{"id":29,"date":"2024-04-22T15:03:20","date_gmt":"2024-04-22T15:03:20","guid":{"rendered":"https:\/\/hta.afiethica.ro\/?page_id=29"},"modified":"2024-08-24T21:20:03","modified_gmt":"2024-08-24T18:20:03","slug":"formular-de-evaluare-pacient","status":"publish","type":"page","link":"https:\/\/hta.afiethica.ro\/","title":{"rendered":"FI\u0218\u0102 DE ASISTEN\u021a\u0102 FARMACEUTIC\u0102"},"content":{"rendered":"\n<p class=\"has-text-align-center wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"has-text-align-center has-medium-font-size wp-block-paragraph\" style=\"padding-top:0;padding-bottom:0\"><strong>Serviciul de consiliere a pacientului cu valori tensionale crescute\u00a0<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center has-large-font-size wp-block-paragraph\"><strong>FI\u0218\u0102 DE ASISTEN\u021a\u0102 FARMACEUTIC\u0102<\/strong><\/p>\n\n\n\n<div class=\"wp-block-uagb-container uagb-block-fca4a6c6 alignfull uagb-is-root-container\"><div class=\"uagb-container-inner-blocks-wrap\"><div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-584cd727-fb27-4e28-8edd-cd9568185901 wpforms-render-modern\" id=\"wpforms-55\"><form id=\"wpforms-form-55\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"55\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/29\" data-token=\"ee3ba59b8e20d4102f04861ddfccc1d2\" data-token-time=\"1791800094\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-hidden\" id=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#72b239\" data-scroll=\"1\" role=\"progressbar\" aria-valuenow=\"1\" aria-valuemin=\"1\" aria-valuemax=\"2\" tabindex=\"-1\"><span class=\"wpforms-page-indicator-page-title\" ><\/span><span class=\"wpforms-page-indicator-page-title-sep\" style=\"display:none;\"> &#8211; <\/span><span class=\"wpforms-page-indicator-steps\">Pasul <span class=\"wpforms-page-indicator-steps-current\">1<\/span> din 2<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:50%;background-color:#72b239\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-55-field_53-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"53\"><\/div><div id=\"wpforms-55-field_8-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"8\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-55-field_58-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-modern\" data-field-type=\"select\" data-field-id=\"58\"><label class=\"wpforms-field-label\" for=\"wpforms-55-field_58\">Farmacia <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-55-field_58\" class=\"wpforms-field-medium wpforms-field-required choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-medium\" data-search-enabled=\"1\" name=\"wpforms[fields][58]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Alege farmacia (click si apoi scrie primiele litere)<\/option><option value=\"A.F. Tehno-farm\" >A.F. Tehno-farm<\/option><option value=\"Ana Farm Brasov\" >Ana Farm Brasov<\/option><option value=\"Andra-Farm Dumbraveni\" >Andra-Farm Dumbraveni<\/option><option value=\"Andra-Farm Siminicea\" >Andra-Farm Siminicea<\/option><option value=\"Apoteca 1 Gara B\" >Apoteca 1 Gara B<\/option><option value=\"Arnica 1 Cluj-Napoca\" >Arnica 1 Cluj-Napoca<\/option><option value=\"Arnica Oasului Cluj-Napoca\" >Arnica Oasului Cluj-Napoca<\/option><option value=\"Artemisia Negresti-Oas\" >Artemisia Negresti-Oas<\/option><option value=\"Astra BV\" >Astra BV<\/option><option value=\"Crisfarm Frumosu SV\" >Crisfarm Frumosu SV<\/option><option value=\"Doktoralec Farm BR\" >Doktoralec Farm BR<\/option><option value=\"Dracaena Farm SV\" >Dracaena Farm SV<\/option><option value=\"Elami Farm Calarasi\" >Elami Farm Calarasi<\/option><option value=\"Elisafarm Galati\" >Elisafarm Galati<\/option><option value=\"Ethica 1 Brasov\" >Ethica 1 Brasov<\/option><option value=\"FarmAna 2007\" >FarmAna 2007<\/option><option value=\"Farmacia Remedia&amp;Farm Suli\u021ba\" >Farmacia Remedia&amp;Farm Suli\u021ba<\/option><option value=\"Farm Alex Lunca\" >Farm Alex Lunca<\/option><option value=\"Farm Alex Rusetu\" >Farm Alex Rusetu<\/option><option value=\"Farm Alex Padina\" >Farm Alex Padina<\/option><option value=\"Farm Alex Marghiloman\" >Farm Alex Marghiloman<\/option><option value=\"Flavina CJ\" >Flavina CJ<\/option><option value=\"Firuta Farm MM\" >Firuta Farm MM<\/option><option value=\"Granathalma Giroc\" >Granathalma Giroc<\/option><option value=\"Gentiana Tufesti\" >Gentiana Tufesti<\/option><option value=\"Grigorescu Cluj\" >Grigorescu Cluj<\/option><option value=\"Herba Farm CJ\" >Herba Farm CJ<\/option><option value=\"Hyperici Gura Humorului SV\" >Hyperici Gura Humorului SV<\/option><option value=\"Intendo Farm Dumbravita\" >Intendo Farm Dumbravita<\/option><option value=\"Iris Codlea\" >Iris Codlea<\/option><option value=\"MB Farm\" >MB Farm<\/option><option value=\"Farmacia Maxima Farm\" >Farmacia Maxima Farm<\/option><option value=\"Micsandra Vatra Dornei\" >Micsandra Vatra Dornei<\/option><option value=\"Mirafarm AR 2 Crinului\" >Mirafarm AR 2 Crinului<\/option><option value=\"Mirafarm AR 1 Cri\u0219an\" >Mirafarm AR 1 Cri\u0219an<\/option><option value=\"Mirafarm BV\" >Mirafarm BV<\/option><option value=\"Panaceea CJ\" >Panaceea CJ<\/option><option value=\"Paniteka Dej\" >Paniteka Dej<\/option><option value=\"Paulbrito BR\" >Paulbrito BR<\/option><option value=\"Primula 2 Ulmeni MM\" >Primula 2 Ulmeni MM<\/option><option value=\"Primula Farm - Ulmeni CL\" >Primula Farm &#8211; Ulmeni CL<\/option><option value=\"Remedia BV\" >Remedia BV<\/option><option value=\"Rodal Farm