";
                                // print_r($history);
                            @endphp

                            



                                

                                    
                                            @foreach ($history->data->submissions as $sub)
                                                @php
                                                    $sub->formdata->id = $sub->id;
                                                @endphp
                                                
                                            @endforeach
                                        


                                        

                                            

                                                
Action
                                                
Plan Date
                                                
Executed Date
                                                
Doctor Name
                                                
Speciality
                                                
Dr part of SuperQ310
                                                
Activity
                                                
Activity 2

                                                
Cheston-D Cough Syrup 100 ML Rx
                                                
Cheston-D Cough Syrup 100 ML POB

                                                
Cheston-D Plus 1 x 10'S Rx
                                                
Cheston-D Plus 1 x 10'S POB

                                                
Cheston-LS Cough Syrup 100 ML Rx
                                                
Cheston-LS Cough Syrup 100 ML POB
                                                
Cheston-LS Junior 60 ML Rx
                                                
Cheston-LS Junior 60 ML POB
                                                
EMESET SYRUP STRAWBERRY 30 ML Rx
                                                
EMESET SYRUP STRAWBERRY 30 ML POB
                                                
Emeset-MD 4mg Tablets 10's Rx
                                                
Emeset-MD 4mg Tablets 10's POB
                                                
Emeset 4 ODT/India/1 X 10'S Rx
                                                
Emeset 4 ODT/India/1 X 10'S POB
                                                
Emeset MD 4 (1 x 10'S) Rx
                                                
Emeset MD 4 (1 x 10'S) POB
                                                
EMESET 4MG (10'S) Rx
                                                
EMESET 4MG (10'S) POB
                                                
EMESET 8MG (10'S) Rx
                                                
EMESET 8MG (10'S) POB
                                                
EMESET- 8 MG TABLETS 1 X 10'S Rx
                                                
EMESET- 8 MG TABLETS 1 X 10'S POB
                                                
EMESET- 4 MG TABLETS 1 X 10'S Rx
                                                
EMESET- 4 MG TABLETS 1 X 10'S POB
                                                
EMESET SYRUP Rx
                                                
EMESET SYRUP POB
                                                
FAROBACT 200 Rx
                                                
FAROBACT 200 POB
                                                
Farobact 300 ER TABLETS Rx
                                                
Farobact 300 ER TABLETS POB
                                                
FAROBACT 200 TABS 1 x 10 S Rx
                                                
FAROBACT 200 TABS 1 x 10 S POB
                                                
FAROBACT 300 ER TABS 10 S Rx
                                                
FAROBACT 300 ER TABS 10 S POB
                                                
Farobact Dry Syrup Rx
                                                
Farobact Dry Syrup POB
                                                
NOVAMOX CV 625 TABLETS 10 Rx
                                                
NOVAMOX CV 625 TABLETS 10 POB
                                                
Novamox-CV 625 Tablets 1 x10'S Rx
                                                
Novamox-CV 625 Tablets 1 x10'S POB
                                                
NOVAMOX CV 1000 MG Rx
                                                
NOVAMOX CV 1000 MG POB
                                                
Novamox CV ES Rx
                                                
Novamox CV ES POB
                                                
NOVAMOX CV DROPS Rx
                                                
NOVAMOX CV DROPS POB
                                                
NOVAMOX CV DS Rx
                                                
NOVAMOX CV DS POB
                                                
NOVAMOX CV FORTE SYP Rx
                                                
NOVAMOX CV FORTE SYP POB
                                                
NOVAMOX CV 375 TAB 1 Rx
                                                
NOVAMOX CV 375 TAB 1 POB
                                                
Novamox CV Forte Syp 60 ml Rx
                                                
Novamox CV Forte Syp 60 ml POB
                                                
NOVAMOX CV 375 TAB 10s Rx
                                                
NOVAMOX CV 375 TAB 10s POB
                                                
Novamox CV Dry Syrup 30 ML Rx
                                                
Novamox CV Dry Syrup 30 ML POB
                                                
Novamox CV Forte Syrup 30 ML Rx
                                                
