{"id":6999,"date":"2026-05-23T13:20:35","date_gmt":"2026-05-23T13:20:35","guid":{"rendered":"https:\/\/talpadent.lu\/medical-and-dental-history\/"},"modified":"2026-05-29T12:44:50","modified_gmt":"2026-05-29T12:44:50","slug":"medical-and-dental-history","status":"publish","type":"page","link":"https:\/\/talpadent.lu\/ru\/medical-and-dental-history\/","title":{"rendered":"\u041c\u0415\u0414\u0418\u0426\u0418\u041d\u0421\u041a\u0410\u042f \u0418 \u0421\u0422\u041e\u041c\u0410\u0422\u041e\u041b\u041e\u0413\u0418\u0427\u0415\u0421\u041a\u0410\u042f \u0418\u0421\u0422\u041e\u0420\u0418\u042f"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"6999\" class=\"elementor elementor-6999 elementor-6906\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-17450b0 e-flex e-con-boxed e-con e-parent\" data-id=\"17450b0\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-98423cd elementor-widget elementor-widget-heading\" data-id=\"98423cd\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">\u0412\u043e\u043f\u0440\u043e\u0441\u043d\u0438\u043a<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-642fd67 e-flex e-con-boxed e-con e-parent\" data-id=\"642fd67\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-91190aa elementor-widget elementor-widget-heading\" data-id=\"91190aa\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">\u041c\u0415\u0414\u0418\u0426\u0418\u041d\u0421\u041a\u0410\u042f \u0418 \u0421\u0422\u041e\u041c\u0410\u0422\u041e\u041b\u041e\u0413\u0418\u0427\u0415\u0421\u041a\u0410\u042f \u0418\u0421\u0422\u041e\u0420\u0418\u042f <\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fd3ead0 elementor-widget elementor-widget-formidable\" data-id=\"fd3ead0\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"formidable.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_1_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_ajax_submit  frm_pro_form \" id=\"form_questionnaire\" >\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">\u0412\u043e\u043f\u0440\u043e\u0441\u043d\u0438\u043a<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"1\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_1\" id=\"frm_hide_fields_1\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"questionnaire\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_1\" name=\"frm_submit_entry_1\" value=\"6d8837a883\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/ru\/wp-json\/wp\/v2\/pages\/6999\" \/><div id=\"frm_field_89_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_qfeg1_label\" class=\"frm_primary_label\">\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_qfeg1_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_89-0\">\t\t\t<label  for=\"field_qfeg1-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[89]\" id=\"field_qfeg1-0\" value=\"Mrs\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041c\u0438\u0441\u0441\u0438\u0441<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_89-1\">\t\t\t<label  for=\"field_qfeg1-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[89]\" id=\"field_qfeg1-1\" value=\"Miss\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0421\u043a\u0443\u0447\u0430\u0442\u044c<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_89-2\">\t\t\t<label  for=\"field_qfeg1-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[89]\" id=\"field_qfeg1-2\" value=\"Mr\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041c\u0438\u0441\u0442\u0435\u0440<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_87_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n\t<label for=\"field_1fe0c\" id=\"field_1fe0c_label\" class=\"frm_primary_label\">\u0424\u0430\u043c\u0438\u043b\u0438\u044f\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_1fe0c\" name=\"item_meta[87]\" value=\"\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" aria-required=\"true\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_88_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n\t<label for=\"field_4je2c\" id=\"field_4je2c_label\" class=\"frm_primary_label\">\u0418\u043c\u044f\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_4je2c\" name=\"item_meta[88]\" value=\"\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" aria-required=\"true\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_8_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n\t<label for=\"field_47ajn\" id=\"field_47ajn_label\" class=\"frm_primary_label\">\u041f\u043e\u0447\u0442\u043e\u0432\u044b\u0439 \u0438\u043d\u0434\u0435\u043a\u0441\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_47ajn\" name=\"item_meta[8]\" value=\"\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" aria-required=\"true\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_9_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n\t<label for=\"field_o81u1\" id=\"field_o81u1_label\" class=\"frm_primary_label\">\u0420\u0430\u0441\u043f\u043e\u043b\u043e\u0436\u0435\u043d\u0438\u0435\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_o81u1\" name=\"item_meta[9]\" value=\"\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" aria-required=\"true\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_10_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n\t<label for=\"field_oz2a2\" id=\"field_oz2a2_label\" class=\"frm_primary_label\">\u041d\u043e\u043c\u0435\u0440 \u0443\u043b\u0438\u0446\u044b\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_oz2a2\" name=\"item_meta[10]\" value=\"\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" aria-required=\"true\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_11_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n\t<label for=\"field_fr76c\" id=\"field_fr76c_label\" class=\"frm_primary_label\">\u041f\u0440\u043e\u0444\u0435\u0441\u0441\u0438\u044f\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_fr76c\" name=\"item_meta[11]\" value=\"\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" aria-required=\"true\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_12_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n\t<label for=\"field_ydxcj\" id=\"field_ydxcj_label\" class=\"frm_primary_label\">\u0414\u0430\u0442\u0430 \u0440\u043e\u0436\u0434\u0435\u043d\u0438\u044f\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_ydxcj\" name=\"item_meta[12]\" value=\"\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" aria-required=\"true\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_14_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n\t<label for=\"field_e2907\" id=\"field_e2907_label\" class=\"frm_primary_label\">\u041d\u043e\u043c\u0435\u0440 \u0441\u043e\u0446\u0438\u0430\u043b\u044c\u043d\u043e\u0433\u043e \u0441\u0442\u0440\u0430\u0445\u043e\u0432\u0430\u043d\u0438\u044f\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_e2907\" name=\"item_meta[14]\" value=\"\"  data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_16_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm6 frm_first\">\r\n\t<label for=\"field_e5dpy\" id=\"field_e5dpy_label\" class=\"frm_primary_label\">\u041e\u0445\u0440\u0430\u043d\u043d\u0430\u044f \u043a\u043e\u043c\u043f\u0430\u043d\u0438\u044f\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_e5dpy\" name=\"item_meta[16]\" value=\"\"  data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_15_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n\t<label for=\"field_ghtzs\" id=\"field_ghtzs_label\" class=\"frm_primary_label\">\u0414\u043e\u043f\u043e\u043b\u043d\u0438\u0442\u0435\u043b\u044c\u043d\u043e\u0435 \u0441\u0442\u0440\u0430\u0445\u043e\u0432\u0430\u043d\u0438\u0435\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_ghtzs\" name=\"item_meta[15]\" value=\"\"  data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_17_container\" class=\"frm_form_field form-field  frm_top_container frm4 frm_first\">\r\n\t<label for=\"field_yiwmf\" id=\"field_yiwmf_label\" class=\"frm_primary_label\">GSM\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_yiwmf\" name=\"item_meta[17]\" value=\"\"  data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_18_container\" class=\"frm_form_field form-field  frm_top_container frm4\">\r\n\t<label for=\"field_kzh37\" id=\"field_kzh37_label\" class=\"frm_primary_label\">\u0414\u043e\u043c\u0430\u0448\u043d\u0438\u0439 \u0442\u0435\u043b\u0435\u0444\u043e\u043d\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"tel\" id=\"field_kzh37\" name=\"item_meta[18]\" value=\"\"  data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_19_container\" class=\"frm_form_field form-field  frm_top_container frm4\">\r\n\t<label for=\"field_4cxnh\" id=\"field_4cxnh_label\" class=\"frm_primary_label\">\u041e\u0444\u0438\u0441\u043d\u044b\u0439 \u0442\u0435\u043b\u0435\u0444\u043e\u043d\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"tel\" id=\"field_4cxnh\" name=\"item_meta[19]\" value=\"\"  data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_3_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_full\">\r\n\t<label for=\"field_29yf4d\" id=\"field_29yf4d_label\" class=\"frm_primary_label\">Email-\u0430\u0434\u0440\u0435\u0441\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"email\" id=\"field_29yf4d\" name=\"item_meta[3]\" value=\"\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" aria-required=\"true\" data-invmsg=\"\u041f\u043e\u0436\u0430\u043b\u0443\u0439\u0441\u0442\u0430, \u0432\u0432\u0435\u0434\u0438\u0442\u0435 \u0434\u0435\u0439\u0441\u0442\u0432\u0438\u0442\u0435\u043b\u044c\u043d\u044b\u0439 \u0430\u0434\u0440\u0435\u0441 \u044d\u043b\u0435\u043a\u0442\u0440\u043e\u043d\u043d\u043e\u0439 \u043f\u043e\u0447\u0442\u044b\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_4_container\" class=\"frm_form_field form-field  frm_top_container frm_full\">\r\n\t<label for=\"field_e6lis6\" id=\"field_e6lis6_label\" class=\"frm_primary_label\">\u041a\u0430\u043a \u0432\u044b \u043d\u0430\u0448\u043b\u0438 \u043e\u0444\u0438\u0441? (\u0418\u043d\u0442\u0435\u0440\u043d\u0435\u0442, Doctena, \u0434\u0440\u0443\u0437\u044c\u044f\u2026)\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_e6lis6\" name=\"item_meta[4]\" value=\"\"  data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_20_container\" class=\"frm_form_field  frm_html_container form-field\">\n<h3>\u0418\u0421\u0422\u041e\u0420\u0418\u042f \u0411\u041e\u041b\u0415\u0417\u041d\u0418<\/h3>\n<\/div>\n<div id=\"frm_field_5_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first\">\r\n\t<label for=\"field_9jv0r1\" id=\"field_9jv0r1_label\" class=\"frm_primary_label\">\u0424\u0430\u043c\u0438\u043b\u0438\u044f, \u0430\u0434\u0440\u0435\u0441 \u0438 \u043d\u043e\u043c\u0435\u0440 \u0442\u0435\u043b\u0435\u0444\u043e\u043d\u0430 \u0432\u0430\u0448\u0435\u0433\u043e \u0432\u0440\u0430\u0447\u0430.\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[5]\" id=\"field_9jv0r1\" rows=\"4\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" aria-required=\"true\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_21_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n\t<label for=\"field_gvfbp\" id=\"field_gvfbp_label\" class=\"frm_primary_label\">\u041a\u043e\u0433\u0434\u0430 \u0432\u044b \u0432 \u043f\u043e\u0441\u043b\u0435\u0434\u043d\u0438\u0439 \u0440\u0430\u0437 \u043f\u0440\u043e\u0445\u043e\u0434\u0438\u043b\u0438 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0438\u0439 \u043e\u0441\u043c\u043e\u0442\u0440?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_gvfbp\" name=\"item_meta[21]\" value=\"\"  data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_22_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_ujiy6_label\" class=\"frm_primary_label\">\u0417\u0430 \u043f\u043e\u0441\u043b\u0435\u0434\u043d\u0438\u0439 \u0433\u043e\u0434 \u0432\u044b \u0437\u0430\u043c\u0435\u0442\u0438\u043b\u0438 \u043a\u0430\u043a\u0438\u0435-\u043b\u0438\u0431\u043e \u0438\u0437\u043c\u0435\u043d\u0435\u043d\u0438\u044f \u0432 \u0441\u043e\u0441\u0442\u043e\u044f\u043d\u0438\u0438 \u0441\u0432\u043e\u0435\u0433\u043e \u0437\u0434\u043e\u0440\u043e\u0432\u044c\u044f?