(\"#gform_13\").trigger(\"submit\",[true]); }' \/> <input type='hidden' name='gform_ajax' value='form_id=13&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_13' value='1' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='13' \/>\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_13' value='WyJbXSIsIjc3NmM1ZTkyNmUzZDg2ZDhhYjEwOGNiNDViZjVmOWRjIl0=' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_13' id='gform_target_page_number_13' value='0' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_13' id='gform_source_page_number_13' 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_13' id='gform_ajax_frame_13' 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( 13, 'https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_13').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_13');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_13').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_13').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_13').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_13').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_13').val();gformInitSpinner( 13, 'https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [13, current_page]);window['gf_submitting_13'] = 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_13').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [13]);window['gf_submitting_13'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_13').text());}, 50);}else{jQuery('#gform_13').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gpnf_post_render', [13, current_page]);gform.utils.trigger({ event: 'gform\/postRender', native: false, data: { formId: 13, currentPage: current_page } });} );} ); <\/script>            <\/div>\r\n            \r\n            <div class=\"gpnf-edit-form gpnf-edit-form-1-115\" 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-1-98\" 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_10' style='display:none'><style>#gform_wrapper_10[data-form-index=\"0\"].gform-theme,[data-parent-form=\"10_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_10' id='gform_10' class='popup_form' action='\/safety\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F29' data-formid='10' novalidate><input type=\"hidden\" name=\"gpnf_parent_form_id\" value=\"1\" \/><input type=\"hidden\" value=\"1\" id=\"gpnf_is_valid_10\" \/><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_10' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_10_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_10_39\" ><\/li><li id=\"field_10_78\" class=\"gfield gfield--type-text \u0414\u0414\/\u041c\u041c\/\u0413\u0413\u0413\u0413 gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_78\" ><label class='gfield_label gform-field-label' for='input_10_78'>\u041d\u0435\u0436\u0435\u043b\u0430\u043d\u043e \u0441\u044a\u0431\u0438\u0442\u0438\u0435(\u044f)\/\u0421\u043f\u0435\u0446\u0438\u0430\u043b\u043d\u0430 \u0441\u0438\u0442\u0443\u0430\u0446\u0438\u044f(\u0438):<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_78' id='input_10_78' type='text' value='' class='medium'   tabindex='99999'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_10_91\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_91\" ><label class='gfield_label gform-field-label' for='input_10_91'>\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_91' id='input_10_91' type='text' value='' class='small'   tabindex='100000' placeholder='\u0414\u0414\/\u041c\u041c\/\u0413\u0413\u0413\u0413'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_10_92\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_92\" ><label class='gfield_label gform-field-label' for='input_10_92'>\u0414\u0430\u0442\u0430 \u043d\u0430 \u0438\u0437\u043b\u0435\u043a\u0443\u0432\u0430\u043d\u0435\/\u043f\u043e\u0434\u043e\u0431\u0440\u0435\u043d\u0438\u0435:<\/label><div class='ginput_container ginput_container_text'><input name='input_92' id='input_10_92' type='text' value='' class='small'   