{"id":989462,"date":"2024-06-12T16:55:05","date_gmt":"2024-06-12T15:55:05","guid":{"rendered":"https:\/\/pharmcontrol.az\/report-an-adverse-reaction\/"},"modified":"2024-07-17T18:52:57","modified_gmt":"2024-07-17T17:52:57","slug":"report-an-adverse-reaction","status":"publish","type":"page","link":"https:\/\/pharmcontrol.az\/az\/report-an-adverse-reaction\/","title":{"rendered":"\u018flav\u0259 t\u0259sir bar\u0259d\u0259 m\u0259lumat verin"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"989462\" class=\"elementor elementor-989462 elementor-988307\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-c711362 elementor-section-height-min-height elementor-section-items-stretch elementor-section-boxed elementor-section-height-default\" data-id=\"c711362\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-259f340\" data-id=\"259f340\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-07e9123 elementor-widget elementor-widget-heading\" data-id=\"07e9123\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.22.0 - 26-06-2024 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h2 class=\"elementor-heading-title elementor-size-default\">\u018flav\u0259 t\u0259sir bar\u0259d\u0259 m\u0259lumat verin<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-408ec4e elementor-widget elementor-widget-wpforms\" data-id=\"408ec4e\" data-element_type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style id=\"wpforms-css-vars-root\">\n\t\t\t\t:root {\n\t\t\t\t\t--wpforms-field-border-radius: 3px;\n--wpforms-field-border-style: solid;\n--wpforms-field-border-size: 1px;\n--wpforms-field-background-color: #ffffff;\n--wpforms-field-border-color: rgba( 0, 0, 0, 0.25 );\n--wpforms-field-border-color-spare: rgba( 0, 0, 0, 0.25 );\n--wpforms-field-text-color: rgba( 0, 0, 0, 0.7 );\n--wpforms-field-menu-color: #ffffff;\n--wpforms-label-color: rgba( 0, 0, 0, 0.85 );\n--wpforms-label-sublabel-color: rgba( 0, 0, 0, 0.55 );\n--wpforms-label-error-color: #d63637;\n--wpforms-button-border-radius: 3px;\n--wpforms-button-border-style: none;\n--wpforms-button-border-size: 1px;\n--wpforms-button-background-color: #066aab;\n--wpforms-button-border-color: #066aab;\n--wpforms-button-text-color: #ffffff;\n--wpforms-page-break-color: #066aab;\n--wpforms-background-image: none;\n--wpforms-background-position: center center;\n--wpforms-background-repeat: no-repeat;\n--wpforms-background-size: cover;\n--wpforms-background-width: 100px;\n--wpforms-background-height: 100px;\n--wpforms-background-color: rgba( 0, 0, 0, 0 );\n--wpforms-background-url: none;\n--wpforms-container-padding: 0px;\n--wpforms-container-border-style: none;\n--wpforms-container-border-width: 1px;\n--wpforms-container-border-color: #000000;\n--wpforms-container-border-radius: 3px;\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\n\t\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-render-modern\" id=\"wpforms-988283\"><form id=\"wpforms-form-988283\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"988283\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/az\/wp-json\/wp\/v2\/pages\/989462?wpforms_form_id=988283\" data-token=\"62eddbcae169bd649b6762c80e5aca6b\" data-token-time=\"1778674891\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-hidden\" id=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-988283-field_8-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"8\"><fieldset><legend class=\"wpforms-field-label\">REPORTYOR <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-988283-field_8\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-988283-field_8_1\" name=\"wpforms[fields][8]\" value=\"\u00d6z\u00fcm \u00fc\u00e7\u00fcn\" aria-errormessage=\"wpforms-988283-field_8_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_8_1\">\u00d6z\u00fcm \u00fc\u00e7\u00fcn<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-988283-field_8_2\" name=\"wpforms[fields][8]\" value=\"Dig\u0259r\" aria-errormessage=\"wpforms-988283-field_8_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_8_2\">Dig\u0259r<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-988283-field_10-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"10\"><h3 id=\"wpforms-988283-field_10\" aria-errormessage=\"wpforms-988283-field_10-error\">A. X\u018fST\u018f M\u018fLUMATI<\/h3><\/div><div id=\"wpforms-988283-field_13-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"13\"><label class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Layout<\/label><div class=\"wpforms-field-layout-rows\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-988283-field_11-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_11\">1. X\u0259st\u0259nin Identifikasiyas\u0131 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-988283-field_11\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][11]\" aria-errormessage=\"wpforms-988283-field_11-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-988283-field_12-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_12\">2. Do\u011fum tarixi <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-988283-field_12\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-small\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][12][date]\" aria-errormessage=\"wpforms-988283-field_12-error\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-988283-field_14-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"14\"><fieldset><legend class=\"wpforms-field-label\">3. Cins <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-988283-field_14\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-988283-field_14_1\" name=\"wpforms[fields][14]\" value=\"Ki\u015fi\" aria-errormessage=\"wpforms-988283-field_14_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_14_1\">Ki\u015fi<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-988283-field_14_2\" name=\"wpforms[fields][14]\" value=\"Qad\u0131n\" aria-errormessage=\"wpforms-988283-field_14_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_14_2\">Qad\u0131n<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-988283-field_14_4\" name=\"wpforms[fields][14]\" value=\"M\u0259n