{"id":2990,"date":"2025-10-23T11:35:09","date_gmt":"2025-10-23T11:35:09","guid":{"rendered":"https:\/\/www.jamjoompharma.com\/%d9%86%d9%85%d9%88%d8%b0%d8%ac-%d8%a7%d9%84%d8%a5%d8%a8%d9%84%d8%a7%d8%ba-%d8%b9%d9%86-%d8%a7%d9%84%d8%a2%d8%ab%d8%a7%d8%b1-%d8%a7%d9%84%d8%ac%d8%a7%d9%86%d8%a8%d9%8a%d8%a9-%d9%84%d9%84%d8%a3%d8%af\/"},"modified":"2025-11-19T13:54:12","modified_gmt":"2025-11-19T13:54:12","slug":"%d9%86%d9%85%d9%88%d8%b0%d8%ac-%d8%a7%d9%84%d8%a5%d8%a8%d9%84%d8%a7%d8%ba-%d8%b9%d9%86-%d8%a7%d9%84%d8%a2%d8%ab%d8%a7%d8%b1-%d8%a7%d9%84%d8%ac%d8%a7%d9%86%d8%a8%d9%8a%d8%a9-%d9%84%d9%84%d8%a3%d8%af","status":"publish","type":"page","link":"https:\/\/www.jamjoompharma.com\/ar\/%d9%86%d9%85%d9%88%d8%b0%d8%ac-%d8%a7%d9%84%d8%a5%d8%a8%d9%84%d8%a7%d8%ba-%d8%b9%d9%86-%d8%a7%d9%84%d8%a2%d8%ab%d8%a7%d8%b1-%d8%a7%d9%84%d8%ac%d8%a7%d9%86%d8%a8%d9%8a%d8%a9-%d9%84%d9%84%d8%a3%d8%af\/","title":{"rendered":"\u0646\u0645\u0648\u0630\u062c \u0627\u0644\u0625\u0628\u0644\u0627\u063a \u0639\u0646 \u0627\u0644\u0622\u062b\u0627\u0631 \u0627\u0644\u062c\u0627\u0646\u0628\u064a\u0629 \u0644\u0644\u0623\u062f\u0648\u064a\u0629"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column]<div id=\"ultimate-heading-945969dbd7ac2793f\" class=\"uvc-heading ult-adjust-bottom-margin ultimate-heading-945969dbd7ac2793f uvc-8699  uvc-heading-default-font-sizes\" data-hspacer=\"no_spacer\"  data-halign=\"center\" style=\"text-align:center\"><div class=\"uvc-heading-spacer no_spacer\" style=\"top\"><\/div><div class=\"uvc-main-heading ult-responsive\"  data-ultimate-target='.uvc-heading.ultimate-heading-945969dbd7ac2793f h2'  data-responsive-json-new='{\"font-size\":\"\",\"line-height\":\"\"}' ><h2 style=\"font-weight:bold;margin-bottom:0.5em;\">\u0646\u0645\u0648\u0630\u062c \u0627\u0644\u0625\u0628\u0644\u0627\u063a \u0639\u0646 \u0627\u0644\u0622\u062b\u0627\u0631\/\u0627\u0644\u0623\u0639\u0631\u0627\u0636 \u0627\u0644\u062c\u0627\u0646\u0628\u064a\u0629 \u0644\u0644\u0623\u062f\u0648\u064a\u0629<\/h2><\/div><div class=\"uvc-sub-heading ult-responsive\"  data-ultimate-target='.uvc-heading.ultimate-heading-945969dbd7ac2793f .uvc-sub-heading '  data-responsive-json-new='{\"font-size\":\"\",\"line-height\":\"\"}'  style=\"font-weight:normal;color:#30318C;margin-bottom:1.5em;\"><strong>\u0642\u0645 \u0628\u0627\u0644\u0625\u0628\u0644\u0627\u063a \u062d\u062a\u0649 \u0644\u0648 \u0644\u0645 \u062a\u0643\u0646 \u0645\u062a\u0623\u0643\u062f\u064b\u0627 \u0645\u0646 \u0623\u0646 \u0627\u0644\u0645\u0646\u062a\u062c \u062a\u0633\u0628\u0628 \u0641\u064a \u0631\u062f \u0638\u0647\u0648\u0631 \u0627\u0644\u0639\u0631\u0636 \u0627\u0644\u062c\u0627\u0646\u0628\u064a.<\/strong><\/div><\/div>[vc_column_text css=&#8221;&#8221;]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f2989-o1\" lang=\"ar\" dir=\"rtl\" data-wpcf7-id=\"2989\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/ar\/wp-json\/wp\/v2\/pages\/2990#wpcf7-f2989-o1\" method=\"post\" class=\"wpcf7-form init cf7mls-no-scroll cf7mls-auto-return-first-step cf7mls-no-moving-animation\" aria-label=\"\u0646\u0645\u0648\u0630\u062c \u0627\u0644\u0627\u062a\u0635\u0627\u0644\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"2989\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.4\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"ar\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f2989-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"fieldset-cf7mls-wrapper\" data-transition-effects><fieldset class=\"fieldset-cf7mls cf7mls_current_fs\"><style>\n .vc_row {\n display: flex;\n }\n\n .become-form .vc_row .vc_col-sm-3,\n .become-form .vc_row .vc_col-sm-4,\n .become-form .vc_row .vc_col-sm-5,\n .become-form .vc_row .vc_col-sm-6,\n .become-form .vc_row .vc_col-sm-7,\n .become-form .vc_row .vc_col-sm-12 {\n margin-bottom: 25px;\n }\n\n .become-form label {\n width: 100%;\n }\n<\/style>\n<div class=\"become-form\">\n\n <!-- 1. PARTICULARS OF PATIENT BEGIN -->\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-12 heading-form\">\n\t\t\t<h4>\u0628\u064a\u0627\u0646\u0627\u062a \u0627\u0644\u0645\u0631\u064a\u0636\n\t\t\t<\/h4>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-3\">\n\t\t\t<p><label for=\"patient-initials\">\u0627\u0644\u0623\u062d\u0631\u0641 \u0627\u0644\u0623\u0648\u0644\u0649 \u0645\u0646 \u0627\u0633\u0645 \u0627\u0644\u0645\u0631\u064a\u0636*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"patient-initials\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"patient-initials\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-3\">\n\t\t\t<p><label for=\"country\">\u0627\u0644\u062f\u0648\u0644\u0629*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"country\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"country\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-2\">\n\t\t\t<p><label for=\"date-of-birth\">\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0645\u064a\u0644\u0627\u062f*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"date-of-birth\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-of-birth\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-2\">\n\t\t\t<p><label