{"id":1351,"date":"2025-04-22T05:27:09","date_gmt":"2025-04-22T05:27:09","guid":{"rendered":"https:\/\/www.vieco-pharma.com\/%d9%86%d9%85%d9%88%d8%b0%d8%ac-%d8%a7%d9%84%d9%85%d8%b1%d9%8a%d8%b6\/"},"modified":"2025-06-23T13:31:22","modified_gmt":"2025-06-23T13:31:22","slug":"patient-form","status":"publish","type":"page","link":"https:\/\/www.vieco-pharma.com\/ar\/patient-form\/","title":{"rendered":"\u0646\u0645\u0648\u0630\u062c \u0627\u0644\u0645\u0631\u064a\u0636"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1560-o1\" lang=\"ar\" dir=\"rtl\" data-wpcf7-id=\"1560\">\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\/1351#wpcf7-f1560-o1\" method=\"post\" class=\"wpcf7-form init cf7mls-no-scroll cf7mls-auto-return-first-step cf7mls-no-moving-animation\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1560\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"ar\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1560-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/><input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:1560,&quot;conditions&quot;:[{&quot;then_field&quot;:&quot;pregnacy-status&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;gender&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;\\u0623\\u0646\\u062b\\u0649&quot;}]},{&quot;then_field&quot;:&quot;pregnant-status&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;pregnancy-status&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;\\u062d\\u0627\\u0645\\u0644&quot;}]},{&quot;then_field&quot;:&quot;group-healthcare-form&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;contacthealthcare&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;\\u0646\\u0639\\u0645&quot;}]},{&quot;then_field&quot;:&quot;group-hospitalization&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;eventresult&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;\\u0627\\u0644\\u062f\\u062e\\u0648\\u0644 \\u0627\\u0644\\u0649 \\u0627\\u0644\\u0645\\u0633\\u062a\\u0634\\u0641\\u0649\\u061f&quot;}]},{&quot;then_field&quot;:&quot;adverseeventstop&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;adverseeventresult&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;\\u062a\\u0645 \\u0627\\u0633\\u062a\\u0631\\u062f\\u0627\\u062f\\u0647\\u0627&quot;}]},{&quot;then_field&quot;:&quot;adverseeventstop&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;adverseeventresult&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;\\u062a\\u0645 \\u0627\\u0644\\u062a\\u0639\\u0627\\u0641\\u064a \\u0645\\u0639 \\u062a\\u0623\\u062b\\u064a\\u0631\\u0627\\u062a \\u062f\\u0627\\u0626\\u0645\\u0629&quot;}]},{&quot;then_field&quot;:&quot;group-product2&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;othermedications&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;\\u0646\\u0639\\u0645&quot;}]},{&quot;then_field&quot;:&quot;group-adverse-event&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;treatmentreceived&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;\\u0646\\u0639\\u0645&quot;}]}],&quot;settings&quot;:{&quot;animation&quot;:&quot;yes&quot;,&quot;animation_intime&quot;:200,&quot;animation_outtime&quot;:200,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:false}}\" \/>\n<\/fieldset>\n<div class=\"fieldset-cf7mls-wrapper\" data-transition-effects><fieldset class=\"fieldset-cf7mls cf7mls_current_fs\"><div class=\"single_box patientFormBox\">\n                <h2>\u0628\u064a\u0627\u0646\u0627\u062a \u0627\u0644\u0645\u0631\u064a\u0636 \u0648\u0627\u0644\u0645\u064f\u0628\u0644\u0651\u063a<\/h2>\n                <h2 style=\"text-align:right;\">\u0628\u064a\u0627\u0646\u0627\u062a \u0627\u0644\u0645\u0631\u064a\u0636<\/h2>\n                <h6>\u064a\u0631\u062c\u0649 \u062a\u0642\u062f\u064a\u0645 \u0631\u062f \u0639\u0644\u0649 \u0627\u0644\u0623\u0642\u0644 \u0639\u0644\u0649 \u0623\u062d\u062f \u0627\u0644\u062d\u0642\u0648\u0644 \u0627\u0644\u062a\u064a \u062a\u062d\u0645\u0644 \u0639\u0644\u0627\u0645\u0629 * (\u0641\u064a <span style=\"color:red;\">\u0623\u062d\u0645\u0631<\/span>)<\/h6>\n                <p>\u0630\u0627 \u0643\u0646\u062a \u062a\u064f\u0628\u0644\u063a \u0645\u0646 \u062f\u0627\u062e\u0644 \u0627\u0644\u0645\u0646\u0637\u0642\u0629 \u0627\u0644\u0627\u0642\u062a\u0635\u0627\u062f\u064a\u0629 \u0627\u0644\u0623\u0648\u0631\u0648\u0628\u064a\u0629 \u0623\u0648 \u0627\u0644\u0645\u0645\u0644\u0643\u0629 \u0627\u0644\u0645\u062a\u062d\u062f\u0629\u060c \u064a\u064f\u0631\u062c\u0649 \u0627\u0633\u062a\u062e\u062f\u0627\u0645 \u0627\u0644\u0623\u062d\u0631\u0641 \u0627\u0644\u0623\u0648\u0644\u0649 \u0641\u0642\u0637. \u062a\u0642\u062f\u064a\u0645 \u0645\u064f\u0639\u0631\u0651\u0641\u0627\u062a \u0623\u062e\u0631\u0649 \u0627\u062e\u062a\u064a\u0627\u0631\u064a.\n                <\/p>\n\n                <div class=\"form_wrapper mt-[27px]\">\n                    <div\n                        class=\"multi_wrapper form_wrapper_div\">\n                        <div\n                            class=\"input_group form_input_style\">\n                            <label for=\"\">\u0627\u0644\u0623\u062d\u0631\u0641 \u0627\u0644\u0623\u0648\u0644\u0649 \u0645\u0646 \u0627\u0633\u0645 \u0627\u0644\u0645\u0631\u064a\u0636 <span>*<\/span><\/label>\n                            <span class=\"wpcf7-form-control-wrap\" data-name=\"initials\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"initials\" \/><\/span>\n                        <\/div>\n                        <div\n                            class=\"input_group select_input form_input_style\">\n                            <label for=\"\">\u0627\u0644\u0633\u0646 <span>*<\/span><\/label>\n                            <span class=\"wpcf7-form-control-wrap\" data-name=\"agegroup\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"\" value=\"\" type=\"text\" name=\"agegroup\" \/><\/span>\n                        <\/div>\n                    <\/div>\n\n                    <div\n                        class=\"multi_wrapper radio_multiwrapper form_wrapper_div\">\n                        <div\n                            class=\"input_group radio_group form_input_style\">\n                            <label for=\"\">\u0627\u0644\u062c\u0646\u0633 <span>*<\/span><\/label>\n                            <div class=\"radio_wrapper\">\n                                <span class=\"wpcf7-form-control-wrap\" data-name=\"gender\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"gender\" value=\"\u0630\u0643\u0631\" \/><span class=\"wpcf7-list-item-label\">\u0630\u0643\u0631<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"gender\" value=\"\u0623\u0646\u062b\u0649\" \/><span class=\"wpcf7-list-item-label\">\u0623\u0646\u062b\u0649<\/span><\/span><\/span><\/span>\n                            <\/div>\n                        <\/div>\n<div data-id=\"pregnacy-status\" data-orig_data_id=\"pregnacy-status\"  class=\"conditional_input_group\" data-class=\"wpcf7cf_group\">\n                        <div\n                            class=\"input_group radio_group form_input_style Pregnancy_wrapper\">\n                            <label for=\"\">\u062d\u0627\u0644\u0629 \u0627\u0644\u062d\u0645\u0644<\/label>\n                            <div class=\"radio_wrapper\">\n                                <span