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  background-size: cover;
}
.supernova {
  background-image: none;
  background-image: url("https://www.jotform.com/uploads/batuhan/form_files/final_20864245705555.5b18e0a95657b9.83368454.jpg");
}
#stage {
  background-image: none;
  background-image: url("https://www.jotform.com/uploads/batuhan/form_files/final_20864245705555.5b18e0a95657b9.83368454.jpg");
}
/* | */
.form-all {
  background-repeat: no-repeat;
  background-attachment: scroll;
  background-position: center top;
}
.form-header-group {
  background-repeat: no-repeat;
  background-attachment: scroll;
  background-position: center top;
}
.form-line {
  margin-top: 12px;
  margin-bottom: 12px;
}
.form-line {
  padding: 0px 36px;
}
.form-all .form-submit-button,
.form-all .form-submit-reset,
.form-all .form-submit-print {
  border-radius: 100px;
}
.form-all .form-sub-label {
  margin-left: 3px;
}
.form-all {
  border-radius: 6px;
}
.form-section:first-child {
  border-radius: 6px 6px 0 0;
}
.form-section:last-child {
  border-radius: 0 0 6px 6px;
}
.form-all .qq-upload-button,
.form-all .form-submit-button,
.form-all .form-submit-reset,
.form-all .form-submit-print {
  font-size: 1em;
  padding: 9px 15px;
  font-family: "Lucida Grande", sans-serif;
  font-size: 14px;
  font-weight: normal;
}
.form-all .form-pagebreak-back,
.form-all .form-pagebreak-next {
  font-size: 1em;
  padding: 9px 15px;
  font-family: "Lucida Grande", sans-serif;
  font-size: 14px;
  font-weight: normal;
}
/*
& when ( @buttonFontType = google ) {
	@import (css) "@{buttonFontLink}";
}
*/
h2.form-header {
  line-height: 1.618em;
  font-size: 1.714em;
}
h2 ~ .form-subHeader {
  line-height: 1.5em;
  font-size: 1.071em;
}
.form-header-group {
  text-align: left;
}
/*.form-dropdown,
.form-radio-item,
.form-checkbox-item,
.form-radio-other-input,
.form-checkbox-other-input,*/
.form-captcha input,
.form-spinner input,
.form-error-message {
  padding: 4px 3px 2px 3px;
}
.form-header-group {
  font-family: "Lucida Grande", sans-serif;
}
.form-section {
  padding: 0px 0px 0px 0px;
}
.form-header-group {
  margin: 12px 36px 12px 36px;
}
.form-header-group {
  padding: 24px 0px 24px 0px;
}
.form-textbox,
.form-textarea {
  padding: 4px 3px 2px 3px;
}
.form-textbox,
.form-textarea,
.form-radio-other-input,
.form-checkbox-other-input,
.form-captcha input,
.form-spinner input {
  background-color: #ffffff;
}
.form-matrix-row-headers,
.form-matrix-column-headers,
.form-matrix-values {
  padding: 4px;
}
.form-dropdown {
  border-color: #cccccc;
}
[data-type="control_dropdown"] .form-input,
[data-type="control_dropdown"] .form-input-wide {
  width: 150px;
}
.form-label {
  margin-right: 0px;
  margin-bottom: 0;
}
.form-label {
  font-family: "Lucida Grande", sans-serif;
}
li[data-type="control_image"] div {
  text-align: left;
}
li[data-type="control_image"] img {
  border: none;
  border-width: 0px !important;
  border-style: solid !important;
  border-color: false !important;
}
.form-line-column {
  width: auto;
}
.form-line-error {
  background-color: rgba(255, 255, 255, 0.88);
  box-shadow: inset 0px 3px 11px -7px #ff3200;
}
.form-line-error input:not(#coupon-input),
.form-line-error textarea,
.form-line-error .form-validation-error {
  -webkit-transition-property: none;
  -moz-transition-property: none;
  -ms-transition-property: none;
  -o-transition-property: none;
  transition-property: none;
  -webkit-transition-duration: 0.3s;
  -moz-transition-duration: 0.3s;
  -ms-transition-duration: 0.3s;
  -o-transition-duration: 0.3s;
  transition-duration: 0.3s;
  -webkit-transition-timing-function: ease;
  -moz-transition-timing-function: ease;
  -ms-transition-timing-function: ease;
  -o-transition-timing-function: ease;
  transition-timing-function: ease;
  border: 1px solid #fff4f4;
  box-shadow: 0 0 3px #fff4f4;
}
.form-line-error .form-error-message {
  margin: 0;
  position: absolute;
  color: #fff;
  display: inline-block;
  right: 0;
  font-size: 12px;
  position: absolute!important;
  box-shadow: none;
  top: 0px;
  color: #FFF;
  background: #ff3200;
  padding: 0px 5px;
  bottom: auto;
  border-radius: 0;
  box-shadow: 0px 2px 4px rgba(102, 102, 102, 0.5);
}
.form-line-error .form-error-message img,
.form-line-error .form-error-message .form-error-arrow {
  display: none;
}
.ie-8 .form-all {
  margin-top: auto;
  margin-top: initial;
}
.ie-8 .form-all:before {
  display: none;
}
[data-type="control_clear"] {
  display: none;
}
/* | */
@media screen and (max-width: 480px), screen and (max-device-width: 767px) and (orientation: portrait), screen and (max-device-width: 415px) and (orientation: landscape) {
  .testOne {
    letter-spacing: 0;
  }
  .form-all {
    border: 0;
    max-width: initial;
  }
  .form-sub-label-container {
    width: 100%;
    margin: 0;
    margin-right: 0;
    float: left;
    box-sizing: border-box;
  }
  span.form-sub-label-container + span.form-sub-label-container {
    margin-right: 0;
  }
  .form-sub-label {
    white-space: normal;
  }
  .form-address-table td,
  .form-address-table th {
    padding: 0 1px 10px;
  }
  .form-submit-button,
  .form-submit-print,
  .form-submit-reset {
    width: 100%;
    margin-left: 0!important;
  }
  div[id*=at_] {
    font-size: 14px;
    font-weight: 700;
    height: 8px;
    margin-top: 6px;
  }
  .showAutoCalendar {
    width: 20px;
  }
  img.form-image {
    max-width: 100%;
    height: auto;
  }
  .form-matrix-row-headers {
    width: 100%;
    word-break: break-all;
    min-width: 80px;
  }
  .form-collapse-table,
  .form-header-group {
    margin: 0;
  }
  .form-collapse-table {
    height: 100%;
    display: inline-block;
    width: 100%;
  }
  .form-collapse-hidden {
    display: none !important;
  }
  .form-input {
    width: 100%;
  }
  .form-label {
    width: 100% !important;
  }
  .form-label-left,
  .form-label-right {
    display: block;
    float: none;
    text-align: left;
    width: auto!important;
  }
  .form-line,
  .form-line.form-line-column {
    padding: 2% 5%;
    box-sizing: border-box;
  }
  input[type=text],
  input[type=email],
  input[type=tel],
  textarea {
    width: 100%;
    box-sizing: border-box;
    max-width: initial !important;
  }
  .form-radio-other-input,
  .form-checkbox-other-input {
    max-width: 55% !important;
  }
  .form-dropdown,
  .form-textarea,
  .form-textbox {
    width: 100%!important;
    box-sizing: border-box;
  }
  .form-input,
  .form-input-wide,
  .form-textarea,
  .form-textbox,
  .form-dropdown {
    max-width: initial!important;
  }
  .form-checkbox-item:not(#foo),
  .form-radio-item:not(#foo) {
    width: 100%;
  }
  .form-address-city,
  .form-address-line,
  .form-address-postal,
  .form-address-state,
  .form-address-table,
  .form-address-table .form-sub-label-container,
  .form-address-table select,
  .form-input {
    width: 100%;
  }
  div.form-header-group {
    padding: 24px 0px !important;
    margin: 0 12px 2% !important;
    margin-left: 5%!important;
    margin-right: 5%!important;
    box-sizing: border-box;
  }
  div.form-header-group.hasImage img {
    max-width: 100%;
  }
  [data-type="control_button"] {
    margin-bottom: 0 !important;
  }
  [data-type=control_fullname] .form-sub-label-container {
    width: 48%;
  }
  [data-type=control_fullname] .form-sub-label-container:first-child {
    margin-right: 4%;
  }
  [data-type=control_phone] .form-sub-label-container {
    width: 65%;
    margin-right: 0;
    margin-left: 0;
    float: left;
  }
  [data-type=control_phone] .form-sub-label-container:first-child {
    width: 31%;
    margin-right: 4%;
  }
  [data-type=control_datetime] .allowTime-container {
    width: 100%;
  }
  [data-type=control_datetime] .allowTime-container .form-sub-label-container {
    width: 24%!important;
    margin-left: 6%;
    margin-right: 0;
  }
  [data-type=control_datetime] .allowTime-container .form-sub-label-container:first-child {
    margin-left: 0;
  }
  [data-type=control_datetime] span + span + span > span:first-child {
    display: block;
    width: 100% !important;
  }
  [data-type=control_birthdate] .form-sub-label-container,
  [data-type=control_time] .form-sub-label-container {
    width: 27.3%!important;
    margin-right: 6% !important;
  }
  [data-type=control_time] .form-sub-label-container:last-child {
    width: 33.3%!important;
    margin-right: 0 !important;
  }
  .form-pagebreak-back-container,
  .form-pagebreak-next-container {
    min-height: 1px;
    width: 50% !important;
  }
  .form-pagebreak-back,
  .form-pagebreak-next,
  .form-product-item.hover-product-item {
    width: 100%;
  }
  .form-pagebreak-back-container {
    padding: 0;
    text-align: right;
  }
  .form-pagebreak-next-container {
    padding: 0;
    text-align: left;
  }
  .form-pagebreak {
    margin: 0 auto;
  }
  .form-buttons-wrapper {
    margin: 0!important;
    margin-left: 0!important;
  }
  .form-buttons-wrapper button {
    width: 100%;
  }
  .form-buttons-wrapper .form-submit-print {
    margin: 0 !important;
  }
  table {
    width: 100%!important;
    max-width: initial!important;
  }
  table td + td {
    padding-left: 3%;
  }
  .form-checkbox-item,
  .form-radio-item {
    white-space: normal!important;
  }
  .form-checkbox-item input,
  .form-radio-item input {
    width: auto;
  }
  .form-collapse-table {
    margin: 0 5%;
    display: block;
    zoom: 1;
    width: auto;
  }
  .form-collapse-table:before,
  .form-collapse-table:after {
    display: table;
    content: '';
    line-height: 0;
  }
  .form-collapse-table:after {
    clear: both;
  }
  .fb-like-box {
    width: 98% !important;
  }
  .form-error-message {
    clear: both;
    bottom: -10px;
  }
  .date-separate,
  .phone-separate {
    display: none;
  }
  .custom-field-frame,
  .direct-embed-widgets,
  .signature-pad-wrapper {
    width: 100% !important;
  }
}
/* | */

/*__INSPECT_SEPERATOR__*/
/*---------------------
Theme: Generic Theme
Author: Elton Cris - idarktech@jotform.com
www.jotform.com
----------------------*/
.form-all {
    -moz-box-sizing : border-box;
    -webkit-box-sizing : border-box;
    box-sizing : border-box;
}

[data-type="control_head"] {
    padding-bottom : 20px;
}

/*responsive fields*/
[data-type="control_textbox"] .form-textbox, 
[data-type="control_fullname"] .form-textbox,
[data-type="control_email"] .form-textbox,
[data-type="control_textarea"] .form-textarea, 
[data-type="control_dropdown"] .form-dropdown {
    width : 100% !important;
    max-width : none !important;
}

.form-textbox, .form-textarea, .form-dropdown {
    max-width : none !important;
    box-shadow : none;
    outline : none;
    box-sizing : border-box;
    -webkit-box-sizing : border-box;
    -moz-box-sizing : border-box;
    font-family : inherit;
}

[data-type="control_dropdown"] .form-input, 
[data-type="control_dropdown"] .form-input-wide {
    width : 100%;
}

/*input focus*/
.form-line-active input:focus, .form-line-active textarea:focus, .form-line-active select:focus {
    box-shadow : none;
}

/*reset error*/
.form-line-error {
    box-shadow : none;
}

/*input error*/
.form-line-error input:not(#coupon-input), .form-line-error textarea, .form-line-error select, .form-line-error .form-validation-error {
    border : 1px solid #e15353 !important;
    box-shadow : none !important;
}

.form-line-active {
    color : inherit !important;
}

/*responsive content -wide or shrink*/
.form-label {
    width : 35% !important;
    box-sizing : border-box;
    -webkit-box-sizing : border-box;
    -moz-box-sizing : border-box;
}

.form-label-top {
    width : 100% !important;
}

.form-line {
    box-sizing : border-box;
    -webkit-box-sizing : border-box;
    -moz-box-sizing : border-box;
    width : 100%;
}

.form-checkbox-other-input {
    width : 80% !important;
}

.form-input {
    width : 65% !important;
    max-width : none !important;
}

.form-input-wide {
    max-width : none !important;
    display : inline-block;
    width : 100%;
}

/*single fields with sublabels*/
[data-type="control_textbox"] .form-input-wide .form-sub-label-container, 
[data-type="control_fullname"] .form-input-wide .form-sub-label-container,
[data-type="control_email"] .form-input-wide .form-sub-label-container,
[data-type="control_textarea"] .form-input-wide .form-sub-label-container, 
[data-type="control_dropdown"] .form-input-wide .form-sub-label-container,
[data-type="control_textbox"] .form-input .form-sub-label-container, 
[data-type="control_fullname"] .form-input .form-sub-label-container,
[data-type="control_email"] .form-input .form-sub-label-container,
[data-type="control_textarea"] .form-input .form-sub-label-container, 
[data-type="control_dropdown"] .form-input .form-sub-label-container {
    width : 100%;
    max-width : none !important;
}

[data-type="control_dropdown"] .form-input-wide {
    width : 100%;
}

/*responsive full name*/
[data-type="control_fullname"] .form-sub-label-container {
    width : 50% !important;
    margin : 0;
    float : left;
    box-sizing : border-box;
}

[data-type="control_fullname"] .form-label + div .form-sub-label-container {
    display : inline-block;
    padding-right : 5px;
}

[data-type="control_fullname"] .form-label + div .form-sub-label-container + .form-sub-label-container {
    margin-right : 0;
    padding-right : 0;
    padding-left : 5px;
}

[data-type="control_fullname"] .form-label + div .form-sub-label-container + .form-sub-label-container {
    margin-right : 0;
    padding-right : 0;
    padding-left : 5px;
}

[data-type="control_fullname"] .form-label + div .form-sub-label-container + .form-sub-label-container + .form-sub-label-container {
    padding-left : 0;
    padding-right : 5px;
}

[data-type="control_fullname"] .form-label + div .form-sub-label-container + .form-sub-label-container + .form-sub-label-container + .form-sub-label-container {
    padding-left : 5px;
    padding-right : 0;
}

[data-type="control_fullname"] .form-label + div .form-sub-label-container + .form-sub-label-container  + .form-sub-label-container + .form-sub-label-container + .form-sub-label-container {
    padding-right : 5px;
    padding-left : 0;
}

#sublabel_prefix, #sublabel_first, #sublabel_middle {
    /*margin-bottom : 10px;
    */;
}

/*remove sepatators on date and phone*/
.phone-separate, .date-separate {
    display : none;
}

/*responsive phone fields*/
[data-type="control_phone"] input[name$="[area]"] {
    width : 100%;
}

[data-type="control_phone"] input[name$="[phone]"] {
    width : 100%;
}

[data-type="control_phone"] input[name$="[full]"] {
    width : 100%;
}

[data-type="control_phone"] .form-sub-label-container {
    width : 40%;
    float : left;
    box-sizing : border-box;
    margin-right : 0;
    padding-right : 12px;
}

/* responsive date time field */
[data-type="control_datetime"] .form-textbox,
[data-type="control_datetime"] .form-dropdown {
    width : 100%;
}

[data-type="control_datetime"] .form-sub-label-container {
    width : 28%;
    padding-left : 4px;
    box-sizing : border-box;
    margin-right : 0;
}

[data-type="control_datetime"] .form-sub-label-container:first-child {
    padding-left : 0;
}

[data-type="control_datetime"] .form-sub-label-container:first-child + .form-sub-label-container + .form-sub-label-container {
    padding-right : 0;
}

[data-type="control_datetime"] .form-sub-label-container:last-child {
    width : auto !important;
}

.allowTime-container .form-sub-label-container:last-child {
    width : 20% !important;
}

span.allowTime-container {
    width : 80%;
    padding-top : 14px;
}

.allowTime-container span.form-sub-label-container {
    width : 35%;
}

span.allowTime-container .form-dropdown {
    width : 100%;
}

span.allowTime-container > span:first-child {
    display : none;
}

span.allowTime-container > span:first-child + span {
    padding-left : 0;
}

.showAutoCalendar + label {
    display : none;
}

span.allowTime-container + span {
    padding-top : 14px;
}

/*calendar lite mode*/
[data-type="control_datetime"] div[style*="none"] + .form-sub-label-container {
    width : 84%;
    padding-left : 0;
}

/*responsive phone field*/
[data-type="control_phone"] .form-sub-label-container + .form-sub-label-container {
    width : 60%;
    margin-right : 0;
    padding-right : 0;
    padding-left : 12px;
}

/*responsive full address fields*/
.form-address-city, .form-address-line, .form-address-postal, 
.form-address-state, .form-address-table, 
.form-address-table .form-sub-label-container, .form-address-table select {
    width : 100%;
    max-width : 100%;
}

[data-type="control_address"] input[name$="[city]"],
[data-type="control_address"] input[name$="[postal]"] {
    width : 90% !important;
}

[data-type="control_address"] input[name$="[area]"] {
    width : 60%;
}

/*reset submit button*/
[data-type="control_button"] {
    background : transparent !important;
}

.form-submit-button,
.form-submit-reset,
.form-submit-print {
    outline : none;
}

/*remove other checkbox*/
.form-checkbox-other, 
.form-radio-other {
    visibility : hidden !important;
}

/*shruken fields*/
.form-line-column {
    width : 50%;
}

.form-line-column .form-label-top {
    width : 100% !important;
}

/*fix form builder display*/
div#stage.form-all {
    max-width : none !important;
    margin-right : 0;
}

div#stage .form-input {
    width : 64% !important;
}

/*remove first pagebreak back button*/
.form-all .page-section:first-child .form-pagebreak .form-pagebreak-back-container {
    display : none !important;
}

/* responsive pagebreak */
.form-pagebreak-back-container {
    width : 50% !important;
    text-align : left;
    box-sizing : border-box;
    -webkit-box-sizing : border-box;
    float : left;
}

.form-pagebreak-next-container {
    width : 50% !important;
    text-align : right;
    box-sizing : border-box;
    -webkit-box-sizing : border-box;
    float : left;
}

/* radio-checkbox button make border 1px */
.form-radio-item:not(#foo) label:after,
.form-radio-item:not(#foo) label:before {
    border-radius : 50%;
}

.form-checkbox-item:not(#foo) label:after,
.form-checkbox-item:not(#foo) label:before {
    border-radius : 0;
}

.form-radio-item:not(#foo) label:before,
.form-checkbox-item:not(#foo) label:before {
    border-width : 1px;
}

/*responsive credit card on payment fields*/
table td + td {
    padding-left : 0;
}

.form-address-table {
    width : 100%;
}

[data-type="control_stripe"] .form-address-table,
[data-type="control_stripe"] .form-address-table .form-textbox,
[data-type="control_authnet"] .form-address-table,
[data-type="control_authnet"] .form-address-table .form-textbox,
#creditCardTable.form-address-table,
#creditCardTable.form-address-table .form-textbox {
    max-width : none;
}

[data-type="control_stripe"] .form-address-table td:last-child .form-sub-label-container,
[data-type="control_authnet"] .form-address-table td:last-child .form-sub-label-container,
#creditCardTable.form-address-table td:last-child .form-sub-label-container {
    margin-left : 0;
    white-space : normal;
}

[data-type="control_stripe"] .form-address-table td .form-sub-label-container,
[data-type="control_authnet"] .form-address-table td .form-sub-label-container,
#creditCardTable.form-address-table td .form-sub-label-container {
    width : 100%;
}

[data-type="control_stripe"] .form-address-table .form-textbox,
[data-type="control_stripe"] .form-address-table .form-dropdown,
[data-type="control_authnet"] .form-address-table .form-textbox,
[data-type="control_authnet"] .form-address-table .form-dropdown,
#creditCardTable.form-address-table .form-textbox,
#creditCardTable.form-address-table .form-dropdown {
    width : 100%;
    visibility : visible;
}

[data-type="control_stripe"] .form-address-table tbody > tr:first-child + tr td:first-child span,
[data-type="control_authnet"] .form-address-table tbody > tr:first-child + tr td:first-child span,
#creditCardTable.form-address-table tbody > tr:first-child + tr td:first-child span {
    margin : 0;
    padding-right : 6px;
    box-sizing : border-box;
    -webkit-box-sizing : border-box;
}

[data-type="control_stripe"] .form-address-table tbody > tr:first-child + tr td:first-child + td span,
[data-type="control_authnet"] .form-address-table tbody > tr:first-child + tr td:first-child + td span,
#creditCardTable.form-address-table tbody > tr:first-child + tr td:first-child + td span {
    margin : 0;
    padding-left : 6px;
    box-sizing : border-box;
    -webkit-box-sizing : border-box;
}

[data-type="control_stripe"] .form-address-table tbody > tr:first-child + tr +tr td:first-child span,
[data-type="control_stripe"] .form-address-table tbody > tr:first-child + tr +tr+tr td:first-child span,
[data-type="control_authnet"] .form-address-table tbody > tr:first-child + tr +tr td:first-child span,
[data-type="control_authnet"] .form-address-table tbody > tr:first-child + tr +tr+tr td:first-child span,
#creditCardTable.form-address-table tbody > tr:first-child + tr +tr td:first-child span,
#creditCardTable.form-address-table tbody > tr:first-child + tr +tr+tr td:first-child span {
    margin : 0;
    padding-right : 6px;
    width : 50% !important;
    visibility : hidden;
    float : left;
    box-sizing : border-box;
    -webkit-box-sizing : border-box;
}

[data-type="control_stripe"] .form-address-table tbody > tr:first-child + tr +tr td:first-child span + span,
[data-type="control_stripe"] .form-address-table tbody > tr:first-child + tr +tr+tr td:first-child span + span,
[data-type="control_authnet"] .form-address-table tbody > tr:first-child + tr +tr td:first-child span + span,
[data-type="control_authnet"] .form-address-table tbody > tr:first-child + tr +tr+tr td:first-child span + span,
#creditCardTable.form-address-table tbody > tr:first-child + tr +tr td:first-child span + span,
#creditCardTable.form-address-table tbody > tr:first-child + tr +tr+tr td:first-child span + span {
    margin : 0;
    padding-top : 0 !important;
    padding-right : 0;
    padding-left : 6px;
    width : 50% !important;
    box-sizing : border-box;
    -webkit-box-sizing : border-box;
}

.cc_ccv {
    width : 100% !important;
}

[data-type="control_stripe"] .form-address-table .form-sub-label,
[data-type="control_authnet"] .form-address-table .form-sub-label,
#creditCardTable.form-address-table .form-sub-label {
    visibility : visible;
}

/*cc fix city state, country */
[data-type="control_stripe"] .form-address-table td[width="50%"]>span:first-child,
[data-type="control_authnet"] .form-address-table td[width="50%"]>span:first-child,
#creditCardTable.form-address-table td[width="50%"]>span:first-child {
    box-sizing : border-box;
    padding-right : 7px;
}

[data-type="control_stripe"] .form-address-table td[width="50%"] + td >span:first-child,
[data-type="control_authnet"] .form-address-table td[width="50%"] + td >span:first-child,
#creditCardTable.form-address-table td[width="50%"] + td >span:first-child {
    box-sizing : border-box;
    padding-left : 7px;
}

[data-type="control_stripe"] .form-address-table td[width="50%"] + td[width="50%"] >span:first-child,
[data-type="control_authnet"] .form-address-table td[width="50%"] + td[width="50%"] >span:first-child,
#creditCardTable.form-address-table td[width="50%"] + td[width="50%"] >span:first-child {
    box-sizing : border-box;
    padding-right : 0;
}

.hover-product-item:hover {
    color : inherit;
}

/*fix for braintree cc styling*/
[data-type="control_braintree"] .form-sub-label-container {
    width : 100% !important;
    padding : 4px;
    box-sizing : border-box;
}

[data-type="control_braintree"] .form-textbox {
    width : 100%;
}

.braintree-hosted-fields {
    width : 100% !important;
    box-sizing : border-box;
    min-height : 28px;
}

/*remove bottom spacing on CC section*/
.form-address-table tbody tr + tr + tr td {
    padding-bottom : 0;
}

@media screen and (max-width:768px){
    .form-all {
        margin : 0 auto !important;
        width : 100% !important;
    }

    [data-type=control_fullname] .form-sub-label-container:first-child {
        margin-right : 0;
    }

}

@media screen and (max-width:480px){
    .jotform-form {
        padding : 0;
    }

    .form-input {
        width : 100% !important;
    }

    .form-label {
        width : 100% !important;
        float : none !important;
    }

    .form-line-column {
        width : 100% !important;
    }

    div.form-header-group {
        margin : 0 !important;
        padding : 24px 20px !important;
    }

    [data-type="control_datetime"] .form-sub-label-container {
        float : left;
    }

    [data-type=control_fullname] .form-sub-label-container:first-child {
        margin-right : 0;
    }

}

/*******NEW responsive tableless address field ******/
[data-type="control_address"] .form-address-line input {
    width : 100%;
}

[data-type="control_address"] .form-sub-label-container {
    margin : 0;
}

[data-type="control_address"] .form-address-table 
.form-address-line-wrapper + 
.form-address-line-wrapper +
.form-address-line-wrapper {
    width : 100%;
}

[data-type="control_address"] .form-address-table 
.form-address-line-wrapper + 
.form-address-line-wrapper +
.form-address-line-wrapper .form-address-line {
    width : 50%;
    float : left;
    display : inline-block;
    box-sizing : border-box;
}

.form-address-city-line,
.form-address-zip-line {
    padding-right : 4px;
}

.form-address-state-line,
.form-address-country-line {
    padding-left : 4px;
}

[data-type="control_address"] .form-address-table 
.form-address-line-wrapper + 
.form-address-line-wrapper +
.form-address-line-wrapper +
.form-address-line-wrapper {
    width : 100%;
}

[data-type="control_address"] .form-address-table 
.form-address-line-wrapper + 
.form-address-line-wrapper +
.form-address-line-wrapper +
.form-address-line-wrapper .form-address-line {
    width : 50%;
    float : left;
    box-sizing : border-box;
}