for=\"age-by-year\">\u0627\u0644\u0639\u0645\u0631 \u0628\u0627\u0644\u0633\u0646\u0648\u0627\u062a*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"age-by-year\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"5 \u0633\u0646\u0648\u0627\u062a\" type=\"text\" name=\"age-by-year\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-2\">\n\t\t\t<p><label for=\"age-by-month\">\u0627\u0644\u0639\u0645\u0631 \u0628\u0627\u0644\u0623\u0634\u0647\u0631*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"age-by-month\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"8 \u0623\u0634\u0647\u0631\" type=\"text\" name=\"age-by-month\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-3\">\n\t\t\t<p><label for=\"weight\">\u0627\u0644\u0648\u0632\u0646 (\u0643\u062c\u0645)<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"weight\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"weight\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-3\">\n\t\t\t<p><label for=\"height\">\u0627\u0644\u0637\u0648\u0644 (\u0633\u0645)<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"height\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"height\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-3\">\n\t\t\t<p><label for=\"patient-address\">\u0639\u0646\u0648\u0627\u0646 \u0627\u0644\u0645\u0631\u064a\u0636<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"patient-address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"patient-address\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-3 selector-form\">\n\t\t\t<p><label for=\"sex\">\u0627\u0644\u062c\u0646\u0633*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"sex\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"sex\"><option value=\"\u0630\u0643\u0631\">\u0630\u0643\u0631<\/option><option value=\"\u0623\u0646\u062b\u0649\">\u0623\u0646\u062b\u0649<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-3 selector-form\">\n\t\t\t<p><label for=\"pregnant\">\u0647\u0644 \u0627\u0644\u0645\u0631\u064a\u0636\u0629 \u062d\u0627\u0645\u0644\u061f*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"pregnant\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"pregnant\"><option value=\"\u0646\u0639\u0645\">\u0646\u0639\u0645<\/option><option value=\"\u0644\u0627\">\u0644\u0627<\/option><option value=\"\u0644\u0627 \u064a\u0646\u0637\u0628\u0642\">\u0644\u0627 \u064a\u0646\u0637\u0628\u0642<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-3\">\n\t\t\t<p><label for=\"pregnancy-week\">\u0623\u0633\u0628\u0648\u0639 \u0627\u0644\u062d\u0645\u0644<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"pregnancy-week\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"pregnancy-week\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\n <!-- 1. PARTICULARS OF PATIENT END -->\n\n <!-- EMPTY SPACE BEGIN -->\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_empty_space empty-space-form\">\n\t\t<\/div>\n\t<\/div>\n <!-- EMPTY SPACE END -->\n\n <!-- 2. ADVERSE EVENT BEGIN -->\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-12 heading-form\">\n\t\t\t<h4>\u0627\u0644\u062d\u062f\u062b \u0627\u0644\u0639\u0631\u0636 \u0627\u0644\u062c\u0627\u0646\u0628\u064a\n\t\t\t<\/h4>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-3\">\n\t\t\t<p><label for=\"reaction-start-date\">\u062a\u0627\u0631\u064a\u062e \u0628\u062f\u0621 \u0638\u0647\u0648\u0631 \u0627\u0644\u0639\u0631\u0636 \u0627\u0644\u062c\u0627\u0646\u0628\u064a<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"reaction-start-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"reaction-start-date\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-3\">\n\t\t\t<p><label for=\"recovery-date\">\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u062a\u0639\u0627\u0641\u064a<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"recovery-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"recovery-date\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-6 textarea-form\">\n\t\t\t<p><label for=\"reaction-description\">\u0648\u0635\u0641 \u0627\u0644\u0639\u0631\u0636 \u0627\u0644\u062c\u0627\u0646\u0628\u064a*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"reaction-description\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"reaction-description\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\n <!-- 2. ADVERSE EVENT END -->\n\n <!-- EMPTY SPACE BEGIN -->\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_empty_space empty-space-form\">\n\t\t<\/div>\n\t<\/div>\n <!-- EMPTY SPACE END -->\n\n <!