Hilpiceni\" >Rodal Farm Hilpiceni<\/option><option value=\"Rodal Farm Rauseni\" >Rodal Farm Rauseni<\/option><option value=\"Sf\u00e2ntul \u0218tefan SM\" >Sf\u00e2ntul \u0218tefan SM<\/option><option value=\"Sanimex Buzau\" >Sanimex Buzau<\/option><option value=\"Somesan Pasunii\" >Somesan Pasunii<\/option><option value=\"SicVolo BV\" >SicVolo BV<\/option><option value=\"Terrapharm Bv\" >Terrapharm Bv<\/option><option value=\"Timifarm BV\" >Timifarm BV<\/option><option value=\"Viomed Spital Calarasi\" >Viomed Spital Calarasi<\/option><option value=\"Vitafarm Andrieseni\" >Vitafarm Andrieseni<\/option><option value=\"Vitafarm Vladeni\" >Vitafarm Vladeni<\/option><option value=\"Yucca Bodesti\" >Yucca Bodesti<\/option><\/select><\/div><div id=\"wpforms-55-field_125-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"125\" style=\"display:none;\"><div id=\"wpforms-55-field_125\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_125-error\"><p>Farmacia Remedia&amp;Farm<br \/>\nAdresa: Str. Principal\u0103, nr. 129, Suli\u021ba, jud. Boto\u0219ani<br \/>\nTelefon: 0372 937 408<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_171-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"171\" style=\"display:none;\"><div id=\"wpforms-55-field_171\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_171-error\"><p>Farmacia Maxima Farm<br \/>\nAdresa: H\u00e2r\u0219ani 101a, jud Bra\u0219ov<br \/>\nTelefon: 0268.247.772<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_170-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"170\" style=\"display:none;\"><div id=\"wpforms-55-field_170\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_170-error\"><p>Farmacia Somesan<br \/>\nAdresa: Str. Pa\u0219unii nr.2\/30 Baia Mare, Maramures<br \/>\nTelefon: 0733.025.804<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_169-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"169\" style=\"display:none;\"><div id=\"wpforms-55-field_169\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_169-error\"><p>Farmacia Intendo Farm Dumbravita<br \/>\nAdresa: Dumbravita, Brasov<br \/>\nTelefon: 0268483472<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_165-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"165\" style=\"display:none;\"><div id=\"wpforms-55-field_165\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_165-error\"><p>Farmacia Farm Alex Lunca<br \/>\nAdresa: Sat Lunca, Com. C.A. Rosetti, Buz\u0103u<br \/>\nTelefon: 0238.733.815<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_166-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"166\" style=\"display:none;\"><div id=\"wpforms-55-field_166\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_166-error\"><p>Farmacia Farm Alex Ru\u015fe\u0163u<br \/>\nAdresa: Bloc 2, Ru\u015fe\u0163u, Buz\u0103u<br \/>\nTelefon: 0238.733.575<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_167-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"167\" style=\"display:none;\"><div id=\"wpforms-55-field_167\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_167-error\"><p>Farmacia Farm Alex Padina<br \/>\nAdresa: Str. Bibescu, nr. 45, Padina, Buz\u0103u<br \/>\nTelefon: 0238.531.948<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_168-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"168\" style=\"display:none;\"><div id=\"wpforms-55-field_168\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_168-error\"><p>Farmacia Farm Alex Marghiloman<br \/>\nAdresa: Str. Alexandru Marghiloman, nr. 94, Buz\u0103u<br \/>\nTelefon: 0238.721.027<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_164-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"164\" style=\"display:none;\"><div id=\"wpforms-55-field_164\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_164-error\"><p>Farmacia Ethica 1 Brasov<br \/>\nAdresa: Harmanului nr. 25, Brasov<br \/>\nTelefon: 0771.574.767<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_163-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"163\" style=\"display:none;\"><div id=\"wpforms-55-field_163\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_163-error\"><p>Farmacia Artemisia Negre\u0219ti-Oa\u0219<br \/>\nAdresa: Str. Victoriei nr. 91, Negre\u0219ti-Oa\u0219, Satu Mare<br \/>\nTelefon: 0261.854.591<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_162-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"162\" style=\"display:none;\"><div id=\"wpforms-55-field_162\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_162-error\"><p>Farmacia Elisafarm<br \/>\nAdresa: Bdl. Traian nr. 301, Gala\u021bi<br \/>\nTelefon: 0236.412.579<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_161-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"161\" style=\"display:none;\"><div id=\"wpforms-55-field_161\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_161-error\"><p>Farmacia Sanimex<br \/>\nAdresa: Bdl. Stadionului nr. 62, Buz\u0103u<br \/>\nTelefon: 0238.721.041<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_160-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"160\" style=\"display:none;\"><div id=\"wpforms-55-field_160\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_160-error\"><p>Farmacia FarmAna 2007<br \/>\nAdresa: Palanca, Giurgiu<br \/>\nTelefon: 0246.257.333<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_159-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"159\" style=\"display:none;\"><div id=\"wpforms-55-field_159\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_159-error\"><p>Farmacia