    /* Injected CSS Code */
</style>

<form class="jotform-form" action="https://submit.jotform.com/submit/202932287096562/" method="post" enctype="multipart/form-data" name="form_202932287096562" id="202932287096562" accept-charset="utf-8" autocomplete="on">
  <input type="hidden" name="formID" value="202932287096562" />
  <input type="hidden" id="JWTContainer" value="" />
  <input type="hidden" id="cardinalOrderNumber" value="" />
  <div role="main" class="form-all">
    <ul class="form-section page-section">
      <li class="form-line" data-type="control_image" id="id_105">
        <div id="cid_105" class="form-input-wide">
          <div style="text-align:center">
            <img alt="" class="form-image" style="border:0" src="../Red-logo.png" height="212px" width="508px" data-component="image" />
          </div>
        </div>
      </li>
      <li id="cid_19" class="form-input-wide" data-type="control_head">
        <div class="form-header-group  header-default">
          <div class="header-text httal htvam">
            <h2 id="header_19" class="form-header" data-component="header">
              Enrollee Registration Form
            </h2>
            <div id="subHeader_19" class="form-subHeader">
              Fill the form below indicating indicating your personal details, preferred plan and provider. We will get back soon to you for more updates.
            </div>
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_text" id="id_48">
        <div id="cid_48" class="form-input-wide">
          <div id="text_48" class="form-html" data-component="text">
            <p style="text-align: center;"><strong style="text-align: center;"><span style="font-size: 18pt; color: #0000ff;"><strong><strong>PRINCIPAL</strong></strong></span></strong></p>
          </div>
        </div>
      </li>
      <li class="form-line jf-required" data-type="control_textbox" id="id_98">
        <label class="form-label form-label-left form-label-auto" id="label_98" for="input_98">
          Company Name
          <span class="form-required">
            *
          </span>
        </label>
        <div id="cid_98" class="form-input jf-required">
          <input type="text" id="input_98" name="q98_companyName" data-type="input-textbox" class="form-readonly form-textbox validate[required]" size="20" value="FEDERAL INLAND REVENUE SERVICE (FIRS)" tabindex="-1" data-component="textbox" aria-labelledby="label_98" readonly="" required="" />
        </div>
      </li>
      <li class="form-line jf-required" data-type="control_textbox" id="id_4">
        <label class="form-label form-label-left form-label-auto" id="label_4" for="input_4">
          Surname
          <span class="form-required">
            *
          </span>
        </label>
        <div id="cid_4" class="form-input jf-required">
          <input type="text" id="input_4" name="q4_surname" data-type="input-textbox" class="form-textbox validate[required]" size="30" value="" placeholder=" " data-component="textbox" aria-labelledby="label_4" required="" />
        </div>
      </li>
      <li class="form-line jf-required" data-type="control_textbox" id="id_26">
        <label class="form-label form-label-left form-label-auto" id="label_26" for="input_26">
          First Name
          <span class="form-required">
            *
          </span>
        </label>
        <div id="cid_26" class="form-input jf-required">
          <input type="text" id="input_26" name="q26_firstName" data-type="input-textbox" class="form-textbox validate[required]" size="30" value="" placeholder=" " data-component="textbox" aria-labelledby="label_26" required="" />
        </div>
      </li>
      <li class="form-line jf-required" data-type="control_textbox" id="id_27">
        <label class="form-label form-label-left form-label-auto" id="label_27" for="input_27">
          Middle Name
          <span class="form-required">
            *
          </span>
        </label>
        <div id="cid_27" class="form-input jf-required">
          <input type="text" id="input_27" name="q27_middleName" data-type="input-textbox" class="form-textbox validate[required]" size="30" value="" placeholder=" " data-component="textbox" aria-labelledby="label_27" required="" />
        </div>
      </li>
      <li class="form-line jf-required" data-type="control_dropdown" id="id_22">
        <label class="form-label form-label-left form-label-auto" id="label_22" for="input_22">
          Gender
          <span class="form-required">
            *
          </span>
        </label>
        <div id="cid_22" class="form-input jf-required">
          <select class="form-dropdown validate[required]" id="input_22" name="q22_gender" style="width:150px" data-component="dropdown" required="" aria-labelledby="label_22">
            <option value="">  </option>
            <option value="Male"> Male </option>
            <option value="Female"> Female </option>
            <option value="Not willing to Disclose"> Not willing to Disclose </option>
          </select>
        </div>
      </li>
      <li class="form-line jf-required" data-type="control_phone" id="id_23" data-compound-hint=",">
        <label class="form-label form-label-left form-label-auto" id="label_23" for="input_23_area">
          Phone Number
          <span class="form-required">
            *
          </span>
        </label>
        <div id="cid_23" class="form-input jf-required">
          <div data-wrapper-react="true">
            <span class="form-sub-label-container" style="vertical-align:top" data-input-type="areaCode">
              <input type="tel" id="input_23_area" name="q23_phoneNumber23[area]" class="form-textbox validate[required]" value="" data-component="areaCode" aria-labelledby="label_23 sublabel_23_area" required="" />
              <span class="phone-separate" aria-hidden="true">
                 -
              </span>
              <label class="form-sub-label" for="input_23_area" id="sublabel_23_area" style="min-height:13px" aria-hidden="false"> Area Code </label>
            </span>
            <span class="form-sub-label-container" style="vertical-align:top" data-input-type="phone">
              <input type="tel" id="input_23_phone" name="q23_phoneNumber23[phone]" class="form-textbox validate[required]" value="" data-component="phone" aria-labelledby="label_23 sublabel_23_phone" required="" />
              <label class="form-sub-label" for="input_23_phone" id="sublabel_23_phone" style="min-height:13px" aria-hidden="false"> Phone Number </label>
            </span>
          </div>
        </div>
      </li>
      <li class="form-line jf-required" data-type="control_birthdate" id="id_9">
        <label class="form-label form-label-left form-label-auto" id="label_9" for="input_9">
          Date of Birth
          <span class="form-required">
            *
          </span>
        </label>
        <div id="cid_9" class="form-input jf-required">
          <div data-wrapper-react="true">
            <span class="form-sub-label-container" style="vertical-align:top">
              <select name="q9_dateOf[day]" id="input_9_day" class="form-dropdown validate[required]" data-component="birthdate-day" aria-labelledby="label_9 sublabel_9_day">
                <option>  </option>
                <option value="1"> 1 </option>
                <option value="2"> 2 </option>
                <option value="3"> 3 </option>
                <option value="4"> 4 </option>
                <option value="5"> 5 </option>
                <option value="6"> 6 </option>
                <option value="7"> 7 </option>
                <option value="8"> 8 </option>
                <option value="9"> 9 </option>
                <option value="10"> 10 </option>
                <option value="11"> 11 </option>
                <option value="12"> 12 </option>
                <option value="13"> 13 </option>
                <option value="14"> 14 </option>
                <option value="15"> 15 </option>
                <option value="16"> 16 </option>
                <option value="17"> 17 </option>
                <option value="18"> 18 </option>
                <option value="19"> 19 </option>
                <option value="20"> 20 </option>
                <option value="21"> 21 </option>
                <option value="22"> 22 </option>
                <option value="23"> 23 </option>
                <option value="24"> 24 </option>
                <option value="25"> 25 </option>
                <option value="26"> 26 </option>
                <option value="27"> 27 </option>
                <option value="28"> 28 </option>
                <option value="29"> 29 </option>
                <option value="30"> 30 </option>
                <option value="31"> 31 </option>
              </select>
              <label class="form-sub-label" for="input_9_day" id="sublabel_9_day" style="min-height:13px" aria-hidden="false"> Day </label>
            </span>
            <span class="form-sub-label-container" style="vertical-align:top">
              <select name="q9_dateOf[month]" id="input_9_month" class="form-dropdown validate[required]" data-component="birthdate-month" aria-labelledby="label_9 sublabel_9_month">
                <option>  </option>
                <option value="January"> January </option>
                <option value="February"> February </option>
                <option value="March"> March </option>
                <option value="April"> April </option>
                <option value="May"> May </option>
                <option value="June"> June </option>
                <option value="July"> July </option>
                <option value="August"> August </option>
                <option value="September"> September </option>
                <option value="October"> October </option>
                <option value="November"> November </option>
                <option value="December"> December </option>
              </select>
              <label class="form-sub-label" for="input_9_month" id="sublabel_9_month" style="min-height:13px" aria-hidden="false"> Month </label>
            </span>
            <span class="form-sub-label-container" style="vertical-align:top">
              <select name="q9_dateOf[year]" id="input_9_year" class="form-dropdown validate[required]" data-component="birthdate-year" aria-labelledby="label_9 sublabel_9_year">
                <option>  </option>
                <option value="2020"> 2020 </option>
                <option value="2019"> 2019 </option>
                <option value="2018"> 2018 </option>
                <option value="2017"> 2017 </option>
                <option value="2016"> 2016 </option>
                <option value="2015"> 2015 </option>
                <option value="2014"> 2014 </option>
                <option value="2013"> 2013 </option>
                <option value="2012"> 2012 </option>
                <option value="2011"> 2011 </option>
                <option value="2010"> 2010 </option>
                <option value="2009"> 2009 </option>
                <option value="2008"> 2008 </option>
                <option value="2007"> 2007 </option>
                <option value="2006"> 2006 </option>
                <option value="2005"> 2005 </option>
                <option value="2004"> 2004 </option>
                <option value="2003"> 2003 </option>
                <option value="2002"> 2002 </option>
                <option value="2001"> 2001 </option>
                <option value="2000"> 2000 </option>
                <option value="1999"> 1999 </option>
                <option value="1998"> 1998 </option>
                <option value="1997"> 1997 </option>
                <option value="1996"> 1996 </option>
                <option value="1995"> 1995 </option>
                <option value="1994"> 1994 </option>
                <option value="1993"> 1993 </option>
                <option value="1992"> 1992 </option>
                <option value="1991"> 1991 </option>
                <option value="1990"> 1990 </option>
                <option value="1989"> 1989 </option>
                <option value="1988"> 1988 </option>
                <option value="1987"> 1987 </option>
                <option value="1986"> 1986 </option>
                <option value="1985"> 1985 </option>
                <option value="1984"> 1984 </option>
                <option value="1983"> 1983 </option>
                <option value="1982"> 1982 </option>
                <option value="1981"> 1981 </option>
                <option value="1980"> 1980 </option>
                <option value="1979"> 1979 </option>
                <option value="1978"> 1978 </option>
                <option value="1977"> 1977 </option>
                <option value="1976"> 1976 </option>
                <option value="1975"> 1975 </option>
                <option value="1974"> 1974 </option>
                <option value="1973"> 1973 </option>
                <option value="1972"> 1972 </option>
                <option value="1971"> 1971 </option>
                <option value="1970"> 1970 </option>
                <option value="1969"> 1969 </option>
                <option value="1968"> 1968 </option>
                <option value="1967"> 1967 </option>
                <option value="1966"> 1966 </option>
                <option value="1965"> 1965 </option>
                <option value="1964"> 1964 </option>
                <option value="1963"> 1963 </option>
                <option value="1962"> 1962 </option>
                <option value="1961"> 1961 </option>
                <option value="1960"> 1960 </option>
                <option value="1959"> 1959 </option>
                <option value="1958"> 1958 </option>
                <option value="1957"> 1957 </option>
                <option value="1956"> 1956 </option>
                <option value="1955"> 1955 </option>
                <option value="1954"> 1954 </option>
                <option value="1953"> 1953 </option>
                <option value="1952"> 1952 </option>
                <option value="1951"> 1951 </option>
                <option value="1950"> 1950 </option>
                <option value="1949"> 1949 </option>
                <option value="1948"> 1948 </option>
                <option value="1947"> 1947 </option>
                <option value="1946"> 1946 </option>
                <option value="1945"> 1945 </option>
                <option value="1944"> 1944 </option>
                <option value="1943"> 1943 </option>
                <option value="1942"> 1942 </option>
                <option value="1941"> 1941 </option>
                <option value="1940"> 1940 </option>
                <option value="1939"> 1939 </option>
                <option value="1938"> 1938 </option>
                <option value="1937"> 1937 </option>
                <option value="1936"> 1936 </option>
                <option value="1935"> 1935 </option>
                <option value="1934"> 1934 </option>
                <option value="1933"> 1933 </option>
                <option value="1932"> 1932 </option>
                <option value="1931"> 1931 </option>
                <option value="1930"> 1930 </option>
                <option value="1929"> 1929 </option>
                <option value="1928"> 1928 </option>
                <option value="1927"> 1927 </option>
                <option value="1926"> 1926 </option>
                <option value="1925"> 1925 </option>
                <option value="1924"> 1924 </option>
                <option value="1923"> 1923 </option>
                <option value="1922"> 1922 </option>
                <option value="1921"> 1921 </option>
                <option value="1920"> 1920 </option>
              </select>
              <label class="form-sub-label" for="input_9_year" id="sublabel_9_year" style="min-height:13px" aria-hidden="false"> Year </label>
            </span>
          </div>
        </div>
      </li>
      <li class="form-line jf-required" data-type="control_dropdown" id="id_30">
        <label class="form-label form-label-left form-label-auto" id="label_30" for="input_30">
          Type of Plan
          <span class="form-required">
            *
          </span>
        </label>
        <div id="cid_30" class="form-input jf-required">
          <select class="form-dropdown validate[required]" id="input_30" name="q30_typeOf30" style="width:150px" data-component="dropdown" required="" aria-labelledby="label_30">
            <option value="">  </option>
            <option value="Platinum Plan"> Platinum Plan </option>
            <option value="Diamond Plan "> Diamond Plan </option>
            <option value="Gold Plus Plan"> Gold Plus Plan </option>
            <option value="Gold Plan"> Gold Plan </option>
            <option value="Silver Plan"> Silver Plan </option>
            <option value="Standard Plan"> Standard Plan </option>
            <option value="TPA"> TPA </option>
          </select>
        </div>
      </li>
      <li class="form-line jf-required" data-type="control_radio" id="id_106">
        <label class="form-label form-label-left form-label-auto" id="label_106" for="input_106">
          Group of Plan
          <span class="form-required">
            *
          </span>
        </label>
        <div id="cid_106" class="form-input jf-required">
          <div class="form-single-column" role="group" aria-labelledby="label_106" data-component="radio">
            <span class="form-radio-item" style="clear:left">
              <span class="dragger-item">
              </span>
              <input type="radio" class="form-radio validate[required]" id="input_106_0" name="q106_groupOf" value="Family" required="" />
              <label id="label_input_106_0" for="input_106_0"> Family </label>
            </span>
            <span class="form-radio-item" style="clear:left">
              <span class="dragger-item">
              </span>
              <input type="radio" class="form-radio validate[required]" id="input_106_1" name="q106_groupOf" value="Individual" required="" />
              <label id="label_input_106_1" for="input_106_1"> Individual </label>
            </span>
          </div>
        </div>
      </li>
      <li class="form-line jf-required" data-type="control_address" id="id_20">
        <label class="form-label form-label-left form-label-auto" id="label_20" for="input_20undefined">
          Address
          <span class="form-required">
            *
          </span>
        </label>
        <div id="cid_20" class="form-input jf-required">
          <div summary="" class="form-address-table jsTest-addressField">
            <div class="form-address-line-wrapper jsTest-address-line-wrapperField">
              <span class="form-address-line form-address-street-line jsTest-address-lineField">
                <span class="form-sub-label-container" style="vertical-align:top">
                  <input type="text" id="input_20_addr_line1" name="q20_address[addr_line1]" class="form-textbox validate[required] form-address-line" value="" data-component="address_line_1" aria-labelledby="label_20 sublabel_20_addr_line1" required="" />
                  <label class="form-sub-label" for="input_20_addr_line1" id="sublabel_20_addr_line1" style="min-height:13px" aria-hidden="false"> Street Address </label>
                </span>
              </span>
            </div>
            <div class="form-address-line-wrapper jsTest-address-line-wrapperField">
              <span class="form-address-line form-address-street-line jsTest-address-lineField">
                <span class="form-sub-label-container" style="vertical-align:top">
                  <input type="text" id="input_20_addr_line2" name="q20_address[addr_line2]" class="form-textbox form-address-line" value="" data-component="address_line_2" aria-labelledby="label_20 sublabel_20_addr_line2" />
                  <label class="form-sub-label" for="input_20_addr_line2" id="sublabel_20_addr_line2" style="min-height:13px" aria-hidden="false"> Street Address Line 2 </label>
                </span>
              </span>
            </div>
            <div class="form-address-line-wrapper jsTest-address-line-wrapperField">
              <span class="form-address-line form-address-city-line jsTest-address-lineField ">
                <span class="form-sub-label-container" style="vertical-align:top">
                  <input type="text" id="input_20_city" name="q20_address[city]" class="form-textbox validate[required] form-address-city" value="" data-component="city" aria-labelledby="label_20 sublabel_20_city" required="" />
                  <label class="form-sub-label" for="input_20_city" id="sublabel_20_city" style="min-height:13px" aria-hidden="false"> City </label>
                </span>
              </span>
              <span class="form-address-line form-address-state-line jsTest-address-lineField ">
                <span class="form-sub-label-container" style="vertical-align:top">
                  <input type="text" id="input_20_state" name="q20_address[state]" class="form-textbox validate[required] form-address-state" value="" data-component="state" aria-labelledby="label_20 sublabel_20_state" required="" />
                  <label class="form-sub-label" for="input_20_state" id="sublabel_20_state" style="min-height:13px" aria-hidden="false"> State </label>
                </span>
              </span>
            </div>
            <div class="form-address-line-wrapper jsTest-address-line-wrapperField">
              <span class="form-address-line form-address-zip-line jsTest-address-lineField ">
                <span class="form-sub-label-container" style="vertical-align:top">
                  <input type="text" id="input_20_postal" name="q20_address[postal]" class="form-textbox form-address-postal" value="" data-component="zip" aria-labelledby="label_20 sublabel_20_postal" />
                  <label class="form-sub-label" for="input_20_postal" id="sublabel_20_postal" style="min-height:13px" aria-hidden="false"> Post Code </label>
                </span>
              </span>
              <span class="form-address-line form-address-country-line jsTest-address-lineField ">
                <span class="form-sub-label-container" style="vertical-align:top">
                  <select class="form-dropdown validate[required] form-address-country noTranslate" name="q20_address[country]" id="input_20_country" data-component="country" required="" aria-labelledby="label_20 sublabel_20_country">
                    <option value=""> Please Select </option>
                    <option value="United States"> United States </option>
                    <option value="Afghanistan"> Afghanistan </option>
                    <option value="Albania"> Albania </option>
                    <option value="Algeria"> Algeria </option>
                    <option value="American Samoa"> American Samoa </option>
                    <option value="Andorra"> Andorra </option>
                    <option value="Angola"> Angola </option>
                    <option value="Anguilla"> Anguilla </option>
                    <option value="Antigua and Barbuda"> Antigua and Barbuda </option>
                    <option value="Argentina"> Argentina </option>
                    <option value="Armenia"> Armenia </option>
                    <option value="Aruba"> Aruba </option>
                    <option value="Australia"> Australia </option>
                    <option value="Austria"> Austria </option>
                    <option value="Azerbaijan"> Azerbaijan </option>
                    <option value="The Bahamas"> The Bahamas </option>
                    <option value="Bahrain"> Bahrain </option>
                    <option value="Bangladesh"> Bangladesh </option>
                    <option value="Barbados"> Barbados </option>
                    <option value="Belarus"> Belarus </option>
                    <option value="Belgium"> Belgium </option>
                    <option value="Belize"> Belize </option>
                    <option value="Benin"> Benin </option>
                    <option value="Bermuda"> Bermuda </option>
                    <option value="Bhutan"> Bhutan </option>
                    <option value="Bolivia"> Bolivia </option>
                    <option value="Bosnia and Herzegovina"> Bosnia and Herzegovina </option>
                    <option value="Botswana"> Botswana </option>
                    <option value="Brazil"> Brazil </option>
                    <option value="Brunei"> Brunei </option>
                    <option value="Bulgaria"> Bulgaria </option>
                    <option value="Burkina Faso"> Burkina Faso </option>
                    <option value="Burundi"> Burundi </option>
                    <option value="Cambodia"> Cambodia </option>
                    <option value="Cameroon"> Cameroon </option>
                    <option value="Canada"> Canada </option>
                    <option value="Cape Verde"> Cape Verde </option>
                    <option value="Cayman Islands"> Cayman Islands </option>
                    <option value="Central African Republic"> Central African Republic </option>
                    <option value="Chad"> Chad </option>
                    <option value="Chile"> Chile </option>
                    <option value="China"> China </option>
                    <option value="Christmas Island"> Christmas Island </option>
                    <option value="Cocos (Keeling) Islands"> Cocos (Keeling) Islands </option>
                    <option value="Colombia"> Colombia </option>
                    <option value="Comoros"> Comoros </option>
                    <option value="Congo"> Congo </option>
                    <option value="Cook Islands"> Cook Islands </option>
                    <option value="Costa Rica"> Costa Rica </option>
                    <option value="Cote d&#x27;Ivoire"> Cote d&#x27;Ivoire </option>
                    <option value="Croatia"> Croatia </option>
                    <option value="Cuba"> Cuba </option>
                    <option value="Curacao"> Curacao </option>
                    <option value="Cyprus"> Cyprus </option>
                    <option value="Czech Republic"> Czech Republic </option>
                    <option value="Democratic Republic of the Congo"> Democratic Republic of the Congo </option>
                    <option value="Denmark"> Denmark </option>
                    <option value="Djibouti"> Djibouti </option>
                    <option value="Dominica"> Dominica </option>
                    <option value="Dominican Republic"> Dominican Republic </option>
                    <option value="Ecuador"> Ecuador </option>
                    <option value="Egypt"> Egypt </option>
                    <option value="El Salvador"> El Salvador </option>
                    <option value="Equatorial Guinea"> Equatorial Guinea </option>
                    <option value="Eritrea"> Eritrea </option>
                    <option value="Estonia"> Estonia </option>
                    <option value="Ethiopia"> Ethiopia </option>
                    <option value="Falkland Islands"> Falkland Islands </option>
                    <option value="Faroe Islands"> Faroe Islands </option>
                    <option value="Fiji"> Fiji </option>
                    <option value="Finland"> Finland </option>
                    <option value="France"> France </option>
                    <option value="French Polynesia"> French Polynesia </option>
                    <option value="Gabon"> Gabon </option>
                    <option value="The Gambia"> The Gambia </option>
                    <option value="Georgia"> Georgia </option>
                    <option value="Germany"> Germany </option>
                    <option value="Ghana"> Ghana </option>
                    <option value="Gibraltar"> Gibraltar </option>
                    <option value="Greece"> Greece </option>
                    <option value="Greenland"> Greenland </option>
                    <option value="Grenada"> Grenada </option>
                    <option value="Guadeloupe"> Guadeloupe </option>
                    <option value="Guam"> Guam </option>
                    <option value="Guatemala"> Guatemala </option>
                    <option value="Guernsey"> Guernsey </option>
                    <option value="Guinea"> Guinea </option>
                    <option value="Guinea-Bissau"> Guinea-Bissau </option>
                    <option value="Guyana"> Guyana </option>
                    <option value="Haiti"> Haiti </option>
                    <option value="Honduras"> Honduras </option>
                    <option value="Hong Kong"> Hong Kong </option>
                    <option value="Hungary"> Hungary </option>
                    <option value="Iceland"> Iceland </option>
                    <option value="India"> India </option>
                    <option value="Indonesia"> Indonesia </option>
                    <option value="Iran"> Iran </option>
                    <option value="Iraq"> Iraq </option>
                    <option value="Ireland"> Ireland </option>
                    <option value="Israel"> Israel </option>
                    <option value="Italy"> Italy </option>
                    <option value="Jamaica"> Jamaica </option>
                    <option value="Japan"> Japan </option>
                    <option value="Jersey"> Jersey </option>
                    <option value="Jordan"> Jordan </option>
                    <option value="Kazakhstan"> Kazakhstan </option>
                    <option value="Kenya"> Kenya </option>
                    <option value="Kiribati"> Kiribati </option>
                    <option value="North Korea"> North Korea </option>
                    <option value="South Korea"> South Korea </option>
                    <option value="Kosovo"> Kosovo </option>
                    <option value="Kuwait"> Kuwait </option>
                    <option value="Kyrgyzstan"> Kyrgyzstan </option>
                    <option value="Laos"> Laos </option>
                    <option value="Latvia"> Latvia </option>
                    <option value="Lebanon"> Lebanon </option>
                    <option value="Lesotho"> Lesotho </option>
                    <option value="Liberia"> Liberia </option>
                    <option value="Libya"> Libya </option>
                    <option value="Liechtenstein"> Liechtenstein </option>
                    <option value="Lithuania"> Lithuania </option>
                    <option value="Luxembourg"> Luxembourg </option>
                    <option value="Macau"> Macau </option>
                    <option value="Macedonia"> Macedonia </option>
                    <option value="Madagascar"> Madagascar </option>
                    <option value="Malawi"> Malawi </option>
                    <option value="Malaysia"> Malaysia </option>
                    <option value="Maldives"> Maldives </option>