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_ujiy6_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_22-0\">\t\t\t<label  for=\"field_ujiy6-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[22]\" id=\"field_ujiy6-0\" value=\"Yes\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0430<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_22-1\">\t\t\t<label  for=\"field_ujiy6-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[22]\" id=\"field_ujiy6-1\" value=\"No\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_23_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_three_col\">\r\n\t<div  id=\"field_9zzx7_label\" class=\"frm_primary_label\">\u041f\u043e\u0436\u0430\u043b\u0443\u0439\u0441\u0442\u0430, \u043e\u0442\u043c\u0435\u0442\u044c\u0442\u0435 \u0433\u0430\u043b\u043e\u0447\u043a\u043e\u0439 \u043a\u0430\u0436\u0434\u043e\u0435 \u0438\u0437 \u0441\u043b\u0435\u0434\u0443\u044e\u0449\u0438\u0445 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u0439 \u0438\u043b\u0438 \u043f\u0440\u043e\u0431\u043b\u0435\u043c \u0441\u043e \u0437\u0434\u043e\u0440\u043e\u0432\u044c\u0435\u043c, \u043a\u043e\u0442\u043e\u0440\u044b\u0435 \u0443 \u0432\u0430\u0441 \u043c\u043e\u0433\u043b\u0438 \u0431\u044b\u0442\u044c \u0432 \u043f\u0440\u043e\u0448\u043b\u043e\u043c \u0438\u043b\u0438 \u043a\u043e\u0442\u043e\u0440\u044b\u0435 \u0443 \u0432\u0430\u0441 \u0435\u0441\u0442\u044c \u0432 \u043d\u0430\u0441\u0442\u043e\u044f\u0449\u0435\u0435 \u0432\u0440\u0435\u043c\u044f.\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_9zzx7_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-0\">\t\t\t<label  for=\"field_9zzx7-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-0\" value=\"Depression\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   aria-required=\"true\"  \/> \u0414\u0435\u043f\u0440\u0435\u0441\u0441\u0438\u044f<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-1\">\t\t\t<label  for=\"field_9zzx7-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-1\" value=\"Liver Disease\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0411\u043e\u043b\u0435\u0437\u043d\u044c \u043f\u0435\u0447\u0435\u043d\u0438<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-2\">\t\t\t<label  for=\"field_9zzx7-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-2\" value=\"Prostheses(Other Than Dental)\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041f\u0440\u043e\u0442\u0435\u0437\u044b (\u043a\u0440\u043e\u043c\u0435 \u0437\u0443\u0431\u043d\u044b\u0445)<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-3\">\t\t\t<label  for=\"field_9zzx7-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-3\" value=\"Asthma\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0410\u0441\u0442\u043c\u0430<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-4\">\t\t\t<label  for=\"field_9zzx7-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-4\" value=\"Heart Disease\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0421\u0435\u0440\u0434\u0435\u0447\u043d\u043e\u0435 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u0435<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-5\">\t\t\t<label  for=\"field_9zzx7-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-5\" value=\"Acute Articular Rhumatism\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041e\u0441\u0442\u0440\u044b\u0439 \u0441\u0443\u0441\u0442\u0430\u0432\u043d\u043e\u0439 \u0440\u0435\u0432\u043c\u0430\u0442\u0438\u0437\u043c<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-6\">\t\t\t<label  for=\"field_9zzx7-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-6\" value=\"Plastic Surgery\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041f\u043b\u0430\u0441\u0442\u0438\u0447\u0435\u0441\u043a\u0430\u044f \u0445\u0438\u0440\u0443\u0440\u0433\u0438\u044f<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-7\">\t\t\t<label  for=\"field_9zzx7-7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-7\" value=\"Blood Disease\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0411\u043e\u043b\u0435\u0437\u043d\u044c \u043a\u0440\u043e\u0432\u0438<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-8\">\t\t\t<label  for=\"field_9zzx7-8\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-8\" value=\"HIV Positive\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0412\u0418\u0427-\u043f\u043e\u043b\u043e\u0436\u0438\u0442\u0435\u043b\u044c\u043d\u044b\u0439<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-9\">\t\t\t<label  for=\"field_9zzx7-9\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-9\" value=\"Hormonal Disorders\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0413\u043e\u0440\u043c\u043e\u043d\u0430\u043b\u044c\u043d\u044b\u0435 \u0440\u0430\u0441\u0441\u0442\u0440\u043e\u0439\u0441\u0442\u0432\u0430<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-10\">\t\t\t<label  for=\"field_9zzx7-10\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-10\" value=\"Venereal Diseases\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0412\u0435\u043d\u0435\u0440\u0438\u0447\u0435\u0441\u043a\u0438\u0435 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-11\">\t\t\t<label  for=\"field_9zzx7-11\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-11\" value=\"Repeated Sinusitis\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041f\u043e\u0432\u0442\u043e\u0440\u043d\u044b\u0439 \u0441\u0438\u043d\u0443\u0441\u0438\u0442<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-12\">\t\t\t<label  for=\"field_9zzx7-12\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-12\" value=\"Diabetes\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0438\u0430\u0431\u0435\u0442<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-13\">\t\t\t<label  for=\"field_9zzx7-13\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-13\" value=\"Edema (Swelling)\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041e\u0442\u0435\u043a (\u043f\u0440\u0438\u043f\u0443\u0445\u043b\u043e\u0441\u0442\u044c)<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-14\">\t\t\t<label  for=\"field_9zzx7-14\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-14\" value=\"Syncope,Dizziness\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041e\u0431\u043c\u043e\u0440\u043e\u043a, \u0433\u043e\u043b\u043e\u0432\u043e\u043a\u0440\u0443\u0436\u0435\u043d\u0438\u0435<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-15\">\t\t\t<label  for=\"field_9zzx7-15\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-15\" value=\"Glaucoma\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0413\u043b\u0430\u0443\u043a\u043e\u043c\u0430<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-16\">\t\t\t<label  for=\"field_9zzx7-16\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-16\" value=\"Pacemaker\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041a\u0430\u0440\u0434\u0438\u043e\u0441\u0442\u0438\u043c\u0443\u043b\u044f\u0442\u043e\u0440<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-17\">\t\t\t<label  for=\"field_9zzx7-17\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-17\" value=\"Thyroid\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0429\u0438\u0442\u043e\u0432\u0438\u0434\u043d\u0430\u044f \u0436\u0435\u043b\u0435\u0437\u0430<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-18\">\t\t\t<label  for=\"field_9zzx7-18\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-18\" value=\"Hepatitis A, B or C\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0413\u0435\u043f\u0430\u0442\u0438\u0442 \u0410, \u0412 \u0438\u043b\u0438 \u0421<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-19\">\t\t\t<label  for=\"field_9zzx7-19\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-19\" value=\"Loss of consciousness\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041f\u043e\u0442\u0435\u0440\u044f \u0441\u043e\u0437\u043d\u0430\u043d\u0438\u044f<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-20\">\t\t\t<label  for=\"field_9zzx7-20\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-20\" value=\"Kidney Problems\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041f\u0440\u043e\u0431\u043b\u0435\u043c\u044b \u0441 \u043f\u043e\u0447\u043a\u0430\u043c\u0438<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-21\">\t\t\t<label  for=\"field_9zzx7-21\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-21\" value=\"Congenital Heart Damage\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0412\u0440\u043e\u0436\u0434\u0435\u043d\u043d\u043e\u0435 \u043f\u043e\u0432\u0440\u0435\u0436\u0434\u0435\u043d\u0438\u0435 \u0441\u0435\u0440\u0434\u0446\u0430<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-22\">\t\t\t<label  for=\"field_9zzx7-22\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-22\" value=\"Circulatory Problems\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041f\u0440\u043e\u0431\u043b\u0435\u043c\u044b \u0441 \u043a\u0440\u043e\u0432\u043e\u043e\u0431\u0440\u0430\u0449\u0435\u043d\u0438\u0435\u043c<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-23\">\t\t\t<label  for=\"field_9zzx7-23\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-23\" value=\"Malignant Tumor\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0417\u043b\u043e\u043a\u0430\u0447\u0435\u0441\u0442\u0432\u0435\u043d\u043d\u0430\u044f \u043e\u043f\u0443\u0445\u043e\u043b\u044c<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-24\">\t\t\t<label  for=\"field_9zzx7-24\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-24\" value=\"Stomach Ulcers\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u042f\u0437\u0432\u044b \u0436\u0435\u043b\u0443\u0434\u043a\u0430<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-25\">\t\t\t<label  for=\"field_9zzx7-25\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-25\" value=\"Nervous Problems\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0440\u0432\u043d\u044b\u0435 \u043f\u0440\u043e\u0431\u043b\u0435\u043c\u044b<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_23-26\">\t\t\t<label  for=\"field_9zzx7-26\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[23][]\" id=\"field_9zzx7-26\" value=\"Other Diseases\"  data-frmlimit=\"27\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0440\u0443\u0433\u0438\u0435 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_24_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_ii0t4_label\" class=\"frm_primary_label\">\u0423 \u0432\u0430\u0441 \u043a\u043e\u0433\u0434\u0430-\u043d\u0438\u0431\u0443\u0434\u044c \u0441\u043b\u0443\u0447\u0430\u043b\u043e\u0441\u044c \u0430\u043d\u043e\u043c\u0430\u043b\u044c\u043d\u043e\u0435 \u043a\u0440\u043e\u0432\u043e\u0442\u0435\u0447\u0435\u043d\u0438\u0435 \u0432\u043e \u0432\u0440\u0435\u043c\u044f \u043e\u043f\u0435\u0440\u0430\u0446\u0438\u0438 \u0438\u043b\u0438 \u043d\u0435\u0441\u0447\u0430\u0441\u0442\u043d\u043e\u0433\u043e \u0441\u043b\u0443\u0447\u0430\u044f?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_ii0t4_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_24-0\">\t\t\t<label  for=\"field_ii0t4-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[24]\" id=\"field_ii0t4-0\" value=\"Yes\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0430<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_24-1\">\t\t\t<label  for=\"field_ii0t4-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[24]\" id=\"field_ii0t4-1\" value=\"No\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_25_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_ndk1z_label\" class=\"frm_primary_label\">\u0412\u0430\u043c \u043a\u043e\u0433\u0434\u0430-\u043d\u0438\u0431\u0443\u0434\u044c \u043f\u0440\u043e\u0432\u043e\u0434\u0438\u043b\u0438 \u043b\u0443\u0447\u0435\u0432\u0443\u044e \u0438\u043b\u0438 \u0445\u0438\u043c\u0438\u043e\u0442\u0435\u0440\u0430\u043f\u0438\u044e?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_ndk1z_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_25-0\">\t\t\t<label  for=\"field_ndk1z-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[25]\" id=\"field_ndk1z-0\" value=\"Yes\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0430<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_25-1\">\t\t\t<label  for=\"field_ndk1z-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[25]\" id=\"field_ndk1z-1\" value=\"No\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_26_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_mq9uv_label\" class=\"frm_primary_label\">\u0412\u044b \u0441\u0435\u0439\u0447\u0430\u0441 \u043f\u0440\u0438\u043d\u0438\u043c\u0430\u0435\u0442\u0435 \u043a\u0430\u043a\u0438\u0435-\u043b\u0438\u0431\u043e \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0430?