{"id":540,"date":"2018-11-27T09:16:54","date_gmt":"2018-11-27T09:16:54","guid":{"rendered":"https:\/\/prescription.kidneyhealthkolkata.com\/index.php\/home\/"},"modified":"2023-07-01T02:48:34","modified_gmt":"2023-07-01T02:48:34","slug":"home","status":"publish","type":"page","link":"https:\/\/prescription.kidneyhealthkolkata.com\/","title":{"rendered":"PRESCRIPTION"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"540\" class=\"elementor elementor-540\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-c50838b elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"c50838b\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\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-55b0429\" data-id=\"55b0429\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-453e782 elementor-widget elementor-widget-heading\" data-id=\"453e782\" 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 - v3.14.0 - 26-06-2023 *\/\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><h1 class=\"elementor-heading-title elementor-size-default\">WRITE PRESCRIPTION<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-92570e2 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"92570e2\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.14.0 - 26-06-2023 *\/\n.elementor-widget-divider{--divider-border-style:none;--divider-border-width:1px;--divider-color:#0c0d0e;--divider-icon-size:20px;--divider-element-spacing:10px;--divider-pattern-height:24px;--divider-pattern-size:20px;--divider-pattern-url:none;--divider-pattern-repeat:repeat-x}.elementor-widget-divider .elementor-divider{display:flex}.elementor-widget-divider .elementor-divider__text{font-size:15px;line-height:1;max-width:95%}.elementor-widget-divider .elementor-divider__element{margin:0 var(--divider-element-spacing);flex-shrink:0}.elementor-widget-divider .elementor-icon{font-size:var(--divider-icon-size)}.elementor-widget-divider .elementor-divider-separator{display:flex;margin:0;direction:ltr}.elementor-widget-divider--view-line_icon .elementor-divider-separator,.elementor-widget-divider--view-line_text .elementor-divider-separator{align-items:center}.elementor-widget-divider--view-line_icon .elementor-divider-separator:after,.elementor-widget-divider--view-line_icon .elementor-divider-separator:before,.elementor-widget-divider--view-line_text .elementor-divider-separator:after,.elementor-widget-divider--view-line_text .elementor-divider-separator:before{display:block;content:\"\";border-bottom:0;flex-grow:1;border-top:var(--divider-border-width) var(--divider-border-style) var(--divider-color)}.elementor-widget-divider--element-align-left .elementor-divider .elementor-divider-separator>.elementor-divider__svg:first-of-type{flex-grow:0;flex-shrink:100}.elementor-widget-divider--element-align-left .elementor-divider-separator:before{content:none}.elementor-widget-divider--element-align-left .elementor-divider__element{margin-left:0}.elementor-widget-divider--element-align-right .elementor-divider .elementor-divider-separator>.elementor-divider__svg:last-of-type{flex-grow:0;flex-shrink:100}.elementor-widget-divider--element-align-right .elementor-divider-separator:after{content:none}.elementor-widget-divider--element-align-right .elementor-divider__element{margin-right:0}.elementor-widget-divider:not(.elementor-widget-divider--view-line_text):not(.elementor-widget-divider--view-line_icon) .elementor-divider-separator{border-top:var(--divider-border-width) var(--divider-border-style) var(--divider-color)}.elementor-widget-divider--separator-type-pattern{--divider-border-style:none}.elementor-widget-divider--separator-type-pattern.elementor-widget-divider--view-line .elementor-divider-separator,.elementor-widget-divider--separator-type-pattern:not(.elementor-widget-divider--view-line) .elementor-divider-separator:after,.elementor-widget-divider--separator-type-pattern:not(.elementor-widget-divider--view-line) .elementor-divider-separator:before,.elementor-widget-divider--separator-type-pattern:not([class*=elementor-widget-divider--view]) .elementor-divider-separator{width:100%;min-height:var(--divider-pattern-height);-webkit-mask-size:var(--divider-pattern-size) 100%;mask-size:var(--divider-pattern-size) 100%;-webkit-mask-repeat:var(--divider-pattern-repeat);mask-repeat:var(--divider-pattern-repeat);background-color:var(--divider-color);-webkit-mask-image:var(--divider-pattern-url);mask-image:var(--divider-pattern-url)}.elementor-widget-divider--no-spacing{--divider-pattern-size:auto}.elementor-widget-divider--bg-round{--divider-pattern-repeat:round}.rtl .elementor-widget-divider .elementor-divider__text{direction:rtl}.e-con-inner>.elementor-widget-divider,.e-con>.elementor-widget-divider{width:var(--container-widget-width,100%);--flex-grow:var(--container-widget-flex-grow)}<\/style>\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\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\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-4d462e3 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"4d462e3\" 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-172e97c\" data-id=\"172e97c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-99aac6e elementor-widget elementor-widget-shortcode\" data-id=\"99aac6e\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-560 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-560\" data-uid=\"6a47f1267d482\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-560\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-560 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"560\"\n\t\t\t\t\n\t\t\t\tdata-design=\"default\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tdata-grid=\"open\"\n\t\t\t\tenctype=\"multipart\/form-data\"\n\t\t\t\t\n\t\t\t\tstyle=\"display: none;\"\n\t\t\t\t\n\t\t\t\tdata-uid=\"6a47f1267d482\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div role=\"tablist\" class=\"forminator-pagination-steps\" aria-label=\"Pagination\"><\/div><div tabindex=\"0\" role=\"tabpanel\" id=\"forminator-custom-form-560--page-0\" class=\"forminator-pagination forminator-pagination-start\" aria-labelledby=\"forminator-custom-form-560--page-0-label\" data-step=\"0\" data-label=\"Finish\" data-name=\"page-break-1\"><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a47f1267d482\" class=\"forminator-label\" id=\"forminator-field-name-1_6a47f1267d482-label\">Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"E.g. John Doe\" id=\"forminator-field-name-1_6a47f1267d482\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-1\" class=\"forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-1_6a47f1267d482\" class=\"forminator-label\" id=\"forminator-field-number-1_6a47f1267d482-label\">Patient Age <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-1\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-1_6a47f1267d482\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"100\" \/><\/div><\/div><div id=\"select-1\" class=\"forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-form-560__field--select-1_6a47f1267d482\" id=\"forminator-form-560__field--select-1_6a47f1267d482-label\" class=\"forminator-label\">Select Patient Gender <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-560__field--select-1_6a47f1267d482\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-1\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Gender\" data-search=\"false\" aria-labelledby=\"forminator-form-560__field--select-1_6a47f1267d482-label\" aria-describedby=\"forminator-form-560__field--select-1_6a47f1267d482-description\"><option value=\"\">Gender<\/option><option value=\"one\"  data-calculation=\"0\">M<\/option><option value=\"two\"  data-calculation=\"0\">F<\/option><option value=\"Neither\"  data-calculation=\"0\">N<\/option><\/select><\/div><\/div><div id=\"date-1\" class=\"forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_6a47f1267d482\" class=\"forminator-label\" id=\"forminator-field-date-1-picker_6a47f1267d482-label\">Date <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-1-picker_6a47f1267d482\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"07\/03\/2026\" placeholder=\"Choose Date\" id=\"forminator-field-date-1-picker_6a47f1267d482\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"number-2\" class=\"forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-2_6a47f1267d482\" class=\"forminator-label\" id=\"forminator-field-number-2_6a47f1267d482-label\">Enter Patient Weight <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-2\" value=\"\" placeholder=\"E.g. 30 KG\" id=\"forminator-field-number-2_6a47f1267d482\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"200\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a47f1267d482\" class=\"forminator-label\" id=\"forminator-field-email-1_6a47f1267d482-label\">Email Address<\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"E.g. john@doe.com\" id=\"forminator-field-email-1_6a47f1267d482\" class=\"forminator-input forminator-email--field\" data-required=\"\" aria-required=\"false\" \/><\/div><\/div><div id=\"phone-1\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6a47f1267d482\" class=\"forminator-label\" id=\"forminator-field-phone-1_6a47f1267d482-label\">Phone <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"E.g. 0000000000\" id=\"forminator-field-phone-1_6a47f1267d482\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" maxlength=\"10\" data-validation=\"character_limit\" \/><span id=\"forminator-field-phone-1_6a47f1267d482-description\" class=\"forminator-description\" id=\"forminator-field-phone-1_6a47f1267d482-description\"><span data-limit=\"10\" data-type=\"\">0 \/ 10<\/span><\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-2\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-560__field--select-2_6a47f1267d482\" id=\"forminator-form-560__field--select-2_6a47f1267d482-label\" class=\"forminator-label\">Select Chamber <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-560__field--select-2_6a47f1267d482\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-2\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Chamber\" data-search=\"true\" aria-labelledby=\"forminator-form-560__field--select-2_6a47f1267d482-label\" aria-describedby=\"forminator-form-560__field--select-2_6a47f1267d482-description\"><option