                    <option value="Mali"> Mali </option>
                    <option value="Malta"> Malta </option>
                    <option value="Marshall Islands"> Marshall Islands </option>
                    <option value="Martinique"> Martinique </option>
                    <option value="Mauritania"> Mauritania </option>
                    <option value="Mauritius"> Mauritius </option>
                    <option value="Mayotte"> Mayotte </option>
                    <option value="Mexico"> Mexico </option>
                    <option value="Micronesia"> Micronesia </option>
                    <option value="Moldova"> Moldova </option>
                    <option value="Monaco"> Monaco </option>
                    <option value="Mongolia"> Mongolia </option>
                    <option value="Montenegro"> Montenegro </option>
                    <option value="Montserrat"> Montserrat </option>
                    <option value="Morocco"> Morocco </option>
                    <option value="Mozambique"> Mozambique </option>
                    <option value="Myanmar"> Myanmar </option>
                    <option value="Nagorno-Karabakh"> Nagorno-Karabakh </option>
                    <option value="Namibia"> Namibia </option>
                    <option value="Nauru"> Nauru </option>
                    <option value="Nepal"> Nepal </option>
                    <option value="Netherlands"> Netherlands </option>
                    <option value="Netherlands Antilles"> Netherlands Antilles </option>
                    <option value="New Caledonia"> New Caledonia </option>
                    <option value="New Zealand"> New Zealand </option>
                    <option value="Nicaragua"> Nicaragua </option>
                    <option value="Niger"> Niger </option>
                    <option value="Nigeria"> Nigeria </option>
                    <option value="Niue"> Niue </option>
                    <option value="Norfolk Island"> Norfolk Island </option>
                    <option value="Turkish Republic of Northern Cyprus"> Turkish Republic of Northern Cyprus </option>
                    <option value="Northern Mariana"> Northern Mariana </option>
                    <option value="Norway"> Norway </option>
                    <option value="Oman"> Oman </option>
                    <option value="Pakistan"> Pakistan </option>
                    <option value="Palau"> Palau </option>
                    <option value="Palestine"> Palestine </option>
                    <option value="Panama"> Panama </option>
                    <option value="Papua New Guinea"> Papua New Guinea </option>
                    <option value="Paraguay"> Paraguay </option>
                    <option value="Peru"> Peru </option>
                    <option value="Philippines"> Philippines </option>
                    <option value="Pitcairn Islands"> Pitcairn Islands </option>
                    <option value="Poland"> Poland </option>
                    <option value="Portugal"> Portugal </option>
                    <option value="Puerto Rico"> Puerto Rico </option>
                    <option value="Qatar"> Qatar </option>
                    <option value="Republic of the Congo"> Republic of the Congo </option>
                    <option value="Romania"> Romania </option>
                    <option value="Russia"> Russia </option>
                    <option value="Rwanda"> Rwanda </option>
                    <option value="Saint Barthelemy"> Saint Barthelemy </option>
                    <option value="Saint Helena"> Saint Helena </option>
                    <option value="Saint Kitts and Nevis"> Saint Kitts and Nevis </option>
                    <option value="Saint Lucia"> Saint Lucia </option>
                    <option value="Saint Martin"> Saint Martin </option>
                    <option value="Saint Pierre and Miquelon"> Saint Pierre and Miquelon </option>
                    <option value="Saint Vincent and the Grenadines"> Saint Vincent and the Grenadines </option>
                    <option value="Samoa"> Samoa </option>
                    <option value="San Marino"> San Marino </option>
                    <option value="Sao Tome and Principe"> Sao Tome and Principe </option>
                    <option value="Saudi Arabia"> Saudi Arabia </option>
                    <option value="Senegal"> Senegal </option>
                    <option value="Serbia"> Serbia </option>
                    <option value="Seychelles"> Seychelles </option>
                    <option value="Sierra Leone"> Sierra Leone </option>
                    <option value="Singapore"> Singapore </option>
                    <option value="Slovakia"> Slovakia </option>
                    <option value="Slovenia"> Slovenia </option>
                    <option value="Solomon Islands"> Solomon Islands </option>
                    <option value="Somalia"> Somalia </option>
                    <option value="Somaliland"> Somaliland </option>
                    <option value="South Africa"> South Africa </option>
                    <option value="South Ossetia"> South Ossetia </option>
                    <option value="South Sudan"> South Sudan </option>
                    <option value="Spain"> Spain </option>
                    <option value="Sri Lanka"> Sri Lanka </option>
                    <option value="Sudan"> Sudan </option>
                    <option value="Suriname"> Suriname </option>
                    <option value="Svalbard"> Svalbard </option>
                    <option value="eSwatini"> eSwatini </option>
                    <option value="Sweden"> Sweden </option>
                    <option value="Switzerland"> Switzerland </option>
                    <option value="Syria"> Syria </option>
                    <option value="Taiwan"> Taiwan </option>
                    <option value="Tajikistan"> Tajikistan </option>
                    <option value="Tanzania"> Tanzania </option>
                    <option value="Thailand"> Thailand </option>
                    <option value="Timor-Leste"> Timor-Leste </option>
                    <option value="Togo"> Togo </option>
                    <option value="Tokelau"> Tokelau </option>
                    <option value="Tonga"> Tonga </option>
                    <option value="Transnistria Pridnestrovie"> Transnistria Pridnestrovie </option>
                    <option value="Trinidad and Tobago"> Trinidad and Tobago </option>
                    <option value="Tristan da Cunha"> Tristan da Cunha </option>
                    <option value="Tunisia"> Tunisia </option>
                    <option value="Turkey"> Turkey </option>
                    <option value="Turkmenistan"> Turkmenistan </option>
                    <option value="Turks and Caicos Islands"> Turks and Caicos Islands </option>
                    <option value="Tuvalu"> Tuvalu </option>
                    <option value="Uganda"> Uganda </option>
                    <option value="Ukraine"> Ukraine </option>
                    <option value="United Arab Emirates"> United Arab Emirates </option>
                    <option value="United Kingdom"> United Kingdom </option>
                    <option value="Uruguay"> Uruguay </option>
                    <option value="Uzbekistan"> Uzbekistan </option>
                    <option value="Vanuatu"> Vanuatu </option>
                    <option value="Vatican City"> Vatican City </option>
                    <option value="Venezuela"> Venezuela </option>
                    <option value="Vietnam"> Vietnam </option>
                    <option value="British Virgin Islands"> British Virgin Islands </option>
                    <option value="Isle of Man"> Isle of Man </option>
                    <option value="US Virgin Islands"> US Virgin Islands </option>
                    <option value="Wallis and Futuna"> Wallis and Futuna </option>
                    <option value="Western Sahara"> Western Sahara </option>
                    <option value="Yemen"> Yemen </option>
                    <option value="Zambia"> Zambia </option>
                    <option value="Zimbabwe"> Zimbabwe </option>
                    <option value="other"> Other </option>
                  </select>
                  <label class="form-sub-label" for="input_20_country" id="sublabel_20_country" style="min-height:13px" aria-hidden="false"> Country </label>
                </span>
              </span>
            </div>
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_textbox" id="id_29">
        <label class="form-label form-label-left form-label-auto" id="label_29" for="input_29"> Employee ID </label>
        <div id="cid_29" class="form-input">
          <input type="text" id="input_29" name="q29_employeeId" data-type="input-textbox" class="form-textbox" size="30" value="" placeholder=" " data-component="textbox" aria-labelledby="label_29" />
        </div>
      </li>
      <li class="form-line jf-required" data-type="control_email" id="id_24">
        <label class="form-label form-label-left form-label-auto" id="label_24" for="input_24">
          E-mail Address
          <span class="form-required">
            *
          </span>
        </label>
        <div id="cid_24" class="form-input jf-required">
          <input type="email" id="input_24" name="q24_emailAddress" class="form-textbox validate[required, Email]" size="30" value="" placeholder="ex: myname@example.com" data-component="email" aria-labelledby="label_24" required="" />
        </div>
      </li>
      <li class="form-line jf-required" data-type="control_dropdown" id="id_31">
        <label class="form-label form-label-left form-label-auto" id="label_31" for="input_31">
          Hospitals
          <span class="form-required">
            *
          </span>
        </label>
        <div id="cid_31" class="form-input jf-required">
          <span class="form-sub-label-container" style="vertical-align:top">
            <select class="form-dropdown validate[required]" id="input_31" name="q31_hospitals" style="width:150px" data-component="dropdown" required="" aria-labelledby="label_31 sublabel_input_31">
              <option value="">  </option>
              <option value="">  </option>
            </select>
            <label class="form-sub-label" for="input_31" id="sublabel_input_31" style="min-height:13px" aria-hidden="false"> Choose From our Network of Hospitals* (State-Town-Hospital) * </label>
          </span>
        </div>
      </li>
      <li class="form-line jf-required" data-type="control_fileupload" id="id_99">
        <label class="form-label form-label-left form-label-auto" id="label_99" for="input_99">
          Passport
          <span class="form-required">
            *
          </span>
        </label>
        <div id="cid_99" class="form-input jf-required">
          <span class="form-sub-label-container" style="vertical-align:top">
            <input type="file" id="input_99" name="q99_passport" class="form-upload validate[required]" data-imagevalidate="yes" data-file-accept="jpg, jpeg, png, gif" data-file-maxsize="10240" data-file-minsize="0" data-file-limit="" data-component="fileupload" required="" />
            <label class="form-sub-label" for="input_99" style="min-height:13px" aria-hidden="false"> Select passport photo from your device. </label>
          </span>
        </div>
      </li>
      <li class="form-line" data-type="control_divider" id="id_34">
        <div id="cid_34" class="form-input-wide">
          <div data-component="divider" style="border-bottom:1px solid #e6e6e6;height:1px;margin-left:0px;margin-right:0px;margin-top:5px;margin-bottom:5px">
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_text" id="id_35">
        <div id="cid_35" class="form-input-wide">
          <div id="text_35" class="form-html" data-component="text">
            <p style="text-align: center;"><span style="font-size: 18pt; color: #0000ff;"><strong><strong>SPOUSE</strong></strong></span></p>
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_textbox" id="id_36">
        <label class="form-label form-label-left form-label-auto" id="label_36" for="input_36"> Spouse's Surname </label>
        <div id="cid_36" class="form-input">
          <input type="text" id="input_36" name="q36_spousesSurname" data-type="input-textbox" class="form-textbox" size="30" value="" placeholder=" " data-component="textbox" aria-labelledby="label_36" />
        </div>
      </li>
      <li class="form-line" data-type="control_textbox" id="id_37">
        <label class="form-label form-label-left form-label-auto" id="label_37" for="input_37"> Spouse's First Name </label>
        <div id="cid_37" class="form-input">
          <input type="text" id="input_37" name="q37_spousesFirst" data-type="input-textbox" class="form-textbox" size="30" value="" placeholder=" " data-component="textbox" aria-labelledby="label_37" />
        </div>
      </li>
      <li class="form-line" data-type="control_textbox" id="id_38">
        <label class="form-label form-label-left form-label-auto" id="label_38" for="input_38"> Spouse's Middle Name </label>
        <div id="cid_38" class="form-input">
          <input type="text" id="input_38" name="q38_spousesMiddle" data-type="input-textbox" class="form-textbox" size="30" value="" placeholder=" " data-component="textbox" aria-labelledby="label_38" />
        </div>
      </li>
      <li class="form-line" data-type="control_phone" id="id_41">
        <label class="form-label form-label-left form-label-auto" id="label_41" for="input_41_area"> Spouse's Phone Number </label>
        <div id="cid_41" class="form-input">
          <div data-wrapper-react="true">
            <span class="form-sub-label-container" style="vertical-align:top" data-input-type="areaCode">
              <input type="tel" id="input_41_area" name="q41_spousesPhone[area]" class="form-textbox" value="" data-component="areaCode" aria-labelledby="label_41 sublabel_41_area" />
              <span class="phone-separate" aria-hidden="true">
                 -
              </span>
              <label class="form-sub-label" for="input_41_area" id="sublabel_41_area" style="min-height:13px" aria-hidden="false"> Area Code </label>
            </span>
            <span class="form-sub-label-container" style="vertical-align:top" data-input-type="phone">
              <input type="tel" id="input_41_phone" name="q41_spousesPhone[phone]" class="form-textbox" value="" data-component="phone" aria-labelledby="label_41 sublabel_41_phone" />
              <label class="form-sub-label" for="input_41_phone" id="sublabel_41_phone" style="min-height:13px" aria-hidden="false"> Phone Number </label>
            </span>
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_birthdate" id="id_42">
        <label class="form-label form-label-left form-label-auto" id="label_42" for="input_42"> Spouse's Date of Birth </label>
        <div id="cid_42" class="form-input">
          <div data-wrapper-react="true">
            <span class="form-sub-label-container" style="vertical-align:top">
              <select name="q42_spousesDate[day]" id="input_42_day" class="form-dropdown" data-component="birthdate-day" aria-labelledby="label_42 sublabel_42_day">
                <option>  </option>
                <option value="1"> 1 </option>
                <option value="2"> 2 </option>
                <option value="3"> 3 </option>
                <option value="4"> 4 </option>
                <option value="5"> 5 </option>
                <option value="6"> 6 </option>
                <option value="7"> 7 </option>
                <option value="8"> 8 </option>
                <option value="9"> 9 </option>
                <option value="10"> 10 </option>
                <option value="11"> 11 </option>
                <option value="12"> 12 </option>
                <option value="13"> 13 </option>
                <option value="14"> 14 </option>
                <option value="15"> 15 </option>
                <option value="16"> 16 </option>
                <option value="17"> 17 </option>
                <option value="18"> 18 </option>
                <option value="19"> 19 </option>
                <option value="20"> 20 </option>
                <option value="21"> 21 </option>
                <option value="22"> 22 </option>
                <option value="23"> 23 </option>
                <option value="24"> 24 </option>
                <option value="25"> 25 </option>
                <option value="26"> 26 </option>
                <option value="27"> 27 </option>
                <option value="28"> 28 </option>
                <option value="29"> 29 </option>
                <option value="30"> 30 </option>
                <option value="31"> 31 </option>
              </select>
              <label class="form-sub-label" for="input_42_day" id="sublabel_42_day" style="min-height:13px" aria-hidden="false"> Day </label>
            </span>
            <span class="form-sub-label-container" style="vertical-align:top">
              <select name="q42_spousesDate[month]" id="input_42_month" class="form-dropdown" data-component="birthdate-month" aria-labelledby="label_42 sublabel_42_month">
                <option>  </option>
                <option value="January"> January </option>
                <option value="February"> February </option>
                <option value="March"> March </option>
                <option value="April"> April </option>
                <option value="May"> May </option>
                <option value="June"> June </option>
                <option value="July"> July </option>
                <option value="August"> August </option>
                <option value="September"> September </option>
                <option value="October"> October </option>
                <option value="November"> November </option>
                <option value="December"> December </option>
              </select>
              <label class="form-sub-label" for="input_42_month" id="sublabel_42_month" style="min-height:13px" aria-hidden="false"> Month </label>
            </span>
            <span class="form-sub-label-container" style="vertical-align:top">
              <select name="q42_spousesDate[year]" id="input_42_year" class="form-dropdown" data-component="birthdate-year" aria-labelledby="label_42 sublabel_42_year">
                <option>  </option>
                <option value="2020"> 2020 </option>
                <option value="2019"> 2019 </option>
                <option value="2018"> 2018 </option>
                <option value="2017"> 2017 </option>
                <option value="2016"> 2016 </option>
                <option value="2015"> 2015 </option>
                <option value="2014"> 2014 </option>
                <option value="2013"> 2013 </option>
                <option value="2012"> 2012 </option>
                <option value="2011"> 2011 </option>
                <option value="2010"> 2010 </option>
                <option value="2009"> 2009 </option>
                <option value="2008"> 2008 </option>
                <option value="2007"> 2007 </option>
                <option value="2006"> 2006 </option>
                <option value="2005"> 2005 </option>
                <option value="2004"> 2004 </option>
                <option value="2003"> 2003 </option>
                <option value="2002"> 2002 </option>
                <option value="2001"> 2001 </option>
                <option value="2000"> 2000 </option>
                <option value="1999"> 1999 </option>
                <option value="1998"> 1998 </option>
                <option value="1997"> 1997 </option>
                <option value="1996"> 1996 </option>
                <option value="1995"> 1995 </option>
                <option value="1994"> 1994 </option>
                <option value="1993"> 1993 </option>
                <option value="1992"> 1992 </option>
                <option value="1991"> 1991 </option>
                <option value="1990"> 1990 </option>
                <option value="1989"> 1989 </option>
                <option value="1988"> 1988 </option>
                <option value="1987"> 1987 </option>
                <option value="1986"> 1986 </option>
                <option value="1985"> 1985 </option>
                <option value="1984"> 1984 </option>
                <option value="1983"> 1983 </option>
                <option value="1982"> 1982 </option>
                <option value="1981"> 1981 </option>
                <option value="1980"> 1980 </option>
                <option value="1979"> 1979 </option>
                <option value="1978"> 1978 </option>
                <option value="1977"> 1977 </option>
                <option value="1976"> 1976 </option>
                <option value="1975"> 1975 </option>
                <option value="1974"> 1974 </option>
                <option value="1973"> 1973 </option>
                <option value="1972"> 1972 </option>
                <option value="1971"> 1971 </option>
                <option value="1970"> 1970 </option>
                <option value="1969"> 1969 </option>
                <option value="1968"> 1968 </option>
                <option value="1967"> 1967 </option>
                <option value="1966"> 1966 </option>
                <option value="1965"> 1965 </option>
                <option value="1964"> 1964 </option>
                <option value="1963"> 1963 </option>
                <option value="1962"> 1962 </option>
                <option value="1961"> 1961 </option>
                <option value="1960"> 1960 </option>
                <option value="1959"> 1959 </option>
                <option value="1958"> 1958 </option>
                <option value="1957"> 1957 </option>
                <option value="1956"> 1956 </option>
                <option value="1955"> 1955 </option>
                <option value="1954"> 1954 </option>
                <option value="1953"> 1953 </option>
                <option value="1952"> 1952 </option>
                <option value="1951"> 1951 </option>
                <option value="1950"> 1950 </option>
                <option value="1949"> 1949 </option>
                <option value="1948"> 1948 </option>
                <option value="1947"> 1947 </option>
                <option value="1946"> 1946 </option>
                <option value="1945"> 1945 </option>
                <option value="1944"> 1944 </option>
                <option value="1943"> 1943 </option>
                <option value="1942"> 1942 </option>
                <option value="1941"> 1941 </option>
                <option value="1940"> 1940 </option>
                <option value="1939"> 1939 </option>
                <option value="1938"> 1938 </option>
                <option value="1937"> 1937 </option>
                <option value="1936"> 1936 </option>
                <option value="1935"> 1935 </option>
                <option value="1934"> 1934 </option>
                <option value="1933"> 1933 </option>
                <option value="1932"> 1932 </option>
                <option value="1931"> 1931 </option>
                <option value="1930"> 1930 </option>
                <option value="1929"> 1929 </option>
                <option value="1928"> 1928 </option>
                <option value="1927"> 1927 </option>
                <option value="1926"> 1926 </option>
                <option value="1925"> 1925 </option>
                <option value="1924"> 1924 </option>
                <option value="1923"> 1923 </option>
                <option value="1922"> 1922 </option>
                <option value="1921"> 1921 </option>
                <option value="1920"> 1920 </option>
              </select>
              <label class="form-sub-label" for="input_42_year" id="sublabel_42_year" style="min-height:13px" aria-hidden="false"> Year </label>
            </span>
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_dropdown" id="id_87">
        <label class="form-label form-label-left form-label-auto" id="label_87" for="input_87"> Spouse's Gender </label>
        <div id="cid_87" class="form-input">
          <select class="form-dropdown" id="input_87" name="q87_spousesGender" style="width:150px" data-component="dropdown" aria-labelledby="label_87">
            <option value="">  </option>
            <option value="Male"> Male </option>
            <option value="Female"> Female </option>
            <option value="Not willing to Disclose"> Not willing to Disclose </option>
          </select>
        </div>
      </li>
      <li class="form-line" data-type="control_dropdown" id="id_58">
        <label class="form-label form-label-left form-label-auto" id="label_58" for="input_58"> Spouse's Hospitals </label>
        <div id="cid_58" class="form-input">
          <span class="form-sub-label-container" style="vertical-align:top">
            <select class="form-dropdown" id="input_58" name="q58_spousesHospitals" style="width:150px" data-component="dropdown" aria-labelledby="label_58 sublabel_input_58">
              <option value="">  </option>
              <option value="">  </option>
            </select>
            <label class="form-sub-label" for="input_58" id="sublabel_input_58" style="min-height:13px" aria-hidden="false"> Choose From our Network of Hospitals* (State-Town-Hospital) * </label>
          </span>
        </div>
      </li>
      <li class="form-line" data-type="control_fileupload" id="id_100">
        <label class="form-label form-label-left form-label-auto" id="label_100" for="input_100"> Spouse's Passport </label>
        <div id="cid_100" class="form-input">
          <span class="form-sub-label-container" style="vertical-align:top">
            <input type="file" id="input_100" name="q100_spousesPassport" class="form-upload" data-imagevalidate="yes" data-file-accept="jpg, jpeg, png, gif" data-file-maxsize="10240" data-file-minsize="0" data-file-limit="" data-component="fileupload" />
            <label class="form-sub-label" for="input_100" style="min-height:13px" aria-hidden="false"> Select passport photo from your device. </label>
          </span>
        </div>
      </li>
      <li class="form-line" data-type="control_divider" id="id_45">
        <div id="cid_45" class="form-input-wide">
          <div data-component="divider" style="border-bottom:1px solid #e6e6e6;height:1px;margin-left:0px;margin-right:0px;margin-top:5px;margin-bottom:5px">
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_text" id="id_46">
        <div id="cid_46" class="form-input-wide">
          <div id="text_46" class="form-html" data-component="text">
            <p style="text-align: center;"><span style="font-size: 18pt; color: #0000ff;"><strong><strong>DEPENDENTS<br /></strong></strong></span></p>
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_text" id="id_49">
        <div id="cid_49" class="form-input-wide">
          <div id="text_49" class="form-html" data-component="text">
            <p style="text-align: left;"><span style="font-size: 12pt; color: #ff0000;"><strong><strong>DEPENDENT 1<br /></strong></strong></span></p>
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_textbox" id="id_50">
        <label class="form-label form-label-left form-label-auto" id="label_50" for="input_50"> 1st Dependent's Surname </label>
        <div id="cid_50" class="form-input">
          <input type="text" id="input_50" name="q50_1stDependents" data-type="input-textbox" class="form-textbox" size="30" value="" placeholder=" " data-component="textbox" aria-labelledby="label_50" />
        </div>
      </li>
      <li class="form-line" data-type="control_textbox" id="id_51">
        <label class="form-label form-label-left form-label-auto" id="label_51" for="input_51"> 1st DependEnt's First Name </label>
        <div id="cid_51" class="form-input">
          <input type="text" id="input_51" name="q51_1stDependents51" data-type="input-textbox" class="form-textbox" size="30" value="" placeholder=" " data-component="textbox" aria-labelledby="label_51" />
        </div>
      </li>
      <li class="form-line" data-type="control_textbox" id="id_52">
        <label class="form-label form-label-left form-label-auto" id="label_52" for="input_52"> 1st Dependent's Middle Name </label>
        <div id="cid_52" class="form-input">
          <input type="text" id="input_52" name="q52_1stDependents52" data-type="input-textbox" class="form-textbox" size="30" value="" placeholder=" " data-component="textbox" aria-labelledby="label_52" />
        </div>
      </li>
      <li class="form-line" data-type="control_phone" id="id_54">
        <label class="form-label form-label-left form-label-auto" id="label_54" for="input_54_area"> 1st Dependent's Phone Number </label>
        <div id="cid_54" class="form-input">
          <div data-wrapper-react="true">
            <span class="form-sub-label-container" style="vertical-align:top" data-input-type="areaCode">
              <input type="tel" id="input_54_area" name="q54_1stDependents54[area]" class="form-textbox" value="" data-component="areaCode" aria-labelledby="label_54 sublabel_54_area" />
              <span class="phone-separate" aria-hidden="true">
                 -
              </span>
              <label class="form-sub-label" for="input_54_area" id="sublabel_54_area" style="min-height:13px" aria-hidden="false"> Area Code </label>
            </span>
            <span class="form-sub-label-container" style="vertical-align:top" data-input-type="phone">
              <input type="tel" id="input_54_phone" name="q54_1stDependents54[phone]" class="form-textbox" value="" data-component="phone" aria-labelledby="label_54 sublabel_54_phone" />
              <label class="form-sub-label" for="input_54_phone" id="sublabel_54_phone" style="min-height:13px" aria-hidden="false"> Phone Number </label>
            </span>
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_birthdate" id="id_55">
        <label class="form-label form-label-left form-label-auto" id="label_55" for="input_55"> 1st Dependent's Date of Birth </label>
        <div id="cid_55" class="form-input">
          <div data-wrapper-react="true">
            <span class="form-sub-label-container" style="vertical-align:top">
              <select name="q55_1stDependents55[day]" id="input_55_day" class="form-dropdown" data-component="birthdate-day" aria-labelledby="label_55 sublabel_55_day">
                <option>  </option>
                <option value="1"> 1 </option>
                <option value="2"> 2 </option>
                <option value="3"> 3 </option>
                <option value="4"> 4 </option>
                <option value="5"> 5 </option>
                <option value="6"> 6 </option>
                <option value="7"> 7 </option>
                <option value="8"> 8 </option>
                <option value="9"> 9 </option>
                <option value="10"> 10 </option>
                <option value="11"> 11 </option>
                <option value="12"> 12 </option>
