{"id":5484,"date":"2025-10-24T10:32:32","date_gmt":"2025-10-24T10:32:32","guid":{"rendered":"https:\/\/bostononcology.com\/?page_id=5484"},"modified":"2025-10-24T11:14:55","modified_gmt":"2025-10-24T11:14:55","slug":"report-adverse-event-arabic","status":"publish","type":"page","link":"https:\/\/bostononcology.com\/ar\/report-adverse-event-arabic\/","title":{"rendered":"Report an Adverse Event Arabic"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"5484\" class=\"elementor elementor-5484 elementor-5487\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-8053ef9 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"8053ef9\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 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data-name=\"ri-request-type\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"ri-request-type\"><option value=\"\u062c\u0648\u062f\u0629 \u0645\u0633\u062a\u062d\u0636\u0631\">\u062c\u0648\u062f\u0629 \u0645\u0633\u062a\u062d\u0636\u0631<\/option><option value=\"\u0639\u0631\u0636 \u062c\u0627\u0646\u0628\u064a \/ \u0623\u062b\u0631 \u062f\u0648\u0627\u0626\u064a\">\u0639\u0631\u0636 \u062c\u0627\u0646\u0628\u064a \/ \u0623\u062b\u0631 \u062f\u0648\u0627\u0626\u064a<\/option><option value=\"\u0627\u0644\u0623\u062e\u0637\u0627\u0621 \u0627\u0644\u062f\u0648\u0627\u0626\u064a\u0629\">\u0627\u0644\u0623\u062e\u0637\u0627\u0621 \u0627\u0644\u062f\u0648\u0627\u0626\u064a\u0629<\/option><\/select><\/span> <\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"all-fld-item op-adr\">\n\t\t\t<p><span class=\"radio-ele\">\u0647\u0644 \u0627\u0644\u0639\u0631\u0636 \u0627\u0644\u062c\u0627\u0646\u0628\u064a 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name=\"ri-trade-name\"><option value=\"\">&#8212; \u0627\u0644\u0631\u062c\u0627\u0621 \u062a\u062d\u062f\u064a\u062f \u0627\u062e\u062a\u064a\u0627\u0631 &#8212;<\/option><option value=\"Acalabrutinib BOS\u060c 100 \u0645\u0644\u063a\">Acalabrutinib BOS\u060c 100 \u0645\u0644\u063a<\/option><option value=\"Accofil\u060c 300 \u0645\u064a\u0643\u0631\u0648\u063a\u0631\u0627\u0645 \/0.5 \u0645\u0644\">Accofil\u060c 300 \u0645\u064a\u0643\u0631\u0648\u063a\u0631\u0627\u0645 \/0.5 \u0645\u0644<\/option><option value=\"Accofil\u060c 480 \u0645\u064a\u0643\u0631\u0648\u063a\u0631\u0627\u0645 \/ 0.5 \u0645\u0644\">Accofil\u060c 480 \u0645\u064a\u0643\u0631\u0648\u063a\u0631\u0627\u0645 \/ 0.5 \u0645\u0644<\/option><option value=\"Acetaminophen 300 \u0645\u0644\u063a + Codeine Phosphate 30 \u0645\u0644\u063a \u0642\u0631\u0635\">Acetaminophen 300 \u0645\u0644\u063a + Codeine Phosphate 30 \u0645\u0644\u063a \u0642\u0631\u0635<\/option><option value=\"Acidoxax\u060c 4 \u0645\u0644\u063a\">Acidoxax\u060c 4 \u0645\u0644\u063a<\/option><option value=\"Allbloc\u060c 1 \u0645\u0644\u063a\/\u0645\u0644\">Allbloc\u060c 1 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Anidulafungin\u060c BOS\u060c 100 \u0645\u0644\u063a\">Anidulafungin\u060c BOS\u060c 100 \u0645\u0644\u063a<\/option><option value=\"Apeto\u060c 100 \u0645\u0644\u063a\">Apeto\u060c 100 \u0645\u0644\u063a<\/option><option value=\"Apeto\u060c 15 \u0645\u0644\u063a\">Apeto\u060c 15 \u0645\u0644\u063a<\/option><option value=\"Apixaban BOS\u060c 2.5 \u0645\u0644\u063a\">Apixaban BOS\u060c 2.5 \u0645\u0644\u063a<\/option><option value=\"Apixaban BOS\u060c 5 \u0645\u0644\u063a\">Apixaban BOS\u060c 5 \u0645\u0644\u063a<\/option><option value=\"Azithromycin BOS\u060c 500 \u0645\u0644\u063a\">Azithromycin BOS\u060c 500 \u0645\u0644\u063a<\/option><option value=\"Batipan\u060c 100 \u0645\u0644\u063a \u0644\u0643\u0644 50 \u0645\u0644\">Batipan\u060c 100 \u0645\u0644\u063a \u0644\u0643\u0644 50 \u0645\u0644<\/option><option value=\"Batipan\u060c 50 \u0645\u0644\u063a\">Batipan\u060c 50 \u0645\u0644\u063a<\/option><option value=\"Bimtoprost BOS\u060c 0.1 \u0645\u0644\u063a\/\u0645\u0644\">Bimtoprost BOS\u060c 0.1 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Birato\u060c 250 \u0645\u0644\u063a\">Birato\u060c 250 \u0645\u0644\u063a<\/option><option value=\"Bortezomib BOS\u060c 3.5 \u0645\u0644\u063a\">Bortezomib BOS\u060c 3.5 \u0645\u0644\u063a<\/option><option value=\"Busulfan BOS\u060c 6 \u0645\u0644\u063a\/\u0645\u0644\">Busulfan BOS\u060c 6 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Cabozantinib BOS\u060c 20 \u0645\u0644\u063a\">Cabozantinib BOS\u060c 20 \u0645\u0644\u063a<\/option><option value=\"Cabozantinib BOS\u060c 40 \u0645\u0644\u063a\">Cabozantinib BOS\u060c 40 \u0645\u0644\u063a<\/option><option value=\"Cabozantinib BOS\u060c 60 \u0645\u0644\u063a\">Cabozantinib BOS\u060c 60 \u0645\u0644\u063a<\/option><option value=\"Citarox\u060c 1000 \u0645\u0644\u063a\">Citarox\u060c 1000 \u0645\u0644\u063a<\/option><option value=\"Citarox\u060c 200 \u0645\u0644\u063a\">Citarox\u060c 200 \u0645\u0644\u063a<\/option><option value=\"Copsfin\u060c 50 \u0645\u0644\u063a\">Copsfin\u060c 50 \u0645\u0644\u063a<\/option><option value=\"Copsfin\u060c 70 \u0645\u0644\u063a\">Copsfin\u060c 70 \u0645\u0644\u063a<\/option><option value=\"Daptomycin BOS\u060c 350 \u0645\u0644\u063a\">Daptomycin BOS\u060c 350 \u0645\u0644\u063a<\/option><option value=\"Demexa\u060c 100 \u0645\u064a\u0643\u0631\u0648\u063a\u0631\u0627\u0645\/\u0645\u0644\">Demexa\u060c 100 \u0645\u064a\u0643\u0631\u0648\u063a\u0631\u0627\u0645\/\u0645\u0644<\/option><option value=\"Dextroamphetamine Sulfate\u060c Dextroamphetamine Saccharate\u060c Amphetamine Sulfate\u060c Amphetamine Aspartate Extended-Release Capsules 10 \u0645\u0644\u063a\">Dextroamphetamine Sulfate\u060c Dextroamphetamine Saccharate\u060c Amphetamine Sulfate\u060c Amphetamine Aspartate Extended-Release Capsules 10 \u0645\u0644\u063a<\/option><option value=\"Docadex\u060c 20 \u0645\u0644\u063a\/\u0645\u0644\">Docadex\u060c 20 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Docadex\u060c 80 \u0645\u0644\u063a\/4 \u0645\u0644\">Docadex\u060c 80 \u0645\u0644\u063a\/4 \u0645\u0644<\/option><option value=\"Emcap\u060c 500 \u0645\u0644\u063a\">Emcap\u060c 500 \u0645\u0644\u063a<\/option><option value=\"Enoxaparin BOS\u060c 20 \u0645\u0644\u063a\/\u0645\u0644\">Enoxaparin BOS\u060c 20 