izah etm\u0259m\u0259yi \u00fcst\u00fcn tuturam\" aria-errormessage=\"wpforms-988283-field_14_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_14_4\">M\u0259n izah etm\u0259m\u0259yi \u00fcst\u00fcn tuturam<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-988283-field_15-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_15\">4. B\u0259d\u0259n k\u00fctl\u0259si<\/label><input type=\"number\" id=\"wpforms-988283-field_15\" class=\"wpforms-field-medium\" name=\"wpforms[fields][15]\" aria-errormessage=\"wpforms-988283-field_15-error\" ><\/div><div id=\"wpforms-988283-field_16-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"16\"><h3 id=\"wpforms-988283-field_16\" aria-errormessage=\"wpforms-988283-field_16-error\">B. \u018fLAV\u018f T\u018fS\u0130R, M\u018fHSULLA BA\u011eLI PROBLEM<\/h3><\/div><div id=\"wpforms-988283-field_18-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"18\"><fieldset><legend class=\"wpforms-field-label\">1. Hesabat n\u00f6v\u00fc<\/legend><ul id=\"wpforms-988283-field_18\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_18_1\" name=\"wpforms[fields][18][]\" value=\"Yan t\u0259sir\" aria-errormessage=\"wpforms-988283-field_18_1-error\" aria-describedby=\"wpforms-988283-field_18-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_18_1\">Yan t\u0259sir<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_18_2\" name=\"wpforms[fields][18][]\" value=\"M\u0259hsulla ba\u011fl\u0131 problem\" aria-errormessage=\"wpforms-988283-field_18_2-error\" aria-describedby=\"wpforms-988283-field_18-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_18_2\">M\u0259hsulla ba\u011fl\u0131 problem<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_18_3\" name=\"wpforms[fields][18][]\" value=\"M\u0259hsulun istifad\u0259si \/ m\u00fcalic\u0259 reseptind\u0259 s\u0259hv\" aria-errormessage=\"wpforms-988283-field_18_3-error\" aria-describedby=\"wpforms-988283-field_18-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_18_3\">M\u0259hsulun istifad\u0259si \/ m\u00fcalic\u0259 reseptind\u0259 s\u0259hv<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_18_4\" name=\"wpforms[fields][18][]\" value=\"D\u0259rmanda q\u00fcsurlar\" aria-errormessage=\"wpforms-988283-field_18_4-error\" aria-describedby=\"wpforms-988283-field_18-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_18_4\">D\u0259rmanda q\u00fcsurlar<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_18_5\" name=\"wpforms[fields][18][]\" value=\"Eyni d\u0259rman\u0131n m\u00fcxt\u0259lif istehsal\u00e7\u0131lar\u0131 il\u0259 problem\" aria-errormessage=\"wpforms-988283-field_18_5-error\" aria-describedby=\"wpforms-988283-field_18-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_18_5\">Eyni d\u0259rman\u0131n m\u00fcxt\u0259lif istehsal\u00e7\u0131lar\u0131 il\u0259 problem<\/label><\/li><\/ul><div id=\"wpforms-988283-field_18-description\" class=\"wpforms-field-description\">(uy\u011fun olanlar\u0131n ham\u0131s\u0131n\u0131 se\u00e7in) <\/div><\/fieldset><\/div><div id=\"wpforms-988283-field_65-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"65\"><label class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Layout (copy) (copy)<\/label><div class=\"wpforms-field-layout-rows\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-988283-field_19-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-trigger\" data-field-id=\"19\"><fieldset><legend class=\"wpforms-field-label\">2. Yan tesir\/menfi hadise ile ba\u011fl\u0131 netic\u0259 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-988283-field_19\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_19_1\" name=\"wpforms[fields][19][]\" value=\"\u00d6l\u00fcm (\u00d6l\u00fcm g\u00fcn\u00fc)\" aria-errormessage=\"wpforms-988283-field_19_1-error\" aria-describedby=\"wpforms-988283-field_19-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_19_1\">\u00d6l\u00fcm (\u00d6l\u00fcm g\u00fcn\u00fc)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_19_2\" name=\"wpforms[fields][19][]\" value=\"H\u0259yat \u00fc\u00e7\u00fcn t\u0259hl\u00fck\u0259\" aria-errormessage=\"wpforms-988283-field_19_2-error\" aria-describedby=\"wpforms-988283-field_19-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_19_2\">H\u0259yat \u00fc\u00e7\u00fcn t\u0259hl\u00fck\u0259<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_19_3\" name=\"wpforms[fields][19][]\" value=\"X\u0259st\u0259xanaya yerl\u0259\u015fdirm\u0259\" aria-errormessage=\"wpforms-988283-field_19_3-error\" aria-describedby=\"wpforms-988283-field_19-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_19_3\">X\u0259st\u0259xanaya yerl\u0259\u015fdirm\u0259<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_19_4\" name=\"wpforms[fields][19][]\" value=\"Tibbi c\u0259h\u0259td\u0259n vacib hadis\u0259\" aria-errormessage=\"wpforms-988283-field_19_4-error\" aria-describedby=\"wpforms-988283-field_19-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_19_4\">Tibbi c\u0259h\u0259td\u0259n vacib hadis\u0259<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_19_5\" name=\"wpforms[fields][19][]\" value=\"\u018fm\u0259k qabilliy\u0259tinin itirilm\u0259si \/ \u0259lillik\" aria-errormessage=\"wpforms-988283-field_19_5-error\" aria-describedby=\"wpforms-988283-field_19-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_19_5\">\u018fm\u0259k qabilliy\u0259tinin itirilm\u0259si \/ \u0259lillik<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_19_6\" name=\"wpforms[fields][19][]\" value=\"Anadang\u0259lm\u0259 anomaliyalar\/ q\u00fcsurlar\" aria-errormessage=\"wpforms-988283-field_19_6-error\" aria-describedby=\"wpforms-988283-field_19-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_19_6\">Anadang\u0259lm\u0259 anomaliyalar\/ q\u00fcsurlar<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_19_7\" name=\"wpforms[fields][19][]\" value=\"\u00d6m\u00fcrl\u00fck z\u0259d\u0259\/z\u0259r\u0259rin qar\u015f\u0131s\u0131n\u0131 almaq \u00fc\u00e7\u00fcn z\u0259ruri