                <option value="13"> 13 </option>
                <option value="14"> 14 </option>
                <option value="15"> 15 </option>
                <option value="16"> 16 </option>
                <option value="17"> 17 </option>
                <option value="18"> 18 </option>
                <option value="19"> 19 </option>
                <option value="20"> 20 </option>
                <option value="21"> 21 </option>
                <option value="22"> 22 </option>
                <option value="23"> 23 </option>
                <option value="24"> 24 </option>
                <option value="25"> 25 </option>
                <option value="26"> 26 </option>
                <option value="27"> 27 </option>
                <option value="28"> 28 </option>
                <option value="29"> 29 </option>
                <option value="30"> 30 </option>
                <option value="31"> 31 </option>
              </select>
              <label class="form-sub-label" for="input_55_day" id="sublabel_55_day" style="min-height:13px" aria-hidden="false"> Day </label>
            </span>
            <span class="form-sub-label-container" style="vertical-align:top">
              <select name="q55_1stDependents55[month]" id="input_55_month" class="form-dropdown" data-component="birthdate-month" aria-labelledby="label_55 sublabel_55_month">
                <option>  </option>
                <option value="January"> January </option>
                <option value="February"> February </option>
                <option value="March"> March </option>
                <option value="April"> April </option>
                <option value="May"> May </option>
                <option value="June"> June </option>
                <option value="July"> July </option>
                <option value="August"> August </option>
                <option value="September"> September </option>
                <option value="October"> October </option>
                <option value="November"> November </option>
                <option value="December"> December </option>
              </select>
              <label class="form-sub-label" for="input_55_month" id="sublabel_55_month" style="min-height:13px" aria-hidden="false"> Month </label>
            </span>
            <span class="form-sub-label-container" style="vertical-align:top">
              <select name="q55_1stDependents55[year]" id="input_55_year" class="form-dropdown" data-component="birthdate-year" aria-labelledby="label_55 sublabel_55_year">
                <option>  </option>
                <option value="2020"> 2020 </option>
                <option value="2019"> 2019 </option>
                <option value="2018"> 2018 </option>
                <option value="2017"> 2017 </option>
                <option value="2016"> 2016 </option>
                <option value="2015"> 2015 </option>
                <option value="2014"> 2014 </option>
                <option value="2013"> 2013 </option>
                <option value="2012"> 2012 </option>
                <option value="2011"> 2011 </option>
                <option value="2010"> 2010 </option>
                <option value="2009"> 2009 </option>
                <option value="2008"> 2008 </option>
                <option value="2007"> 2007 </option>
                <option value="2006"> 2006 </option>
                <option value="2005"> 2005 </option>
                <option value="2004"> 2004 </option>
                <option value="2003"> 2003 </option>
                <option value="2002"> 2002 </option>
                <option value="2001"> 2001 </option>
                <option value="2000"> 2000 </option>
                <option value="1999"> 1999 </option>
                <option value="1998"> 1998 </option>
                <option value="1997"> 1997 </option>
                <option value="1996"> 1996 </option>
                <option value="1995"> 1995 </option>
                <option value="1994"> 1994 </option>
                <option value="1993"> 1993 </option>
                <option value="1992"> 1992 </option>
                <option value="1991"> 1991 </option>
                <option value="1990"> 1990 </option>
                <option value="1989"> 1989 </option>
                <option value="1988"> 1988 </option>
                <option value="1987"> 1987 </option>
                <option value="1986"> 1986 </option>
                <option value="1985"> 1985 </option>
                <option value="1984"> 1984 </option>
                <option value="1983"> 1983 </option>
                <option value="1982"> 1982 </option>
                <option value="1981"> 1981 </option>
                <option value="1980"> 1980 </option>
                <option value="1979"> 1979 </option>
                <option value="1978"> 1978 </option>
                <option value="1977"> 1977 </option>
                <option value="1976"> 1976 </option>
                <option value="1975"> 1975 </option>
                <option value="1974"> 1974 </option>
                <option value="1973"> 1973 </option>
                <option value="1972"> 1972 </option>
                <option value="1971"> 1971 </option>
                <option value="1970"> 1970 </option>
                <option value="1969"> 1969 </option>
                <option value="1968"> 1968 </option>
                <option value="1967"> 1967 </option>
                <option value="1966"> 1966 </option>
                <option value="1965"> 1965 </option>
                <option value="1964"> 1964 </option>
                <option value="1963"> 1963 </option>
                <option value="1962"> 1962 </option>
                <option value="1961"> 1961 </option>
                <option value="1960"> 1960 </option>
                <option value="1959"> 1959 </option>
                <option value="1958"> 1958 </option>
                <option value="1957"> 1957 </option>
                <option value="1956"> 1956 </option>
                <option value="1955"> 1955 </option>
                <option value="1954"> 1954 </option>
                <option value="1953"> 1953 </option>
                <option value="1952"> 1952 </option>
                <option value="1951"> 1951 </option>
                <option value="1950"> 1950 </option>
                <option value="1949"> 1949 </option>
                <option value="1948"> 1948 </option>
                <option value="1947"> 1947 </option>
                <option value="1946"> 1946 </option>
                <option value="1945"> 1945 </option>
                <option value="1944"> 1944 </option>
                <option value="1943"> 1943 </option>
                <option value="1942"> 1942 </option>
                <option value="1941"> 1941 </option>
                <option value="1940"> 1940 </option>
                <option value="1939"> 1939 </option>
                <option value="1938"> 1938 </option>
                <option value="1937"> 1937 </option>
                <option value="1936"> 1936 </option>
                <option value="1935"> 1935 </option>
                <option value="1934"> 1934 </option>
                <option value="1933"> 1933 </option>
                <option value="1932"> 1932 </option>
                <option value="1931"> 1931 </option>
                <option value="1930"> 1930 </option>
                <option value="1929"> 1929 </option>
                <option value="1928"> 1928 </option>
                <option value="1927"> 1927 </option>
                <option value="1926"> 1926 </option>
                <option value="1925"> 1925 </option>
                <option value="1924"> 1924 </option>
                <option value="1923"> 1923 </option>
                <option value="1922"> 1922 </option>
                <option value="1921"> 1921 </option>
                <option value="1920"> 1920 </option>
              </select>
              <label class="form-sub-label" for="input_55_year" id="sublabel_55_year" style="min-height:13px" aria-hidden="false"> Year </label>
            </span>
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_dropdown" id="id_89">
        <label class="form-label form-label-left form-label-auto" id="label_89" for="input_89"> 1st Dependent's Gender </label>
        <div id="cid_89" class="form-input">
          <select class="form-dropdown" id="input_89" name="q89_1stDependents89" style="width:150px" data-component="dropdown" aria-labelledby="label_89">
            <option value="">  </option>
            <option value="Male"> Male </option>
            <option value="Female"> Female </option>
            <option value="Not willing to Disclose"> Not willing to Disclose </option>
          </select>
        </div>
      </li>
      <li class="form-line" data-type="control_dropdown" id="id_90">
        <label class="form-label form-label-left form-label-auto" id="label_90" for="input_90"> 1st Dependent's Hospitals </label>
        <div id="cid_90" class="form-input">
          <span class="form-sub-label-container" style="vertical-align:top">
            <select class="form-dropdown" id="input_90" name="q90_1stDependents90" style="width:150px" data-component="dropdown" aria-labelledby="label_90 sublabel_input_90">
              <option value="">  </option>
              <option value="">  </option>
            </select>
            <label class="form-sub-label" for="input_90" id="sublabel_input_90" style="min-height:13px" aria-hidden="false"> Choose From our Network of Hospitals* (State-Town-Hospital) * </label>
          </span>
        </div>
      </li>
      <li class="form-line" data-type="control_fileupload" id="id_101">
        <label class="form-label form-label-left form-label-auto" id="label_101" for="input_101"> 1st Dependent's Passport </label>
        <div id="cid_101" class="form-input">
          <span class="form-sub-label-container" style="vertical-align:top">
            <input type="file" id="input_101" name="q101_1stDependents101" class="form-upload" data-imagevalidate="yes" data-file-accept="jpg, jpeg, png, gif" data-file-maxsize="10240" data-file-minsize="0" data-file-limit="" data-component="fileupload" />
            <label class="form-sub-label" for="input_101" style="min-height:13px" aria-hidden="false"> Select passport photo from your device. </label>
          </span>
        </div>
      </li>
      <li class="form-line" data-type="control_text" id="id_59">
        <div id="cid_59" class="form-input-wide">
          <div id="text_59" class="form-html" data-component="text">
            <p style="text-align: left;"><span style="font-size: 12pt; color: #ff0000;"><strong><strong>DEPENDENT 2<br /></strong></strong></span></p>
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_textbox" id="id_60">
        <label class="form-label form-label-left form-label-auto" id="label_60" for="input_60"> 2nd Dependent's Surname </label>
        <div id="cid_60" class="form-input">
          <input type="text" id="input_60" name="q60_2ndDependents" data-type="input-textbox" class="form-textbox" size="30" value="" placeholder=" " data-component="textbox" aria-labelledby="label_60" />
        </div>
      </li>
      <li class="form-line" data-type="control_textbox" id="id_61">
        <label class="form-label form-label-left form-label-auto" id="label_61" for="input_61"> 2nd Dependent's First Name </label>
        <div id="cid_61" class="form-input">
          <input type="text" id="input_61" name="q61_2ndDependents61" data-type="input-textbox" class="form-textbox" size="30" value="" placeholder=" " data-component="textbox" aria-labelledby="label_61" />
        </div>
      </li>
      <li class="form-line" data-type="control_textbox" id="id_62">
        <label class="form-label form-label-left form-label-auto" id="label_62" for="input_62"> 2nd Dependent's Middle Name </label>
        <div id="cid_62" class="form-input">
          <input type="text" id="input_62" name="q62_2ndDependents62" data-type="input-textbox" class="form-textbox" size="30" value="" placeholder=" " data-component="textbox" aria-labelledby="label_62" />
        </div>
      </li>
      <li class="form-line" data-type="control_phone" id="id_64">
        <label class="form-label form-label-left form-label-auto" id="label_64" for="input_64_area"> 2nd Dependent's Phone Number </label>
        <div id="cid_64" class="form-input">
          <div data-wrapper-react="true">
            <span class="form-sub-label-container" style="vertical-align:top" data-input-type="areaCode">
              <input type="tel" id="input_64_area" name="q64_2ndDependents64[area]" class="form-textbox" value="" data-component="areaCode" aria-labelledby="label_64 sublabel_64_area" />
              <span class="phone-separate" aria-hidden="true">
                 -
              </span>
              <label class="form-sub-label" for="input_64_area" id="sublabel_64_area" style="min-height:13px" aria-hidden="false"> Area Code </label>
            </span>
            <span class="form-sub-label-container" style="vertical-align:top" data-input-type="phone">
              <input type="tel" id="input_64_phone" name="q64_2ndDependents64[phone]" class="form-textbox" value="" data-component="phone" aria-labelledby="label_64 sublabel_64_phone" />
              <label class="form-sub-label" for="input_64_phone" id="sublabel_64_phone" style="min-height:13px" aria-hidden="false"> Phone Number </label>
            </span>
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_birthdate" id="id_65">
        <label class="form-label form-label-left form-label-auto" id="label_65" for="input_65"> 2nd Dependent's Date of Birth </label>
        <div id="cid_65" class="form-input">
          <div data-wrapper-react="true">
            <span class="form-sub-label-container" style="vertical-align:top">
              <select name="q65_2ndDependents65[day]" id="input_65_day" class="form-dropdown" data-component="birthdate-day" aria-labelledby="label_65 sublabel_65_day">
                <option>  </option>
                <option value="1"> 1 </option>
                <option value="2"> 2 </option>
                <option value="3"> 3 </option>
                <option value="4"> 4 </option>
                <option value="5"> 5 </option>
                <option value="6"> 6 </option>
                <option value="7"> 7 </option>
                <option value="8"> 8 </option>
                <option value="9"> 9 </option>
                <option value="10"> 10 </option>
                <option value="11"> 11 </option>
                <option value="12"> 12 </option>
                <option value="13"> 13 </option>
                <option value="14"> 14 </option>
                <option value="15"> 15 </option>
                <option value="16"> 16 </option>
                <option value="17"> 17 </option>
                <option value="18"> 18 </option>
                <option value="19"> 19 </option>
                <option value="20"> 20 </option>
                <option value="21"> 21 </option>
                <option value="22"> 22 </option>
                <option value="23"> 23 </option>
                <option value="24"> 24 </option>
                <option value="25"> 25 </option>
                <option value="26"> 26 </option>
                <option value="27"> 27 </option>
                <option value="28"> 28 </option>
                <option value="29"> 29 </option>
                <option value="30"> 30 </option>
                <option value="31"> 31 </option>
              </select>
              <label class="form-sub-label" for="input_65_day" id="sublabel_65_day" style="min-height:13px" aria-hidden="false"> Day </label>
            </span>
            <span class="form-sub-label-container" style="vertical-align:top">
              <select name="q65_2ndDependents65[month]" id="input_65_month" class="form-dropdown" data-component="birthdate-month" aria-labelledby="label_65 sublabel_65_month">
                <option>  </option>
                <option value="January"> January </option>
                <option value="February"> February </option>
                <option value="March"> March </option>
                <option value="April"> April </option>
                <option value="May"> May </option>
                <option value="June"> June </option>
                <option value="July"> July </option>
                <option value="August"> August </option>
                <option value="September"> September </option>
                <option value="October"> October </option>
                <option value="November"> November </option>
                <option value="December"> December </option>
              </select>
              <label class="form-sub-label" for="input_65_month" id="sublabel_65_month" style="min-height:13px" aria-hidden="false"> Month </label>
            </span>
            <span class="form-sub-label-container" style="vertical-align:top">
              <select name="q65_2ndDependents65[year]" id="input_65_year" class="form-dropdown" data-component="birthdate-year" aria-labelledby="label_65 sublabel_65_year">
                <option>  </option>
                <option value="2020"> 2020 </option>
                <option value="2019"> 2019 </option>
                <option value="2018"> 2018 </option>
                <option value="2017"> 2017 </option>
                <option value="2016"> 2016 </option>
                <option value="2015"> 2015 </option>
                <option value="2014"> 2014 </option>
                <option value="2013"> 2013 </option>
                <option value="2012"> 2012 </option>
                <option value="2011"> 2011 </option>
                <option value="2010"> 2010 </option>
                <option value="2009"> 2009 </option>
                <option value="2008"> 2008 </option>
                <option value="2007"> 2007 </option>
                <option value="2006"> 2006 </option>
                <option value="2005"> 2005 </option>
                <option value="2004"> 2004 </option>
                <option value="2003"> 2003 </option>
                <option value="2002"> 2002 </option>
                <option value="2001"> 2001 </option>
                <option value="2000"> 2000 </option>
                <option value="1999"> 1999 </option>
                <option value="1998"> 1998 </option>
                <option value="1997"> 1997 </option>
                <option value="1996"> 1996 </option>
                <option value="1995"> 1995 </option>
                <option value="1994"> 1994 </option>
                <option value="1993"> 1993 </option>
                <option value="1992"> 1992 </option>
                <option value="1991"> 1991 </option>
                <option value="1990"> 1990 </option>
                <option value="1989"> 1989 </option>
                <option value="1988"> 1988 </option>
                <option value="1987"> 1987 </option>
                <option value="1986"> 1986 </option>
                <option value="1985"> 1985 </option>
                <option value="1984"> 1984 </option>
                <option value="1983"> 1983 </option>
                <option value="1982"> 1982 </option>
                <option value="1981"> 1981 </option>
                <option value="1980"> 1980 </option>
                <option value="1979"> 1979 </option>
                <option value="1978"> 1978 </option>
                <option value="1977"> 1977 </option>
                <option value="1976"> 1976 </option>
                <option value="1975"> 1975 </option>
                <option value="1974"> 1974 </option>
                <option value="1973"> 1973 </option>
                <option value="1972"> 1972 </option>
                <option value="1971"> 1971 </option>
                <option value="1970"> 1970 </option>
                <option value="1969"> 1969 </option>
                <option value="1968"> 1968 </option>
                <option value="1967"> 1967 </option>
                <option value="1966"> 1966 </option>
                <option value="1965"> 1965 </option>
                <option value="1964"> 1964 </option>
                <option value="1963"> 1963 </option>
                <option value="1962"> 1962 </option>
                <option value="1961"> 1961 </option>
                <option value="1960"> 1960 </option>
                <option value="1959"> 1959 </option>
                <option value="1958"> 1958 </option>
                <option value="1957"> 1957 </option>
                <option value="1956"> 1956 </option>
                <option value="1955"> 1955 </option>
                <option value="1954"> 1954 </option>
                <option value="1953"> 1953 </option>
                <option value="1952"> 1952 </option>
                <option value="1951"> 1951 </option>
                <option value="1950"> 1950 </option>
                <option value="1949"> 1949 </option>
                <option value="1948"> 1948 </option>
                <option value="1947"> 1947 </option>
                <option value="1946"> 1946 </option>
                <option value="1945"> 1945 </option>
                <option value="1944"> 1944 </option>
                <option value="1943"> 1943 </option>
                <option value="1942"> 1942 </option>
                <option value="1941"> 1941 </option>
                <option value="1940"> 1940 </option>
                <option value="1939"> 1939 </option>
                <option value="1938"> 1938 </option>
                <option value="1937"> 1937 </option>
                <option value="1936"> 1936 </option>
                <option value="1935"> 1935 </option>
                <option value="1934"> 1934 </option>
                <option value="1933"> 1933 </option>
                <option value="1932"> 1932 </option>
                <option value="1931"> 1931 </option>
                <option value="1930"> 1930 </option>
                <option value="1929"> 1929 </option>
                <option value="1928"> 1928 </option>
                <option value="1927"> 1927 </option>
                <option value="1926"> 1926 </option>
                <option value="1925"> 1925 </option>
                <option value="1924"> 1924 </option>
                <option value="1923"> 1923 </option>
                <option value="1922"> 1922 </option>
                <option value="1921"> 1921 </option>
                <option value="1920"> 1920 </option>
              </select>
              <label class="form-sub-label" for="input_65_year" id="sublabel_65_year" style="min-height:13px" aria-hidden="false"> Year </label>
            </span>
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_dropdown" id="id_91">
        <label class="form-label form-label-left form-label-auto" id="label_91" for="input_91"> 2nd Dependent's Gender </label>
        <div id="cid_91" class="form-input">
          <select class="form-dropdown" id="input_91" name="q91_2ndDependents91" style="width:150px" data-component="dropdown" aria-labelledby="label_91">
            <option value="">  </option>
            <option value="Male"> Male </option>
            <option value="Female"> Female </option>
            <option value="Not willing to Disclose"> Not willing to Disclose </option>
          </select>
        </div>
      </li>
      <li class="form-line" data-type="control_dropdown" id="id_92">
        <label class="form-label form-label-left form-label-auto" id="label_92" for="input_92"> 2nd Dependent's Hospitals </label>
        <div id="cid_92" class="form-input">
          <span class="form-sub-label-container" style="vertical-align:top">
            <select class="form-dropdown" id="input_92" name="q92_2ndDependents92" style="width:150px" data-component="dropdown" aria-labelledby="label_92 sublabel_input_92">
              <option value="">  </option>
              <option value="">  </option>
            </select>
            <label class="form-sub-label" for="input_92" id="sublabel_input_92" style="min-height:13px" aria-hidden="false"> Choose From our Network of Hospitals* (State-Town-Hospital) * </label>
          </span>
        </div>
      </li>
      <li class="form-line" data-type="control_fileupload" id="id_102">
        <label class="form-label form-label-left form-label-auto" id="label_102" for="input_102"> 2nd Dependent's Passport </label>
        <div id="cid_102" class="form-input">
          <span class="form-sub-label-container" style="vertical-align:top">
            <input type="file" id="input_102" name="q102_2ndDependents102" class="form-upload" data-imagevalidate="yes" data-file-accept="jpg, jpeg, png, gif" data-file-maxsize="10240" data-file-minsize="0" data-file-limit="" data-component="fileupload" />
            <label class="form-sub-label" for="input_102" style="min-height:13px" aria-hidden="false"> Select passport photo from your device. </label>
          </span>
        </div>
      </li>
      <li class="form-line" data-type="control_text" id="id_68">
        <div id="cid_68" class="form-input-wide">
          <div id="text_68" class="form-html" data-component="text">
            <p style="text-align: left;"><span style="font-size: 12pt; color: #ff0000;"><strong><strong>DEPENDENT 3<br /></strong></strong></span></p>
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_textbox" id="id_69">
        <label class="form-label form-label-left form-label-auto" id="label_69" for="input_69"> 3rd Dependent's Surname </label>
        <div id="cid_69" class="form-input">
          <input type="text" id="input_69" name="q69_3rdDependents" data-type="input-textbox" class="form-textbox" size="30" value="" placeholder=" " data-component="textbox" aria-labelledby="label_69" />
        </div>
      </li>
      <li class="form-line" data-type="control_textbox" id="id_70">
        <label class="form-label form-label-left form-label-auto" id="label_70" for="input_70"> 3rd Dependent's First Name </label>
        <div id="cid_70" class="form-input">
          <input type="text" id="input_70" name="q70_3rdDependents70" data-type="input-textbox" class="form-textbox" size="30" value="" placeholder=" " data-component="textbox" aria-labelledby="label_70" />
        </div>
      </li>
      <li class="form-line" data-type="control_textbox" id="id_71">
        <label class="form-label form-label-left form-label-auto" id="label_71" for="input_71"> 3rd Dependent's Middle Name </label>
        <div id="cid_71" class="form-input">
          <input type="text" id="input_71" name="q71_3rdDependents71" data-type="input-textbox" class="form-textbox" size="30" value="" placeholder=" " data-component="textbox" aria-labelledby="label_71" />
        </div>
      </li>
      <li class="form-line" data-type="control_phone" id="id_73">
        <label class="form-label form-label-left form-label-auto" id="label_73" for="input_73_area"> 3rd Dependent's Phone Number </label>
        <div id="cid_73" class="form-input">
          <div data-wrapper-react="true">
            <span class="form-sub-label-container" style="vertical-align:top" data-input-type="areaCode">
              <input type="tel" id="input_73_area" name="q73_3rdDependents73[area]" class="form-textbox" value="" data-component="areaCode" aria-labelledby="label_73 sublabel_73_area" />
              <span class="phone-separate" aria-hidden="true">
                 -
              </span>
              <label class="form-sub-label" for="input_73_area" id="sublabel_73_area" style="min-height:13px" aria-hidden="false"> Area Code </label>
            </span>
            <span class="form-sub-label-container" style="vertical-align:top" data-input-type="phone">
              <input type="tel" id="input_73_phone" name="q73_3rdDependents73[phone]" class="form-textbox" value="" data-component="phone" aria-labelledby="label_73 sublabel_73_phone" />
              <label class="form-sub-label" for="input_73_phone" id="sublabel_73_phone" style="min-height:13px" aria-hidden="false"> Phone Number </label>
            </span>
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_birthdate" id="id_74">
        <label class="form-label form-label-left form-label-auto" id="label_74" for="input_74"> 3rd Dependent's Date of Birth </label>
        <div id="cid_74" class="form-input">
          <div data-wrapper-react="true">
            <span class="form-sub-label-container" style="vertical-align:top">
              <select name="q74_3rdDependents74[day]" id="input_74_day" class="form-dropdown" data-component="birthdate-day" aria-labelledby="label_74 sublabel_74_day">
                <option>  </option>
                <option value="1"> 1 </option>
                <option value="2"> 2 </option>
                <option value="3"> 3 </option>
                <option value="4"> 4 </option>
                <option value="5"> 5 </option>
                <option value="6"> 6 </option>
                <option value="7"> 7 </option>
                <option value="8"> 8 </option>
                <option value="9"> 9 </option>
                <option value="10"> 10 </option>
                <option value="11"> 11 </option>
                <option value="12"> 12 </option>
                <option value="13"> 13 </option>
                <option value="14"> 14 </option>
                <option value="15"> 15 </option>
                <option value="16"> 16 </option>
                <option value="17"> 17 </option>
                <option value="18"> 18 </option>
                <option value="19"> 19 </option>
                <option value="20"> 20 </option>
                <option value="21"> 21 </option>
                <option value="22"> 22 </option>
                <option value="23"> 23 </option>
                <option value="24"> 24 </option>
                <option value="25"> 25 </option>
                <option value="26"> 26 </option>
                <option value="27"> 27 </option>
                <option value="28"> 28 </option>
                <option value="29"> 29 </option>
                <option value="30"> 30 </option>
                <option value="31"> 31 </option>
              </select>
              <label class="form-sub-label" for="input_74_day" id="sublabel_74_day" style="min-height:13px" aria-hidden="false"> Day </label>
            </span>
            <span class="form-sub-label-container" style="vertical-align:top">
              <select name="q74_3rdDependents74[month]" id="input_74_month" class="form-dropdown" data-component="birthdate-month" aria-labelledby="label_74 sublabel_74_month">
                <option>  </option>
                <option value="January"> January </option>
                <option value="February"> February </option>
                <option value="March"> March </option>
                <option value="April"> April </option>
                <option value="May"> May </option>
                <option value="June"> June </option>
                <option value="July"> July </option>