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Enoxaparin BOS\u060c 40 \u0645\u0644\u063a\/\u0645\u0644\">Enoxaparin BOS\u060c 40 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Enoxaparin BOS\u060c 60 \u0645\u0644\u063a\/\u0645\u0644\">Enoxaparin BOS\u060c 60 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Enoxaparin BOS\u060c 80 \u0645\u0644\u063a\/\u0645\u0644\">Enoxaparin BOS\u060c 80 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Everolimus BOS\u060c 5 \u0645\u0644\u063a\">Everolimus BOS\u060c 5 \u0645\u0644\u063a<\/option><option value=\"Everolimus BOS\u060c 10 \u0645\u0644\u063a\">Everolimus BOS\u060c 10 \u0645\u0644\u063a<\/option><option value=\"Evonanz\u060c 18 \u0645\u0644\u063a \u0644\u0643\u0644 3 \u0645\u0644\">Evonanz\u060c 18 \u0645\u0644\u063a \u0644\u0643\u0644 3 \u0645\u0644<\/option><option value=\"Fenido\u060c 257 \u0645\u0644\u063a\">Fenido\u060c 257 \u0645\u0644\u063a<\/option><option value=\"Fenido\u060c 801 \u0645\u0644\u063a\">Fenido\u060c 801 \u0645\u0644\u063a<\/option><option value=\"Ferasiro\u060c 180 \u0645\u0644\u063a\">Ferasiro\u060c 180 \u0645\u0644\u063a<\/option><option value=\"Ferasiro\u060c 360 \u0645\u0644\u063a\">Ferasiro\u060c 360 \u0645\u0644\u063a<\/option><option value=\"Ferasiro\u060c 90 \u0645\u0644\u063a\">Ferasiro\u060c 90 \u0645\u0644\u063a<\/option><option value=\"Fomepizole BOS 1 \u063a\/\u0645\u0644\">Fomepizole BOS 1 \u063a\/\u0645\u0644<\/option><option value=\"Foscarnet BOS\u060c 24 \u0645\u0644\u063a\/\u0645\u0644\">Foscarnet BOS\u060c 24 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Gemcitabine BOS\u060c 1000 \u0645\u0644\u063a\">Gemcitabine BOS\u060c 1000 \u0645\u0644\u063a<\/option><option value=\"Hemabo\u060c 24 \u0645\u0644\u063a\/1.2 \u0645\u0644\">Hemabo\u060c 24 \u0645\u0644\u063a\/1.2 \u0645\u0644<\/option><option value=\"Hulio\u060c 40 \u0645\u0644\u063a\">Hulio\u060c 40 \u0645\u0644\u063a<\/option><option value=\"Hydromorphone HCL 2 \u0645\u0644\u063a \u0642\u0631\u0635\">Hydromorphone HCL 2 \u0645\u0644\u063a \u0642\u0631\u0635<\/option><option value=\"Hydromorphone HCL 4 \u0645\u0644\u063a \u0642\u0631\u0635\">Hydromorphone HCL 4 \u0645\u0644\u063a \u0642\u0631\u0635<\/option><option value=\"Ketorolac BOS\u060c 30 \u0645\u0644\u063a\/\u0645\u0644\">Ketorolac BOS\u060c 30 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Lenalidomide BOS\u060c 10 \u0645\u0644\u063a\">Lenalidomide BOS\u060c 10 \u0645\u0644\u063a<\/option><option value=\"Lenalidomide BOS\u060c 15 \u0645\u0644\u063a\">Lenalidomide BOS\u060c 15 \u0645\u0644\u063a<\/option><option value=\"Lenalidomide BOS\u060c 25 \u0645\u0644\u063a\">Lenalidomide BOS\u060c 25 \u0645\u0644\u063a<\/option><option value=\"Lenalidomide BOS\u060c 5 \u0645\u0644\u063a\">Lenalidomide BOS\u060c 5 \u0645\u0644\u063a<\/option><option value=\"Lenvatinib TBM\u060c 10 \u0645\u0644\u063a\">Lenvatinib TBM\u060c 10 \u0645\u0644\u063a<\/option><option value=\"Lenvatinib TBM\u060c 4 \u0645\u0644\u063a\">Lenvatinib TBM\u060c 4 \u0645\u0644\u063a<\/option><option value=\"Levetiracetam BOS\u060c 100 \u0645\u0644\u063a\/\u0645\u0644\">Levetiracetam BOS\u060c 100 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Methadone HCL 5 \u0645\u0644\u063a \u0642\u0631\u0635\">Methadone HCL 5 \u0645\u0644\u063a \u0642\u0631\u0635<\/option><option value=\"Methadone HCL 10 \u0645\u0644\u063a \u0642\u0631\u0635\">Methadone HCL 10 \u0645\u0644\u063a \u0642\u0631\u0635<\/option><option value=\"Milrinone BOS\u060c 1 \u0645\u0644\u063a\/\u0645\u0644\">Milrinone BOS\u060c 1 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Morphine Sulfate Extended-Release 60 \u0645\u0644\u063a \u0642\u0631\u0635\">Morphine Sulfate Extended-Release 60 \u0645\u0644\u063a \u0642\u0631\u0635<\/option><option value=\"Morphine Sulfate Extended-Release 100 \u0645\u0644\u063a \u0642\u0631\u0635\">Morphine Sulfate Extended-Release 100 \u0645\u0644\u063a \u0642\u0631\u0635<\/option><option value=\"Nepexto\u060c 50 \u0645\u0644\u063a\/\u0645\u0644\">Nepexto\u060c 50 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Nepexto\u060c 25 \u0645\u0644\u063a\/\u0645\u0644\">Nepexto\u060c 25 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Oselow\u060c 75 \u0645\u0644\u063a\">Oselow\u060c 75 \u0645\u0644\u063a<\/option><option value=\"Oxycodone HCL 5 \u0645\u0644\u063a + Acetaminophen 325 \u0645\u0644\u063a \u0642\u0631\u0635\">Oxycodone HCL 5 \u0645\u0644\u063a + Acetaminophen 325 \u0645\u0644\u063a \u0642\u0631\u0635<\/option><option value=\"Pelgraz\u060c 6 \u0645\u0644\u063a \u0641\u064a 0.6 \u0645\u0644\">Pelgraz\u060c 6 \u0645\u0644\u063a \u0641\u064a 0.6 \u0645\u0644<\/option><option value=\"Pemitax\u060c 500 \u0645\u0644\u063a\">Pemitax\u060c 500 \u0645\u0644\u063a<\/option><option value=\"Pomalidomide BOS\u060c 1 \u0645\u0644\u063a\">Pomalidomide BOS\u060c 1 \u0645\u0644\u063a<\/option><option value=\"Pomalidomide BOS\u060c 2 \u0645\u0644\u063a\">Pomalidomide BOS\u060c 2 \u0645\u0644\u063a<\/option><option value=\"Pomalidomide BOS\u060c 3 \u0645\u0644\u063a\">Pomalidomide BOS\u060c 3 \u0645\u0644\u063a<\/option><option value=\"Pomalidomide BOS\u060c 4 \u0645\u0644\u063a\">Pomalidomide BOS\u060c 4 \u0645\u0644\u063a<\/option><option value=\"Rocuronium Bromide BOS\u060c 10 \u0645\u0644\u063a\/\u0645\u0644\">Rocuronium Bromide BOS\u060c 10 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Sermitor\u060c 60 \u0645\u0644\u063a\">Sermitor\u060c 60 \u0645\u0644\u063a<\/option><option value=\"Sorafenib BOS\u060c 200 \u0645\u0644\u063a\">Sorafenib BOS\u060c 200 \u0645\u0644\u063a<\/option><option value=\"Tecana\u060c 20 \u0645\u0644\u063a\/\u0645\u0644\">Tecana\u060c 20 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Teriflunomide BOS\u060c 14 \u0645\u0644\u063a\">Teriflunomide BOS\u060c 14 \u0645\u0644\u063a<\/option><option value=\"Tigacycline BOS\u060c 50 \u0645\u0644\u063a\">Tigacycline BOS\u060c 50 \u0645\u0644\u063a<\/option><option value=\"Tranexamic acid BOS\u060c 100 \u0645\u0644\u063a\/\u0645\u0644\">Tranexamic acid BOS\u060c 100 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Trumavar\u060c 15\/6.14 \u0645\u0644\u063a\">Trumavar\u060c 15\/6.14 \u0645\u0644\u063a<\/option><option value=\"Trumavar\u060c 20\/8.19 \u0645\u0644\u063a\">Trumavar\u060c 20\/8.19 \u0645\u0644\u063a<\/option><option value=\"Tyenne\u060c 162 \u0645\u0644\u063a \u0644\u0643\u0644 0.9 \u0645\u0644\">Tyenne\u060c 162 \u0645\u0644\u063a \u0644\u0643\u0644 0.9 \u0645\u0644<\/option><option value=\"Tyenne\u060c 200 \u0645\u0644\u063a \u0644\u0643\u0644 10 \u0645\u0644\">Tyenne\u060c 200 \u0645\u0644\u063a \u0644\u0643\u0644 10 \u0645\u0644<\/option><option value=\"Tyenne\u060c 400 \u0645\u0644\u063a \u0644\u0643\u0644 20 \u0645\u0644\">Tyenne\u060c 400 \u0645\u0644\u063a \u0644\u0643\u0644 20 \u0645\u0644<\/option><option value=\"Tyenne\u060c 80 \u0645\u0644\u063a \u0644\u0643\u0644 4 \u0645\u0644\">Tyenne\u060c 80 \u0645\u0644\u063a \u0644\u0643\u0644 4 \u0645\u0644<\/option><option value=\"Tykodas\u060c 100 \u0645\u0644\u063a\">Tykodas\u060c 100 \u0645\u0644\u063a<\/option><option value=\"Tykodas\u060c 50 \u0645\u0644\u063a\">Tykodas\u060c 50 \u0645\u0644\u063a<\/option><option value=\"Tykodas\u060c 70 \u0645\u0644\u063a\">Tykodas\u060c 70 \u0645\u0644\u063a<\/option><option value=\"Vasopressin BOS\u060c 20 \u0648\u062d\u062f\u0629\/\u0645\u0644\">Vasopressin BOS\u060c 20 \u0648\u062d\u062f\u0629\/\u0645\u0644<\/option><option value=\"Voriole\u060c 200 \u0645\u0644\u063a\">Voriole\u060c 200 \u0645\u0644\u063a<\/option><option value=\"Xatiza\u060c 60 \u0645\u0644\u063a \/ 1.5 \u0645\u0644\">Xatiza\u060c 60 \u0645\u0644\u063a \/ 1.5 \u0645\u0644<\/option><option value=\"Xorola\u060c 2.5 \u0645\u0644\u063a\">Xorola\u060c 2.5 \u0645\u0644\u063a<\/option><option value=\"Zelyssa\u060c 18 \u0645\u0644\u063a \u0644\u0643\u0644 3 \u0645\u0644\">Zelyssa\u060c 18 \u0645\u0644\u063a \u0644\u0643\u0644 3 \u0645\u0644<\/option><option value=\"Zercepac\u060c 150 \u0645\u0644\u063a\">Zercepac\u060c 150 \u0645\u0644\u063a<\/option><\/select><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"elementor-field elementor-select-wrapper\">\n\t\t\t<p><label>\u0627\u0644\u0634\u0643\u0644 \u0627\u0644\u0635\u064a\u062f\u0644\u0627\u0646\u064a <span class=\"wpcf7-form-control-wrap\" data-name=\"ri-dosage-form\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"ri-dosage-form\"><option value=\"\">&#8212; \u0627\u0644\u0631\u062c\u0627\u0621 \u062a\u062d\u062f\u064a\u062f \u0627\u062e\u062a\u064a\u0627\u0631 &#8212;<\/option><option value=\"\u0645\u062d\u0644\u0648\u0644 \u0644\u0644\u062d\u0642\u0646\">\u0645\u062d\u0644\u0648\u0644 \u0644\u0644\u062d\u0642\u0646<\/option><option value=\"\u0642\u0631\u0635 \u0645\u063a\u0644\u0641 \u0628\u0627\u0644\u0641\u064a\u0644\u0645\">\u0642\u0631\u0635 \u0645\u063a\u0644\u0641 \u0628\u0627\u0644\u0641\u064a\u0644\u0645<\/option><option value=\"\u0645\u0633\u062d\u0648\u0642 \u0644\u0644\u0645\u062d\u0644\u0648\u0644\">\u0645\u0633\u062d\u0648\u0642 \u0644\u0644\u0645\u062d\u0644\u0648\u0644<\/option><option value=\"\u0645\u0631\u0643\u0632 \u0644\u0644\u0645\u062d\u0644\u0648\u0644\">\u0645\u0631\u0643\u0632 \u0644\u0644\u0645\u062d\u0644\u0648\u0644<\/option><option value=\"\u0645\u0633\u062d\u0648\u0642 \u0644\u0645\u0631\u0643\u0632 \u0627\u0644\u0645\u062d\u0644\u0648\u0644\">\u0645\u0633\u062d\u0648\u0642 \u0644\u0645\u0631\u0643\u0632 \u0627\u0644\u0645\u062d\u0644\u0648\u0644<\/option><option value=\"\u0643\u0628\u0633\u0648\u0644\u0629\">\u0643\u0628\u0633\u0648\u0644\u0629<\/option><option value=\"\u0645\u062d\u0644\u0648\u0644 \u0644\u0644\u062a\u0633\u0631\u064a\u0628\">\u0645\u062d\u0644\u0648\u0644 \u0644\u0644\u062a\u0633\u0631\u064a\u0628<\/option><option value=\"\u0642\u0631\u0635\">\u0642\u0631\u0635<\/option><option value=\"\u062d\u0642\u0646\u0629 \u0645\u0645\u0644\u0648\u0621\u0629 \u0645\u0633\u0628\u0642\u064b\u0627\">\u062d\u0642\u0646\u0629 \u0645\u0645\u0644\u0648\u0621\u0629 \u0645\u0633\u0628\u0642\u064b\u0627<\/option><option value=\"\u0642\u0644\u0645 \u0645\u0645\u0644\u0648\u0621 \u0645\u0633\u0628\u0642\u064b\u0627\">\u0642\u0644\u0645 \u0645\u0645\u0644\u0648\u0621 \u0645\u0633\u0628\u0642\u064b\u0627<\/option><\/select><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"all-fld-item op-me\">\n\t\t\t<p><label>\u0627\u0633\u0645 \u0627\u0644\u0645\u0633\u062a\u062d\u0636\u0631 \u0627\u0644\u0639\u0644\u0645\u064a <span class=\"wpcf7-form-control-wrap\" data-name=\"ri-generic-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"ri-generic-name\" \/><\/span> <\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"all-fld-item op-pq\">\n\t\t\t<p><label>\u0631\u0642\u0645 \u0627\u0644\u062a\u0633\u062c\u064a\u0644 <span class=\"wpcf7-form-control-wrap\" data-name=\"ri-registration-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"ri-registration-number\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"all-fld-item op-pq op-adr op-is-drug-eff-yes op-me\">\n\t\t\t<p><label>\u0631\u0642\u0645 \u0627\u0644\u062a\u0634\u063a\u064a\u0644\u0629 <span class=\"wpcf7-form-control-wrap\" data-name=\"ri-batch-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"\u0631\u0642\u0645 \u0627\u0644\u062a\u0634\u063a\u064a\u0644\u0629\" value=\"\" type=\"text\" name=\"ri-batch-number\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"all-fld-item op-pq op-adr op-is-drug-eff-yes\">\n\t\t\t<p><label>\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u062a\u0635\u0646\u064a\u0639 <span class=\"wpcf7-form-control-wrap\" data-name=\"ri-manufacturing-date\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text walcf7-datepicker\" aria-invalid=\"false\" placeholder=\"\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u062a\u0635\u0646\u064a\u0639\" value=\"\" type=\"text\" name=\"ri-manufacturing-date\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"all-fld-item op-pq op-adr op-is-drug-eff-yes\">\n\t\t\t<p><label>\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0625\u0646\u062a\u0647\u0627\u0621 <span class=\"wpcf7-form-control-wrap\" data-name=\"ri-expiry-date\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text walcf7-datepicker\" aria-invalid=\"false\" placeholder=\"\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0635\u0644\u0627\u062d\u064a\u0629\" value=\"\" type=\"text\" name=\"ri-expiry-date\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"all-fld-item