class=\"wpcf7-form-control-wrap\" data-name=\"pregnancy-status\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"pregnancy-status\" value=\"\u062d\u0627\u0645\u0644\" \/><span class=\"wpcf7-list-item-label\">\u062d\u0627\u0645\u0644<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"pregnancy-status\" value=\"\u063a\u064a\u0631 \u062d\u0627\u0645\u0644\" \/><span class=\"wpcf7-list-item-label\">\u063a\u064a\u0631 \u062d\u0627\u0645\u0644<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"pregnancy-status\" value=\"\u0645\u062c\u0647\u0648\u0644\" \/><span class=\"wpcf7-list-item-label\">\u0645\u062c\u0647\u0648\u0644<\/span><\/span><\/span><\/span>\n                            <\/div>\n                        <\/div>\n<\/div>\n                    <\/div>\n<div class=\"displayError\"><\/div>\n<div class=\"single_itemwrapper multi_wrapper form_wrapper_div\">\n<div data-id=\"pregnant-status\" data-orig_data_id=\"pregnant-status\"  class=\"conditional_input_group\" data-class=\"wpcf7cf_group\">\n                        <div class=\"input_group form_input_style Pregnancy_wrapper\">\n                            <label for=\"\">\u0627\u0644\u064a\u0648\u0645 \u0627\u0644\u0623\u0648\u0644 \u0645\u0646 \u0622\u062e\u0631 \u062f\u0648\u0631\u0629 \u0634\u0647\u0631\u064a\u0629<\/label>\n                            <div class=\"\">\n                                <span class=\"wpcf7-form-control-wrap\" data-name=\"menstrual-full-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date date-picker\" max=\"2026-06-05\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"menstrual-full-date\" \/><\/span>\n                            <\/div>\n                        <\/div>\n\n<div class=\"input_group radio_group form_input_style Pregnancy_wrapper\">\n                            <label for=\"\">\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u062a\u0633\u0644\u064a\u0645 \u0627\u0644\u0645\u062a\u0648\u0642\u0639<\/label>\n                            <div class=\"\">\n                                <span class=\"wpcf7-form-control-wrap\" data-name=\"delivery-full-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date date-picker\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"delivery-full-date\" \/><\/span>\n                            <\/div>\n                        <\/div>\n\n                        <div class=\"input_group radio_group form_input_style Pregnancy_wrapper\">\n                            <label for=\"\">\u0641\u062a\u0631\u0629 \u0627\u0644\u062d\u0645\u0644 (\u0623\u0633\u0627\u0628\u064a\u0639)<\/label>\n                            <div class=\"\">\n                                <span class=\"wpcf7-form-control-wrap\" data-name=\"gestational-period\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"gestational-period\" \/><\/span>\n                            <\/div>\n                        <\/div>\n<\/div>\n<\/div>\n                <\/div>\n            <\/div>\n\n<div class=\"single_box\">\n                <h2 style=\"text-align:right;\">\u064a\u0631\u062c\u0649 \u0643\u062a\u0627\u0628\u0629 \u0628\u064a\u0627\u0646\u0627\u062a\u0643<\/h2>\n\n                <div class=\"form_wrapper mt-[27px]\">\n                    <div class=\"multi_wrapper form_wrapper_div medicalStatus\">\n                        <div class=\"input_group select_input form_input_style\">\n                            <label for=\"\">\u0627\u0644\u0645\u0624\u0647\u0644<\/label>\n                            <span class=\"wpcf7-form-control-wrap\" data-name=\"occupation1\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"occupation1\"><option value=\"\">\u0627\u062e\u062a\u0631 \u0627\u0644\u0645\u0624\u0647\u0644<\/option><option value=\"\u0637\u0628\u064a\u0628\">\u0637\u0628\u064a\u0628<\/option><option value=\"\u0635\u064a\u062f\u0644\u064a\">\u0635\u064a\u062f\u0644\u064a<\/option><option value=\"\u0645\u0645\u0631\u0636\u0629\">\u0645\u0645\u0631\u0636\u0629<\/option><option value=\"\u0623\u062e\u0635\u0627\u0626\u064a\u0648 \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0635\u062d\u064a\u0629 \u0627\u0644\u0622\u062e\u0631\u0648\u0646\">\u0623\u062e\u0635\u0627\u0626\u064a\u0648 \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0635\u062d\u064a\u0629 \u0627\u0644\u0622\u062e\u0631\u0648\u0646<\/option><option value=\"\u0644\u0627 \u0634\u064a\u0621 \u0645\u0645\u0627 \u0633\u0628\u0642\">\u0644\u0627 \u0634\u064a\u0621 \u0645\u0645\u0627 \u0633\u0628\u0642<\/option><\/select><\/span>\n                        <\/div>\n                    <\/div>\n                    <div class=\"multi_wrapper form_wrapper_div\">\n                        <div class=\"input_group form_input_style\">\n                            <label for=\"\">\u0627\u0644\u0623\u0633\u0645 <span class=\"reqStar\" style=\"display: none;\">*<\/span><\/label>\n                            <span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" id=\"informationName\" aria-invalid=\"false\" placeholder=\"\u0627\u0633\u0645\u0643 \u0623\u0648 \u0627\u0644\u0623\u062d\u0631\u0641 \u0627\u0644\u0623\u0648\u0644\u0649 \u0645\u0646 \u0627\u0633\u0645\u0643.\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span>\n                        <\/div>\n<div class=\"input_group form_input_style\">\n                            <label for=\"\">\u0627\u0644\u0647\u0627\u062a\u0641 (\u0627\u0644\u0645\u0641\u0636\u0644) <span class=\"reqStar\" style=\"display: none;\">*<\/span><\/label>\n                            <span class=\"wpcf7-form-control-wrap\" data-name=\"phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" id=\"informationPhone\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"phone\" \/><\/span>\n                        <\/div>\n                    <\/div>\n                    <div\n                        class=\"multi_wrapper form_wrapper_div\">\n                        \n                        <div\n                            class=\"input_group form_input_style\">\n                            <label for=\"\">\u0639\u0646\u0648\u0627\u0646 \u0627\u0644\u0634\u0627\u0631\u0639 <\/label>\n                            <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                        <\/div>\n<div\n                            class=\"input_group form_input_style\">\n                            <label for=\"\">\u0627\u0644\u0645\u062f\u064a\u0646\u0629 <\/label>\n                            <span class=\"wpcf7-form-control-wrap\" data-name=\"city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"city\" \/><\/span>\n                        <\/div>\n                    <\/div>\n                    <div class=\"multi_wrapper form_wrapper_div\">\n                        <div class=\"input_group form_input_style\">\n                            <label for=\"\">\u0627\u0644\u0631\u0645\u0632 \u0627\u0644\u0628\u0631\u064a\u062f\u064a <\/label>\n                            <span class=\"wpcf7-form-control-wrap\" data-name=\"postal\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"postal\" \/><\/span>\n                        <\/div>\n<div class=\"input_group form_input_style\">\n                            <label for=\"\">\u0627\u0644\u062f\u0648\u0644\u0629 <\/label>\n                            <span class=\"wpcf7-form-control-wrap\" data-name=\"countrytext-203\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-countrytext