                <option value="August"> August </option>
                <option value="September"> September </option>
                <option value="October"> October </option>
                <option value="November"> November </option>
                <option value="December"> December </option>
              </select>
              <label class="form-sub-label" for="input_74_month" id="sublabel_74_month" style="min-height:13px" aria-hidden="false"> Month </label>
            </span>
            <span class="form-sub-label-container" style="vertical-align:top">
              <select name="q74_3rdDependents74[year]" id="input_74_year" class="form-dropdown" data-component="birthdate-year" aria-labelledby="label_74 sublabel_74_year">
                <option>  </option>
                <option value="2020"> 2020 </option>
                <option value="2019"> 2019 </option>
                <option value="2018"> 2018 </option>
                <option value="2017"> 2017 </option>
                <option value="2016"> 2016 </option>
                <option value="2015"> 2015 </option>
                <option value="2014"> 2014 </option>
                <option value="2013"> 2013 </option>
                <option value="2012"> 2012 </option>
                <option value="2011"> 2011 </option>
                <option value="2010"> 2010 </option>
                <option value="2009"> 2009 </option>
                <option value="2008"> 2008 </option>
                <option value="2007"> 2007 </option>
                <option value="2006"> 2006 </option>
                <option value="2005"> 2005 </option>
                <option value="2004"> 2004 </option>
                <option value="2003"> 2003 </option>
                <option value="2002"> 2002 </option>
                <option value="2001"> 2001 </option>
                <option value="2000"> 2000 </option>
                <option value="1999"> 1999 </option>
                <option value="1998"> 1998 </option>
                <option value="1997"> 1997 </option>
                <option value="1996"> 1996 </option>
                <option value="1995"> 1995 </option>
                <option value="1994"> 1994 </option>
                <option value="1993"> 1993 </option>
                <option value="1992"> 1992 </option>
                <option value="1991"> 1991 </option>
                <option value="1990"> 1990 </option>
                <option value="1989"> 1989 </option>
                <option value="1988"> 1988 </option>
                <option value="1987"> 1987 </option>
                <option value="1986"> 1986 </option>
                <option value="1985"> 1985 </option>
                <option value="1984"> 1984 </option>
                <option value="1983"> 1983 </option>
                <option value="1982"> 1982 </option>
                <option value="1981"> 1981 </option>
                <option value="1980"> 1980 </option>
                <option value="1979"> 1979 </option>
                <option value="1978"> 1978 </option>
                <option value="1977"> 1977 </option>
                <option value="1976"> 1976 </option>
                <option value="1975"> 1975 </option>
                <option value="1974"> 1974 </option>
                <option value="1973"> 1973 </option>
                <option value="1972"> 1972 </option>
                <option value="1971"> 1971 </option>
                <option value="1970"> 1970 </option>
                <option value="1969"> 1969 </option>
                <option value="1968"> 1968 </option>
                <option value="1967"> 1967 </option>
                <option value="1966"> 1966 </option>
                <option value="1965"> 1965 </option>
                <option value="1964"> 1964 </option>
                <option value="1963"> 1963 </option>
                <option value="1962"> 1962 </option>
                <option value="1961"> 1961 </option>
                <option value="1960"> 1960 </option>
                <option value="1959"> 1959 </option>
                <option value="1958"> 1958 </option>
                <option value="1957"> 1957 </option>
                <option value="1956"> 1956 </option>
                <option value="1955"> 1955 </option>
                <option value="1954"> 1954 </option>
                <option value="1953"> 1953 </option>
                <option value="1952"> 1952 </option>
                <option value="1951"> 1951 </option>
                <option value="1950"> 1950 </option>
                <option value="1949"> 1949 </option>
                <option value="1948"> 1948 </option>
                <option value="1947"> 1947 </option>
                <option value="1946"> 1946 </option>
                <option value="1945"> 1945 </option>
                <option value="1944"> 1944 </option>
                <option value="1943"> 1943 </option>
                <option value="1942"> 1942 </option>
                <option value="1941"> 1941 </option>
                <option value="1940"> 1940 </option>
                <option value="1939"> 1939 </option>
                <option value="1938"> 1938 </option>
                <option value="1937"> 1937 </option>
                <option value="1936"> 1936 </option>
                <option value="1935"> 1935 </option>
                <option value="1934"> 1934 </option>
                <option value="1933"> 1933 </option>
                <option value="1932"> 1932 </option>
                <option value="1931"> 1931 </option>
                <option value="1930"> 1930 </option>
                <option value="1929"> 1929 </option>
                <option value="1928"> 1928 </option>
                <option value="1927"> 1927 </option>
                <option value="1926"> 1926 </option>
                <option value="1925"> 1925 </option>
                <option value="1924"> 1924 </option>
                <option value="1923"> 1923 </option>
                <option value="1922"> 1922 </option>
                <option value="1921"> 1921 </option>
                <option value="1920"> 1920 </option>
              </select>
              <label class="form-sub-label" for="input_74_year" id="sublabel_74_year" style="min-height:13px" aria-hidden="false"> Year </label>
            </span>
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_dropdown" id="id_93">
        <label class="form-label form-label-left form-label-auto" id="label_93" for="input_93"> 3rd Dependent's Gender </label>
        <div id="cid_93" class="form-input">
          <select class="form-dropdown" id="input_93" name="q93_3rdDependents93" style="width:150px" data-component="dropdown" aria-labelledby="label_93">
            <option value="">  </option>
            <option value="Male"> Male </option>
            <option value="Female"> Female </option>
            <option value="Not willing to Disclose"> Not willing to Disclose </option>
          </select>
        </div>
      </li>
      <li class="form-line" data-type="control_dropdown" id="id_94">
        <label class="form-label form-label-left form-label-auto" id="label_94" for="input_94"> 3rd Dependent's Hospitals </label>
        <div id="cid_94" class="form-input">
          <span class="form-sub-label-container" style="vertical-align:top">
            <select class="form-dropdown" id="input_94" name="q94_3rdDependents94" style="width:150px" data-component="dropdown" aria-labelledby="label_94 sublabel_input_94">
              <option value="">  </option>
              <option value="">  </option>
            </select>
            <label class="form-sub-label" for="input_94" id="sublabel_input_94" style="min-height:13px" aria-hidden="false"> Choose From our Network of Hospitals* (State-Town-Hospital) * </label>
          </span>
        </div>
      </li>
      <li class="form-line" data-type="control_fileupload" id="id_103">
        <label class="form-label form-label-left form-label-auto" id="label_103" for="input_103"> 3rd Dependent's Passport </label>
        <div id="cid_103" class="form-input">
          <span class="form-sub-label-container" style="vertical-align:top">
            <input type="file" id="input_103" name="q103_3rdDependents103" class="form-upload" data-imagevalidate="yes" data-file-accept="jpg, jpeg, png, gif" data-file-maxsize="10240" data-file-minsize="0" data-file-limit="" data-component="fileupload" />
            <label class="form-sub-label" for="input_103" style="min-height:13px" aria-hidden="false"> Select passport photo from your device. </label>
          </span>
        </div>
      </li>
      <li class="form-line" data-type="control_text" id="id_77">
        <div id="cid_77" class="form-input-wide">
          <div id="text_77" class="form-html" data-component="text">
            <p style="text-align: left;"><span style="font-size: 12pt; color: #ff0000;"><strong><strong>DEPENDENT 4<br /></strong></strong></span></p>
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_textbox" id="id_78">
        <label class="form-label form-label-left form-label-auto" id="label_78" for="input_78"> 4th Dependent's Surname </label>
        <div id="cid_78" class="form-input">
          <input type="text" id="input_78" name="q78_4thDependents" data-type="input-textbox" class="form-textbox" size="30" value="" placeholder=" " data-component="textbox" aria-labelledby="label_78" />
        </div>
      </li>
      <li class="form-line" data-type="control_textbox" id="id_79">
        <label class="form-label form-label-left form-label-auto" id="label_79" for="input_79"> 4th Dependent's First Name </label>
        <div id="cid_79" class="form-input">
          <input type="text" id="input_79" name="q79_4thDependents79" data-type="input-textbox" class="form-textbox" size="30" value="" placeholder=" " data-component="textbox" aria-labelledby="label_79" />
        </div>
      </li>
      <li class="form-line" data-type="control_textbox" id="id_80">
        <label class="form-label form-label-left form-label-auto" id="label_80" for="input_80"> 4th Dependent's Middle Name </label>
        <div id="cid_80" class="form-input">
          <input type="text" id="input_80" name="q80_4thDependents80" data-type="input-textbox" class="form-textbox" size="30" value="" placeholder=" " data-component="textbox" aria-labelledby="label_80" />
        </div>
      </li>
      <li class="form-line" data-type="control_phone" id="id_82">
        <label class="form-label form-label-left form-label-auto" id="label_82" for="input_82_area"> 4th Dependent's Phone Number </label>
        <div id="cid_82" class="form-input">
          <div data-wrapper-react="true">
            <span class="form-sub-label-container" style="vertical-align:top" data-input-type="areaCode">
              <input type="tel" id="input_82_area" name="q82_4thDependents82[area]" class="form-textbox" value="" data-component="areaCode" aria-labelledby="label_82 sublabel_82_area" />
              <span class="phone-separate" aria-hidden="true">
                 -
              </span>
              <label class="form-sub-label" for="input_82_area" id="sublabel_82_area" style="min-height:13px" aria-hidden="false"> Area Code </label>
            </span>
            <span class="form-sub-label-container" style="vertical-align:top" data-input-type="phone">
              <input type="tel" id="input_82_phone" name="q82_4thDependents82[phone]" class="form-textbox" value="" data-component="phone" aria-labelledby="label_82 sublabel_82_phone" />
              <label class="form-sub-label" for="input_82_phone" id="sublabel_82_phone" style="min-height:13px" aria-hidden="false"> Phone Number </label>
            </span>
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_birthdate" id="id_83">
        <label class="form-label form-label-left form-label-auto" id="label_83" for="input_83"> 4th Dependent's Date of Birth </label>
        <div id="cid_83" class="form-input">
          <div data-wrapper-react="true">
            <span class="form-sub-label-container" style="vertical-align:top">
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                <option value="2"> 2 </option>
                <option value="3"> 3 </option>
                <option value="4"> 4 </option>
                <option value="5"> 5 </option>
                <option value="6"> 6 </option>
                <option value="7"> 7 </option>
                <option value="8"> 8 </option>
                <option value="9"> 9 </option>
                <option value="10"> 10 </option>
                <option value="11"> 11 </option>
                <option value="12"> 12 </option>
                <option value="13"> 13 </option>
                <option value="14"> 14 </option>
                <option value="15"> 15 </option>
                <option value="16"> 16 </option>
                <option value="17"> 17 </option>
                <option value="18"> 18 </option>
                <option value="19"> 19 </option>
                <option value="20"> 20 </option>
                <option value="21"> 21 </option>
                <option value="22"> 22 </option>
                <option value="23"> 23 </option>
                <option value="24"> 24 </option>
                <option value="25"> 25 </option>
                <option value="26"> 26 </option>
                <option value="27"> 27 </option>
                <option value="28"> 28 </option>
                <option value="29"> 29 </option>
                <option value="30"> 30 </option>
                <option value="31"> 31 </option>
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              <label class="form-sub-label" for="input_83_day" id="sublabel_83_day" style="min-height:13px" aria-hidden="false"> Day </label>
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            <span class="form-sub-label-container" style="vertical-align:top">
              <select name="q83_4thDependents83[month]" id="input_83_month" class="form-dropdown" data-component="birthdate-month" aria-labelledby="label_83 sublabel_83_month">
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                <option value="January"> January </option>
                <option value="February"> February </option>
                <option value="March"> March </option>
                <option value="April"> April </option>
                <option value="May"> May </option>
                <option value="June"> June </option>
                <option value="July"> July </option>
                <option value="August"> August </option>
                <option value="September"> September </option>
                <option value="October"> October </option>
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                <option value="December"> December </option>
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                <option value="2019"> 2019 </option>
                <option value="2018"> 2018 </option>
                <option value="2017"> 2017 </option>
                <option value="2016"> 2016 </option>
                <option value="2015"> 2015 </option>
                <option value="2014"> 2014 </option>
                <option value="2013"> 2013 </option>
                <option value="2012"> 2012 </option>
                <option value="2011"> 2011 </option>
                <option value="2010"> 2010 </option>
                <option value="2009"> 2009 </option>
                <option value="2008"> 2008 </option>
                <option value="2007"> 2007 </option>
                <option value="2006"> 2006 </option>
                <option value="2005"> 2005 </option>
                <option value="2004"> 2004 </option>
                <option value="2003"> 2003 </option>
                <option value="2002"> 2002 </option>
                <option value="2001"> 2001 </option>
                <option value="2000"> 2000 </option>
                <option value="1999"> 1999 </option>
                <option value="1998"> 1998 </option>
                <option value="1997"> 1997 </option>
                <option value="1996"> 1996 </option>
                <option value="1995"> 1995 </option>
                <option value="1994"> 1994 </option>
                <option value="1993"> 1993 </option>
                <option value="1992"> 1992 </option>
                <option value="1991"> 1991 </option>
                <option value="1990"> 1990 </option>
                <option value="1989"> 1989 </option>
                <option value="1988"> 1988 </option>
                <option value="1987"> 1987 </option>
                <option value="1986"> 1986 </option>
                <option value="1985"> 1985 </option>
                <option value="1984"> 1984 </option>
                <option value="1983"> 1983 </option>
                <option value="1982"> 1982 </option>
                <option value="1981"> 1981 </option>
                <option value="1980"> 1980 </option>
                <option value="1979"> 1979 </option>
                <option value="1978"> 1978 </option>
                <option value="1977"> 1977 </option>
                <option value="1976"> 1976 </option>
                <option value="1975"> 1975 </option>
                <option value="1974"> 1974 </option>
                <option value="1973"> 1973 </option>
                <option value="1972"> 1972 </option>
                <option value="1971"> 1971 </option>
                <option value="1970"> 1970 </option>
                <option value="1969"> 1969 </option>
                <option value="1968"> 1968 </option>
                <option value="1967"> 1967 </option>
                <option value="1966"> 1966 </option>
                <option value="1965"> 1965 </option>
                <option value="1964"> 1964 </option>
                <option value="1963"> 1963 </option>
                <option value="1962"> 1962 </option>
                <option value="1961"> 1961 </option>
                <option value="1960"> 1960 </option>
                <option value="1959"> 1959 </option>
                <option value="1958"> 1958 </option>
                <option value="1957"> 1957 </option>
                <option value="1956"> 1956 </option>
                <option value="1955"> 1955 </option>
                <option value="1954"> 1954 </option>
                <option value="1953"> 1953 </option>
                <option value="1952"> 1952 </option>
                <option value="1951"> 1951 </option>
                <option value="1950"> 1950 </option>
                <option value="1949"> 1949 </option>
                <option value="1948"> 1948 </option>
                <option value="1947"> 1947 </option>
                <option value="1946"> 1946 </option>
                <option value="1945"> 1945 </option>
                <option value="1944"> 1944 </option>
                <option value="1943"> 1943 </option>
                <option value="1942"> 1942 </option>
                <option value="1941"> 1941 </option>
                <option value="1940"> 1940 </option>
                <option value="1939"> 1939 </option>
                <option value="1938"> 1938 </option>
                <option value="1937"> 1937 </option>
                <option value="1936"> 1936 </option>
                <option value="1935"> 1935 </option>
                <option value="1934"> 1934 </option>
                <option value="1933"> 1933 </option>
                <option value="1932"> 1932 </option>
                <option value="1931"> 1931 </option>
                <option value="1930"> 1930 </option>
                <option value="1929"> 1929 </option>
                <option value="1928"> 1928 </option>
                <option value="1927"> 1927 </option>
                <option value="1926"> 1926 </option>
                <option value="1925"> 1925 </option>
                <option value="1924"> 1924 </option>
                <option value="1923"> 1923 </option>
                <option value="1922"> 1922 </option>
                <option value="1921"> 1921 </option>
                <option value="1920"> 1920 </option>
              </select>
              <label class="form-sub-label" for="input_83_year" id="sublabel_83_year" style="min-height:13px" aria-hidden="false"> Year </label>
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      <li class="form-line" data-type="control_dropdown" id="id_95">
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        <div id="cid_95" class="form-input">
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            <option value="Female"> Female </option>
            <option value="Not willing to Disclose"> Not willing to Disclose </option>
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      </li>
      <li class="form-line" data-type="control_dropdown" id="id_96">
        <label class="form-label form-label-left form-label-auto" id="label_96" for="input_96"> 4th Dependent's Hospitals </label>
        <div id="cid_96" class="form-input">
          <span class="form-sub-label-container" style="vertical-align:top">
            <select class="form-dropdown" id="input_96" name="q96_4thDependents96" style="width:150px" data-component="dropdown" aria-labelledby="label_96 sublabel_input_96">
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              <option value="">  </option>
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        </div>
      </li>
      <li class="form-line" data-type="control_fileupload" id="id_104">
        <label class="form-label form-label-left form-label-auto" id="label_104" for="input_104"> 4th Dependent's Passport </label>
        <div id="cid_104" class="form-input">
          <span class="form-sub-label-container" style="vertical-align:top">
            <input type="file" id="input_104" name="q104_4thDependents104" class="form-upload" data-imagevalidate="yes" data-file-accept="jpg, jpeg, png, gif" data-file-maxsize="10240" data-file-minsize="0" data-file-limit="" data-component="fileupload" />
            <label class="form-sub-label" for="input_104" style="min-height:13px" aria-hidden="false"> Select passport photo from your device. </label>
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        </div>
      </li>
      <li class="form-line jf-required" data-type="control_checkbox" id="id_86">
        <label class="form-label form-label-left form-label-auto" id="label_86" for="input_86">
          By clicking SUBMIT you are agreeing to share your information with Alleanza Health.
          <span class="form-required">
            *
          </span>
        </label>
        <div id="cid_86" class="form-input jf-required">
          <div class="form-multiple-column" data-columncount="2" role="group" aria-labelledby="label_86" data-component="checkbox">
            <span class="form-checkbox-item">
              <span class="dragger-item">
              </span>
              <input type="checkbox" class="form-checkbox validate[required]" id="input_86_0" name="q86_byClicking86[]" value="I agree." required="" />
              <label id="label_input_86_0" for="input_86_0"> I agree. </label>
            </span>
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_button" id="id_2">
        <div id="cid_2" class="form-input-wide">
          <div style="text-align:center" data-align="center" class="form-buttons-wrapper form-buttons-center   jsTest-button-wrapperField">
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IKEJA - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" LAGOS - IKORODU - CLINIX HEALTHCARE "> LAGOS - IKORODU - CLINIX HEALTHCARE </option> <option value=" LAGOS - IKORODU - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> LAGOS - IKORODU - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" LAGOS - IKOTUN - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> LAGOS - IKOTUN - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" LAGOS - ILUPEJU - CLINIX HEALTHCARE "> LAGOS - ILUPEJU - CLINIX HEALTHCARE </option> <option value=" LAGOS - LAGOS ISLAND - CLINA-LANCET LABORATORIES NIG LTD "> LAGOS - LAGOS ISLAND - CLINA-LANCET LABORATORIES NIG LTD </option> <option value=" LAGOS - LEKKI - MECURE DIAGNOSTICS "> LAGOS - LEKKI - MECURE DIAGNOSTICS </option> <option value=" LAGOS - OSHODI EXPRESSWAY - MECURE DIAGNOSTICS "> LAGOS - OSHODI EXPRESSWAY - MECURE DIAGNOSTICS </option> <option value=" LAGOS - SURULERE - CLINA-LANCET LABORATORIES NIG LTD "> LAGOS - SURULERE - CLINA-LANCET LABORATORIES NIG LTD </option> <option value=" LAGOS - SURULERE - FOREMOST RADIOLOGY CONSULTANTS LIMITED "> LAGOS - SURULERE - FOREMOST RADIOLOGY CONSULTANTS LIMITED </option> <option value=" LAGOS - VICTORIA ISLAND - CLINA-LANCET LABORATORIES NIG LTD "> LAGOS - VICTORIA ISLAND - CLINA-LANCET LABORATORIES NIG LTD </option> <option value=" LAGOS - VICTORIA ISLAND - CRESTVIEW RADIOLOGY LIMITED "> LAGOS - VICTORIA ISLAND - CRESTVIEW RADIOLOGY LIMITED </option> <option value=" LAGOS - VICTORIA ISLAND - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> LAGOS - VICTORIA ISLAND - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" OGUN - ABEOKUTA - CLINIX HEALTHCARE "> OGUN - ABEOKUTA - CLINIX HEALTHCARE </option> <option value=" OGUN - ABEOKUTA - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> OGUN - ABEOKUTA - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" OYO - BODIJA - MECURE DIAGNOSTICS "> OYO - BODIJA - MECURE DIAGNOSTICS </option> <option value=" OYO - MOKOLA - CLINA-LANCET LABORATORIES NIG LTD "> OYO - MOKOLA - CLINA-LANCET LABORATORIES NIG LTD </option> <option value=" OYO - MOKOLA - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> OYO - MOKOLA - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" OSUN - OSOGBO - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> OSUN - OSOGBO - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" ONDO - ONDO - MECURE DIAGNOSTICS "> ONDO - ONDO - MECURE DIAGNOSTICS </option> <option value=" ONDO - AKURE - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> ONDO - AKURE - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" KWARA - ILORIN - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> KWARA - ILORIN - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" KADUNA - KADUNA - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> KADUNA - KADUNA - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" KANO - KANO - MECURE DIAGNOSTICS "> KANO - KANO - MECURE DIAGNOSTICS </option> <option value=" KANO - KANO - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> KANO - KANO - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" KANO - SABON GARI - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> KANO - SABON GARI - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" PLATEAU - JOS - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> PLATEAU - JOS - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" BORNO - MAIDUGURI - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> BORNO - MAIDUGURI - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" ABIA - ABA - MECURE DIAGNOSTICS "> ABIA - ABA - MECURE DIAGNOSTICS </option> <option value=" ABIA - UMUAHIA - MECURE DIAGNOSTICS "> ABIA - UMUAHIA - MECURE DIAGNOSTICS </option> <option value=" EDO - BENIN - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> EDO - BENIN - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" DELTA - WARRI - CLINA-LANCET LABORATORIES NIG LTD "> DELTA - WARRI - CLINA-LANCET LABORATORIES NIG LTD </option> <option value=" RIVERS - D/LINE - CLINA-LANCET LABORATORIES NIG LTD "> RIVERS - D/LINE - CLINA-LANCET LABORATORIES NIG LTD </option> <option value=" RIVERS - OLD GRA - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> RIVERS - OLD GRA - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option>';