Yucca Bode\u0219ti<br \/>\nAdresa: Bode\u0219ti, Neam\u021b<br \/>\nTelefon: 0233.243.403<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_158-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"158\" style=\"display:none;\"><div id=\"wpforms-55-field_158\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_158-error\"><p>Farmacia MB Farm<br \/>\nAdresa: Bdl. Matei Basarab nr.77, Slobozia, Ialomita<br \/>\nTelefon: 0243.234.454<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_157-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"157\" style=\"display:none;\"><div id=\"wpforms-55-field_157\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_157-error\"><p>Farmacia Ana Farm<br \/>\nAdresa: Calea Bucure\u0219ti nr. 91, Bra\u0219ov<br \/>\nTelefon: 0268.316.666<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_156-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"156\" style=\"display:none;\"><div id=\"wpforms-55-field_156\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_156-error\"><p>Farmacia A.F. Tehno-Farm<br \/>\nAdresa: DN31 nr. 81, M\u00e2n\u0103stirea, C\u0103l\u0103ra\u0219i<br \/>\nTelefon: 0242.520.140<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_152-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"152\" style=\"display:none;\"><div id=\"wpforms-55-field_152\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_152-error\"><p>Farmacia Gentiana Tufesti<br \/>\nAdresa: Str. Brailei 226, Sat Tufesti, Braila<br \/>\nTelefon: 0239.665.487<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_155-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"155\" style=\"display:none;\"><div id=\"wpforms-55-field_155\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_155-error\"><p>Farmacia Paniteka Dej<br \/>\nAdresa: Pia\u0163a Bob\u00e2lna, Dej, Cluj<br \/>\nTelefon: 0754.663.009<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_154-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"154\" style=\"display:none;\"><div id=\"wpforms-55-field_154\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_154-error\"><p>Farmacia Vitafarm Vladeni<br \/>\nAdresa: Bl G, Tr. III, parter, Vladeni, Iasi<br \/>\nTelefon: 0232.297.381<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_153-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"153\" style=\"display:none;\"><div id=\"wpforms-55-field_153\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_153-error\"><p>Farmacia Vitafarm Andrieseni<br \/>\nAdresa: Andrie\u0219eni, Iasi<br \/>\nTelefon: 0232.297.381<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_151-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"151\" style=\"display:none;\"><div id=\"wpforms-55-field_151\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_151-error\"><p>Farmacia Iris Codlea<br \/>\nAdresa: Str. Pie\u021bii nr.12, Codlea, Brasov<br \/>\nTelefon: 0268.253.020<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_150-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"150\" style=\"display:none;\"><div id=\"wpforms-55-field_150\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_150-error\"><p>Farmacia Apoteca 1 Gara<br \/>\nAdresa: Str. G\u0103rii De Nord, nr. 2, Sector 1, Bucure\u0219ti<br \/>\nTelefon: 0748.156.367<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_146-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"146\" style=\"display:none;\"><div id=\"wpforms-55-field_146\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_146-error\"><p>Farmacia Andra-Farm Siminicea<br \/>\nAdresa: Simincea, Suceava<br \/>\nTelefon: 0730.567.608<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_149-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"149\" style=\"display:none;\"><div id=\"wpforms-55-field_149\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_149-error\"><p>Farmacia Micsandra Vatra Dornei<br \/>\nAdresa: Str. Unirii, nr. 29<br \/>\nTelefon: 0230.370.031<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_148-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"148\" style=\"display:none;\"><div id=\"wpforms-55-field_148\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_148-error\"><p>Farmacia Andra-Farm Dumbr\u0103veni<br \/>\nAdresa: Dumbr\u0103veni, Suceava<br \/>\nTelefon: 0730.567.408<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_147-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"147\" style=\"display:none;\"><div id=\"wpforms-55-field_147\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_147-error\"><p>Farmacia Rodal Farm R\u00e2u\u0219eni<br \/>\nAdresa: R\u0103useni, Boto\u0219ani<br \/>\nTelefon: 0231.648.239<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_145-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"145\" style=\"display:none;\"><div id=\"wpforms-55-field_145\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_145-error\"><p>Farmacia Rodal Farm Hilpiceni<br \/>\nAdresa: Hilpiceni, Boto\u0219ani<br \/>\nTelefon: 0758.631.198<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_144-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"144\" style=\"display:none;\"><div id=\"wpforms-55-field_144\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_144-error\"><p>Farmacia Elami Farm<br \/>\nAdresa: Sat Petri\u0219oru, C\u0103l\u0103ra\u0219i<br \/>\nTelefon: 0726.731.744<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_143-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"143\" style=\"display:none;\"><div id=\"wpforms-55-field_143\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_143-error\"><p>Farmacia