-- 3. SERIOUSNESS OF THE REACTION & 4. OUTCOME OF THE REACTION BEGIN -->\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-6 heading-form\">\n\t\t\t<h4>\u0645\u062f\u0649 \u062e\u0637\u0648\u0631\u0647 \u0627\u0644\u0639\u0631\u0636 \u0627\u0644\u062c\u0627\u0646\u0649\n\t\t\t<\/h4>\n\t\t\t<div class=\"vc_col-sm-12 flex-form\">\n\t\t\t\t<p style=\"margin-bottom: 8px;\">\u062d\u062f\u062f \u0645\u062f\u0649 \u062e\u0637\u0648\u0631\u0647 \u0627\u0644\u0639\u0631\u0636 \u0627\u0644\u062c\u0627\u0646\u0649 (\u0644\u0644\u0645\u0645\u0627\u0631\u0633 \u0627\u0644\u0635\u062d\u064a):\n\t\t\t\t<\/p>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"seriousness\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"seriousness[]\" value=\"\u0645\u0647\u062f\u062f \u0644\u0644\u062d\u064a\u0627\u0629\" \/><span class=\"wpcf7-list-item-label\">\u0645\u0647\u062f\u062f \u0644\u0644\u062d\u064a\u0627\u0629<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"seriousness[]\" value=\"\u0648\u0641\u0627\u0629\" \/><span class=\"wpcf7-list-item-label\">\u0648\u0641\u0627\u0629<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"seriousness[]\" value=\"\u062a\u0634\u0648\u0651\u0647 \u062e\u0644\u0642\u064a\" \/><span class=\"wpcf7-list-item-label\">\u062a\u0634\u0648\u0651\u0647 \u062e\u0644\u0642\u064a<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"seriousness[]\" value=\"\u064a\u062a\u0637\u0644\u0628 \u0623\u0648 \u064a\u0637\u064a\u0644 \u0645\u062f\u0629 \u0627\u0644\u0625\u0642\u0627\u0645\u0629 \u0641\u064a \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649\" \/><span class=\"wpcf7-list-item-label\">\u064a\u062a\u0637\u0644\u0628 \u0623\u0648 \u064a\u0637\u064a\u0644 \u0645\u062f\u0629 \u0627\u0644\u0625\u0642\u0627\u0645\u0629 \u0641\u064a \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"seriousness[]\" value=\"\u0625\u0639\u0627\u0642\u0629 \u062f\u0627\u0626\u0645\u0629 \u0623\u0648 \u0645\u0633\u062a\u0645\u0631\u0629\" \/><span class=\"wpcf7-list-item-label\">\u0625\u0639\u0627\u0642\u0629 \u062f\u0627\u0626\u0645\u0629 \u0623\u0648 \u0645\u0633\u062a\u0645\u0631\u0629<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"seriousness[]\" value=\"\u062d\u0627\u0644\u0629 \u0637\u0628\u064a\u0629 \u062e\u0637\u064a\u0631\u0629 \u0623\u062e\u0631\u0649\" \/><span class=\"wpcf7-list-item-label\">\u062d\u0627\u0644\u0629 \u0637\u0628\u064a\u0629 \u062e\u0637\u064a\u0631\u0629 \u0623\u062e\u0631\u0649<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<div class=\"vc_col-sm-12 textarea-form\">\n\t\t\t\t\t<p><label for=\"seriousness-other\">\u0625\u0630\u0627 \u0643\u0627\u0646 \"\u0623\u062e\u0631\u0649\"\u060c \u064a\u0631\u062c\u0649 \u0627\u0644\u062a\u062d\u062f\u064a\u062f<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"seriousness-other\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" id=\"seriousness-other\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"seriousness-other\" \/><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-6 heading-form\">\n\t\t\t<h4>\u062d\u0627\u0644\u0647 \u0627\u0644\u0645\u0631\u064a\u0636 (\u0627\u0644\u0645\u0633\u062a\u062e\u062f\u0645)\n\t\t\t<\/h4>\n\t\t\t<div class=\"vc_col-sm-12 flex-form\">\n\t\t\t\t<p style=\"margin-bottom: 8px;\">\n\t\t\t\t<\/p>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"outcome\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"outcome[]\" value=\"\u0648\u0641\u0627\u0629\" \/><span class=\"wpcf7-list-item-label\">\u0648\u0641\u0627\u0629<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"outcome[]\" value=\"\u0641\u064a \u0637\u0648\u0631 \u0627\u0644\u062a\u0639\u0627\u0641\u064a\" \/><span class=\"wpcf7-list-item-label\">\u0641\u064a \u0637\u0648\u0631 \u0627\u0644\u062a\u0639\u0627\u0641\u064a<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"outcome[]\" value=\"\u0645\u062a\u0639\u0627\u0641\u064d \u062a\u0645\u0627\u0645\u064b\u0627\" \/><span class=\"wpcf7-list-item-label\">\u0645\u062a\u0639\u0627\u0641\u064d \u062a\u0645\u0627\u0645\u064b\u0627<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"outcome[]\" value=\"\u0645\u0633\u062a\u0645\u0631\" \/><span class=\"wpcf7-list-item-label\">\u0645\u0633\u062a\u0645\u0631<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"outcome[]\" value=\"\u063a\u064a\u0631 \u0645\u0639\u0631\u0648\u0641\" \/><span class=\"wpcf7-list-item-label\">\u063a\u064a\u0631 \u0645\u0639\u0631\u0648\u0641<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"outcome[]\" value=\"\u0623\u062e\u0631\u0649 (\u062d\u062f\u062f \u0623\u062f\u0646\u0627\u0647)\" \/><span class=\"wpcf7-list-item-label\">\u0623\u062e\u0631\u0649 (\u062d\u062f\u062f \u0623\u062f\u0646\u0627\u0647)<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<div class=\"vc_col-sm-12 textarea-form\">\n\t\t\t\t\t<p><label for=\"outcome-other\">\u0625\u0630\u0627 \u0643\u0627\u0646 \"\u0623\u062e\u0631\u0649\"\u060c \u064a\u0631\u062c\u0649 \u0627\u0644\u062a\u062d\u062f\u064a\u062f<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"outcome-other\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" id=\"outcome-other\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"outcome-other\" \/><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n <!