tabindex='100001' placeholder='\u0414\u0414\/\u041c\u041c\/\u0413\u0413\u0413\u0413'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_10_74\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_74\" ><label class='gfield_label gform-field-label' >\u0418\u0437\u0445\u043e\u0434 \u043e\u0442 \u043d\u0435\u0436\u0435\u043b\u0430\u043d\u0430\u0442\u0430 \u0440\u0435\u0430\u043a\u0446\u0438\u044f:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_74'>\r\n\t\t\t<li class='gchoice gchoice_10_74_0'>\r\n\t\t\t\t<input name='input_74' type='radio' value='\u0438\u0437\u043b\u0435\u043a\u0443\u0432\u0430\u043d'  id='choice_10_74_0' tabindex='100002'   \/>\r\n\t\t\t\t<label for='choice_10_74_0' id='label_10_74_0' class='gform-field-label gform-field-label--type-inline'>\u0438\u0437\u043b\u0435\u043a\u0443\u0432\u0430\u043d<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_10_74_1'>\r\n\t\t\t\t<input name='input_74' type='radio' value='\u043d\u0435\u0438\u0437\u043b\u0435\u043a\u0443\u0432\u0430\u043d'  id='choice_10_74_1' tabindex='100003'   \/>\r\n\t\t\t\t<label for='choice_10_74_1' id='label_10_74_1' class='gform-field-label gform-field-label--type-inline'>\u043d\u0435\u0438\u0437\u043b\u0435\u043a\u0443\u0432\u0430\u043d<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_10_74_2'>\r\n\t\t\t\t<input name='input_74' type='radio' value='\u043f\u043e\u0434\u043e\u0431\u0440\u0435\u043d'  id='choice_10_74_2' tabindex='100004'   \/>\r\n\t\t\t\t<label for='choice_10_74_2' id='label_10_74_2' class='gform-field-label gform-field-label--type-inline'>\u043f\u043e\u0434\u043e\u0431\u0440\u0435\u043d<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_10_74_3'>\r\n\t\t\t\t<input name='input_74' type='radio' value='\u0432\u043b\u043e\u0448\u0435\u043d'  id='choice_10_74_3' tabindex='100005'   \/>\r\n\t\t\t\t<label for='choice_10_74_3' id='label_10_74_3' class='gform-field-label gform-field-label--type-inline'>\u0432\u043b\u043e\u0448\u0435\u043d<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_10_74_4'>\r\n\t\t\t\t<input name='input_74' type='radio' value='\u043f\u0440\u043e\u0434\u044a\u043b\u0436\u0430\u0432\u0430'  id='choice_10_74_4' tabindex='100006'   \/>\r\n\t\t\t\t<label for='choice_10_74_4' id='label_10_74_4' class='gform-field-label gform-field-label--type-inline'>\u043f\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_10_74_5'>\r\n\t\t\t\t<input name='input_74' type='radio' value='\u043d\u0435\u0438\u0437\u0432\u0435\u0441\u0442\u0435\u043d'  id='choice_10_74_5' tabindex='100007'   \/>\r\n\t\t\t\t<label for='choice_10_74_5' id='label_10_74_5' class='gform-field-label gform-field-label--type-inline'>\u043d\u0435\u0438\u0437\u0432\u0435\u0441\u0442\u0435\u043d<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_10_74_6'>\r\n\t\t\t\t<input name='input_74' type='radio' value='\u0444\u0430\u0442\u0430\u043b\u0435\u043d'  id='choice_10_74_6' tabindex='100008'   \/>\r\n\t\t\t\t<label for='choice_10_74_6' id='label_10_74_6' class='gform-field-label gform-field-label--type-inline'>\u0444\u0430\u0442\u0430\u043b\u0435\u043d<\/label>\r\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_77\" 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_10_77\" ><label class='gfield_label gform-field-label' for='input_10_77'>\u0414\u0430\u0442\u0430 \u043d\u0430 \u0441\u043c\u044a\u0440\u0442\u0442\u0430<\/label><div class='ginput_container ginput_container_text'><input name='input_77' id='input_10_77' type='text' value='' class='medium'   tabindex='100009'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_10_89\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_89\" ><label class='gfield_label gform-field-label' >\u041c\u043e\u043b\u044f, o\u0442\u0431\u0435\u043b\u0435\u0436\u0435\u0442\u0435 \u043a\u0430\u043a\u0432\u043e \u043f\u0440\u0435\u0434\u0438\u0437\u0432\u0438\u043a\u0430 \u043d\u0435\u0436\u0435\u043b\u0430\u043d\u0430\u0442\u0430 \u0440\u0435\u0430\u043a\u0446\u0438\u044f:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_89'>\r\n\t\t\t<li class='gchoice gchoice_10_89_0'>\r\n\t\t\t\t<input