m\u00fcdaxil\u0259\" aria-errormessage=\"wpforms-988283-field_19_7-error\" aria-describedby=\"wpforms-988283-field_19-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_19_7\">\u00d6m\u00fcrl\u00fck z\u0259d\u0259\/z\u0259r\u0259rin qar\u015f\u0131s\u0131n\u0131 almaq \u00fc\u00e7\u00fcn z\u0259ruri m\u00fcdaxil\u0259<\/label><\/li><\/ul><div id=\"wpforms-988283-field_19-description\" class=\"wpforms-field-description\">(uy\u011fun olanlar\u0131n ham\u0131s\u0131n\u0131 se\u00e7in) <\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-988283-field_64-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"64\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_64\">\u00d6l\u00fcm tarixi <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-988283-field_64\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-small\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][64][date]\" aria-errormessage=\"wpforms-988283-field_64-error\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-988283-field_20-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"20\"><label class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Layout (copy)<\/label><div class=\"wpforms-field-layout-rows\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-988283-field_23-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_23\">3. Hadis\u0259nin ba\u015f verdiyi tarix<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-988283-field_23\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-small\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][23][date]\" aria-errormessage=\"wpforms-988283-field_23-error\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-988283-field_22-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_22\">4. Hesabat\u0131n tamamlanma tarixi<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-988283-field_22\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-small\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][22][date]\" aria-errormessage=\"wpforms-988283-field_22-error\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-988283-field_24-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-modern\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_24\">5. Reaksiya\/Simptom se\u00e7in Yuxar\u0131dak\u0131 m\u0259qamlardan he\u00e7 biri siz\u0259 uy\u011fun g\u0259lmirs\u0259, onu \u00f6z\u00fcn\u00fcz \u0259lav\u0259 edin:<\/label><select id=\"wpforms-988283-field_24\" class=\"wpforms-field-large choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-large\" data-search-enabled=\"1\" name=\"wpforms[fields][24][]\" multiple=\"multiple\"><option value=\"\" class=\"placeholder\" disabled >B 12 vitamini \u00e7at\u0131\u015fmazl\u0131\u011f\u0131 anemiyas\u0131<\/option><option value=\"B 12 vitamini \u00e7at\u0131\u015fmazl\u0131\u011f\u0131 anemiyas\u0131\" >B 12 vitamini \u00e7at\u0131\u015fmazl\u0131\u011f\u0131 anemiyas\u0131<\/option><option value=\"D\u0259mir \u00e7at\u0131\u015fmazl\u0131\u011f\u0131 anemiyas\u0131\" >D\u0259mir \u00e7at\u0131\u015fmazl\u0131\u011f\u0131 anemiyas\u0131<\/option><option value=\"Taxikardiya\" >Taxikardiya<\/option><option value=\"Bradikardiya\" >Bradikardiya<\/option><option value=\"Aritmiya\" >Aritmiya<\/option><option value=\"Arterial hipertenziya\" >Arterial hipertenziya<\/option><option value=\"Arterial hipotenziya\" >Arterial hipotenziya<\/option><option value=\"Qanaxma\" >Qanaxma<\/option><option value=\"Q\u0259bizlik\" >Q\u0259bizlik<\/option><option value=\"\u0130shal\" >\u0130shal<\/option><option value=\"\u00dcr\u0259kbulanma\" >\u00dcr\u0259kbulanma<\/option><option value=\"Qusma\" >Qusma<\/option><option value=\"A\u011f\u0131zda quruluq\" >A\u011f\u0131zda quruluq<\/option><option value=\"Abdominal a\u011fr\u0131\" >Abdominal a\u011fr\u0131<\/option><option value=\"Abdominal diskomfort\" >Abdominal diskomfort<\/option><option value=\"K\u00f6p\" >K\u00f6p<\/option><option value=\"Refl\u00fc\" >Refl\u00fc<\/option><option value=\"G\u0259yirm\u0259\" >G\u0259yirm\u0259<\/option><option value=\"Stomatit\" >Stomatit<\/option><option value=\"K\u0259skin pankreatit\" >K\u0259skin pankreatit<\/option><option value=\"Dild\u0259 \u015fi\u015fkinlik\" >Dild\u0259 \u015fi\u015fkinlik<\/option><option value=\"Di\u015f a\u011fr\u0131s\u0131\" >Di\u015f a\u011fr\u0131s\u0131<\/option><option value=\"Ginvit\" >Ginvit<\/option><option value=\"Qaraciy\u0259r disfunksiyas\u0131\" >Qaraciy\u0259r disfunksiyas\u0131<\/option><option value=\"Hepatit\" >Hepatit<\/option><option value=\"\u00d6d kis\u0259sinin disfunksiyas\u0131\" >\u00d6d kis\u0259sinin disfunksiyas\u0131<\/option><option value=\"Qaraciy\u0259rd\u0259 a\u011fr\u0131\" >Qaraciy\u0259rd\u0259 a\u011fr\u0131<\/option><option value=\"S\u0259pgi\" >S\u0259pgi<\/option><option value=\"Dermatit\" >Dermatit<\/option><option value=\"Q\u0131zart\u0131\" >Q\u0131zart\u0131<\/option><option value=\"D\u0259rid\u0259 quruluq\" >D\u0259rid\u0259 quruluq<\/option><option value=\"\u00d6vr\u0259\" >\u00d6vr\u0259<\/option><option value=\"Psoriaz\" >Psoriaz<\/option><option value=\"Ekzema\" >Ekzema<\/option><option value=\"Qa\u015f\u0131nma\" >Qa\u015f\u0131nma<\/option><option value=\"Alopesiya\" >Alopesiya<\/option><option value=\"D\u0259rinin soyulmas\u0131\" >D\u0259rinin soyulmas\u0131<\/option><option value=\"Blisters\" >Blisters<\/option><option value=\"Pigment l\u0259k\u0259l\u0259r\" >Pigment l\u0259k\u0259l\u0259r<\/option><option value=\"D\u0131rnaq pozulmas\u0131\" >D\u0131rnaq pozulmas\u0131<\/option><option value=\"G\u00f6b\u0259l\u0259k infeksiyalar\u0131\" >G\u00f6b\u0259l\u0259k infeksiyalar\u0131<\/option><option value=\"Qanqren\" >Qanqren<\/option><option value=\"\u015ei\u015fkinlik\" >\u015ei\u015fkinlik<\/option><option value=\"\u0130rinli s\u0259pgil\u0259r\" >\u0130rinli s\u0259pgil\u0259r<\/option><option value=\"Rosacea\" >Rosacea<\/option><option value=\"D\u0259rinin z\u0259d\u0259l\u0259nm\u0259si\" >D\u0259rinin z\u0259d\u0259l\u0259nm\u0259si<\/option><option value=\"Sa\u00e7 t\u00f6k\u00fclm\u0259si\" >Sa\u00e7 t\u00f6k\u00fclm\u0259si<\/option><option value=\"D\u0259ri r\u0259nginin