wpcf7-text wpcf7-validates-as-countrytext\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"countrytext-203\" \/><\/span>\n                        <\/div>\n                    <\/div>\n                    <div class=\"multi_wrapper form_wrapper_div\">\n                        \n<div class=\"input_group form_input_style\">\n                            <label for=\"\">\u0627\u0644\u0628\u0631\u064a\u062f \u0627\u0644\u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a <\/label>\n                            <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                        <\/div>\n<div class=\"input_group form_input_style\">\n                            <label for=\"\">\u0627\u0644\u0641\u0627\u0643\u0633 <\/label>\n                            <span class=\"wpcf7-form-control-wrap\" data-name=\"fax\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"fax\" \/><\/span>\n                        <\/div>\n                    <\/div>\n\n                    <div\n                        class=\"single_itemwrapper multi_wrapper radio_multiwrapper form_wrapper_div\">\n                        <div\n                            class=\"input_group radio_group form_input_style\">\n                            <div class=\"content_wrap\">\n                                <label for=\"\">\u0647\u0644 \u0644\u062f\u0649 \u0634\u0631\u0643\u0629 \u0641\u064a\u0643\u0648 \u0627\u0644\u0625\u0630\u0646 \u0628\u0627\u0644\u062a\u0648\u0627\u0635\u0644 \u0645\u0639\u0643 \u0628\u062e\u0635\u0648\u0635 \u0647\u0630\u0627 \u0627\u0644\u062a\u0642\u0631\u064a\u0631\u061f <\/label>\n                                <p>\u0627\u0630\u0627 \u0623\u062e\u062a\u0631\u062a \"\u0646\u0639\u0645\" \u0641\u0633\u064a\u0643\u0648\u0646 \u0645\u0646 \u0627\u0644\u0636\u0631\u0648\u0631\u0649 \u062a\u0632\u0648\u064a\u062f\u0646\u0627 \u0628\u0628\u0639\u0636 \u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0627\u0644\u0627\u062a\u0635\u0627\u0644 \u0627\u0644\u0645\u0630\u0643\u0648\u0631\u0629 \u0623\u0639\u0644\u0627\u0647.\n                                <\/p>\n                            <\/div>\n                            <div class=\"radio_wrapper\">\n                                <span class=\"wpcf7-form-control-wrap\" data-name=\"contactreport\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"contactreport\" value=\"\u0646\u0639\u0645\" \/><span class=\"wpcf7-list-item-label\">\u0646\u0639\u0645<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"contactreport\" value=\"\u0644\u0627\" \/><span class=\"wpcf7-list-item-label\">\u0644\u0627<\/span><\/span><\/span><\/span>\n                            <\/div>\n                        <\/div>\n                    <\/div>\n                    <div class=\"single_itemwrapper multi_wrapper last_inputitem radio_multiwrapper form_wrapper_div\">\n                        <div class=\"input_group radio_group form_input_style\">\n                            <div class=\"content_wrap\">\n                                <label for=\"\">\u0647\u0644 \u0644\u062f\u0649 \u0634\u0631\u0643\u0629 \u0641\u064a\u0643\u0648 \u0627\u0644\u0625\u0630\u0646 \u0628\u0627\u0644\u0627\u062a\u0635\u0627\u0644 \u0628\u0645\u0642\u062f\u0645 \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0635\u062d\u064a\u0629 \u0627\u0644\u062e\u0627\u0635 \u0628\u0643 \u0628\u062e\u0635\u0648\u0635 \u0647\u0630\u0627 \u0627\u0644\u062a\u0642\u0631\u064a\u0631\u061f<\/label>\n                            <\/div>\n                            <div class=\"radio_wrapper\">\n                                <span class=\"wpcf7-form-control-wrap\" data-name=\"contacthealthcare\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"contacthealthcare\" value=\"\u0646\u0639\u0645\" \/><span class=\"wpcf7-list-item-label\">\u0646\u0639\u0645<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"contacthealthcare\" value=\"\u0644\u0627\" \/><span class=\"wpcf7-list-item-label\">\u0644\u0627<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"contacthealthcare\" value=\"\u0623\u0646\u0627 \u0645\u062a\u062e\u0635\u0635 \u0641\u064a \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0635\u062d\u064a\u0629\" \/><span class=\"wpcf7-list-item-label\">\u0623\u0646\u0627 \u0645\u062a\u062e\u0635\u0635 \u0641\u064a \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0635\u062d\u064a\u0629<\/span><\/span><\/span><\/span>\n                            <\/div>\n                        <\/div>\n                    <\/div>\n                <\/div>\n<div class=\"form_wrapper mt-[27px]\">\n<div data-id=\"group-healthcare-form\" data-orig_data_id=\"group-healthcare-form\" data-clear_on_hide class=\"\" data-class=\"wpcf7cf_group\">\n<h2>\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0627\u0644\u0645\u062a\u062e\u0635\u0635\u064a\u0646 \u0641\u064a \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0635\u062d\u064a\u0629<\/h2>\n<div class=\"\">\n<div class=\"multi_wrapper form_wrapper_div\">\n                        <div class=\"input_group form_input_style\">\n                            <label for=\"\">\u0627\u0633\u0645 <span>*<\/span><\/label>\n                            <span class=\"wpcf7-form-control-wrap\" data-name=\"health-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u0627\u0644\u0627\u0633\u0645 \u0623\u0648 \u0627\u0644\u0623\u062d\u0631\u0641 \u0627\u0644\u0623\u0648\u0644\u0649.\" value=\"\" type=\"text\" name=\"health-name\" \/><\/span>\n                        <\/div>\n<div class=\"input_group form_input_style\">\n                            <label for=\"\">\u0627\u0644\u0647\u0627\u062a\u0641 (\u0627\u0644\u0645\u0641\u0636\u0644)<\/label>\n                            <span class=\"wpcf7-form-control-wrap\" data-name=\"health-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=\"health-phone\" \/><\/span>\n                        <\/div>\n                    <\/div>\n                    <div class=\"multi_wrapper form_wrapper_div\">\n                        <div class=\"input_group form_input_style\">\n                            <label for=\"\">\u0639\u0646\u0648\u0627\u0646 \u0627\u0644\u0634\u0627\u0631\u0639<\/label>\n                            <span class=\"wpcf7-form-control-wrap\" data-name=\"health-address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"health-address\" \/><\/span>\n                        <\/div>\n<div class=\"input_group form_input_style\">\n                            <label for=\"\">\u0645\u062f\u064a\u0646\u0629 <\/label>\n                            <span class=\"wpcf7-form-control-wrap\" data-name=\"health-city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"health-city\" \/><\/span>\n                        <\/div>\n                    <\/div>\n                    <div class=\"multi_wrapper form_wrapper_div\">\n                        <div class=\"input_group form_input_style\">\n                            <label for=\"\">\u0631\u0645\u0632 \u0628\u0631\u064a\u062f\u064a <\/label>\n                            <span class=\"wpcf7-form-control-wrap\" data-name=\"health-postal\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"health-postal\" \/><\/span>\n                        <\/div>\n                        <div\n                            class=\"input_group