var plndiagnostics='<option value=" LAGOS - ABULE EGBA - GUARDIAN HEALTH HOSPITAL "> LAGOS - ABULE EGBA - GUARDIAN HEALTH HOSPITAL </option> <option value=" LAGOS - ABULE-EGBA - STANDARD LIFE CARE HOSPITAL "> LAGOS - ABULE-EGBA - STANDARD LIFE CARE HOSPITAL </option> <option value=" LAGOS - AGEGE - MUCAS HOSPITAL LIMITED "> LAGOS - AGEGE - MUCAS HOSPITAL LIMITED </option> <option value=" LAGOS - AJAH - THE FIRST GRACELAND HOSPITAL "> LAGOS - AJAH - THE FIRST GRACELAND HOSPITAL </option> <option value=" LAGOS - AJAH - THE ROYAL INFIRMARY HOSPITAL "> LAGOS - AJAH - THE ROYAL INFIRMARY HOSPITAL </option> <option value=" LAGOS - AJAH-OLOKUNLA - J-RAPHA CLINIC,AJAH,LAGOS "> LAGOS - AJAH-OLOKUNLA - J-RAPHA CLINIC,AJAH,LAGOS </option> <option value=" LAGOS - AJAH-OLOKUNLA - LENNOX HOSPITAL "> LAGOS - AJAH-OLOKUNLA - LENNOX HOSPITAL </option> <option value=" LAGOS - AJAO ESTATE - HEDA HOSPITAL "> LAGOS - AJAO ESTATE - HEDA HOSPITAL </option> <option value=" LAGOS - AKOWONJO - BEE HESS HOSPITAL "> LAGOS - AKOWONJO - BEE HESS HOSPITAL </option> <option value=" LAGOS - AKOWONJO - CRYSTAL SPECIALIST HOSPITAL "> LAGOS - AKOWONJO - CRYSTAL SPECIALIST HOSPITAL </option> <option value=" LAGOS - ALAGBADO - PAULATE HOSPITAL "> LAGOS - ALAGBADO - PAULATE HOSPITAL </option> <option value=" LAGOS - ALAKUKO - JEFIS SPECIALIST HOSPITAL LTD "> LAGOS - ALAKUKO - JEFIS SPECIALIST HOSPITAL LTD </option> <option value=" LAGOS - ALIMOSHO - LIGHT HOSPITAL & MATERNITY HOME LTD "> LAGOS - ALIMOSHO - LIGHT HOSPITAL & MATERNITY HOME LTD </option> <option value=" LAGOS - ALIMOSHO - LOTA MEDICAL CENTRE "> LAGOS - ALIMOSHO - LOTA MEDICAL CENTRE </option> <option value=" LAGOS - ALIMOSHO-EGBE - OOHBEE HOSPITAL "> LAGOS - ALIMOSHO-EGBE - OOHBEE HOSPITAL </option> <option value=" LAGOS - AMUWO ODOFIN - AMUWO MEDICAL CENTRE "> LAGOS - AMUWO ODOFIN - AMUWO MEDICAL CENTRE </option> <option value=" LAGOS - APAPA - ST LOUIS MEDICAL CENTRE "> LAGOS - APAPA - ST LOUIS MEDICAL CENTRE </option> <option value=" LAGOS - APAPA-OLODI - DAKO MEDICAL CENTRE "> LAGOS - APAPA-OLODI - DAKO MEDICAL CENTRE </option> <option value=" LAGOS - APAPA-OLODI - PATOL MEDICAL SERVICES "> LAGOS - APAPA-OLODI - PATOL MEDICAL SERVICES </option> <option value=" LAGOS - BADAGRY - APPLEYARD MEDICAL CENTRE "> LAGOS - BADAGRY - APPLEYARD MEDICAL CENTRE </option> <option value=" LAGOS - BADAGRY - CARE GIVERS HOSPITAL "> LAGOS - BADAGRY - CARE GIVERS HOSPITAL </option> <option value=" LAGOS - BADAGRY - IBIJOLA MEDICAL CENTRE (SPECIALIST CLINIC) "> LAGOS - BADAGRY - IBIJOLA MEDICAL CENTRE (SPECIALIST CLINIC) </option> <option value=" LAGOS - DOPEMU - SANTOS MEDICAL CENTRE "> LAGOS - DOPEMU - SANTOS MEDICAL CENTRE </option> <option value=" LAGOS - DOPEMU/AGEGE - PROMISE HOSPITAL "> LAGOS - DOPEMU/AGEGE - PROMISE HOSPITAL </option> <option value=" LAGOS - EPE - TRUE CARE MODEL HOSPITAL "> LAGOS - EPE - TRUE CARE MODEL HOSPITAL </option> <option value=" LAGOS - FAGBA-IJU - AYODELE MEDICAL CENTRE "> LAGOS - FAGBA-IJU - AYODELE MEDICAL CENTRE </option> <option value=" LAGOS - FESTAC TOWN - BETHSEDA FAMILY CLINIC "> LAGOS - FESTAC TOWN - BETHSEDA FAMILY CLINIC </option> <option value=" LAGOS - FESTAC TOWN - ST. JUDES HOSPITAL "> LAGOS - FESTAC TOWN - ST. JUDES HOSPITAL </option> <option value=" LAGOS - GBAGADA - ANIYUN HOSPITALS LIMITED "> LAGOS - GBAGADA - ANIYUN HOSPITALS LIMITED </option> <option value=" LAGOS - GBAGADA - R-JOLAD HOSPITAL NIGERIA LIMITED "> LAGOS - GBAGADA - R-JOLAD HOSPITAL NIGERIA LIMITED </option> <option value=" LAGOS - IBA - CARES AND CARES HOSPITAL "> LAGOS - IBA - CARES AND CARES HOSPITAL </option> <option value=" LAGOS - IFAKO-IJAIYE - AB10 SPECIALIST HOSPITAL "> LAGOS - IFAKO-IJAIYE - AB10 SPECIALIST HOSPITAL </option> <option value=" LAGOS - IJAIYE-OJOKORO - LONGING MEDICAL CENTRE HOSPITAL & MATERNITY "> LAGOS - IJAIYE-OJOKORO - LONGING MEDICAL CENTRE HOSPITAL & MATERNITY </option> <option value=" LAGOS - IJEGUN - D-BETTER LIFE HOSPITAL "> LAGOS - IJEGUN - D-BETTER LIFE HOSPITAL </option> <option value=" LAGOS - IJU-ISHAGA - DEJI CLINICS "> LAGOS - IJU-ISHAGA - DEJI CLINICS </option> <option value=" LAGOS - IJU-ISHAGA - OSUNTUYI MEDICAL CENTRE, IJU "> LAGOS - IJU-ISHAGA - OSUNTUYI MEDICAL CENTRE, IJU </option> <option value=" LAGOS - IKEJA - IKEJA MEDICAL CENTRE "> LAGOS - IKEJA - IKEJA MEDICAL CENTRE </option> <option value=" LAGOS - IKEJA - THE TMAC SPECIALIST HOSPITAL "> LAGOS - IKEJA - THE TMAC SPECIALIST HOSPITAL </option> <option value=" LAGOS - IKEJA - TRIUMPH MEDICAL CENTRE "> LAGOS - IKEJA - TRIUMPH MEDICAL CENTRE </option> <option value=" LAGOS - IKEJA - ZOE MEDICAL CENTRE "> LAGOS - IKEJA - ZOE MEDICAL CENTRE </option> <option value=" LAGOS - IKORODU - BIDEMS VICTORY HOSPITAL & DIAGNOSTICS CENTRE "> LAGOS - IKORODU - BIDEMS VICTORY HOSPITAL & DIAGNOSTICS CENTRE </option> <option value=" LAGOS - IKORODU - BOLAKUNMI-IDOWU MEMORIAL MEDICAL CENTRE "> LAGOS - IKORODU - BOLAKUNMI-IDOWU MEMORIAL MEDICAL CENTRE </option> <option value=" LAGOS - IKORODU - BRONILA MEDICAL CENTRE "> LAGOS - IKORODU - BRONILA MEDICAL CENTRE </option> <option value=" LAGOS - IKORODU - HOLYFILL HOSPITAL "> LAGOS - IKORODU - HOLYFILL HOSPITAL </option> <option value=" LAGOS - IKORODU - ST RAPHAEL DIVINE MERCY SPECIALIST HOSPITAL "> LAGOS - IKORODU - ST RAPHAEL DIVINE MERCY SPECIALIST HOSPITAL </option> <option value=" LAGOS - IKORODU - THE EXCELLENCE HOSPITAL "> LAGOS - IKORODU - THE EXCELLENCE HOSPITAL </option> <option value=" LAGOS - IKOTUN - BROAD HOSPITAL & MATERNITY HOME "> LAGOS - IKOTUN - BROAD HOSPITAL & MATERNITY HOME </option> <option value=" LAGOS - IKOTUN - MT. SINAI HOSPITAL, IKOTUN EGBE "> LAGOS - IKOTUN - MT. SINAI HOSPITAL, IKOTUN EGBE </option> <option value=" LAGOS - IKOTUN - SUBOL HOSPITAL "> LAGOS - IKOTUN - SUBOL HOSPITAL </option> <option value=" LAGOS - IPAJA - SOLAD MEDICAL CENTRE & MATERNITY HOSPITAL "> LAGOS - IPAJA - SOLAD MEDICAL CENTRE & MATERNITY HOSPITAL </option> <option value=" LAGOS - ISHERI-OSUN - D-BETTER LIFE HOSPITAL "> LAGOS - ISHERI-OSUN - D-BETTER LIFE HOSPITAL </option> <option value=" LAGOS - ISOLO - HEALS SPECIALIST CLINIC "> LAGOS - ISOLO - HEALS SPECIALIST CLINIC </option> <option value=" LAGOS - IYANA IPAJA - FAITH-HILLS SPECIALIST HOSPITAL "> LAGOS - IYANA IPAJA - FAITH-HILLS SPECIALIST HOSPITAL </option> <option value=" LAGOS - IYANA-IPAJA - VETA HOSPITALS LIMITED "> LAGOS - IYANA-IPAJA - VETA HOSPITALS LIMITED </option> <option value=" LAGOS - KETU - DELTA-CROWN HOSPITAL AND MATERNITY HOME "> LAGOS - KETU - DELTA-CROWN HOSPITAL AND MATERNITY HOME </option> <option value=" LAGOS - KETU- IKOSI - ELEGBELEYE SPECIALIST HOSPITAL "> LAGOS - KETU- IKOSI - ELEGBELEYE SPECIALIST HOSPITAL </option> <option value=" LAGOS - KETU-ALAPERE - DEJI CLINICS "> LAGOS - KETU-ALAPERE - DEJI CLINICS </option> <option value=" LAGOS - LEKKI - FIRST CITY DIAGNOSTICS HOSPITAL "> LAGOS - LEKKI - FIRST CITY DIAGNOSTICS HOSPITAL </option> <option value=" LAGOS - MAGODO - QUEENS SPECIALIST HOSPITAL "> LAGOS - MAGODO - QUEENS SPECIALIST HOSPITAL </option> <option value=" LAGOS - MAGODO-ISHERI - SAMA CLINIC "> LAGOS - MAGODO-ISHERI - SAMA CLINIC </option> <option value=" LAGOS - MARYLAND - CHION FAMILY MEDICAL CENTRE "> LAGOS - MARYLAND - CHION FAMILY MEDICAL CENTRE </option> <option value=" LAGOS - MIERAN IJAYE - ABS MEDICARE CENTRE "> LAGOS - MIERAN IJAYE - ABS MEDICARE CENTRE </option> <option value=" LAGOS - MUSHIN - BRODIE-MENDS HOSPITAL "> LAGOS - MUSHIN - BRODIE-MENDS HOSPITAL </option> <option value=" LAGOS - MUSHIN - OLANIBA MEMORIAL SPECIALIST HOSPITAL MUSHIN "> LAGOS - MUSHIN - OLANIBA MEMORIAL SPECIALIST HOSPITAL MUSHIN </option> <option value=" LAGOS - OBANIKORO - OSUNTUYI MEDICAL CENTRE, OBANIKORO "> LAGOS - OBANIKORO - OSUNTUYI MEDICAL CENTRE, OBANIKORO </option> <option value=" LAGOS - OGBA - COUNTY HOSPITAL "> LAGOS - OGBA - COUNTY HOSPITAL </option> <option value=" LAGOS - OGBA - FANIMED HOSPITAL "> LAGOS - OGBA - FANIMED HOSPITAL </option> <option value=" LAGOS - OJODU - ALHERI HOSPITAL, LAGOS "> LAGOS - OJODU - ALHERI HOSPITAL, LAGOS </option> <option value=" LAGOS - OJOKORO - LEX MEDICAL CENTRE "> LAGOS - OJOKORO - LEX MEDICAL CENTRE </option> <option value=" LAGOS - OKERUBE-IKOTUN - D-BETTER LIFE HOSPITAL "> LAGOS - OKERUBE-IKOTUN - D-BETTER LIFE HOSPITAL </option> <option value=" LAGOS - OKOKOMAIKO - KILADEJO HOSPITAL & SPECIALIST CLINICS "> LAGOS - OKOKOMAIKO - KILADEJO HOSPITAL & SPECIALIST CLINICS </option> <option value=" LAGOS - OKOKOMAIKO - ST ANTHONYS MEDICAL CENTRE & MATERNITY HOME "> LAGOS - OKOKOMAIKO - ST ANTHONYS MEDICAL CENTRE & MATERNITY HOME </option> <option value=" LAGOS - OKOTA - ALBERTO CLINICS ( FORMER GERMAN FRIENDSHIP SPECIALIST CLINIC) "> LAGOS - OKOTA - ALBERTO CLINICS ( FORMER GERMAN FRIENDSHIP SPECIALIST CLINIC) </option> <option value=" LAGOS - OKOTA - ST. RAPHAEL HOSPITAL "> LAGOS - OKOTA - ST. RAPHAEL HOSPITAL </option> <option value=" LAGOS - ORILE - HIS STRIPE SPECIALIST HOSPITAL "> LAGOS - ORILE - HIS STRIPE SPECIALIST HOSPITAL </option> <option value=" LAGOS - OSHODI - DIALYZER MEDICAL CENTRE "> LAGOS - OSHODI - DIALYZER MEDICAL CENTRE </option> <option value=" LAGOS - SHOMOLU - MEDOL CONSULTANT CLINIC LIMITED "> LAGOS - SHOMOLU - MEDOL CONSULTANT CLINIC LIMITED </option> <option value=" LAGOS - SURULERE - GOOD TIDINGS HOSPITAL "> LAGOS - SURULERE - GOOD TIDINGS HOSPITAL </option> <option value=" LAGOS - SURULERE - MERCY THOMAS OREDUGBA HOSPITAL "> LAGOS - SURULERE - MERCY THOMAS OREDUGBA HOSPITAL </option> <option value=" LAGOS - SURULERE - MOUNT SINAI HOSPITAL, SURULERE "> LAGOS - SURULERE - MOUNT SINAI HOSPITAL, SURULERE </option> <option value=" LAGOS - SURULERE - OLANIBA MEMORIAL SPECIALIST HOSPITAL SURULERE "> LAGOS - SURULERE - OLANIBA MEMORIAL SPECIALIST HOSPITAL SURULERE </option> <option value=" LAGOS - SURULERE - ROYAL PINNACLE CLINIC "> LAGOS - SURULERE - ROYAL PINNACLE CLINIC </option> <option value=" LAGOS - YABA - COTTAGE MEDICARE HOSPITAL "> LAGOS - YABA - COTTAGE MEDICARE HOSPITAL </option> <option value=" OGUN - ABEOKUTA - JOSEPH AND CHRISTIANAH SPECIALIST HOSPITAL "> OGUN - ABEOKUTA - JOSEPH AND CHRISTIANAH SPECIALIST HOSPITAL </option> <option value=" OGUN - AGBARA - IBIJOLA MEDICAL CENTRE( SPECIALIST CLINIC) "> OGUN - AGBARA - IBIJOLA MEDICAL CENTRE( SPECIALIST CLINIC) </option> <option value=" OGUN - AGBARA - IBIJOLA MEDICAL CENTRE( SPECIALIST CLINIC) "> OGUN - AGBARA - IBIJOLA MEDICAL CENTRE( SPECIALIST CLINIC) </option> <option value=" OGUN - AGBARA - ROPHE MEDICAL CENTRE "> OGUN - AGBARA - ROPHE MEDICAL CENTRE </option> <option value=" OGUN - AKUTE - BALDA HOSPITAL AND MATERNITY HOME "> OGUN - AKUTE - BALDA HOSPITAL AND MATERNITY HOME </option> <option value=" OGUN - AREPO - BEACHLAND SPECIALIST HOSPITAL "> OGUN - AREPO - BEACHLAND SPECIALIST HOSPITAL </option> <option value=" OGUN - AREPO - ROA SPECIALIST HOSPITAL "> OGUN - AREPO - ROA SPECIALIST HOSPITAL </option> <option value=" OGUN - IDIROKO - CENTRAL SPECIALIST HOSPITAL "> OGUN - IDIROKO - CENTRAL SPECIALIST HOSPITAL </option> <option value=" OGUN - MOWE - LANTOS SPECIALIST HOSPITAL "> OGUN - MOWE - LANTOS SPECIALIST HOSPITAL </option> <option value=" OGUN - MOWE - SPRINGHILL HOSPITAL "> OGUN - MOWE - SPRINGHILL HOSPITAL </option> <option value=" OGUN - OTA - HETTA MEDICAL CENTRE "> OGUN - OTA - HETTA MEDICAL CENTRE </option> <option value=" OGUN - SAGAMU - ALPHA CLINIC, SAGAMU "> OGUN - SAGAMU - ALPHA CLINIC, SAGAMU </option> <option value=" OGUN - SAGAMU - AYOTOLA SPECIALIST HOSPITAL "> OGUN - SAGAMU - AYOTOLA SPECIALIST HOSPITAL </option> <option value=" OGUN - SAGAMU - EL-BETHEL MEDICAL "> OGUN - SAGAMU - EL-BETHEL MEDICAL </option> <option value=" OGUN - SAGAMU - Idera Hospital And Trauma Centre "> OGUN - SAGAMU - Idera Hospital And Trauma Centre </option> <option value=" OGUN - SAGAMU - IMPERIAL MEDICARE & CONSULTANCY SERVICES "> OGUN - SAGAMU - IMPERIAL MEDICARE & CONSULTANCY SERVICES </option> <option value=" OGUN - SAGAMU - MEDYTOP SPECIALIST HOSPITAL "> OGUN - SAGAMU - MEDYTOP SPECIALIST HOSPITAL </option> <option value=" OGUN - SAGAMU - Owokoniran Memorial Hospital "> OGUN - SAGAMU - Owokoniran Memorial Hospital </option> <option value=" OGUN - SAGAMU - REDEMPTION HOSPITAL "> OGUN - SAGAMU - REDEMPTION HOSPITAL </option> <option value=" OGUN - SAGAMU - TWINS SPECIALIST CLINIC "> OGUN - SAGAMU - TWINS SPECIALIST CLINIC </option> <option value=" OGUN - SANGO-OTA - PROMISE HOSPITAL "> OGUN - SANGO-OTA - PROMISE HOSPITAL </option> <option value=" OGUN - SANGO-OTA - SHIRISH CLINIC "> OGUN - SANGO-OTA - SHIRISH CLINIC </option> <option value=" OGUN - SANGO-OTA - ST. Shiloh Medical Centre "> OGUN - SANGO-OTA - ST. Shiloh Medical Centre </option> <option value=" OYO - IBADAN - CAMARIA HOSPITAL "> OYO - IBADAN - CAMARIA HOSPITAL </option> <option value=" OYO - IBADAN - EL-ROPHI HOSPITAL "> OYO - IBADAN - EL-ROPHI HOSPITAL </option> <option value=" OYO - IBADAN - LANARK SPECIALIST HOSPITAL "> OYO - IBADAN - LANARK SPECIALIST HOSPITAL </option> <option value=" OYO - IBADAN - OKE ADO HOSPITAL "> OYO - IBADAN - OKE ADO HOSPITAL </option> <option value=" OYO - IBADAN - T.Z. MEDICAL CENTRE,IBADAN,OYO "> OYO - IBADAN - T.Z. MEDICAL CENTRE,IBADAN,OYO </option> <option value=" OYO - IBADAN - TEJU SPECIALIST HOSPITAL "> OYO - IBADAN - TEJU SPECIALIST HOSPITAL </option> <option value=" OYO - ISEYIN - OUR LADY S CATHOLIC HOSPITAL "> OYO - ISEYIN - OUR LADY S CATHOLIC HOSPITAL </option> <option value=" OYO - OGBOMOSHO - BOWEN UNIVERSITY TEACHING HOSPITAL "> OYO - OGBOMOSHO - BOWEN UNIVERSITY TEACHING HOSPITAL </option> <option value=" OYO - OWODE - SHEKINAH MEDICAL CENTRE "> OYO - OWODE - SHEKINAH MEDICAL CENTRE </option> <option value=" OYO - OYO - MOMOH MEMORIAL HOSPITAL "> OYO - OYO - MOMOH MEMORIAL HOSPITAL </option> <option value=" OYO - OYO - PEAMAK HOSPITAL "> OYO - OYO - PEAMAK HOSPITAL </option> <option value=" OYO - SAKI - BAPTIST MEDICAL CENTRE "> OYO - SAKI - BAPTIST MEDICAL CENTRE </option> <option value=" OSUN - IKIRUN - SPRING HOPE SPECIALIST HOSPITAL "> OSUN - IKIRUN - SPRING HOPE SPECIALIST HOSPITAL </option> <option value=" OSUN - IKIRUN - TITILOPE MEDICAL CENTRE "> OSUN - IKIRUN - TITILOPE MEDICAL CENTRE </option> <option value=" OSUN - ILE-IFE - APEX MEDICAL CENTRE "> OSUN - ILE-IFE - APEX MEDICAL CENTRE </option> <option value=" OSUN - ILESA - HOLY TRINITY HOSPITAL LTD. "> OSUN - ILESA - HOLY TRINITY HOSPITAL LTD. </option> <option value=" OSUN - IPETUMODU - OUR LADY OF LOURDES CATHOLIC HOSPITAL "> OSUN - IPETUMODU - OUR LADY OF LOURDES CATHOLIC HOSPITAL </option> <option value=" OSUN - OSOGBO - EMMANUEL MEDICAL CENTRE "> OSUN - OSOGBO - EMMANUEL MEDICAL CENTRE </option> <option value=" OSUN - OSOGBO - ONWARD SPECIALIST HOSPITAL "> OSUN - OSOGBO - ONWARD SPECIALIST HOSPITAL </option> <option value=" OSUN - OSOGBO - OUR LADY OF FATIMA CATHOLIC HOSPITAL "> OSUN - OSOGBO - OUR LADY OF FATIMA CATHOLIC HOSPITAL </option> <option value=" ONDO - AKURE - FIRST MERCY SPECIALIST HOSPITAL LIMITED "> ONDO - AKURE - FIRST MERCY SPECIALIST HOSPITAL LIMITED </option> <option value=" ONDO - AKURE - HOPELAND SPECIALIST MEDICAL CENTRE "> ONDO - AKURE - HOPELAND SPECIALIST MEDICAL CENTRE </option> <option value=" ONDO - IKARE-AKOKO - INLAND MEDICAL CENTRE "> ONDO - IKARE-AKOKO - INLAND MEDICAL CENTRE </option> <option value=" ONDO - AKURE - JOE JANE MEDICAL CENTRE "> ONDO - AKURE - JOE JANE MEDICAL CENTRE </option> <option value=" EKITI - ADO EKITI - AFOLABI HOSPITAL "> EKITI - ADO EKITI - AFOLABI HOSPITAL </option> <option value=" EKITI - ADO EKITI - ALAAFIA HOSPITAL "> EKITI - ADO EKITI - ALAAFIA HOSPITAL </option> <option value=" EKITI - ADO EKITI - GILEAD SPECIALIST HOSPITAL "> EKITI - ADO EKITI - GILEAD SPECIALIST HOSPITAL </option> <option value=" EKITI - ADO EKITI - OLIVES SPECIALIST CLINICS & FERTILITY CENTRE LTD "> EKITI - ADO EKITI - OLIVES SPECIALIST CLINICS & FERTILITY CENTRE LTD </option> <option value=" EKITI - ARAMOKO - ADEBAYO MEDICAL CLINIC "> EKITI - ARAMOKO - ADEBAYO MEDICAL CLINIC </option> <option value=" EKITI - EMURE - ORE-OFE MATERNITY & MEDICAL CENTRE "> EKITI - EMURE - ORE-OFE MATERNITY & MEDICAL CENTRE </option> <option value=" EKITI - IDO-EKITI - FOLASADE CLINIC "> EKITI - IDO-EKITI - FOLASADE CLINIC </option> <option value=" EKITI - ILA-ORANGUN - HOPE MEDICAL CENTRE & MATERNITY "> EKITI - ILA-ORANGUN - HOPE MEDICAL CENTRE & MATERNITY </option> <option value=" KWARA - ILORIN - OLANREWAJU HOSPITAL "> KWARA - ILORIN - OLANREWAJU HOSPITAL </option> <option value=" KWARA - ILORIN - OLAOLU HOSPITAL "> KWARA - ILORIN - OLAOLU HOSPITAL </option> <option value=" KWARA - ILORIN - SADIKU HOSPITAL "> KWARA - ILORIN - SADIKU HOSPITAL </option> <option value=" KWARA - OFFA - OLALOMI HOSPITAL "> KWARA - OFFA - OLALOMI HOSPITAL </option> <option value=" KWARA - OMU-ARAN - AJISAFE HOSPITAL "> KWARA - OMU-ARAN - AJISAFE HOSPITAL </option> <option value=" KWARA - OMU-ARAN - LANDMARK UNIVERSITY MEDICAL CENTRE "> KWARA - OMU-ARAN - LANDMARK UNIVERSITY MEDICAL CENTRE </option> <option value=" FCT (ABUJA) - APO - ROUZ HOSPITAL & MATERNITY "> FCT (ABUJA) - APO - ROUZ HOSPITAL & MATERNITY </option> <option value=" FCT (ABUJA) - GARKI - SYBRON MEDICAL CENTRE LTD. "> FCT (ABUJA) - GARKI - SYBRON MEDICAL CENTRE LTD. </option> <option value=" FCT (ABUJA) - GWAGWALADA - JERAB HOSPITALS "> FCT (ABUJA) - GWAGWALADA - JERAB HOSPITALS </option> <option value=" FCT (ABUJA) - GWARIMPA - PRIMECARE MULTISPECIALTY HOSPITAL "> FCT (ABUJA) - GWARIMPA - PRIMECARE MULTISPECIALTY HOSPITAL </option> <option value=" FCT (ABUJA) - LUGBE - STANDARD CARE HOSPITAL & MATERNITY "> FCT (ABUJA) - LUGBE - STANDARD CARE HOSPITAL & MATERNITY </option> <option value=" FCT (ABUJA) - LUGBE - JOJO HOSPITAL LTD "> FCT (ABUJA) - LUGBE - JOJO HOSPITAL LTD </option> <option value=" FCT (ABUJA) - WUSE 2 - KOLSTAF MEDICAL CENTRE "> FCT (ABUJA) - WUSE 2 - KOLSTAF MEDICAL CENTRE </option> <option value=" NASSARAWA - AKWANGA - ROYAL HOSPITAL "> NASSARAWA - AKWANGA - ROYAL HOSPITAL </option> <option value=" NASSARAWA - DOGO ROAD - ALPHA HOSPITAL, NASSARAWA "> NASSARAWA - DOGO ROAD - ALPHA HOSPITAL, NASSARAWA </option> <option value=" NASSARAWA - KEFFI - NAGARI ALLAH MAGANI HOSPITAL "> NASSARAWA - KEFFI - NAGARI ALLAH MAGANI HOSPITAL </option> <option value=" NASSARAWA - KEFFI - NASARA HOSPITAL & MATERNITY - KEFFI "> NASSARAWA - KEFFI - NASARA HOSPITAL & MATERNITY - KEFFI </option> <option value=" NASSARAWA - LAFIA - AGU HOSPITAL - LAFIA "> NASSARAWA - LAFIA - AGU HOSPITAL - LAFIA </option> <option value=" NASSARAWA - LAFIA - DALHATU ARAF SPECIALIST HOSPITAL "> NASSARAWA - LAFIA - DALHATU ARAF SPECIALIST HOSPITAL </option> <option value=" BENUE - GBOKO - BAKI CLINIC & MATERNITY CENTRE "> BENUE - GBOKO - BAKI CLINIC & MATERNITY CENTRE </option> <option value=" BENUE - GBOKO - MYOM HOSPITAL "> BENUE - GBOKO - MYOM HOSPITAL </option> <option value=" BENUE - MAKURDI - FAMILY PRACTICE HOSPITAL "> BENUE - MAKURDI - FAMILY PRACTICE HOSPITAL </option> <option value=" BENUE - MAKURDI - HOSPITAL OF IMMACULATE CONCEPTION "> BENUE - MAKURDI - HOSPITAL OF IMMACULATE CONCEPTION </option> <option value=" BENUE - OTUKPO - ST. DANIEL HOSPITAL "> BENUE - OTUKPO - ST. DANIEL HOSPITAL </option> <option value=" NIGER - BIDA - YEBOSOKO SPECIALIST HOSPITAL "> NIGER - BIDA - YEBOSOKO SPECIALIST HOSPITAL </option> <option value=" NIGER - MINNA - STANDARD HOSPITAL & DIAGNOSTIC CENTRE, MINNA. "> NIGER - MINNA - STANDARD HOSPITAL & DIAGNOSTIC CENTRE, MINNA. </option> <option value=" NIGER - SULEJA - SUZAN MEMORIAL CLINIC & MATERNITY "> NIGER - SULEJA - SUZAN MEMORIAL CLINIC & MATERNITY </option> <option value=" NIGER - SULEJA - LIBERTY HOSPITAL - NIGER STATE "> NIGER - SULEJA - LIBERTY HOSPITAL - NIGER STATE </option> <option value=" KOGI - AYINGBA - BLUE HOUSE HOSPITAL "> KOGI - AYINGBA - BLUE HOUSE HOSPITAL </option> <option value=" KOGI - AYINGBA - PEACE HOSPITAL "> KOGI - AYINGBA - PEACE HOSPITAL </option> <option value=" KOGI - INOZIOMI - OYIZA HOSPITAL "> KOGI - INOZIOMI - OYIZA HOSPITAL </option> <option value=" KOGI - LOKOJA - NIGER HOSPITAL,KOGI "> KOGI - LOKOJA - NIGER HOSPITAL,KOGI </option> <option value=" KOGI - LOKOJA - POLY HOSPITAL & MATERNITY HOME "> KOGI - LOKOJA - POLY HOSPITAL & MATERNITY HOME </option> <option value=" KADUNA - ABAKPA - GIWA HOSPITAL & SPECIALIST CLINIC "> KADUNA - ABAKPA - GIWA HOSPITAL & SPECIALIST CLINIC </option> <option value=" KADUNA - BARNAWA GRA - HARMONY HOSPITAL LIMITED - KADUNA "> KADUNA - BARNAWA GRA - HARMONY HOSPITAL LIMITED - KADUNA </option> <option value=" KADUNA - BARNAWA GRA - EPSILON SPECIALIST HOSPITAL "> KADUNA - BARNAWA GRA - EPSILON SPECIALIST HOSPITAL </option> <option value=" KADUNA - KACHIA - MC ROYAL HOSPITAL "> KADUNA - KACHIA - MC ROYAL HOSPITAL </option> <option value=" KADUNA - KADUNA - ABI CLINIC & HOSPITAL "> KADUNA - KADUNA - ABI CLINIC & HOSPITAL </option> <option value=" KADUNA - KADUNA - ALBA CLINICS & MEDICAL CENTRE "> KADUNA - KADUNA - ALBA CLINICS & MEDICAL CENTRE </option> <option value=" KADUNA - KADUNA - MANEKS HOSPITAL LIMITED "> KADUNA - KADUNA - MANEKS HOSPITAL LIMITED </option> <option value=" KADUNA - KADUNA - SEFA HOSPITAL "> KADUNA - KADUNA - SEFA HOSPITAL </option> <option value=" KADUNA - KADUNA - THE CHASEL HOSPITAL "> KADUNA - KADUNA - THE CHASEL HOSPITAL </option> <option value=" KADUNA - KADUNA - GARKUWA SPECIALIST HOSPITAL "> KADUNA - KADUNA - GARKUWA SPECIALIST HOSPITAL </option> <option value=" KADUNA - KADUNA - MT. HOREB SPECIALIST HOSPITAL LTD - KADUNA "> KADUNA - KADUNA - MT. HOREB SPECIALIST HOSPITAL LTD - KADUNA </option> <option value=" KADUNA - KADUNA - THE CHASEL HOSPITAL "> KADUNA - KADUNA - THE CHASEL HOSPITAL </option> <option value=" KADUNA - KADUNA - ABI CLINIC & HOSPITAL "> KADUNA - KADUNA - ABI CLINIC & HOSPITAL </option> <option value=" KADUNA - KADUNA - MOUFAY CLINICS "> KADUNA - KADUNA - MOUFAY CLINICS </option> <option value=" KADUNA - KADUNA - RIMI CLINIC "> KADUNA - KADUNA - RIMI CLINIC </option> <option value=" KADUNA - KADUNA - AMINA HOSPITAL "> KADUNA - KADUNA - AMINA HOSPITAL </option> <option value=" KADUNA - KADUNA - GILTOOE ARIS SPECIALIST HOSPITAL "> KADUNA - KADUNA - GILTOOE ARIS SPECIALIST HOSPITAL </option> <option value=" KADUNA - KADUNA - ISHAKU HOSPITAL - KADUNA "> KADUNA - KADUNA - ISHAKU HOSPITAL - KADUNA </option> <option value=" KADUNA - KADUNA - MENDS HOSPITAL "> KADUNA - KADUNA - MENDS HOSPITAL </option> <option value=" KADUNA - KADUNA - SALVATION HOSPITAL - KADUNA "> KADUNA - KADUNA - SALVATION HOSPITAL - KADUNA </option> <option value=" KADUNA - KADUNA - ST. GERALD\'S CATHOLIC HOSPITAL "> KADUNA - KADUNA - ST. GERALD\'S CATHOLIC HOSPITAL </option> <option value=" KADUNA - KADUNA - TIM UNITY SPECIALIST HOSPITAL "> KADUNA - KADUNA - TIM UNITY SPECIALIST HOSPITAL </option> <option value=" KADUNA - KADUNA - GARDEN CITY SPECIALIST HOSPITAL "> KADUNA - KADUNA - GARDEN CITY SPECIALIST HOSPITAL </option> <option value=" KADUNA - KADUNA - OUTFIT HOSPITAL "> KADUNA - KADUNA - OUTFIT HOSPITAL </option> <option value=" KADUNA - KAFANCHAN - SIR PATRICK IBRAHIM YAKOWA MEMORIAL HOSPITAL (SPIYM) "> KADUNA - KAFANCHAN - SIR PATRICK IBRAHIM YAKOWA MEMORIAL HOSPITAL (SPIYM) </option> <option value=" KADUNA - KAFANCHAN - SALEM MEDICAL CENTRE "> KADUNA - KAFANCHAN - SALEM MEDICAL CENTRE </option> <option value=" KADUNA - KAFANCHAN - NEW ERA HOSPITAL & MATERNITY, KAFANCHAN "> KADUNA - KAFANCHAN - NEW ERA HOSPITAL & MATERNITY, KAFANCHAN </option> <option value=" KADUNA - KUDENDA - ASHMED SPECIALIST HOSPITAL "> KADUNA - KUDENDA - ASHMED SPECIALIST HOSPITAL </option> <option value=" KADUNA - TUNDA WADA - BIBA HOSPITAL LTD "> KADUNA - TUNDA WADA - BIBA HOSPITAL LTD </option> <option value=" KADUNA - UNGWA RIMI - GARDEN CITY SPECIALIST HOSPITAL "> KADUNA - UNGWA RIMI - GARDEN CITY SPECIALIST HOSPITAL </option> <option value=" KADUNA - UNGWA RIMI - MONARCH SPECIALIST HOSPITAL "> KADUNA - UNGWA RIMI - MONARCH SPECIALIST HOSPITAL </option> <option value=" KADUNA - ZARIA - AL-MADINA "> KADUNA - ZARIA - AL-MADINA </option> <option value=" KADUNA - ZARIA - SALAMA INFIRMARY,ZARIA,KADUNA "> KADUNA - ZARIA - SALAMA INFIRMARY,ZARIA,KADUNA </option> <option value=" KADUNA - ZARIA - ST. LUKES ANGLICAN HOSPITAL "> KADUNA - ZARIA - ST. LUKES ANGLICAN HOSPITAL </option> <option value=" KADUNA - ZARIA - LADIYA HOSPITAL "> KADUNA - ZARIA - LADIYA HOSPITAL </option> <option value=" KANO - GYADI - PREMIER CLINICS "> KANO - GYADI - PREMIER CLINICS </option> <option value=" KANO - HOTORO - KINGSGATE HOSPITAL "> KANO - HOTORO - KINGSGATE HOSPITAL </option> <option value=" KANO - AIRPORT ROAD - INTERNATIONAL CLINICS & HOSPITAL LIMITED,KANO "> KANO - AIRPORT ROAD - INTERNATIONAL CLINICS & HOSPITAL LIMITED,KANO </option> <option value=" KANO - KANO - KHADIJAT MEMORIAL HOSPITAL "> KANO - KANO - KHADIJAT MEMORIAL HOSPITAL </option> <option value=" KANO - TARAUNI - STANDARD SPECIALIST HOSPITAL, KANO "> KANO - TARAUNI - STANDARD SPECIALIST HOSPITAL, KANO </option> <option value=" KANO - NOMANSLAND - GOODPASTURES CLINICS "> KANO - NOMANSLAND - GOODPASTURES CLINICS </option> <option value=" KANO - KANO - BAREWA CLINICS & MATERNITY "> KANO - KANO - BAREWA CLINICS & MATERNITY </option> <option value=" KANO - NOMANSLAND - TUNIK HOSPITAL LIMITED "> KANO - NOMANSLAND - TUNIK HOSPITAL LIMITED </option> <option value=" KANO - KANO - CORPERSTONE HOSPITAL "> KANO - KANO - CORPERSTONE HOSPITAL </option> <option value=" KANO - NASSARAWA - MEDICUS CLINIC "> KANO - NASSARAWA - MEDICUS CLINIC </option> <option value=" KANO - SABON GARI - LAFIYA SURGERY "> KANO - SABON GARI - LAFIYA SURGERY </option> <option value=" KANO - KANO - AL-BASAR INTERNATIONAL FOUNDATION TRUST (MSEH) "> KANO - KANO - AL-BASAR INTERNATIONAL FOUNDATION TRUST (MSEH) </option> <option value=" KANO - NASSARAWA - AMISAL DENTAL CARE "> KANO - NASSARAWA - AMISAL DENTAL CARE </option> <option value=" KANO - HAUSAWA - AMITY HOSPITAL AND MEDICAL SERVICES "> KANO - HAUSAWA - AMITY HOSPITAL AND MEDICAL SERVICES </option> <option value=" KANO - KANO - IVORY CLINIC & MATERNITY "> KANO - KANO - IVORY CLINIC & MATERNITY </option> <option value=" KANO - KANO - AMINU KANO TEACHING HOSPITAL "> KANO - KANO - AMINU KANO TEACHING HOSPITAL </option> <option value=" KANO - KANO - NOL INTERNATIONAL HOSPITAL "> KANO - KANO - NOL INTERNATIONAL HOSPITAL </option> <option value=" KATSINA - KATSINA - KHADIJAT MEDICAL CENTER, KATSINA "> KATSINA - KATSINA - KHADIJAT MEDICAL CENTER, KATSINA </option> <option value=" KATSINA - KATSINA - FEDERAL MEDICAL CENTRE, KATSINA "> KATSINA - KATSINA - FEDERAL MEDICAL CENTRE, KATSINA </option> <option value=" KATSINA - KATSINA - BASITIT HOSPITAL LIMITED "> KATSINA - KATSINA - BASITIT HOSPITAL LIMITED </option> <option value=" KATSINA - KATSINA - KATSINA NURSING HOME "> KATSINA - KATSINA - KATSINA NURSING HOME </option> <option value=" JIGAWA - DUTSE - DUTSE GENERAL HOSPITAL, JIGAWA STATE "> JIGAWA - DUTSE - DUTSE GENERAL HOSPITAL, JIGAWA STATE </option> <option value=" JIGAWA - DUTSE - RASHEED SHEKONI SPECIALIST HOSPITAL "> JIGAWA - DUTSE - RASHEED SHEKONI SPECIALIST HOSPITAL </option> <option value=" PLATEAU - JOS - KAUNA SPECIALIST HOSPITAL "> PLATEAU - JOS - KAUNA SPECIALIST HOSPITAL </option> <option value=" PLATEAU - JOS - SAUKI HOSPITAL, JOS "> PLATEAU - JOS - SAUKI HOSPITAL, JOS </option> <option value=" KEBBI - BIRNIN-KEBBI - GODIYA HOSPITAL "> KEBBI - BIRNIN-KEBBI - GODIYA HOSPITAL </option> <option value=" KEBBI - BIRNIN-KEBBI - FEDERAL MEDICAL CENTRE, BIRNIN-KEBBI "> KEBBI - BIRNIN-KEBBI - FEDERAL MEDICAL CENTRE, BIRNIN-KEBBI </option> <option value=" ZAMFARA - GUSAU - DAULA HOSPITAL & MATERNITY HOME "> ZAMFARA - GUSAU - DAULA HOSPITAL & MATERNITY HOME </option> <option value=" ZAMFARA - ANKA - GENERAL HOSPITAL, ANKA "> ZAMFARA - ANKA - GENERAL HOSPITAL, ANKA </option> <option value=" ADAMAWA - YOLA - MATCO CLINIC "> ADAMAWA - YOLA - MATCO CLINIC </option> <option value=" YOBE - DAMATURU - CITY MEDICAL CENTRE "> YOBE - DAMATURU - CITY MEDICAL CENTRE </option> <option value=" YOBE - POTISKUM - POTISKUM MEDICAL CENTRE "> YOBE - POTISKUM - POTISKUM MEDICAL CENTRE </option> <option value=" GOMBE - GOMBE - DOMA HOSPITAL "> GOMBE - GOMBE - DOMA HOSPITAL </option> <option value=" GOMBE - GOMBE - METRO CONSULTANTS CLINIC "> GOMBE - GOMBE - METRO CONSULTANTS CLINIC </option> <option value=" BORNO - MAIDUGURI - NAKOWA SPECIALIST HOSPITAL "> BORNO - MAIDUGURI - NAKOWA SPECIALIST HOSPITAL </option> <option value=" BAUCHI - BAUCHI - PAHLYCON HOSPITAL "> BAUCHI - BAUCHI - PAHLYCON HOSPITAL </option> <option value=" BAUCHI - BAUCHI - AL-AMIN HEALTH CLINIC & MATERNITY "> BAUCHI - BAUCHI - AL-AMIN HEALTH CLINIC & MATERNITY </option> <option value=" BAUCHI - BAUCHI - ALAMEEN HOSPITAL "> BAUCHI - BAUCHI - ALAMEEN HOSPITAL </option> <option value=" TARABA - ABUJA PHASE 1 - FIRST DOMINION SPECIALIST CLLINIC AND MATERNITY "> TARABA - ABUJA PHASE 1 - FIRST DOMINION SPECIALIST CLLINIC AND MATERNITY </option> <option value=" TARABA - JALINGO - FEDERAL MEDICAL CENTRE, JALINGO "> TARABA - JALINGO - FEDERAL MEDICAL CENTRE, JALINGO </option> <option value=" TARABA - JALINGO - GATEWAY HOSPITAL JALINGO "> TARABA - JALINGO - GATEWAY HOSPITAL JALINGO </option> <option value=" TARABA - WUKARI - BETHEL HOSPITAL "> TARABA - WUKARI - BETHEL HOSPITAL </option> <option value=" ENUGU - ABAKPA - KENECHUKWU SPECIALIST HOSPITAL "> ENUGU - ABAKPA - KENECHUKWU SPECIALIST HOSPITAL </option> <option value=" ENUGU - NGWO - OUR SAVIOUR MEDICAL CENTRE "> ENUGU - NGWO - OUR SAVIOUR MEDICAL CENTRE </option> <option value=" ENUGU - NSUKA - AKULUE MEMORIAL HOSPITAL "> ENUGU - NSUKA - AKULUE MEMORIAL HOSPITAL </option> <option value=" ENUGU - NSUKA - ALL SAINTS MEDICAL CENTER "> ENUGU - NSUKA - ALL SAINTS MEDICAL CENTER </option> <option value=" ENUGU - TRANS EKULU - CHRIST THE KING HOSPITAL, TRANS EKULU "> ENUGU - TRANS EKULU - CHRIST THE KING HOSPITAL, TRANS EKULU </option> <option value=" ENUGU - UWANI - EASTERN NIGERIA MEDICAL CENTRE "> ENUGU - UWANI - EASTERN NIGERIA MEDICAL CENTRE </option> <option value=" IMO - OKIGWE - IVORY CLINIC "> IMO - OKIGWE - IVORY CLINIC </option> <option value=" ANAMBRA - AGULERI - IMMACULATE HEART MULTISPECIALTY HOSPITAL "> ANAMBRA - AGULERI - IMMACULATE HEART MULTISPECIALTY HOSPITAL </option> <option value=" ANAMBRA - AWKA - BEACON HOSPITAL & MATERNITY "> ANAMBRA - AWKA - BEACON HOSPITAL & MATERNITY </option> <option value=" ANAMBRA - AWKA - IFEBI MEDICAL CENTRE "> ANAMBRA - AWKA - IFEBI MEDICAL CENTRE </option> <option value=" ANAMBRA - AWKA - HARMONY SPECIALIST HOSPITAL "> ANAMBRA - AWKA - HARMONY SPECIALIST HOSPITAL </option> <option value=" ANAMBRA - AWKA - ROCK FOUNDATION "> ANAMBRA - AWKA - ROCK FOUNDATION </option> <option value=" ANAMBRA - AWKA - ELDORADO MULTI-SPECIALIST HOSPITAL, AWKA "> ANAMBRA - AWKA - ELDORADO MULTI-SPECIALIST HOSPITAL, AWKA </option> <option value=" ANAMBRA - AWKA - PRIME SPECIALIST HOSPITAL "> ANAMBRA - AWKA - PRIME SPECIALIST HOSPITAL </option> <option value=" ANAMBRA - AWKA - REGINA CAELI HOSPITAL "> ANAMBRA - AWKA - REGINA CAELI HOSPITAL </option> <option value=" ANAMBRA - AWKA - SEFTON HOSPITAL "> ANAMBRA - AWKA - SEFTON HOSPITAL </option> <option value=" ANAMBRA - AWKA - ISSAC CHIRA MEMORIAL HOSPITAL "> ANAMBRA - AWKA - ISSAC CHIRA MEMORIAL HOSPITAL </option> <option value=" ANAMBRA - Akwuzu - ISSAC CHIRA MEMORIAL HOSPITAL "> ANAMBRA - Akwuzu - ISSAC CHIRA MEMORIAL HOSPITAL </option> <option value=" ANAMBRA - IHIALA - OUR LADY OF LOURDES HOSPITAL "> ANAMBRA - IHIALA - OUR LADY OF LOURDES HOSPITAL </option> <option value=" ANAMBRA - NNEWI - CHIMEX HOSPITAL "> ANAMBRA - NNEWI - CHIMEX HOSPITAL </option> <option value=" ANAMBRA - ONITSHA - BETHSAIDA SPECIALIST HOSPITAL "> ANAMBRA - ONITSHA - BETHSAIDA SPECIALIST HOSPITAL </option> <option value=" ANAMBRA - ONITSHA - VENIK SPECIALIST HOSPITAL & MATERNITY "> ANAMBRA - ONITSHA - VENIK SPECIALIST HOSPITAL & MATERNITY </option> <option value=" ANAMBRA - ONITSHA - MERCY SPECIALIST HOSPITAL "> ANAMBRA - ONITSHA - MERCY SPECIALIST HOSPITAL </option> <option value=" EBONYI - ABAKALIKI - CHRIST THE KING HOSPITAL "> EBONYI - ABAKALIKI - CHRIST THE KING HOSPITAL </option> <option value=" EBONYI - ABAKILIKI - FEDERAL MEDICAL CENTRE, ABAKILIKI,EBONYI "> EBONYI - ABAKILIKI - FEDERAL MEDICAL CENTRE, ABAKILIKI,EBONYI </option> <option value=" EBONYI - ABAKALIKI - SMILE SPECIALIST HOSPITAL "> EBONYI - ABAKALIKI - SMILE SPECIALIST HOSPITAL </option> <option value=" ABIA - ABA - THE BLESSED HAVEN HOSPITAL LIMITED "> ABIA - ABA - THE BLESSED HAVEN HOSPITAL LIMITED </option> <option value=" ABIA - ABA - SPRINGS CLINIC "> ABIA - ABA - SPRINGS CLINIC </option> <option value=" ABIA - ABA - EKEOMA MEMORIAL HOSPITAL "> ABIA - ABA - EKEOMA MEMORIAL HOSPITAL </option> <option value=" ABIA - AMAEKPU - UZONDU POLY CLINIC "> ABIA - AMAEKPU - UZONDU POLY CLINIC </option> <option value=" ABIA - UMUAHIA - THE LORDS FOUNDATION CLINIC "> ABIA - UMUAHIA - THE LORDS FOUNDATION CLINIC </option> <option value=" EDO - AUCHI - FATE MEDICAL CENTRE "> EDO - AUCHI - FATE MEDICAL CENTRE </option> <option value=" EDO - BENIN - BETHEL FAITH MEDICAL CENTRE "> EDO - BENIN - BETHEL FAITH MEDICAL CENTRE </option> <option value=" EDO - BENIN - ECHOS HOSPITAL "> EDO - BENIN - ECHOS HOSPITAL </option> <option value=" EDO - BENIN - EKPEN HOSPITAL "> EDO - BENIN - EKPEN HOSPITAL </option> <option value=" EDO - BENIN - MODIC MEDICAL CENTRE "> EDO - BENIN - MODIC MEDICAL CENTRE </option> <option value=" EDO - BENIN - OSULA ROYAL HOSPITAL "> EDO - BENIN - OSULA ROYAL HOSPITAL </option> <option value=" EDO - BENIN - MOUNT GILEAD HOSPITAL "> EDO - BENIN - MOUNT GILEAD HOSPITAL </option> <option value=" EDO - JATTU - HOPE CLINIC, EDO "> EDO - JATTU - HOPE CLINIC, EDO </option> <option value=" EDO - OREDO - ROCK HOSPITAL "> EDO - OREDO - ROCK HOSPITAL </option> <option value=" EDO - UROMI - ORIAIFO MEDICAL CENTRE "> EDO - UROMI - ORIAIFO MEDICAL CENTRE </option> <option value=" EDO - BENIN - MAVISCOPE HOSPITAL AND FERTILITY CENTRE "> EDO - BENIN - MAVISCOPE HOSPITAL AND FERTILITY CENTRE </option> <option value=" DELTA - ASABA - ICON CLINIC & MATERNITY "> DELTA - ASABA - ICON CLINIC & MATERNITY </option> <option value=" DELTA - EMEBIREN - BRYANTS HOSPITAL/CLINIC LIMITED "> DELTA - EMEBIREN - BRYANTS HOSPITAL/CLINIC LIMITED </option> <option value=" DELTA - IGBUDU - HEALING STREAM CLINIC AND MATERNITY "> DELTA - IGBUDU - HEALING STREAM CLINIC AND MATERNITY </option> <option value=" DELTA - KWALE - BREMA HOSPITAL "> DELTA - KWALE - BREMA HOSPITAL </option> <option value=" DELTA - OBIARUKU - QUEEN OF THE APOSTLES