value=\"\">Chamber<\/option><option value=\"one\"  data-calculation=\"0\">KPC Medical College &amp; Hospital, Jadavpur<\/option><option value=\"two\"  data-calculation=\"0\">Fortis Hospital, Anandapur<\/option><option value=\"Fortis-Hospital-and-Kidney-Institute,-Rash-Behari\"  data-calculation=\"0\">Fortis Hospital and Kidney Institute, Rash Behari<\/option><option value=\"Reliable-Diagnostics\"  data-calculation=\"0\">Reliable Diagnostics, Chetla<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-3\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-560__field--select-3_6a47f1267d482\" id=\"forminator-form-560__field--select-3_6a47f1267d482-label\" class=\"forminator-label\">Patient Disease<\/label><div class=\"forminator-multiselect\" aria-labelledby=\"forminator-form-560__field--select-3_6a47f1267d482-label\" aria-describedby=\"forminator-form-560__field--select-3_6a47f1267d482-description\"><label id=\"forminator-form-560__field--select-3_6a47f1267d482-1-label\" for=\"forminator-form-560__field--select-3_6a47f1267d482-1\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-3[]\" value=\"one\" id=\"forminator-form-560__field--select-3_6a47f1267d482-1\" aria-labelledby=\"forminator-form-560__field--select-3_6a47f1267d482-1-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Chronic kidney disease (CKD)<\/label><label id=\"forminator-form-560__field--select-3_6a47f1267d482-2-label\" for=\"forminator-form-560__field--select-3_6a47f1267d482-2\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-3[]\" value=\"two\" id=\"forminator-form-560__field--select-3_6a47f1267d482-2\" aria-labelledby=\"forminator-form-560__field--select-3_6a47f1267d482-2-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Polycystic kidney disease (PKD)<\/label><label id=\"forminator-form-560__field--select-3_6a47f1267d482-3-label\" for=\"forminator-form-560__field--select-3_6a47f1267d482-3\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-3[]\" value=\"Glomerulonephritis\" id=\"forminator-form-560__field--select-3_6a47f1267d482-3\" aria-labelledby=\"forminator-form-560__field--select-3_6a47f1267d482-3-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Glomerulonephritis<\/label><label id=\"forminator-form-560__field--select-3_6a47f1267d482-4-label\" for=\"forminator-form-560__field--select-3_6a47f1267d482-4\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-3[]\" value=\"Acute-Kidney-Failure\" id=\"forminator-form-560__field--select-3_6a47f1267d482-4\" aria-labelledby=\"forminator-form-560__field--select-3_6a47f1267d482-4-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Acute Kidney Failure<\/label><label id=\"forminator-form-560__field--select-3_6a47f1267d482-5-label\" for=\"forminator-form-560__field--select-3_6a47f1267d482-5\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-3[]\" value=\"Urinary-Tract-Infection\" id=\"forminator-form-560__field--select-3_6a47f1267d482-5\" aria-labelledby=\"forminator-form-560__field--select-3_6a47f1267d482-5-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Urinary Tract Infection<\/label><label id=\"forminator-form-560__field--select-3_6a47f1267d482-6-label\" for=\"forminator-form-560__field--select-3_6a47f1267d482-6\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-3[]\" value=\"Nephrotic-Syndrome\" id=\"forminator-form-560__field--select-3_6a47f1267d482-6\" aria-labelledby=\"forminator-form-560__field--select-3_6a47f1267d482-6-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Nephrotic Syndrome<\/label><label id=\"forminator-form-560__field--select-3_6a47f1267d482-7-label\" for=\"forminator-form-560__field--select-3_6a47f1267d482-7\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-3[]\" value=\"Kidney-Stones\" id=\"forminator-form-560__field--select-3_6a47f1267d482-7\" aria-labelledby=\"forminator-form-560__field--select-3_6a47f1267d482-7-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Kidney Stones<\/label><label id=\"forminator-form-560__field--select-3_6a47f1267d482-8-label\" for=\"forminator-form-560__field--select-3_6a47f1267d482-8\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-3[]\" value=\"Benign-Prostatic-Hyperplasia-(BPH)\" id=\"forminator-form-560__field--select-3_6a47f1267d482-8\" aria-labelledby=\"forminator-form-560__field--select-3_6a47f1267d482-8-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Benign Prostatic Hyperplasia (BPH)<\/label><label id=\"forminator-form-560__field--select-3_6a47f1267d482-9-label\" for=\"forminator-form-560__field--select-3_6a47f1267d482-9\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-3[]\" value=\"Other-Disease\" id=\"forminator-form-560__field--select-3_6a47f1267d482-9\" aria-labelledby=\"forminator-form-560__field--select-3_6a47f1267d482-9-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Other Disease<\/label><input type='hidden' name='select-3-multiselect-default-values' class='multiselect-default-values' value='' \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-4\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-560__field--select-4_6a47f1267d482\" id=\"forminator-form-560__field--select-4_6a47f1267d482-label\" class=\"forminator-label\">Select Dialysis<\/label><select id=\"forminator-form-560__field--select-4_6a47f1267d482\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-4\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Dialysis\" data-search=\"false\" aria-labelledby=\"forminator-form-560__field--select-4_6a47f1267d482-label\" aria-describedby=\"forminator-form-560__field--select-4_6a47f1267d482-description\"><option value=\"\">Dialysis<\/option><option value=\"one\"  data-calculation=\"0\">Required<\/option><option value=\"two\"  data-calculation=\"0\">Not Required<\/option><option value=\"NA\"  data-calculation=\"0\">NA<\/option><option value=\"Already-On-Dialysis\"  data-calculation=\"0\">Already On Dialysis<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-5\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-560__field--select-5_6a47f1267d482\" id=\"forminator-form-560__field--select-5_6a47f1267d482-label\" class=\"forminator-label\">Select Dialysis Type<\/label><select id=\"forminator-form-560__field--select-5_6a47f1267d482\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-5\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Type Of Dialysis\" data-search=\"false\" aria-labelledby=\"forminator-form-560__field--select-5_6a47f1267d482-label\" aria-describedby=\"forminator-form-560__field--select-5_6a47f1267d482-description\"><option value=\"\">Type Of Dialysis<\/option><option value=\"one\"  data-calculation=\"0\">Haemodialysis<\/option><option value=\"two\"  data-calculation=\"0\">Peritoneal Dialysis<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6a47f1267d482\" id=\"forminator-field-textarea-1_6a47f1267d482-label\" class=\"forminator-label\">Vitals<\/label><textarea name=\"textarea-1\" placeholder=\"E.g. text placeholder\nYou can add new line\" id=\"forminator-field-textarea-1_6a47f1267d482\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><\/div><\/div><div tabindex=\"0\" role=\"tabpanel\" id=\"forminator-custom-form-560--page-1\" class=\"forminator-pagination\" aria-labelledby=\"forminator-custom-form-560--page-1-label\" aria-hidden=\"true\" data-step=\"1\" data-label=\"Page  1\" data-name=\"\" hidden><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Chronic kidney disease (CKD)<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-6\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-560__field--select-6_6a47f1267d482\" id=\"forminator-form-560__field--select-6_6a47f1267d482-label\" class=\"forminator-label\">Select Medicines<\/label><div class=\"forminator-multiselect\" aria-labelledby=\"forminator-form-560__field--select-6_6a47f1267d482-label\" aria-describedby=\"forminator-form-560__field--select-6_6a47f1267d482-description\"><label id=\"forminator-form-560__field--select-6_6a47f1267d482-1-label\" for=\"forminator-form-560__field--select-6_6a47f1267d482-1\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-6[]\" value=\"one\" id=\"forminator-form-560__field--select-6_6a47f1267d482-1\" aria-labelledby=\"forminator-form-560__field--select-6_6a47f1267d482-1-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Metoz 2.5Mg  BD <\/label><label id=\"forminator-form-560__field--select-6_6a47f1267d482-2-label\" for=\"forminator-form-560__field--select-6_6a47f1267d482-2\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-6[]\" value=\"two\" id=\"forminator-form-560__field--select-6_6a47f1267d482-2\" aria-labelledby=\"forminator-form-560__field--select-6_6a47f1267d482-2-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Toxiphage Forte 1 - BD<\/label><label id=\"forminator-form-560__field--select-6_6a47f1267d482-3-label\" for=\"forminator-form-560__field--select-6_6a47f1267d482-3\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-6[]\" value=\"Concor-5\" id=\"forminator-form-560__field--select-6_6a47f1267d482-3\" aria-labelledby=\"forminator-form-560__field--select-6_6a47f1267d482-3-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>NODOSIS 500 Mg -  BD<\/label><label id=\"forminator-form-560__field--select-6_6a47f1267d482-4-label\" for=\"forminator-form-560__field--select-6_6a47f1267d482-4\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-6[]\" value=\"Toxiphage\" id=\"forminator-form-560__field--select-6_6a47f1267d482-4\" aria-labelledby=\"forminator-form-560__field--select-6_6a47f1267d482-4-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Toxiphage Forte 1 - BL<\/label><label id=\"forminator-form-560__field--select-6_6a47f1267d482-5-label\" for=\"forminator-form-560__field--select-6_6a47f1267d482-5\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-6[]\" value=\"Apresol\" id=\"forminator-form-560__field--select-6_6a47f1267d482-5\" aria-labelledby=\"forminator-form-560__field--select-6_6a47f1267d482-5-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Vymada 50 Mg - Morning<\/label><label id=\"forminator-form-560__field--select-6_6a47f1267d482-6-label\" for=\"forminator-form-560__field--select-6_6a47f1267d482-6\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-6[]\" value=\"Thyronorm-25-mcg\" id=\"forminator-form-560__field--select-6_6a47f1267d482-6\" aria-labelledby=\"forminator-form-560__field--select-6_6a47f1267d482-6-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Vymada 