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_mq9uv_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_26-0\">\t\t\t<label  for=\"field_mq9uv-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[26]\" id=\"field_mq9uv-0\" value=\"Yes\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0430<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_26-1\">\t\t\t<label  for=\"field_mq9uv-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[26]\" id=\"field_mq9uv-1\" value=\"No\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_28_container\" class=\"frm_form_field form-field  frm_required_field frm_left_container frm_three_col\">\r\n\t<div  id=\"field_5qyr4_label\" class=\"frm_primary_label\">\u041a\u0430\u043a\u0438\u0435\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_5qyr4_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-0\">\t\t\t<label  for=\"field_5qyr4-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_5qyr4-0\" value=\"Antibiotics\"  data-frmlimit=\"12\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   aria-required=\"true\"  \/> \u0410\u043d\u0442\u0438\u0431\u0438\u043e\u0442\u0438\u043a\u0438<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-1\">\t\t\t<label  for=\"field_5qyr4-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_5qyr4-1\" value=\"Aspirin\"  data-frmlimit=\"12\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0410\u0441\u043f\u0438\u0440\u0438\u043d<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-2\">\t\t\t<label  for=\"field_5qyr4-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_5qyr4-2\" value=\"Antihistamine\"  data-frmlimit=\"12\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0410\u043d\u0442\u0438\u0433\u0438\u0441\u0442\u0430\u043c\u0438\u043d\u043d\u044b\u0439 \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-3\">\t\t\t<label  for=\"field_5qyr4-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_5qyr4-3\" value=\"Treatment for Blood Pressure\"  data-frmlimit=\"12\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041b\u0435\u0447\u0435\u043d\u0438\u0435 \u0430\u0440\u0442\u0435\u0440\u0438\u0430\u043b\u044c\u043d\u043e\u0433\u043e \u0434\u0430\u0432\u043b\u0435\u043d\u0438\u044f<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-4\">\t\t\t<label  for=\"field_5qyr4-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_5qyr4-4\" value=\"Tranquilizer\"  data-frmlimit=\"12\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0422\u0440\u0430\u043d\u043a\u0432\u0438\u043b\u0438\u0437\u0430\u0442\u043e\u0440<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-5\">\t\t\t<label  for=\"field_5qyr4-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_5qyr4-5\" value=\"Cortisone\"  data-frmlimit=\"12\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041a\u043e\u0440\u0442\u0438\u0437\u043e\u043d<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-6\">\t\t\t<label  for=\"field_5qyr4-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_5qyr4-6\" value=\"Insulin\"  data-frmlimit=\"12\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0418\u043d\u0441\u0443\u043b\u0438\u043d<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-7\">\t\t\t<label  for=\"field_5qyr4-7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_5qyr4-7\" value=\"Biphosphonate\"  data-frmlimit=\"12\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0431\u0438\u0444\u043e\u0441\u0444\u043e\u043d\u0430\u0442<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-8\">\t\t\t<label  for=\"field_5qyr4-8\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_5qyr4-8\" value=\"Di-Hydan (Anti-Epileptic)\"  data-frmlimit=\"12\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0438-\u0413\u0438\u0434\u0430\u043d (\u043f\u0440\u043e\u0442\u0438\u0432\u043e\u044d\u043f\u0438\u043b\u0435\u043f\u0442\u0438\u0447\u0435\u0441\u043a\u043e\u0435 \u0441\u0440\u0435\u0434\u0441\u0442\u0432\u043e)<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-9\">\t\t\t<label  for=\"field_5qyr4-9\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_5qyr4-9\" value=\"Anticoagulant\"  data-frmlimit=\"12\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0410\u043d\u0442\u0438\u043a\u043e\u0430\u0433\u0443\u043b\u044f\u043d\u0442<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-10\">\t\t\t<label  for=\"field_5qyr4-10\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_5qyr4-10\" value=\"Other\"  data-frmlimit=\"12\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0440\u0443\u0433\u043e\u0435<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_29_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_8dlx0_label\" class=\"frm_primary_label\">\u0423 \u0432\u0430\u0441 \u0430\u043b\u043b\u0435\u0440\u0433\u0438\u044f \u043d\u0430 \u043e\u043f\u0440\u0435\u0434\u0435\u043b\u0435\u043d\u043d\u044b\u0435 \u0442\u043e\u0432\u0430\u0440\u044b \u0438\u043b\u0438 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0430?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_8dlx0_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_29-0\">\t\t\t<label  for=\"field_8dlx0-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[29]\" id=\"field_8dlx0-0\" value=\"Yes\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0430<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_29-1\">\t\t\t<label  for=\"field_8dlx0-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[29]\" id=\"field_8dlx0-1\" value=\"No\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_30_container\" class=\"frm_form_field form-field  frm_required_field frm_left_container frm_three_col\">\r\n\t<div  id=\"field_6zw98_label\" class=\"frm_primary_label\">\u041a\u0430\u043a\u0438\u0435\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_6zw98_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_30-0\">\t\t\t<label  for=\"field_6zw98-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[30][]\" id=\"field_6zw98-0\" value=\"Dentist\u2019s Local Anesthesic\"  data-frmlimit=\"15\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   aria-required=\"true\"  \/> \u041c\u0435\u0441\u0442\u043d\u0430\u044f \u0430\u043d\u0435\u0441\u0442\u0435\u0437\u0438\u044f \u0443 \u0441\u0442\u043e\u043c\u0430\u0442\u043e\u043b\u043e\u0433\u0430<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_30-1\">\t\t\t<label  for=\"field_6zw98-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[30][]\" id=\"field_6zw98-1\" value=\"Iodine and Derivatives\"  data-frmlimit=\"15\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0419\u043e\u0434 \u0438 \u0435\u0433\u043e \u043f\u0440\u043e\u0438\u0437\u0432\u043e\u0434\u043d\u044b\u0435<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_30-2\">\t\t\t<label  for=\"field_6zw98-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[30][]\" id=\"field_6zw98-2\" value=\"Metal\"  data-frmlimit=\"15\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041b\u0430\u0442\u0435\u043a\u0441<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_30-3\">\t\t\t<label  for=\"field_6zw98-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[30][]\" id=\"field_6zw98-3\" value=\"Antibiotic\"  data-frmlimit=\"15\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0410\u043d\u0442\u0438\u0431\u0438\u043e\u0442\u0438\u043a<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_30-4\">\t\t\t<label  for=\"field_6zw98-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[30][]\" id=\"field_6zw98-4\" value=\"Latex\"  data-frmlimit=\"15\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041b\u0430\u0442\u0435\u043a\u0441<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_30-5\">\t\t\t<label  for=\"field_6zw98-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[30][]\" id=\"field_6zw98-5\" value=\"Barbituriques\"  data-frmlimit=\"15\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0411\u0430\u0440\u0431\u0438\u0442\u0443\u0440\u043e\u0432\u044b\u0435<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_30-6\">\t\t\t<label  for=\"field_6zw98-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[30][]\" id=\"field_6zw98-6\" value=\"Anti-inflammatory or Aspirin\"  data-frmlimit=\"15\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041f\u0440\u043e\u0442\u0438\u0432\u043e\u0432\u043e\u0441\u043f\u0430\u043b\u0438\u0442\u0435\u043b\u044c\u043d\u043e\u0435 \u0441\u0440\u0435\u0434\u0441\u0442\u0432\u043e \u0438\u043b\u0438 \u0430\u0441\u043f\u0438\u0440\u0438\u043d<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_30-7\">\t\t\t<label  for=\"field_6zw98-7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[30][]\" id=\"field_6zw98-7\" value=\"Penicillin\"  data-frmlimit=\"15\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041f\u0435\u043d\u0438\u0446\u0438\u043b\u043b\u0438\u043d<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_30-8\">\t\t\t<label  for=\"field_6zw98-8\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[30][]\" id=\"field_6zw98-8\" value=\"Neuroleptic or Sleeping Pill\"  data-frmlimit=\"15\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0439\u0440\u043e\u043b\u0435\u043f\u0442\u0438\u043a \u0438\u043b\u0438 \u0441\u043d\u043e\u0442\u0432\u043e\u0440\u043d\u043e\u0435<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_30-9\">\t\t\t<label  for=\"field_6zw98-9\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[30][]\" id=\"field_6zw98-9\" value=\"Codeine\"  data-frmlimit=\"15\"  data-frmmin=\"1\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041a\u043e\u0434\u0435\u0438\u043d<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_33_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first horizontal_radio\">\r\n\t<div  id=\"field_kpwmb_label\" class=\"frm_primary_label\">\u0412\u044b \u043a\u0443\u0440\u0438\u0442\u0435?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_kpwmb_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_33-0\">\t\t\t<label  for=\"field_kpwmb-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[33]\" id=\"field_kpwmb-0\" value=\"Yes\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0430<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_33-1\">\t\t\t<label  for=\"field_kpwmb-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[33]\" id=\"field_kpwmb-1\" value=\"No\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_32_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n\t<label for=\"field_hiuys\" id=\"field_hiuys_label\" class=\"frm_primary_label\">\u041a\u043e\u043b\u0438\u0447\u0435\u0441\u0442\u0432\u043e \u0441\u0438\u0433\u0430\u0440\u0435\u0442 \u0432 \u0434\u0435\u043d\u044c \u0438 \u043f\u0440\u043e\u0434\u043e\u043b\u0436\u0438\u0442\u0435\u043b\u044c\u043d\u043e\u0441\u0442\u044c \u043a\u0443\u0440\u0435\u043d\u0438\u044f\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_hiuys\" name=\"item_meta[32]\" value=\"\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" aria-required=\"true\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_31_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first horizontal_radio\">\r\n\t<div  id=\"field_epcls_label\" class=\"frm_primary_label\">\u0423\u0432\u0430\u0436\u0430\u0435\u043c\u044b\u0435 \u0433\u043e\u0441\u043f\u043e\u0436\u0430, \u043c\u0438\u0441\u0441, \u0432\u044b \u0431\u0435\u0440\u0435\u043c\u0435\u043d\u043d\u044b?