name='input_89' type='radio' value='\u043f\u0440\u0435\u0434\u0438\u0437\u0432\u0438\u043a\u0430 \u043b\u0435\u043a\u043e \u043d\u0435\u0443\u0434\u043e\u0431\u0441\u0442\u0432\u043e'  id='choice_10_89_0' tabindex='100010'   \/>\r\n\t\t\t\t<label for='choice_10_89_0' id='label_10_89_0' class='gform-field-label gform-field-label--type-inline'>\u043f\u0440\u0435\u0434\u0438\u0437\u0432\u0438\u043a\u0430 \u043b\u0435\u043a\u043e \u043d\u0435\u0443\u0434\u043e\u0431\u0441\u0442\u0432\u043e<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_10_89_1'>\r\n\t\t\t\t<input name='input_89' type='radio' value='\u043f\u0440\u0438\u0447\u0438\u043d\u0438 \u043d\u0435\u0440\u0430\u0431\u043e\u0442\u043e\u0441\u043f\u043e\u0441\u043e\u0431\u043d\u043e\u0441\u0442'  id='choice_10_89_1' tabindex='100011'   \/>\r\n\t\t\t\t<label for='choice_10_89_1' id='label_10_89_1' class='gform-field-label gform-field-label--type-inline'>\u043f\u0440\u0438\u0447\u0438\u043d\u0438 \u043d\u0435\u0440\u0430\u0431\u043e\u0442\u043e\u0441\u043f\u043e\u0441\u043e\u0431\u043d\u043e\u0441\u0442<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_10_89_2'>\r\n\t\t\t\t<input name='input_89' type='radio' value='\u0434\u043e\u0432\u0435\u0434\u0435 \u0434\u043e \u043f\u0440\u0438\u0435\u043c\u0430\u043d\u0435 \u0432 \u0431\u043e\u043b\u043d\u0438\u0446\u0430'  id='choice_10_89_2' tabindex='100012'   \/>\r\n\t\t\t\t<label for='choice_10_89_2' id='label_10_89_2' class='gform-field-label gform-field-label--type-inline'>\u0434\u043e\u0432\u0435\u0434\u0435 \u0434\u043e \u043f\u0440\u0438\u0435\u043c\u0430\u043d\u0435 \u0432 \u0431\u043e\u043b\u043d\u0438\u0446\u0430<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_10_89_3'>\r\n\t\t\t\t<input name='input_89' type='radio' value='\u043d\u0430\u043b\u043e\u0436\u0438 \u0436\u0438\u0432\u043e\u0442\u043e\u0441\u043f\u0430\u0441\u044f\u0432\u0430\u0449\u0438 \u0434\u0435\u0439\u0441\u0442\u0432\u0438\u044f'  id='choice_10_89_3' tabindex='100013'   \/>\r\n\t\t\t\t<label for='choice_10_89_3' id='label_10_89_3' class='gform-field-label gform-field-label--type-inline'>\u043d\u0430\u043b\u043e\u0436\u0438 \u0436\u0438\u0432\u043e\u0442\u043e\u0441\u043f\u0430\u0441\u044f\u0432\u0430\u0449\u0438 \u0434\u0435\u0439\u0441\u0442\u0432\u0438\u044f<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_10_89_4'>\r\n\t\t\t\t<input name='input_89' type='radio' value='\u043f\u0440\u0438\u0447\u0438\u043d\u0438 \u0438\u043d\u0432\u0430\u043b\u0438\u0434\u043d\u043e\u0441\u0442'  id='choice_10_89_4' tabindex='100014'   \/>\r\n\t\t\t\t<label for='choice_10_89_4' id='label_10_89_4' class='gform-field-label gform-field-label--type-inline'>\u043f\u0440\u0438\u0447\u0438\u043d\u0438 \u0438\u043d\u0432\u0430\u043b\u0438\u0434\u043d\u043e\u0441\u0442<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_10_89_5'>\r\n\t\t\t\t<input name='input_89' type='radio' value='\u0434\u0440\u0443\u0433\u043e'  id='choice_10_89_5' tabindex='100015'   \/>\r\n\t\t\t\t<label for='choice_10_89_5' id='label_10_89_5' 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_10_82\" 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_10_82\" ><label class='gfield_label gform-field-label' for='input_10_82'>\u041c\u043e\u043b\u044f, \u043e\u043f\u0438\u0448\u0435\u0442\u0435:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_82' id='input_10_82' class='textarea small' tabindex='100016'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_10_85\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_85\" ><label class='gfield_label gform-field-label' >\u0411\u044f\u0445\u0430 \u043b\u0438 \u043f\u0440\u0435\u0434\u043f\u0440\u0438\u0435\u0442\u0438 \u043c\u0435\u0440\u043a\u0438 \u0437\u0430 \u043b\u0435\u0447\u0435\u043d\u0438\u0435 \u043d\u0430 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u0430\u0442\u0430 \u0440\u0435\u0430\u043a\u0446\u0438\u044f?