Viomed Spital<br \/>\nAdresa: Str. Mihai Eminescu 10, Oltenita, Calara\u0219i<br \/>\nTelefon: 0342.401.890<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_142-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"142\" style=\"display:none;\"><div id=\"wpforms-55-field_142\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_142-error\"><p>Farmacia Grigorescu<br \/>\nAdresa: Str . Alexandru Vlahuta nr. 50, Cluj-Napoca<br \/>\nTelefon: 0264.420.915<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_141-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"141\" style=\"display:none;\"><div id=\"wpforms-55-field_141\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_141-error\"><p>Farmacia Terrapharm<br \/>\nAdresa: Str. Prunului nr 9, Brasov<br \/>\nTelefon: 0268.336.032<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_139-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"139\" style=\"display:none;\"><div id=\"wpforms-55-field_139\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_139-error\"><p>Farmacia Hyperici Suceava<br \/>\nAdresa: Bd. Bucovinei Nr. 39 bis Gura Humorului, Suceava<br \/>\nTelefon: 0742.229.494<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_140-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"140\" style=\"display:none;\"><div id=\"wpforms-55-field_140\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_140-error\"><p>Farmacia Firu\u021ba Farm<br \/>\nAdresa: Berbe\u0219ti, Maramure\u0219<br \/>\nTelefon: 0740.237.104<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_138-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"138\" style=\"display:none;\"><div id=\"wpforms-55-field_138\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_138-error\"><p>Farmacia Paulbrito<br \/>\nAdresa: Sat Jirl\u0103u, Br\u0103ila<br \/>\nTelefon: 0758.038.820<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_137-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"137\" style=\"display:none;\"><div id=\"wpforms-55-field_137\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_137-error\"><p>Farmacia Doktoralec Farm<br \/>\nAdresa: Str. Tineretului nr. 1 \u00censur\u0103\u021bei, Br\u0103ila<br \/>\nTelefon: 0741.365.165<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_135-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"135\" style=\"display:none;\"><div id=\"wpforms-55-field_135\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_135-error\"><p>Farmacia Arnica 1 Cluj-Napoca<br \/>\nAdresa: str. Izlazului, nr.10\/2 Cluj-Napoca<br \/>\nTelefon: 0264.458.081<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_136-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"136\" style=\"display:none;\"><div id=\"wpforms-55-field_136\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_136-error\"><p>Farmacia Arnica Cluj-Napoca<br \/>\nAdresa: Str. Oasului 86-90 Cluj-Napoca<br \/>\nTelefon: 0364.114.836<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_110-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"110\" style=\"display:none;\"><div id=\"wpforms-55-field_110\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_110-error\"><p>Farmacia Astra BV<br \/>\nAdresa: Bulevardul G\u0103rii 1, Bra\u0219ov<br \/>\nTelefon: 0268.329.437<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_122-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"122\" style=\"display:none;\"><div id=\"wpforms-55-field_122\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_122-error\"><p>Farmacia Crisfarm SV<br \/>\nAdresa: Suceava, Localitatea Frumosu<br \/>\nTelefon: 0230.576.429<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_123-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"123\" style=\"display:none;\"><div id=\"wpforms-55-field_123\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_123-error\"><p>Farmacia Dracaena Farm SV<br \/>\nAdresa: Str. Drago\u0219 Vod\u0103 nr. 40, R\u0103d\u0103u\u021bi, jud. Suceava<br \/>\nTelefon: 0748.299.993\/ 0374.060.766<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_127-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"127\" style=\"display:none;\"><div id=\"wpforms-55-field_127\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_127-error\"><p>Farmacia Herba Farm CJ<br \/>\nAdresa: Str. Fantanele, nr. 5, bloc R, scara 1, Cluj-Napoca, jud. Cluj<br \/>\nTelefon: 0264.582.112<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_119-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"119\" style=\"display:none;\"><div id=\"wpforms-55-field_119\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_119-error\"><p>Farmacia Panaceea CJ<br \/>\nAdresa: Strada Donath 15, Cluj-Napoca<br \/>\nTelefon: 0755.035.959<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_128-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"128\" style=\"display:none;\"><div id=\"wpforms-55-field_128\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_128-error\"><p>Farmacia Primula 2 &#8211; Ulmeni SM<br \/>\nAdresa: Str. Petre Dulfu Nr 30a, Ulmeni, Maramures<br \/>\nTelefon: 0262.264.555<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_126-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"126\" style=\"display:none;\"><div id=\"wpforms-55-field_126\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_126-error\"><p>Farmacia Primula Farm &#8211; Ulmeni C\u0103l\u0103ra\u0219i<br \/>\nAdresa: \u0218oseaua Oltenitei, nr. 316, Sat Ulmeni, Comuna Ulmeni, jud. C\u0103l\u0103ra\u0219i<br \/>\nTelefon: 0729.126.722<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_109-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"109\" style=\"display:none;\"><div id=\"wpforms-55-field_109\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_109-error\"><p>Farmacia Remedia BV<br \/>\nAdresa: Bulevardul G\u0103rii 5, Bra\u0219ov<br \/>\nTelefon: 0268.422.120<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_121-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"121\" style=\"display:none;\"><div id=\"wpforms-55-field_121\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_121-error\"><p>Farmacia Sic-Volo BV<br \/>\nAdresa: Str. Nicolae B\u0103lcescu, Nr. 16, Bra\u0219ov<br \/>\nTelefon: 0742.036.236<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_124-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"124\" style=\"display:none;\"><div id=\"wpforms-55-field_124\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_124-error\"><p>Farmacia Sf\u00e2ntul \u0218tefan SM<br \/>\nAdresa: Str. Satu-Mare, nr. 14, Livada, Jud. Satu-Mare<br \/>\nTelefon: 0745.824.408<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_120-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"120\" style=\"display:none;\"><div id=\"wpforms-55-field_120\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_120-error\"><p>Farmacia Timifarm BV<br \/>\nAdresa: Str. Republicii Nr. 652, S\u00e2npetru<br \/>\nTelefon: 0726.742.267<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_129-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"129\" style=\"display:none;\"><div id=\"wpforms-55-field_129\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_129-error\"><p>Farmacia Mirafarm BV<br \/>\nAdresa: Loc. Codlea, str. Muntisor, nr.5, Jud. Brasov<br \/>\nTelefon: 0268.252.751<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_130-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"130\" style=\"display:none;\"><div id=\"wpforms-55-field_130\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_130-error\"><p>Farmacia Flavina CJ<br \/>\nAdresa: Sat Lujerdiu, nr. 45, com. Corne\u0219ti, jud. Cluj<br \/>\nTelefon: 0774.693.644<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_131-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"131\" style=\"display:none;\"><div id=\"wpforms-55-field_131\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_131-error\"><p>Farmacia Granathalma Timi\u0219oara<br \/>\nAdresa: Str. Mare\u0219al Al. Averescu, nr. 70<br \/>\nTelefon: 0356.102.584<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_132-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"132\" style=\"display:none;\"><div id=\"wpforms-55-field_132\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_132-error\"><p>Farmacia Granathalma Giroc<br \/>\nAdresa: Str. F\u00e2nt\u00e2nii, nr 2, Complex comercial Profi, Giroc<br \/>\nTelefon: 0356.176.314<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_133-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"133\" style=\"display:none;\"><div id=\"wpforms-55-field_133\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_133-error\"><p>Farmacia Mirafarm AR 1 Cri\u0219an<br \/>\nAdresa: Str. Cri\u0219an, nr. 9, Arad, jud. Arad<br \/>\nTelefon: 0257.250.015<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-55-field_134-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"134\" style=\"display:none;\"><div id=\"wpforms-55-field_134\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_134-error\"><p>Farmacia Mirafarm AR 2 Crinului<br \/>\nAdresa: Str. Crinului, nr. 2, Arad, jud. Arad<br \/>\nTelefon: 0357.405.863<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-55-field_6-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-55-field_6\">Nume farmacist: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-55-field_6\" class=\"wpforms-field-large wpforms-field-required wpforms-limit-characters-enabled\" data-form-id=\"55\" data-field-id=\"6\" data-text-limit=\"500\" name=\"wpforms[fields][6]\" aria-errormessage=\"wpforms-55-field_6-error\" maxlength=\"500\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-55-field_5-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"5\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-25-25\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-55-field_1-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-55-field_1\">Nume pacient: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-55-field_1\" class=\"wpforms-field-small wpforms-field-required wpforms-limit-characters-enabled\" data-form-id=\"55\" data-field-id=\"1\" data-text-limit=\"500\" name=\"wpforms[fields][1]\" aria-errormessage=\"wpforms-55-field_1-error\" maxlength=\"500\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-55-field_4-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-55-field_4\">V\u00e2rsta <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-55-field_4\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][4]\" aria-errormessage=\"wpforms-55-field_4-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-55-field_118-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"118\"><label class=\"wpforms-field-label\" for=\"wpforms-55-field_118\">Nr. de telefon pacient <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-55-field_118\" class=\"wpforms-field-medium wpforms-field-required wpforms-limit-characters-enabled\" data-form-id=\"55\" data-field-id=\"118\" data-text-limit=\"20\" name=\"wpforms[fields][118]\" aria-errormessage=\"wpforms-55-field_118-error\" maxlength=\"20\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-55-field_35-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"35\"><fieldset><legend