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_epcls_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_31-0\">\t\t\t<label  for=\"field_epcls-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[31]\" id=\"field_epcls-0\" value=\"Yes\"\n\t\t data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0430<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_31-1\">\t\t\t<label  for=\"field_epcls-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[31]\" id=\"field_epcls-1\" value=\"No\"\n\t\t data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_34_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_55n61\" id=\"field_55n61_label\" class=\"frm_primary_label\">\u0421\u043a\u043e\u043b\u044c\u043a\u043e \u043c\u0435\u0441\u044f\u0446\u0435\u0432\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_55n61\" name=\"item_meta[34]\" value=\"\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" aria-required=\"true\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_36_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first horizontal_radio\">\r\n\t<div  id=\"field_apcag_label\" class=\"frm_primary_label\">\u0412\u044b \u0441\u0435\u0439\u0447\u0430\u0441 \u043f\u0440\u0438\u043d\u0438\u043c\u0430\u0435\u0442\u0435 \u043f\u0440\u043e\u0442\u0438\u0432\u043e\u0437\u0430\u0447\u0430\u0442\u043e\u0447\u043d\u044b\u0435 \u0442\u0430\u0431\u043b\u0435\u0442\u043a\u0438?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_apcag_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_36-0\">\t\t\t<label  for=\"field_apcag-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[36]\" id=\"field_apcag-0\" value=\"Yes\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0430<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_36-1\">\t\t\t<label  for=\"field_apcag-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[36]\" id=\"field_apcag-1\" value=\"No\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_35_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_3a0wy\" id=\"field_3a0wy_label\" class=\"frm_primary_label\">\u0421\u043a\u043e\u043b\u044c\u043a\u043e \u043c\u0435\u0441\u044f\u0446\u0435\u0432\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_3a0wy\" name=\"item_meta[35]\" value=\"\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" aria-required=\"true\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_38_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first horizontal_radio\">\r\n\t<div  id=\"field_bkvqb_label\" class=\"frm_primary_label\">\u041f\u0440\u043e\u0445\u043e\u0434\u0438\u0442\u0435 \u043b\u0438 \u0432\u044b \u043a\u0430\u043a\u043e\u0435-\u043b\u0438\u0431\u043e \u043b\u0435\u0447\u0435\u043d\u0438\u0435 \u043e\u0442 \u043e\u0441\u0442\u0435\u043e\u043f\u043e\u0440\u043e\u0437\u0430 \u0438\u043b\u0438 \u0434\u0440\u0443\u0433\u043e\u0433\u043e \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f \u043a\u043e\u0441\u0442\u0435\u0439?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_bkvqb_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_38-0\">\t\t\t<label  for=\"field_bkvqb-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[38]\" id=\"field_bkvqb-0\" value=\"Yes\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0430<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_38-1\">\t\t\t<label  for=\"field_bkvqb-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[38]\" id=\"field_bkvqb-1\" value=\"No\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_39_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first horizontal_radio\">\r\n\t<div  id=\"field_xn548_label\" class=\"frm_primary_label\">\u041a\u0430\u043a\u0438\u0435 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0430 \u0432\u044b \u043f\u0440\u0438\u043d\u0438\u043c\u0430\u0435\u0442\u0435?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_xn548_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_39-0\">\t\t\t<label  for=\"field_xn548-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[39][]\" id=\"field_xn548-0\" value=\"Hormones\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   aria-required=\"true\"  \/> \u0413\u043e\u0440\u043c\u043e\u043d\u044b<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_39-1\">\t\t\t<label  for=\"field_xn548-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[39][]\" id=\"field_xn548-1\" value=\"Estrogens\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u042d\u0441\u0442\u0440\u043e\u0433\u0435\u043d\u044b<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_39-2\">\t\t\t<label  for=\"field_xn548-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[39][]\" id=\"field_xn548-2\" value=\"Biphosphonates\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0411\u0438\u0444\u043e\u0441\u0444\u043e\u043d\u0430\u0442\u044b<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_40_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_werjp\" id=\"field_werjp_label\" class=\"frm_primary_label\">\u0415\u0441\u043b\u0438 \u0432\u044b \u0441\u0447\u0438\u0442\u0430\u0435\u0442\u0435, \u0447\u0442\u043e \u0443 \u0432\u0430\u0441 \u0435\u0441\u0442\u044c \u043a\u0430\u043a\u043e\u0435-\u043b\u0438\u0431\u043e \u0434\u0440\u0443\u0433\u043e\u0435 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u0435 \u0438\u043b\u0438 \u043f\u0440\u043e\u0431\u043b\u0435\u043c\u0430, \u043d\u0435 \u0443\u043a\u0430\u0437\u0430\u043d\u043d\u0430\u044f \u0432 \u043f\u0440\u0438\u0432\u0435\u0434\u0435\u043d\u043d\u043e\u043c \u0432\u044b\u0448\u0435 \u0441\u043f\u0438\u0441\u043a\u0435, \u043a\u043e\u0442\u043e\u0440\u0430\u044f \u043c\u043e\u0433\u043b\u0430 \u0431\u044b \u043f\u043e\u043c\u043e\u0447\u044c \u043d\u0430\u043c \u043e\u043a\u0430\u0437\u0430\u0442\u044c \u0432\u0430\u043c \u043d\u0430\u0438\u043b\u0443\u0447\u0448\u0435\u0435 \u043b\u0435\u0447\u0435\u043d\u0438\u0435, \u043f\u043e\u0436\u0430\u043b\u0443\u0439\u0441\u0442\u0430, \u0443\u043a\u0430\u0436\u0438\u0442\u0435 \u044d\u0442\u043e \u0437\u0434\u0435\u0441\u044c.\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[40]\" id=\"field_werjp\" rows=\"5\"  data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_41_container\" class=\"frm_form_field  frm_html_container form-field\">\n<h3>\u0418\u0421\u0422\u041e\u0420\u0418\u042f \u0411\u041e\u041b\u0415\u0417\u041d\u0418<\/h3>\n<\/div>\n<div id=\"frm_field_42_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_4q25g\" id=\"field_4q25g_label\" class=\"frm_primary_label\">\u041a\u043e\u0433\u0434\u0430 \u0432\u044b \u0432 \u043f\u043e\u0441\u043b\u0435\u0434\u043d\u0438\u0439 \u0440\u0430\u0437 \u043e\u0441\u043c\u0430\u0442\u0440\u0438\u0432\u0430\u043b\u0438 \u0441\u0442\u043e\u043c\u0430\u0442\u043e\u043b\u043e\u0433\u0430?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_4q25g\" name=\"item_meta[42]\" value=\"\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" aria-required=\"true\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_43_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_7u79t\" id=\"field_7u79t_label\" class=\"frm_primary_label\">\u041f\u043e \u043a\u0430\u043a\u043e\u0439 \u043f\u0440\u0438\u0447\u0438\u043d\u0435 \u0432\u044b \u043e\u0431\u0440\u0430\u0442\u0438\u043b\u0438\u0441\u044c \u0437\u0430 \u043a\u043e\u043d\u0441\u0443\u043b\u044c\u0442\u0430\u0446\u0438\u0435\u0439?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_7u79t\" name=\"item_meta[43]\" value=\"\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" aria-required=\"true\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_44_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_z02bg\" id=\"field_z02bg_label\" class=\"frm_primary_label\">\u0412\u043e \u0432\u0440\u0435\u043c\u044f \u0432\u0430\u0448\u0438\u0445 \u043f\u0440\u0435\u0434\u044b\u0434\u0443\u0449\u0438\u0445 \u0432\u0438\u0437\u0438\u0442\u043e\u0432 \u043a \u0441\u0442\u043e\u043c\u0430\u0442\u043e\u043b\u043e\u0433\u0443 \u0432\u044b \u0441\u0442\u0430\u043b\u043a\u0438\u0432\u0430\u043b\u0438\u0441\u044c \u0441 \u043a\u0430\u043a\u0438\u043c\u0438-\u043b\u0438\u0431\u043e \u043e\u0441\u043e\u0431\u044b\u043c\u0438 \u0442\u0440\u0443\u0434\u043d\u043e\u0441\u0442\u044f\u043c\u0438? \u0415\u0441\u043b\u0438 \u0434\u0430, \u0442\u043e \u0441 \u043a\u0430\u043a\u0438\u043c\u0438?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_z02bg\" name=\"item_meta[44]\" value=\"\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" aria-required=\"true\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_45_container\" class=\"frm_form_field  frm_html_container form-field\">\n<h5><strong>\u0413\u0418\u0413\u0418\u0415\u041d\u0410 \u0417\u0423\u0411\u041e\u0412<\/strong><\/h5>\n<\/div>\n<div id=\"frm_field_46_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_oynlr_label\" class=\"frm_primary_label\">\u0412\u044b \u043f\u043e\u043b\u044c\u0437\u0443\u0435\u0442\u0435\u0441\u044c \u0437\u0443\u0431\u043d\u043e\u0439 \u0449\u0435\u0442\u043a\u043e\u0439?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_oynlr_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_46-0\">\t\t\t<label  for=\"field_oynlr-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[46][]\" id=\"field_oynlr-0\" value=\"Electric\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   aria-required=\"true\"  \/> \u042d\u043b\u0435\u043a\u0442\u0440\u0438\u0447\u0435\u0441\u043a\u0438\u0439<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_46-1\">\t\t\t<label  for=\"field_oynlr-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[46][]\" id=\"field_oynlr-1\" value=\"Manual\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0420\u0443\u043a\u043e\u0432\u043e\u0434\u0441\u0442\u0432\u043e<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_46-2\">\t\t\t<label  for=\"field_oynlr-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[46][]\" id=\"field_oynlr-2\" value=\"Hard\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0416\u0435\u0441\u0442\u043a\u0438\u0439<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_46-3\">\t\t\t<label  for=\"field_oynlr-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[46][]\" id=\"field_oynlr-3\" value=\"Medium\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0421\u0440\u0435\u0434\u043d\u0438\u0439<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_46-4\">\t\t\t<label  for=\"field_oynlr-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[46][]\" id=\"field_oynlr-4\" value=\"Soft\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041c\u044f\u0433\u043a\u0438\u0439<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_47_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_1tdq3_label\" class=\"frm_primary_label\">\u041a\u043e\u0433\u0434\u0430 \u0432\u044b \u0447\u0438\u0441\u0442\u0438\u0442\u0435 \u0437\u0443\u0431\u044b?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_1tdq3_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_47-0\">\t\t\t<label  for=\"field_1tdq3-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[47][]\" id=\"field_1tdq3-0\" value=\"Morning\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   aria-required=\"true\"  \/> \u0423\u0442\u0440\u043e<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_47-1\">\t\t\t<label  for=\"field_1tdq3-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[47][]\" id=\"field_1tdq3-1\" value=\"Afternoon\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041f\u043e\u043b\u0434\u0435\u043d\u044c<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_47-2\">\t\t\t<label  for=\"field_1tdq3-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[47][]\" id=\"field_1tdq3-2\" value=\"Evening\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0412\u0435\u0447\u0435\u0440<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_48_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_dsuba\" id=\"field_dsuba_label\" class=\"frm_primary_label\">\u041a\u0430\u043a \u0447\u0430\u0441\u0442\u043e \u0432\u044b \u043c\u0435\u043d\u044f\u0435\u0442\u0435 \u0437\u0443\u0431\u043d\u0443\u044e \u0449\u0435\u0442\u043a\u0443?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_dsuba\" name=\"item_meta[48]\" value=\"\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" aria-required=\"true\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_49_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_c9nu_label\" class=\"frm_primary_label\">\u0412\u044b \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u0443\u0435\u0442\u0435\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_c9nu_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_49-0\">\t\t\t<label  for=\"field_c9nu-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[49]\" id=\"field_c9nu-0\" value=\"Dental Floss\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0417\u0443\u0431\u043d\u0430\u044f \u043d\u0438\u0442\u044c<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_49-1\">\t\t\t<label  for=\"field_c9nu-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[49]\" id=\"field_c9nu-1\" value=\"Interdental Brushes\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041c\u0435\u0436\u0437\u0443\u0431\u043d\u044b\u0435 \u0449\u0435\u0442\u043a\u0438<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_50_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_isspd_label\" class=\"frm_primary_label\">\u0412\u044b \u0447\u0443\u0432\u0441\u0442\u0432\u0443\u0435\u0442\u0435 \u043d\u0435\u043f\u0440\u0438\u044f\u0442\u043d\u044b\u0439 \u0437\u0430\u043f\u0430\u0445 \u0438\u0437\u043e \u0440\u0442\u0430 \/ \u043d\u0435\u043f\u0440\u0438\u044f\u0442\u043d\u044b\u0439 \u043f\u0440\u0438\u0432\u043a\u0443\u0441 \u0432\u043e \u0440\u0442\u0443?