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_85'>\r\n\t\t\t<li class='gchoice gchoice_10_85_0'>\r\n\t\t\t\t<input name='input_85' type='radio' value='\u0414\u0430'  id='choice_10_85_0' tabindex='100017'   \/>\r\n\t\t\t\t<label for='choice_10_85_0' id='label_10_85_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_10_85_1'>\r\n\t\t\t\t<input name='input_85' type='radio' value='\u041d\u0435'  id='choice_10_85_1' tabindex='100018'   \/>\r\n\t\t\t\t<label for='choice_10_85_1' id='label_10_85_1' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_10_85_2'>\r\n\t\t\t\t<input name='input_85' type='radio' value='\u041d\u0435 \u0437\u043d\u0430\u043c'  id='choice_10_85_2' tabindex='100019'   \/>\r\n\t\t\t\t<label for='choice_10_85_2' id='label_10_85_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435 \u0437\u043d\u0430\u043c<\/label>\r\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_86\" 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_10_86\" ><label class='gfield_label gform-field-label' for='input_10_86'>\u041c\u043e\u043b\u044f \u043f\u0440\u0435\u0434\u043e\u0441\u0442\u0430\u0432\u0435\u0442\u0435 \u043f\u043e\u0432\u0435\u0447\u0435 \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_86' id='input_10_86' class='textarea small' tabindex='100020'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_10_84\" 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_10_84\" ><label class='gfield_label gform-field-label' >\u0421\u043c\u044f\u0442\u0430\u0442\u0435 \u043b\u0438, \u0447\u0435 \u0438\u043c\u0430 \u0432\u0440\u044a\u0437\u043a\u0430 \u043c\u0435\u0436\u0434\u0443 \u043f\u043e\u0434\u043e\u0437\u0438\u0440\u0430\u043d\u0438\u044f \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d \u043f\u0440\u043e\u0434\u0443\u043a\u0442 \u0438 \u043d\u0435\u0436\u0435\u043b\u0430\u043d\u0430\u0442\u0430 \u0440\u0435\u0430\u043a\u0446\u0438\u044f<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_10_84'>\r\n\t\t\t<li class='gchoice gchoice_10_84_0'>\r\n\t\t\t\t<input name='input_84' type='radio' value='\u0414\u0430'  id='choice_10_84_0' tabindex='100021'   \/>\r\n\t\t\t\t<label for='choice_10_84_0' id='label_10_84_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_10_84_1'>\r\n\t\t\t\t<input name='input_84' type='radio' value='\u041d\u0435'  id='choice_10_84_1' tabindex='100022'   \/>\r\n\t\t\t\t<label for='choice_10_84_1' id='label_10_84_1' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435<\/label>\r\n\t\t\t<\/li>\r\n\t\t\t<li class='gchoice gchoice_10_84_2'>\r\n\t\t\t\t<input name='input_84' type='radio' value='\u041d\u0435 \u043c\u043e\u0433\u0430 \u0434\u0430 \u043f\u0440\u0435\u0446\u0435\u043d\u044f'  id='choice_10_84_2' tabindex='100023'   \/>\r\n\t\t\t\t<label for='choice_10_84_2' id='label_10_84_2' class='gform-field-label gform-field-label--type-inline'>\u041d\u0435 \u043c\u043e\u0433\u0430 \u0434\u0430 \u043f\u0440\u0435\u0446\u0435\u043d\u044f<\/label>\r\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_90\" class=\"gfield gfield--type-post_custom_field gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_90\" ><label class='gfield_label gform-field-label' >\u0421\u043c\u044f\u0442\u0430\u0442\u0435 \u043b\u0438, \u0447\u0435 \u0442\u0430\u0437\u0438 \u0440\u0435\u0430\u043a\u0446\u0438\u044f \u0435 \u043d\u0430\u0441\u0442\u044a\u043f\u0438\u043b\u0430 \u0432 \u0440\u0435\u0437\u0443\u043b\u0442\u0430\u0442 \u043d\u0430 \u0433\u0440\u0435\u0448\u043a\u0430 \u043d\u0430\u043f\u0440\u0430\u0432\u0435\u043d\u0430 \u0432 \u043f\u0440\u0435\u0434\u043f\u0438\u0441\u0430\u043d\u0438\u0435\u0442\u043e, \u0434\u043e\u0437\u0438\u0440\u0430\u043d\u0435\u0442\u043e, \u043e\u0442\u043f\u0443\u0441\u043a\u0430\u043d\u0435\u0442\u043e \u0438\u043b\u0438 \u043f\u0440\u0438\u043b\u0430\u0433\u0430\u043d\u0435\u0442\u043e \u043d\u0430 \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_10_90'>\r\n\t\t\t<li class='gchoice gchoice_10_90_0'>\r\n\t\t\t\t<input name='input_90' type='radio' value='\u0414\u0430'  id='choice_10_90_0' tabindex='100024'   \/>\r\n\t\t\t\t<label for='choice_10_90_0' id='label_10_90_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_10_90_1'>\r\n\t\t\t\t<input name='input_90' type='radio' value='\u041d\u0435'  