-- 3. SERIOUSNESS OF THE REACTION & 4. OUTCOME OF THE REACTION END -->\n<\/div>\n<div class=\"cf7mls-btns \"><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-1\">\u0627\u0644\u062a\u0627\u0644\u064a<img decoding=\"async\" src=\"https:\/\/www.jamjoompharma.com\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/www.jamjoompharma.com\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\" \/><\/button><\/div><p><\/p><\/fieldset><fieldset class=\"fieldset-cf7mls\">\n<\/p>\n<div class=\"become-form\">\n <!-- 5. SUSPECTED MEDICATIONS BEGIN -->\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-12 heading-form\">\n\t\t\t<h4>\u0627\u0644\u0623\u062f\u0648\u064a\u0629 \u0623\u0648 \u0627\u0644\u0645\u0633\u062a\u062d\u0636\u0631\u0627\u062a \u0627\u0644\u0645\u0634\u062a\u0628\u0647 \u0628\u0647\u0627*\n\t\t\t<\/h4>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-3\">\n\t\t\t<p><label for=\"brand-name\">\u0627\u0644\u0627\u0633\u0645 \u0627\u0644\u062a\u062c\u0627\u0631\u064a (\u0645\u0646\u062a\u062c \u062c\u0645\u062c\u0648\u0645 \u0641\u0627\u0631\u0645\u0627 \u0641\u0642\u0637)*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"brand-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"brand-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-3\">\n\t\t\t<p><label for=\"generic-name\">\u0627\u0644\u0627\u0633\u0645 \u0627\u0644\u0639\u0644\u0645\u064a<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"generic-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"generic-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-3\">\n\t\t\t<p><label for=\"manufacturer\">\u0627\u0644\u0634\u0631\u0643\u0629 \u0627\u0644\u0645\u0635\u0646\u0639\u0629<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"manufacturer\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"manufacturer\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-3\">\n\t\t\t<p><label for=\"batch-no\">\u0631\u0642\u0645 \u0627\u0644\u062a\u0634\u063a\u064a\u0644\u0629<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"batch-no\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"batch-no\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-3\">\n\t\t\t<p><label for=\"strength\">\u0627\u0644\u062a\u0631\u0643\u064a\u0632*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"strength\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"strength\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-3\">\n\t\t\t<p><label for=\"dose\">\u0627\u0644\u062c\u0631\u0639\u0629 (\u0643\u0645\u064a\u0629 \u0627\u0644\u062f\u0648\u0627\u0621 \u0627\u0644\u0645\u0633\u062a\u062e\u062f\u0645\u0629)*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"dose\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"dose\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-3\">\n\t\t\t<p><label for=\"route\">\u0637\u0631\u064a\u0642\u0629 \u0627\u0644\u062a\u0639\u0627\u0637\u0649 (\u0639\u0646 \u0637\u0631\u064a\u0642 \u0627\u0644\u0641\u0645, \u0627\u0644\u062c\u0644\u062f, \u0627\u0644\u0639\u064a\u0646... \u0627\u0644\u062e)*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"route\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"route\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-3\">\n\t\t\t<p><label for=\"dosage-form\">\u0634\u0643\u0644 \u0627\u0644\u062c\u0631\u0639\u0629 (\u0642\u0631\u0635, \u0643\u0628\u0633\u0648\u0644\u0629, \u0643\u0631\u064a\u0645.. \u0627\u0644\u062e)*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"dosage-form\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"dosage-form\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-3\">\n\t\t\t<p><label for=\"purpose\">\u0627\u0644\u063a\u0631\u0636 \u0645\u0646 \u0627\u0644\u0627\u0633\u062a\u062e\u062f\u0627\u0645 (\u0627\u0644\u062f\u0644\u0627\u0644\u0629)<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"purpose\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"purpose\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-3\">\n\t\t\t<p><label for=\"duration\">\u0645\u062f\u0629 \u0627\u0644\u0639\u0644\u0627\u062c<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"duration\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"duration\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-3\">\n\t\t\t<p><label for=\"de-challenge\">\u0647\u0644 \u062a\u0645 \u0625\u064a\u0642\u0627\u0641 \u0627\u0644\u062f\u0648\u0627\u0621 \u0623\u0648 \u062a\u0642\u0644\u064a\u0644 \u0627\u0644\u062c\u0631\u0639\u0629\u061f<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"de-challenge\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"de-challenge\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-6 selector-form\">\n\t\t\t<p><label for=\"reaction-stopped\">\u0647\u0644 \u062a\u0648\u0642\u0641 \u0627\u0644\u0639\u0631\u0636 \u0627\u0644\u062c\u0627\u0646\u0628\u064a \u0628\u0639\u062f \u0625\u064a\u0642\u0627\u0641 \u0627\u0644\u062f\u0648\u0627\u0621\u061f<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"reaction-stopped\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"reaction-stopped\"><option value=\"\u0646\u0639\u0645\">\u0646\u0639\u0645<\/option><option