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_isspd_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_50-0\">\t\t\t<label  for=\"field_isspd-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[50]\" id=\"field_isspd-0\" value=\"Yes\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0430<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_50-1\">\t\t\t<label  for=\"field_isspd-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[50]\" id=\"field_isspd-1\" value=\"No\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_52_container\" class=\"frm_form_field  frm_html_container form-field\">\n<h5>\u0416\u0415\u0412\u0410\u0422\u0415\u041b\u042c\u041d\u0410\u042f \u0420\u0415\u0417\u0418\u041d\u041a\u0410<\/h5>\n<\/div>\n<div id=\"frm_field_51_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_mt3uc_label\" class=\"frm_primary_label\">\u0412\u044b \u0437\u0430\u043c\u0435\u0442\u0438\u043b\u0438, \u0447\u0442\u043e \u0432\u0430\u0448\u0438 \u0437\u0443\u0431\u044b \u0441\u043e \u0432\u0440\u0435\u043c\u0435\u043d\u0435\u043c \u0440\u0430\u0437\u043e\u0448\u043b\u0438\u0441\u044c?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_mt3uc_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_51-0\">\t\t\t<label  for=\"field_mt3uc-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[51]\" id=\"field_mt3uc-0\" value=\"Yes\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0430<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_51-1\">\t\t\t<label  for=\"field_mt3uc-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[51]\" id=\"field_mt3uc-1\" value=\"No\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_53_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_7l487_label\" class=\"frm_primary_label\">\u0423 \u0432\u0430\u0441 \u043a\u0440\u043e\u0432\u043e\u0442\u043e\u0447\u0430\u0442 \u0434\u0435\u0441\u043d\u044b \u043f\u043e\u0441\u043b\u0435 \u0447\u0438\u0441\u0442\u043a\u0438 \u0437\u0443\u0431\u043e\u0432, \u0438\u043b\u0438 \u0434\u0430\u0436\u0435 \u0441\u043f\u043e\u043d\u0442\u0430\u043d\u043d\u043e?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_7l487_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_53-0\">\t\t\t<label  for=\"field_7l487-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[53]\" id=\"field_7l487-0\" value=\"Yes\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0430<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_53-1\">\t\t\t<label  for=\"field_7l487-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[53]\" id=\"field_7l487-1\" value=\"No\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_54_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_39wvv_label\" class=\"frm_primary_label\">\u0412\u044b \u043a\u043e\u0433\u0434\u0430-\u043d\u0438\u0431\u0443\u0434\u044c \u043b\u0435\u0447\u0438\u043b\u0438 \u0441\u0432\u043e\u0438 \u0434\u0435\u0441\u043d\u044b?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_39wvv_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_54-0\">\t\t\t<label  for=\"field_39wvv-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[54]\" id=\"field_39wvv-0\" value=\"Yes\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0430<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_54-1\">\t\t\t<label  for=\"field_39wvv-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[54]\" id=\"field_39wvv-1\" value=\"No\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_55_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_k9pa2_label\" class=\"frm_primary_label\">By\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_k9pa2_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_55-0\">\t\t\t<label  for=\"field_k9pa2-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[55][]\" id=\"field_k9pa2-0\" value=\"Surgery\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   aria-required=\"true\"  \/> \u041e\u043f\u0435\u0440\u0430\u0446\u0438\u044f<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_55-1\">\t\t\t<label  for=\"field_k9pa2-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[55][]\" id=\"field_k9pa2-1\" value=\"Medicines\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0430<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_55-2\">\t\t\t<label  for=\"field_k9pa2-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[55][]\" id=\"field_k9pa2-2\" value=\"Descaling\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0423\u0434\u0430\u043b\u0435\u043d\u0438\u0435 \u043d\u0430\u043a\u0438\u043f\u0438<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_56_container\" class=\"frm_form_field  frm_html_container form-field\">\n<h5>\u0417\u0423\u0411\u042b<\/h5>\n<\/div>\n<div id=\"frm_field_58_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_i5i5d_label\" class=\"frm_primary_label\">\u0412\u044b \u043a\u043e\u0433\u0434\u0430-\u043d\u0438\u0431\u0443\u0434\u044c \u0443\u0434\u0430\u043b\u044f\u043b\u0438 \u0437\u0443\u0431\u044b?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_i5i5d_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_58-0\">\t\t\t<label  for=\"field_i5i5d-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[58]\" id=\"field_i5i5d-0\" value=\"Yes\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0430<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_58-1\">\t\t\t<label  for=\"field_i5i5d-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[58]\" id=\"field_i5i5d-1\" value=\"No\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_59_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_8r99_label\" class=\"frm_primary_label\">\u041f\u043e\u0447\u0435\u043c\u0443\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_8r99_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_59-0\">\t\t\t<label  for=\"field_8r99-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[59][]\" id=\"field_8r99-0\" value=\"Caries\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   aria-required=\"true\"  \/> \u041a\u0430\u0440\u0438\u0435\u0441<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_59-1\">\t\t\t<label  for=\"field_8r99-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[59][]\" id=\"field_8r99-1\" value=\"Infection or Abscess\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0418\u043d\u0444\u0435\u043a\u0446\u0438\u044f \u0438\u043b\u0438 \u0430\u0431\u0441\u0446\u0435\u0441\u0441<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_59-2\">\t\t\t<label  for=\"field_8r99-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[59][]\" id=\"field_8r99-2\" value=\"Receding Gums\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0420\u0435\u0446\u0435\u0441\u0441\u0438\u044f \u0434\u0435\u0441\u0435\u043d<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_59-3\">\t\t\t<label  for=\"field_8r99-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[59][]\" id=\"field_8r99-3\" value=\"Wisdom Tooth\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0417\u0443\u0431 \u043c\u0443\u0434\u0440\u043e\u0441\u0442\u0438<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_59-4\">\t\t\t<label  for=\"field_8r99-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[59][]\" id=\"field_8r99-4\" value=\"Fracture\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041f\u0435\u0440\u0435\u043b\u043e\u043c<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_61_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_bbsc_label\" class=\"frm_primary_label\">\u0423\u0434\u0430\u043b\u0451\u043d\u043d\u044b\u0435 \u0437\u0443\u0431\u044b \u0431\u044b\u043b\u0438 \u0432\u043e\u0437\u0432\u0440\u0430\u0449\u0435\u043d\u044b \u043d\u0430 \u043c\u0435\u0441\u0442\u043e?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_bbsc_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_61-0\">\t\t\t<label  for=\"field_bbsc-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[61]\" id=\"field_bbsc-0\" value=\"Yes\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0430<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_61-1\">\t\t\t<label  for=\"field_bbsc-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[61]\" id=\"field_bbsc-1\" value=\"No\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_60_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_xhryl_label\" class=\"frm_primary_label\">\u041a\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_xhryl_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_60-0\">\t\t\t<label  for=\"field_xhryl-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[60][]\" id=\"field_xhryl-0\" value=\"A Fixed Bridge\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   aria-required=\"true\"  \/> \u0424\u0438\u043a\u0441\u0438\u0440\u043e\u0432\u0430\u043d\u043d\u044b\u0439 \u043c\u043e\u0441\u0442<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_60-1\">\t\t\t<label  for=\"field_xhryl-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[60][]\" id=\"field_xhryl-1\" value=\"Denture\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041f\u0440\u043e\u0442\u0435\u0437<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_60-2\">\t\t\t<label  for=\"field_xhryl-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[60][]\" id=\"field_xhryl-2\" value=\"An Implant\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0418\u043c\u043f\u043b\u0430\u043d\u0442\u0430\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_63_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_71thp\" id=\"field_71thp_label\" class=\"frm_primary_label\">\u041a\u0430\u043a \u0432\u044b \u0441\u0435\u0431\u044f \u0447\u0443\u0432\u0441\u0442\u0432\u0443\u0435\u0442\u0435 \u0441 \u0432\u0430\u0448\u0438\u043c\u0438 \u043d\u044b\u043d\u0435\u0448\u043d\u0438\u043c\u0438 \u043f\u0440\u043e\u0442\u0435\u0437\u0430\u043c\u0438?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_71thp\" name=\"item_meta[63]\" value=\"\"  data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_64_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_mqq80_label\" class=\"frm_primary_label\">\u0427\u0442\u043e \u043a\u0430\u0441\u0430\u0435\u0442\u0441\u044f \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u043e\u0432\u0430\u043d\u0438\u044f \u043c\u0435\u0442\u0430\u043b\u043b\u043e\u0432 \u0432 \u043f\u043e\u043b\u043e\u0441\u0442\u0438 \u0440\u0442\u0430, \u0435\u0441\u0442\u044c \u043b\u0438 \u0443 \u0432\u0430\u0441 \u043a\u0430\u043a\u0438\u0435-\u043b\u0438\u0431\u043e \u043e\u0441\u043e\u0431\u044b\u0435 \u043f\u0440\u0435\u0434\u043f\u043e\u0447\u0442\u0435\u043d\u0438\u044f?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_mqq80_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_64-0\">\t\t\t<label  for=\"field_mqq80-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[64]\" id=\"field_mqq80-0\" value=\"Yes\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0430<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_64-1\">\t\t\t<label  for=\"field_mqq80-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[64]\" id=\"field_mqq80-1\" value=\"No\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_62_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_e7cdm\" id=\"field_e7cdm_label\" class=\"frm_primary_label\">\u0415\u0441\u043b\u0438 \u043d\u0435\u0442, \u0442\u043e \u043f\u043e \u043a\u0430\u043a\u043e\u0439 \u043f\u0440\u0438\u0447\u0438\u043d\u0435?