Вы будете поставлены в очередь на госпитализацию после того как ваша заявка будет рассмотренна специалистом.
Array ( [CAPTION] => ФИО [IS_HTML_CAPTION] => N [REQUIRED] => Y [IS_INPUT_CAPTION_IMAGE] => N [HTML_CODE] => [STRUCTURE] => Array ( [0] => Array ( [ID] => 1 [FIELD_ID] => 1 [QUESTION_ID] => 1 [TIMESTAMP_X] => 13.06.2019 14:10:11 [MESSAGE] => [VALUE] => [FIELD_TYPE] => text [FIELD_WIDTH] => 50 [FIELD_HEIGHT] => 0 [FIELD_PARAM] => [C_SORT] => 0 [ACTIVE] => Y ) ) [VALUE] => )
Array ( [CAPTION] => E-mail [IS_HTML_CAPTION] => N [REQUIRED] => Y [IS_INPUT_CAPTION_IMAGE] => N [HTML_CODE] => [STRUCTURE] => Array ( [0] => Array ( [ID] => 2 [FIELD_ID] => 2 [QUESTION_ID] => 2 [TIMESTAMP_X] => 13.06.2019 14:10:11 [MESSAGE] => [VALUE] => [FIELD_TYPE] => email [FIELD_WIDTH] => 50 [FIELD_HEIGHT] => 0 [FIELD_PARAM] => [C_SORT] => 0 [ACTIVE] => Y ) ) [VALUE] => )
Array ( [CAPTION] => Телефон [IS_HTML_CAPTION] => N [REQUIRED] => Y [IS_INPUT_CAPTION_IMAGE] => N [HTML_CODE] => [STRUCTURE] => Array ( [0] => Array ( [ID] => 3 [FIELD_ID] => 3 [QUESTION_ID] => 3 [TIMESTAMP_X] => 02.10.2023 06:40:41 [MESSAGE] => [VALUE] => [FIELD_TYPE] => text [FIELD_WIDTH] => 50 [FIELD_HEIGHT] => 0 [FIELD_PARAM] => data-inputmask-alias="phoneMobile" [C_SORT] => 0 [ACTIVE] => Y ) ) [VALUE] => )
Array ( [CAPTION] => Период госпитализации с [IS_HTML_CAPTION] => N [REQUIRED] => N [IS_INPUT_CAPTION_IMAGE] => N [HTML_CODE] => (DD.MM.YYYY) [STRUCTURE] => Array ( [0] => Array ( [ID] => 4 [FIELD_ID] => 4 [QUESTION_ID] => 4 [TIMESTAMP_X] => 13.06.2019 14:10:11 [MESSAGE] => [VALUE] => [FIELD_TYPE] => date [FIELD_WIDTH] => 50 [FIELD_HEIGHT] => 0 [FIELD_PARAM] => [C_SORT] => 0 [ACTIVE] => Y ) ) [VALUE] => )
Array ( [CAPTION] => по [IS_HTML_CAPTION] => N [REQUIRED] => N [IS_INPUT_CAPTION_IMAGE] => N [HTML_CODE] => (DD.MM.YYYY) [STRUCTURE] => Array ( [0] => Array ( [ID] => 5 [FIELD_ID] => 5 [QUESTION_ID] => 5 [TIMESTAMP_X] => 13.06.2019 14:10:11 [MESSAGE] => [VALUE] => [FIELD_TYPE] => date [FIELD_WIDTH] => 50 [FIELD_HEIGHT] => 0 [FIELD_PARAM] => [C_SORT] => 0 [ACTIVE] => Y ) ) [VALUE] => )
Array ( [CAPTION] => Комментарий [IS_HTML_CAPTION] => N [REQUIRED] => N [IS_INPUT_CAPTION_IMAGE] => N [HTML_CODE] => [STRUCTURE] => Array ( [0] => Array ( [ID] => 6 [FIELD_ID] => 6 [QUESTION_ID] => 6 [TIMESTAMP_X] => 13.06.2019 14:10:11 [MESSAGE] => [VALUE] => [FIELD_TYPE] => textarea [FIELD_WIDTH] => 50 [FIELD_HEIGHT] => 5 [FIELD_PARAM] => [C_SORT] => 0 [ACTIVE] => Y ) ) [VALUE] => )
* - Поля, обязательные для заполнения