op-me\">\n\t\t\t<p><span class=\"radio-ele\">\u0647\u0644 \u0647\u0630\u0627 \u0627\u0644\u062a\u0642\u0631\u064a\u0631 \u0644\u0644\u0628\u0644\u0627\u063a \u0639\u0646 \u0627\u0644\u062a\u0634\u0627\u0628\u0647 \u0628\u064a\u0646 \u0623\u0633\u0645\u0627\u0621 \u0623\u062f\u0648\u064a\u0629 \u0623\u0648 \u0645\u0633\u062a\u062d\u0636\u0631\u0627\u062a \u0623\u0648 \u0645\u0639\u0644\u0648\u0645\u0627\u062a \u063a\u064a\u0631 \u0627\u0644\u0645\u0644\u0627\u0626\u0645\u0629 \u0623\u0648 \u0645\u0641\u0642\u0648\u062f\u0629 \u0623\u0648 \u0645\u0636\u0644\u0644\u0629 \u0641\u064a \u0627\u0644\u062a\u063a\u0644\u064a\u0641 \u0627\u0644\u062f\u0627\u062e\u0644\u064a \u0623\u0648 \u0627\u0644\u062e\u0627\u0631\u062c\u064a \u0644\u0644\u062f\u0648\u0627\u0621\u060c \u0648\u0644\u0643\u0646 \u0644\u0645 \u064a\u0646\u062a\u062c \u0639\u0646 \u0630\u0644\u0643 \u062e\u0637\u0623 \u0641\u064a \u0627\u0644\u062f\u0648\u0627\u0621\u061f <span class=\"wpcf7-form-control-wrap\" data-name=\"ri-medication-error\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"ri-medication-error\" value=\"\u0646\u0639\u0645\" \/><span class=\"wpcf7-list-item-label\">\u0646\u0639\u0645<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"ri-medication-error\" value=\"\u0644\u0627\" \/><span class=\"wpcf7-list-item-label\">\u0644\u0627<\/span><\/span><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"all-fld-item op-me\">\n\t\t\t<p><span class=\"radio-ele\">\u0627\u0644\u062e\u0637\u0623 \u0627\u0644\u062f\u0648\u0627\u0626\u064a \u0627\u0644\u0645\u062a\u0639\u0644\u0642 \u0628\u0627\u0644\u0645\u0633\u062a\u062d\u0636\u0631 <span class=\"wpcf7-form-control-wrap\" data-name=\"ri-related-to-product\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"ri-related-to-product\" value=\"\u0627\u0633\u0645\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0633\u0645<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"ri-related-to-product\" value=\"\u0627\u0644\u062a\u0639\u0628\u0626\u0629 \u0648\u0627\u0644\u062a\u063a\u0644\u064a\u0641 \/ \u0648\u0636\u0639 \u0627\u0644\u0639\u0644\u0627\u0645\u0627\u062a\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0644\u062a\u0639\u0628\u0626\u0629 \u0648\u0627\u0644\u062a\u063a\u0644\u064a\u0641 \/ \u0648\u0636\u0639 \u0627\u0644\u0639\u0644\u0627\u0645\u0627\u062a<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"ri-related-to-product\" value=\"\u0643\u0644\u0627\u0647\u0645\u0627\" \/><span class=\"wpcf7-list-item-label\">\u0643\u0644\u0627\u0647\u0645\u0627<\/span><\/span><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"all-fld-item op-adr op-is-drug-eff-yes\">\n\t\t\t<p><span class=\"radio-ele\">\u0643\u064a\u0641 \u062d\u0635\u0644\u062a \u0639\u0644\u0649 \u0627\u0644\u0645\u0633\u062a\u062d\u0636\u0631 <span class=\"wpcf7-form-control-wrap\" data-name=\"ri-obtain-medication\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"ri-obtain-medication\" value=\"\u0645\u0646 \u0627\u0644\u0635\u064a\u062f\u0644\u064a\u0629 \u0628\u0648\u0635\u0641\u0629 \u0637\u0628\u064a\u0629\" \/><span class=\"wpcf7-list-item-label\">\u0645\u0646 \u0627\u0644\u0635\u064a\u062f\u0644\u064a\u0629 \u0628\u0648\u0635\u0641\u0629 \u0637\u0628\u064a\u0629<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"ri-obtain-medication\" value=\"\u0645\u0646 \u0627\u0644\u0635\u064a\u062f\u0644\u064a\u0629 \u0628\u062f\u0648\u0646 \u0648\u0635\u0641\u0629\" \/><span class=\"wpcf7-list-item-label\">\u0645\u0646 \u0627\u0644\u0635\u064a\u062f\u0644\u064a\u0629 \u0628\u062f\u0648\u0646 \u0648\u0635\u0641\u0629<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"ri-obtain-medication\" value=\"\u0645\u0646 \u0645\u062d\u0644\u0627\u062a \u0627\u062e\u0631\u0649 \u063a\u064a\u0631 \u0627\u0644\u0635\u064a\u062f\u0644\u064a\u0629\" \/><span class=\"wpcf7-list-item-label\">\u0645\u0646 \u0645\u062d\u0644\u0627\u062a \u0627\u062e\u0631\u0649 \u063a\u064a\u0631 \u0627\u0644\u0635\u064a\u062f\u0644\u064a\u0629<\/span><\/span><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"all-fld-item op-adr op-is-drug-eff-yes\">\n\t\t\t<p><label>\u0627\u0633\u0645 \u0648\u0639\u0646\u0648\u0627\u0646 \u0627\u0644\u0645\u0646\u0634\u0623\u0629 \u0627\u0644\u062a\u064a \u062a\u0645 \u0635\u0631\u0641 \u0627\u0644\u0645\u0633\u062a\u062d\u0636\u0631 \u0645\u0646\u0647\u0627 <span class=\"wpcf7-form-control-wrap\" data-name=\"ri-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"\u0627\u0644\u0627\u0633\u0645\" value=\"\" type=\"text\" name=\"ri-name\" \/><\/span><\/label><label><span class=\"wpcf7-form-control-wrap\" data-name=\"ri-address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"\u0627\u0644\u0639\u0646\u0648\u0627\u0646\" value=\"\" type=\"text\" name=\"ri-address\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"all-fld-item op-adr op-is-drug-eff-yes\">\n\t\t\t<p><label>\u0627\u0644\u063a\u0631\u0636 \u0645\u0646 \u0627\u0633\u062a\u062e\u062f\u0627\u0645\u0647 <span class=\"wpcf7-form-control-wrap\" data-name=\"ri-purpose-of-use\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"ri-purpose-of-use\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"all-fld-item op-adr\">\n\t\t\t<p><span class=\"radio-ele\">\u062c\u0646\u0633 <span class=\"wpcf7-form-control-wrap\" data-name=\"ri-sex\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"ri-sex\" value=\"\u0630\u0643\u0631\" \/><span class=\"wpcf7-list-item-label\">\u0630\u0643\u0631<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"ri-sex\" value=\"\u0623\u0646\u062b\u0649\" \/><span class=\"wpcf7-list-item-label\">\u0623\u0646\u062b\u0649<\/span><\/span><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"all-fld-item op-pq op-adr\">\n\t\t\t<p><label>\u0648\u0635\u0641 \u0627\u0644\u0628\u0644\u0627\u063a \/ \u0627\u0644\u062e\u0637\u0623 \u0627\u0644\u062f\u0648\u0627\u0626\u064a <span class=\"wpcf7-form-control-wrap\" data-name=\"ri-description\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"ri-description\"><\/textarea><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"all-fld-item