50 Mg - Afternoon<\/label><label id=\"forminator-form-560__field--select-6_6a47f1267d482-7-label\" for=\"forminator-form-560__field--select-6_6a47f1267d482-7\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-6[]\" value=\"Urimax\" id=\"forminator-form-560__field--select-6_6a47f1267d482-7\" aria-labelledby=\"forminator-form-560__field--select-6_6a47f1267d482-7-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Shelcal 500 Mg - BD<\/label><label id=\"forminator-form-560__field--select-6_6a47f1267d482-8-label\" for=\"forminator-form-560__field--select-6_6a47f1267d482-8\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-6[]\" value=\"Zincovit\" id=\"forminator-form-560__field--select-6_6a47f1267d482-8\" aria-labelledby=\"forminator-form-560__field--select-6_6a47f1267d482-8-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Zincovit<\/label><label id=\"forminator-form-560__field--select-6_6a47f1267d482-9-label\" for=\"forminator-form-560__field--select-6_6a47f1267d482-9\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-6[]\" value=\"ENCICARB-100MG\" id=\"forminator-form-560__field--select-6_6a47f1267d482-9\" aria-labelledby=\"forminator-form-560__field--select-6_6a47f1267d482-9-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>ENCICARB 100MG<\/label><label id=\"forminator-form-560__field--select-6_6a47f1267d482-10-label\" for=\"forminator-form-560__field--select-6_6a47f1267d482-10\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-6[]\" value=\"PAN-D\" id=\"forminator-form-560__field--select-6_6a47f1267d482-10\" aria-labelledby=\"forminator-form-560__field--select-6_6a47f1267d482-10-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>PAN-D<\/label><label id=\"forminator-form-560__field--select-6_6a47f1267d482-11-label\" for=\"forminator-form-560__field--select-6_6a47f1267d482-11\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-6[]\" value=\"Nefrosave\" id=\"forminator-form-560__field--select-6_6a47f1267d482-11\" aria-labelledby=\"forminator-form-560__field--select-6_6a47f1267d482-11-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Nefrosave<\/label><label id=\"forminator-form-560__field--select-6_6a47f1267d482-12-label\" for=\"forminator-form-560__field--select-6_6a47f1267d482-12\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-6[]\" value=\"Shelcal\" id=\"forminator-form-560__field--select-6_6a47f1267d482-12\" aria-labelledby=\"forminator-form-560__field--select-6_6a47f1267d482-12-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Shelcal<\/label><label id=\"forminator-form-560__field--select-6_6a47f1267d482-13-label\" for=\"forminator-form-560__field--select-6_6a47f1267d482-13\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-6[]\" value=\"Ecosprin-75\" id=\"forminator-form-560__field--select-6_6a47f1267d482-13\" aria-labelledby=\"forminator-form-560__field--select-6_6a47f1267d482-13-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Ecosprin 75<\/label><label id=\"forminator-form-560__field--select-6_6a47f1267d482-14-label\" for=\"forminator-form-560__field--select-6_6a47f1267d482-14\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-6[]\" value=\"Aztor-10\" id=\"forminator-form-560__field--select-6_6a47f1267d482-14\" aria-labelledby=\"forminator-form-560__field--select-6_6a47f1267d482-14-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Aztor 10<\/label><label id=\"forminator-form-560__field--select-6_6a47f1267d482-15-label\" for=\"forminator-form-560__field--select-6_6a47f1267d482-15\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-6[]\" value=\"Awaytox\" id=\"forminator-form-560__field--select-6_6a47f1267d482-15\" aria-labelledby=\"forminator-form-560__field--select-6_6a47f1267d482-15-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>DIAMICRON 60 mg<\/label><label id=\"forminator-form-560__field--select-6_6a47f1267d482-16-label\" for=\"forminator-form-560__field--select-6_6a47f1267d482-16\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-6[]\" value=\"Lantus-Solostar-100IU-ml\" id=\"forminator-form-560__field--select-6_6a47f1267d482-16\" aria-labelledby=\"forminator-form-560__field--select-6_6a47f1267d482-16-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Lantus Solostar 100IU\/ml<\/label><input type='hidden' name='select-6-multiselect-default-values' class='multiselect-default-values' value='' \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-2\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Polycystic kidney disease (PKD)<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-7\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-560__field--select-7_6a47f1267d482\" id=\"forminator-form-560__field--select-7_6a47f1267d482-label\" class=\"forminator-label\">Select Medicines<\/label><div class=\"forminator-multiselect\" aria-labelledby=\"forminator-form-560__field--select-7_6a47f1267d482-label\" aria-describedby=\"forminator-form-560__field--select-7_6a47f1267d482-description\"><label id=\"forminator-form-560__field--select-7_6a47f1267d482-1-label\" for=\"forminator-form-560__field--select-7_6a47f1267d482-1\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-7[]\" value=\"one\" id=\"forminator-form-560__field--select-7_6a47f1267d482-1\" aria-labelledby=\"forminator-form-560__field--select-7_6a47f1267d482-1-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Metoz 2.5Mg  BD <\/label><label id=\"forminator-form-560__field--select-7_6a47f1267d482-2-label\" for=\"forminator-form-560__field--select-7_6a47f1267d482-2\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-7[]\" value=\"two\" id=\"forminator-form-560__field--select-7_6a47f1267d482-2\" aria-labelledby=\"forminator-form-560__field--select-7_6a47f1267d482-2-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Toxiphage Forte 1 - BD<\/label><label id=\"forminator-form-560__field--select-7_6a47f1267d482-3-label\" for=\"forminator-form-560__field--select-7_6a47f1267d482-3\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-7[]\" value=\"Concor-5\" id=\"forminator-form-560__field--select-7_6a47f1267d482-3\" aria-labelledby=\"forminator-form-560__field--select-7_6a47f1267d482-3-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>NODOSIS 500 Mg -  BD<\/label><label id=\"forminator-form-560__field--select-7_6a47f1267d482-4-label\" for=\"forminator-form-560__field--select-7_6a47f1267d482-4\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-7[]\" value=\"Toxiphage\" id=\"forminator-form-560__field--select-7_6a47f1267d482-4\" aria-labelledby=\"forminator-form-560__field--select-7_6a47f1267d482-4-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Toxiphage Forte 1 - BL<\/label><label id=\"forminator-form-560__field--select-7_6a47f1267d482-5-label\" for=\"forminator-form-560__field--select-7_6a47f1267d482-5\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-7[]\" value=\"Apresol\" id=\"forminator-form-560__field--select-7_6a47f1267d482-5\" aria-labelledby=\"forminator-form-560__field--select-7_6a47f1267d482-5-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Vymada 50 Mg - Morning<\/label><label id=\"forminator-form-560__field--select-7_6a47f1267d482-6-label\" for=\"forminator-form-560__field--select-7_6a47f1267d482-6\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-7[]\" value=\"Thyronorm-25-mcg\" id=\"forminator-form-560__field--select-7_6a47f1267d482-6\" aria-labelledby=\"forminator-form-560__field--select-7_6a47f1267d482-6-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Vymada 50 Mg - Afternoon<\/label><label id=\"forminator-form-560__field--select-7_6a47f1267d482-7-label\" for=\"forminator-form-560__field--select-7_6a47f1267d482-7\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-7[]\" value=\"Urimax\" id=\"forminator-form-560__field--select-7_6a47f1267d482-7\" aria-labelledby=\"forminator-form-560__field--select-7_6a47f1267d482-7-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Shelcal 500 Mg - BD<\/label><label id=\"forminator-form-560__field--select-7_6a47f1267d482-8-label\" for=\"forminator-form-560__field--select-7_6a47f1267d482-8\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-7[]\" value=\"Zincovit\" id=\"forminator-form-560__field--select-7_6a47f1267d482-8\" aria-labelledby=\"forminator-form-560__field--select-7_6a47f1267d482-8-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Zincovit<\/label><label id=\"forminator-form-560__field--select-7_6a47f1267d482-9-label\" for=\"forminator-form-560__field--select-7_6a47f1267d482-9\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-7[]\" value=\"ENCICARB-100MG\" id=\"forminator-form-560__field--select-7_6a47f1267d482-9\" aria-labelledby=\"forminator-form-560__field--select-7_6a47f1267d482-9-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>ENCICARB 100MG<\/label><label id=\"forminator-form-560__field--select-7_6a47f1267d482-10-label\" for=\"forminator-form-560__field--select-7_6a47f1267d482-10\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-7[]\" value=\"PAN-D\" id=\"forminator-form-560__field--select-7_6a47f1267d482-10\" aria-labelledby=\"forminator-form-560__field--select-7_6a47f1267d482-10-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>PAN-D<\/label><label id=\"forminator-form-560__field--select-7_6a47f1267d482-11-label\" for=\"forminator-form-560__field--select-7_6a47f1267d482-11\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-7[]\" value=\"Nefrosave\" id=\"forminator-form-560__field--select-7_6a47f1267d482-11\" aria-labelledby=\"forminator-form-560__field--select-7_6a47f1267d482-11-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Nefrosave<\/label><label id=\"forminator-form-560__field--select-7_6a47f1267d482-12-label\" for=\"forminator-form-560__field--select-7_6a47f1267d482-12\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-7[]\" value=\"Shelcal\" id=\"forminator-form-560__field--select-7_6a47f1267d482-12\" aria-labelledby=\"forminator-form-560__field--select-7_6a47f1267d482-12-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Shelcal<\/label><label