Novamox CV Forte Syrup 30 ML POB
                                                
NOVAMOX CV 45 Rx
                                                
NOVAMOX CV 45 POB
                                                
OFLOX OZ T Rx
                                                
OFLOX OZ T POB
                                                
PANSEC TABLETS 15'S Rx
                                                
PANSEC TABLETS 15'S POB
                                                
PANSEC 40 Tablets 1 x 15'S Rx
                                                
PANSEC 40 Tablets 1 x 15'S POB
                                                
Pansec 80 M Rx
                                                
Pansec 80 M POB
                                                
PANSEC D SR CAPSULES 15'S Rx
                                                
PANSEC D SR CAPSULES 15'S POB
                                                
PANSEC-L CAPSULES Rx
                                                
PANSEC-L CAPSULES POB
                                                
UnoBiotics Junior Rx
                                                
UnoBiotics Junior POB
                                                
UNOBIOTICS SB Rx
                                                
UNOBIOTICS SB POB
                                            
                                        
                                        

                                                    

                                                         Edit
                                                    
                                                    
{{ $sub->formdata->plan_date }}
                                                    
                                                    
{{ isset($sub->formdata->execution_date) ? $sub->formdata->execution_date : '' }}
                                                    
                                                    

                                                        

                                                            {{ isset($sub->formdata->contact_id) ? $sub->formdata->contact_id : '' }}
                                                        
                                                    
                                                    
{{ isset($sub->formdata->speciality) ? $sub->formdata->speciality : '' }}
                                                    
                                                    
{{ isset($sub->formdata->dr_part_of_super_q310) ? $sub->formdata->dr_part_of_super_q310 : '' }}

                                                    
{{ isset($sub->formdata->activity) ? $sub->formdata->activity : '' }}
                                                    
                                                    
{{ isset($sub->formdata->activity) ? $sub->formdata->activity_2 : '' }}
                                                    

                                                    
 
                                                        {{ isset($sub->formdata->cheston_d_cough_syrup_100_ml_rx) ? $sub->formdata->cheston_d_cough_syrup_100_ml_rx : '' }}
                                                    
                                                    
 
                                                        {{ isset($sub->formdata->cheston_d_cough_syrup_100_ml_pob) ? $sub->formdata->cheston_d_cough_syrup_100_ml_pob : '' }}
                                                    

                                                    

                                                        {{ isset($sub->formdata->cheston_d_plus_1_x_10s_rx) ? $sub->formdata->cheston_d_plus_1_x_10s_rx : '' }}
                                                    
                                                    
 
                                                        {{ isset($sub->formdata->cheston_d_plus_1_x_10s_pob) ? $sub->formdata->cheston_d_plus_1_x_10s_pob : '' }}
                                                    


                                                    
 {{ isset($sub->formdata->cheston_ls_cough_syrup_100_ml_rx) ? $sub->formdata->cheston_ls_cough_syrup_100_ml_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->cheston_ls_cough_syrup_100_ml_pob) ? $sub->formdata->cheston_ls_cough_syrup_100_ml_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->cheston_ls_junior_60_ml_rx) ? $sub->formdata->cheston_ls_junior_60_ml_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->cheston_ls_junior_60_ml_pob) ? $sub->formdata->cheston_ls_junior_60_ml_pob : '' }}
                                                    


                                                    
 {{ isset($sub->formdata->emeset_syrup_strawberry_30_ml_rx) ? $sub->formdata->emeset_syrup_strawberry_30_ml_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->emeset_syrup_strawberry_30_ml_pob) ? $sub->formdata->emeset_syrup_strawberry_30_ml_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->emeset_md_4mg_tablets_10s_rx) ? $sub->formdata->emeset_md_4mg_tablets_10s_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->emeset_md_4mg_tablets_10s_pob) ? $sub->formdata->emeset_md_4mg_tablets_10s_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->emeset_4_odtindia1_x_10s_rx) ? $sub->formdata->emeset_4_odtindia1_x_10s_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->emeset_4_odtindia1_x_10s_pob) ? $sub->formdata->emeset_4_odtindia1_x_10s_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->emeset_md_4_1_x_10s_rx) ? $sub->formdata->emeset_md_4_1_x_10s_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->emeset_md_4_1_x_10s_pob) ? $sub->formdata->emeset_md_4_1_x_10s_pob : '' }}
                                                    