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_e7cdm\" name=\"item_meta[62]\" value=\"\"  data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_65_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_r6lj1\" id=\"field_r6lj1_label\" class=\"frm_primary_label\">\u0415\u0441\u043b\u0438 \u0434\u0430, \u0442\u043e \u043a\u0430\u043a\u043e\u0439\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_r6lj1\" name=\"item_meta[65]\" value=\"\"  data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_66_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_i2htb_label\" class=\"frm_primary_label\">\u0423 \u0432\u0430\u0441 \u0447\u0443\u0432\u0441\u0442\u0432\u0438\u0442\u0435\u043b\u044c\u043d\u044b\u0435 \u0437\u0443\u0431\u044b?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_i2htb_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_66-0\">\t\t\t<label  for=\"field_i2htb-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[66][]\" id=\"field_i2htb-0\" value=\"Warm\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   aria-required=\"true\"  \/> \u0422\u0435\u043f\u043b\u044b\u0439<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_66-1\">\t\t\t<label  for=\"field_i2htb-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[66][]\" id=\"field_i2htb-1\" value=\"Cold\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0425\u043e\u043b\u043e\u0434\u043d\u044b\u0439<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_66-2\">\t\t\t<label  for=\"field_i2htb-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[66][]\" id=\"field_i2htb-2\" value=\"Sugar\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0421\u0430\u0445\u0430\u0440<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_66-3\">\t\t\t<label  for=\"field_i2htb-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[66][]\" id=\"field_i2htb-3\" value=\"Acids\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041a\u0438\u0441\u043b\u043e\u0442\u044b<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_66-4\">\t\t\t<label  for=\"field_i2htb-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[66][]\" id=\"field_i2htb-4\" value=\"Chewing\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0416\u0435\u0432\u0430\u043d\u0438\u0435<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_67_container\" class=\"frm_form_field  frm_html_container form-field\">\n<h5>\u0427\u0415\u041b\u042e\u0421\u0422\u0418<\/h5>\n<\/div>\n<div id=\"frm_field_68_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_afytk_label\" class=\"frm_primary_label\">\u0412\u044b \u0441\u0436\u0438\u043c\u0430\u0435\u0442\u0435 \u0438\u043b\u0438 \u0441\u043a\u0440\u0435\u0436\u0435\u0449\u0435\u0442\u0435 \u0437\u0443\u0431\u0430\u043c\u0438?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_afytk_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_68-0\">\t\t\t<label  for=\"field_afytk-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[68]\" id=\"field_afytk-0\" value=\"Yes\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0430<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_68-1\">\t\t\t<label  for=\"field_afytk-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[68]\" id=\"field_afytk-1\" value=\"No\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_69_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_was3i_label\" class=\"frm_primary_label\">\u0412\u044b \u0441\u043b\u044b\u0448\u0438\u0442\u0435 \u0442\u0440\u0435\u0441\u043a, \u0449\u0435\u043b\u0447\u043a\u0438 \u0438\u043b\u0438 \u0431\u043e\u043b\u044c \u043f\u0440\u0438 \u043e\u0442\u043a\u0440\u044b\u0432\u0430\u043d\u0438\u0438 \u0447\u0435\u043b\u044e\u0441\u0442\u0438?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_was3i_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_69-0\">\t\t\t<label  for=\"field_was3i-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[69]\" id=\"field_was3i-0\" value=\"Yes\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0430<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_69-1\">\t\t\t<label  for=\"field_was3i-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[69]\" id=\"field_was3i-1\" value=\"No\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_70_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_71vwl_label\" class=\"frm_primary_label\">\u0412\u0430\u043c \u0442\u0440\u0443\u0434\u043d\u043e \u0436\u0435\u0432\u0430\u0442\u044c, \u0438\u043b\u0438 \u0432\u044b \u0447\u0430\u0441\u0442\u043e \u0436\u0443\u0435\u0442\u0435 \u0442\u043e\u043b\u044c\u043a\u043e \u043e\u0434\u043d\u043e\u0439 \u0441\u0442\u043e\u0440\u043e\u043d\u043e\u0439?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_71vwl_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_70-0\">\t\t\t<label  for=\"field_71vwl-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[70]\" id=\"field_71vwl-0\" value=\"Yes\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0430<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_70-1\">\t\t\t<label  for=\"field_71vwl-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[70]\" id=\"field_71vwl-1\" value=\"No\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_71_container\" class=\"frm_form_field  frm_html_container form-field\">\n<h5>\u041f\u0420\u0418\u0412\u042b\u0427\u041a\u0418<\/h5>\n<\/div>\n<div id=\"frm_field_72_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first frm_three_col\">\r\n\t<div  id=\"field_ajsz4_label\" class=\"frm_primary_label\">\u0411\u044b\u043b\u0438 \u043b\u0438 \u0443 \u0432\u0430\u0441 \u0432 \u043f\u0440\u043e\u0448\u043b\u043e\u043c \u0438\u043b\u0438 \u0435\u0441\u0442\u044c \u043b\u0438 \u0443 \u0432\u0430\u0441 \u0441\u0435\u0439\u0447\u0430\u0441 \u043a\u0430\u043a\u0438\u0435-\u043b\u0438\u0431\u043e \u0438\u0437 \u0441\u043b\u0435\u0434\u0443\u044e\u0449\u0438\u0445 \u043f\u0440\u0438\u0432\u044b\u0447\u0435\u043a?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_ajsz4_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_72-0\">\t\t\t<label  for=\"field_ajsz4-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[72][]\" id=\"field_ajsz4-0\" value=\"Thumb sucking\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   aria-required=\"true\"  \/> \u0421\u043e\u0441\u0430\u043d\u0438\u0435 \u0431\u043e\u043b\u044c\u0448\u043e\u0433\u043e \u043f\u0430\u043b\u044c\u0446\u0430<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_72-1\">\t\t\t<label  for=\"field_ajsz4-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[72][]\" id=\"field_ajsz4-1\" value=\"Biting your tongue, lip or cheek\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041f\u0440\u0438\u043a\u0443\u0441\u044b\u0432\u0430\u043d\u0438\u0435 \u044f\u0437\u044b\u043a\u0430, \u0433\u0443\u0431\u044b \u0438\u043b\u0438 \u0449\u0435\u043a\u0438<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_72-2\">\t\t\t<label  for=\"field_ajsz4-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[72][]\" id=\"field_ajsz4-2\" value=\"Playing a musical wind instrument\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0418\u0433\u0440\u0430 \u043d\u0430 \u0434\u0443\u0445\u043e\u0432\u043e\u043c \u043c\u0443\u0437\u044b\u043a\u0430\u043b\u044c\u043d\u043e\u043c \u0438\u043d\u0441\u0442\u0440\u0443\u043c\u0435\u043d\u0442\u0435<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_72-3\">\t\t\t<label  for=\"field_ajsz4-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[72][]\" id=\"field_ajsz4-3\" value=\"Biting your nails\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041a\u0443\u0441\u0430\u0442\u044c \u043d\u043e\u0433\u0442\u0438<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_72-4\">\t\t\t<label  for=\"field_ajsz4-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[72][]\" id=\"field_ajsz4-4\" value=\"Chewing pencils, glasses or pens\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0416\u0435\u0432\u0430\u0442\u0435\u043b\u044c\u043d\u044b\u0435 \u043a\u0430\u0440\u0430\u043d\u0434\u0430\u0448\u0438, \u043e\u0447\u043a\u0438 \u0438\u043b\u0438 \u0440\u0443\u0447\u043a\u0438<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_72-5\">\t\t\t<label  for=\"field_ajsz4-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[72][]\" id=\"field_ajsz4-5\" value=\"Crunch ice cubes\"  data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0425\u0440\u0443\u0441\u0442\u044f\u0449\u0438\u0435 \u043a\u0443\u0431\u0438\u043a\u0438 \u043b\u044c\u0434\u0430<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_73_container\" class=\"frm_form_field  frm12 frm_first frm_html_container form-field\">\n<h5>\u042d\u0421\u0422\u0415\u0422\u0418\u0427\u0415\u0421\u041a\u0410\u042f \u0421\u0422\u041e\u041c\u0410\u0422\u041e\u041b\u041e\u0413\u0418\u042f<\/h5>\n<\/div>\n<div id=\"frm_field_74_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_j6br7_label\" class=\"frm_primary_label\">\u041f\u0440\u0438 \u0448\u0438\u0440\u043e\u043a\u043e\u0439 \u0443\u043b\u044b\u0431\u043a\u0435 \u0432\u0441\u0435 \u0432\u0430\u0448\u0438 \u0437\u0443\u0431\u044b \u043e\u0434\u0438\u043d\u0430\u043a\u043e\u0432\u043e\u0433\u043e \u0446\u0432\u0435\u0442\u0430?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_j6br7_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_74-0\">\t\t\t<label  for=\"field_j6br7-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[74]\" id=\"field_j6br7-0\" value=\"Yes\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0430<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_74-1\">\t\t\t<label  for=\"field_j6br7-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[74]\" id=\"field_j6br7-1\" value=\"No\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_75_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_ukwhb_label\" class=\"frm_primary_label\">\u0425\u043e\u0442\u0438\u0442\u0435 \u0438\u043c\u0435\u0442\u044c \u0431\u043e\u043b\u0435\u0435 \u0431\u0435\u043b\u044b\u0435 \u0437\u0443\u0431\u044b?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_ukwhb_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_75-0\">\t\t\t<label  for=\"field_ukwhb-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[75]\" id=\"field_ukwhb-0\" value=\"Yes\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0430<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_75-1\">\t\t\t<label  for=\"field_ukwhb-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[75]\" id=\"field_ukwhb-1\" value=\"No\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_76_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_g3oz4_label\" class=\"frm_primary_label\">\u0414\u043e\u0432\u043e\u043b\u044c\u043d\u044b \u043b\u0438 \u0432\u044b \u0432\u043d\u0435\u0448\u043d\u0438\u043c \u0432\u0438\u0434\u043e\u043c \u0441\u0432\u043e\u0438\u0445 \u0437\u0443\u0431\u043e\u0432 \u0438 \u0434\u0435\u0441\u0435\u043d?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_g3oz4_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_76-0\">\t\t\t<label  for=\"field_g3oz4-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[76]\" id=\"field_g3oz4-0\" value=\"Yes\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0430<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_76-1\">\t\t\t<label  for=\"field_g3oz4-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[76]\" id=\"field_g3oz4-1\" value=\"No\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_77_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_jgtr7_label\" class=\"frm_primary_label\">\u0412\u044b \u043f\u0440\u0438\u043a\u0440\u044b\u0432\u0430\u0435\u0442\u0435 \u0440\u043e\u0442 \u0440\u0443\u043a\u043e\u0439, \u043a\u043e\u0433\u0434\u0430 \u0441\u043c\u0435\u0435\u0442\u0435\u0441\u044c \u0438\u043b\u0438 \u0443\u043b\u044b\u0431\u0430\u0435\u0442\u0435\u0441\u044c?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_jgtr7_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_77-0\">\t\t\t<label  for=\"field_jgtr7-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[77]\" id=\"field_jgtr7-0\" value=\"Yes\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0430<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_77-1\">\t\t\t<label  for=\"field_jgtr7-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[77]\" id=\"field_jgtr7-1\" value=\"No\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_78_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_yi8hw\" id=\"field_yi8hw_label\" class=\"frm_primary_label\">\u0415\u0441\u043b\u0438 \u0431\u044b \u0443 \u0432\u0430\u0441 \u0431\u044b\u043b\u0430 \u0432\u043e\u0437\u043c\u043e\u0436\u043d\u043e\u0441\u0442\u044c \u0438\u0437\u043c\u0435\u043d\u0438\u0442\u044c \u0441\u0432\u043e\u044e \u0443\u043b\u044b\u0431\u043a\u0443, \u0447\u0442\u043e \u0431\u044b \u0432\u044b \u0445\u043e\u0442\u0435\u043b\u0438 \u0438\u0437\u043c\u0435\u043d\u0438\u0442\u044c?