form_input_style\">\n                            <label for=\"\">\u062f\u0648\u0644\u0629<\/label>\n                            <span class=\"wpcf7-form-control-wrap\" data-name=\"health-countrytext\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-countrytext wpcf7-text wpcf7-validates-as-countrytext\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"health-countrytext\" \/><\/span>\n                        <\/div>\n                    <\/div>\n                    <div class=\"multi_wrapper form_wrapper_div\">\n                        <div class=\"input_group form_input_style\">\n                            <label for=\"\">\u0628\u0631\u064a\u062f \u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a<span><\/span><\/label>\n                            <span class=\"wpcf7-form-control-wrap\" data-name=\"health-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=\"health-email\" \/><\/span>\n                        <\/div>\n                        <div class=\"input_group form_input_style\">\n                            <label for=\"\">\u0641\u0627\u0643\u0633<\/label>\n                            <span class=\"wpcf7-form-control-wrap\" data-name=\"health-fax\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"health-fax\" \/><\/span>\n                        <\/div>\n                    <\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"cancelButton\"><a href=\"javascript:void(0);\" class=\"cancelReport\">\u0625\u0644\u063a\u0627\u0621 \u0627\u0644\u062a\u0642\u0631\u064a\u0631<\/a><\/div>\n            <\/div><div class=\"cf7mls-btns \"><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-1\" style=\" \">\u0627\u0644\u062a\u0627\u0644\u064a<img decoding=\"async\" src=\"https:\/\/www.vieco-pharma.com\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/www.vieco-pharma.com\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\" \/><\/button><\/div><p><\/p><\/fieldset><fieldset class=\"fieldset-cf7mls\"><div class=\"single_box\">\n    <h2>\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0639\u0646 \u0627\u0644\u0645\u0646\u062a\u062c<\/h2>\n    <p>\u064a\u0631\u062c\u0649 \u062a\u0642\u062f\u064a\u0645 \u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0639\u0646 \u0645\u0646\u062a\u062c\u0627\u062a \u0641\u064a\u064a\u0643\u0648 \u0627\u0644\u062a\u064a \u062a\u0631\u063a\u0628 \u0641\u064a \u0627\u0644\u0625\u0628\u0644\u0627\u063a \u0639\u0646\u0647\u0627:<\/p>\n    <p>\u0623\u0636\u0641 \u0627\u0644\u0645\u0646\u062a\u062c\u0627\u062a \u0648\u0627\u062d\u062f\u064b\u0627 \u062a\u0644\u0648 \u0627\u0644\u0622\u062e\u0631 \u062b\u0645 \u062d\u062f\u062f \"\u0625\u0636\u0627\u0641\u0629 \u0622\u062e\u0631\" \u062d\u0633\u0628 \u0627\u0644\u062d\u0627\u062c\u0629.<\/p>\n    <div class=\"form_wrapper mt-[27px]\">\n<div data-wpcf7-group-id=\"product1\" id=\"product-groups\" tabindex=\"1\" class=\"wpcf7-field-groups \"><div class=\"wpcf7-field-group\">\n       <div class=\"single_itemwrapper multi_wrapper radio_multiwrapper form_wrapper_div productTable\">\n          <div class=\"input_group form_input_style productCntnt\">\n<div class=\"product-cwrapper\">\n<div class=\"pdtContnts\">\n              <label for=\"\">\u0627\u0644\u0645\u0646\u062a\u062c\u00a0<span>*<\/span><\/label>\n              <span class=\"wpcf7-form-control-wrap\" data-name=\"vieco-product-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=\"vieco-product-name\" \/><\/span>\n            <\/div>\n            <div class=\"pdtContnts\">\n              <label for=\"\">\u0645\u0648\u0635\u0648\u0641 \u0644\u0623\u0649 \u0645\u0631\u0636\u061f<\/label>\n              <span class=\"wpcf7-form-control-wrap\" data-name=\"vieco-indication\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"vieco-indication\" \/><\/span>\n            <\/div>\n<\/div>\n           <div class=\"product-cwrapper\">\n            <div class=\"pdtContnts\">\n              <label for=\"\">\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0628\u062f\u0621<\/label>\n              <span class=\"wpcf7-form-control-wrap\" data-name=\"vieco-start-full-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" max=\"2026-06-05\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"vieco-start-full-date\" \/><\/span>\n            <\/div>\n            <div class=\"pdtContnts\">\n              <label for=\"\">\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u062a\u0648\u0642\u0641<\/label>\n              <span class=\"wpcf7-form-control-wrap\" data-name=\"vieco-stop-full-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" max=\"2026-06-05\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"vieco-stop-full-date\" \/><\/span>\n            <\/div>\n           <\/div>\n                        <div class=\"product-cwrapper\">\n<div class=\"pdtContnts\">\n              <label for=\"\">\u0631\u0642\u0645 \u0627\u0644\u062a\u0634\u063a\u064a\u0644\u0629<\/label>\n              <span class=\"wpcf7-form-control-wrap\" data-name=\"vieco-batch-no\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"vieco-batch-no\" \/><\/span>\n            <\/div>\n            <div class=\"pdtContnts\">\n              <label for=\"\">\u062c\u0631\u0639\u0629 \u0627\u0644\u0645\u0646\u062a\u062c<\/label>\n              <h6 class=\"egText\">\u0645\u062b\u0644\u0627\u064b 20 \u0645\u0644\u063a \u0645\u0631\u062a\u064a\u0646 \u0641\u064a \u0627\u0644\u064a\u0648\u0645<\/h6>\n              <span class=\"wpcf7-form-control-wrap\" data-name=\"vieco-product-dose\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"vieco-product-dose\" \/><\/span>\n            <\/div>\n<\/div>\n            \n           <\/div>\n       <\/div>\n<button type='button' class='wpcf7-field-group-remove '>-<\/button><button type='button' class='wpcf7-field-group-add '>+<\/button><input type=\"hidden\" class=\"wpcf7-field-group-count\" name=\"_wpcf7_groups_count[product1]\" value=\"1\" \/><\/div><\/div>\n       <div class=\"single_itemwrapper multi_wrapper last_inputitem radio_multiwrapper form_wrapper_div\">\n           <div class=\"input_group radio_group form_input_style\">\n              <div class=\"content_wrap\">\n                 <label for=\"\">\u0647\u0644 \u0643\u0627\u0646 \u0627\u0644\u0645\u0631\u064a\u0636 \u064a\u062a\u0646\u0627\u0648\u0644 \u0623\u064a \u0623\u062f\u0648\u064a\u0629 \u0623\u062e\u0631\u0649 \u062e\u0644\u0627\u0644 \u0623\u0633\u0628\u0648\u0639\u064a\u0646 \u0645\u0646 \u0628\u062f\u0621 \u0627\u0644\u062d\u062f\u062b\u061f<\/label>\n                 <p>\u062a\u0634\u0645\u0644 \u0627\u0644\u0623\u062f\u0648\u064a\u0629 \u0627\u0644\u0645\u0648\u0635\u0648\u0641\u0629\u060c \u0648\u0627\u0644\u0623\u062f\u0648\u064a\u0629 \u0627\u0644\u0645\u0634\u062a\u0631\u0627\u0629 \u0645\u0646 \u0627\u0644\u0645\u062a\u0627\u062c\u0631\u060c \u0648\u0627\u0644\u0645\u0643\u0645\u0644\u0627\u062a \u0627\u0644\u063a\u0630\u0627\u0626\u064a\u0629\u060c \u0648\u0627\u0644\u0639\u0644\u0627\u062c\u0627\u062a \u0627\u0644\u0639\u0634\u0628\u064a\u0629<\/p>\n              <\/div>\n              <div class=\"radio_wrapper\">\n                  <span class=\"wpcf7-form-control-wrap\" data-name=\"othermedications\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"othermedications\" value=\"\u0646\u0639\u0645\" \/><span