                                                    
 {{ isset($sub->formdata->emeset_4mg_10s_rx) ? $sub->formdata->emeset_4mg_10s_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->emeset_4mg_10s_pob) ? $sub->formdata->emeset_4mg_10s_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->emeset_8mg_10s_rx) ? $sub->formdata->emeset_8mg_10s_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->emeset_8mg_10s_pob) ? $sub->formdata->emeset_8mg_10s_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->emeset_8_mg_tablets_1_x_10s_rx) ? $sub->formdata->emeset_8_mg_tablets_1_x_10s_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->emeset_8_mg_tablets_1_x_10s_pob) ? $sub->formdata->emeset_8_mg_tablets_1_x_10s_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->emeset_4_mg_tablets_1_x_10s_rx) ? $sub->formdata->emeset_4_mg_tablets_1_x_10s_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->emeset_4_mg_tablets_1_x_10s_pob) ? $sub->formdata->emeset_4_mg_tablets_1_x_10s_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->emeset_syrup_rx) ? $sub->formdata->emeset_syrup_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->emeset_syrup_pob) ? $sub->formdata->emeset_syrup_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->farobact_200_rx) ? $sub->formdata->farobact_200_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->farobact_200_pob) ? $sub->formdata->farobact_200_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->farobact_300_er_tablets_rx) ? $sub->formdata->farobact_300_er_tablets_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->farobact_300_er_tablets_pob) ? $sub->formdata->farobact_300_er_tablets_pob : '' }}
                                                    


                                                    
 {{ isset($sub->formdata->farobact_200_tabs_1_x_10_s_rx) ? $sub->formdata->farobact_200_tabs_1_x_10_s_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->farobact_200_tabs_1_x_10_s_pob) ? $sub->formdata->farobact_200_tabs_1_x_10_s_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->farobact_300_er_tabs_10_s_rx) ? $sub->formdata->farobact_300_er_tabs_10_s_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->farobact_300_er_tabs_10_s_pob) ? $sub->formdata->farobact_300_er_tabs_10_s_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->farobact_dry_syrup_rx) ? $sub->formdata->farobact_dry_syrup_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->farobact_dry_syrup_pob) ? $sub->formdata->farobact_dry_syrup_pob : '' }}
                                                    


                                                    
 {{ isset($sub->formdata->novamox_cv_625_tablets_10_rx) ? $sub->formdata->novamox_cv_625_tablets_10_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->novamox_cv_625_tablets_10_pob) ? $sub->formdata->novamox_cv_625_tablets_10_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->novamox_cv_625_tablets_1_x10s_rx) ? $sub->formdata->novamox_cv_625_tablets_1_x10s_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->novamox_cv_625_tablets_1_x10s_pob) ? $sub->formdata->novamox_cv_625_tablets_1_x10s_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->novamox_cv_1000_mg_rx) ? $sub->formdata->novamox_cv_1000_mg_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->novamox_cv_1000_mg_pob) ? $sub->formdata->novamox_cv_1000_mg_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->novamox_cv_es_rx) ? $sub->formdata->novamox_cv_es_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->novamox_cv_es_pob) ? $sub->formdata->novamox_cv_es_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->novamox_cv_drops_rx) ? $sub->formdata->novamox_cv_drops_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->novamox_cv_drops_pob) ? $sub->formdata->novamox_cv_drops_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->novamox_cv_ds_rx) ? $sub->formdata->novamox_cv_ds_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->novamox_cv_ds_pob) ? $sub->formdata->novamox_cv_ds_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->novamox_cv_forte_syp_rx) ? $sub->formdata->novamox_cv_forte_syp_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->novamox_cv_forte_syp_pob) ? $sub->formdata->novamox_cv_forte_syp_pob : '' }}
                                                    


                                                    
 {{ isset($sub->formdata->novamox_cv_375_tab_1_rx) ? $sub->formdata->novamox_cv_375_tab_1_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->novamox_cv_375_tab_1_pob) ? $sub->formdata->novamox_cv_375_tab_1_pob : '' }}
                                                    


                                                    
 {{ isset($sub->formdata->novamox_cv_forte_syp_60_ml_rx) ? $sub->formdata->novamox_cv_forte_syp_60_ml_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->novamox_cv_forte_syp_60_ml_pob) ? $sub->formdata->novamox_cv_forte_syp_60_ml_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->novamox_cv_375_tab_10s_rx) ? $sub->formdata->novamox_cv_375_tab_10s_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->novamox_cv_375_tab_10s_pob) ? $sub->formdata->novamox_cv_375_tab_10s_pob : '' }}
                                                    