d\u0259yi\u015fm\u0259si\" >D\u0259ri r\u0259nginin d\u0259yi\u015fm\u0259si<\/option><option value=\"D\u0131rnaq r\u0259nginin d\u0259yi\u015fm\u0259si\" >D\u0131rnaq r\u0259nginin d\u0259yi\u015fm\u0259si<\/option><option value=\"Anafilaktik \u015fok\" >Anafilaktik \u015fok<\/option><option value=\"Allergik reaksiya\" >Allergik reaksiya<\/option><option value=\"Tiroid disfunksiyas\u0131\" >Tiroid disfunksiyas\u0131<\/option><option value=\"M\u0259d\u0259alt\u0131 v\u0259zi disfunksiyas\u0131\" >M\u0259d\u0259alt\u0131 v\u0259zi disfunksiyas\u0131<\/option><option value=\"Hipotiroidizm\" >Hipotiroidizm<\/option><option value=\"Hipertiroidizm\" >Hipertiroidizm<\/option><option value=\"Autoimmune tiroidit\" >Autoimmune tiroidit<\/option><option value=\"Diabet\" >Diabet<\/option><option value=\"B\u00f6yr\u0259k\u00fcst\u00fc v\u0259zil\u0259rin disfunksiyas\u0131\" >B\u00f6yr\u0259k\u00fcst\u00fc v\u0259zil\u0259rin disfunksiyas\u0131<\/option><option value=\"Cinsi hormonlarin disfunksiyas\u0131\" >Cinsi hormonlarin disfunksiyas\u0131<\/option><option value=\"Cinsiyy\u0259t orqanlar\u0131nda qa\u015f\u0131nma\" >Cinsiyy\u0259t orqanlar\u0131nda qa\u015f\u0131nma<\/option><option value=\"Vaginal qanaxma\" >Vaginal qanaxma<\/option><option value=\"Menstruasiya poz\u011funlu\u011fu\" >Menstruasiya poz\u011funlu\u011fu<\/option><option value=\"Prostatit\" >Prostatit<\/option><option value=\"Cinsiyy\u0259t orqanlar\u0131n g\u00f6b\u0259l\u0259k infeksiyalar\u0131\" >Cinsiyy\u0259t orqanlar\u0131n g\u00f6b\u0259l\u0259k infeksiyalar\u0131<\/option><option value=\"S\u00fcd v\u0259zil\u0259rind\u0259 a\u011fr\u0131\" >S\u00fcd v\u0259zil\u0259rind\u0259 a\u011fr\u0131<\/option><option value=\"Cinsiyy\u0259t orqanlar\u0131nda diskomfort\" >Cinsiyy\u0259t orqanlar\u0131nda diskomfort<\/option><option value=\"Cinsiyy\u0259t orqanlar\u0131nda s\u0259pgi\" >Cinsiyy\u0259t orqanlar\u0131nda s\u0259pgi<\/option><option value=\"Cinsi disfunksiya\" >Cinsi disfunksiya<\/option><option value=\"B\u00f6yr\u0259k \u00e7at\u0131\u015fmazl\u0131\u011f\u0131\" >B\u00f6yr\u0259k \u00e7at\u0131\u015fmazl\u0131\u011f\u0131<\/option><option value=\"K\u0259skin b\u00f6yr\u0259k z\u0259d\u0259si\" >K\u0259skin b\u00f6yr\u0259k z\u0259d\u0259si<\/option><option value=\"B\u00f6yr\u0259k a\u011fr\u0131s\u0131\" >B\u00f6yr\u0259k a\u011fr\u0131s\u0131<\/option><option value=\"Sidik tutma\" >Sidik tutma<\/option><option value=\"Sidik qa\u00e7\u0131rma\" >Sidik qa\u00e7\u0131rma<\/option><option value=\"Sidik ifraz\u0131 zaman\u0131 a\u011fr\u0131\" >Sidik ifraz\u0131 zaman\u0131 a\u011fr\u0131<\/option><option value=\"Sidik kis\u0259sind\u0259 a\u011fr\u0131\" >Sidik kis\u0259sind\u0259 a\u011fr\u0131<\/option><option value=\"Yor\u011funluq\" >Yor\u011funluq<\/option><option value=\"Z\u0259iflik\" >Z\u0259iflik<\/option><option value=\"Ba\u015fgic\u0259ll\u0259nm\u0259\" >Ba\u015fgic\u0259ll\u0259nm\u0259<\/option><option value=\"Yuxululuq\" >Yuxululuq<\/option><option value=\"A\u011fr\u0131\" >A\u011fr\u0131<\/option><option value=\"Yuxusuzluq\" >Yuxusuzluq<\/option><option value=\"Hals\u0131zl\u0131q\" >Hals\u0131zl\u0131q<\/option><option value=\"\u00dcmumi v\u0259ziyy\u0259tin pisl\u0259\u015fm\u0259si\" >\u00dcmumi v\u0259ziyy\u0259tin pisl\u0259\u015fm\u0259si<\/option><option value=\"H\u0259rar\u0259t\" >H\u0259rar\u0259t<\/option><option value=\"\u00dc\u015f\u00fctm\u0259\" >\u00dc\u015f\u00fctm\u0259<\/option><option value=\"Yeri\u015fin pozulmas\u0131\" >Yeri\u015fin pozulmas\u0131<\/option><option value=\"H\u0259r\u0259k\u0259tl\u0259rin pozulmas\u0131\" >H\u0259r\u0259k\u0259tl\u0259rin pozulmas\u0131<\/option><option value=\"\u015ei\u015fkin \u00fcz\" >\u015ei\u015fkin \u00fcz<\/option><option value=\"Susuzluq\" >Susuzluq<\/option><option value=\"Artan acl\u0131q hissi\" >Artan acl\u0131q hissi<\/option><option value=\"Artan aqressivlik\" >Artan aqressivlik<\/option><option value=\"Aktivliyin azalmas\u0131\" >Aktivliyin azalmas\u0131<\/option><option value=\"Vestibulyar poz\u011funluq\" >Vestibulyar poz\u011funluq<\/option><option value=\"Qulaqlarda k\u00fcy\" >Qulaqlarda k\u00fcy<\/option><option value=\"Karl\u0131q\" >Karl\u0131q<\/option><option value=\"D\u0259niz x\u0259st\u0259liyi\" >D\u0259niz x\u0259st\u0259liyi<\/option><option value=\"Bulan\u0131q g\u00f6rm\u0259\" >Bulan\u0131q g\u00f6rm\u0259<\/option><option value=\"Korluq\" >Korluq<\/option><option value=\"G\u00f6rm\u0259 poz\u011funlu\u011fu\" >G\u00f6rm\u0259 poz\u011funlu\u011fu<\/option><option value=\"Qulaq a\u011fr\u0131s\u0131\" >Qulaq a\u011fr\u0131s\u0131<\/option><option value=\"Titr\u0259m\u0259\" >Titr\u0259m\u0259<\/option><option value=\"Konsentrasiya itkisi\" >Konsentrasiya itkisi<\/option><option value=\"Koma\" >Koma<\/option><option value=\"Hu\u015funu itirm\u0259\" >Hu\u015funu itirm\u0259<\/option><option value=\"Apatiya\" >Apatiya<\/option><option value=\"\u0130\u015ftahs\u0131zl\u0131q\" >\u0130\u015ftahs\u0131zl\u0131q<\/option><option value=\"Depressiv v\u0259ziyy\u0259t\" >Depressiv v\u0259ziyy\u0259t<\/option><option value=\"Balans itkisi\" >Balans itkisi<\/option><option value=\"Yadda\u015f\u0131n pozulmas\u0131\" >Yadda\u015f\u0131n pozulmas\u0131<\/option><option value=\"Miqren\" >Miqren<\/option><option value=\"Nitq poz\u011funlu\u011fu\" >Nitq poz\u011funlu\u011fu<\/option><option value=\"\u0130flic\" >\u0130flic<\/option><option value=\"\u00dcz iflici\" >\u00dcz iflici<\/option><option value=\"S\u00fcm\u00fck a\u011fr\u0131s\u0131\" >S\u00fcm\u00fck a\u011fr\u0131s\u0131<\/option><option value=\"S\u00fcm\u00fck spazm\u0131\" >S\u00fcm\u00fck spazm\u0131<\/option><option value=\"\u018fz\u0259l\u0259 z\u0259ifl\u0259m\u0259si\" >\u018fz\u0259l\u0259 z\u0259ifl\u0259m\u0259si<\/option><\/select><\/div><div id=\"wpforms-988283-field_25-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"25\"><textarea id=\"wpforms-988283-field_25\" class=\"wpforms-field-medium\" name=\"wpforms[fields][25]\" placeholder=\"\u00d6z\u00fcn\u00fcz t\u0259svir edin\" aria-errormessage=\"wpforms-988283-field_25-error\" ><\/textarea><\/div><div id=\"wpforms-988283-field_26-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_26\">6. Cari analiz\/laboratoriya m\u0259lumatlar\u0131<\/label><textarea id=\"wpforms-988283-field_26\" class=\"wpforms-field-medium\" name=\"wpforms[fields][26]\" aria-errormessage=\"wpforms-988283-field_26-error\" ><\/textarea><\/div><div id=\"wpforms-988283-field_27-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_27\">7. \u018flaq\u0259d\u0259r x\u0259st\u0259lik tarix\u00e7\u0259si\/ yana\u015f\u0131 x\u0259st\u0259likl\u0259r.