class=\"wpforms-field-label\">Pacient aflat sub tratament hipertensiv <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-55-field_35\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_35_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][35][]\" value=\"Nu\" aria-errormessage=\"wpforms-55-field_35_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_35_1\">Nu<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_35_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][35][]\" value=\"Da\" aria-errormessage=\"wpforms-55-field_35_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_35_2\">Da<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-55-field_67-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"67\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-55-field_67\">Enumera\u021bi medica\u021bia antihipertensiv\u0103<\/label><input type=\"text\" id=\"wpforms-55-field_67\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"55\" data-field-id=\"67\" data-text-limit=\"100\" name=\"wpforms[fields][67]\" aria-errormessage=\"wpforms-55-field_67-error\" ><\/div><div id=\"wpforms-55-field_68-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"68\"><fieldset><legend class=\"wpforms-field-label\">Alte tratamente utilizate de pacient <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-55-field_68\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_68_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][68][]\" value=\"Nu\" aria-errormessage=\"wpforms-55-field_68_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_68_1\">Nu<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_68_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][68][]\" value=\"Da\" aria-errormessage=\"wpforms-55-field_68_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_68_2\">Da<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-55-field_69-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"69\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-55-field_69\">Enumera\u021bi <\/label><input type=\"text\" id=\"wpforms-55-field_69\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"55\" data-field-id=\"69\" data-text-limit=\"100\" name=\"wpforms[fields][69]\" aria-errormessage=\"wpforms-55-field_69-error\" ><\/div><div id=\"wpforms-55-field_16-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"16\"><h3 id=\"wpforms-55-field_16\" aria-errormessage=\"wpforms-55-field_16-error\">M\u0103surare tensiune arterial\u0103:<\/h3><\/div><div id=\"wpforms-55-field_22-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"22\"><fieldset><legend class=\"wpforms-field-label\">Pacientul dore\u0219te m\u0103surarea tensiunii arteriale ? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-55-field_22\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_22_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][22][]\" value=\"Da\" aria-errormessage=\"wpforms-55-field_22_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_22_1\">Da<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_22_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][22][]\" value=\"Nu\" aria-errormessage=\"wpforms-55-field_22_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_22_2\">Nu<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-55-field_17-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"17\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-55-field_19-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"19\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-55-field_19\">M\u0103sur\u0103toarea 1: tensiune sistolic\u0103 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-55-field_19\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][19]\" aria-errormessage=\"wpforms-55-field_19-error\" required><\/div><div id=\"wpforms-55-field_27-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"27\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-55-field_27\">M\u0103sur\u0103toarea 2: tensiune sistolic\u0103 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-55-field_27\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][27]\" aria-errormessage=\"wpforms-55-field_27-error\" required><\/div><div id=\"wpforms-55-field_31-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger wpforms-calculations-field\" data-field-type=\"text\" data-field-id=\"31\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-55-field_31\">Media m\u0103sur\u0103torilor tensiune sistolic\u0103<\/label><input type=\"text\" id=\"wpforms-55-field_31\" class=\"wpforms-field-medium\" name=\"wpforms[fields][31]\" readonly=\"readonly\" aria-errormessage=\"wpforms-55-field_31-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-55-field_49-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"49\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-55-field_49\">M\u0103sur\u0103toarea 1: tensiune diastolic\u0103 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-55-field_49\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][49]\" aria-errormessage=\"wpforms-55-field_49-error\" required><\/div><div id=\"wpforms-55-field_50-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"50\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-55-field_50\">M\u0103sur\u0103toarea 2: tensiune diastolic\u0103 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-55-field_50\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][50]\" aria-errormessage=\"wpforms-55-field_50-error\" required><\/div><div