                                                    
 {{ isset($sub->formdata->novamox_cv_dry_syrup_30_ml_rx) ? $sub->formdata->novamox_cv_dry_syrup_30_ml_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->novamox_cv_dry_syrup_30_ml_pob) ? $sub->formdata->novamox_cv_dry_syrup_30_ml_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->novamox_cv_forte_syrup_30_ml_rx) ? $sub->formdata->novamox_cv_forte_syrup_30_ml_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->novamox_cv_forte_syrup_30_ml_pob) ? $sub->formdata->novamox_cv_forte_syrup_30_ml_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->novamox_cv_457_dt_10s_rx) ? $sub->formdata->novamox_cv_457_dt_10s_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->novamox_cv_457_dt_10s_pob) ? $sub->formdata->novamox_cv_457_dt_10s_pob : '' }}
                                                    


                                                    
 {{ isset($sub->formdata->oflox_oz_tablets_ip_rx) ? $sub->formdata->oflox_oz_tablets_ip_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->oflox_oz_tablets_ip_pob) ? $sub->formdata->oflox_oz_tablets_ip_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->pansec_tablets_15s_rx) ? $sub->formdata->pansec_tablets_15s_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->pansec_tablets_15s_pob) ? $sub->formdata->pansec_tablets_15s_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->pansec_40_tablets_1_x_15s_rx) ? $sub->formdata->pansec_40_tablets_1_x_15s_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->pansec_40_tablets_1_x_15s_pob) ? $sub->formdata->pansec_40_tablets_1_x_15s_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->pansec_80_mg_tablets_rx) ? $sub->formdata->pansec_80_mg_tablets_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->pansec_80_mg_tablets_pob) ? $sub->formdata->pansec_80_mg_tablets_pob : '' }}
                                                    


                                                    
 {{ isset($sub->formdata->pansec_d_sr_capsules_15s_rx) ? $sub->formdata->pansec_d_sr_capsules_15s_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->pansec_d_sr_capsules_15s_pob) ? $sub->formdata->pansec_d_sr_capsules_15s_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->pansec_l_capsules_rx) ? $sub->formdata->pansec_l_capsules_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->pansec_l_capsules_pob) ? $sub->formdata->pansec_l_capsules_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->unobiotics_junior_rx) ? $sub->formdata->unobiotics_junior_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->unobiotics_junior_pob) ? $sub->formdata->unobiotics_junior_pob : '' }}
                                                    

                                                    
 {{ isset($sub->formdata->unobiotics_sb_rx) ? $sub->formdata->unobiotics_sb_rx : '' }}
                                                    
                                                    
 {{ isset($sub->formdata->unobiotics_sb_pob) ? $sub->formdata->unobiotics_sb_pob : '' }}
                                                    





                                                
                                    
                                

                            

                            

                                

                                    
                                    @csrf
                                    @if ($id)
                                        
                                    @endif
                                    @foreach ($questions as $question)
                                        @if (in_array($question->code, [
                                                'execution_date',
                                                'activity',
                                                'activity_2',
                                                'tgt_brand_1',
                                                'tgt_brand_2',
                                                'pob_units_brand_1',
                                                'pob_units_brand_2',
                                                'brand_1',
                                                'brand_1_rx',
                                                'brand_1_pob',
                                                'brand_2',
                                                'brand_2_rx',
                                                'brand_2_pob',
                                            ]))
                                            @continue
                                        @endif
                                        

                                            {{ $question->question }} {!! $question->required == 'yes' ? '*' : '' !!}
                                            
                                            @switch($question->type)
                                                @case('hidden')
                                                    
                                                @break

                                                @case('text')
                                                @case('email')

                                                @case('tel')
                                                    required == 'yes' ? 'required' : '' }}
                                                        {{ $question->code == 'camp_date' ? 'min="' . date('Y-m-d', strtotime('now') + 604800) . '"' : '' }}
                                                        value="{{ isset($question->value) ? $question->value : '' }}">
                                                @break

                                                @case('date')
                                                    required == 'yes' ? 'required' : '' }}
                                                        value="{{ isset($question->value) ? $question->value : '' }}">
                                                @break

                                                @case('number')
                                                    required == 'yes' ? 'required' : '' }}
                                                        value="{{ isset($question->value) ? $question->value : 0 }}">
                                                @break

                                                @case('textarea')
                                                    required == 'yes' ? 'required' : '' }}>{{ isset($question->value) ? $question->value : '' }}
                                                @break