id='choice_10_90_1' tabindex='100025'   \/>\r\n\t\t\t\t<label for='choice_10_90_1' id='label_10_90_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_10_87\" class=\"gfield gfield--type-post_custom_field gfield--input-type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_87\" ><label class='gfield_label gform-field-label' for='input_10_87'>\u041c\u043e\u043b\u044f \u043f\u0440\u0435\u0434\u043e\u0441\u0442\u0430\u0432\u0435\u0442\u0435 \u043f\u043e\u0432\u0435\u0447\u0435 \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_87' id='input_10_87' class='textarea small' tabindex='100026'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_10_88\" 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_10_88\" ><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 \u043d\u0435\u0436\u0435\u043b\u0430\u043d\u0438 \u0440\u0435\u0430\u043a\u0446\u0438\u0438.<\/div><\/li><\/ul><\/div>\r\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_10' class='gform_button button' value='\u041f\u0440\u043e\u0434\u044a\u043b\u0436\u0438' tabindex='100027' onclick='if(window[\"gf_submitting_10\"]){return false;}  if( !jQuery(\"#gform_10\")[0].checkValidity || jQuery(\"#gform_10\")[0].checkValidity()){window[\"gf_submitting_10\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_10\"]){return false;} if( !jQuery(\"#gform_10\")[0].checkValidity || jQuery(\"#gform_10\")[0].checkValidity()){window[\"gf_submitting_10\"]=true;}  jQuery(\"#gform_10\").trigger(\"submit\",[true]); }' \/> <input type='hidden' name='gform_ajax' value='form_id=10&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_10' value='1' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='10' \/>\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_10' value='WyJbXSIsIjc3NmM1ZTkyNmUzZDg2ZDhhYjEwOGNiNDViZjVmOWRjIl0=' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_10' id='gform_target_page_number_10' value='0' \/>\r\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_10' id='gform_source_page_number_10' 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_10' id='gform_ajax_frame_10' 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( 10, 'https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_10').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_10');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_10').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_10').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_10').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_10').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_10').val();gformInitSpinner( 10, 'https:\/\/www.roche-forms.bg\/safety\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [10, current_page]);window['gf_submitting_10'] = 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_10').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [10]);window['gf_submitting_10'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_10').text());}, 50);}else{jQuery('#gform_10').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gpnf_post_render', [10, current_page]);gform.utils.trigger({ event: 'gform\/postRender', native: false, data: { formId: 10, currentPage: current_page } });} );} ); <\/script>            <\/div>\r\n            \r\n            <div class=\"gpnf-edit-form gpnf-edit-form-1-98\" 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-1-117\" 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 popup_form_wrapper' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_14' ><style>#gform_wrapper_14[data-form-index=\"0\"].gform-theme,[data-parent-form=\"14_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_14' id='gform_14' class='popup_form' action='\/safety\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F29' data-formid='14' novalidate><input type=\"hidden\" name=\"gpnf_parent_form_id\" value=\"1\" \/><input type=\"hidden\" value=\"1\" id=\"gpnf_is_valid_14\" \/><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_14' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_14_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_14_39\" ><\/li><li