value=\"\u0644\u0627\">\u0644\u0627<\/option><option value=\"\u063a\u064a\u0631 \u0645\u0637\u0628\u0642\">\u063a\u064a\u0631 \u0645\u0637\u0628\u0642<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-6 selector-form\">\n\t\t\t<p><label for=\"reaction-reappeared\">\u0647\u0644 \u0639\u0627\u062f \u0627\u0644\u0639\u0631\u0636 \u0627\u0644\u062c\u0627\u0646\u0628\u064a \u0628\u0639\u062f \u0625\u0639\u0627\u062f\u0629 \u0625\u0639\u0637\u0627\u0621 \u0627\u0644\u062f\u0648\u0627\u0621\u061f<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"reaction-reappeared\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"reaction-reappeared\"><option value=\"\u0646\u0639\u0645\">\u0646\u0639\u0645<\/option><option value=\"\u0644\u0627\">\u0644\u0627<\/option><option value=\"\u063a\u064a\u0631 \u0645\u0637\u0628\u0642\">\u063a\u064a\u0631 \u0645\u0637\u0628\u0642<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n <!-- 5. SUSPECTED MEDICATIONS END -->\n\n <!-- EMPTY SPACE BEGIN -->\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_empty_space empty-space-form\">\n\t\t<\/div>\n\t<\/div>\n <!-- EMPTY SPACE END -->\n\n <!-- 6. CONCOMITANT MEDICATIONS BEGIN -->\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-12 heading-form\">\n\t\t\t<h4>\u0627\u0644\u0623\u062f\u0648\u064a\u0629 \u0627\u0644\u0645\u0635\u0627\u062d\u0628\u0629 (\u063a\u064a\u0631 \u0627\u0644\u0623\u062f\u0648\u064a\u0629 \u0627\u0644\u0645\u0634\u062a\u0628\u0647 \u0628\u0647\u0627)\n\t\t\t<\/h4>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-12 textarea-form\">\n\t\t\t<p><label for=\"concomitant-medications\">\u0645\u0646\u062a\u062c\u0627\u062a \u0637\u0628\u064a\u0629 \u0623\u0648 \u0641\u064a\u062a\u0627\u0645\u064a\u0646\u0627\u062a \u0623\u0648 \u0623\u062f\u0648\u064a\u0629 \u0639\u0634\u0628\u064a\u0629 \u0627\u0644\u0645\u0633\u062a\u062e\u062f\u0645\u0629 \u062e\u0644\u0627\u0644 \u0641\u062a\u0631\u0629 \u0623\u0633\u062a\u062e\u062f\u0627\u0645 \u0627\u0644\u062f\u0648\u0627\u0621\/\u0627\u0644\u0645\u0633\u062a\u062d\u0636\u0631*:<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"concomitant-medications\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"concomitant-medications\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\n <!-- 6. CONCOMITANT MEDICATIONS END -->\n\n <!-- EMPTY SPACE BEGIN -->\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_empty_space empty-space-form\">\n\t\t<\/div>\n\t<\/div>\n <!-- EMPTY SPACE END -->\n\n <!-- 7. MEDICAL HISTORY BEGIN -->\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-12 heading-form\">\n\t\t\t<h4>\u0627\u0644\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0637\u0628\u064a\n\t\t\t<\/h4>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_row\" style=\"display: block;\">\n\t\t<div class=\"vc_col-sm-12 textarea-form\">\n\t\t\t<p><label for=\"medical-history\">\u062a\u0627\u0631\u064a\u062e \u0645\u0631\u0636\u064a \u0630\u064a \u0635\u0644\u0629 \u0628\u0645\u0627 \u0641\u064a \u0630\u0644\u0643 \u0627\u0644\u062d\u0627\u0644\u0627\u062a \u0627\u0644\u0637\u0628\u064a\u0629 \u0627\u0644\u0645\u0648\u062c\u0648\u062f\u0629 \u0645\u0633\u0628\u0642\u064b\u0627 (\u0645\u062b\u0644: \u0627\u0644\u062d\u0633\u0627\u0633\u064a\u0629\u060c \u0627\u0644\u0639\u0650\u0631\u0642\u060c \u0627\u0644\u062d\u0645\u0644\u060c \u0627\u0644\u062a\u062f\u062e\u064a\u0646\u060c \u0634\u0631\u0628 \u0627\u0644\u0643\u062d\u0648\u0644\u060c \u0627\u062e\u062a\u0644\u0627\u0644 \u0627\u0644\u0643\u0628\u062f\/\u0627\u0644\u0643\u0644\u0649\u060c \u0625\u0644\u062e.)<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"medical-history\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"medical-history\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-12 selector-form\">\n\t\t\t<p><label for=\"same-side-effect\">\u0647\u0644 \u0633\u0628\u0642 \u0623\u0646 \u0648\u0627\u062c\u0647\u062a \u0646\u0641\u0633 \u0627\u0644\u0623\u062b\u0631 \u0627\u0644\u062c\u0627\u0646\u0628\u064a\u061f<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"same-side-effect\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"same-side-effect\"><option value=\"\u0646\u0639\u0645\">\u0646\u0639\u0645<\/option><option value=\"\u0644\u0627\">\u0644\u0627<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n <!-- 7. MEDICAL HISTORY END -->\n<\/div>\n<div class=\"cf7mls-btns \"><button type=\"button\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\" id=\"cf7mls-back-btn-cf7mls_step-2\">\u0627\u0644\u0633\u0627\u0628\u0642<\/button><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-2\">\u0627\u0644\u062a\u0627\u0644\u064a<img decoding=\"async\" src=\"https:\/\/www.jamjoompharma.com\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/www.jamjoompharma.com\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\" \/><\/button><\/div><p><\/p><\/fieldset><fieldset class=\"fieldset-cf7mls\">\n<\/p>\n<div class=\"become-form\">\n <!