CATHOLIC HOSPITAL "> DELTA - OBIARUKU - QUEEN OF THE APOSTLES CATHOLIC HOSPITAL </option> <option value=" DELTA - SAPELE - LIBERAL CLINIC "> DELTA - SAPELE - LIBERAL CLINIC </option> <option value=" DELTA - SAPELE - OBULE MEDICAL CENTRE "> DELTA - SAPELE - OBULE MEDICAL CENTRE </option> <option value=" DELTA - UGHELLI - CELIAN CLINIC "> DELTA - UGHELLI - CELIAN CLINIC </option> <option value=" DELTA - WARRI - BU CLINICS LTD "> DELTA - WARRI - BU CLINICS LTD </option> <option value=" DELTA - WARRI - TWINS CLINIC HOSPITAL "> DELTA - WARRI - TWINS CLINIC HOSPITAL </option> <option value=" DELTA - WARRI - VICAH CLINIC "> DELTA - WARRI - VICAH CLINIC </option> <option value=" AKWA IBOM - ABAK ROAD - ST. ATHANASIUS HOSPITAL LIMITED,UYO "> AKWA IBOM - ABAK ROAD - ST. ATHANASIUS HOSPITAL LIMITED,UYO </option> <option value=" AKWA IBOM - EKET - GOOD SHEPHERD MEDICAL CENTER "> AKWA IBOM - EKET - GOOD SHEPHERD MEDICAL CENTER </option> <option value=" AKWA IBOM - EKET - CALEB MEDICAL CENTER "> AKWA IBOM - EKET - CALEB MEDICAL CENTER </option> <option value=" AKWA IBOM - IKOT ABASI - REDEMPTION CLINIC, IKOT ABASI "> AKWA IBOM - IKOT ABASI - REDEMPTION CLINIC, IKOT ABASI </option> <option value=" AKWA IBOM - IKOT ABASI - VEDDYSON HOSPITAL "> AKWA IBOM - IKOT ABASI - VEDDYSON HOSPITAL </option> <option value=" AKWA IBOM - IKOT ABASI - BETHANY MEDICAL CENTER "> AKWA IBOM - IKOT ABASI - BETHANY MEDICAL CENTER </option> <option value=" AKWA IBOM - IKOT EKPENE - EVERGREEN CHRISTIAN HEALTH SERVICES LIMITED "> AKWA IBOM - IKOT EKPENE - EVERGREEN CHRISTIAN HEALTH SERVICES LIMITED </option> <option value=" AKWA IBOM - IKOT EKPENE - TOTAL CARE CLINIC & MATERNITY` "> AKWA IBOM - IKOT EKPENE - TOTAL CARE CLINIC & MATERNITY` </option> <option value=" AKWA IBOM - ORON - PRISCON CLINICS LIMITED "> AKWA IBOM - ORON - PRISCON CLINICS LIMITED </option> <option value=" AKWA IBOM - ORON - ST PATRICK\'S CLINIC & MATERNITY "> AKWA IBOM - ORON - ST PATRICK\'S CLINIC & MATERNITY </option> <option value=" AKWA IBOM - ORON - UWEM FOUNDATION SPECIALIST CLINIC "> AKWA IBOM - ORON - UWEM FOUNDATION SPECIALIST CLINIC </option> <option value=" AKWA IBOM - UYO - CITY CLINIC AND INFIRMARY,UYO "> AKWA IBOM - UYO - CITY CLINIC AND INFIRMARY,UYO </option> <option value=" AKWA IBOM - UYO - DOMINGO SPECIALIST HOSPITAL "> AKWA IBOM - UYO - DOMINGO SPECIALIST HOSPITAL </option> <option value=" AKWA IBOM - UYO - MFONABASI CLINIC "> AKWA IBOM - UYO - MFONABASI CLINIC </option> <option value=" AKWA IBOM - UYO - MOUNT OLIVE CLINC & MATERNITY, UYO "> AKWA IBOM - UYO - MOUNT OLIVE CLINC & MATERNITY, UYO </option> <option value=" AKWA IBOM - UYO - NEDEKE PAEDIATRICS "> AKWA IBOM - UYO - NEDEKE PAEDIATRICS </option> <option value=" AKWA IBOM - UYO - PREMIER MEDICAL SERVICES "> AKWA IBOM - UYO - PREMIER MEDICAL SERVICES </option> <option value=" AKWA IBOM - UYO - SIFON CLINICS LTD "> AKWA IBOM - UYO - SIFON CLINICS LTD </option> <option value=" AKWA IBOM - UYO - UBONG-ABASI SPECIALIST CLINIC "> AKWA IBOM - UYO - UBONG-ABASI SPECIALIST CLINIC </option> <option value=" AKWA IBOM - UYO - MOUNT OLIVE HOSPITAL "> AKWA IBOM - UYO - MOUNT OLIVE HOSPITAL </option> <option value=" AKWA IBOM - UYO - UWAKMFON SPECIALIST CLINICS "> AKWA IBOM - UYO - UWAKMFON SPECIALIST CLINICS </option> <option value=" AKWA IBOM - UYO - UWANA FAMILY CLINIC "> AKWA IBOM - UYO - UWANA FAMILY CLINIC </option> <option value=" AKWA IBOM - UYO - UBONGABASI SPECIALIST HOSPITAL "> AKWA IBOM - UYO - UBONGABASI SPECIALIST HOSPITAL </option> <option value=" AKWA IBOM - UYO - ST. ATHANASIUS HOSPITAL LTD "> AKWA IBOM - UYO - ST. ATHANASIUS HOSPITAL LTD </option> <option value=" AKWA IBOM - UYO - DOMINGO SPECIALIST HOSPITAL "> AKWA IBOM - UYO - DOMINGO SPECIALIST HOSPITAL </option> <option value=" AKWA IBOM - UYO - LIFECARE HOSPITAL "> AKWA IBOM - UYO - LIFECARE HOSPITAL </option> <option value=" BAYELSA - YENAGOA - GLORYLAND MEDICAL CENTER "> BAYELSA - YENAGOA - GLORYLAND MEDICAL CENTER </option> <option value=" BAYELSA - YENAGOA - ST. PETERS HOSPITAL "> BAYELSA - YENAGOA - ST. PETERS HOSPITAL </option> <option value=" RIVERS - EGBEMA - FOUNDATION CLINIC "> RIVERS - EGBEMA - FOUNDATION CLINIC </option> <option value=" RIVERS - ELEKAHAI - CORBAN MEDICALS LIMITED "> RIVERS - ELEKAHAI - CORBAN MEDICALS LIMITED </option> <option value=" RIVERS - ELEME - FAMO CLINIC "> RIVERS - ELEME - FAMO CLINIC </option> <option value=" RIVERS - ELEME - MEDICAL CENTRE ONNE "> RIVERS - ELEME - MEDICAL CENTRE ONNE </option> <option value=" RIVERS - GRA - PONYX HOSPITALS LTD "> RIVERS - GRA - PONYX HOSPITALS LTD </option> <option value=" RIVERS - OBIGBO - QUEEN OF PEACE HOSPITAL AND MATERNITY "> RIVERS - OBIGBO - QUEEN OF PEACE HOSPITAL AND MATERNITY </option> <option value=" RIVERS - OMOKU - GBEYE HOSPITAL & MATERNITY "> RIVERS - OMOKU - GBEYE HOSPITAL & MATERNITY </option> <option value=" RIVERS - PORT HARCOURT - GARRISON CLINIC "> RIVERS - PORT HARCOURT - GARRISON CLINIC </option> <option value=" RIVERS - PORT HARCOURT - KRISANY MEDICAL CENTRE "> RIVERS - PORT HARCOURT - KRISANY MEDICAL CENTRE </option> <option value=" RIVERS - PORT HARCOURT - KRYSTAL CLINIC "> RIVERS - PORT HARCOURT - KRYSTAL CLINIC </option> <option value=" RIVERS - PORT HARCOURT - OFURE SPECIALISTS CLINIC "> RIVERS - PORT HARCOURT - OFURE SPECIALISTS CLINIC </option> <option value=" RIVERS - PORT HARCOURT - ANCHOR HOSPITAL "> RIVERS - PORT HARCOURT - ANCHOR HOSPITAL </option> <option value=" RIVERS - PORT HARCOURT - PAMO CLINICS "> RIVERS - PORT HARCOURT - PAMO CLINICS </option> <option value=" RIVERS - RUKPOKWU - BONMARIA HOSPITAL LTD. "> RIVERS - RUKPOKWU - BONMARIA HOSPITAL LTD. </option> <option value=" RIVERS - RUMUODOMAYA - AMAZING GRACE CLINIC "> RIVERS - RUMUODOMAYA - AMAZING GRACE CLINIC </option> <option value=" RIVERS - RUMUOKWUTA - BENOK-HEROES HOSPITAL "> RIVERS - RUMUOKWUTA - BENOK-HEROES HOSPITAL </option> <option value=" RIVERS - TRANS AMADI - OLUNWA MEDICAL CENTRE "> RIVERS - TRANS AMADI - OLUNWA MEDICAL CENTRE </option> <option value=" RIVERS - TRANS-WOJI - THE SHIELD CLINICS "> RIVERS - TRANS-WOJI - THE SHIELD CLINICS </option> <option value=" RIVERS - WOJI - ST. MARY MOTHER OF MERCY HOSPITALS "> RIVERS - WOJI - ST. MARY MOTHER OF MERCY HOSPITALS </option> <option value=" CROSS RIVERS - ABAKPA OGOJA - SANTA MARIA CLINIC AND MATERNITY "> CROSS RIVERS - ABAKPA OGOJA - SANTA MARIA CLINIC AND MATERNITY </option> <option value=" CROSS RIVERS - AKAMKPA - USY MEDICALS CONSULTING ROOM "> CROSS RIVERS - AKAMKPA - USY MEDICALS CONSULTING ROOM </option> <option value=" CROSS RIVERS - CALABAR - CITY CLINIC "> CROSS RIVERS - CALABAR - CITY CLINIC </option> <option value=" CROSS RIVERS - CALABAR - FAITH FOUNDATION SPECIALIST CLINIC "> CROSS RIVERS - CALABAR - FAITH FOUNDATION SPECIALIST CLINIC </option> <option value=" CROSS RIVERS - CALABAR - MT. ZION MEDICAL CENTRE "> CROSS RIVERS - CALABAR - MT. ZION MEDICAL CENTRE </option> <option value=" CROSS RIVERS - CALABAR - VICTORIA ITAM SPECIALIST HOSPITAL "> CROSS RIVERS - CALABAR - VICTORIA ITAM SPECIALIST HOSPITAL </option> <option value=" CROSS RIVERS - CALABAR - IKPEME MEDICAL CENTER "> CROSS RIVERS - CALABAR - IKPEME MEDICAL CENTER </option> <option value=" CROSS RIVERS - CALABAR - MT. ZION MEDICAL CENTER "> CROSS RIVERS - CALABAR - MT. ZION MEDICAL CENTER </option> <option value=" CROSS RIVERS - CALABAR - HANNAH FOUNDATION CLINIC & TRAUMA CENTER "> CROSS RIVERS - CALABAR - HANNAH FOUNDATION CLINIC & TRAUMA CENTER </option> <option value=" CROSS RIVERS - CALABAR - CALABAR WOMEN & CHILDREN HOSPITAL "> CROSS RIVERS - CALABAR - CALABAR WOMEN & CHILDREN HOSPITAL </option> <option value=" CROSS RIVERS - CALABAR - LUCIAMA MEMORIAL SPECIALIST HOSPITAL "> CROSS RIVERS - CALABAR - LUCIAMA MEMORIAL SPECIALIST HOSPITAL </option> <option value=" CROSS RIVERS - CALABAR - ARUBAH SPECIALIST HOSPITAL "> CROSS RIVERS - CALABAR - ARUBAH SPECIALIST HOSPITAL </option> <option value=" CROSS RIVERS - IKOM - COUNTY SPECIALIST HOSPITAL "> CROSS RIVERS - IKOM - COUNTY SPECIALIST HOSPITAL </option> <option value=" CROSS RIVERS - OBUBRA - EYABA MEMORIAL CLINIC "> CROSS RIVERS - OBUBRA - EYABA MEMORIAL CLINIC </option> <option value=" CROSS RIVERS - OBUDU - SACRED HEART CATHOLIC HOSPITAL "> CROSS RIVERS - OBUDU - SACRED HEART CATHOLIC HOSPITAL </option> <option value=" CROSS RIVERS - OGADA - EKANA MEDICAL CENTRE, OGADA, OBUBRA "> CROSS RIVERS - OGADA - EKANA MEDICAL CENTRE, OGADA, OBUBRA </option> <option value=" CROSS RIVERS - UGEP - DANEX MEDICAL CENTRE "> CROSS RIVERS - UGEP - DANEX MEDICAL CENTRE </option> <option value=" SOKOTO - SOKOTO - FREEHAND SPECIALIST HOSPITAL "> SOKOTO - SOKOTO - FREEHAND SPECIALIST HOSPITAL </option> <option value=" SOKOTO - SOKOTO - HUSSAINI MEDICAL CENTRE "> SOKOTO - SOKOTO - HUSSAINI MEDICAL CENTRE </option> <option value=" SOKOTO - SOKOTO - MADALLA LAFIYA SPECIAL CLINIC LTD "> SOKOTO - SOKOTO - MADALLA LAFIYA SPECIAL CLINIC LTD </option> <option value=" SOKOTO - SOKOTO - SAHEL SPECIALIST HOSPITAL "> SOKOTO - SOKOTO - SAHEL SPECIALIST HOSPITAL </option> <option value=" SOKOTO - SOKOTO - GASKIYA OPTICAL SERVICES AND EYE CLINIC "> SOKOTO - SOKOTO - GASKIYA OPTICAL SERVICES AND EYE CLINIC </option> <option value=" SOKOTO - SOKOTO - SHEPHERD SPECIALIST CLINIC - SOKOTO "> SOKOTO - SOKOTO - SHEPHERD SPECIALIST CLINIC - SOKOTO </option> <option value=" SOKOTO - SOKOTO - Citi Premier Mother And Child Hospital "> SOKOTO - SOKOTO - Citi Premier Mother And Child Hospital </option> <option value=" SOKOTO - SOKOTO - Gaskiya Optical Services And Eye Clinic "> SOKOTO - SOKOTO - Gaskiya Optical Services And Eye Clinic </option>';
var plnent='<option value=" LAGOS - AJAH - AMARA MEDICARE "> LAGOS - AJAH - AMARA MEDICARE </option> <option value=" LAGOS - IKOYI - AMARA MEDICARE "> LAGOS - IKOYI - AMARA MEDICARE </option>';
var plngoldc='<option value=" LAGOS - FESTAC TOWN - GOLDEN CROSS INFIRMARY (HOSPITAL AND MATERNITY) "> LAGOS - FESTAC TOWN - GOLDEN CROSS INFIRMARY (HOSPITAL AND MATERNITY) </option>';
var plndental='<option value=" LAGOS - AJAH VGC - SMILEY DENTAL CARE, VGC "> LAGOS - AJAH VGC - SMILEY DENTAL CARE, VGC </option> <option value=" LAGOS - ANTHONY VILLAGE - DENTAL PLUS "> LAGOS - ANTHONY VILLAGE - DENTAL PLUS </option> <option value=" LAGOS - FESTAC TOWN - RABBONI DENTAL CLINIC "> LAGOS - FESTAC TOWN - RABBONI DENTAL CLINIC </option> <option value=" LAGOS - IKEJA - MICHEL DENTAL CLINIC "> LAGOS - IKEJA - MICHEL DENTAL CLINIC </option> <option value=" LAGOS - IKEJA - SNOW WHITE DENTAL CLINIC "> LAGOS - IKEJA - SNOW WHITE DENTAL CLINIC </option> <option value=" LAGOS - IKORODU - DIVINE DENTAL HOME "> LAGOS - IKORODU - DIVINE DENTAL HOME </option> <option value=" LAGOS - IKORODU - SOLACE DENTAL CLINIC "> LAGOS - IKORODU - SOLACE DENTAL CLINIC </option> <option value=" LAGOS - IKOYI - AMARA MEDICARE CLINIC "> LAGOS - IKOYI - AMARA MEDICARE CLINIC </option> <option value=" LAGOS - IKOYI - SKKY DENTAL SERVICES LIMITED "> LAGOS - IKOYI - SKKY DENTAL SERVICES LIMITED </option> <option value=" LAGOS - KETU - SOLACE DENTAL CLINICS "> LAGOS - KETU - SOLACE DENTAL CLINICS </option> <option value=" LAGOS - LEKKI - CALENS DENTAL CLINIC "> LAGOS - LEKKI - CALENS DENTAL CLINIC </option> <option value=" LAGOS - LEKKI - CALENS DENTAL CLINIC "> LAGOS - LEKKI - CALENS DENTAL CLINIC </option> <option value=" LAGOS - SURULERE - IWOSAN DENTAL CLINIC "> LAGOS - SURULERE - IWOSAN DENTAL CLINIC </option> <option value=" LAGOS - SURULERE - SMILEY DENTAL CARE, SURULERE "> LAGOS - SURULERE - SMILEY DENTAL CARE, SURULERE </option> <option value=" LAGOS - VGC - AMARA MEDICARE CLINIC "> LAGOS - VGC - AMARA MEDICARE CLINIC </option> <option value=" LAGOS - VICTORIA ISLAND - DENTAL PLUS "> LAGOS - VICTORIA ISLAND - DENTAL PLUS </option> <option value=" LAGOS - VICTORIA ISLAND - DIVINE DENTAL HOME "> LAGOS - VICTORIA ISLAND - DIVINE DENTAL HOME </option> <option value=" OGUN - SANGO -OTA - Smilepride Dental Clinic "> OGUN - SANGO -OTA - Smilepride Dental Clinic </option> <option value=" OYO - AGODI - MODOT DENTAL CLINIC "> OYO - AGODI - MODOT DENTAL CLINIC </option> <option value=" FCT (ABUJA) - WUSE - CALENS DENTAL CLINIC "> FCT (ABUJA) - WUSE - CALENS DENTAL CLINIC </option> <option value=" ENUGU - INDEPENDENCE LAYOUT - PEARL DENTAL CLINIC & BRACES CENTER "> ENUGU - INDEPENDENCE LAYOUT - PEARL DENTAL CLINIC & BRACES CENTER </option> <option value=" RIVERS - D/LINE - ESTEEM DENTAL CLINIC "> RIVERS - D/LINE - ESTEEM DENTAL CLINIC </option>';
var plnoptical='<option value=" LAGOS - AGEGE - HEPHZIBAH EYE CARE "> LAGOS - AGEGE - HEPHZIBAH EYE CARE </option> <option value=" LAGOS - AJAH - HEPHZIBAH EYE CARE "> LAGOS - AJAH - HEPHZIBAH EYE CARE </option> <option value=" LAGOS - AMUWO ODOFIN - HEPHZIBAH EYE CARE "> LAGOS - AMUWO ODOFIN - HEPHZIBAH EYE CARE </option> <option value=" LAGOS - EBUTE METTA - VIEW POINT SPECIALIST EYE CENTRE "> LAGOS - EBUTE METTA - VIEW POINT SPECIALIST EYE CENTRE </option> <option value=" LAGOS - IKEJA - CATHEM EYE CENTRE "> LAGOS - IKEJA - CATHEM EYE CENTRE </option> <option value=" LAGOS - IKEJA - EYESPEC OPTICALS "> LAGOS - IKEJA - EYESPEC OPTICALS </option> <option value=" LAGOS - IKEJA - HEPHZIBAH EYE CARE "> LAGOS - IKEJA - HEPHZIBAH EYE CARE </option> <option value=" LAGOS - IKEJA - PEAK EYE CARE "> LAGOS - IKEJA - PEAK EYE CARE </option> <option value=" LAGOS - IKEJA - PERFECT EYES "> LAGOS - IKEJA - PERFECT EYES </option> <option value=" LAGOS - IKOYI - AMARA MEDICARE "> LAGOS - IKOYI - AMARA MEDICARE </option> <option value=" LAGOS - IKOYI - KRYSTAL OPTICAL LIMITED "> LAGOS - IKOYI - KRYSTAL OPTICAL LIMITED </option> <option value=" LAGOS - IKOYI - ULTIMATE EYE CLINIC "> LAGOS - IKOYI - ULTIMATE EYE CLINIC </option> <option value=" LAGOS - ISOLO - HAVILAH EYE CLINIC & OPTICAL SERVICES LIMITED "> LAGOS - ISOLO - HAVILAH EYE CLINIC & OPTICAL SERVICES LIMITED </option> <option value=" LAGOS - LAGOS ISLAND - FARATORI EYE CENTRE "> LAGOS - LAGOS ISLAND - FARATORI EYE CENTRE </option> <option value=" LAGOS - LAGOS ISLAND - TRUVISION LIMITED "> LAGOS - LAGOS ISLAND - TRUVISION LIMITED </option> <option value=" LAGOS - LEKKI - BOOST OPTICALS LIMITED "> LAGOS - LEKKI - BOOST OPTICALS LIMITED </option> <option value=" LAGOS - LEKKI - PHOENIX EYE CLINIC LTD "> LAGOS - LEKKI - PHOENIX EYE CLINIC LTD </option> <option value=" LAGOS - OGBA - FORST EYE CLINIC & OPTICAL SERVICES "> LAGOS - OGBA - FORST EYE CLINIC & OPTICAL SERVICES </option> <option value=" LAGOS - SANGOTEDO - HEPHZIBAH EYE CARE "> LAGOS - SANGOTEDO - HEPHZIBAH EYE CARE </option> <option value=" LAGOS - SANGOTEDO - PHOENIX EYE CLINIC LTD "> LAGOS - SANGOTEDO - PHOENIX EYE CLINIC LTD </option> <option value=" LAGOS - SURULERE - PHOENIX EYE CLINIC LTD "> LAGOS - SURULERE - PHOENIX EYE CLINIC LTD </option> <option value=" LAGOS - SURULERE - SMILEY OPTICAL SERVICES "> LAGOS - SURULERE - SMILEY OPTICAL SERVICES </option> <option value=" LAGOS - SURULERE - VIEW PLUS OPTICAL LIMITED "> LAGOS - SURULERE - VIEW PLUS OPTICAL LIMITED </option> <option value=" LAGOS - VGC - AMARA MEDICARE "> LAGOS - VGC - AMARA MEDICARE </option> <option value=" LAGOS - VICTORIA ISLAND - HEPHZIBAH EYE CARE "> LAGOS - VICTORIA ISLAND - HEPHZIBAH EYE CARE </option> <option value=" OGUN - ABEOKUTA - METRO EYE CLINIC - ABEOKUTA "> OGUN - ABEOKUTA - METRO EYE CLINIC - ABEOKUTA </option> <option value=" OGUN - AGBARA - FORST EYE CLINIC & OPTICAL SERVICES "> OGUN - AGBARA - FORST EYE CLINIC & OPTICAL SERVICES </option> <option value=" OGUN - IJEBU- ODE - METRO EYE CLINIC, OGUN "> OGUN - IJEBU- ODE - METRO EYE CLINIC, OGUN </option> <option value=" OGUN - SANGO-OTA - Metro Eye Clinic - Ota Ogun State "> OGUN - SANGO-OTA - Metro Eye Clinic - Ota Ogun State </option> <option value=" OYO - OLUYOLE ESTATE - HEPHZIBAH EYE CARE "> OYO - OLUYOLE ESTATE - HEPHZIBAH EYE CARE </option> <option value=" FCT (ABUJA) - JABI - LOCUS EYE CLINIC "> FCT (ABUJA) - JABI - LOCUS EYE CLINIC </option> <option value=" FCT (ABUJA) - WUSE - DE-LENS OPHTHALMICS "> FCT (ABUJA) - WUSE - DE-LENS OPHTHALMICS </option> <option value=" KADUNA - KADUNA - THELISH EYE CLINIC "> KADUNA - KADUNA - THELISH EYE CLINIC </option> <option value=" KADUNA - ZARIA - LORRY B EYE CLINIC "> KADUNA - ZARIA - LORRY B EYE CLINIC </option> <option value=" KANO - GYADI - FIRST OPTICIANS EYE CLINIC "> KANO - GYADI - FIRST OPTICIANS EYE CLINIC </option> <option value=" KANO - KANO - ECWA EYE HOSPITAL "> KANO - KANO - ECWA EYE HOSPITAL </option> <option value=" KANO - KANO - MAKKAH SPECIALIST EYE HOSPITAL "> KANO - KANO - MAKKAH SPECIALIST EYE HOSPITAL </option> <option value=" KANO - KANO - RAYSIGHT EYE CLINIC "> KANO - KANO - RAYSIGHT EYE CLINIC </option> <option value=" KANO - KANO - THE SMILE SHOP LTD "> KANO - KANO - THE SMILE SHOP LTD </option> <option value=" ENUGU - UWANI - NIGER OPTICAL SERVICES co (NIG) LTD "> ENUGU - UWANI - NIGER OPTICAL SERVICES co (NIG) LTD </option> <option value=" DELTA - WARRI - ABELO EYE CLINIC "> DELTA - WARRI - ABELO EYE CLINIC </option> <option value=" AKWA IBOM - UYO - HEPHZIBAH EYE CARE "> AKWA IBOM - UYO - HEPHZIBAH EYE CARE </option>';
//var plnall='<option value=" LAGOS - IKORODU - OAK HOSPITAL "> LAGOS - IKORODU - OAK HOSPITAL </option> <option value=" LAGOS - LAGOS ISLAND - ST. NICHOLAS SPECIALIST HOSPITAL "> LAGOS - LAGOS ISLAND - ST. NICHOLAS SPECIALIST HOSPITAL </option> <option value=" LAGOS - OJODU - ROYAN HOSPITAL "> LAGOS - OJODU - ROYAN HOSPITAL </option> <option value=" LAGOS - SURULERE - HAVANA SPECIALIST HOSPITAL "> LAGOS - SURULERE - HAVANA SPECIALIST HOSPITAL </option> <option value=" LAGOS - VICTORIA ISLAND - BARNES HOSPITAL "> LAGOS - VICTORIA ISLAND - BARNES HOSPITAL </option> <option value=" LAGOS - VICTORIA ISLAND - FAITH CITY HOSPITAL, VICTORIA ISLAND "> LAGOS - VICTORIA ISLAND - FAITH CITY HOSPITAL, VICTORIA ISLAND </option> <option value=" LAGOS - VICTORIA ISLAND - PAELON MEMORIAL CLINIC "> LAGOS - VICTORIA ISLAND - PAELON MEMORIAL CLINIC </option> <option value=" LAGOS - VICTORIA ISLAND - Q - LIFE FAMILY CLINIC "> LAGOS - VICTORIA ISLAND - Q - LIFE FAMILY CLINIC </option> <option value=" LAGOS - VICTORIA ISLAND - RENAISSANCE MEDICAL CENTRE "> LAGOS - VICTORIA ISLAND - RENAISSANCE MEDICAL CENTRE </option> <option value=" LAGOS - VICTORIA ISLAND - SOUTHSHORE WOMEN AND CHILDREN\'S HOSPITAL "> LAGOS - VICTORIA ISLAND - SOUTHSHORE WOMEN AND CHILDREN\'S HOSPITAL </option> <option value=" LAGOS - VICTORIA ISLAND - VICTORIA ISLAND CONSULTANCY & HOSPITAL SERVICES "> LAGOS - VICTORIA ISLAND - VICTORIA ISLAND CONSULTANCY & HOSPITAL SERVICES </option> <option value=" OGUN - SANGO-OTA - ACE MEDICARE CLINICS "> OGUN - SANGO-OTA - ACE MEDICARE CLINICS </option> <option value=" RIVERS - BOROKIRI - STERLING SPECIALIST HOSPITAL "> RIVERS - BOROKIRI - STERLING SPECIALIST HOSPITAL </option> <option value=" RIVERS - ELELENWO - ATINU CRITICAL CARE HOSPITAL "> RIVERS - ELELENWO - ATINU CRITICAL CARE HOSPITAL </option> <option value=" RIVERS - PORT HARCOURT - FIRST RIVERS HOSPITAL "> RIVERS - PORT HARCOURT - FIRST RIVERS HOSPITAL </option> <option value=" RIVERS - RUMUOMASI - SAVE A LIFE MISSION HOSPITAL "> RIVERS - RUMUOMASI - SAVE A LIFE MISSION HOSPITAL </option> <option value=" RIVERS - TRANS AMADI - PRINCESS MEDICAL CENTRE,TRANS AMADI,RIVERS "> RIVERS - TRANS AMADI - PRINCESS MEDICAL CENTRE,TRANS AMADI,RIVERS </option> <option value=" bandb - bandb - bandb "> bandb - bandb - bandb </option> <option value=" LAGOS - AJAH-OLOKUNLA - BUDO SPECIALIST HOSPITAL "> LAGOS - AJAH-OLOKUNLA - BUDO SPECIALIST HOSPITAL </option> <option value=" LAGOS - AJAO ESTATE - KUPA MEDICAL CENTRE LTD. "> LAGOS - AJAO ESTATE - KUPA MEDICAL CENTRE LTD. </option> <option value=" LAGOS - IKEJA - EKO HOSPITAL IKEJA "> LAGOS - IKEJA - EKO HOSPITAL IKEJA </option> <option value=" LAGOS - IKEJA - MOTAYO HOSPITAL LIMITED, IKEJA "> LAGOS - IKEJA - MOTAYO HOSPITAL LIMITED, IKEJA </option> <option value=" LAGOS - IKEJA - MOTHER AND CHILD HOSPITALS "> LAGOS - IKEJA - MOTHER AND CHILD HOSPITALS </option> <option value=" LAGOS - MAGODO - KRYSTAL MEDICAL CENTRE "> LAGOS - MAGODO - KRYSTAL MEDICAL CENTRE </option> <option value=" LAGOS - ONIKAN - OMNI MEDICAL CENTRE "> LAGOS - ONIKAN - OMNI MEDICAL CENTRE </option> <option value=" LAGOS - SURULERE - AVON MEDICAL SERVICES "> LAGOS - SURULERE - AVON MEDICAL SERVICES </option> <option value=" LAGOS - SURULERE - EKO HOSPITAL PLC, SURULERE "> LAGOS - SURULERE - EKO HOSPITAL PLC, SURULERE </option> <option value=" LAGOS - SURULERE - SMITH MEDICAL CENTRE "> LAGOS - SURULERE - SMITH MEDICAL CENTRE </option> <option value=" LAGOS - VICTORIA ISLAND - KLEINBURG HOSPITAL "> LAGOS - VICTORIA ISLAND - KLEINBURG HOSPITAL </option> <option value=" OYO - AKOBO - BANBY SPEC. HOSPITAL "> OYO - AKOBO - BANBY SPEC. HOSPITAL </option> <option value=" FCT (ABUJA) - CENTRAL AREA - LIMI HOSPITAL & MATERNITY LIMITED, ABUJA "> FCT (ABUJA) - CENTRAL AREA - LIMI HOSPITAL & MATERNITY LIMITED, ABUJA </option> <option value=" FCT (ABUJA) - GARKI - ALLIANCE HOSPITAL "> FCT (ABUJA) - GARKI - ALLIANCE HOSPITAL </option> <option value=" FCT (ABUJA) - GARKI - ANGELIC CARE HOSPITAL "> FCT (ABUJA) - GARKI - ANGELIC CARE HOSPITAL </option> <option value=" FCT (ABUJA) - JABI - AREWA SPECIALIST HOSPITAL & DIAGNOSTIC CENTRE MAITAMA "> FCT (ABUJA) - JABI - AREWA SPECIALIST HOSPITAL & DIAGNOSTIC CENTRE MAITAMA </option> <option value=" FCT (ABUJA) - MARARABA - ADONAI HOSPITAL "> FCT (ABUJA) - MARARABA - ADONAI HOSPITAL </option> <option value=" KANO - BOMPAI - DOCTORS CLINIC LTD "> KANO - BOMPAI - DOCTORS CLINIC LTD </option> <option value=" DELTA - ETUWEWE - LILY HOSPITAL "> DELTA - ETUWEWE - LILY HOSPITAL </option> <option value=" DELTA - UGHELI - UFOR HOSPITAL "> DELTA - UGHELI - UFOR HOSPITAL </option> <option value=" AKWA IBOM - EKET - RECOVERYHILL CLINIC INC. "> AKWA IBOM - EKET - RECOVERYHILL CLINIC INC. </option> <option value=" RIVERS - BONNY ISLAND - ST PETERS CLINIC HOSPITAL & MATERNITY "> RIVERS - BONNY ISLAND - ST PETERS CLINIC HOSPITAL & MATERNITY </option> <option value=" RIVERS - PORT HARCOURT - ST. MARTINS HOSPITAL "> RIVERS - PORT HARCOURT - ST. MARTINS HOSPITAL </option> <option value=" bandc - bandc - bandc "> bandc - bandc - bandc </option> <option value=" LAGOS - FESTAC TOWN - EMEL HOSPITALS LIMITED "> LAGOS - FESTAC TOWN - EMEL HOSPITALS LIMITED </option> <option value=" LAGOS - IKOYI - CITIZENS MEDICAL CENTRE "> LAGOS - IKOYI - CITIZENS MEDICAL CENTRE </option> <option value=" LAGOS - IKOYI - DIVINE MEDICAL CENTRE "> LAGOS - IKOYI - DIVINE MEDICAL CENTRE </option> <option value=" LAGOS - ILASAMAJA - MAY CLINICS LIMITED, ISOLO "> LAGOS - ILASAMAJA - MAY CLINICS LIMITED, ISOLO </option> <option value=" LAGOS - ILUPEJU - MAY CLINIC LIMITED, ILUPEJU "> LAGOS - ILUPEJU - MAY CLINIC LIMITED, ILUPEJU </option> <option value=" LAGOS - LEKKI - MAY CLINICS ONIRU LEKKI "> LAGOS - LEKKI - MAY CLINICS ONIRU LEKKI </option> <option value=" LAGOS - OGUDU - MED-IN SPECIALIST HOSPITAL "> LAGOS - OGUDU - MED-IN SPECIALIST HOSPITAL </option> <option value=" LAGOS - SURULERE - AB SPECIALIST HOSPITAL "> LAGOS - SURULERE - AB SPECIALIST HOSPITAL </option> <option value=" FCT (ABUJA) - GARKI - AMANA MEDICAL CENTRE "> FCT (ABUJA) - GARKI - AMANA MEDICAL CENTRE </option> <option value=" IMO - OWERRI - AMANDA HOSPITAL INC. "> IMO - OWERRI - AMANDA HOSPITAL INC. </option> <option value=" DELTA - WARRI - CAPITOL HILL HOSPITAL,WARRI, DELTA "> DELTA - WARRI - CAPITOL HILL HOSPITAL,WARRI, DELTA </option> <option value=" AKWA IBOM - EKET - ROMIVIC SPECIALIST CLINIC "> AKWA IBOM - EKET - ROMIVIC SPECIALIST CLINIC </option> <option value=" RIVERS - D/LINE - PEARL CLINICS AND MATERNITY LTD. PORT HARCOURT "> RIVERS - D/LINE - PEARL CLINICS AND MATERNITY LTD. PORT HARCOURT </option> <option value=" CROSS RIVERS - CALABAR - BAKOR MEDICAL CENTRE "> CROSS RIVERS - CALABAR - BAKOR MEDICAL CENTRE </option> <option value=" CROSS RIVERS - IKOM - BAKOR HOSPITAL "> CROSS RIVERS - IKOM - BAKOR HOSPITAL </option> <option value=" bandd - bandd - bandd "> bandd - bandd - bandd </option> <option value=" LAGOS - ABULE EGBA - GUARDIAN HEALTH HOSPITAL "> LAGOS - ABULE EGBA - GUARDIAN HEALTH HOSPITAL </option> <option value=" LAGOS - ABULE-EGBA - STANDARD LIFE CARE HOSPITAL "> LAGOS - ABULE-EGBA - STANDARD LIFE CARE HOSPITAL </option> <option value=" LAGOS - AGEGE - MUCAS HOSPITAL LIMITED "> LAGOS - AGEGE - MUCAS HOSPITAL LIMITED </option> <option value=" LAGOS - AJAH - THE FIRST GRACELAND HOSPITAL "> LAGOS - AJAH - THE FIRST GRACELAND HOSPITAL </option> <option value=" LAGOS - AJAH - THE ROYAL INFIRMARY HOSPITAL "> LAGOS - AJAH - THE ROYAL INFIRMARY HOSPITAL </option> <option value=" LAGOS - AJAH-OLOKUNLA - J-RAPHA CLINIC,AJAH,LAGOS "> LAGOS - AJAH-OLOKUNLA - J-RAPHA CLINIC,AJAH,LAGOS </option> <option value=" LAGOS - AJAH-OLOKUNLA - LENNOX HOSPITAL "> LAGOS - AJAH-OLOKUNLA - LENNOX HOSPITAL </option> <option value=" LAGOS - AJAO ESTATE - HEDA HOSPITAL "> LAGOS - AJAO ESTATE - HEDA HOSPITAL </option> <option value=" LAGOS - AKOWONJO - BEE HESS HOSPITAL "> LAGOS - AKOWONJO - BEE HESS HOSPITAL </option> <option value=" LAGOS - AKOWONJO - CRYSTAL SPECIALIST HOSPITAL "> LAGOS - AKOWONJO - CRYSTAL SPECIALIST HOSPITAL </option> <option value=" LAGOS - ALAGBADO - PAULATE HOSPITAL "> LAGOS - ALAGBADO - PAULATE HOSPITAL </option> <option value=" LAGOS - ALAKUKO - JEFIS SPECIALIST HOSPITAL LTD "> LAGOS - ALAKUKO - JEFIS SPECIALIST HOSPITAL LTD </option> <option value=" LAGOS - ALIMOSHO - LIGHT HOSPITAL & MATERNITY HOME LTD "> LAGOS - ALIMOSHO - LIGHT HOSPITAL & MATERNITY HOME LTD </option> <option value=" LAGOS - ALIMOSHO - LOTA MEDICAL CENTRE "> LAGOS - ALIMOSHO - LOTA MEDICAL CENTRE </option> <option value=" LAGOS - ALIMOSHO-EGBE - OOHBEE HOSPITAL "> LAGOS - ALIMOSHO-EGBE - OOHBEE HOSPITAL </option> <option value=" LAGOS - AMUWO ODOFIN - AMUWO MEDICAL CENTRE "> LAGOS - AMUWO ODOFIN - AMUWO MEDICAL CENTRE </option> <option value=" LAGOS - APAPA - ST LOUIS MEDICAL CENTRE "> LAGOS - APAPA - ST LOUIS MEDICAL CENTRE </option> <option value=" LAGOS - APAPA-OLODI - DAKO MEDICAL CENTRE "> LAGOS - APAPA-OLODI - DAKO MEDICAL CENTRE </option> <option value=" LAGOS - APAPA-OLODI - PATOL MEDICAL SERVICES "> LAGOS - APAPA-OLODI - PATOL MEDICAL SERVICES </option> <option value=" LAGOS - BADAGRY - APPLEYARD MEDICAL CENTRE "> LAGOS - BADAGRY - APPLEYARD MEDICAL CENTRE </option> <option value=" LAGOS - BADAGRY - CARE GIVERS HOSPITAL "> LAGOS - BADAGRY - CARE GIVERS HOSPITAL </option> <option value=" LAGOS - BADAGRY - IBIJOLA MEDICAL CENTRE (SPECIALIST CLINIC) "> LAGOS - BADAGRY - IBIJOLA MEDICAL CENTRE (SPECIALIST CLINIC) </option> <option value=" LAGOS - DOPEMU - SANTOS MEDICAL CENTRE "> LAGOS - DOPEMU - SANTOS MEDICAL CENTRE </option> <option value=" LAGOS - DOPEMU/AGEGE - PROMISE HOSPITAL "> LAGOS - DOPEMU/AGEGE - PROMISE HOSPITAL </option> <option value=" LAGOS - EPE - TRUE CARE MODEL HOSPITAL "> LAGOS - EPE - TRUE CARE MODEL HOSPITAL </option> <option value=" LAGOS - FAGBA-IJU - AYODELE MEDICAL CENTRE "> LAGOS - FAGBA-IJU - AYODELE MEDICAL CENTRE </option> <option value=" LAGOS - FESTAC TOWN - BETHSEDA FAMILY CLINIC "> LAGOS - FESTAC TOWN - BETHSEDA FAMILY CLINIC </option> <option value=" LAGOS - FESTAC TOWN - ST. JUDES HOSPITAL "> LAGOS - FESTAC TOWN - ST. JUDES HOSPITAL </option> <option value=" LAGOS - GBAGADA - ANIYUN HOSPITALS LIMITED "> LAGOS - GBAGADA - ANIYUN HOSPITALS LIMITED </option> <option value=" LAGOS - GBAGADA - R-JOLAD HOSPITAL NIGERIA LIMITED "> LAGOS - GBAGADA - R-JOLAD HOSPITAL NIGERIA LIMITED </option> <option value=" LAGOS - IBA - CARES AND CARES HOSPITAL "> LAGOS - IBA - CARES AND CARES HOSPITAL </option> <option value=" LAGOS - IFAKO-IJAIYE - AB10 SPECIALIST HOSPITAL "> LAGOS - IFAKO-IJAIYE - AB10 SPECIALIST HOSPITAL </option> <option value=" LAGOS - IJAIYE-OJOKORO - LONGING MEDICAL CENTRE HOSPITAL & MATERNITY "> LAGOS - IJAIYE-OJOKORO - LONGING MEDICAL CENTRE HOSPITAL & MATERNITY </option> <option value=" LAGOS - IJEGUN - D-BETTER LIFE HOSPITAL "> LAGOS - IJEGUN - D-BETTER LIFE HOSPITAL </option> <option value=" LAGOS - IJU-ISHAGA - DEJI CLINICS "> LAGOS - IJU-ISHAGA - DEJI CLINICS </option> <option value=" LAGOS - IJU-ISHAGA - OSUNTUYI MEDICAL CENTRE, IJU "> LAGOS - IJU-ISHAGA - OSUNTUYI MEDICAL CENTRE, IJU </option> <option value=" LAGOS - IKEJA - IKEJA MEDICAL CENTRE "> LAGOS - IKEJA - IKEJA MEDICAL CENTRE </option> <option value=" LAGOS - IKEJA - THE TMAC SPECIALIST HOSPITAL "> LAGOS - IKEJA - THE TMAC SPECIALIST HOSPITAL </option> <option value=" LAGOS - IKEJA - TRIUMPH MEDICAL CENTRE "> LAGOS - IKEJA - TRIUMPH MEDICAL CENTRE </option> <option value=" LAGOS - IKEJA - ZOE MEDICAL CENTRE "> LAGOS - IKEJA - ZOE MEDICAL CENTRE </option> <option value=" LAGOS - IKORODU - BIDEMS VICTORY HOSPITAL & DIAGNOSTICS CENTRE "> LAGOS - IKORODU - BIDEMS VICTORY HOSPITAL & DIAGNOSTICS CENTRE </option> <option value=" LAGOS - IKORODU - BOLAKUNMI-IDOWU MEMORIAL MEDICAL CENTRE "> LAGOS - IKORODU - BOLAKUNMI-IDOWU MEMORIAL MEDICAL CENTRE </option> <option value=" LAGOS - IKORODU - BRONILA MEDICAL CENTRE "> LAGOS - IKORODU - BRONILA MEDICAL CENTRE </option> <option value=" LAGOS - IKORODU - HOLYFILL HOSPITAL "> LAGOS - IKORODU - HOLYFILL HOSPITAL </option> <option value=" LAGOS - IKORODU - ST RAPHAEL DIVINE MERCY SPECIALIST HOSPITAL "> LAGOS - IKORODU - ST RAPHAEL DIVINE MERCY SPECIALIST HOSPITAL </option> <option value=" LAGOS - IKORODU - THE EXCELLENCE HOSPITAL "> LAGOS - IKORODU - THE EXCELLENCE HOSPITAL </option> <option value=" LAGOS - IKOTUN - BROAD HOSPITAL & MATERNITY HOME "> LAGOS - IKOTUN - BROAD HOSPITAL & MATERNITY HOME </option> <option value=" LAGOS - IKOTUN - MT. SINAI HOSPITAL, IKOTUN EGBE "> LAGOS - IKOTUN - MT. SINAI HOSPITAL, IKOTUN EGBE </option> <option value=" LAGOS - IKOTUN - SUBOL HOSPITAL "> LAGOS - IKOTUN - SUBOL HOSPITAL </option> <option value=" LAGOS - IPAJA - SOLAD MEDICAL CENTRE & MATERNITY HOSPITAL "> LAGOS - IPAJA - SOLAD MEDICAL CENTRE & MATERNITY HOSPITAL </option> <option value=" LAGOS - ISHERI-OSUN - D-BETTER LIFE HOSPITAL "> LAGOS - ISHERI-OSUN - D-BETTER LIFE HOSPITAL </option> <option value=" LAGOS - ISOLO - HEALS SPECIALIST CLINIC "> LAGOS - ISOLO - HEALS SPECIALIST CLINIC </option> <option value=" LAGOS - IYANA IPAJA - FAITH-HILLS SPECIALIST HOSPITAL "> LAGOS - IYANA IPAJA - FAITH-HILLS SPECIALIST HOSPITAL </option> <option value=" LAGOS - IYANA-IPAJA - VETA HOSPITALS LIMITED "> LAGOS - IYANA-IPAJA - VETA HOSPITALS LIMITED </option> <option value=" LAGOS - KETU - DELTA-CROWN HOSPITAL AND MATERNITY HOME "> LAGOS - KETU - DELTA-CROWN HOSPITAL AND MATERNITY HOME </option> <option value=" LAGOS - KETU- IKOSI - ELEGBELEYE SPECIALIST HOSPITAL "> LAGOS - KETU- IKOSI - ELEGBELEYE SPECIALIST HOSPITAL </option> <option value=" LAGOS - KETU-ALAPERE - DEJI CLINICS "> LAGOS - KETU-ALAPERE - DEJI CLINICS </option> <option value=" LAGOS - LEKKI - FIRST CITY DIAGNOSTICS HOSPITAL "> LAGOS - LEKKI - FIRST CITY DIAGNOSTICS HOSPITAL </option> <option value=" LAGOS - MAGODO - QUEENS SPECIALIST HOSPITAL "> LAGOS - MAGODO - QUEENS SPECIALIST HOSPITAL </option> <option value=" LAGOS - MAGODO-ISHERI - SAMA CLINIC "> LAGOS - MAGODO-ISHERI - SAMA CLINIC </option> <option value=" LAGOS - MARYLAND - CHION FAMILY MEDICAL CENTRE "> LAGOS - MARYLAND - CHION