<\/label><textarea id=\"wpforms-988283-field_27\" class=\"wpforms-field-medium\" name=\"wpforms[fields][27]\" aria-errormessage=\"wpforms-988283-field_27-error\" ><\/textarea><\/div><div id=\"wpforms-988283-field_28-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"28\"><h3 id=\"wpforms-988283-field_28\" aria-errormessage=\"wpforms-988283-field_28-error\">C. M\u018fHSULUN M\u00d6VCUDLU\u011eU<\/h3><\/div><div id=\"wpforms-988283-field_29-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"29\"><fieldset><legend class=\"wpforms-field-label\">1. Qiymetlendirme \u00fc\u00e7\u00fcn mehsul m\u00f6vcuddur?<\/legend><ul id=\"wpforms-988283-field_29\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-988283-field_29_1\" name=\"wpforms[fields][29]\" value=\"B\u0259li\" aria-errormessage=\"wpforms-988283-field_29_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_29_1\">B\u0259li<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-988283-field_29_2\" name=\"wpforms[fields][29]\" value=\"Xeyr\" aria-errormessage=\"wpforms-988283-field_29_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_29_2\">Xeyr<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-988283-field_68-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"68\"><label class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Layout (copy) (copy)<\/label><div class=\"wpforms-field-layout-rows\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-988283-field_32-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-trigger\" data-field-id=\"32\"><fieldset><legend class=\"wpforms-field-label\"><\/legend><ul id=\"wpforms-988283-field_32\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_32_1\" name=\"wpforms[fields][32][]\" value=\"\u0130stehsal\u00e7\u0131ya qaytar\u0131ld\u0131\" aria-errormessage=\"wpforms-988283-field_32_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_32_1\">\u0130stehsal\u00e7\u0131ya qaytar\u0131ld\u0131<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-988283-field_71-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"71\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_71\">Geri qaytar\u0131lma tarixi<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-988283-field_71\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-small\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][71][date]\" aria-errormessage=\"wpforms-988283-field_71-error\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-988283-field_33-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_33\">2. Sizd\u0259 m\u0259hsulun \u015f\u0259kli varm\u0131?<\/label><div\n\t\tclass=\"wpforms-uploader\"\n\t\tdata-field-id=\"33\"\n\t\tdata-form-id=\"988283\"\n\t\tdata-input-name=\"wpforms_988283_33\"\n\t\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,vtt,mp3,m4a,m4b,aac,ra,ram,wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages\"\n\t\tdata-max-size=\"15728640\"\n\t\tdata-max-file-number=\"1\"\n\t\tdata-post-max-size=\"2147483648\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path>\n\t\t<\/svg>\n\t\t<span class=\"modern-title\">Click or drag a file to this area to upload.<\/span>\n\n\t\t\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\treadonly\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-988283-field_33\"\n\t\tname=\"wpforms_988283_33\" \t\tvalue=\"\">\n<\/div><div id=\"wpforms-988283-field_34-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"34\"><h3 id=\"wpforms-988283-field_34\" aria-errormessage=\"wpforms-988283-field_34-error\">D. \u015e\u00dcBH\u018fL\u0130 M\u018fHSULLAR<\/h3><\/div><div id=\"wpforms-988283-field_35-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"35\"><fieldset><legend class=\"wpforms-field-label\"><\/legend><ul id=\"wpforms-988283-field_35\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-988283-field_35_1\" name=\"wpforms[fields][35]\" value=\"Ad; Miqdar; Istehsal\u00e7\u0131\/T\u0259chizat\u00e7\u0131\" aria-errormessage=\"wpforms-988283-field_35_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_35_1\">Ad; Miqdar; Istehsal\u00e7\u0131\/T\u0259chizat\u00e7\u0131<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-988283-field_35_2\" name=\"wpforms[fields][35]\" value=\"Bu hesabat kosmetika, qida \u0259lav\u0259l\u0259ri v\u0259 ya qida\/tibbi qidalanma il\u0259 \u0259laq\u0259dard\u0131rm\u0131\" aria-errormessage=\"wpforms-988283-field_35_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_35_2\">Bu hesabat kosmetika, qida \u0259lav\u0259l\u0259ri v\u0259 ya qida\/tibbi qidalanma il\u0259 \u0259laq\u0259dard\u0131rm\u0131<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-988283-field_72-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"72\" style=\"display:none;\"><h3 id=\"wpforms-988283-field_72\" aria-errormessage=\"wpforms-988283-field_72-error\">E. POTENS\u0130AL T\u018fHL\u00dcK\u018f OLAN T\u0130BB\u0130 C\u0130HAZLAR<\/h3><\/div><div id=\"wpforms-988283-field_36-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_36\">#1 - Ad<\/label><input type=\"text\" id=\"wpforms-988283-field_36\" class=\"wpforms-field-medium\" name=\"wpforms[fields][36]\" aria-errormessage=\"wpforms-988283-field_36-error\" ><\/div><div id=\"wpforms-988283-field_37-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"37\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_37\">#2 - Istehsal\u00e7\u0131\/T\u0259chizat\u00e7\u0131<\/label><input type=\"text\" id=\"wpforms-988283-field_37\" class=\"wpforms-field-medium\" name=\"wpforms[fields][37]\" aria-errormessage=\"wpforms-988283-field_37-error\" ><\/div><div