id=\"wpforms-55-field_51-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show wpforms-calculations-field\" data-field-type=\"text\" data-field-id=\"51\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-55-field_51\">Media m\u0103sur\u0103torilor tensiune diastolic\u0103<\/label><input type=\"text\" id=\"wpforms-55-field_51\" class=\"wpforms-field-medium\" name=\"wpforms[fields][51]\" readonly=\"readonly\" aria-errormessage=\"wpforms-55-field_51-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-55-field_74-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"74\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-33-67\"><div class=\"wpforms-layout-column wpforms-layout-column-33\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-67\" ><div id=\"wpforms-55-field_91-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"91\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Se recomand\u0103 consultul medical la medicul de familie sau \u00een ambulator (medic cardiolog) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-55-field_91\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_91_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][91][]\" value=\"Da\" aria-errormessage=\"wpforms-55-field_91_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_91_1\">Da<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_91_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][91][]\" value=\"Nu\" aria-errormessage=\"wpforms-55-field_91_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_91_2\">Nu<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-55-field_94-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"94\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Pacientul este consiliat s\u0103 accepte apelarea serviciului de urgen\u021b\u0103 sau s\u0103 se \u00eendrepte spre cel mai apropiat UPU\/centru de permanen\u021b\u0103 pentru consult <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-55-field_94\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_94_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][94][]\" value=\"Accept\u0103\" aria-errormessage=\"wpforms-55-field_94_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_94_1\">Accept\u0103<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_94_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][94][]\" value=\"Refuz\u0103\" aria-errormessage=\"wpforms-55-field_94_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_94_2\">Refuz\u0103<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-55-field_95-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"95\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Dac\u0103 tensiunea&gt; 180 \u0219i se consider\u0103 necesar, se poate completa fi\u0219a de asisten\u021b\u0103 farmaceutic\u0103 \u00een situa\u021bii de urgen\u021b\u0103 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-55-field_95\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_95_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][95][]\" value=\"Da\" aria-errormessage=\"wpforms-55-field_95_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_95_1\">Da<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_95_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][95][]\" value=\"Nu\" aria-errormessage=\"wpforms-55-field_95_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_95_2\">Nu<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-55-field_73-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"73\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-55-field_73\">Completa\u021bi medica\u021bia eliberat\u0103<\/label><input type=\"text\" id=\"wpforms-55-field_73\" class=\"wpforms-field-medium wpforms-limit-words-enabled\" data-form-id=\"55\" data-field-id=\"73\" data-text-limit=\"100\" name=\"wpforms[fields][73]\" aria-errormessage=\"wpforms-55-field_73-error\" ><\/div><div id=\"wpforms-55-field_93-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"93\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Dac\u0103 se constat\u0103 c\u0103 pacientul este agitat \/ anxios pot fi oferite recomand\u0103ri specifice pentru calmarea pacientului \u0219i normalizarea TA, preparate OTC sau suplimente <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-55-field_93\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_93_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][93][]\" value=\"Da\" aria-errormessage=\"wpforms-55-field_93_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_93_1\">Da<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_93_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][93][]\" value=\"Nu\" aria-errormessage=\"wpforms-55-field_93_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_93_2\">Nu<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-55-field_117-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"117\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-55-field_117\">Enumera\u021bi recomand\u0103rile farmacistului: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-55-field_117\" class=\"wpforms-field-medium wpforms-field-required wpforms-limit-words-enabled\" data-form-id=\"55\" data-field-id=\"117\" data-text-limit=\"100\" name=\"wpforms[fields][117]\" aria-errormessage=\"wpforms-55-field_117-error\" required><\/div><div id=\"wpforms-55-field_92-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"92\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">S-a oferit eliberarea