-- 8. RELEVANT TESTS BEGIN -->\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-12 heading-form\" style=\"margin-bottom: 0px;\">\n\t\t\t<h4>\u0627\u0644\u0641\u062d\u0648\u0635\u0627\u062a \/ \u0628\u064a\u0627\u0646\u0627\u062a \u0627\u0644\u0645\u062e\u062a\u0628\u0631 \u0630\u0627\u062a \u0627\u0644\u0635\u0644\u0629 \u0645\u0639 \u0627\u0644\u062a\u0648\u0627\u0631\u064a\u062e\n\t\t\t<\/h4>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-12 textarea-form\">\n\t\t\t<p><label for=\"lab-tests\"><\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"lab-tests\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"lab-tests\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n <!-- 8. RELEVANT TESTS END -->\n\n <!-- EMPTY SPACE BEGIN -->\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_empty_space empty-space-form\">\n\t\t<\/div>\n\t<\/div>\n <!-- EMPTY SPACE END -->\n\n <!-- 9. PRIMARY REPORTER DETAILS BEGIN -->\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-12 heading-form\">\n\t\t\t<h4>\u0628\u064a\u0627\u0646\u0627\u062a \u0627\u0644\u0645\u064f\u0628\u0644\u0651\u063a \u0627\u0644\u0623\u0633\u0627\u0633\u064a (\u0645\u0631\u064a\u0636\/\u0637\u0628\u064a\u0628\/\u0635\u064a\u062f\u0644\u064a\/\u0645\u0645\u0631\u0636\u0629\/\u0637\u0628\u064a\u0628 \u0623\u0633\u0646\u0627\u0646\/\u0623\u062e\u0635\u0627\u0626\u064a \u0631\u0639\u0627\u064a\u0629 \u0635\u062d\u064a\u0629 \u0622\u062e\u0631)\n\t\t\t<\/h4>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-4\">\n\t\t\t<p><label for=\"reporter-name\">\u0627\u0644\u0627\u0633\u0645*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"reporter-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"reporter-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-4\">\n\t\t\t<p><label for=\"qualification\">\u0627\u0644\u0645\u0624\u0647\u0644 \u0627\u0644\u0639\u0644\u0645\u064a*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"qualification\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"qualification\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-4\">\n\t\t\t<p><label for=\"organization\">\u062c\u0647\u0629 \u0627\u0644\u0639\u0645\u0644<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"organization\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"organization\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-4\">\n\t\t\t<p><label for=\"reporter-country\">\u0627\u0644\u062f\u0648\u0644\u0629*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"reporter-country\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"reporter-country\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-4\">\n\t\t\t<p><label for=\"address\">\u0627\u0644\u0639\u0646\u0648\u0627\u0646<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"address\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-4\">\n\t\t\t<p><label for=\"town\">\u0627\u0644\u0645\u062f\u064a\u0646\u0629<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"town\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"town\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-4\">\n\t\t\t<p><label for=\"province\">\u0627\u0644\u0645\u062d\u0627\u0641\u0638\u0629 \u0623\u0648 \u0627\u0644\u0648\u0644\u0627\u064a\u0629<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"province\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"province\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-4\">\n\t\t\t<p><label for=\"phone\">\u0631\u0642\u0645 \u0627\u0644\u0647\u0627\u062a\u0641*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"phone\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"phone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-4\">\n\t\t\t<p><label for=\"email\">\u0627\u0644\u0628\u0631\u064a\u062f \u0627\u0644\u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\n <!-- 9. PRIMARY REPORTER DETAILS END -->\n\n <!-- EMPTY SPACE BEGIN -->\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_empty_space empty-space-form\">\n\t\t<\/div>\n\t<\/div>\n <!-- EMPTY SPACE END -->\n\n <!-- 10. SECONDARY REPORTER BEGIN -->\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-12 heading-form\">\n\t\t\t<h4>\u0628\u064a\u0627\u0646\u0627\u062a \u0627\u0644\u0645\u064f\u0628\u0644\u0651\u063a \u0627\u0644\u062b\u0627\u0646\u0648\u064a (\u0645\u0645\u062b\u0644 \u0637\u0628\u064a \/ \u0645\u0648\u0632\u0651\u0639 \/ \u0625\u0644\u062e)\n\t\t\t<\/h4>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-4\">\n\t\t\t<p><label for=\"secondary-name\">\u0627\u0633\u0645 \u0627\u0644\u0645\u064f\u0628\u0644\u0651\u063a \u0627\u0644\u062b\u0627\u0646\u0648\u064a<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"secondary-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"secondary-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-4\">\n\t\t\t<p><label for=\"secondary-qualification\">\u0627\u0644\u0645\u0624\u0647\u0644<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"secondary-qualification\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"secondary-qualification\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-4\">\n\t\t\t<p><label