id=\"forminator-form-560__field--select-7_6a47f1267d482-13-label\" for=\"forminator-form-560__field--select-7_6a47f1267d482-13\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-7[]\" value=\"Ecosprin-75\" id=\"forminator-form-560__field--select-7_6a47f1267d482-13\" aria-labelledby=\"forminator-form-560__field--select-7_6a47f1267d482-13-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Ecosprin 75<\/label><label id=\"forminator-form-560__field--select-7_6a47f1267d482-14-label\" for=\"forminator-form-560__field--select-7_6a47f1267d482-14\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-7[]\" value=\"Aztor-10\" id=\"forminator-form-560__field--select-7_6a47f1267d482-14\" aria-labelledby=\"forminator-form-560__field--select-7_6a47f1267d482-14-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Aztor 10<\/label><label id=\"forminator-form-560__field--select-7_6a47f1267d482-15-label\" for=\"forminator-form-560__field--select-7_6a47f1267d482-15\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-7[]\" value=\"Awaytox\" id=\"forminator-form-560__field--select-7_6a47f1267d482-15\" aria-labelledby=\"forminator-form-560__field--select-7_6a47f1267d482-15-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>DIAMICRON 60 mg<\/label><label id=\"forminator-form-560__field--select-7_6a47f1267d482-16-label\" for=\"forminator-form-560__field--select-7_6a47f1267d482-16\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-7[]\" value=\"Lantus-Solostar-100IU-ml\" id=\"forminator-form-560__field--select-7_6a47f1267d482-16\" aria-labelledby=\"forminator-form-560__field--select-7_6a47f1267d482-16-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Lantus Solostar 100IU\/ml<\/label><input type='hidden' name='select-7-multiselect-default-values' class='multiselect-default-values' value='' \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-3\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Glomerulonephritis<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-8\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-560__field--select-8_6a47f1267d482\" id=\"forminator-form-560__field--select-8_6a47f1267d482-label\" class=\"forminator-label\">Select Medicines<\/label><div class=\"forminator-multiselect\" aria-labelledby=\"forminator-form-560__field--select-8_6a47f1267d482-label\" aria-describedby=\"forminator-form-560__field--select-8_6a47f1267d482-description\"><label id=\"forminator-form-560__field--select-8_6a47f1267d482-1-label\" for=\"forminator-form-560__field--select-8_6a47f1267d482-1\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-8[]\" value=\"one\" id=\"forminator-form-560__field--select-8_6a47f1267d482-1\" aria-labelledby=\"forminator-form-560__field--select-8_6a47f1267d482-1-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Metoz 2.5Mg  BD <\/label><label id=\"forminator-form-560__field--select-8_6a47f1267d482-2-label\" for=\"forminator-form-560__field--select-8_6a47f1267d482-2\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-8[]\" value=\"two\" id=\"forminator-form-560__field--select-8_6a47f1267d482-2\" aria-labelledby=\"forminator-form-560__field--select-8_6a47f1267d482-2-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Toxiphage Forte 1 - BD<\/label><label id=\"forminator-form-560__field--select-8_6a47f1267d482-3-label\" for=\"forminator-form-560__field--select-8_6a47f1267d482-3\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-8[]\" value=\"Concor-5\" id=\"forminator-form-560__field--select-8_6a47f1267d482-3\" aria-labelledby=\"forminator-form-560__field--select-8_6a47f1267d482-3-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>NODOSIS 500 Mg -  BD<\/label><label id=\"forminator-form-560__field--select-8_6a47f1267d482-4-label\" for=\"forminator-form-560__field--select-8_6a47f1267d482-4\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-8[]\" value=\"Toxiphage\" id=\"forminator-form-560__field--select-8_6a47f1267d482-4\" aria-labelledby=\"forminator-form-560__field--select-8_6a47f1267d482-4-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Toxiphage Forte 1 - BL<\/label><label id=\"forminator-form-560__field--select-8_6a47f1267d482-5-label\" for=\"forminator-form-560__field--select-8_6a47f1267d482-5\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-8[]\" value=\"Apresol\" id=\"forminator-form-560__field--select-8_6a47f1267d482-5\" aria-labelledby=\"forminator-form-560__field--select-8_6a47f1267d482-5-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Vymada 50 Mg - Morning<\/label><label id=\"forminator-form-560__field--select-8_6a47f1267d482-6-label\" for=\"forminator-form-560__field--select-8_6a47f1267d482-6\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-8[]\" value=\"Thyronorm-25-mcg\" id=\"forminator-form-560__field--select-8_6a47f1267d482-6\" aria-labelledby=\"forminator-form-560__field--select-8_6a47f1267d482-6-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Vymada 50 Mg - Afternoon<\/label><label id=\"forminator-form-560__field--select-8_6a47f1267d482-7-label\" for=\"forminator-form-560__field--select-8_6a47f1267d482-7\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-8[]\" value=\"Urimax\" id=\"forminator-form-560__field--select-8_6a47f1267d482-7\" aria-labelledby=\"forminator-form-560__field--select-8_6a47f1267d482-7-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Shelcal 500 Mg - BD<\/label><label id=\"forminator-form-560__field--select-8_6a47f1267d482-8-label\" for=\"forminator-form-560__field--select-8_6a47f1267d482-8\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-8[]\" value=\"Zincovit\" id=\"forminator-form-560__field--select-8_6a47f1267d482-8\" aria-labelledby=\"forminator-form-560__field--select-8_6a47f1267d482-8-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Zincovit<\/label><label id=\"forminator-form-560__field--select-8_6a47f1267d482-9-label\" for=\"forminator-form-560__field--select-8_6a47f1267d482-9\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-8[]\" value=\"ENCICARB-100MG\" id=\"forminator-form-560__field--select-8_6a47f1267d482-9\" aria-labelledby=\"forminator-form-560__field--select-8_6a47f1267d482-9-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>ENCICARB 100MG<\/label><label id=\"forminator-form-560__field--select-8_6a47f1267d482-10-label\" for=\"forminator-form-560__field--select-8_6a47f1267d482-10\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-8[]\" value=\"PAN-D\" id=\"forminator-form-560__field--select-8_6a47f1267d482-10\" aria-labelledby=\"forminator-form-560__field--select-8_6a47f1267d482-10-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>PAN-D<\/label><label id=\"forminator-form-560__field--select-8_6a47f1267d482-11-label\" for=\"forminator-form-560__field--select-8_6a47f1267d482-11\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-8[]\" value=\"Nefrosave\" id=\"forminator-form-560__field--select-8_6a47f1267d482-11\" aria-labelledby=\"forminator-form-560__field--select-8_6a47f1267d482-11-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Nefrosave<\/label><label id=\"forminator-form-560__field--select-8_6a47f1267d482-12-label\" for=\"forminator-form-560__field--select-8_6a47f1267d482-12\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-8[]\" value=\"Shelcal\" id=\"forminator-form-560__field--select-8_6a47f1267d482-12\" aria-labelledby=\"forminator-form-560__field--select-8_6a47f1267d482-12-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Shelcal<\/label><label id=\"forminator-form-560__field--select-8_6a47f1267d482-13-label\" for=\"forminator-form-560__field--select-8_6a47f1267d482-13\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-8[]\" value=\"Ecosprin-75\" id=\"forminator-form-560__field--select-8_6a47f1267d482-13\" aria-labelledby=\"forminator-form-560__field--select-8_6a47f1267d482-13-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Ecosprin 75<\/label><label id=\"forminator-form-560__field--select-8_6a47f1267d482-14-label\" for=\"forminator-form-560__field--select-8_6a47f1267d482-14\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-8[]\" value=\"Aztor-10\" id=\"forminator-form-560__field--select-8_6a47f1267d482-14\" aria-labelledby=\"forminator-form-560__field--select-8_6a47f1267d482-14-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Aztor 10<\/label><label id=\"forminator-form-560__field--select-8_6a47f1267d482-15-label\" for=\"forminator-form-560__field--select-8_6a47f1267d482-15\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-8[]\" value=\"Awaytox\" id=\"forminator-form-560__field--select-8_6a47f1267d482-15\" aria-labelledby=\"forminator-form-560__field--select-8_6a47f1267d482-15-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>DIAMICRON 60 mg<\/label><label id=\"forminator-form-560__field--select-8_6a47f1267d482-16-label\" for=\"forminator-form-560__field--select-8_6a47f1267d482-16\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-8[]\" value=\"Lantus-Solostar-100IU-ml\" id=\"forminator-form-560__field--select-8_6a47f1267d482-16\" aria-labelledby=\"forminator-form-560__field--select-8_6a47f1267d482-16-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Lantus Solostar 100IU\/ml<\/label><input type='hidden' name='select-8-multiselect-default-values' class='multiselect-default-values' value='' \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-4\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Acute Kidney Failure<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-9\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-560__field--select-9_6a47f1267d482\" id=\"forminator-form-560__field--select-9_6a47f1267d482-label\" class=\"forminator-label\">Select Medicines<\/label><div class=\"forminator-multiselect\" aria-labelledby=\"forminator-form-560__field--select-9_6a47f1267d482-label\" aria-describedby=\"forminator-form-560__field--select-9_6a47f1267d482-description\"><label id=\"forminator-form-560__field--select-9_6a47f1267d482-1-label\" for=\"forminator-form-560__field--select-9_6a47f1267d482-1\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-9[]\" value=\"one\" id=\"forminator-form-560__field--select-9_6a47f1267d482-1\" aria-labelledby=\"forminator-form-560__field--select-9_6a47f1267d482-1-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Metoz 2.5Mg  BD <\/label><label