class=\"wpcf7-list-item-label\">\u0646\u0639\u0645<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"othermedications\" value=\"\u0644\u0627\" \/><span class=\"wpcf7-list-item-label\">\u0644\u0627<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"othermedications\" value=\"\u063a\u064a\u0631 \u0645\u0639\u0631\u0648\u0641\" \/><span class=\"wpcf7-list-item-label\">\u063a\u064a\u0631 \u0645\u0639\u0631\u0648\u0641<\/span><\/span><\/span><\/span>\n               <\/div>\n           <\/div>\n         <\/div>\n<div data-id=\"group-product2\" data-orig_data_id=\"group-product2\" data-clear_on_hide class=\"\" data-class=\"wpcf7cf_group\">\n<div data-wpcf7-group-id=\"product2\" id=\"product-groupss\" class=\"wpcf7-field-groups product02groups\" tabindex=\"1\"><div class=\"wpcf7-field-group\">\n       <div class=\"single_itemwrapper multi_wrapper radio_multiwrapper form_wrapper_div productTable\">\n          <div class=\"input_group form_input_style productCntnt\">\n            <div class=\"product-cwrapper\">\n              <div class=\"pdtContnts\">\n               <label for=\"\">\u0645\u0646\u062a\u062c\u0627\u062a <span>*<\/span><\/label>\n               <span class=\"wpcf7-form-control-wrap\" data-name=\"medications-product-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=\"medications-product-name\" \/><\/span>\n             <\/div>\n           <\/div>\n           <div class=\"product-cwrapper\">\n            <div class=\"pdtContnts\">\n              <label for=\"\">\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0628\u062f\u0621<\/label>\n              <span class=\"wpcf7-form-control-wrap\" data-name=\"medications-start-full-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" max=\"2026-06-05\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"medications-start-full-date\" \/><\/span>\n            <\/div>\n            <div class=\"pdtContnts\">\n              <label for=\"\">\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u062a\u0648\u0642\u0641<\/label>\n              <span class=\"wpcf7-form-control-wrap\" data-name=\"medications-stop-full-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" max=\"2026-06-05\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"medications-stop-full-date\" \/><\/span>\n            <\/div>\n           <\/div>\n             \n<div class=\"product-cwrapper\">\n<div class=\"pdtContnts\">\n              <label for=\"\">\u0631\u0642\u0645 \u0627\u0644\u062f\u0641\u0639\u0629\/\u0627\u0644\u062f\u0641\u0639\u0629<\/label>\n              <span class=\"wpcf7-form-control-wrap\" data-name=\"medications-batch-no\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"medications-batch-no\" \/><\/span>\n            <\/div>\n<\/div>\n            \n           <\/div>\n       <\/div>\n<button type='button' class='wpcf7-field-group-remove '>-<\/button><button type='button' class='wpcf7-field-group-add '>+<\/button><input type=\"hidden\" class=\"wpcf7-field-group-count\" name=\"_wpcf7_groups_count[product2]\" value=\"1\" \/><\/div><\/div>\n<\/div>\n    <\/div>\n<div class=\"cancelButton\"><a href=\"javascript:void(0);\" class=\"cancelReport\">\u0625\u0644\u063a\u0627\u0621 \u0627\u0644\u062a\u0642\u0631\u064a\u0631<\/a><\/div>\n<\/div><div class=\"cf7mls-btns \"><button type=\"button\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\" id=\"cf7mls-back-btn-cf7mls_step-2\" style=\" \">\u0631\u062c\u0648\u0639<\/button><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-2\" style=\" \">\u0627\u0644\u062a\u0627\u0644\u064a<img decoding=\"async\" src=\"https:\/\/www.vieco-pharma.com\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/www.vieco-pharma.com\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\" \/><\/button><\/div><p><\/p><\/fieldset><fieldset class=\"fieldset-cf7mls\"><div class=\"single_box\">\n    <h2>\u0645\u0639\u0644\u0648\u0645\u0627\u062a  \u0639\u0646 \u0627\u0644\u0623\u062b\u0627\u0631\u0627\u0644\u0633\u0644\u0628\u064a\u0629<\/h2>\n    <div class=\"form_wrapper mt-[27px]\">\n       <div class=\"single_itemwrapper multi_wrapper form_wrapper_div\">\n          <div class=\"input_group full-width form_input_style\">\n              <label for=\"\">\u064a\u0631\u062c\u0649 \u0648\u0635\u0641 \u0627\u0644\u062d\u062f\u062b (\u0627\u0644\u0623\u062d\u062f\u0627\u062b) \u0627\u0644\u0633\u0644\u0628\u064a\u0629 (\u062d\u062a\u0649 1000 \u062d\u0631\u0641)<span>*<\/span><\/label>\n              <span class=\"wpcf7-form-control-wrap\" data-name=\"adverseevent\"><textarea cols=\"40\" rows=\"10\" maxlength=\"1000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"adverseevent\"><\/textarea><\/span>\n           <\/div>\n       <\/div>\n       <div\n                class=\"multi_wrapper form_wrapper_div\">\n                <div\n                    class=\"input_group select_input form_input_style\">\n                    <label for=\"\">\u0641\u064a \u0623\u064a \u0628\u0644\u062f \u062d\u062f\u062b \u0647\u0630\u0627\u061f<span>*<\/span><\/label>\n                    <span class=\"wpcf7-form-control-wrap\" data-name=\"eventcountry\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-countrytext wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-countrytext\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"eventcountry\" \/><\/span>\n                <\/div>\n                <div class=\"input_group radio_wrapper form_input_style\">\n                        <label for=\"\">\u0645\u062a\u0649 \u0628\u062f\u0623\u062a \u0627\u0644\u0623\u062b\u0627\u0631 \u0627\u0644\u0633\u0644\u0628\u064a\u0629\u061f<\/label>\n                        <span class=\"wpcf7-form-control-wrap\" data-name=\"eventfulldate\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" max=\"2026-06-05\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"eventfulldate\" \/><\/span>\n                <\/div>\n            <\/div>\n            <div class=\"single_itemwrapper multi_wrapper last_inputitem radio_multiwrapper form_wrapper_div\">\n           <div class=\"input_group form_input_style\">\n              <div class=\"content_wrap\">\n                 <label for=\"\">\u0647\u0644 \u0623\u062f\u062a \u0627\u0644\u0623\u062b\u0627\u0631 \u0627\u0644\u0633\u0644\u0628\u064a\u0629 \u0625\u0644\u0649 \u0623\u064a \u0645\u0646 \u0627\u0644\u0622\u062a\u064a\u061f<\/label>\n              <\/div>\n              <div class=\"checkbox_wrapper checkboxSelection\">\n<span class=\"wpcf7-form-control-wrap\" data-name=\"eventresult\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"eventresult[]\" value=\"\u0627\u0644\u062f\u062e\u0648\u0644 \u0627\u0644\u0649 \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649\u061f\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0644\u062f\u062e\u0648\u0644 \u0627\u0644\u0649 \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649\u061f<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"eventresult[]\" value=\"\u062a\u0645\u062f\u064a\u062f \u0627\u0644\u0625\u0642\u0627\u0645\u0629 \u0627\u0644\u062d\u0627\u0644\u064a\u0629 \u0641\u064a \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649\u061f (\u0627\u0644\u0639\u0644\u0627\u062c \u0627\u0644\u0645\u0642\u062f\u0645 \u062e\u0644\u0627\u0644 \u0627\u0644\u0625\u0642\u0627\u0645\u0629 \u0627\u0644\u062d\u0627\u0644\u064a\u0629 \u0641\u064a \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649)\" \/><span