id=\"wpforms-988283-field_73-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"73\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_73\">1. Brend ad\u0131<\/label><input type=\"text\" id=\"wpforms-988283-field_73\" class=\"wpforms-field-medium\" name=\"wpforms[fields][73]\" aria-errormessage=\"wpforms-988283-field_73-error\" ><\/div><div id=\"wpforms-988283-field_74-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"74\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_74\">2. Cihaz\u0131n \u00fcmumi ad\u0131<\/label><input type=\"text\" id=\"wpforms-988283-field_74\" class=\"wpforms-field-medium\" name=\"wpforms[fields][74]\" aria-errormessage=\"wpforms-988283-field_74-error\" ><\/div><div id=\"wpforms-988283-field_75-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"75\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_75\">3. M\u0259hsul kodu<\/label><input type=\"text\" id=\"wpforms-988283-field_75\" class=\"wpforms-field-medium\" name=\"wpforms[fields][75]\" aria-errormessage=\"wpforms-988283-field_75-error\" ><\/div><div id=\"wpforms-988283-field_76-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"76\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_76\">4. \u015eirk\u0259tin ad\u0131, istehsal\u00e7\u0131n\u0131n \u015f\u0259h\u0259ri v\u0259 \u00f6lk\u0259si<\/label><textarea id=\"wpforms-988283-field_76\" class=\"wpforms-field-medium\" name=\"wpforms[fields][76]\" aria-errormessage=\"wpforms-988283-field_76-error\" ><\/textarea><\/div><div id=\"wpforms-988283-field_77-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"77\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_77\">5. Model<\/label><input type=\"text\" id=\"wpforms-988283-field_77\" class=\"wpforms-field-medium\" name=\"wpforms[fields][77]\" aria-errormessage=\"wpforms-988283-field_77-error\" ><\/div><div id=\"wpforms-988283-field_78-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"78\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_78\">6. Partiya<\/label><input type=\"text\" id=\"wpforms-988283-field_78\" class=\"wpforms-field-medium\" name=\"wpforms[fields][78]\" aria-errormessage=\"wpforms-988283-field_78-error\" ><\/div><div id=\"wpforms-988283-field_79-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"79\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_79\">7. Kataloq<\/label><input type=\"text\" id=\"wpforms-988283-field_79\" class=\"wpforms-field-medium\" name=\"wpforms[fields][79]\" aria-errormessage=\"wpforms-988283-field_79-error\" ><\/div><div id=\"wpforms-988283-field_82-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"82\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_82\">8. \u0130stifad\u0259 m\u00fcdd\u0259ti<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-988283-field_82\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][82][date]\" aria-errormessage=\"wpforms-988283-field_82-error\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-988283-field_80-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"80\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_80\">9. Seriya n\u00f6mr\u0259si<\/label><input type=\"text\" id=\"wpforms-988283-field_80\" class=\"wpforms-field-medium\" name=\"wpforms[fields][80]\" aria-errormessage=\"wpforms-988283-field_80-error\" ><\/div><div id=\"wpforms-988283-field_81-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"81\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_81\">10. Unikal cihaz identifikasiyas\u0131<\/label><input type=\"text\" id=\"wpforms-988283-field_81\" class=\"wpforms-field-medium\" name=\"wpforms[fields][81]\" aria-errormessage=\"wpforms-988283-field_81-error\" ><\/div><div id=\"wpforms-988283-field_83-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"83\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">11. Cihaz operatoru<\/legend><ul id=\"wpforms-988283-field_83\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_83_1\" name=\"wpforms[fields][83][]\" value=\"S\u0259hiyye i\u015f\u00e7isi\" aria-errormessage=\"wpforms-988283-field_83_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_83_1\">S\u0259hiyye i\u015f\u00e7isi<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_83_2\" name=\"wpforms[fields][83][]\" value=\"X\u0259st\u0259\" aria-errormessage=\"wpforms-988283-field_83_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_83_2\">X\u0259st\u0259<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_83_4\" name=\"wpforms[fields][83][]\" value=\"Dig\u0259r\" aria-errormessage=\"wpforms-988283-field_83_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_83_4\">Dig\u0259r<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-988283-field_38-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"38\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_38\">2.Doza ve ya miqdar<\/label><input type=\"text\" id=\"wpforms-988283-field_38\" class=\"wpforms-field-medium\" name=\"wpforms[fields][38]\" aria-errormessage=\"wpforms-988283-field_38-error\" ><\/div><div id=\"wpforms-988283-field_39-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"39\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_39\">\u0130stifade tezliyi<\/label><input type=\"text\" id=\"wpforms-988283-field_39\" class=\"wpforms-field-medium\" name=\"wpforms[fields][39]\" aria-errormessage=\"wpforms-988283-field_39-error\" ><\/div><div id=\"wpforms-988283-field_40-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"40\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_40\">\u0130stifad\u0259 \u00fcsulu<\/label><input type=\"text\" id=\"wpforms-988283-field_40\" class=\"wpforms-field-medium\" name=\"wpforms[fields][40]\" aria-errormessage=\"wpforms-988283-field_40-error\" ><\/div><div id=\"wpforms-988283-field_41-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"41\"><label class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">3. M\u00fcalic\u0259 tarixi\/Terapiya tarixi<\/label><div