id=\"forminator-form-560__field--select-9_6a47f1267d482-2-label\" for=\"forminator-form-560__field--select-9_6a47f1267d482-2\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-9[]\" value=\"two\" id=\"forminator-form-560__field--select-9_6a47f1267d482-2\" aria-labelledby=\"forminator-form-560__field--select-9_6a47f1267d482-2-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Toxiphage Forte 1 - BD<\/label><label id=\"forminator-form-560__field--select-9_6a47f1267d482-3-label\" for=\"forminator-form-560__field--select-9_6a47f1267d482-3\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-9[]\" value=\"Concor-5\" id=\"forminator-form-560__field--select-9_6a47f1267d482-3\" aria-labelledby=\"forminator-form-560__field--select-9_6a47f1267d482-3-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>NODOSIS 500 Mg -  BD<\/label><label id=\"forminator-form-560__field--select-9_6a47f1267d482-4-label\" for=\"forminator-form-560__field--select-9_6a47f1267d482-4\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-9[]\" value=\"Toxiphage\" id=\"forminator-form-560__field--select-9_6a47f1267d482-4\" aria-labelledby=\"forminator-form-560__field--select-9_6a47f1267d482-4-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Toxiphage Forte 1 - BL<\/label><label id=\"forminator-form-560__field--select-9_6a47f1267d482-5-label\" for=\"forminator-form-560__field--select-9_6a47f1267d482-5\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-9[]\" value=\"Apresol\" id=\"forminator-form-560__field--select-9_6a47f1267d482-5\" aria-labelledby=\"forminator-form-560__field--select-9_6a47f1267d482-5-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Vymada 50 Mg - Morning<\/label><label id=\"forminator-form-560__field--select-9_6a47f1267d482-6-label\" for=\"forminator-form-560__field--select-9_6a47f1267d482-6\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-9[]\" value=\"Thyronorm-25-mcg\" id=\"forminator-form-560__field--select-9_6a47f1267d482-6\" aria-labelledby=\"forminator-form-560__field--select-9_6a47f1267d482-6-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Vymada 50 Mg - Afternoon<\/label><label id=\"forminator-form-560__field--select-9_6a47f1267d482-7-label\" for=\"forminator-form-560__field--select-9_6a47f1267d482-7\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-9[]\" value=\"Urimax\" id=\"forminator-form-560__field--select-9_6a47f1267d482-7\" aria-labelledby=\"forminator-form-560__field--select-9_6a47f1267d482-7-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Shelcal 500 Mg - BD<\/label><label id=\"forminator-form-560__field--select-9_6a47f1267d482-8-label\" for=\"forminator-form-560__field--select-9_6a47f1267d482-8\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-9[]\" value=\"Zincovit\" id=\"forminator-form-560__field--select-9_6a47f1267d482-8\" aria-labelledby=\"forminator-form-560__field--select-9_6a47f1267d482-8-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Zincovit<\/label><label id=\"forminator-form-560__field--select-9_6a47f1267d482-9-label\" for=\"forminator-form-560__field--select-9_6a47f1267d482-9\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-9[]\" value=\"ENCICARB-100MG\" id=\"forminator-form-560__field--select-9_6a47f1267d482-9\" aria-labelledby=\"forminator-form-560__field--select-9_6a47f1267d482-9-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>ENCICARB 100MG<\/label><label id=\"forminator-form-560__field--select-9_6a47f1267d482-10-label\" for=\"forminator-form-560__field--select-9_6a47f1267d482-10\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-9[]\" value=\"PAN-D\" id=\"forminator-form-560__field--select-9_6a47f1267d482-10\" aria-labelledby=\"forminator-form-560__field--select-9_6a47f1267d482-10-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>PAN-D<\/label><label id=\"forminator-form-560__field--select-9_6a47f1267d482-11-label\" for=\"forminator-form-560__field--select-9_6a47f1267d482-11\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-9[]\" value=\"Nefrosave\" id=\"forminator-form-560__field--select-9_6a47f1267d482-11\" aria-labelledby=\"forminator-form-560__field--select-9_6a47f1267d482-11-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Nefrosave<\/label><label id=\"forminator-form-560__field--select-9_6a47f1267d482-12-label\" for=\"forminator-form-560__field--select-9_6a47f1267d482-12\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-9[]\" value=\"Shelcal\" id=\"forminator-form-560__field--select-9_6a47f1267d482-12\" aria-labelledby=\"forminator-form-560__field--select-9_6a47f1267d482-12-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Shelcal<\/label><label id=\"forminator-form-560__field--select-9_6a47f1267d482-13-label\" for=\"forminator-form-560__field--select-9_6a47f1267d482-13\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-9[]\" value=\"Ecosprin-75\" id=\"forminator-form-560__field--select-9_6a47f1267d482-13\" aria-labelledby=\"forminator-form-560__field--select-9_6a47f1267d482-13-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Ecosprin 75<\/label><label id=\"forminator-form-560__field--select-9_6a47f1267d482-14-label\" for=\"forminator-form-560__field--select-9_6a47f1267d482-14\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-9[]\" value=\"Aztor-10\" id=\"forminator-form-560__field--select-9_6a47f1267d482-14\" aria-labelledby=\"forminator-form-560__field--select-9_6a47f1267d482-14-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Aztor 10<\/label><label id=\"forminator-form-560__field--select-9_6a47f1267d482-15-label\" for=\"forminator-form-560__field--select-9_6a47f1267d482-15\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-9[]\" value=\"Awaytox\" id=\"forminator-form-560__field--select-9_6a47f1267d482-15\" aria-labelledby=\"forminator-form-560__field--select-9_6a47f1267d482-15-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>DIAMICRON 60 mg<\/label><label id=\"forminator-form-560__field--select-9_6a47f1267d482-16-label\" for=\"forminator-form-560__field--select-9_6a47f1267d482-16\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-9[]\" value=\"Lantus-Solostar-100IU-ml\" id=\"forminator-form-560__field--select-9_6a47f1267d482-16\" aria-labelledby=\"forminator-form-560__field--select-9_6a47f1267d482-16-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Lantus Solostar 100IU\/ml<\/label><input type='hidden' name='select-9-multiselect-default-values' class='multiselect-default-values' value='' \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-5\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Urinary Tract Infection<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-10\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-560__field--select-10_6a47f1267d482\" id=\"forminator-form-560__field--select-10_6a47f1267d482-label\" class=\"forminator-label\">Select Medicines<\/label><div class=\"forminator-multiselect\" aria-labelledby=\"forminator-form-560__field--select-10_6a47f1267d482-label\" aria-describedby=\"forminator-form-560__field--select-10_6a47f1267d482-description\"><label id=\"forminator-form-560__field--select-10_6a47f1267d482-1-label\" for=\"forminator-form-560__field--select-10_6a47f1267d482-1\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-10[]\" value=\"one\" id=\"forminator-form-560__field--select-10_6a47f1267d482-1\" aria-labelledby=\"forminator-form-560__field--select-10_6a47f1267d482-1-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Metoz 2.5Mg  BD <\/label><label id=\"forminator-form-560__field--select-10_6a47f1267d482-2-label\" for=\"forminator-form-560__field--select-10_6a47f1267d482-2\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-10[]\" value=\"two\" id=\"forminator-form-560__field--select-10_6a47f1267d482-2\" aria-labelledby=\"forminator-form-560__field--select-10_6a47f1267d482-2-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Toxiphage Forte 1 - BD<\/label><label id=\"forminator-form-560__field--select-10_6a47f1267d482-3-label\" for=\"forminator-form-560__field--select-10_6a47f1267d482-3\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-10[]\" value=\"Concor-5\" id=\"forminator-form-560__field--select-10_6a47f1267d482-3\" aria-labelledby=\"forminator-form-560__field--select-10_6a47f1267d482-3-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>NODOSIS 500 Mg -  BD<\/label><label id=\"forminator-form-560__field--select-10_6a47f1267d482-4-label\" for=\"forminator-form-560__field--select-10_6a47f1267d482-4\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-10[]\" value=\"Toxiphage\" id=\"forminator-form-560__field--select-10_6a47f1267d482-4\" aria-labelledby=\"forminator-form-560__field--select-10_6a47f1267d482-4-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Toxiphage Forte 1 - BL<\/label><label id=\"forminator-form-560__field--select-10_6a47f1267d482-5-label\" for=\"forminator-form-560__field--select-10_6a47f1267d482-5\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-10[]\" value=\"Apresol\" id=\"forminator-form-560__field--select-10_6a47f1267d482-5\" aria-labelledby=\"forminator-form-560__field--select-10_6a47f1267d482-5-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Vymada 50 Mg - Morning<\/label><label id=\"forminator-form-560__field--select-10_6a47f1267d482-6-label\" for=\"forminator-form-560__field--select-10_6a47f1267d482-6\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-10[]\" value=\"Thyronorm-25-mcg\" id=\"forminator-form-560__field--select-10_6a47f1267d482-6\" aria-labelledby=\"forminator-form-560__field--select-10_6a47f1267d482-6-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Vymada 50 Mg - Afternoon<\/label><label id=\"forminator-form-560__field--select-10_6a47f1267d482-7-label\" for=\"forminator-form-560__field--select-10_6a47f1267d482-7\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-10[]\" value=\"Urimax\" id=\"forminator-form-560__field--select-10_6a47f1267d482-7\" aria-labelledby=\"forminator-form-560__field--select-10_6a47f1267d482-7-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Shelcal 500 Mg - BD<\/label><label id=\"forminator-form-560__field--select-10_6a47f1267d482-8-label\" for=\"forminator-form-560__field--select-10_6a47f1267d482-8\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-10[]\" value=\"Zincovit\" id=\"forminator-form-560__field--select-10_6a47f1267d482-8\" aria-labelledby=\"forminator-form-560__field--select-10_6a47f1267d482-8-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Zincovit<\/label><label