op-pq\">\n\t\t\t<p><label>\u0645\u0644\u0641 \u0645\u0631\u0641\u0642 (PDF \u060c IMG) <span class=\"wpcf7-form-control-wrap\" data-name=\"attached-file\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".pdf,.png,.jpeg,.jpg\" aria-invalid=\"false\" type=\"file\" name=\"attached-file\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"set\">\n\t\t<p><a href=\"javascript:void(0);\">\u0628\u064a\u0627\u0646\u0627\u062a \u0627\u0644\u0645\u0633\u062a\u062d\u0636\u0631 (\u0625\u062e\u062a\u064a\u0627\u0631\u064a) <i class=\"fa fa-plus\"><\/i><\/a>\n\t\t<\/p>\n\t\t<div class=\"content\">\n\t\t\t<div class=\"elementor-field elementor-select-wrapper\">\n\t\t\t\t<p><label>\u0627\u0644\u062f\u0648\u0627\u0621 <span class=\"wpcf7-form-control-wrap\" data-name=\"sdi-suspected-drugs\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"sdi-suspected-drugs\"><option value=\"\">&#8212; \u0627\u0644\u0631\u062c\u0627\u0621 \u062a\u062d\u062f\u064a\u062f \u0627\u062e\u062a\u064a\u0627\u0631 &#8212;<\/option><option value=\"Abiraterone acetate\u060c 250 \u0645\u0644\u063a\">Abiraterone acetate\u060c 250 \u0645\u0644\u063a<\/option><option value=\"Anidulafungin\u060c 100 \u0645\u0644\u063a\">Anidulafungin\u060c 100 \u0645\u0644\u063a<\/option><option value=\"Bortezomib\u060c 3.5 \u0645\u0644\u063a\">Bortezomib\u060c 3.5 \u0645\u0644\u063a<\/option><option value=\"Capecitabine\u060c 500 \u0645\u0644\u063a\">Capecitabine\u060c 500 \u0645\u0644\u063a<\/option><option value=\"Caspofungin Acetate\u060c 50 \u0645\u0644\u063a\">Caspofungin Acetate\u060c 50 \u0645\u0644\u063a<\/option><option value=\"Caspofungin Acetate\u060c 70 \u0645\u0644\u063a\">Caspofungin Acetate\u060c 70 \u0645\u0644\u063a<\/option><option value=\"Clofarabin\u060c 1 \u0645\u0644\u063a\/\u0645\u0644\">Clofarabin\u060c 1 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Daptomycin\u060c 350 \u0645\u0644\u063a\">Daptomycin\u060c 350 \u0645\u0644\u063a<\/option><option value=\"Dasatinib\u060c 100 \u0645\u0644\u063a\">Dasatinib\u060c 100 \u0645\u0644\u063a<\/option><option value=\"Dasatinib\u060c 50 \u0645\u0644\u063a\">Dasatinib\u060c 50 \u0645\u0644\u063a<\/option><option value=\"Dasatinib\u060c 70 \u0645\u0644\u063a\">Dasatinib\u060c 70 \u0645\u0644\u063a<\/option><option value=\"Deferasirox\u060c 180 \u0645\u0644\u063a\">Deferasirox\u060c 180 \u0645\u0644\u063a<\/option><option value=\"Deferasirox\u060c 360 \u0645\u0644\u063a\">Deferasirox\u060c 360 \u0645\u0644\u063a<\/option><option value=\"Deferasirox\u060c 90 \u0645\u0644\u063a\">Deferasirox\u060c 90 \u0645\u0644\u063a<\/option><option value=\"Dexmedetomidine\u060c 0.1 \u0645\u0644\u063a\/\u0645\u0644\">Dexmedetomidine\u060c 0.1 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Docetaxel\u060c 20 \u0645\u0644\u063a\/\u0645\u0644\">Docetaxel\u060c 20 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Docetaxel\u060c 80 \u0645\u0644\u063a\/\u0645\u0644\">Docetaxel\u060c 80 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Enoxaparin\u060c 20 \u0645\u0644\u063a\">Enoxaparin\u060c 20 \u0645\u0644\u063a<\/option><option value=\"Enoxaparin\u060c 40 \u0645\u0644\u063a\">Enoxaparin\u060c 40 \u0645\u0644\u063a<\/option><option value=\"Enoxaparin\u060c 60 \u0645\u0644\u063a\">Enoxaparin\u060c 60 \u0645\u0644\u063a<\/option><option value=\"Enoxaparin\u060c 80 \u0645\u0644\u063a\">Enoxaparin\u060c 80 \u0645\u0644\u063a<\/option><option value=\"Fosaprepitant dimeglumine\u060c 150 \u0645\u0644\u063a\">Fosaprepitant dimeglumine\u060c 150 \u0645\u0644\u063a<\/option><option value=\"Foscarnet\u060c 24 \u0645\u0644\u063a\/\u0645\u0644\">Foscarnet\u060c 24 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Gemcitabine RTU\u060c 1000 \u0645\u0644\u063a\">Gemcitabine RTU\u060c 1000 \u0645\u0644\u063a<\/option><option value=\"Gemcitabine\u060c 1000 \u0645\u0644\u063a\">Gemcitabine\u060c 1000 \u0645\u0644\u063a<\/option><option value=\"Gemcitabine\u060c 200 \u0645\u0644\u063a\">Gemcitabine\u060c 200 \u0645\u0644\u063a<\/option><option value=\"Irinotecan\u060c 20 \u0645\u0644\u063a\/\u0645\u0644\">Irinotecan\u060c 20 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Ketorolac\u060c 30 \u0645\u0644\u063a\/\u0645\u0644\">Ketorolac\u060c 30 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Letrozole\u060c 2.5 \u0645\u0644\u063a\">Letrozole\u060c 2.5 \u0645\u0644\u063a<\/option><option value=\"Levetiracetam\u060c 100 \u0645\u0644\u063a\/\u0645\u0644\">Levetiracetam\u060c 100 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Milrinone\u060c 1 \u0645\u0644\u063a\/\u0645\u0644\">Milrinone\u060c 1 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Oseltamivir\u060c 75 \u0645\u0644\u063a\">Oseltamivir\u060c 75 \u0645\u0644\u063a<\/option><option value=\"Oxaliplatin\u060c 100 \u0645\u0644\u063a\">Oxaliplatin\u060c 100 \u0645\u0644\u063a<\/option><option value=\"Oxaliplatin\u060c 50 \u0645\u0644\u063a\">Oxaliplatin\u060c 50 \u0645\u0644\u063a<\/option><option value=\"Pemetrexed\u060c 500 \u0645\u0644\u063a\">Pemetrexed\u060c 500 \u0645\u0644\u063a<\/option><option value=\"Plerixafor\u060c 24 \u0645\u0644\u063a\/\u0645\u0644\">Plerixafor\u060c 24 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Rocuronium\u060c 10 \u0645\u0644\u063a \/\u0645\u0644\">Rocuronium\u060c 10 \u0645\u0644\u063a \/\u0645\u0644<\/option><option value=\"Tigacycline\u060c 50 \u0645\u0644\u063a\/\u0642\u0627\u0631\u0648\u0631\u0629\">Tigacycline\u060c 50 \u0645\u0644\u063a\/\u0642\u0627\u0631\u0648\u0631\u0629<\/option><option value=\"Toremifene\u060c 60 \u0645\u0644\u063a\">Toremifene\u060c 60 \u0645\u0644\u063a<\/option><option value=\"Tranexamic acid\u060c 100 \u0645\u0644\u063a\/\u0645\u0644\">Tranexamic acid\u060c 100 \u0645\u0644\u063a\/\u0645\u0644<\/option><option value=\"Zoledronic Acid\u060c 4 \u0645\u0644\u063a\">Zoledronic Acid\u060c 4 \u0645\u0644\u063a<\/option><\/select><\/span> <\/label>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><label>\u062a\u0627\u0631\u064a\u062e \u0628\u062f\u0621 \u0627\u0633\u062a\u062e\u062f\u0627\u0645 \u0627\u0644\u0645\u0633\u062a\u062d\u0636\u0631 <span class=\"wpcf7-form-control-wrap\" data-name=\"sdi-start-date\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text