                                                @case('dropdown')
                                                    required == 'yes' ? 'required' : '' }}>
                                                         -- Select -- 
                                                        @foreach ($question->options as $option)
                                                            value) && $question->value == $option->value ? 'selected' : '' }}
                                                                {{ $question->code == 'contact_id' ? ' msl_code=' . $option->contact->msl_code . ' speciality=' . $option->contact->speciality : '' }}>
                                                                {{ $option->display }}
                                                        @endforeach
                                                    
                                                @break

                                                @case('checkbox')
                                                    @foreach ($question->options as $option)
                                                        

                                                            value) && $question->value != '' && in_array($option->value, $question->value) ? 'checked' : '' }}>
                                                            {{ $option->display }}
                                                        
                                                    @endforeach
                                                @break

                                                @case('file')
                                                    
                                                @break
                                            @endswitch
                                        
                                    @endforeach
                                    @if (!isset($form->is_approval) || (isset($form->is_approval) && $form->is_approval != 'yes'))
                                        

                                             Submit
                                            
                                        
                                    @endif
                                
                            



                            

                                

                                    
                                    
                                    
                                    

                                    
                                    @csrf
                                    
                                    @foreach ($questions as $question)
                                        @if (in_array($question->code, ['brand_1', 'brand_1_rx', 'brand_1_pob', 'brand_2', 'brand_2_rx', 'brand_2_pob']))
                                            @continue
                                        @endif
                                        

                                            {{ $question->question }} {!! $question->required == 'yes' ? '*' : '' !!}
                                            
                                            @switch($question->type)
                                                @case('hidden')
                                                    
                                                @break

                                                @case('text')
                                                @case('email')

                                                @case('tel')
                                                @case('date')
                                                    required == 'yes' ? 'required' : '' }}
                                                        value="{{ isset($question->value) ? $question->value : '' }}">
                                                @break

                                                @case('number')
                                                    required == 'yes' ? 'required' : '' }}
                                                        value="{{ isset($question->value) ? $question->value : 0 }}">
                                                @break

                                                @case('textarea')
                                                    required == 'yes' ? 'required' : '' }}>{{ isset($question->value) ? $question->value : '' }}
                                                @break

                                                @case('dropdown')
                                                    required == 'yes' ? 'required' : '' }}>
                                                         -- Select -- 
                                                        @foreach ($question->options as $option)
                                                            value) && $question->value == $option->value ? 'selected' : '' }}>
                                                                {{ $option->display }}
                                                        @endforeach
                                                    
                                                @break

                                                @case('checkbox')
                                                    @foreach ($question->options as $option)
                                                        

                                                            value) && $question->value != '' && in_array($option->value, $question->value) ? 'checked' : '' }}>
                                                            {{ $option->display }}
                                                        
                                                    @endforeach
                                                @break

                                                @case('file')
                                                    required == 'yes' ? 'required' : '' }}>
                                                @break
                                            @endswitch
                                        
                                    @endforeach
                                    

                                        

                                            

                                                

                                                    Target Brand 1*
                                                    
                                                    
                                                        --select--
                                                        Cheston-D Cough
                                                            Syrup 100 ML
                                                        Cheston-D Plus 1 x 10'S
                                                        
                                                        Cheston-LS Cough
                                                            Syrup 100 ML
                                                        Cheston-LS Junior 60 ML
                                                        
                                                        EMESET SYRUP
                                                            STRAWBERRY 30 ML
                                                        Emeset-MD 4mg Tablets
                                                            10's
                                                        Emeset 4 ODT/India/1 X
                                                            10'S
                                                        Emeset MD 4 (1 x 10'S)
                                                        
                                                        EMESET 4MG (10'S)
                                                        EMESET 8MG (10'S)
                                                        EMESET- 8 MG
                                                            TABLETS 1 X 10'S
                                                        EMESET- 4 MG
                                                            TABLETS 1 X 10'S
                                                        EMESET SYRUP
                                                        FAROBACT 200
                                                        Farobact 300 ER TABLETS
                                                        
                                                        FAROBACT 200 TABS 1
                                                            x 10 S
                                                        FAROBACT 300 ER TABS
                                                            10 S
                                                        Farobact Dry Syrup