unei scrisori c\u0103tre medicul de familie\/ medicul specialist\/ medicul prescriptor\/ UPU <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-55-field_92\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_92_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][92][]\" value=\"Da\" aria-errormessage=\"wpforms-55-field_92_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_92_1\">Da<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_92_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][92][]\" value=\"Nu\" aria-errormessage=\"wpforms-55-field_92_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_92_2\">Nu<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-55-field_72-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"72\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">S-a recomandat monitorizarea TA la domiciliu timp de 7 zile (jurnal) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-55-field_72\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_72_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][72][]\" value=\"Da\" aria-errormessage=\"wpforms-55-field_72_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_72_1\">Da<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_72_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][72][]\" value=\"Nu\" aria-errormessage=\"wpforms-55-field_72_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_72_2\">Nu<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-55-field_47-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-3-columns wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"47\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">S-a oferit consiliere privind modific\u0103ri ale stilului de via\u021b\u0103 :<\/legend><ul id=\"wpforms-55-field_47\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_47_1\" name=\"wpforms[fields][47][]\" value=\"Diet\u0103\" aria-errormessage=\"wpforms-55-field_47_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_47_1\">Diet\u0103<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_47_2\" name=\"wpforms[fields][47][]\" value=\"Fumat\" aria-errormessage=\"wpforms-55-field_47_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_47_2\">Fumat<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_47_3\" name=\"wpforms[fields][47][]\" value=\"Activitate fizic\u0103\" aria-errormessage=\"wpforms-55-field_47_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_47_3\">Activitate fizic\u0103<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_47_4\" name=\"wpforms[fields][47][]\" value=\"Consum alcool\" aria-errormessage=\"wpforms-55-field_47_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_47_4\">Consum alcool<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_47_5\" name=\"wpforms[fields][47][]\" value=\"Managementul greut\u0103\u021bii\" aria-errormessage=\"wpforms-55-field_47_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_47_5\">Managementul greut\u0103\u021bii<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-55-field_116-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"116\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">S-au oferit informa\u021bii suplimentare, documentate, at\u00e2t verbal c\u00e2t \u0219i \u00een scris (bro\u0219uri), legat de HTA \u0219i riscurile asociate cu valorile tensionale crescute <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-55-field_116\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_116_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][116][]\" value=\"Da\" aria-errormessage=\"wpforms-55-field_116_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_116_1\">Da<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-55-field_116_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][116][]\" value=\"Nu\" aria-errormessage=\"wpforms-55-field_116_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-55-field_116_2\">Nu<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-55-field_115-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"115\" style=\"display:none;\"><div id=\"wpforms-55-field_115\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-55-field_115-error\"><div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-55-field_39-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"39\"><label class=\"wpforms-field-label\" for=\"wpforms-55-field_39\">Observa\u021bii: <\/label><input type=\"text\" id=\"wpforms-55-field_39\" class=\"wpforms-field-large\" name=\"wpforms[fields][39]\" aria-errormessage=\"wpforms-55-field_39-error\" ><\/div><div id=\"wpforms-55-field_59-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"59\"><label class=\"wpforms-field-label\" for=\"wpforms-55-field_59\">Adresa de E-mail a farmaciei \u00eenregistrat\u0103 \u00een programul de consiliere a pacientului cu valori tensionale crescute <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-55-field_59\" class=\"wpforms-field-large wpforms-field-required\" data-rule-restricted-email=\"1\" name=\"wpforms[fields][59]\" spellcheck=\"false\" aria-errormessage=\"wpforms-55-field_59-error\" aria-describedby=\"wpforms-55-field_59-description\" required><div id=\"wpforms-55-field_59-description\" class=\"wpforms-field-description\"><span style=\"color:#FF0000;\">Numele farmaciei, adresa farmaciei, numarul de telefon si adresa de e-mail trebuie sa fie preinregistrata de AFIE<\/span><br \/>\nPe aceasta adresa de email veti primi formularele precompletate in format pdf, pe care urmeaza sa le 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