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_yi8hw\" name=\"item_meta[78]\" value=\"\"  data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_79_container\" class=\"frm_form_field  frm_html_container form-field\">\n<h5>\u0420\u0410\u0417\u041b\u0418\u0427\u041d\u042b\u0415<\/h5>\n<\/div>\n<div id=\"frm_field_80_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n\t<div  id=\"field_o3ojn_label\" class=\"frm_primary_label\">\u0412\u044b \u043d\u043e\u0441\u0438\u043b\u0438 \u043a\u0430\u043a\u0438\u0435-\u043b\u0438\u0431\u043e \u043e\u0440\u0442\u043e\u0434\u043e\u043d\u0442\u0438\u0447\u0435\u0441\u043a\u0438\u0435 \u0430\u043f\u043f\u0430\u0440\u0430\u0442\u044b \u0438\u043b\u0438 \u0431\u0440\u0435\u043a\u0435\u0442\u044b \u0434\u043b\u044f \u0432\u044b\u0440\u0430\u0432\u043d\u0438\u0432\u0430\u043d\u0438\u044f \u0437\u0443\u0431\u043e\u0432?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_o3ojn_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_80-0\">\t\t\t<label  for=\"field_o3ojn-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[80]\" id=\"field_o3ojn-0\" value=\"Yes\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"\u0412\u044b \u043d\u043e\u0441\u0438\u043b\u0438 \u043a\u0430\u043a\u0438\u0435-\u043b\u0438\u0431\u043e \u043e\u0440\u0442\u043e\u0434\u043e\u043d\u0442\u0438\u0447\u0435\u0441\u043a\u0438\u0435 \u0430\u043f\u043f\u0430\u0440\u0430\u0442\u044b \u0438\u043b\u0438 \u0431\u0440\u0435\u043a\u0435\u0442\u044b \u0434\u043b\u044f \u0432\u044b\u0440\u0430\u0432\u043d\u0438\u0432\u0430\u043d\u0438\u044f \u0437\u0443\u0431\u043e\u0432? \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0414\u0430<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_80-1\">\t\t\t<label  for=\"field_o3ojn-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[80]\" id=\"field_o3ojn-1\" value=\"No\"\n\t\t data-reqmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u0443\u0441\u0442\u044b\u043c.\" data-invmsg=\"\u0412\u044b \u043d\u043e\u0441\u0438\u043b\u0438 \u043a\u0430\u043a\u0438\u0435-\u043b\u0438\u0431\u043e \u043e\u0440\u0442\u043e\u0434\u043e\u043d\u0442\u0438\u0447\u0435\u0441\u043a\u0438\u0435 \u0430\u043f\u043f\u0430\u0440\u0430\u0442\u044b \u0438\u043b\u0438 \u0431\u0440\u0435\u043a\u0435\u0442\u044b \u0434\u043b\u044f \u0432\u044b\u0440\u0430\u0432\u043d\u0438\u0432\u0430\u043d\u0438\u044f \u0437\u0443\u0431\u043e\u0432? \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u0442<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_81_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_6943a\" id=\"field_6943a_label\" class=\"frm_primary_label\">\u0427\u0442\u043e \u0432\u0430\u0441 \u0431\u043e\u043b\u044c\u0448\u0435 \u0432\u0441\u0435\u0433\u043e \u0431\u0435\u0441\u043f\u043e\u043a\u043e\u0438\u0442 \u0432 \u043e\u0442\u043d\u043e\u0448\u0435\u043d\u0438\u0438 \u0432\u0430\u0448\u0438\u0445 \u0437\u0443\u0431\u043e\u0432?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[81]\" id=\"field_6943a\" rows=\"3\"  data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_82_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n\t<label for=\"field_7vvce\" id=\"field_7vvce_label\" class=\"frm_primary_label\">\u0412 \u0438\u0434\u0435\u0430\u043b\u0435, \u0447\u0442\u043e \u0431\u044b \u0432\u044b \u0445\u043e\u0442\u0435\u043b\u0438 \u0438\u0437\u043c\u0435\u043d\u0438\u0442\u044c \u0432\u043e \u0440\u0442\u0443?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[82]\" id=\"field_7vvce\" rows=\"3\"  data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_83_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first horizontal_radio\">\r\n\t<div  id=\"field_j1x9h_label\" class=\"frm_primary_label\">\u0412\u044b \u0438\u0441\u043f\u044b\u0442\u044b\u0432\u0430\u0435\u0442\u0435 \u0442\u0440\u0435\u0432\u043e\u0433\u0443 \u043f\u043e \u043f\u043e\u0432\u043e\u0434\u0443 \u043f\u043e\u0441\u0435\u0449\u0435\u043d\u0438\u044f \u0441\u0442\u043e\u043c\u0430\u0442\u043e\u043b\u043e\u0433\u0430?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_j1x9h_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_83-0\">\t\t\t<label  for=\"field_j1x9h-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[83]\" id=\"field_j1x9h-0\" value=\"Not at all\"\n\t\t data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0438\u0441\u043a\u043e\u043b\u044c\u043a\u043e<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_83-1\">\t\t\t<label  for=\"field_j1x9h-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[83]\" id=\"field_j1x9h-1\" value=\"A Little\"\n\t\t data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041d\u0435\u043c\u043d\u043e\u0433\u043e<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_83-2\">\t\t\t<label  for=\"field_j1x9h-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[83]\" id=\"field_j1x9h-2\" value=\"Moderately\"\n\t\t data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u0423\u043c\u0435\u0440\u0435\u043d\u043d\u043e<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_83-3\">\t\t\t<label  for=\"field_j1x9h-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[83]\" id=\"field_j1x9h-3\" value=\"A lot\"\n\t\t data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\"   \/> \u041c\u043d\u043e\u0433\u043e<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_86_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_t9ceh\" id=\"field_t9ceh_label\" class=\"frm_primary_label\">\u0414\u0440\u0443\u0433\u0438\u0435 \u043f\u043e\u043b\u0435\u0437\u043d\u044b\u0435 \u0438\u043b\u0438 \u0432\u0430\u0436\u043d\u044b\u0435 \u0437\u0430\u043c\u0435\u0447\u0430\u043d\u0438\u044f\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[86]\" id=\"field_t9ceh\" rows=\"5\"  data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_90_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p><strong>\u0411\u043e\u043b\u044c\u0448\u043e\u0435 \u0441\u043f\u0430\u0441\u0438\u0431\u043e \u0437\u0430 \u0441\u043e\u0442\u0440\u0443\u0434\u043d\u0438\u0447\u0435\u0441\u0442\u0432\u043e.<\/strong><\/p>\n<p><em>\u042f \u043f\u043e\u0434\u0442\u0432\u0435\u0440\u0436\u0434\u0430\u044e \u0442\u043e\u0447\u043d\u043e\u0441\u0442\u044c \u0434\u0430\u043d\u043d\u043e\u0433\u043e \u0434\u043e\u043a\u0443\u043c\u0435\u043d\u0442\u0430 \u0438 \u0442\u043e, \u0447\u0442\u043e \u043d\u0438\u0447\u0435\u0433\u043e \u043d\u0435 \u0443\u043f\u0443\u0441\u0442\u0438\u043b.<\/em><br \/><em>\u042f \u043d\u0435\u0437\u0430\u043c\u0435\u0434\u043b\u0438\u0442\u0435\u043b\u044c\u043d\u043e \u0441\u043e\u043e\u0431\u0449\u0443 \u043e \u043b\u044e\u0431\u044b\u0445<\/em><br \/><em>\u0438\u0437\u043c\u0435\u043d\u0435\u043d\u0438\u044f\u0445, \u043a\u0430\u0441\u0430\u044e\u0449\u0438\u0445\u0441\u044f \u043c\u043e\u0435\u0433\u043e \u0441\u043e\u0441\u0442\u043e\u044f\u043d\u0438\u044f \u0437\u0434\u043e\u0440\u043e\u0432\u044c\u044f \u0438 \u043c\u043e\u0438\u0445 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0438\u0445 \u043d\u0430\u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0439.<\/em><\/p>\n<\/div>\n<div id=\"frm_field_91_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n\t<label for=\"field_2mbts\" id=\"field_2mbts_label\" class=\"frm_primary_label\">\u0414\u0430\u0442\u0430\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_2mbts\" name=\"item_meta[91]\" value=\"[\u0434\u0430\u0442\u0430]\"  maxlength=\"10\" data-frmval=\"[\u0434\u0430\u0442\u0430]\" data-invmsg=\"[\u0438\u043c\u044f_\u043f\u043e\u043b\u044f] \u043d\u0435\u0434\u043e\u043f\u0443\u0441\u0442\u0438\u043c\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_92_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n\t<label for=\"field_tl7nv\" id=\"field_tl7nv_label\" class=\"frm_primary_label\">\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<div class=\"sigPad\" id='sigPad92' style=\"max-width:400px;\">\n\t<div class=\"sig sigWrapper\" style=\"height:150px;border-color:#D0D5DD;--bg-color:#ffffff;--active:#01d3be;--inactive:#EAECF0;--active-text:#ffffff;--inactive-text:#1D2939;--button-margin:22px;--button-size:20px;--button-padding:10px;--button-side-margin:22px;--icon:20px\">\n\n\t\t<ul class=\"sigNav\">\n\t\t\t\t<li class=\"drawIt\">\n\t\t\t\t\t<a href=\"#\" class=\"frm-active-sig-type\" title=\"\u041d\u0430\u0440\u0438\u0441\u0443\u0439 \u044d\u0442\u043e\" aria-label=\"\u041d\u0430\u0440\u0438\u0441\u0443\u0439 \u044d\u0442\u043e\">\n\t\t\t\t\t\t<svg  viewBox=\"0 0 22 20\" class=\"frmsvg\">\n\t<title>signature<\/title>\n\t<path d=\"M19.7 2.2A3.5 3.5 0 0 0 14 1.1L1.7 13.4a1 1 0 0 0-.3.4l-1.3 5a.9.9 0 0 0 0 .5 1 1 0 0 0 1 .6l5-1.3c.2 0 .4-.1.5-.3L18.9 6a3.5 3.5 0 0 0 .7-3.8zm-6.8 2.6L15.2 7l-8.6 8.7-2.4-2.4zm-10.7 13l1-3.3L5.4 17zM18 4.2l-.4.5L16.3 6 14 3.7l1.3-1.3A1.7 1.7 0 0 1 18 3.6l-.1.6zM9 17.9h11v1H9v-1z\"><\/path>\n\n<\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t\t\t<li class=\"typeIt\">\n\t\t\t\t\t<a href=\"#\" class=\"\" title=\"\u0412\u0432\u0435\u0434\u0438\u0442\u0435 \u044d\u0442\u043e\" aria-label=\"\u0412\u0432\u0435\u0434\u0438\u0442\u0435 \u044d\u0442\u043e\">\n\t\t\t\t\t\t<svg  viewBox=\"0 0 22 20\" class=\"frmsvg\">\n\t<title>keyboard<\/title>\n\t<path d=\"M20.6 2.5H2c-1 0-1.9.8-1.9 1.9v11.2c0 1 .8 1.9 1.9 1.9h18.7c1 0 1.9-.8 1.9-1.9V4.4c0-1-.8-1.9-1.9-1.9zm.3 13.1c0 .2-.1.3-.3.3H2a.3.3 0 0 1-.3-.3V4.4c0-.2.1-.3.3-.3h18.7c.2 0 .3.1.3.3v11.2zm-14.3-5V9.4c0-.3-.2-.5-.4-.5H5c-.3 0-.5.2-.5.5v1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0V9.4c0-.3-.2-.5-.5-.5H9c-.3 0-.5.2-.5.5v1c0 .3.2.5.4.5H10c.3 0 .5-.2.5-.5zm3.7 0V9.4c0-.3-.2-.5-.4-.5h-1.1c-.3 0-.5.2-.5.5v1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0V9.4c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.5v1c0 .3.2.5.4.5h1.1c.3 0 .5-.2.5-.5zM4.8 7.2v-1c0-.3-.2-.5-.5-.5H3.2c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm3.7 0v-1c0-.3-.2-.5-.5-.5H7c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0v-1c0-.3-.2-.5-.5-.5h-1.1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm3.7 0v-1c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0v-1c0-.3-.2-.5-.5-.5h-1.1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm-2 6.2V13c0-.3-.2-.5-.6-.5h-12c-.3 0-.6.2-.6.5v.6c0 .3.3.5.7.5h12c.3 0 .6-.2.6-.5z\"><\/path>\n<\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t<\/ul>\n\n\t\t<span class=\"frm-typed-drawline\"><\/span>\n\n\t\t<div class=\"typed\">\n\t\t\t<input type=\"text\" name=\"item_meta[92][typed]\" class=\"name\" id=\"field_tl7nv\" autocomplete=\"off\" value=\"\"  style=\"width:400px\" maxlength=\"150\" class=\"auto_width\" aria-invalid=\"false\"   \/>\n\t\t<\/div>\n\n\t\t<canvas class=\"pad\" data-fieldid=\"92\" data-fieldname=\"item_meta[92]\" width=\"396\" height=\"150\"><\/canvas>\n\t\t<div class=\"clearButton\"><a href=\"#clear\">\u041f\u0440\u043e\u0437\u0440\u0430\u0447\u043d\u044b\u0439<\/a><\/div>\n\n\t\t<input type=\"hidden\" name=\"item_meta[92][output]\" class=\"output\" value=\"\" \/>\n\t<\/div>\n<\/div>\n\r\n\t<div class=\"frm_description\" id=\"frm_desc_field_tl7nv\">\u041f\u043e\u0434\u043f\u0438\u0441\u044c \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430 (\u0438\u043b\u0438 \u0437\u0430\u043a\u043e\u043d\u043d\u043e\u0433\u043e \u043e\u043f\u0435\u043a\u0443\u043d\u0430)<\/div>\r\n\t\r\n<\/div>\n<div id=\"frm_field_6_container\" class=\"frm_form_field form-field \">\r\n\t<div class=\"frm_submit frm_flex\">\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">\u041f\u0440\u0435\u0434\u0441\u0442\u0430\u0432\u043b\u044f\u0442\u044c \u043d\u0430 \u0440\u0430\u0441\u0441\u043c\u043e\u0442\u0440\u0435\u043d\u0438\u0435<\/button>\r\n\r\n\r\n\r\n<\/div>\r\n<\/div>\n<input type=\"hidden\" name=\"item_meta[93]\" id=\"field_ny4vq\" value=\"\" data-frmval=\"\"\/>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t<style>.frm-abandonment-modal * {\n\tbox-sizing: border-box;\n}\n\n.frm-abandonment-modal {\n\tposition: fixed;\n\ttop: 0;\n\tright: 0;\n\tbottom: 0;\n\tleft: 0;\n\tz-index: 1000;\n\tdisplay: flex;\n\tflex-direction: column;\n\talign-items: center;\n\tvisibility: hidden;\n\toverflow: hidden;\n\topacity: 0;\n\t-webkit-overflow-scrolling: touch;\n}\n\n.frm-abandonment-modal .tingle-modal__close {\n\tdisplay: none;\n}\n\n.frm-abandonment-modal .tingle-modal-box {\n\tposition: relative;\n\tflex-shrink: 0;\n\tmargin-top: auto;\n\tmargin-bottom: auto;\n\tmax-width: 345px;\n\tbackground: #fff;\n\topacity: 1;\n\tcursor: auto;\n\tborder-radius: var(--border-radius);\n\twill-change: transform, opacity;\n\tpadding: 1.5rem;\n\tbox-shadow: 1px 1px 11px 2px rgba(0, 0, 0, 0.2);\n}\n\n.frm-abandonment-modal .tingle-modal-box__content h3{\n\tmargin-top: 0;\n}\n\na.frm-abandonment-close {\n\tposition: absolute;\n\ttop: 10px;\n\tright: 5%;\n\ttext-decoration: none;\n\tcolor: currentColor;\n\topacity: .8;\n\tfont-size: 30px;\n\tfont-weight: 300;\n\tline-height: 21px;\n}\n\n.frm-abandonment-btn-invisible {\n\topacity: 0;\n}\n\n.tingle-enabled {\n\tposition: fixed;\n\tright: 0;\n\tleft: 0;\n\toverflow: hidden;\n}\n\n.frm-abandonment-modal.tingle-modal--visible .tingle-modal-box__footer {\n\tbottom: 0;\n}\n\n.frm-abandonment-modal.tingle-modal--visible {\n\tvisibility: visible;\n\topacity: 1;\n\tbackground: rgba(0, 0, 0, 0.5);\n}\n\n.frm-abandonment-modal.tingle-modal--visible .tingle-modal-box {\n\tanimation: abdn-scale .2s cubic-bezier(.68, -.55, .265, 1.55) forwards;\n}\n\n.tingle-modal--overflow {\n\toverflow-y: scroll;\n\tpadding-top: 8px;\n}\n\n@keyframes abdn-scale {\n\t0% {\n\t\topacity: 0;\n\t\ttransform: scale(.9);\n\t}\n\t100% {\n\t\topacity: 1;\n\t\ttransform: scale(1);\n\t}\n}<\/style><input type=\"hidden\" name=\"auto_save\" value=\"20000\"\/><input name=\"frm_state\" type=\"hidden\" value=\"505xh7OciK\/9aWYxohyEd2kBse2nIAmaqEQme9SfyyQ=\" \/><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n<script>\nvar frmSigs=[{\"bgColour\":\"rgba(0,0,0,0)\",\"id\":\"92\",\"width\":\"400\",\"height\":\"150\",\"line_top\":105.5,\"line_margin\":20,\"line_color\":\"#D0D5DD\",\"line_width\":1,\"default_tab\":\"drawIt\",\"bg_color\":\"#ffffff\",\"text_color\":\"#1D2939\",\"border_color\":\"#D0D5DD\"}];\nif(typeof __FRMSIG === 'undefined'){__FRMSIG=frmSigs;}else{__FRMSIG=jQuery.extend(__FRMSIG,frmSigs);}\n<\/script>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>\u0412\u043e\u043f\u0440\u043e\u0441\u043d\u0438\u043a \u041c\u0415\u0414\u0418\u0426\u0418\u041d\u0421\u041a\u0410\u042f \u0418 \u0421\u0422\u041e\u041c\u0410\u0422\u041e\u041b\u041e\u0413\u0418\u0427\u0415\u0421\u041a\u0410\u042f \u0418\u0421\u0422\u041e\u0420\u0418\u042f Questionnaire Mrs Miss Mr Last Name First Name ZIP code Location Street Number Profession Date of Birth Social Security Number Security Company Complementary Insurance GSM Home Phone Office Phone Email address How did you find the office ? (internet, Doctena, friends\u2026) MEDICAL HISTORY Your doctor\u2019s last name, address and phone [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-6999","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>\u041c\u0415\u0414\u0418\u0426\u0418\u041d\u0421\u041a\u0410\u042f \u0418 \u0421\u0422\u041e\u041c\u0410\u0422\u041e\u041b\u041e\u0413\u0418\u0427\u0415\u0421\u041a\u0410\u042f \u0418\u0421\u0422\u041e\u0420\u0418\u042f - Talpa<\/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:\/\/talpadent.lu\/ru\/medical-and-dental-history\/\" \/>\n<meta property=\"og:locale\" content=\"ru_RU\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"\u041c\u0415\u0414\u0418\u0426\u0418\u041d\u0421\u041a\u0410\u042f \u0418 \u0421\u0422\u041e\u041c\u0410\u0422\u041e\u041b\u041e\u0413\u0418\u0427\u0415\u0421\u041a\u0410\u042f \u0418\u0421\u0422\u041e\u0420\u0418\u042f - Talpa\" \/>\n<meta property=\"og:description\" content=\"\u0412\u043e\u043f\u0440\u043e\u0441\u043d\u0438\u043a \u041c\u0415\u0414\u0418\u0426\u0418\u041d\u0421\u041a\u0410\u042f \u0418 \u0421\u0422\u041e\u041c\u0410\u0422\u041e\u041b\u041e\u0413\u0418\u0427\u0415\u0421\u041a\u0410\u042f \u0418\u0421\u0422\u041e\u0420\u0418\u042f Questionnaire Mrs Miss Mr Last Name First Name ZIP code Location Street Number Profession Date of Birth Social Security Number Security Company Complementary Insurance GSM Home Phone Office Phone Email address How did you find the office ? (internet, Doctena, friends\u2026) MEDICAL HISTORY Your doctor\u2019s last name, address and phone [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/talpadent.lu\/ru\/medical-and-dental-history\/\" \/>\n<meta property=\"og:site_name\" content=\"Talpa\" \/>\n<meta property=\"article:modified_time\" content=\"2026-05-29T12:44:50+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"\u041f\u0440\u0438\u043c\u0435\u0440\u043d\u043e\u0435 \u0432\u0440\u0435\u043c\u044f \u0434\u043b\u044f \u0447\u0442\u0435\u043d\u0438\u044f\" \/>\n\t<meta name=\"twitter:data1\" content=\"4 \u043c\u0438\u043d\u0443\u0442\u044b\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/talpadent.lu\\\/ru\\\/medical-and-dental-history\\\/\",\"url\":\"https:\\\/\\\/talpadent.lu\\\/ru\\\/medical-and-dental-history\\\/\",\"name\":\"\u041c\u0415\u0414\u0418\u0426\u0418\u041d\u0421\u041a\u0410\u042f \u0418 \u0421\u0422\u041e\u041c\u0410\u0422\u041e\u041b\u041e\u0413\u0418\u0427\u0415\u0421\u041a\u0410\u042f \u0418\u0421\u0422\u041e\u0420\u0418\u042f - Talpa\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/talpadent.lu\\\/ru\\\/#website\"},\"datePublished\":\"2026-05-23T13:20:35+00:00\",\"dateModified\":\"2026-05-29T12:44:50+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/talpadent.lu\\\/ru\\\/medical-and-dental-history\\\/#breadcrumb\"},\"inLanguage\":\"ru-RU\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/talpadent.lu\\\/ru\\\/medical-and-dental-history\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/talpadent.lu\\\/ru\\\/medical-and-dental-history\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"\u0413\u043b\u0430\u0432\u043d\u0430\u044f\",\"item\":\"https:\\\/\\\/talpadent.lu\\\/ru\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"\u041c\u0415\u0414\u0418\u0426\u0418\u041d\u0421\u041a\u0410\u042f \u0418 \u0421\u0422\u041e\u041c\u0410\u0422\u041e\u041b\u041e\u0413\u0418\u0427\u0415\u0421\u041a\u0410\u042f \u0418\u0421\u0422\u041e\u0420\u0418\u042f\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/talpadent.lu\\\/ru\\\/#website\",\"url\":\"https:\\\/\\\/talpadent.lu\\\/ru\\\/\",\"name\":\"Talpa\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\\\/\\\/talpadent.lu\\\/ru\\\/#\\\/schema\\\/person\\\/8243d213f72d21b76a4edefd9db9aa2a\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/talpadent.lu\\\/ru\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"ru-RU\"},{\"@type\":[\"Person\",\"Organization\"],\"@id\":\"https:\\\/\\\/talpadent.lu\\\/ru\\\/#\\\/schema\\\/person\\\/8243d213f72d21b76a4edefd9db9aa2a\",\"name\":\"admin\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"ru-RU\",\"@id\":\"https:\\\/\\\/talpadent.lu\\\/wp-content\\\/uploads\\\/2023\\\/04\\\/Logo_Talpadent.lu-1-e1771352825857.png\",\"url\":\"https:\\\/\\\/talpadent.lu\\\/wp-content\\\/uploads\\\/2023\\\/04\\\/Logo_Talpadent.lu-1-e1771352825857.png\",\"contentUrl\":\"https:\\\/\\\/talpadent.lu\\\/wp-content\\\/uploads\\\/2023\\\/04\\\/Logo_Talpadent.lu-1-e1771352825857.png\",\"width\":800,\"height\":600,\"caption\":\"admin\"},\"logo\":{\"@id\":\"https:\\\/\\\/talpadent.lu\\\/wp-content\\\/uploads\\\/2023\\\/04\\\/Logo_Talpadent.lu-1-e1771352825857.png\"},\"sameAs\":[\"https:\\\/\\\/talpadent.lu\"]}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"\u041c\u0415\u0414\u0418\u0426\u0418\u041d\u0421\u041a\u0410\u042f \u0418 \u0421\u0422\u041e\u041c\u0410\u0422\u041e\u041b\u041e\u0413\u0418\u0427\u0415\u0421\u041a\u0410\u042f \u0418\u0421\u0422\u041e\u0420\u0418\u042f - Talpa","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/talpadent.lu\/ru\/medical-and-dental-history\/","og_locale":"ru_RU","og_type":"article","og_title":"\u041c\u0415\u0414\u0418\u0426\u0418\u041d\u0421\u041a\u0410\u042f \u0418 \u0421\u0422\u041e\u041c\u0410\u0422\u041e\u041b\u041e\u0413\u0418\u0427\u0415\u0421\u041a\u0410\u042f \u0418\u0421\u0422\u041e\u0420\u0418\u042f - Talpa","og_description":"\u0412\u043e\u043f\u0440\u043e\u0441\u043d\u0438\u043a \u041c\u0415\u0414\u0418\u0426\u0418\u041d\u0421\u041a\u0410\u042f \u0418 \u0421\u0422\u041e\u041c\u0410\u0422\u041e\u041b\u041e\u0413\u0418\u0427\u0415\u0421\u041a\u0410\u042f \u0418\u0421\u0422\u041e\u0420\u0418\u042f Questionnaire Mrs Miss Mr Last Name First Name ZIP code Location Street Number Profession Date of Birth Social Security Number Security Company Complementary Insurance GSM Home Phone Office Phone Email address How did you find the office ? (internet, Doctena, friends\u2026) MEDICAL HISTORY Your doctor\u2019s last name, address and phone [&hellip;]","og_url":"https:\/\/talpadent.lu\/ru\/medical-and-dental-history\/","og_site_name":"Talpa","article_modified_time":"2026-05-29T12:44:50+00:00","twitter_card":"summary_large_image","twitter_misc":{"\u041f\u0440\u0438\u043c\u0435\u0440\u043d\u043e\u0435 \u0432\u0440\u0435\u043c\u044f \u0434\u043b\u044f \u0447\u0442\u0435\u043d\u0438\u044f":"4 \u043c\u0438\u043d\u0443\u0442\u044b"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/talpadent.lu\/ru\/medical-and-dental-history\/","url":"https:\/\/talpadent.lu\/ru\/medical-and-dental-history\/","name":"\u041c\u0415\u0414\u0418\u0426\u0418\u041d\u0421\u041a\u0410\u042f \u0418 \u0421\u0422\u041e\u041c\u0410\u0422\u041e\u041b\u041e\u0413\u0418\u0427\u0415\u0421\u041a\u0410\u042f \u0418\u0421\u0422\u041e\u0420\u0418\u042f - Talpa","isPartOf":{"@id":"https:\/\/talpadent.lu\/ru\/#website"},"datePublished":"2026-05-23T13:20:35+00:00","dateModified":"2026-05-29T12:44:50+00:00","breadcrumb":{"@id":"https:\/\/talpadent.lu\/ru\/medical-and-dental-history\/#breadcrumb"},"inLanguage":"ru-RU","potentialAction":[{"@type":"ReadAction","target":["https:\/\/talpadent.lu\/ru\/medical-and-dental-history\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/talpadent.lu\/ru\/medical-and-dental-history\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"\u0413\u043b\u0430\u0432\u043d\u0430\u044f","item":"https:\/\/talpadent.lu\/ru\/"},{"@type":"ListItem","position":2,"name":"\u041c\u0415\u0414\u0418\u0426\u0418\u041d\u0421\u041a\u0410\u042f \u0418 \u0421\u0422\u041e\u041c\u0410\u0422\u041e\u041b\u041e\u0413\u0418\u0427\u0415\u0421\u041a\u0410\u042f \u0418\u0421\u0422\u041e\u0420\u0418\u042f"}]},{"@type":"WebSite","@id":"https:\/\/talpadent.lu\/ru\/#website","url":"https:\/\/talpadent.lu\/ru\/","name":"Talpa","description":"","publisher":{"@id":"https:\/\/talpadent.lu\/ru\/#\/schema\/person\/8243d213f72d21b76a4edefd9db9aa2a"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/talpadent.lu\/ru\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"ru-RU"},{"@type":["Person","Organization"],"@id":"https:\/\/talpadent.lu\/ru\/#\/schema\/person\/8243d213f72d21b76a4edefd9db9aa2a","name":"admin","image":{"@type":"ImageObject","inLanguage":"ru-RU","@id":"https:\/\/talpadent.lu\/wp-content\/uploads\/2023\/04\/Logo_Talpadent.lu-1-e1771352825857.png","url":"https:\/\/talpadent.lu\/wp-content\/uploads\/2023\/04\/Logo_Talpadent.lu-1-e1771352825857.png","contentUrl":"https:\/\/talpadent.lu\/wp-content\/uploads\/2023\/04\/Logo_Talpadent.lu-1-e1771352825857.png","width":800,"height":600,"caption":"admin"},"logo":{"@id":"https:\/\/talpadent.lu\/wp-content\/uploads\/2023\/04\/Logo_Talpadent.lu-1-e1771352825857.png"},"sameAs":["https:\/\/talpadent.lu"]}]}},"_links":{"self":[{"href":"https:\/\/talpadent.lu\/ru\/wp-json\/wp\/v2\/pages\/6999","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/talpadent.lu\/ru\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/talpadent.lu\/ru\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/talpadent.lu\/ru\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/talpadent.lu\/ru\/wp-json\/wp\/v2\/comments?post=6999"}],"version-history":[{"count":2,"href":"https:\/\/talpadent.lu\/ru\/wp-json\/wp\/v2\/pages\/6999\/revisions"}],"predecessor-version":[{"id":7008,"href":"https:\/\/talpadent.lu\/ru\/wp-json\/wp\/v2\/pages\/6999\/revisions\/7008"}],"wp:attachment":[{"href":"https:\/\/talpadent.lu\/ru\/wp-json\/wp\/v2\/media?parent=6999"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}