                                                        NOVAMOX CV 625
                                                            TABLETS 10
                                                        Novamox-CV 625
                                                            Tablets 1 x10'S
                                                        NOVAMOX CV 1000 MG
                                                        Novamox CV ES
                                                        NOVAMOX CV DROPS
                                                        NOVAMOX CV DS
                                                        NOVAMOX CV FORTE SYP
                                                        
                                                        NOVAMOX CV 375 TAB 1
                                                        
                                                        Novamox CV Forte Syp
                                                            60 ml
                                                        NOVAMOX CV 375 TAB 10s
                                                        
                                                        Novamox CV Dry Syrup
                                                            30 ML
                                                        Novamox CV Forte
                                                            Syrup 30 ML
                                                        NOVAMOX CV 457 DT 10's
                                                        
                                                        OFLOX OZ TABLETS IP
                                                        
                                                        PANSEC TABLETS 15'S
                                                        PANSEC 40 Tablets 1 x
                                                            15'S
                                                        Pansec 80 MG Tablets
                                                        
                                                        PANSEC D SR CAPSULES
                                                            15'S
                                                        PANSEC-L CAPSULES
                                                        UnoBiotics Junior
                                                        UNOBIOTICS SB
                                                    
                                                
                                                

                                                    Rx*
                                                    

                                                    
                                                
                                                

                                                    POB Units*
                                                    

                                                    
                                                

                                            
                                            

                                                

                                                    Target Brand 2*
                                                        
                                                            --select--
                                                            Cheston-D
                                                                Cough
                                                                Syrup 100 ML
                                                            Cheston-D Plus 1 x
                                                                10'S
                                                            
                                                            Cheston-LS
                                                                Cough
                                                                Syrup 100 ML
                                                            Cheston-LS Junior
                                                                60 ML
                                                            
                                                            EMESET SYRUP
                                                                STRAWBERRY 30 ML
                                                            Emeset-MD 4mg
                                                                Tablets
                                                                10's
                                                            Emeset 4
                                                                ODT/India/1 X
                                                                10'S
                                                            Emeset MD 4 (1 x 10'S)
                                                            
                                                            EMESET 4MG (10'S)
                                                            EMESET 8MG (10'S)
                                                            EMESET- 8 MG
                                                                TABLETS 1 X 10'S
                                                            EMESET- 4 MG
                                                                TABLETS 1 X 10'S
                                                            EMESET SYRUP
                                                            FAROBACT 200
                                                            Farobact 300 ER
                                                                TABLETS
                                                            
                                                            FAROBACT 200
                                                                TABS 1
                                                                x 10 S
                                                            FAROBACT 300 ER
                                                                TABS
                                                                10 S
                                                            Farobact Dry Syrup
                                                            

                                                            NOVAMOX CV 625
                                                                TABLETS 10
                                                            Novamox-CV
                                                                625
                                                                Tablets 1 x10'S
                                                            NOVAMOX CV 1000 MG
                                                            
                                                            Novamox CV ES
                                                            NOVAMOX CV DROPS
                                                            NOVAMOX CV DS
                                                            NOVAMOX CV FORTE SYP
                                                            
                                                            NOVAMOX CV 375 TAB 1
                                                            
                                                            Novamox CV Forte
                                                                Syp
                                                                60 ml
                                                            NOVAMOX CV 375 TAB
                                                                10s
                                                            
                                                            Novamox CV Dry
                                                                Syrup
                                                                30 ML
                                                            Novamox CV
                                                                Forte
                                                                Syrup 30 ML
                                                            NOVAMOX CV 457 DT
                                                                10's
                                                            
                                                            OFLOX OZ TABLETS IP
                                                            
                                                            PANSEC TABLETS 15'S
                                                            
                                                            PANSEC 40 Tablets
                                                                1 x
                                                                15'S
                                                            Pansec 80 MG Tablets
                                                            
                                                            PANSEC D SR
                                                                CAPSULES
                                                                15'S
                                                            PANSEC-L CAPSULES
                                                            
                                                            UnoBiotics Junior
                                                            
                                                            UNOBIOTICS SB
                                                        
                                                
                                                

                                                    Rx*
                                                    

                                                    
                                                
                                                

                                                    POB Units*
                                                    

                                                    
                                                
                                            
                                        
                                    
                                    @if (!isset($form->is_approval) || (isset($form->is_approval) && $form->is_approval != 'yes'))
                                        

                                             Submit
                                            
                                        
                                    @endif