for=\"secondary-organization\">\u0627\u0644\u062c\u0647\u0629<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"secondary-organization\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"secondary-organization\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-4\">\n\t\t\t<p><label for=\"secondary-country\">\u0627\u0644\u062f\u0648\u0644\u0629<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"secondary-country\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"secondary-country\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-4\">\n\t\t\t<p><label for=\"secondary-address\">\u0627\u0644\u0639\u0646\u0648\u0627\u0646<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"secondary-address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"secondary-address\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-4\">\n\t\t\t<p><label for=\"secondary-town\">\u0627\u0644\u0645\u062f\u064a\u0646\u0629<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"secondary-town\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"secondary-town\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-4\">\n\t\t\t<p><label for=\"secondary-province\">\u0627\u0644\u0645\u062d\u0627\u0641\u0638\u0629<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"secondary-province\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"secondary-province\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-4\">\n\t\t\t<p><label for=\"secondary-phone\">\u0631\u0642\u0645 \u0627\u0644\u0647\u0627\u062a\u0641<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"secondary-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"secondary-phone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-4\">\n\t\t\t<p><label for=\"secondary-email\">\u0627\u0644\u0628\u0631\u064a\u062f \u0627\u0644\u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"secondary-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"secondary-email\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\n <!-- 10. SECONDARY REPORTER END -->\n\n <!-- EMPTY SPACE BEGIN -->\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_empty_space empty-space-form\">\n\t\t<\/div>\n\t<\/div>\n <!-- EMPTY SPACE END -->\n\n <!-- 11. CAUSALITY ASSESSMENT & 12. DATE OF REPORT BEGIN -->\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-7\">\n\t\t\t<p style=\"margin-bottom: 8px;\">\u062a\u0642\u064a\u064a\u0645 \u0627\u0644\u0639\u0644\u0627\u0642\u0629 \u0627\u0644\u0633\u0628\u0628\u064a\u0629: (\u064a\u064f\u0645\u0644\u0623 \u0628\u0648\u0627\u0633\u0637\u0629 \u0623\u062e\u0635\u0627\u0626\u064a \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0635\u062d\u064a\u0629 \u0641\u0642\u0637)\n\t\t\t<\/p>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"causality\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"causality[]\" value=\"\u0645\u0624\u0643\u062f\" \/><span class=\"wpcf7-list-item-label\">\u0645\u0624\u0643\u062f<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"causality[]\" value=\"\u0645\u062d\u062a\u0645\u0644\" \/><span class=\"wpcf7-list-item-label\">\u0645\u062d\u062a\u0645\u0644<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"causality[]\" value=\"\u0645\u0631\u062c\u062d\" \/><span class=\"wpcf7-list-item-label\">\u0645\u0631\u062c\u062d<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"causality[]\" value=\"\u063a\u064a\u0631 \u0645\u0631\u062a\u0628\u0637\" \/><span class=\"wpcf7-list-item-label\">\u063a\u064a\u0631 \u0645\u0631\u062a\u0628\u0637<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"causality[]\" value=\"\u063a\u064a\u0631 \u0642\u0627\u0628\u0644 \u0644\u0644\u062a\u0642\u064a\u064a\u0645\" \/><span class=\"wpcf7-list-item-label\">\u063a\u064a\u0631 \u0642\u0627\u0628\u0644 \u0644\u0644\u062a\u0642\u064a\u064a\u0645<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"causality[]\" value=\"\u063a\u064a\u0631 \u0645\u0639\u0631\u0648\u0641\" \/><span class=\"wpcf7-list-item-label\">\u063a\u064a\u0631 \u0645\u0639\u0631\u0648\u0641<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"vc_col-sm-5\">\n\t\t\t<p><label for=\"report-date\">\u062a\u0627\u0631\u064a\u062e \u0625\u0639\u062f\u0627\u062f \u0647\u0630\u0627 \u0627\u0644\u062a\u0642\u0631\u064a\u0631<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"report-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"report-date\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n <!-- 11. CAUSALITY ASSESSMENT & 12. DATE OF REPORT END -->\n\n <!-- EMPTY SPACE BEGIN -->\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_empty_space empty-space-form\">\n\t\t<\/div>\n\t<\/div>\n <!-- EMPTY SPACE END -->\n\n <!