id=\"forminator-form-560__field--select-10_6a47f1267d482-9-label\" for=\"forminator-form-560__field--select-10_6a47f1267d482-9\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-10[]\" value=\"ENCICARB-100MG\" id=\"forminator-form-560__field--select-10_6a47f1267d482-9\" aria-labelledby=\"forminator-form-560__field--select-10_6a47f1267d482-9-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>ENCICARB 100MG<\/label><label id=\"forminator-form-560__field--select-10_6a47f1267d482-10-label\" for=\"forminator-form-560__field--select-10_6a47f1267d482-10\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-10[]\" value=\"PAN-D\" id=\"forminator-form-560__field--select-10_6a47f1267d482-10\" aria-labelledby=\"forminator-form-560__field--select-10_6a47f1267d482-10-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>PAN-D<\/label><label id=\"forminator-form-560__field--select-10_6a47f1267d482-11-label\" for=\"forminator-form-560__field--select-10_6a47f1267d482-11\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-10[]\" value=\"Nefrosave\" id=\"forminator-form-560__field--select-10_6a47f1267d482-11\" aria-labelledby=\"forminator-form-560__field--select-10_6a47f1267d482-11-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Nefrosave<\/label><label id=\"forminator-form-560__field--select-10_6a47f1267d482-12-label\" for=\"forminator-form-560__field--select-10_6a47f1267d482-12\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-10[]\" value=\"Shelcal\" id=\"forminator-form-560__field--select-10_6a47f1267d482-12\" aria-labelledby=\"forminator-form-560__field--select-10_6a47f1267d482-12-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Shelcal<\/label><label id=\"forminator-form-560__field--select-10_6a47f1267d482-13-label\" for=\"forminator-form-560__field--select-10_6a47f1267d482-13\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-10[]\" value=\"Ecosprin-75\" id=\"forminator-form-560__field--select-10_6a47f1267d482-13\" aria-labelledby=\"forminator-form-560__field--select-10_6a47f1267d482-13-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Ecosprin 75<\/label><label id=\"forminator-form-560__field--select-10_6a47f1267d482-14-label\" for=\"forminator-form-560__field--select-10_6a47f1267d482-14\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-10[]\" value=\"Aztor-10\" id=\"forminator-form-560__field--select-10_6a47f1267d482-14\" aria-labelledby=\"forminator-form-560__field--select-10_6a47f1267d482-14-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Aztor 10<\/label><label id=\"forminator-form-560__field--select-10_6a47f1267d482-15-label\" for=\"forminator-form-560__field--select-10_6a47f1267d482-15\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-10[]\" value=\"Awaytox\" id=\"forminator-form-560__field--select-10_6a47f1267d482-15\" aria-labelledby=\"forminator-form-560__field--select-10_6a47f1267d482-15-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>DIAMICRON 60 mg<\/label><label id=\"forminator-form-560__field--select-10_6a47f1267d482-16-label\" for=\"forminator-form-560__field--select-10_6a47f1267d482-16\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-10[]\" value=\"Lantus-Solostar-100IU-ml\" id=\"forminator-form-560__field--select-10_6a47f1267d482-16\" aria-labelledby=\"forminator-form-560__field--select-10_6a47f1267d482-16-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Lantus Solostar 100IU\/ml<\/label><input type='hidden' name='select-10-multiselect-default-values' class='multiselect-default-values' value='' \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-6\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Nephrotic Syndrome<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-11\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-560__field--select-11_6a47f1267d482\" id=\"forminator-form-560__field--select-11_6a47f1267d482-label\" class=\"forminator-label\">Select Medicines<\/label><div class=\"forminator-multiselect\" aria-labelledby=\"forminator-form-560__field--select-11_6a47f1267d482-label\" aria-describedby=\"forminator-form-560__field--select-11_6a47f1267d482-description\"><label id=\"forminator-form-560__field--select-11_6a47f1267d482-1-label\" for=\"forminator-form-560__field--select-11_6a47f1267d482-1\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-11[]\" value=\"one\" id=\"forminator-form-560__field--select-11_6a47f1267d482-1\" aria-labelledby=\"forminator-form-560__field--select-11_6a47f1267d482-1-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Metoz 2.5Mg  BD <\/label><label id=\"forminator-form-560__field--select-11_6a47f1267d482-2-label\" for=\"forminator-form-560__field--select-11_6a47f1267d482-2\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-11[]\" value=\"two\" id=\"forminator-form-560__field--select-11_6a47f1267d482-2\" aria-labelledby=\"forminator-form-560__field--select-11_6a47f1267d482-2-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Toxiphage Forte 1 - BD<\/label><label id=\"forminator-form-560__field--select-11_6a47f1267d482-3-label\" for=\"forminator-form-560__field--select-11_6a47f1267d482-3\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-11[]\" value=\"Concor-5\" id=\"forminator-form-560__field--select-11_6a47f1267d482-3\" aria-labelledby=\"forminator-form-560__field--select-11_6a47f1267d482-3-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>NODOSIS 500 Mg -  BD<\/label><label id=\"forminator-form-560__field--select-11_6a47f1267d482-4-label\" for=\"forminator-form-560__field--select-11_6a47f1267d482-4\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-11[]\" value=\"Toxiphage\" id=\"forminator-form-560__field--select-11_6a47f1267d482-4\" aria-labelledby=\"forminator-form-560__field--select-11_6a47f1267d482-4-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Toxiphage Forte 1 - BL<\/label><label id=\"forminator-form-560__field--select-11_6a47f1267d482-5-label\" for=\"forminator-form-560__field--select-11_6a47f1267d482-5\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-11[]\" value=\"Apresol\" id=\"forminator-form-560__field--select-11_6a47f1267d482-5\" aria-labelledby=\"forminator-form-560__field--select-11_6a47f1267d482-5-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Vymada 50 Mg - Morning<\/label><label id=\"forminator-form-560__field--select-11_6a47f1267d482-6-label\" for=\"forminator-form-560__field--select-11_6a47f1267d482-6\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-11[]\" value=\"Thyronorm-25-mcg\" id=\"forminator-form-560__field--select-11_6a47f1267d482-6\" aria-labelledby=\"forminator-form-560__field--select-11_6a47f1267d482-6-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Vymada 50 Mg - Afternoon<\/label><label id=\"forminator-form-560__field--select-11_6a47f1267d482-7-label\" for=\"forminator-form-560__field--select-11_6a47f1267d482-7\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-11[]\" value=\"Urimax\" id=\"forminator-form-560__field--select-11_6a47f1267d482-7\" aria-labelledby=\"forminator-form-560__field--select-11_6a47f1267d482-7-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Shelcal 500 Mg - BD<\/label><label id=\"forminator-form-560__field--select-11_6a47f1267d482-8-label\" for=\"forminator-form-560__field--select-11_6a47f1267d482-8\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-11[]\" value=\"Zincovit\" id=\"forminator-form-560__field--select-11_6a47f1267d482-8\" aria-labelledby=\"forminator-form-560__field--select-11_6a47f1267d482-8-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Zincovit<\/label><label id=\"forminator-form-560__field--select-11_6a47f1267d482-9-label\" for=\"forminator-form-560__field--select-11_6a47f1267d482-9\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-11[]\" value=\"ENCICARB-100MG\" id=\"forminator-form-560__field--select-11_6a47f1267d482-9\" aria-labelledby=\"forminator-form-560__field--select-11_6a47f1267d482-9-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>ENCICARB 100MG<\/label><label id=\"forminator-form-560__field--select-11_6a47f1267d482-10-label\" for=\"forminator-form-560__field--select-11_6a47f1267d482-10\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-11[]\" value=\"PAN-D\" id=\"forminator-form-560__field--select-11_6a47f1267d482-10\" aria-labelledby=\"forminator-form-560__field--select-11_6a47f1267d482-10-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>PAN-D<\/label><label id=\"forminator-form-560__field--select-11_6a47f1267d482-11-label\" for=\"forminator-form-560__field--select-11_6a47f1267d482-11\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-11[]\" value=\"Nefrosave\" id=\"forminator-form-560__field--select-11_6a47f1267d482-11\" aria-labelledby=\"forminator-form-560__field--select-11_6a47f1267d482-11-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Nefrosave<\/label><label id=\"forminator-form-560__field--select-11_6a47f1267d482-12-label\" for=\"forminator-form-560__field--select-11_6a47f1267d482-12\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-11[]\" value=\"Shelcal\" id=\"forminator-form-560__field--select-11_6a47f1267d482-12\" aria-labelledby=\"forminator-form-560__field--select-11_6a47f1267d482-12-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Shelcal<\/label><label id=\"forminator-form-560__field--select-11_6a47f1267d482-13-label\" for=\"forminator-form-560__field--select-11_6a47f1267d482-13\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-11[]\" value=\"Ecosprin-75\" id=\"forminator-form-560__field--select-11_6a47f1267d482-13\" aria-labelledby=\"forminator-form-560__field--select-11_6a47f1267d482-13-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Ecosprin 75<\/label><label id=\"forminator-form-560__field--select-11_6a47f1267d482-14-label\" for=\"forminator-form-560__field--select-11_6a47f1267d482-14\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-11[]\" value=\"Aztor-10\" id=\"forminator-form-560__field--select-11_6a47f1267d482-14\" aria-labelledby=\"forminator-form-560__field--select-11_6a47f1267d482-14-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Aztor 10<\/label><label