class=\"wpforms-field-layout-rows\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-988283-field_43-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"43\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_43\">Ba\u015flan\u011f\u0131c:<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-988283-field_43\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][43][date]\" aria-errormessage=\"wpforms-988283-field_43-error\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-988283-field_44-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"44\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_44\">Biti\u015f:<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-988283-field_44\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][44][date]\" aria-errormessage=\"wpforms-988283-field_44-error\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-988283-field_45-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"45\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_45\">4. Diaqnoz<\/label><input type=\"text\" id=\"wpforms-988283-field_45\" class=\"wpforms-field-medium\" name=\"wpforms[fields][45]\" aria-errormessage=\"wpforms-988283-field_45-error\" ><\/div><div id=\"wpforms-988283-field_46-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"46\"><fieldset><legend class=\"wpforms-field-label\">M\u00fcalic\u0259 h\u0259l\u0259 d\u0259 davam edir?<\/legend><ul id=\"wpforms-988283-field_46\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-988283-field_46_1\" name=\"wpforms[fields][46]\" value=\"B\u0259li\" aria-errormessage=\"wpforms-988283-field_46_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_46_1\">B\u0259li<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-988283-field_46_2\" name=\"wpforms[fields][46]\" value=\"Xeyr\" aria-errormessage=\"wpforms-988283-field_46_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_46_2\">Xeyr<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-988283-field_47-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"47\"><fieldset><legend class=\"wpforms-field-label\">5. M\u0259hsul n\u00f6v\u00fc<\/legend><ul id=\"wpforms-988283-field_47\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_47_1\" name=\"wpforms[fields][47][]\" value=\"OTC\" aria-errormessage=\"wpforms-988283-field_47_1-error\" aria-describedby=\"wpforms-988283-field_47-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_47_1\">OTC<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_47_2\" name=\"wpforms[fields][47][]\" value=\"Kombinasiya m\u0259hsullar\u0131\" aria-errormessage=\"wpforms-988283-field_47_2-error\" aria-describedby=\"wpforms-988283-field_47-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_47_2\">Kombinasiya m\u0259hsullar\u0131<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_47_3\" name=\"wpforms[fields][47][]\" value=\"\u00dcmumi d\u0259rmanlar\" aria-errormessage=\"wpforms-988283-field_47_3-error\" aria-describedby=\"wpforms-988283-field_47-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_47_3\">\u00dcmumi d\u0259rmanlar<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_47_4\" name=\"wpforms[fields][47][]\" value=\"Bioanaloqlar\" aria-errormessage=\"wpforms-988283-field_47_4-error\" aria-describedby=\"wpforms-988283-field_47-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_47_4\">Bioanaloqlar<\/label><\/li><\/ul><div id=\"wpforms-988283-field_47-description\" class=\"wpforms-field-description\">(uy\u011fun olanlar\u0131n ham\u0131s\u0131n\u0131 se\u00e7in) <\/div><\/fieldset><\/div><div id=\"wpforms-988283-field_49-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"49\"><fieldset><legend class=\"wpforms-field-label\">6. Istifad\u0259 dayand\u0131r\u0131ld\u0131qdan ve ya doza azald\u0131landan sonra yan t\u0259sirl\u0259rin simptomlan azald\u0131?<\/legend><ul id=\"wpforms-988283-field_49\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-988283-field_49_1\" name=\"wpforms[fields][49]\" value=\"B\u0259li\" aria-errormessage=\"wpforms-988283-field_49_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_49_1\">B\u0259li<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-988283-field_49_2\" name=\"wpforms[fields][49]\" value=\"Xeyr\" aria-errormessage=\"wpforms-988283-field_49_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_49_2\">Xeyr<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-988283-field_49_3\" name=\"wpforms[fields][49]\" value=\"Uy\u011fun deyil\" aria-errormessage=\"wpforms-988283-field_49_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_49_3\">Uy\u011fun deyil<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-988283-field_50-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"50\"><h3 id=\"wpforms-988283-field_50\" aria-errormessage=\"wpforms-988283-field_50-error\">F. D\u0130G\u018fR \u018fLAQ\u018fL\u0130 T\u0130BB\u0130 M\u018fHSULLAR<\/h3><\/div><div id=\"wpforms-988283-field_51-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"51\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_51\">1. M\u0259hsullar\u0131n adlar\u0131 v\u0259 m\u00fcalic\u0259 tarixl\u0259ri<\/label><textarea id=\"wpforms-988283-field_51\" class=\"wpforms-field-medium\" name=\"wpforms[fields][51]\" aria-errormessage=\"wpforms-988283-field_51-error\" ><\/textarea><\/div><div id=\"wpforms-988283-field_52-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"52\"><h3 id=\"wpforms-988283-field_52\" aria-errormessage=\"wpforms-988283-field_52-error\">G. REPORTYOR<\/h3><\/div><div id=\"wpforms-988283-field_53-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"53\"><label class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Layout<\/label><div class=\"wpforms-field-layout-rows\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-988283-field_54-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_54\">Ad <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-988283-field_54\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][54]\" aria-errormessage=\"wpforms-988283-field_54-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-988283-field_57-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"57\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_57\">Soyad <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-988283-field_57\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][57]\" aria-errormessage=\"wpforms-988283-field_57-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-988283-field_56-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"56\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_56\">Telefon<\/label><input type=\"tel\" id=\"wpforms-988283-field_56\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][56]\" aria-errormessage=\"wpforms-988283-field_56-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-988283-field_55-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"55\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_55\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-988283-field_55\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][55]\" spellcheck=\"false\" aria-errormessage=\"wpforms-988283-field_55-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-988283-field_58-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"58\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_58\">\u00d6lk\u0259<\/label><input type=\"text\" id=\"wpforms-988283-field_58\" class=\"wpforms-field-medium\" name=\"wpforms[fields][58]\" aria-errormessage=\"wpforms-988283-field_58-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-988283-field_59-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"59\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_59\">Po\u00e7t indeksi<\/label><input type=\"text\" id=\"wpforms-988283-field_59\" class=\"wpforms-field-medium\" name=\"wpforms[fields][59]\" aria-errormessage=\"wpforms-988283-field_59-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-988283-field_60-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"60\"><fieldset><legend class=\"wpforms-field-label\"><\/legend><ul id=\"wpforms-988283-field_60\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_60_1\" name=\"wpforms[fields][60][]\" value=\"2. Tibb i\u015f\u00e7isi\" aria-errormessage=\"wpforms-988283-field_60_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_60_1\">2. Tibb i\u015f\u00e7isi<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-988283-field_61-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"61\"><label class=\"wpforms-field-label\" for=\"wpforms-988283-field_61\">3. Pe\u015f\u0259<\/label><input type=\"text\" id=\"wpforms-988283-field_61\" class=\"wpforms-field-medium\" name=\"wpforms[fields][61]\" aria-errormessage=\"wpforms-988283-field_61-error\" ><\/div><div id=\"wpforms-988283-field_62-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"62\"><fieldset><legend class=\"wpforms-field-label\"><\/legend><ul id=\"wpforms-988283-field_62\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_62_1\" name=\"wpforms[fields][62][]\" value=\"4. \u018fger \u015f\u0259xsiyy\u0259tinizin istehsal\u00e7\u0131ya a\u00e7\u0131qlanmas\u0131n\u0131 ist\u0259mirsinizs\u0259, bo\u015f kvadrat\u0131 i\u015far\u0259l\u0259yin:\" aria-errormessage=\"wpforms-988283-field_62_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_62_1\">4. \u018fger \u015f\u0259xsiyy\u0259tinizin istehsal\u00e7\u0131ya a\u00e7\u0131qlanmas\u0131n\u0131 ist\u0259mirsinizs\u0259, bo\u015f kvadrat\u0131 i\u015far\u0259l\u0259yin:<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-988283-field_63-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"63\"><fieldset><legend class=\"wpforms-field-label\">5. H\u0259m\u00e7inin m\u0259lumat verilib:<\/legend><ul id=\"wpforms-988283-field_63\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_63_1\" name=\"wpforms[fields][63][]\" value=\"\u0130stehsal\u00e7\u0131ya\/T\u0259darik\u00e7iy\u0259\" aria-errormessage=\"wpforms-988283-field_63_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_63_1\">\u0130stehsal\u00e7\u0131ya\/T\u0259darik\u00e7iy\u0259<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_63_2\" name=\"wpforms[fields][63][]\" value=\"\u0130stifad\u0259\u00e7i agentliyi\" aria-errormessage=\"wpforms-988283-field_63_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_63_2\">\u0130stifad\u0259\u00e7i agentliyi<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-988283-field_63_3\" name=\"wpforms[fields][63][]\" value=\"Distribyutor\/\u0130dxal\u00e7\u0131\" aria-errormessage=\"wpforms-988283-field_63_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-988283-field_63_3\">Distribyutor\/\u0130dxal\u00e7\u0131<\/label><\/li><\/ul><\/fieldset><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"988283\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/pharmcontrol.az\/az\/wp-json\/wp\/v2\/pages\/989462\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-988283\" class=\"wpforms-submit\" data-alt-text=\"G\u00f6nd\u0259rilir...\" data-submit-text=\"G\u00f6nd\u0259r\" aria-live=\"assertive\" value=\"wpforms-submit\">G\u00f6nd\u0259r<\/button><img decoding=\"async\" src=\"https:\/\/pharmcontrol.az\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>\u018flav\u0259 t\u0259sir bar\u0259d\u0259 m\u0259lumat verin Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. Reporter * For myself Other A. Patient information Layout1. Patient identifier *2. Date of birth * 3. Gender * Male Female Prefer not to disclose Weight B. Adverse event, product problem&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>\u018flav\u0259 t\u0259sir bar\u0259d\u0259 m\u0259lumat verin - Pharmcontrol<\/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:\/\/pharmcontrol.az\/az\/report-an-adverse-reaction\/\" \/>\n<meta property=\"og:locale\" content=\"az_AZ\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"\u018flav\u0259 t\u0259sir bar\u0259d\u0259 m\u0259lumat verin - Pharmcontrol\" \/>\n<meta property=\"og:description\" content=\"\u018flav\u0259 t\u0259sir bar\u0259d\u0259 m\u0259lumat verin Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. 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Reporter * For myself Other A. Patient information Layout1. Patient identifier *2. Date of birth * 3. Gender * Male Female Prefer not to disclose Weight B. 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