-- 12. CONFIDENTIALITY PRIVACY BEGIN -->\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-12 heading-form\">\n\t\t\t<h4>\u0627\u0644\u0633\u0631\u064a\u0629 \u0648\u062e\u0635\u0648\u0635\u064a\u0629 \u0627\u0644\u0628\u064a\u0627\u0646\u0627\u062a\n\t\t\t<\/h4>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-12\" id=\"privacy-title\">\n\t\t\t<p style=\"margin-bottom: 8px;\">\u064a\u062a\u0645 \u0627\u0644\u062d\u0641\u0627\u0638 \u0639\u0644\u0649 \u0647\u0648\u064a\u0629 \u0627\u0644\u0645\u0631\u064a\u0636 \u0628\u0633\u0631\u064a\u0629 \u062a\u0627\u0645\u0629 \u0648\u062d\u0645\u0627\u064a\u062a\u0647\u0627 \u0628\u0627\u0644\u0643\u0627\u0645\u0644. \u0645\u0648\u0638\u0641\u0648 \u0634\u0631\u0643\u0629 \u062c\u0645\u062c\u0648\u0645 \u063a\u064a\u0631 \u0645\u0644\u0632\u0645\u064a\u0646 \u0648\u0644\u0627 \u064a\u0642\u0648\u0645\u0648\u0646 \u0628\u0627\u0644\u0643\u0634\u0641 \u0639\u0646 \u0647\u0648\u064a\u0629 \u0627\u0644\u0645\u064f\u0628\u0644\u0651\u063a \u0644\u0623\u064a \u0637\u0631\u0641 \u0645\u0646 \u0627\u0644\u062c\u0645\u0647\u0648\u0631.\n\t\t\t<\/p>\n\t\t\t<ul>\n\t\t\t\t<li>\n\t\t\t\t\t<p>\u0645\u0646 \u062e\u0644\u0627\u0644 \u062a\u0642\u062f\u064a\u0645\u0643 \u0644\u0644\u0628\u064a\u0627\u0646\u0627\u062a\u060c \u0641\u0625\u0646\u0643 \u062a\u0648\u0627\u0641\u0642 \u0639\u0644\u0649 \u062c\u0645\u0639\u0647\u0627 \u0648\u0645\u0639\u0627\u0644\u062c\u062a\u0647\u0627 \u0648\u0625\u0631\u0633\u0627\u0644\u0647\u0627 \u0625\u0644\u0649 \u0627\u0644\u0633\u0644\u0637\u0627\u062a \u0627\u0644\u062a\u0646\u0638\u064a\u0645\u064a\u0629\u060c \u0639\u0646\u062f \u0627\u0644\u062d\u0627\u062c\u0629.\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/li>\n\t\t\t\t<li>\n\t\t\t\t\t<p>\u062a\u0642\u0631 \u0628\u0623\u0646 \u0628\u064a\u0627\u0646\u0627\u062a\u0643 \u0633\u062a\u064f\u062f\u0627\u0631 \u0648\u0641\u0642\u064b\u0627 \u0644\u0642\u0648\u0627\u0646\u064a\u0646 \u062d\u0645\u0627\u064a\u0629 \u0627\u0644\u062e\u0635\u0648\u0635\u064a\u0629 \u0627\u0644\u0645\u0639\u0645\u0648\u0644 \u0628\u0647\u0627 \u0648\u0642\u062f \u062a\u062a\u0645 \u0645\u0634\u0627\u0631\u0643\u062a\u0647\u0627 \u0645\u0639 \u0627\u0644\u062c\u0647\u0627\u062a \u0627\u0644\u0645\u062e\u0648\u0651\u0644\u0629.\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/li>\n\t\t\t\t<li>\n\t\t\t\t\t<p>\u0633\u064a\u062a\u0645 \u0627\u0644\u0627\u062d\u062a\u0641\u0627\u0638 \u0628\u0647\u0630\u0647 \u0627\u0644\u0628\u064a\u0627\u0646\u0627\u062a \u0644\u0645\u062f\u0629 10 \u0633\u0646\u0648\u0627\u062a \u0644\u0623\u063a\u0631\u0627\u0636 \u0627\u0644\u0627\u0645\u062a\u062b\u0627\u0644 \u0627\u0644\u062a\u0646\u0638\u064a\u0645\u064a \u0648\u0645\u0627 \u064a\u062a\u0639\u0644\u0642 \u0628\u0647\u0627.\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/li>\n\t\t\t\t<li>\n\t\t\t\t\t<p>\u062a\u0642\u062f\u064a\u0645 \u0647\u0630\u0627 \u0627\u0644\u0628\u0644\u0627\u063a \u0644\u0627 \u064a\u064f\u0639\u062f \u0627\u0639\u062a\u0631\u0627\u0641\u064b\u0627 \u0628\u0623\u0646 \u0627\u0644\u0637\u0627\u0642\u0645 \u0627\u0644\u0637\u0628\u064a \u0623\u0648 \u0627\u0644\u0634\u0631\u0643\u0629 \u0627\u0644\u0645\u0635\u0646\u0639\u0629 \u0623\u0648 \u0627\u0644\u0645\u0646\u062a\u062c \u062a\u0633\u0628\u0628 \u0623\u0648 \u0633\u0627\u0647\u0645 \u0641\u064a \u062d\u062f\u0648\u062b \u0627\u0644\u062a\u0641\u0627\u0639\u0644.\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/li>\n\t\t\t<\/ul>\n\t\t<\/div>\n\t<\/div>\n\n <!-- 12. CONFIDENTIALITY PRIVACY END -->\n\t<div class=\"vc_row\">\n\t\t<div class=\"vc_col-sm-12\">\n\t\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"\u0625\u0631\u0633\u0627\u0644 \u0627\u0644\u062a\u0642\u0631\u064a\u0631\" \/>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"cf7mls-btns cf7mls-btns-last-step\"><button type=\"button\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\" id=\"cf7mls-back-btn-cf7mls_step-3\">\u0627\u0644\u0633\u0627\u0628\u0642<\/button><button type=\"button\" style=\"display: none;\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-3\"><img decoding=\"async\" src=\"https:\/\/www.jamjoompharma.com\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/www.jamjoompharma.com\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\" \/><\/button>\n<\/p><\/fieldset><\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column][vc_column_text css=&#8221;&#8221;][\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-2990","page","type-page","status-publish","hentry","description-off"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.jamjoompharma.com\/ar\/wp-json\/wp\/v2\/pages\/2990","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.jamjoompharma.com\/ar\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.jamjoompharma.com\/ar\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.jamjoompharma.com\/ar\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.jamjoompharma.com\/ar\/wp-json\/wp\/v2\/comments?post=2990"}],"version-history":[{"count":4,"href":"https:\/\/www.jamjoompharma.com\/ar\/wp-json\/wp\/v2\/pages\/2990\/revisions"}],"predecessor-version":[{"id":3005,"href":"https:\/\/www.jamjoompharma.com\/ar\/wp-json\/wp\/v2\/pages\/2990\/revisions\/3005"}],"wp:attachment":[{"href":"https:\/\/www.jamjoompharma.com\/ar\/wp-json\/wp\/v2\/media?parent=2990"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}