walcf7-datepicker\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"sdi-start-date\" \/><\/span> <\/label><br \/>\n<label>\u062a\u0627\u0631\u064a\u062e \u0625\u064a\u0642\u0627\u0641 \u0627\u0633\u062a\u062e\u062f\u0627\u0645 \u0627\u0644\u0645\u0633\u062a\u062d\u0636\u0631 <span class=\"wpcf7-form-control-wrap\" data-name=\"sdi-end-date\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text walcf7-datepicker\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"sdi-end-date\" \/><\/span> <\/label><br \/>\n<label>\u0627\u0644\u063a\u0631\u0636 \u0645\u0646 \u0627\u0633\u062a\u062e\u062f\u0627\u0645\u0647 <span class=\"wpcf7-form-control-wrap\" data-name=\"sdi-purpose-of-use\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"sdi-purpose-of-use\" \/><\/span> <\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"set\">\n\t\t<p><a href=\"javascript:void(0);\">\u0645\u0633\u062a\u062e\u062f\u0645 \u0627\u0644\u0645\u0633\u062a\u062d\u0636\u0631 (\u0625\u062e\u062a\u064a\u0627\u0631\u064a) <i class=\"fa fa-plus\"><\/i><\/a>\n\t\t<\/p>\n\t\t<div class=\"content\">\n\t\t\t<p><label>\u0627\u0644\u0625\u0633\u0645 \u0628\u0627\u0644\u0643\u0627\u0645\u0644 <span class=\"wpcf7-form-control-wrap\" data-name=\"pi-full-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"pi-full-name\" \/><\/span> <\/label><br \/>\n<label>\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0645\u064a\u0644\u0627\u062f <span class=\"wpcf7-form-control-wrap\" data-name=\"pi-date-of-birth\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text walcf7-datepicker\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"pi-date-of-birth\" \/><\/span> <\/label><br \/>\n<label>\u0627\u0644\u0637\u0648\u0644 (\u0633\u0645) <span class=\"wpcf7-form-control-wrap\" data-name=\"pi-height\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"pi-height\" \/><\/span> <\/label><br \/>\n<label>\u0627\u0644\u0648\u0632\u0646 (\u0643\u062c\u0645) <span class=\"wpcf7-form-control-wrap\" data-name=\"pi-weight\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"pi-weight\" \/><\/span> <\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"set\">\n\t\t<p><a href=\"javascript:void(0);\">\u0628\u064a\u0627\u0646\u0627\u062a \u0627\u0644\u0645\u0633\u062a\u062d\u0636\u0631 \u0627\u0644\u0625\u0636\u0627\u0641\u064a\u0629 (\u0625\u062e\u062a\u064a\u0627\u0631\u064a) <i class=\"fa fa-plus\"><\/i><\/a>\n\t\t<\/p>\n\t\t<div class=\"content\">\n\t\t\t<p><label>\u0627\u0633\u0645 \u0627\u0644\u0645\u0633\u062a\u062d\u0636\u0631 \u0627\u0644\u0639\u0644\u0645\u064a <span class=\"wpcf7-form-control-wrap\" data-name=\"pd-generic-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"pd-generic-name\" \/><\/span> <\/label>\n\t\t\t<\/p>\n\t\t\t<div class=\"elementor-field elementor-select-wrapper\">\n\t\t\t\t<p><label>\u0643\u064a\u0641 \u062d\u0635\u0644\u062a \u0639\u0644\u0649 \u0627\u0644\u0645\u0633\u062a\u062d\u0636\u0631 <span class=\"wpcf7-form-control-wrap\" data-name=\"pd-obtain-medication\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"pd-obtain-medication\"><option value=\"\">&#8212; \u0627\u0644\u0631\u062c\u0627\u0621 \u062a\u062d\u062f\u064a\u062f \u0627\u062e\u062a\u064a\u0627\u0631 &#8212;<\/option><option value=\"\u0645\u0646 \u0627\u0644\u0635\u064a\u062f\u0644\u064a\u0629 \u0628\u0648\u0635\u0641\u0629 \u0637\u0628\u064a\u0629\">\u0645\u0646 \u0627\u0644\u0635\u064a\u062f\u0644\u064a\u0629 \u0628\u0648\u0635\u0641\u0629 \u0637\u0628\u064a\u0629<\/option><option value=\"\u0645\u0646 \u0627\u0644\u0635\u064a\u062f\u0644\u064a\u0629 \u0628\u062f\u0648\u0646 \u0648\u0635\u0641\u0629\">\u0645\u0646 \u0627\u0644\u0635\u064a\u062f\u0644\u064a\u0629 \u0628\u062f\u0648\u0646 \u0648\u0635\u0641\u0629<\/option><option value=\"\u0645\u0646 \u0645\u062d\u0644\u0627\u062a \u0627\u062e\u0631\u0649 \u063a\u064a\u0631 \u0627\u0644\u0635\u064a\u062f\u0644\u064a\u0629\">\u0645\u0646 \u0645\u062d\u0644\u0627\u062a \u0627\u062e\u0631\u0649 \u063a\u064a\u0631 \u0627\u0644\u0635\u064a\u062f\u0644\u064a\u0629<\/option><\/select><\/span><\/label>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><label>\u0627\u0633\u0645 \u0648\u0639\u0646\u0648\u0627\u0646 \u0627\u0644\u0645\u0646\u0634\u0623\u0629 \u0627\u0644\u062a\u064a \u062a\u0645 \u0635\u0631\u0641 \u0627\u0644\u0645\u0633\u062a\u062d\u0636\u0631 \u0645\u0646\u0647\u0627 <span class=\"wpcf7-form-control-wrap\" data-name=\"pd-address-of-pharmacy\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"pd-address-of-pharmacy\"><\/textarea><\/span><\/label><br \/>\n<label>\u0627\u0644\u063a\u0631\u0636 \u0645\u0646 \u0627\u0633\u062a\u062e\u062f\u0627\u0645\u0647 <span class=\"wpcf7-form-control-wrap\" data-name=\"pd-purpose-of-use\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"pd-purpose-of-use\" \/><\/span><\/label><br \/>\n<label>\u0627\u0644\u062c\u0631\u0639\u0629 <span class=\"wpcf7-form-control-wrap\" data-name=\"pd-strength\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"pd-strength\" \/><\/span><\/label><br \/>\n<label>\u062a\u0627\u0631\u064a\u062e \u0628\u062f\u0621 \u0627\u0633\u062a\u062e\u062f\u0627\u0645 \u0627\u0644\u0645\u0633\u062a\u062d\u0636\u0631 <span class=\"wpcf7-form-control-wrap\" data-name=\"pd-start-date\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text walcf7-datepicker\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"pd-start-date\" \/><\/span> <\/label><br \/>\n<span class=\"radio-ele\">\u0647\u0644 \u0623\u0648\u0642\u0641\u062a \u0627\u0633\u062a\u062e\u062f\u0627\u0645 \u0627\u0644\u0645\u0633\u062a\u062d\u0636\u0631 <span class=\"wpcf7-form-control-wrap\" data-name=\"pd-stop-medication\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"pd-stop-medication\" value=\"\u0646\u0639\u0645\" \/><span class=\"wpcf7-list-item-label\">\u0646\u0639\u0645<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"pd-stop-medication\" value=\"\u0644\u0627\" \/><span class=\"wpcf7-list-item-label\">\u0644\u0627<\/span><\/span><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"set\">\n\t\t<p><a href=\"javascript:void(0);\">\u0628\u064a\u0627\u0646\u0627\u062a \u0627\u0644\u0623\u0639\u0631\u0627\u0636 \u0627\u0644\u062c\u0627\u0646\u0628\u064a\u0629 (\u0625\u062e\u062a\u064a\u0627\u0631\u064a) <i class=\"fa fa-plus\"><\/i><\/a>\n\t\t<\/p>\n\t\t<div class=\"content\">\n\t\t\t<p><label>\u062a\u0627\u0631\u064a\u062e \u0628\u062f\u0621 \u0638\u0647\u0648\u0631 \u0627\u0644\u0639\u0631\u0636 \u0627\u0644\u062c\u0627\u0646\u0628\u064a <span class=\"wpcf7-form-control-wrap\" data-name=\"se-event-started\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text walcf7-datepicker\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"se-event-started\" \/><\/span> <\/label>\n\t\t\t<\/p>\n\t\t\t<div class=\"elementor-field elementor-select-wrapper\">\n\t\t\t\t<p><label>\u0645\u062f\u0649 \u062e\u0637\u0648\u0631\u062a\u0647 <span class=\"wpcf7-form-control-wrap\" data-name=\"se-adr\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"se-adr\"><option value=\"\">&#8212; \u0627\u0644\u0631\u062c\u0627\u0621 \u062a\u062d\u062f\u064a\u062f \u0627\u062e\u062a\u064a\u0627\u0631 &#8212;<\/option><option value=\"\u0645\u0645\u064a\u062a\">\u0645\u0645\u064a\u062a<\/option><option value=\"\u0645\u0647\u062f\u062f \u0644\u0644\u062d\u064a\u0627\u0629\">\u0645\u0647\u062f\u062f \u0644\u0644\u062d\u064a\u0627\u0629<\/option><option value=\"\u0633\u0628\u0628 \u0625\u0639\u0627\u0642\u0629 \u062f\u0627\u0626\u0645\u0629\">\u0633\u0628\u0628 \u0625\u0639\u0627\u0642\u0629 \u062f\u0627\u0626\u0645\u0629<\/option><option value=\"\u062a\u0637\u0644\u0628 \u0627\u0644\u062f\u062e\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649\">\u062a\u0637\u0644\u0628 \u0627\u0644\u062f\u062e\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649<\/option><option value=\"\u0623\u0637\u0627\u0644 \u0645\u062f\u0629 \u0627\u0644\u0628\u0642\u0627\u0621 \u0641\u064a \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649\">\u0623\u0637\u0627\u0644 \u0645\u062f\u0629 \u0627\u0644\u0628\u0642\u0627\u0621 \u0641\u064a \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649<\/option><option value=\"\u062a\u0633\u0628\u0628 \u0641\u064a \u0639\u064a\u0648\u0628 \u062e\u0644\u0642\u064a\u0629 \u0644\u0644\u0623\u062c\u0646\u0629\">\u062a\u0633\u0628\u0628 \u0641\u064a \u0639\u064a\u0648\u0628 \u062e\u0644\u0642\u064a\u0629 \u0644\u0644\u0623\u062c\u0646\u0629<\/option><option value=\"\u062a\u0637\u0644\u0628 \u062a\u062f\u062e\u0644 \u0637\u0628\u064a \u0623\u0648 \u062c\u0631\u0627\u062d\u064a \u0644\u0645\u0646\u0639 \u062d\u062f\u0648\u062b \u0625\u0639\u0627\u0642\u0629 \u0623\u0648 \u062a\u0644\u0641 \u062f\u0627\u0626\u0645\">\u062a\u0637\u0644\u0628 \u062a\u062f\u062e\u0644 \u0637\u0628\u064a \u0623\u0648 \u062c\u0631\u0627\u062d\u064a \u0644\u0645\u0646\u0639 \u062d\u062f\u0648\u062b \u0625\u0639\u0627\u0642\u0629 \u0623\u0648 \u062a\u0644\u0641 \u062f\u0627\u0626\u0645<\/option><option value=\"\u0623\u062e\u0631\u0649\">\u0623\u062e\u0631\u0649<\/option><\/select><\/span><\/label>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><label>\u062a\u0627\u0631\u064a\u062e \u0632\u0648\u0627\u0644 \u0627\u0644\u0639\u0631\u0636 \u0627\u0644\u062c\u0627\u0646\u0628\u064a <span class=\"wpcf7-form-control-wrap\" data-name=\"se-event-ended\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text walcf7-datepicker\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"se-event-ended\" \/><\/span> <\/label><br \/>\n<span class=\"radio-ele\">\u0647\u0644 \u062a\u0645 \u0625\u0628\u0644\u0627\u063a \u0627\u0644\u0637\u0628\u064a\u0628 \u0623\u0648 \u0627\u0644\u0635\u064a\u062f\u0644\u064a \u0628\u0647\u0630\u0647 \u0627\u0644\u0623\u0639\u0631\u0627\u0636 <span class=\"wpcf7-form-control-wrap\" data-name=\"se-inform\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"se-inform\" value=\"\u0646\u0639\u0645\" \/><span class=\"wpcf7-list-item-label\">\u0646\u0639\u0645<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"se-inform\" value=\"\u0644\u0627\" \/><span class=\"wpcf7-list-item-label\">\u0644\u0627<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"se-inform\" value=\"\u0644\u0627 \u0623\u062f\u0631\u064a\" \/><span class=\"wpcf7-list-item-label\">\u0644\u0627 \u0623\u062f\u0631\u064a<\/span><\/span><\/span><\/span><\/span><br \/>\n<span class=\"radio-ele\">\u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0627\u0644\u0625\u062c\u0627\u0628\u0629 \u0628\u0646\u0639\u0645 \u0647\u0644 \u0642\u0627\u0645 \u0628\u062a\u0639\u0628\u0626\u0629 \u0646\u0645\u0648\u0630\u062c \u0627\u0644\u0625\u0628\u0644\u0627\u063a \u0639\u0646 \u0627\u0644\u0623\u0639\u0631\u0627\u0636 \u0627\u0644\u062c\u0627\u0646\u0628\u064a\u0629 <span class=\"wpcf7-form-control-wrap\" data-name=\"se-reporting-form\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"se-reporting-form\" value=\"\u0646\u0639\u0645\" \/><span class=\"wpcf7-list-item-label\">\u0646\u0639\u0645<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"se-reporting-form\" value=\"\u0644\u0627\" \/><span class=\"wpcf7-list-item-label\">\u0644\u0627<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"se-reporting-form\" value=\"\u0644\u0627 \u0623\u062f\u0631\u064a\" \/><span class=\"wpcf7-list-item-label\">\u0644\u0627 \u0623\u062f\u0631\u064a<\/span><\/span><\/span><\/span><\/span><br \/>\n<span class=\"radio-ele\">\u0647\u0644 \u064a\u0645\u0643\u0646\u0646\u0627 \u0627\u0644\u062d\u0635\u0648\u0644 \u0639\u0644\u0649 \u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0625\u0636\u0627\u0641\u064a\u0629 \u0645\u0646 \u0637\u0628\u064a\u0628\u0643 \u0627\u0644\u0645\u0639\u0627\u0644\u062c\u061f <span class=\"wpcf7-form-control-wrap\" data-name=\"se-treating-physician\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"se-treating-physician\" value=\"\u0646\u0639\u0645\" \/><span class=\"wpcf7-list-item-label\">\u0646\u0639\u0645<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"se-treating-physician\" value=\"\u0644\u0627\" \/><span class=\"wpcf7-list-item-label\">\u0644\u0627<\/span><\/span><\/span><\/span><\/span><br \/>\n<label>\u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0627\u0644\u0625\u062c\u0627\u0628\u0629 \u0628\u0646\u0639\u0645 \u0627\u0644\u0631\u062c\u0627\u0621 \u062a\u0632\u0648\u064a\u062f\u0646\u0627 \u0628\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0627\u0644\u0627\u062a\u0635\u0627\u0644 \u0627\u0644\u062e\u0627\u0635\u0629 \u0628\u0637\u0628\u064a\u0628\u0643 <span class=\"wpcf7-form-control-wrap\" data-name=\"se-communication-information\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"se-communication-information\"><\/textarea><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"set\">\n\t\t<p><a href=\"javascript:void(0);\">\u0627\u0644\u0645\u0633\u062a\u062d\u0636\u0631\u0627\u062a \u0627\u0644\u0623\u062e\u0631\u0649 \u0627\u0644\u0645\u0633\u062a\u062e\u062f\u0645\u0629 (\u0625\u062e\u062a\u064a\u0627\u0631\u064a) <i class=\"fa fa-plus\"><\/i><\/a>\n\t\t<\/p>\n\t\t<div class=\"content\">\n\t\t\t<p><label>\u0625\u0633\u0645 \u0627\u0644\u0645\u0633\u062a\u062d\u0636\u0631 <span class=\"wpcf7-form-control-wrap\" data-name=\"cd-trade-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"cd-trade-name\" \/><\/span> <\/label><br \/>\n<label>\u0627\u0644\u062c\u0631\u0639\u0629 <span class=\"wpcf7-form-control-wrap\" data-name=\"cd-strength\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"cd-strength\" \/><\/span><\/label><br \/>\n<label>\u062a\u0627\u0631\u064a\u062e \u0628\u062f\u0621 \u0627\u0633\u062a\u062e\u062f\u0627\u0645 \u0627\u0644\u0645\u0633\u062a\u062d\u0636\u0631 <span class=\"wpcf7-form-control-wrap\" data-name=\"cd-start-date\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text walcf7-datepicker\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"cd-start-date\" \/><\/span> <\/label><br \/>\n<label>\u0627\u0644\u062a\u0627\u0631\u064a\u062e <span class=\"wpcf7-form-control-wrap\" data-name=\"cd-end-date\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text walcf7-datepicker\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"cd-end-date\" \/><\/span> <\/label><br \/>\n<label>\u0627\u0644\u063a\u0631\u0636 \u0645\u0646 \u0627\u0633\u062a\u062e\u062f\u0627\u0645\u0647 <span class=\"wpcf7-form-control-wrap\" data-name=\"cd-purpose-of-use\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"cd-purpose-of-use\" \/><\/span> <\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"set\">\n\t\t<p><a href=\"javascript:void(0);\">\u0628\u064a\u0627\u0646\u0627\u062a \u0627\u0644\u062a\u0648\u0627\u0635\u0644 (\u0625\u062e\u062a\u064a\u0627\u0631\u064a) <i class=\"fa fa-plus\"><\/i><\/a>\n\t\t<\/p>\n\t\t<div class=\"content\">\n\t\t\t<p><label>\u0627\u0644\u0625\u0633\u0645 \u0628\u0627\u0644\u0643\u0627\u0645\u0644 <span class=\"wpcf7-form-control-wrap\" data-name=\"ci2-full-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"ci2-full-name\" \/><\/span> <\/label>\n\t\t\t<\/p>\n\t\t\t<div class=\"elementor-field elementor-select-wrapper\">\n\t\t\t\t<p><label>\u0627\u0644\u0645\u0633\u0645\u0649 \u0627\u0644\u0648\u0638\u064a\u0641\u064a <span class=\"wpcf7-form-control-wrap\" data-name=\"ci2-professional\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"ci2-professional\"><option value=\"\">&#8212; \u0627\u0644\u0631\u062c\u0627\u0621 \u062a\u062d\u062f\u064a\u062f \u0627\u062e\u062a\u064a\u0627\u0631 &#8212;<\/option><option value=\"\u0637\u0628\u064a\u0628\">\u0637\u0628\u064a\u0628<\/option><option value=\"\u0635\u064a\u062f\u0644\u064a\">\u0635\u064a\u062f\u0644\u064a<\/option><option value=\"\u0645\u062d\u0627\u0645\u064d\">\u0645\u062d\u0627\u0645\u064d<\/option><option value=\"\u0645\u062a\u062e\u0635\u0635 \u0631\u0639\u0627\u064a\u0629 \u0635\u062d\u064a\u0629 \u0622\u062e\u0631\">\u0645\u062a\u062e\u0635\u0635 \u0631\u0639\u0627\u064a\u0629 \u0635\u062d\u064a\u0629 \u0622\u062e\u0631<\/option><option value=\"\u0645\u0645\u0631\u0636\u0629\">\u0645\u0645\u0631\u0636\u0629<\/option><option value=\"\u0645\u0633\u062a\u0647\u0644\u0643\">\u0645\u0633\u062a\u0647\u0644\u0643<\/option><option value=\"\u0622\u062e\u0631\">\u0622\u062e\u0631<\/option><\/select><\/span> <\/label>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><label>\u0635\u0644\u0629 \u0627\u0644\u0642\u0631\u0627\u0628\u0629 <span class=\"wpcf7-form-control-wrap\" data-name=\"ci2-patient-relation\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"ci2-patient-relation\" \/><\/span> <\/label><br \/>\n<label>\u0627\u0644\u0627\u064a\u0645\u064a\u0644 <span class=\"wpcf7-form-control-wrap\" data-name=\"ci2-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"ci2-email\" \/><\/span> <\/label><br \/>\n<label>\u0627\u0644\u0647\u0627\u062a\u0641 <span class=\"wpcf7-form-control-wrap\" data-name=\"ci2-mobile\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"ci2-mobile\" \/><\/span> <\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\n\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"\u0625\u0631\u0633\u0627\u0644\" \/>\n\t<\/p>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>\u0627\u0644\u0625\u0628\u0644\u0627\u063a \u0639\u0646 \u0627\u0644\u0623\u0639\u0631\u0627\u0636 \u0627\u0644\u062c\u0627\u0646\u0628\u064a\u0629<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-5484","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Report an Adverse Event Arabic - Boston Oncology<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/bostononcology.com\/ar\/report-adverse-event-arabic\/\" \/>\n<meta property=\"og:locale\" content=\"ar_AR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Report an Adverse Event Arabic - Boston Oncology\" \/>\n<meta property=\"og:description\" content=\"\u0627\u0644\u0625\u0628\u0644\u0627\u063a \u0639\u0646 \u0627\u0644\u0623\u0639\u0631\u0627\u0636 \u0627\u0644\u062c\u0627\u0646\u0628\u064a\u0629\" \/>\n<meta property=\"og:url\" content=\"https:\/\/bostononcology.com\/ar\/report-adverse-event-arabic\/\" \/>\n<meta property=\"og:site_name\" content=\"Boston Oncology\" \/>\n<meta property=\"article:modified_time\" content=\"2025-10-24T11:14:55+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"\u0648\u0642\u062a \u0627\u0644\u0642\u0631\u0627\u0621\u0629 \u0627\u0644\u0645\u064f\u0642\u062f\u0651\u0631\" \/>\n\t<meta name=\"twitter:data1\" content=\"1 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