id=\"forminator-form-560__field--select-11_6a47f1267d482-15-label\" for=\"forminator-form-560__field--select-11_6a47f1267d482-15\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-11[]\" value=\"Awaytox\" id=\"forminator-form-560__field--select-11_6a47f1267d482-15\" aria-labelledby=\"forminator-form-560__field--select-11_6a47f1267d482-15-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>DIAMICRON 60 mg<\/label><label id=\"forminator-form-560__field--select-11_6a47f1267d482-16-label\" for=\"forminator-form-560__field--select-11_6a47f1267d482-16\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-11[]\" value=\"Lantus-Solostar-100IU-ml\" id=\"forminator-form-560__field--select-11_6a47f1267d482-16\" aria-labelledby=\"forminator-form-560__field--select-11_6a47f1267d482-16-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Lantus Solostar 100IU\/ml<\/label><input type='hidden' name='select-11-multiselect-default-values' class='multiselect-default-values' value='' \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-7\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Kidney Stones<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-12\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-560__field--select-12_6a47f1267d482\" id=\"forminator-form-560__field--select-12_6a47f1267d482-label\" class=\"forminator-label\">Select Medicines<\/label><div class=\"forminator-multiselect\" aria-labelledby=\"forminator-form-560__field--select-12_6a47f1267d482-label\" aria-describedby=\"forminator-form-560__field--select-12_6a47f1267d482-description\"><label id=\"forminator-form-560__field--select-12_6a47f1267d482-1-label\" for=\"forminator-form-560__field--select-12_6a47f1267d482-1\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-12[]\" value=\"one\" id=\"forminator-form-560__field--select-12_6a47f1267d482-1\" aria-labelledby=\"forminator-form-560__field--select-12_6a47f1267d482-1-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Metoz 2.5Mg  BD <\/label><label id=\"forminator-form-560__field--select-12_6a47f1267d482-2-label\" for=\"forminator-form-560__field--select-12_6a47f1267d482-2\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-12[]\" value=\"two\" id=\"forminator-form-560__field--select-12_6a47f1267d482-2\" aria-labelledby=\"forminator-form-560__field--select-12_6a47f1267d482-2-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Toxiphage Forte 1 - BD<\/label><label id=\"forminator-form-560__field--select-12_6a47f1267d482-3-label\" for=\"forminator-form-560__field--select-12_6a47f1267d482-3\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-12[]\" value=\"Concor-5\" id=\"forminator-form-560__field--select-12_6a47f1267d482-3\" aria-labelledby=\"forminator-form-560__field--select-12_6a47f1267d482-3-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>NODOSIS 500 Mg -  BD<\/label><label id=\"forminator-form-560__field--select-12_6a47f1267d482-4-label\" for=\"forminator-form-560__field--select-12_6a47f1267d482-4\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-12[]\" value=\"Toxiphage\" id=\"forminator-form-560__field--select-12_6a47f1267d482-4\" aria-labelledby=\"forminator-form-560__field--select-12_6a47f1267d482-4-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Toxiphage Forte 1 - BL<\/label><label id=\"forminator-form-560__field--select-12_6a47f1267d482-5-label\" for=\"forminator-form-560__field--select-12_6a47f1267d482-5\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-12[]\" value=\"Apresol\" id=\"forminator-form-560__field--select-12_6a47f1267d482-5\" aria-labelledby=\"forminator-form-560__field--select-12_6a47f1267d482-5-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Vymada 50 Mg - Morning<\/label><label id=\"forminator-form-560__field--select-12_6a47f1267d482-6-label\" for=\"forminator-form-560__field--select-12_6a47f1267d482-6\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-12[]\" value=\"Thyronorm-25-mcg\" id=\"forminator-form-560__field--select-12_6a47f1267d482-6\" aria-labelledby=\"forminator-form-560__field--select-12_6a47f1267d482-6-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Vymada 50 Mg - Afternoon<\/label><label id=\"forminator-form-560__field--select-12_6a47f1267d482-7-label\" for=\"forminator-form-560__field--select-12_6a47f1267d482-7\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-12[]\" value=\"Urimax\" id=\"forminator-form-560__field--select-12_6a47f1267d482-7\" aria-labelledby=\"forminator-form-560__field--select-12_6a47f1267d482-7-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Shelcal 500 Mg - BD<\/label><label id=\"forminator-form-560__field--select-12_6a47f1267d482-8-label\" for=\"forminator-form-560__field--select-12_6a47f1267d482-8\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-12[]\" value=\"Zincovit\" id=\"forminator-form-560__field--select-12_6a47f1267d482-8\" aria-labelledby=\"forminator-form-560__field--select-12_6a47f1267d482-8-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Zincovit<\/label><label id=\"forminator-form-560__field--select-12_6a47f1267d482-9-label\" for=\"forminator-form-560__field--select-12_6a47f1267d482-9\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-12[]\" value=\"ENCICARB-100MG\" id=\"forminator-form-560__field--select-12_6a47f1267d482-9\" aria-labelledby=\"forminator-form-560__field--select-12_6a47f1267d482-9-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>ENCICARB 100MG<\/label><label id=\"forminator-form-560__field--select-12_6a47f1267d482-10-label\" for=\"forminator-form-560__field--select-12_6a47f1267d482-10\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-12[]\" value=\"PAN-D\" id=\"forminator-form-560__field--select-12_6a47f1267d482-10\" aria-labelledby=\"forminator-form-560__field--select-12_6a47f1267d482-10-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>PAN-D<\/label><label id=\"forminator-form-560__field--select-12_6a47f1267d482-11-label\" for=\"forminator-form-560__field--select-12_6a47f1267d482-11\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-12[]\" value=\"Nefrosave\" id=\"forminator-form-560__field--select-12_6a47f1267d482-11\" aria-labelledby=\"forminator-form-560__field--select-12_6a47f1267d482-11-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Nefrosave<\/label><label id=\"forminator-form-560__field--select-12_6a47f1267d482-12-label\" for=\"forminator-form-560__field--select-12_6a47f1267d482-12\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-12[]\" value=\"Shelcal\" id=\"forminator-form-560__field--select-12_6a47f1267d482-12\" aria-labelledby=\"forminator-form-560__field--select-12_6a47f1267d482-12-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Shelcal<\/label><label id=\"forminator-form-560__field--select-12_6a47f1267d482-13-label\" for=\"forminator-form-560__field--select-12_6a47f1267d482-13\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-12[]\" value=\"Ecosprin-75\" id=\"forminator-form-560__field--select-12_6a47f1267d482-13\" aria-labelledby=\"forminator-form-560__field--select-12_6a47f1267d482-13-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Ecosprin 75<\/label><label id=\"forminator-form-560__field--select-12_6a47f1267d482-14-label\" for=\"forminator-form-560__field--select-12_6a47f1267d482-14\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-12[]\" value=\"Aztor-10\" id=\"forminator-form-560__field--select-12_6a47f1267d482-14\" aria-labelledby=\"forminator-form-560__field--select-12_6a47f1267d482-14-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Aztor 10<\/label><label id=\"forminator-form-560__field--select-12_6a47f1267d482-15-label\" for=\"forminator-form-560__field--select-12_6a47f1267d482-15\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-12[]\" value=\"Awaytox\" id=\"forminator-form-560__field--select-12_6a47f1267d482-15\" aria-labelledby=\"forminator-form-560__field--select-12_6a47f1267d482-15-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>DIAMICRON 60 mg<\/label><label id=\"forminator-form-560__field--select-12_6a47f1267d482-16-label\" for=\"forminator-form-560__field--select-12_6a47f1267d482-16\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-12[]\" value=\"Lantus-Solostar-100IU-ml\" id=\"forminator-form-560__field--select-12_6a47f1267d482-16\" aria-labelledby=\"forminator-form-560__field--select-12_6a47f1267d482-16-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Lantus Solostar 100IU\/ml<\/label><input type='hidden' name='select-12-multiselect-default-values' class='multiselect-default-values' value='' \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-8\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Benign Prostatic Hyperplasia (BPH)<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-13\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-560__field--select-13_6a47f1267d482\" id=\"forminator-form-560__field--select-13_6a47f1267d482-label\" class=\"forminator-label\">Select Medicines<\/label><div class=\"forminator-multiselect\" aria-labelledby=\"forminator-form-560__field--select-13_6a47f1267d482-label\" aria-describedby=\"forminator-form-560__field--select-13_6a47f1267d482-description\"><label id=\"forminator-form-560__field--select-13_6a47f1267d482-1-label\" for=\"forminator-form-560__field--select-13_6a47f1267d482-1\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-13[]\" value=\"one\" id=\"forminator-form-560__field--select-13_6a47f1267d482-1\" aria-labelledby=\"forminator-form-560__field--select-13_6a47f1267d482-1-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Metoz 2.5Mg  BD <\/label><label id=\"forminator-form-560__field--select-13_6a47f1267d482-2-label\" for=\"forminator-form-560__field--select-13_6a47f1267d482-2\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-13[]\" value=\"two\" id=\"forminator-form-560__field--select-13_6a47f1267d482-2\" aria-labelledby=\"forminator-form-560__field--select-13_6a47f1267d482-2-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Toxiphage Forte 1 - BD<\/label><label id=\"forminator-form-560__field--select-13_6a47f1267d482-3-label\" for=\"forminator-form-560__field--select-13_6a47f1267d482-3\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-13[]\" value=\"Concor-5\" id=\"forminator-form-560__field--select-13_6a47f1267d482-3\" aria-labelledby=\"forminator-form-560__field--select-13_6a47f1267d482-3-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>NODOSIS 