class=\"wpcf7-list-item-label\">\u062a\u0645\u062f\u064a\u062f \u0627\u0644\u0625\u0642\u0627\u0645\u0629 \u0627\u0644\u062d\u0627\u0644\u064a\u0629 \u0641\u064a \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649\u061f (\u0627\u0644\u0639\u0644\u0627\u062c \u0627\u0644\u0645\u0642\u062f\u0645 \u062e\u0644\u0627\u0644 \u0627\u0644\u0625\u0642\u0627\u0645\u0629 \u0627\u0644\u062d\u0627\u0644\u064a\u0629 \u0641\u064a \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"eventresult[]\" value=\"\u0645\u0631\u0636 \u064a\u0647\u062f\u062f \u0627\u0644\u062d\u064a\u0627\u0629 (\u062e\u0637\u0631 \u0641\u0648\u0631\u064a \u0644\u0644\u0648\u0641\u0627\u0629 \u0646\u0627\u062a\u062c \u0639\u0646 \u0627\u0644\u0623\u062b\u0631 \u0627\u0644\u0633\u0644\u0628\u064a\u061f)\" \/><span class=\"wpcf7-list-item-label\">\u0645\u0631\u0636 \u064a\u0647\u062f\u062f \u0627\u0644\u062d\u064a\u0627\u0629 (\u062e\u0637\u0631 \u0641\u0648\u0631\u064a \u0644\u0644\u0648\u0641\u0627\u0629 \u0646\u0627\u062a\u062c \u0639\u0646 \u0627\u0644\u0623\u062b\u0631 \u0627\u0644\u0633\u0644\u0628\u064a\u061f)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"eventresult[]\" value=\"\u0625\u0639\u0627\u0642\u0629 \u0623\u0648 \u062a\u0644\u0641 \u062f\u0627\u0626\u0645\" \/><span class=\"wpcf7-list-item-label\">\u0625\u0639\u0627\u0642\u0629 \u0623\u0648 \u062a\u0644\u0641 \u062f\u0627\u0626\u0645<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"eventresult[]\" value=\"\u0627\u0644\u0645\u0631\u064a\u0636 \u062a\u0648\u0641\u064a\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0644\u0645\u0631\u064a\u0636 \u062a\u0648\u0641\u064a<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"eventresult[]\" value=\"\u062a\u0634\u0648\u0647 \u062e\u0644\u0642\u064a \u0623\u0648 \u0639\u064a\u0628 \u0639\u0646\u062f \u0627\u0644\u0648\u0644\u0627\u062f\u0629\" \/><span class=\"wpcf7-list-item-label\">\u062a\u0634\u0648\u0647 \u062e\u0644\u0642\u064a \u0623\u0648 \u0639\u064a\u0628 \u0639\u0646\u062f \u0627\u0644\u0648\u0644\u0627\u062f\u0629<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"eventresult[]\" value=\"\u0644\u0627 \u0634\u064a\u0621 \u0645\u0645\u0627 \u0633\u0628\u0642\" \/><span class=\"wpcf7-list-item-label\">\u0644\u0627 \u0634\u064a\u0621 \u0645\u0645\u0627 \u0633\u0628\u0642<\/span><\/label><\/span><\/span><\/span> <\/div>\n           <\/div>\n         <\/div>\n<div data-id=\"group-hospitalization\" data-orig_data_id=\"group-hospitalization\" data-clear_on_hide class=\"\" data-class=\"wpcf7cf_group\">\n<div class=\"multi_wrapper last_inputitem radio_multiwrapper form_wrapper_div\">\n                        <div class=\"input_group form_input_style formExtra hospitalStay\">\n                            <label for=\"\">\u0643\u0645 \u0643\u0627\u0646\u062a \u0645\u062f\u0629 \u0627\u0644\u0625\u0642\u0627\u0645\u0629 \u0641\u064a \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649\u061f<\/label>\n                            <span class=\"wpcf7-form-control-wrap\" data-name=\"hospital-stay\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"hospital-stay\" \/><\/span>\n                        <\/div>\n                    <\/div>\n<\/div>\n<div class=\"single_itemwrapper multi_wrapper last_inputitem radio_multiwrapper form_wrapper_div\">\n                        <div class=\"input_group radio_group form_input_style\">\n                            <div class=\"content_wrap\">\n                                <label for=\"\">\u0647\u0644 \u062a\u0645 \u062a\u0644\u0642\u064a \u0639\u0644\u0627\u062c \u0644\u0644\u0623\u062b\u0631 (\u0627\u0644\u0623\u062b\u0627\u0631) \u0627\u0644\u0633\u0644\u0628\u064a\u0629\u061f<\/label>\n                            <\/div>\n                            <div class=\"radio_wrapper\">\n                                <span class=\"wpcf7-form-control-wrap\" data-name=\"treatmentreceived\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"treatmentreceived\" value=\"\u0646\u0639\u0645\" \/><span class=\"wpcf7-list-item-label\">\u0646\u0639\u0645<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"treatmentreceived\" value=\"\u0644\u0627\" \/><span class=\"wpcf7-list-item-label\">\u0644\u0627<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"treatmentreceived\" value=\"\u0645\u062c\u0647\u0648\u0644\" \/><span class=\"wpcf7-list-item-label\">\u0645\u062c\u0647\u0648\u0644<\/span><\/span><\/span><\/span>\n                            <\/div>\n                        <\/div>\n                    <\/div> \n<div data-id=\"group-adverse-event\" data-orig_data_id=\"group-adverse-event\" data-clear_on_hide class=\"\" data-class=\"wpcf7cf_group\">\n<div class=\"single_itemwrapper multi_wrapper last_inputitem form_wrapper_div\">\n                        <div\n                            class=\"input_group form_input_style formExtra\">\n                            <label for=\"\">\u0645\u0627 \u0647\u0648 \u0627\u0644\u0639\u0644\u0627\u062c \u0627\u0644\u0630\u064a \u062a\u0644\u0642\u0627\u0647 \u0627\u0644\u0645\u0631\u064a\u0636\u061f<\/label>\n                            <span class=\"wpcf7-form-control-wrap\" data-name=\"treatment-receive\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"treatment-receive\" \/><\/span>\n                        <\/div>\n                    <\/div>\n<\/div>\n<div class=\"multi_wrapper form_wrapper_div medicalStatus\">\n                <div class=\"input_group select_input form_input_style\">\n                    <label for=\"\">\u0647\u0644 \u062a\u0639\u0627\u0641\u0649 \u0627\u0644\u0645\u0631\u064a\u0636 \u0645\u0646 \u0647\u0630\u0627 \u0627\u0644\u062d\u062f\u062b (\u0627\u0644\u0623\u062d\u062f\u0627\u062b)\u061f\n<\/label>\n                    <span class=\"wpcf7-form-control-wrap\" data-name=\"adverseeventresult\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"adverseeventresult\"><option value=\"\">\u0627\u062e\u062a\u0631 \u0627\u0644\u062d\u0627\u0644\u0629 \u0627\u0644\u0637\u0628\u064a\u0629<\/option><option value=\"\u062a\u0645 \u0627\u0633\u062a\u0631\u062f\u0627\u062f\u0647\u0627\">\u062a\u0645 \u0627\u0633\u062a\u0631\u062f\u0627\u062f\u0647\u0627<\/option><option value=\"\u062a\u0645 \u0627\u0644\u062a\u0639\u0627\u0641\u064a \u0645\u0639 \u062a\u0623\u062b\u064a\u0631\u0627\u062a \u062f\u0627\u0626\u0645\u0629\">\u062a\u0645 \u0627\u0644\u062a\u0639\u0627\u0641\u064a \u0645\u0639 \u062a\u0623\u062b\u064a\u0631\u0627\u062a \u062f\u0627\u0626\u0645\u0629<\/option><option value=\"\u0627\u0644\u062a\u0639\u0627\u0641\u064a\">\u0627\u0644\u062a\u0639\u0627\u0641\u064a<\/option><option value=\"\u0644\u0645 \u064a\u062a\u0645 \u0627\u0633\u062a\u0631\u062f\u0627\u062f\u0647\u0627\">\u0644\u0645 \u064a\u062a\u0645 \u0627\u0633\u062a\u0631\u062f\u0627\u062f\u0647\u0627<\/option><option value=\"\u0645\u062c\u0647\u0648\u0644\">\u0645\u062c\u0647\u0648\u0644<\/option><\/select><\/span>\n                <\/div>\n<div data-id=\"adverseeventstop\" data-orig_data_id=\"adverseeventstop\" data-clear_on_hide class=\"half-width\" data-class=\"wpcf7cf_group\">\n                <div class=\"input_group select_input form_input_style\">\n<label for=\"\">\u0645\u062a\u0649 \u062a\u0648\u0642\u0641 \u0627\u0644\u062d\u062f\u062b \u0627\u0644\u0636\u0627\u0631\u061f<\/label>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"adverse_event_stop\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" max=\"2026-06-05\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"adverse_event_stop\" \/><\/span> \n                <\/div>\n<\/div>\n    <\/div>  \n<div class=\"single_itemwrapper multi_wrapper last_inputitem radio_multiwrapper form_wrapper_div\">\n                        <div class=\"input_group radio_group form_input_style\">\n                            <div class=\"content_wrap\">\n                                <label for=\"\">\u0647\u0644 \u062a\u0639\u062a\u0642\u062f \u0623\u0646 \u0627\u0644\u0622\u062b\u0627\u0631 \u0627\u0644\u062c\u0627\u0646\u0628\u064a\u0629 \u0646\u0627\u062a\u062c\u0629 \u0639\u0646 \u0627\u0644\u0645\u0646\u062a\u062c \u0627\u0644\u0645\u0628\u0644\u063a \u0639\u0646\u0647\u061f<\/label>\n                            <\/div>\n                            <div class=\"radio_wrapper\">\n                                <span class=\"wpcf7-form-control-wrap\" data-name=\"product_side_effect\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"product_side_effect\" value=\"\u0645\u062d\u062a\u0645\u0644\" \/><span class=\"wpcf7-list-item-label\">\u0645\u062d\u062a\u0645\u0644<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"product_side_effect\" value=\"\u0645\u0645\u0643\u0646\" \/><span class=\"wpcf7-list-item-label\">\u0645\u0645\u0643\u0646<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"product_side_effect\" value=\"\u0645\u0646 \u063a\u064a\u0631 \u0627\u0644\u0645\u062d\u062a\u0645\u0644\" \/><span class=\"wpcf7-list-item-label\">\u0645\u0646 \u063a\u064a\u0631 \u0627\u0644\u0645\u062d\u062a\u0645\u0644<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"product_side_effect\" value=\"\u0645\u062c\u0647\u0648\u0644\" \/><span class=\"wpcf7-list-item-label\">\u0645\u062c\u0647\u0648\u0644<\/span><\/span><\/span><\/span>\n                            <\/div>\n                        <\/div>\n                    <\/div>\n<div class=\"cancelButton\"><a href=\"javascript:void(0);\" class=\"cancelReport\">\u0625\u0644\u063a\u0627\u0621 \u0627\u0644\u062a\u0642\u0631\u064a\u0631<\/a><\/div>\n<\/div><div class=\"cf7mls-btns \"><button type=\"button\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\" id=\"cf7mls-back-btn-cf7mls_step-3\" style=\" \">\u0631\u062c\u0648\u0639<\/button><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-3\" style=\" \">\u0627\u0644\u062a\u0627\u0644\u064a<img decoding=\"async\" src=\"https:\/\/www.vieco-pharma.com\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/www.vieco-pharma.com\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\" \/><\/button><\/div><p><\/p><\/fieldset><fieldset class=\"fieldset-cf7mls\"><div class=\"single_box\">\n    <h2>\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0625\u0636\u0627\u0641\u064a\u0629<\/h2>\n    <div class=\"form_wrapper mt-[27px]\">\n       <div\n                        class=\"multi_wrapper single_itemwrapper form_wrapper_div\">\n                        <div\n                            class=\"input_group form_input_style\">\n                            <label for=\"\">\u0623\u0645\u0631\u0627\u0636 \u0623\u062e\u0631\u0649 \u062a\u0645 \u062a\u0634\u062e\u064a\u0635\u0647\u0627 \/ \u0627\u0644\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0637\u0628\u064a \/ \u0627\u0644\u062d\u0627\u0644\u0627\u062a \u0627\u0644\u0645\u0631\u0636\u064a\u0629 \u0627\u0644\u0645\u0632\u0645\u0646\u0629<\/label>\n                            <span class=\"wpcf7-form-control-wrap\" data-name=\"health-conditions\"><input size=\"100\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"health-conditions\" \/><\/span>\n                        <\/div>\n                    <\/div>\n    <\/div>\n<div class=\"cancelButton\"><a href=\"javascript:void(0);\" class=\"cancelReport\">\u0625\u0644\u063a\u0627\u0621 \u0627\u0644\u062a\u0642\u0631\u064a\u0631<\/a><\/div>\n<\/div><div class=\"cf7mls-btns \"><button type=\"button\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\" id=\"cf7mls-back-btn-cf7mls_step-4\" style=\" \">\u0631\u062c\u0648\u0639<\/button><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-4\" style=\" \">\u0627\u0644\u062a\u0627\u0644\u064a<img decoding=\"async\" src=\"https:\/\/www.vieco-pharma.com\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/www.vieco-pharma.com\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\" \/><\/button><\/div><p><\/p><\/fieldset><fieldset class=\"fieldset-cf7mls\"><div class=\"single_box\">\n    <h2 class=\"review-title\">\u0645\u0631\u0627\u062c\u0639\u0629<\/h2>\n<div class=\"reviewDisplay\">\n<\/div>\n<div class=\"ackSection\">\n<p>\u0633\u064a\u062a\u0645 \u0627\u0644\u062a\u0639\u0627\u0645\u0644 \u0645\u0639 \u0647\u0630\u0627 \u0627\u0644\u062d\u062f\u062b \u0627\u0644\u0633\u0644\u0628\u064a\u060c \u0648\u062a\u0641\u0627\u0635\u064a\u0644 \u0627\u0644\u0627\u062a\u0635\u0627\u0644\u060c \u0648\u0627\u0644\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0627\u0644\u0634\u062e\u0635\u064a\u0629 \u0627\u0644\u0645\u0642\u062f\u0645\u0629 \u0645\u0646\u0643\u0645 \u0645\u0646 \u0642\u0628\u0644 \u0634\u0631\u0643\u0629 \u0641\u064a\u0643\u0648 \u0648\u0641\u0642\u064b\u0627 \u0644\u0633\u064a\u0627\u0633\u0629 \u0627\u0644\u062e\u0635\u0648\u0635\u064a\u0629 \u0627\u0644\u062e\u0627\u0635\u0629 \u0628\u0634\u0631\u0643\u0629 \u0641\u064a\u0643\u0648\u060c \u0648\u0627\u0644\u062a\u064a \u062a\u062a\u0648\u0641\u0631 \u0641\u064a \u0627\u0644\u0631\u0627\u0628\u0637 \u0623\u062f\u0646\u0627\u0647. <a href=\"https:\/\/www.vieco-pharma.com\/privacy-policy\/\" target=\"_blank\">\u0627\u0637\u0644\u0639 \u0639\u0644\u0649 \u0633\u064a\u0627\u0633\u0629 \u0627\u0644\u062e\u0635\u0648\u0635\u064a\u0629 \u0627\u0644\u062e\u0627\u0635\u0629 \u0628\u0634\u0631\u0643\u0629 \u0641\u064a\u0643\u0648<\/a><\/p><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"acceptance-294\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"acceptance-294\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">&nbsp; \u0623\u0648\u0627\u0641\u0642 \u0639\u0644\u0649  \u0627\u0644\u062e\u0627\u0635\u0629 \u0628\u0634\u0631\u0643\u0629 \u0641\u064a\u0643\u0648 <a href=\"https:\/\/www.vieco-pharma.com\/privacy-policy\/\" target=\"_blank\"> \u0633\u064a\u0627\u0633\u0629 \u0627\u0644\u062e\u0635\u0648\u0635\u064a\u0629 <\/a><\/span><\/label><\/span><\/span><\/span>\n<br>\n<\/div>\n<div id=\"cf7sr-6a21f0c5f23b8\" class=\"cf7sr-g-recaptcha\" data-theme=\"light\" data-type=\"image\" data-size=\"normal\" data-sitekey=\"6LcRrz8rAAAAABB29HSO7T2OGfyXaiGITVR2OwHO\"><\/div><span class=\"wpcf7-form-control-wrap cf7sr-recaptcha\" data-name=\"cf7sr-recaptcha\"><input type=\"hidden\" name=\"cf7sr-recaptcha\" value=\"\" class=\"wpcf7-form-control\"><\/span>\n<div class=\"submit-button\">\n<input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"\u0623\u0631\u0633\u0627\u0644\" \/>\n<\/div>\n<div class=\"cancelButton\"><a href=\"javascript:void(0);\" class=\"cancelReport\">\u0625\u0644\u063a\u0627\u0621 \u0627\u0644\u062a\u0642\u0631\u064a\u0631<\/a><\/div>\n<\/div><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-5\" style=\" \">\u0631\u062c\u0648\u0639<\/button><button type=\"button\" style=\"display: none;\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-5\" style=\" \"><img decoding=\"async\" src=\"https:\/\/www.vieco-pharma.com\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/www.vieco-pharma.com\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\" \/><\/button><\/fieldset><\/div><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"175\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"patient-form.php","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-1351","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>\u0646\u0645\u0648\u0630\u062c \u0627\u0644\u0645\u0631\u064a\u0636 - Vieco Pharmaceuticals FZCO<\/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:\/\/www.vieco-pharma.com\/ar\/patient-form\/\" \/>\n<meta property=\"og:locale\" content=\"ar_AR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"\u0646\u0645\u0648\u0630\u062c \u0627\u0644\u0645\u0631\u064a\u0636 - Vieco Pharmaceuticals FZCO\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.vieco-pharma.com\/ar\/patient-form\/\" \/>\n<meta property=\"og:site_name\" content=\"Vieco Pharmaceuticals FZCO\" \/>\n<meta property=\"article:modified_time\" content=\"2025-06-23T13:31:22+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.vieco-pharma.com\/wp-content\/uploads\/2025\/03\/VieCo-Logo-1.png\" \/>\n\t<meta property=\"og:image:width\" content=\"150\" \/>\n\t<meta property=\"og:image:height\" content=\"67\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"1 \u062f\u0642\u064a\u0642\u0629\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.vieco-pharma.com\\\/ar\\\/patient-form\\\/\",\"url\":\"https:\\\/\\\/www.vieco-pharma.com\\\/ar\\\/patient-form\\\/\",\"name\":\"\u0646\u0645\u0648\u0630\u062c \u0627\u0644\u0645\u0631\u064a\u0636 - Vieco Pharmaceuticals FZCO\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.vieco-pharma.com\\\/ar\\\/#website\"},\"datePublished\":\"2025-04-22T05:27:09+00:00\",\"dateModified\":\"2025-06-23T13:31:22+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/www.vieco-pharma.com\\\/ar\\\/patient-form\\\/#breadcrumb\"},\"inLanguage\":\"ar\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/www.vieco-pharma.com\\\/ar\\\/patient-form\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/www.vieco-pharma.com\\\/ar\\\/patient-form\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/www.vieco-pharma.com\\\/ar\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"\u0646\u0645\u0648\u0630\u062c \u0627\u0644\u0645\u0631\u064a\u0636\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/www.vieco-pharma.com\\\/ar\\\/#website\",\"url\":\"https:\\\/\\\/www.vieco-pharma.com\\\/ar\\\/\",\"name\":\"Vieco Pharmaceuticals FZCO\",\"description\":\"Pharmaceutical company in Dubai\",\"publisher\":{\"@id\":\"https:\\\/\\\/www.vieco-pharma.com\\\/ar\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/www.vieco-pharma.com\\\/ar\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"ar\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/www.vieco-pharma.com\\\/ar\\\/#organization\",\"name\":\"Vieco Pharmaceuticals FZCO\",\"url\":\"https:\\\/\\\/www.vieco-pharma.com\\\/ar\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"ar\",\"@id\":\"https:\\\/\\\/www.vieco-pharma.com\\\/ar\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/www.vieco-pharma.com\\\/wp-content\\\/uploads\\\/2025\\\/03\\\/VieCo-Logo-1.png\",\"contentUrl\":\"https:\\\/\\\/www.vieco-pharma.com\\\/wp-content\\\/uploads\\\/2025\\\/03\\\/VieCo-Logo-1.png\",\"width\":150,\"height\":67,\"caption\":\"Vieco Pharmaceuticals FZCO\"},\"image\":{\"@id\":\"https:\\\/\\\/www.vieco-pharma.com\\\/ar\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.linkedin.com\\\/company\\\/vieco-pharmaceuticals\\\/\"]}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"\u0646\u0645\u0648\u0630\u062c \u0627\u0644\u0645\u0631\u064a\u0636 - Vieco Pharmaceuticals FZCO","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.vieco-pharma.com\/ar\/patient-form\/","og_locale":"ar_AR","og_type":"article","og_title":"\u0646\u0645\u0648\u0630\u062c \u0627\u0644\u0645\u0631\u064a\u0636 - Vieco Pharmaceuticals FZCO","og_url":"https:\/\/www.vieco-pharma.com\/ar\/patient-form\/","og_site_name":"Vieco Pharmaceuticals FZCO","article_modified_time":"2025-06-23T13:31:22+00:00","og_image":[{"width":150,"height":67,"url":"https:\/\/www.vieco-pharma.com\/wp-content\/uploads\/2025\/03\/VieCo-Logo-1.png","type":"image\/png"}],"twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"1 \u062f\u0642\u064a\u0642\u0629"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/www.vieco-pharma.com\/ar\/patient-form\/","url":"https:\/\/www.vieco-pharma.com\/ar\/patient-form\/","name":"\u0646\u0645\u0648\u0630\u062c \u0627\u0644\u0645\u0631\u064a\u0636 - Vieco Pharmaceuticals FZCO","isPartOf":{"@id":"https:\/\/www.vieco-pharma.com\/ar\/#website"},"datePublished":"2025-04-22T05:27:09+00:00","dateModified":"2025-06-23T13:31:22+00:00","breadcrumb":{"@id":"https:\/\/www.vieco-pharma.com\/ar\/patient-form\/#breadcrumb"},"inLanguage":"ar","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.vieco-pharma.com\/ar\/patient-form\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/www.vieco-pharma.com\/ar\/patient-form\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.vieco-pharma.com\/ar\/"},{"@type":"ListItem","position":2,"name":"\u0646\u0645\u0648\u0630\u062c \u0627\u0644\u0645\u0631\u064a\u0636"}]},{"@type":"WebSite","@id":"https:\/\/www.vieco-pharma.com\/ar\/#website","url":"https:\/\/www.vieco-pharma.com\/ar\/","name":"Vieco Pharmaceuticals FZCO","description":"Pharmaceutical company in Dubai","publisher":{"@id":"https:\/\/www.vieco-pharma.com\/ar\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.vieco-pharma.com\/ar\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"ar"},{"@type":"Organization","@id":"https:\/\/www.vieco-pharma.com\/ar\/#organization","name":"Vieco Pharmaceuticals FZCO","url":"https:\/\/www.vieco-pharma.com\/ar\/","logo":{"@type":"ImageObject","inLanguage":"ar","@id":"https:\/\/www.vieco-pharma.com\/ar\/#\/schema\/logo\/image\/","url":"https:\/\/www.vieco-pharma.com\/wp-content\/uploads\/2025\/03\/VieCo-Logo-1.png","contentUrl":"https:\/\/www.vieco-pharma.com\/wp-content\/uploads\/2025\/03\/VieCo-Logo-1.png","width":150,"height":67,"caption":"Vieco Pharmaceuticals FZCO"},"image":{"@id":"https:\/\/www.vieco-pharma.com\/ar\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.linkedin.com\/company\/vieco-pharmaceuticals\/"]}]}},"_links":{"self":[{"href":"https:\/\/www.vieco-pharma.com\/ar\/wp-json\/wp\/v2\/pages\/1351","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.vieco-pharma.com\/ar\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.vieco-pharma.com\/ar\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.vieco-pharma.com\/ar\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.vieco-pharma.com\/ar\/wp-json\/wp\/v2\/comments?post=1351"}],"version-history":[{"count":2,"href":"https:\/\/www.vieco-pharma.com\/ar\/wp-json\/wp\/v2\/pages\/1351\/revisions"}],"predecessor-version":[{"id":1421,"href":"https:\/\/www.vieco-pharma.com\/ar\/wp-json\/wp\/v2\/pages\/1351\/revisions\/1421"}],"wp:attachment":[{"href":"https:\/\/www.vieco-pharma.com\/ar\/wp-json\/wp\/v2\/media?parent=1351"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}