id=\"field_14_78\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_14_78\" ><label class='gfield_label gform-field-label' for='input_14_78'>\u0418\u0437\u0432\u044a\u0440\u0448\u0435\u043d \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0438\/\u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440e\u043d \u0442\u0435\u0441\u0442. \u041c\u043e\u043b\u044f, \u043e\u043f\u0438\u0448\u0435\u0442\u0435 \u0432\u0438\u0434\u0430:<\/label><div class='ginput_container ginput_container_text'><input name='input_78' id='input_14_78' type='text' value='' class='small'  aria-describedby=\"gfield_description_14_78\" tabindex='99999'   aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_14_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\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, \u043f\u0440\u043e\u0442\u0440\u043e\u043c\u0431\u0438\u043d\u043e\u0432\u043e \u0432\u0440\u0435\u043c\u0435, ASAT, ALAT, \u043a\u0440\u0435\u0430\u0442\u0435\u043d\u0438\u043d\u043e\u0432 \u043a\u043b\u0438\u0440\u044a\u043d\u0441, \u0431\u0438\u043e\u043f\u0441\u0438\u044f, \u0442\u0443\u043c\u043e\u0440\u043d\u0438 \u043c\u0430\u0440\u043a\u0435\u0440\u0438, \u0435\u0445\u043e\u0433\u0440\u0430\u0444\u0438\u044f, \u0415\u041a\u0413, \u0441\u043a\u0435\u043d\u0435\u0440, \u042f\u041c\u0420 \u0438 \u0434\u0440. <\/div>\n<\/div><\/div><\/li><li id=\"field_14_87\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_14_87\" ><label class='gfield_label gform-field-label' for='input_14_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_14_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_14_84\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_14_84\" ><label class='gfield_label gform-field-label' for='input_14_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_14_84' class='textarea medium' tabindex='100001'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_14_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_14_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_14_81'><li class='gchoice gchoice_14_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_14_81_1' tabindex='100002'  \/>\r\n\t\t\t\t\t\t\t\t<label for='choice_14_81_1' id='label_14_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_14_83\" class=\"gfield gfield--type-fileupload field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_14_83\" ><label class='gfield_label gform-field-label' for='gform_browse_button_14_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_14_83' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_14_83&quot;,&quot;container&quot;:&quot;gform_multifile_upload_14_83&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_14_83&quot;,&quot;filelist&quot;:&quot;gform_preview_14_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;:14,&quot;field_id&quot;:83},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_14_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_14_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_14_83' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_14_83 gfield_description_14_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_14_83'>Max. file size: 2 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_14_83'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_14_83' class='ginput_preview_list'><\/div><div class='gfield_description' id='gfield_description_14_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_14_86\" class=\"gfield gfield--type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_14_86\" ><div class='ginput_container ginput_container_text'><input name='input_86' id='input_14_86' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='hidden safety field' \/><\/div><\/li><li id=\"field_14_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_14_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_14' class='gform_button button' value='\u041f\u0440\u043e\u0434\u044a\u043b\u0436\u0438' tabindex='100004' onclick='if(window[\"gf_submitting_14\"]){return false;}  if( 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