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{"0":{"lid":"1531306243545","ls":"10","loff":"","li_type":"nm","li_title":"Medical facility data","li_ph":"Name","li_req":"y","li_nm":"Name"},"1":{"lid":"1531306540094","ls":"20","loff":"","li_type":"nm","li_name":"name","li_ph":"The contact person","li_req":"y","li_nm":"name"},"2":{"lid":"1619002476925","ls":"30","loff":"","li_type":"em","li_ph":"E-mail","li_req":"y","li_nm":"Email"},"3":{"lid":"1619002513727","ls":"40","loff":"","li_type":"nm","li_ph":"Full name of the doctor","li_req":"y","li_nm":"Name_2"},"4":{"lid":"1619002587660","ls":"50","loff":"","li_type":"sb","li_req":"y","li_variants":"Male\nFemale","li_selfirstvar":"Patient gender","li_nm":"Selectbox"},"5":{"lid":"1619002678979","ls":"60","loff":"","li_type":"in","li_ph":"Patient age","li_rule":"number","li_req":"y","li_nm":"Input"},"6":{"lid":"1619002826012","ls":"70","loff":"","li_type":"in","li_title":"Medical device data","li_ph":"Name","li_rule":"name","li_req":"y","li_nm":"Medical device data"},"7":{"lid":"1619002857340","ls":"80","loff":"","li_type":"in","li_ph":"Vendor code","li_rule":"name","li_req":"y","li_nm":"Input_2"},"8":{"lid":"1619003205771","ls":"90","loff":"","li_type":"in","li_ph":"Lot number*","li_rule":"name","li_req":"y","li_nm":"Input_3"},"9":{"lid":"1619003230057","ls":"100","loff":"","li_type":"qn","li_title":"Number","li_ph":"1","li_req":"y","li_nm":"Number"},"10":{"lid":"1619003242950","ls":"110","loff":"","li_type":"cb","li_subtitle":"* Without specifying the lot number, consideration of the complaint is impossible.","li_req":"y","li_label":"Submitted for analysis (check if directed)","li_nm":"Checkbox"},"11":{"lid":"1619003344787","ls":"120","loff":"","li_type":"cb","li_title":"For the analysis, records were sent: (check the appropriate box, if directed)","li_req":"y","li_label":"Angiography recording","li_nm":"For the analysis records were sent: check the appropriate box if directed"},"12":{"lid":"1619003895076","ls":"130","loff":"","li_type":"cb","li_req":"y","li_label":"Operation protocol<br>","li_nm":"Checkbox_2"},"13":{"lid":"1619003962319","ls":"140","loff":"","li_type":"cb","li_title":"The complaint is sent","li_req":"y","li_label":"For informational purposes","li_nm":"The complaint is sent"},"14":{"lid":"1619004051893","ls":"150","loff":"","li_type":"cb","li_title":" ","li_req":"y","li_label":"For informational purposes<br>","li_nm":" "},"15":{"lid":"1619004092194","ls":"160","loff":"","li_type":"ta","li_title":"Description of the event (mandatory, if the operation protocol is not provided)","li_ph":"Indicate the date, the most detailed description and the consequences of the incident.","li_rows":"3","li_nm":"Description of the event mandatory if the operation protocol is not provided"},"16":{"lid":"1619006802521","ls":"170","loff":"","li_type":"cb","li_label":"I agree to the transfer and <a href=\"https://drive.google.com/file/d/1fGv8jivszafWx3ZBkwyoiKX2vebQpcDI/view?usp=sharing\" style=\"color:rgb(135, 135, 135) !important;\">processing of personal data</a>* ","li_nm":"Checkbox_3"}}
Reclamation