500 Mg -  BD<\/label><label id=\"forminator-form-560__field--select-13_6a47f1267d482-4-label\" for=\"forminator-form-560__field--select-13_6a47f1267d482-4\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-13[]\" value=\"Toxiphage\" id=\"forminator-form-560__field--select-13_6a47f1267d482-4\" aria-labelledby=\"forminator-form-560__field--select-13_6a47f1267d482-4-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Toxiphage Forte 1 - BL<\/label><label id=\"forminator-form-560__field--select-13_6a47f1267d482-5-label\" for=\"forminator-form-560__field--select-13_6a47f1267d482-5\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-13[]\" value=\"Apresol\" id=\"forminator-form-560__field--select-13_6a47f1267d482-5\" aria-labelledby=\"forminator-form-560__field--select-13_6a47f1267d482-5-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Vymada 50 Mg - Morning<\/label><label id=\"forminator-form-560__field--select-13_6a47f1267d482-6-label\" for=\"forminator-form-560__field--select-13_6a47f1267d482-6\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-13[]\" value=\"Thyronorm-25-mcg\" id=\"forminator-form-560__field--select-13_6a47f1267d482-6\" aria-labelledby=\"forminator-form-560__field--select-13_6a47f1267d482-6-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>T. Vymada 50 Mg - Afternoon<\/label><label id=\"forminator-form-560__field--select-13_6a47f1267d482-7-label\" for=\"forminator-form-560__field--select-13_6a47f1267d482-7\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-13[]\" value=\"Urimax\" id=\"forminator-form-560__field--select-13_6a47f1267d482-7\" aria-labelledby=\"forminator-form-560__field--select-13_6a47f1267d482-7-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Shelcal 500 Mg - BD<\/label><label id=\"forminator-form-560__field--select-13_6a47f1267d482-8-label\" for=\"forminator-form-560__field--select-13_6a47f1267d482-8\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-13[]\" value=\"Zincovit\" id=\"forminator-form-560__field--select-13_6a47f1267d482-8\" aria-labelledby=\"forminator-form-560__field--select-13_6a47f1267d482-8-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Zincovit<\/label><label id=\"forminator-form-560__field--select-13_6a47f1267d482-9-label\" for=\"forminator-form-560__field--select-13_6a47f1267d482-9\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-13[]\" value=\"ENCICARB-100MG\" id=\"forminator-form-560__field--select-13_6a47f1267d482-9\" aria-labelledby=\"forminator-form-560__field--select-13_6a47f1267d482-9-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>ENCICARB 100MG<\/label><label id=\"forminator-form-560__field--select-13_6a47f1267d482-10-label\" for=\"forminator-form-560__field--select-13_6a47f1267d482-10\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-13[]\" value=\"PAN-D\" id=\"forminator-form-560__field--select-13_6a47f1267d482-10\" aria-labelledby=\"forminator-form-560__field--select-13_6a47f1267d482-10-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>PAN-D<\/label><label id=\"forminator-form-560__field--select-13_6a47f1267d482-11-label\" for=\"forminator-form-560__field--select-13_6a47f1267d482-11\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-13[]\" value=\"Nefrosave\" id=\"forminator-form-560__field--select-13_6a47f1267d482-11\" aria-labelledby=\"forminator-form-560__field--select-13_6a47f1267d482-11-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Nefrosave<\/label><label id=\"forminator-form-560__field--select-13_6a47f1267d482-12-label\" for=\"forminator-form-560__field--select-13_6a47f1267d482-12\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-13[]\" value=\"Shelcal\" id=\"forminator-form-560__field--select-13_6a47f1267d482-12\" aria-labelledby=\"forminator-form-560__field--select-13_6a47f1267d482-12-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Shelcal<\/label><label id=\"forminator-form-560__field--select-13_6a47f1267d482-13-label\" for=\"forminator-form-560__field--select-13_6a47f1267d482-13\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-13[]\" value=\"Ecosprin-75\" id=\"forminator-form-560__field--select-13_6a47f1267d482-13\" aria-labelledby=\"forminator-form-560__field--select-13_6a47f1267d482-13-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Ecosprin 75<\/label><label id=\"forminator-form-560__field--select-13_6a47f1267d482-14-label\" for=\"forminator-form-560__field--select-13_6a47f1267d482-14\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-13[]\" value=\"Aztor-10\" id=\"forminator-form-560__field--select-13_6a47f1267d482-14\" aria-labelledby=\"forminator-form-560__field--select-13_6a47f1267d482-14-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Aztor 10<\/label><label id=\"forminator-form-560__field--select-13_6a47f1267d482-15-label\" for=\"forminator-form-560__field--select-13_6a47f1267d482-15\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-13[]\" value=\"Awaytox\" id=\"forminator-form-560__field--select-13_6a47f1267d482-15\" aria-labelledby=\"forminator-form-560__field--select-13_6a47f1267d482-15-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>DIAMICRON 60 mg<\/label><label id=\"forminator-form-560__field--select-13_6a47f1267d482-16-label\" for=\"forminator-form-560__field--select-13_6a47f1267d482-16\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-13[]\" value=\"Lantus-Solostar-100IU-ml\" id=\"forminator-form-560__field--select-13_6a47f1267d482-16\" aria-labelledby=\"forminator-form-560__field--select-13_6a47f1267d482-16-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Lantus Solostar 100IU\/ml<\/label><input type='hidden' name='select-13-multiselect-default-values' class='multiselect-default-values' value='' \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6a47f1267d482\" id=\"forminator-field-textarea-2_6a47f1267d482-label\" class=\"forminator-label\">Doctor Suggestion \/ Write Your Suggestion<\/label><textarea name=\"textarea-2\" placeholder=\"E.g. text placeholder\nYou can add new line\" id=\"forminator-field-textarea-2_6a47f1267d482\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-3\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_6a47f1267d482\" id=\"forminator-field-textarea-3_6a47f1267d482-label\" class=\"forminator-label\">Any Other Condition Or Disease<\/label><textarea name=\"textarea-3\" placeholder=\"E.g. text placeholder\nYou can add new line\" id=\"forminator-field-textarea-3_6a47f1267d482\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-4\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-4_6a47f1267d482\" id=\"forminator-field-textarea-4_6a47f1267d482-label\" class=\"forminator-label\">Any Other Medications<\/label><textarea name=\"textarea-4\" placeholder=\"E.g. text placeholder\nYou can add new line\" id=\"forminator-field-textarea-4_6a47f1267d482\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-5\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-5_6a47f1267d482\" id=\"forminator-field-textarea-5_6a47f1267d482-label\" class=\"forminator-label\">Doctor Suggestion \/ Write Your Suggestion<\/label><textarea name=\"textarea-5\" placeholder=\"E.g. text placeholder\nYou can add new line\" id=\"forminator-field-textarea-5_6a47f1267d482\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-2\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-picker_6a47f1267d482\" class=\"forminator-label\" id=\"forminator-field-date-2-picker_6a47f1267d482-label\">Next Follow-Up Date<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-2-picker_6a47f1267d482\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-2\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-2-picker_6a47f1267d482\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-1_6a47f1267d482\" class=\"forminator-label\">Upload file<\/label><div class=\"forminator-file-upload \" data-element=\"upload-1_6a47f1267d482\" aria-describedby=\"forminator-field-upload-1_6a47f1267d482-description\"><input type=\"file\" name=\"upload-1\" id=\"forminator-field-upload-1_6a47f1267d482\" class=\"forminator-input-file\" accept=\".webp,.css,.htm,.html,.js,.svg,.svgz,.xml,.json,.jpg,.jpeg,.jpe,.doc,.docx,.pdf\"><button id=\"forminator-field-upload-1_6a47f1267d482_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-1_6a47f1267d482\">Choose File<\/button><span data-empty-text=\"No file chosen\">No file chosen<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Delete uploaded file<\/span><\/button><\/div><\/div><\/div><\/div><\/div><button class=\"forminator-button forminator-pagination-submit\" style=\"display: none;\" disabled>Upload Prescription<\/button><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"cf93fe25b4\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/540\" \/><input type=\"hidden\" name=\"form_id\" value=\"560\"><input type=\"hidden\" name=\"page_id\" value=\"540\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/prescription.kidneyhealthkolkata.com\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><\/div>\n\t\t\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\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>WRITE PRESCRIPTION<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","theme-transparent-header-meta":"enabled","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":""},"_links":{"self":[{"href":"https:\/\/prescription.kidneyhealthkolkata.com\/index.php\/wp-json\/wp\/v2\/pages\/540"}],"collection":[{"href":"https:\/\/prescription.kidneyhealthkolkata.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/prescription.kidneyhealthkolkata.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/prescription.kidneyhealthkolkata.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/prescription.kidneyhealthkolkata.com\/index.php\/wp-json\/wp\/v2\/comments?post=540"}],"version-history":[{"count":8,"href":"https:\/\/prescription.kidneyhealthkolkata.com\/index.php\/wp-json\/wp\/v2\/pages\/540\/revisions"}],"predecessor-version":[{"id":563,"href":"https:\/\/prescription.kidneyhealthkolkata.com\/index.php\/wp-json\/wp\/v2\/pages\/540\/revisions\/563"}],"wp:attachment":[{"href":"https:\/\/prescription.kidneyhealthkolkata.com\/index.php\/wp-json\/wp\/v2\/media?parent=540"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}