FAMILY MEDICAL CENTRE </option> <option value=" LAGOS - MIERAN IJAYE - ABS MEDICARE CENTRE "> LAGOS - MIERAN IJAYE - ABS MEDICARE CENTRE </option> <option value=" LAGOS - MUSHIN - BRODIE-MENDS HOSPITAL "> LAGOS - MUSHIN - BRODIE-MENDS HOSPITAL </option> <option value=" LAGOS - MUSHIN - OLANIBA MEMORIAL SPECIALIST HOSPITAL MUSHIN "> LAGOS - MUSHIN - OLANIBA MEMORIAL SPECIALIST HOSPITAL MUSHIN </option> <option value=" LAGOS - OBANIKORO - OSUNTUYI MEDICAL CENTRE, OBANIKORO "> LAGOS - OBANIKORO - OSUNTUYI MEDICAL CENTRE, OBANIKORO </option> <option value=" LAGOS - OGBA - COUNTY HOSPITAL "> LAGOS - OGBA - COUNTY HOSPITAL </option> <option value=" LAGOS - OGBA - FANIMED HOSPITAL "> LAGOS - OGBA - FANIMED HOSPITAL </option> <option value=" LAGOS - OJODU - ALHERI HOSPITAL, LAGOS "> LAGOS - OJODU - ALHERI HOSPITAL, LAGOS </option> <option value=" LAGOS - OJOKORO - LEX MEDICAL CENTRE "> LAGOS - OJOKORO - LEX MEDICAL CENTRE </option> <option value=" LAGOS - OKERUBE-IKOTUN - D-BETTER LIFE HOSPITAL "> LAGOS - OKERUBE-IKOTUN - D-BETTER LIFE HOSPITAL </option> <option value=" LAGOS - OKOKOMAIKO - KILADEJO HOSPITAL & SPECIALIST CLINICS "> LAGOS - OKOKOMAIKO - KILADEJO HOSPITAL & SPECIALIST CLINICS </option> <option value=" LAGOS - OKOKOMAIKO - ST ANTHONYS MEDICAL CENTRE & MATERNITY HOME "> LAGOS - OKOKOMAIKO - ST ANTHONYS MEDICAL CENTRE & MATERNITY HOME </option> <option value=" LAGOS - OKOTA - ALBERTO CLINICS ( FORMER GERMAN FRIENDSHIP SPECIALIST CLINIC) "> LAGOS - OKOTA - ALBERTO CLINICS ( FORMER GERMAN FRIENDSHIP SPECIALIST CLINIC) </option> <option value=" LAGOS - OKOTA - ST. RAPHAEL HOSPITAL "> LAGOS - OKOTA - ST. RAPHAEL HOSPITAL </option> <option value=" LAGOS - ORILE - HIS STRIPE SPECIALIST HOSPITAL "> LAGOS - ORILE - HIS STRIPE SPECIALIST HOSPITAL </option> <option value=" LAGOS - OSHODI - DIALYZER MEDICAL CENTRE "> LAGOS - OSHODI - DIALYZER MEDICAL CENTRE </option> <option value=" LAGOS - SHOMOLU - MEDOL CONSULTANT CLINIC LIMITED "> LAGOS - SHOMOLU - MEDOL CONSULTANT CLINIC LIMITED </option> <option value=" LAGOS - SURULERE - GOOD TIDINGS HOSPITAL "> LAGOS - SURULERE - GOOD TIDINGS HOSPITAL </option> <option value=" LAGOS - SURULERE - MERCY THOMAS OREDUGBA HOSPITAL "> LAGOS - SURULERE - MERCY THOMAS OREDUGBA HOSPITAL </option> <option value=" LAGOS - SURULERE - MOUNT SINAI HOSPITAL, SURULERE "> LAGOS - SURULERE - MOUNT SINAI HOSPITAL, SURULERE </option> <option value=" LAGOS - SURULERE - OLANIBA MEMORIAL SPECIALIST HOSPITAL SURULERE "> LAGOS - SURULERE - OLANIBA MEMORIAL SPECIALIST HOSPITAL SURULERE </option> <option value=" LAGOS - SURULERE - ROYAL PINNACLE CLINIC "> LAGOS - SURULERE - ROYAL PINNACLE CLINIC </option> <option value=" LAGOS - YABA - COTTAGE MEDICARE HOSPITAL "> LAGOS - YABA - COTTAGE MEDICARE HOSPITAL </option> <option value=" OGUN - ABEOKUTA - JOSEPH AND CHRISTIANAH SPECIALIST HOSPITAL "> OGUN - ABEOKUTA - JOSEPH AND CHRISTIANAH SPECIALIST HOSPITAL </option> <option value=" OGUN - AGBARA - IBIJOLA MEDICAL CENTRE( SPECIALIST CLINIC) "> OGUN - AGBARA - IBIJOLA MEDICAL CENTRE( SPECIALIST CLINIC) </option> <option value=" OGUN - AGBARA - IBIJOLA MEDICAL CENTRE( SPECIALIST CLINIC) "> OGUN - AGBARA - IBIJOLA MEDICAL CENTRE( SPECIALIST CLINIC) </option> <option value=" OGUN - AGBARA - ROPHE MEDICAL CENTRE "> OGUN - AGBARA - ROPHE MEDICAL CENTRE </option> <option value=" OGUN - AKUTE - BALDA HOSPITAL AND MATERNITY HOME "> OGUN - AKUTE - BALDA HOSPITAL AND MATERNITY HOME </option> <option value=" OGUN - AREPO - BEACHLAND SPECIALIST HOSPITAL "> OGUN - AREPO - BEACHLAND SPECIALIST HOSPITAL </option> <option value=" OGUN - AREPO - ROA SPECIALIST HOSPITAL "> OGUN - AREPO - ROA SPECIALIST HOSPITAL </option> <option value=" OGUN - IDIROKO - CENTRAL SPECIALIST HOSPITAL "> OGUN - IDIROKO - CENTRAL SPECIALIST HOSPITAL </option> <option value=" OGUN - MOWE - LANTOS SPECIALIST HOSPITAL "> OGUN - MOWE - LANTOS SPECIALIST HOSPITAL </option> <option value=" OGUN - MOWE - SPRINGHILL HOSPITAL "> OGUN - MOWE - SPRINGHILL HOSPITAL </option> <option value=" OGUN - OTA - HETTA MEDICAL CENTRE "> OGUN - OTA - HETTA MEDICAL CENTRE </option> <option value=" OGUN - SAGAMU - ALPHA CLINIC, SAGAMU "> OGUN - SAGAMU - ALPHA CLINIC, SAGAMU </option> <option value=" OGUN - SAGAMU - AYOTOLA SPECIALIST HOSPITAL "> OGUN - SAGAMU - AYOTOLA SPECIALIST HOSPITAL </option> <option value=" OGUN - SAGAMU - EL-BETHEL MEDICAL "> OGUN - SAGAMU - EL-BETHEL MEDICAL </option> <option value=" OGUN - SAGAMU - Idera Hospital And Trauma Centre "> OGUN - SAGAMU - Idera Hospital And Trauma Centre </option> <option value=" OGUN - SAGAMU - IMPERIAL MEDICARE & CONSULTANCY SERVICES "> OGUN - SAGAMU - IMPERIAL MEDICARE & CONSULTANCY SERVICES </option> <option value=" OGUN - SAGAMU - MEDYTOP SPECIALIST HOSPITAL "> OGUN - SAGAMU - MEDYTOP SPECIALIST HOSPITAL </option> <option value=" OGUN - SAGAMU - Owokoniran Memorial Hospital "> OGUN - SAGAMU - Owokoniran Memorial Hospital </option> <option value=" OGUN - SAGAMU - REDEMPTION HOSPITAL "> OGUN - SAGAMU - REDEMPTION HOSPITAL </option> <option value=" OGUN - SAGAMU - TWINS SPECIALIST CLINIC "> OGUN - SAGAMU - TWINS SPECIALIST CLINIC </option> <option value=" OGUN - SANGO-OTA - PROMISE HOSPITAL "> OGUN - SANGO-OTA - PROMISE HOSPITAL </option> <option value=" OGUN - SANGO-OTA - SHIRISH CLINIC "> OGUN - SANGO-OTA - SHIRISH CLINIC </option> <option value=" OGUN - SANGO-OTA - ST. Shiloh Medical Centre "> OGUN - SANGO-OTA - ST. Shiloh Medical Centre </option> <option value=" OYO - IBADAN - CAMARIA HOSPITAL "> OYO - IBADAN - CAMARIA HOSPITAL </option> <option value=" OYO - IBADAN - EL-ROPHI HOSPITAL "> OYO - IBADAN - EL-ROPHI HOSPITAL </option> <option value=" OYO - IBADAN - LANARK SPECIALIST HOSPITAL "> OYO - IBADAN - LANARK SPECIALIST HOSPITAL </option> <option value=" OYO - IBADAN - OKE ADO HOSPITAL "> OYO - IBADAN - OKE ADO HOSPITAL </option> <option value=" OYO - IBADAN - T.Z. MEDICAL CENTRE,IBADAN,OYO "> OYO - IBADAN - T.Z. MEDICAL CENTRE,IBADAN,OYO </option> <option value=" OYO - IBADAN - TEJU SPECIALIST HOSPITAL "> OYO - IBADAN - TEJU SPECIALIST HOSPITAL </option> <option value=" OYO - ISEYIN - OUR LADY S CATHOLIC HOSPITAL "> OYO - ISEYIN - OUR LADY S CATHOLIC HOSPITAL </option> <option value=" OYO - OGBOMOSHO - BOWEN UNIVERSITY TEACHING HOSPITAL "> OYO - OGBOMOSHO - BOWEN UNIVERSITY TEACHING HOSPITAL </option> <option value=" OYO - OWODE - SHEKINAH MEDICAL CENTRE "> OYO - OWODE - SHEKINAH MEDICAL CENTRE </option> <option value=" OYO - OYO - MOMOH MEMORIAL HOSPITAL "> OYO - OYO - MOMOH MEMORIAL HOSPITAL </option> <option value=" OYO - OYO - PEAMAK HOSPITAL "> OYO - OYO - PEAMAK HOSPITAL </option> <option value=" OYO - SAKI - BAPTIST MEDICAL CENTRE "> OYO - SAKI - BAPTIST MEDICAL CENTRE </option> <option value=" OSUN - IKIRUN - SPRING HOPE SPECIALIST HOSPITAL "> OSUN - IKIRUN - SPRING HOPE SPECIALIST HOSPITAL </option> <option value=" OSUN - IKIRUN - TITILOPE MEDICAL CENTRE "> OSUN - IKIRUN - TITILOPE MEDICAL CENTRE </option> <option value=" OSUN - ILE-IFE - APEX MEDICAL CENTRE "> OSUN - ILE-IFE - APEX MEDICAL CENTRE </option> <option value=" OSUN - ILESA - HOLY TRINITY HOSPITAL LTD. "> OSUN - ILESA - HOLY TRINITY HOSPITAL LTD. </option> <option value=" OSUN - IPETUMODU - OUR LADY OF LOURDES CATHOLIC HOSPITAL "> OSUN - IPETUMODU - OUR LADY OF LOURDES CATHOLIC HOSPITAL </option> <option value=" OSUN - OSOGBO - EMMANUEL MEDICAL CENTRE "> OSUN - OSOGBO - EMMANUEL MEDICAL CENTRE </option> <option value=" OSUN - OSOGBO - ONWARD SPECIALIST HOSPITAL "> OSUN - OSOGBO - ONWARD SPECIALIST HOSPITAL </option> <option value=" OSUN - OSOGBO - OUR LADY OF FATIMA CATHOLIC HOSPITAL "> OSUN - OSOGBO - OUR LADY OF FATIMA CATHOLIC HOSPITAL </option> <option value=" ONDO - AKURE - FIRST MERCY SPECIALIST HOSPITAL LIMITED "> ONDO - AKURE - FIRST MERCY SPECIALIST HOSPITAL LIMITED </option> <option value=" ONDO - AKURE - HOPELAND SPECIALIST MEDICAL CENTRE "> ONDO - AKURE - HOPELAND SPECIALIST MEDICAL CENTRE </option> <option value=" ONDO - IKARE-AKOKO - INLAND MEDICAL CENTRE "> ONDO - IKARE-AKOKO - INLAND MEDICAL CENTRE </option> <option value=" ONDO - AKURE - JOE JANE MEDICAL CENTRE "> ONDO - AKURE - JOE JANE MEDICAL CENTRE </option> <option value=" EKITI - ADO EKITI - AFOLABI HOSPITAL "> EKITI - ADO EKITI - AFOLABI HOSPITAL </option> <option value=" EKITI - ADO EKITI - ALAAFIA HOSPITAL "> EKITI - ADO EKITI - ALAAFIA HOSPITAL </option> <option value=" EKITI - ADO EKITI - GILEAD SPECIALIST HOSPITAL "> EKITI - ADO EKITI - GILEAD SPECIALIST HOSPITAL </option> <option value=" EKITI - ADO EKITI - OLIVES SPECIALIST CLINICS & FERTILITY CENTRE LTD "> EKITI - ADO EKITI - OLIVES SPECIALIST CLINICS & FERTILITY CENTRE LTD </option> <option value=" EKITI - ARAMOKO - ADEBAYO MEDICAL CLINIC "> EKITI - ARAMOKO - ADEBAYO MEDICAL CLINIC </option> <option value=" EKITI - EMURE - ORE-OFE MATERNITY & MEDICAL CENTRE "> EKITI - EMURE - ORE-OFE MATERNITY & MEDICAL CENTRE </option> <option value=" EKITI - IDO-EKITI - FOLASADE CLINIC "> EKITI - IDO-EKITI - FOLASADE CLINIC </option> <option value=" EKITI - ILA-ORANGUN - HOPE MEDICAL CENTRE & MATERNITY "> EKITI - ILA-ORANGUN - HOPE MEDICAL CENTRE & MATERNITY </option> <option value=" KWARA - ILORIN - OLANREWAJU HOSPITAL "> KWARA - ILORIN - OLANREWAJU HOSPITAL </option> <option value=" KWARA - ILORIN - OLAOLU HOSPITAL "> KWARA - ILORIN - OLAOLU HOSPITAL </option> <option value=" KWARA - ILORIN - SADIKU HOSPITAL "> KWARA - ILORIN - SADIKU HOSPITAL </option> <option value=" KWARA - OFFA - OLALOMI HOSPITAL "> KWARA - OFFA - OLALOMI HOSPITAL </option> <option value=" KWARA - OMU-ARAN - AJISAFE HOSPITAL "> KWARA - OMU-ARAN - AJISAFE HOSPITAL </option> <option value=" KWARA - OMU-ARAN - LANDMARK UNIVERSITY MEDICAL CENTRE "> KWARA - OMU-ARAN - LANDMARK UNIVERSITY MEDICAL CENTRE </option> <option value=" FCT (ABUJA) - APO - ROUZ HOSPITAL & MATERNITY "> FCT (ABUJA) - APO - ROUZ HOSPITAL & MATERNITY </option> <option value=" FCT (ABUJA) - GARKI - SYBRON MEDICAL CENTRE LTD. "> FCT (ABUJA) - GARKI - SYBRON MEDICAL CENTRE LTD. </option> <option value=" FCT (ABUJA) - GWAGWALADA - JERAB HOSPITALS "> FCT (ABUJA) - GWAGWALADA - JERAB HOSPITALS </option> <option value=" FCT (ABUJA) - GWARIMPA - PRIMECARE MULTISPECIALTY HOSPITAL "> FCT (ABUJA) - GWARIMPA - PRIMECARE MULTISPECIALTY HOSPITAL </option> <option value=" FCT (ABUJA) - LUGBE - STANDARD CARE HOSPITAL & MATERNITY "> FCT (ABUJA) - LUGBE - STANDARD CARE HOSPITAL & MATERNITY </option> <option value=" FCT (ABUJA) - LUGBE - JOJO HOSPITAL LTD "> FCT (ABUJA) - LUGBE - JOJO HOSPITAL LTD </option> <option value=" FCT (ABUJA) - WUSE 2 - KOLSTAF MEDICAL CENTRE "> FCT (ABUJA) - WUSE 2 - KOLSTAF MEDICAL CENTRE </option> <option value=" NASSARAWA - AKWANGA - ROYAL HOSPITAL "> NASSARAWA - AKWANGA - ROYAL HOSPITAL </option> <option value=" NASSARAWA - DOGO ROAD - ALPHA HOSPITAL, NASSARAWA "> NASSARAWA - DOGO ROAD - ALPHA HOSPITAL, NASSARAWA </option> <option value=" NASSARAWA - KEFFI - NAGARI ALLAH MAGANI HOSPITAL "> NASSARAWA - KEFFI - NAGARI ALLAH MAGANI HOSPITAL </option> <option value=" NASSARAWA - KEFFI - NASARA HOSPITAL & MATERNITY - KEFFI "> NASSARAWA - KEFFI - NASARA HOSPITAL & MATERNITY - KEFFI </option> <option value=" NASSARAWA - LAFIA - AGU HOSPITAL - LAFIA "> NASSARAWA - LAFIA - AGU HOSPITAL - LAFIA </option> <option value=" NASSARAWA - LAFIA - DALHATU ARAF SPECIALIST HOSPITAL "> NASSARAWA - LAFIA - DALHATU ARAF SPECIALIST HOSPITAL </option> <option value=" BENUE - GBOKO - BAKI CLINIC & MATERNITY CENTRE "> BENUE - GBOKO - BAKI CLINIC & MATERNITY CENTRE </option> <option value=" BENUE - GBOKO - MYOM HOSPITAL "> BENUE - GBOKO - MYOM HOSPITAL </option> <option value=" BENUE - MAKURDI - FAMILY PRACTICE HOSPITAL "> BENUE - MAKURDI - FAMILY PRACTICE HOSPITAL </option> <option value=" BENUE - MAKURDI - HOSPITAL OF IMMACULATE CONCEPTION "> BENUE - MAKURDI - HOSPITAL OF IMMACULATE CONCEPTION </option> <option value=" BENUE - OTUKPO - ST. DANIEL HOSPITAL "> BENUE - OTUKPO - ST. DANIEL HOSPITAL </option> <option value=" NIGER - BIDA - YEBOSOKO SPECIALIST HOSPITAL "> NIGER - BIDA - YEBOSOKO SPECIALIST HOSPITAL </option> <option value=" NIGER - MINNA - STANDARD HOSPITAL & DIAGNOSTIC CENTRE, MINNA. "> NIGER - MINNA - STANDARD HOSPITAL & DIAGNOSTIC CENTRE, MINNA. </option> <option value=" NIGER - SULEJA - SUZAN MEMORIAL CLINIC & MATERNITY "> NIGER - SULEJA - SUZAN MEMORIAL CLINIC & MATERNITY </option> <option value=" NIGER - SULEJA - LIBERTY HOSPITAL - NIGER STATE "> NIGER - SULEJA - LIBERTY HOSPITAL - NIGER STATE </option> <option value=" KOGI - AYINGBA - BLUE HOUSE HOSPITAL "> KOGI - AYINGBA - BLUE HOUSE HOSPITAL </option> <option value=" KOGI - AYINGBA - PEACE HOSPITAL "> KOGI - AYINGBA - PEACE HOSPITAL </option> <option value=" KOGI - INOZIOMI - OYIZA HOSPITAL "> KOGI - INOZIOMI - OYIZA HOSPITAL </option> <option value=" KOGI - LOKOJA - NIGER HOSPITAL,KOGI "> KOGI - LOKOJA - NIGER HOSPITAL,KOGI </option> <option value=" KOGI - LOKOJA - POLY HOSPITAL & MATERNITY HOME "> KOGI - LOKOJA - POLY HOSPITAL & MATERNITY HOME </option> <option value=" KADUNA - ABAKPA - GIWA HOSPITAL & SPECIALIST CLINIC "> KADUNA - ABAKPA - GIWA HOSPITAL & SPECIALIST CLINIC </option> <option value=" KADUNA - BARNAWA GRA - HARMONY HOSPITAL LIMITED - KADUNA "> KADUNA - BARNAWA GRA - HARMONY HOSPITAL LIMITED - KADUNA </option> <option value=" KADUNA - BARNAWA GRA - EPSILON SPECIALIST HOSPITAL "> KADUNA - BARNAWA GRA - EPSILON SPECIALIST HOSPITAL </option> <option value=" KADUNA - KACHIA - MC ROYAL HOSPITAL "> KADUNA - KACHIA - MC ROYAL HOSPITAL </option> <option value=" KADUNA - KADUNA - ABI CLINIC & HOSPITAL "> KADUNA - KADUNA - ABI CLINIC & HOSPITAL </option> <option value=" KADUNA - KADUNA - ALBA CLINICS & MEDICAL CENTRE "> KADUNA - KADUNA - ALBA CLINICS & MEDICAL CENTRE </option> <option value=" KADUNA - KADUNA - MANEKS HOSPITAL LIMITED "> KADUNA - KADUNA - MANEKS HOSPITAL LIMITED </option> <option value=" KADUNA - KADUNA - SEFA HOSPITAL "> KADUNA - KADUNA - SEFA HOSPITAL </option> <option value=" KADUNA - KADUNA - THE CHASEL HOSPITAL "> KADUNA - KADUNA - THE CHASEL HOSPITAL </option> <option value=" KADUNA - KADUNA - GARKUWA SPECIALIST HOSPITAL "> KADUNA - KADUNA - GARKUWA SPECIALIST HOSPITAL </option> <option value=" KADUNA - KADUNA - MT. HOREB SPECIALIST HOSPITAL LTD - KADUNA "> KADUNA - KADUNA - MT. HOREB SPECIALIST HOSPITAL LTD - KADUNA </option> <option value=" KADUNA - KADUNA - THE CHASEL HOSPITAL "> KADUNA - KADUNA - THE CHASEL HOSPITAL </option> <option value=" KADUNA - KADUNA - ABI CLINIC & HOSPITAL "> KADUNA - KADUNA - ABI CLINIC & HOSPITAL </option> <option value=" KADUNA - KADUNA - MOUFAY CLINICS "> KADUNA - KADUNA - MOUFAY CLINICS </option> <option value=" KADUNA - KADUNA - RIMI CLINIC "> KADUNA - KADUNA - RIMI CLINIC </option> <option value=" KADUNA - KADUNA - AMINA HOSPITAL "> KADUNA - KADUNA - AMINA HOSPITAL </option> <option value=" KADUNA - KADUNA - GILTOOE ARIS SPECIALIST HOSPITAL "> KADUNA - KADUNA - GILTOOE ARIS SPECIALIST HOSPITAL </option> <option value=" KADUNA - KADUNA - ISHAKU HOSPITAL - KADUNA "> KADUNA - KADUNA - ISHAKU HOSPITAL - KADUNA </option> <option value=" KADUNA - KADUNA - MENDS HOSPITAL "> KADUNA - KADUNA - MENDS HOSPITAL </option> <option value=" KADUNA - KADUNA - SALVATION HOSPITAL - KADUNA "> KADUNA - KADUNA - SALVATION HOSPITAL - KADUNA </option> <option value=" KADUNA - KADUNA - ST. GERALD\'S CATHOLIC HOSPITAL "> KADUNA - KADUNA - ST. GERALD\'S CATHOLIC HOSPITAL </option> <option value=" KADUNA - KADUNA - TIM UNITY SPECIALIST HOSPITAL "> KADUNA - KADUNA - TIM UNITY SPECIALIST HOSPITAL </option> <option value=" KADUNA - KADUNA - GARDEN CITY SPECIALIST HOSPITAL "> KADUNA - KADUNA - GARDEN CITY SPECIALIST HOSPITAL </option> <option value=" KADUNA - KADUNA - OUTFIT HOSPITAL "> KADUNA - KADUNA - OUTFIT HOSPITAL </option> <option value=" KADUNA - KAFANCHAN - SIR PATRICK IBRAHIM YAKOWA MEMORIAL HOSPITAL (SPIYM) "> KADUNA - KAFANCHAN - SIR PATRICK IBRAHIM YAKOWA MEMORIAL HOSPITAL (SPIYM) </option> <option value=" KADUNA - KAFANCHAN - SALEM MEDICAL CENTRE "> KADUNA - KAFANCHAN - SALEM MEDICAL CENTRE </option> <option value=" KADUNA - KAFANCHAN - NEW ERA HOSPITAL & MATERNITY, KAFANCHAN "> KADUNA - KAFANCHAN - NEW ERA HOSPITAL & MATERNITY, KAFANCHAN </option> <option value=" KADUNA - KUDENDA - ASHMED SPECIALIST HOSPITAL "> KADUNA - KUDENDA - ASHMED SPECIALIST HOSPITAL </option> <option value=" KADUNA - TUNDA WADA - BIBA HOSPITAL LTD "> KADUNA - TUNDA WADA - BIBA HOSPITAL LTD </option> <option value=" KADUNA - UNGWA RIMI - GARDEN CITY SPECIALIST HOSPITAL "> KADUNA - UNGWA RIMI - GARDEN CITY SPECIALIST HOSPITAL </option> <option value=" KADUNA - UNGWA RIMI - MONARCH SPECIALIST HOSPITAL "> KADUNA - UNGWA RIMI - MONARCH SPECIALIST HOSPITAL </option> <option value=" KADUNA - ZARIA - AL-MADINA "> KADUNA - ZARIA - AL-MADINA </option> <option value=" KADUNA - ZARIA - SALAMA INFIRMARY,ZARIA,KADUNA "> KADUNA - ZARIA - SALAMA INFIRMARY,ZARIA,KADUNA </option> <option value=" KADUNA - ZARIA - ST. LUKES ANGLICAN HOSPITAL "> KADUNA - ZARIA - ST. LUKES ANGLICAN HOSPITAL </option> <option value=" KADUNA - ZARIA - LADIYA HOSPITAL "> KADUNA - ZARIA - LADIYA HOSPITAL </option> <option value=" KANO - GYADI - PREMIER CLINICS "> KANO - GYADI - PREMIER CLINICS </option> <option value=" KANO - HOTORO - KINGSGATE HOSPITAL "> KANO - HOTORO - KINGSGATE HOSPITAL </option> <option value=" KANO - AIRPORT ROAD - INTERNATIONAL CLINICS & HOSPITAL LIMITED,KANO "> KANO - AIRPORT ROAD - INTERNATIONAL CLINICS & HOSPITAL LIMITED,KANO </option> <option value=" KANO - KANO - KHADIJAT MEMORIAL HOSPITAL "> KANO - KANO - KHADIJAT MEMORIAL HOSPITAL </option> <option value=" KANO - TARAUNI - STANDARD SPECIALIST HOSPITAL, KANO "> KANO - TARAUNI - STANDARD SPECIALIST HOSPITAL, KANO </option> <option value=" KANO - NOMANSLAND - GOODPASTURES CLINICS "> KANO - NOMANSLAND - GOODPASTURES CLINICS </option> <option value=" KANO - KANO - BAREWA CLINICS & MATERNITY "> KANO - KANO - BAREWA CLINICS & MATERNITY </option> <option value=" KANO - NOMANSLAND - TUNIK HOSPITAL LIMITED "> KANO - NOMANSLAND - TUNIK HOSPITAL LIMITED </option> <option value=" KANO - KANO - CORPERSTONE HOSPITAL "> KANO - KANO - CORPERSTONE HOSPITAL </option> <option value=" KANO - NASSARAWA - MEDICUS CLINIC "> KANO - NASSARAWA - MEDICUS CLINIC </option> <option value=" KANO - SABON GARI - LAFIYA SURGERY "> KANO - SABON GARI - LAFIYA SURGERY </option> <option value=" KANO - KANO - AL-BASAR INTERNATIONAL FOUNDATION TRUST (MSEH) "> KANO - KANO - AL-BASAR INTERNATIONAL FOUNDATION TRUST (MSEH) </option> <option value=" KANO - NASSARAWA - AMISAL DENTAL CARE "> KANO - NASSARAWA - AMISAL DENTAL CARE </option> <option value=" KANO - HAUSAWA - AMITY HOSPITAL AND MEDICAL SERVICES "> KANO - HAUSAWA - AMITY HOSPITAL AND MEDICAL SERVICES </option> <option value=" KANO - KANO - IVORY CLINIC & MATERNITY "> KANO - KANO - IVORY CLINIC & MATERNITY </option> <option value=" KANO - KANO - AMINU KANO TEACHING HOSPITAL "> KANO - KANO - AMINU KANO TEACHING HOSPITAL </option> <option value=" KANO - KANO - NOL INTERNATIONAL HOSPITAL "> KANO - KANO - NOL INTERNATIONAL HOSPITAL </option> <option value=" KATSINA - KATSINA - KHADIJAT MEDICAL CENTER, KATSINA "> KATSINA - KATSINA - KHADIJAT MEDICAL CENTER, KATSINA </option> <option value=" KATSINA - KATSINA - FEDERAL MEDICAL CENTRE, KATSINA "> KATSINA - KATSINA - FEDERAL MEDICAL CENTRE, KATSINA </option> <option value=" KATSINA - KATSINA - BASITIT HOSPITAL LIMITED "> KATSINA - KATSINA - BASITIT HOSPITAL LIMITED </option> <option value=" KATSINA - KATSINA - KATSINA NURSING HOME "> KATSINA - KATSINA - KATSINA NURSING HOME </option> <option value=" JIGAWA - DUTSE - DUTSE GENERAL HOSPITAL, JIGAWA STATE "> JIGAWA - DUTSE - DUTSE GENERAL HOSPITAL, JIGAWA STATE </option> <option value=" JIGAWA - DUTSE - RASHEED SHEKONI SPECIALIST HOSPITAL "> JIGAWA - DUTSE - RASHEED SHEKONI SPECIALIST HOSPITAL </option> <option value=" PLATEAU - JOS - KAUNA SPECIALIST HOSPITAL "> PLATEAU - JOS - KAUNA SPECIALIST HOSPITAL </option> <option value=" PLATEAU - JOS - SAUKI HOSPITAL, JOS "> PLATEAU - JOS - SAUKI HOSPITAL, JOS </option> <option value=" KEBBI - BIRNIN-KEBBI - GODIYA HOSPITAL "> KEBBI - BIRNIN-KEBBI - GODIYA HOSPITAL </option> <option value=" KEBBI - BIRNIN-KEBBI - FEDERAL MEDICAL CENTRE, BIRNIN-KEBBI "> KEBBI - BIRNIN-KEBBI - FEDERAL MEDICAL CENTRE, BIRNIN-KEBBI </option> <option value=" ZAMFARA - GUSAU - DAULA HOSPITAL & MATERNITY HOME "> ZAMFARA - GUSAU - DAULA HOSPITAL & MATERNITY HOME </option> <option value=" ZAMFARA - ANKA - GENERAL HOSPITAL, ANKA "> ZAMFARA - ANKA - GENERAL HOSPITAL, ANKA </option> <option value=" ADAMAWA - YOLA - MATCO CLINIC "> ADAMAWA - YOLA - MATCO CLINIC </option> <option value=" YOBE - DAMATURU - CITY MEDICAL CENTRE "> YOBE - DAMATURU - CITY MEDICAL CENTRE </option> <option value=" YOBE - POTISKUM - POTISKUM MEDICAL CENTRE "> YOBE - POTISKUM - POTISKUM MEDICAL CENTRE </option> <option value=" GOMBE - GOMBE - DOMA HOSPITAL "> GOMBE - GOMBE - DOMA HOSPITAL </option> <option value=" GOMBE - GOMBE - METRO CONSULTANTS CLINIC "> GOMBE - GOMBE - METRO CONSULTANTS CLINIC </option> <option value=" BORNO - MAIDUGURI - NAKOWA SPECIALIST HOSPITAL "> BORNO - MAIDUGURI - NAKOWA SPECIALIST HOSPITAL </option> <option value=" BAUCHI - BAUCHI - PAHLYCON HOSPITAL "> BAUCHI - BAUCHI - PAHLYCON HOSPITAL </option> <option value=" BAUCHI - BAUCHI - AL-AMIN HEALTH CLINIC & MATERNITY "> BAUCHI - BAUCHI - AL-AMIN HEALTH CLINIC & MATERNITY </option> <option value=" BAUCHI - BAUCHI - ALAMEEN HOSPITAL "> BAUCHI - BAUCHI - ALAMEEN HOSPITAL </option> <option value=" TARABA - ABUJA PHASE 1 - FIRST DOMINION SPECIALIST CLLINIC AND MATERNITY "> TARABA - ABUJA PHASE 1 - FIRST DOMINION SPECIALIST CLLINIC AND MATERNITY </option> <option value=" TARABA - JALINGO - FEDERAL MEDICAL CENTRE, JALINGO "> TARABA - JALINGO - FEDERAL MEDICAL CENTRE, JALINGO </option> <option value=" TARABA - JALINGO - GATEWAY HOSPITAL JALINGO "> TARABA - JALINGO - GATEWAY HOSPITAL JALINGO </option> <option value=" TARABA - WUKARI - BETHEL HOSPITAL "> TARABA - WUKARI - BETHEL HOSPITAL </option> <option value=" ENUGU - ABAKPA - KENECHUKWU SPECIALIST HOSPITAL "> ENUGU - ABAKPA - KENECHUKWU SPECIALIST HOSPITAL </option> <option value=" ENUGU - NGWO - OUR SAVIOUR MEDICAL CENTRE "> ENUGU - NGWO - OUR SAVIOUR MEDICAL CENTRE </option> <option value=" ENUGU - NSUKA - AKULUE MEMORIAL HOSPITAL "> ENUGU - NSUKA - AKULUE MEMORIAL HOSPITAL </option> <option value=" ENUGU - NSUKA - ALL SAINTS MEDICAL CENTER "> ENUGU - NSUKA - ALL SAINTS MEDICAL CENTER </option> <option value=" ENUGU - TRANS EKULU - CHRIST THE KING HOSPITAL, TRANS EKULU "> ENUGU - TRANS EKULU - CHRIST THE KING HOSPITAL, TRANS EKULU </option> <option value=" ENUGU - UWANI - EASTERN NIGERIA MEDICAL CENTRE "> ENUGU - UWANI - EASTERN NIGERIA MEDICAL CENTRE </option> <option value=" IMO - OKIGWE - IVORY CLINIC "> IMO - OKIGWE - IVORY CLINIC </option> <option value=" ANAMBRA - AGULERI - IMMACULATE HEART MULTISPECIALTY HOSPITAL "> ANAMBRA - AGULERI - IMMACULATE HEART MULTISPECIALTY HOSPITAL </option> <option value=" ANAMBRA - AWKA - BEACON HOSPITAL & MATERNITY "> ANAMBRA - AWKA - BEACON HOSPITAL & MATERNITY </option> <option value=" ANAMBRA - AWKA - IFEBI MEDICAL CENTRE "> ANAMBRA - AWKA - IFEBI MEDICAL CENTRE </option> <option value=" ANAMBRA - AWKA - HARMONY SPECIALIST HOSPITAL "> ANAMBRA - AWKA - HARMONY SPECIALIST HOSPITAL </option> <option value=" ANAMBRA - AWKA - ROCK FOUNDATION "> ANAMBRA - AWKA - ROCK FOUNDATION </option> <option value=" ANAMBRA - AWKA - ELDORADO MULTI-SPECIALIST HOSPITAL, AWKA "> ANAMBRA - AWKA - ELDORADO MULTI-SPECIALIST HOSPITAL, AWKA </option> <option value=" ANAMBRA - AWKA - PRIME SPECIALIST HOSPITAL "> ANAMBRA - AWKA - PRIME SPECIALIST HOSPITAL </option> <option value=" ANAMBRA - AWKA - REGINA CAELI HOSPITAL "> ANAMBRA - AWKA - REGINA CAELI HOSPITAL </option> <option value=" ANAMBRA - AWKA - SEFTON HOSPITAL "> ANAMBRA - AWKA - SEFTON HOSPITAL </option> <option value=" ANAMBRA - AWKA - ISSAC CHIRA MEMORIAL HOSPITAL "> ANAMBRA - AWKA - ISSAC CHIRA MEMORIAL HOSPITAL </option> <option value=" ANAMBRA - Akwuzu - ISSAC CHIRA MEMORIAL HOSPITAL "> ANAMBRA - Akwuzu - ISSAC CHIRA MEMORIAL HOSPITAL </option> <option value=" ANAMBRA - IHIALA - OUR LADY OF LOURDES HOSPITAL "> ANAMBRA - IHIALA - OUR LADY OF LOURDES HOSPITAL </option> <option value=" ANAMBRA - NNEWI - CHIMEX HOSPITAL "> ANAMBRA - NNEWI - CHIMEX HOSPITAL </option> <option value=" ANAMBRA - ONITSHA - BETHSAIDA SPECIALIST HOSPITAL "> ANAMBRA - ONITSHA - BETHSAIDA SPECIALIST HOSPITAL </option> <option value=" ANAMBRA - ONITSHA - VENIK SPECIALIST HOSPITAL & MATERNITY "> ANAMBRA - ONITSHA - VENIK SPECIALIST HOSPITAL & MATERNITY </option> <option value=" ANAMBRA - ONITSHA - MERCY SPECIALIST HOSPITAL "> ANAMBRA - ONITSHA - MERCY SPECIALIST HOSPITAL </option> <option value=" EBONYI - ABAKALIKI - CHRIST THE KING HOSPITAL "> EBONYI - ABAKALIKI - CHRIST THE KING HOSPITAL </option> <option value=" EBONYI - ABAKILIKI - FEDERAL MEDICAL CENTRE, ABAKILIKI,EBONYI "> EBONYI - ABAKILIKI - FEDERAL MEDICAL CENTRE, ABAKILIKI,EBONYI </option> <option value=" EBONYI - ABAKALIKI - SMILE SPECIALIST HOSPITAL "> EBONYI - ABAKALIKI - SMILE SPECIALIST HOSPITAL </option> <option value=" ABIA - ABA - THE BLESSED HAVEN HOSPITAL LIMITED "> ABIA - ABA - THE BLESSED HAVEN HOSPITAL LIMITED </option> <option value=" ABIA - ABA - SPRINGS CLINIC "> ABIA - ABA - SPRINGS CLINIC </option> <option value=" ABIA - ABA - EKEOMA MEMORIAL HOSPITAL "> ABIA - ABA - EKEOMA MEMORIAL HOSPITAL </option> <option value=" ABIA - AMAEKPU - UZONDU POLY CLINIC "> ABIA - AMAEKPU - UZONDU POLY CLINIC </option> <option value=" ABIA - UMUAHIA - THE LORDS FOUNDATION CLINIC "> ABIA - UMUAHIA - THE LORDS FOUNDATION CLINIC </option> <option value=" EDO - AUCHI - FATE MEDICAL CENTRE "> EDO - AUCHI - FATE MEDICAL CENTRE </option> <option value=" EDO - BENIN - BETHEL FAITH MEDICAL CENTRE "> EDO - BENIN - BETHEL FAITH MEDICAL CENTRE </option> <option value=" EDO - BENIN - ECHOS HOSPITAL "> EDO - BENIN - ECHOS HOSPITAL </option> <option value=" EDO - BENIN - EKPEN HOSPITAL "> EDO - BENIN - EKPEN HOSPITAL </option> <option value=" EDO - BENIN - MODIC MEDICAL CENTRE "> EDO - BENIN - MODIC MEDICAL CENTRE </option> <option value=" EDO - BENIN - OSULA ROYAL HOSPITAL "> EDO - BENIN - OSULA ROYAL HOSPITAL </option> <option value=" EDO - BENIN - MOUNT GILEAD HOSPITAL "> EDO - BENIN - MOUNT GILEAD HOSPITAL </option> <option value=" EDO - JATTU - HOPE CLINIC, EDO "> EDO - JATTU - HOPE CLINIC, EDO </option> <option value=" EDO - OREDO - ROCK HOSPITAL "> EDO - OREDO - ROCK HOSPITAL </option> <option value=" EDO - UROMI - ORIAIFO MEDICAL CENTRE "> EDO - UROMI - ORIAIFO MEDICAL CENTRE </option> <option value=" EDO - BENIN - MAVISCOPE HOSPITAL AND FERTILITY CENTRE "> EDO - BENIN - MAVISCOPE HOSPITAL AND FERTILITY CENTRE </option> <option value=" DELTA - ASABA - ICON CLINIC & MATERNITY "> DELTA - ASABA - ICON CLINIC & MATERNITY </option> <option value=" DELTA - EMEBIREN - BRYANTS HOSPITAL/CLINIC LIMITED "> DELTA - EMEBIREN - BRYANTS HOSPITAL/CLINIC LIMITED </option> <option value=" DELTA - IGBUDU - HEALING STREAM CLINIC AND MATERNITY "> DELTA - IGBUDU - HEALING STREAM CLINIC AND MATERNITY </option> <option value=" DELTA - KWALE - BREMA HOSPITAL "> DELTA - KWALE - BREMA HOSPITAL </option> <option value=" DELTA - OBIARUKU - QUEEN OF THE APOSTLES CATHOLIC HOSPITAL "> DELTA - OBIARUKU - QUEEN OF THE APOSTLES CATHOLIC HOSPITAL </option> <option value=" DELTA - SAPELE - LIBERAL CLINIC "> DELTA - SAPELE - LIBERAL CLINIC </option> <option value=" DELTA - SAPELE - OBULE MEDICAL CENTRE "> DELTA - SAPELE - OBULE MEDICAL CENTRE </option> <option value=" DELTA - UGHELLI - CELIAN CLINIC "> DELTA - UGHELLI - CELIAN CLINIC </option> <option value=" DELTA - WARRI - BU CLINICS LTD "> DELTA - WARRI - BU CLINICS LTD </option> <option value=" DELTA - WARRI - TWINS CLINIC HOSPITAL "> DELTA - WARRI - TWINS CLINIC HOSPITAL </option> <option value=" DELTA - WARRI - VICAH CLINIC "> DELTA - WARRI - VICAH CLINIC </option> <option value=" AKWA IBOM - ABAK ROAD - ST. ATHANASIUS HOSPITAL LIMITED,UYO "> AKWA IBOM - ABAK ROAD - ST. ATHANASIUS HOSPITAL LIMITED,UYO </option> <option value=" AKWA IBOM - EKET - GOOD SHEPHERD MEDICAL CENTER "> AKWA IBOM - EKET - GOOD SHEPHERD MEDICAL CENTER </option> <option value=" AKWA IBOM - EKET - CALEB MEDICAL CENTER "> AKWA IBOM - EKET - CALEB MEDICAL CENTER </option> <option value=" AKWA IBOM - IKOT ABASI - REDEMPTION CLINIC, IKOT ABASI "> AKWA IBOM - IKOT ABASI - REDEMPTION CLINIC, IKOT ABASI </option> <option value=" AKWA IBOM - IKOT ABASI - VEDDYSON HOSPITAL "> AKWA IBOM - IKOT ABASI - VEDDYSON HOSPITAL </option> <option value=" AKWA IBOM - IKOT ABASI - BETHANY MEDICAL CENTER "> AKWA IBOM - IKOT ABASI - BETHANY MEDICAL CENTER </option> <option value=" AKWA IBOM - IKOT EKPENE - EVERGREEN CHRISTIAN HEALTH SERVICES LIMITED "> AKWA IBOM - IKOT EKPENE - EVERGREEN CHRISTIAN HEALTH SERVICES LIMITED </option> <option value=" AKWA IBOM - IKOT EKPENE - TOTAL CARE CLINIC & MATERNITY` "> AKWA IBOM - IKOT EKPENE - TOTAL CARE CLINIC & MATERNITY` </option> <option value=" AKWA IBOM - ORON - PRISCON CLINICS LIMITED "> AKWA IBOM - ORON - PRISCON CLINICS LIMITED </option> <option value=" AKWA IBOM - ORON - ST PATRICK\'S CLINIC & MATERNITY "> AKWA IBOM - ORON - ST PATRICK\'S CLINIC & MATERNITY </option> <option value=" AKWA IBOM - ORON - UWEM FOUNDATION SPECIALIST CLINIC "> AKWA IBOM - ORON - UWEM FOUNDATION SPECIALIST CLINIC </option> <option value=" AKWA IBOM - UYO - CITY CLINIC AND INFIRMARY,UYO "> AKWA IBOM - UYO - CITY CLINIC AND INFIRMARY,UYO </option> <option value=" AKWA IBOM - UYO - DOMINGO SPECIALIST HOSPITAL "> AKWA IBOM - UYO - DOMINGO SPECIALIST HOSPITAL </option> <option value=" AKWA IBOM - UYO - MFONABASI CLINIC "> AKWA IBOM - UYO - MFONABASI CLINIC </option> <option value=" AKWA IBOM - UYO - MOUNT OLIVE CLINC & MATERNITY, UYO "> AKWA IBOM - UYO - MOUNT OLIVE CLINC & MATERNITY, UYO </option> <option value=" AKWA IBOM - UYO - NEDEKE PAEDIATRICS "> AKWA IBOM - UYO - NEDEKE PAEDIATRICS </option> <option value=" AKWA IBOM - UYO - PREMIER MEDICAL SERVICES "> AKWA IBOM - UYO - PREMIER MEDICAL SERVICES </option> <option value=" AKWA IBOM - UYO - SIFON CLINICS LTD "> AKWA IBOM - UYO - SIFON CLINICS LTD </option> <option value=" AKWA IBOM - UYO - UBONG-ABASI SPECIALIST CLINIC "> AKWA IBOM - UYO - UBONG-ABASI SPECIALIST CLINIC </option> <option value=" AKWA IBOM - UYO - MOUNT OLIVE HOSPITAL "> AKWA IBOM - UYO - MOUNT OLIVE HOSPITAL </option> <option value=" AKWA IBOM - UYO - UWAKMFON SPECIALIST CLINICS "> AKWA IBOM - UYO - UWAKMFON SPECIALIST CLINICS </option> <option value=" AKWA IBOM - UYO - UWANA FAMILY CLINIC "> AKWA IBOM - UYO - UWANA FAMILY CLINIC </option> <option value=" AKWA IBOM - UYO - UBONGABASI SPECIALIST HOSPITAL "> AKWA IBOM - UYO - UBONGABASI SPECIALIST HOSPITAL </option> <option value=" AKWA IBOM - UYO - ST. ATHANASIUS HOSPITAL LTD "> AKWA IBOM - UYO - ST. ATHANASIUS HOSPITAL LTD </option> <option value=" AKWA IBOM - UYO - DOMINGO SPECIALIST HOSPITAL "> AKWA IBOM - UYO - DOMINGO SPECIALIST HOSPITAL </option> <option value=" AKWA IBOM - UYO - LIFECARE HOSPITAL "> AKWA IBOM - UYO - LIFECARE HOSPITAL </option> <option value=" BAYELSA - YENAGOA - GLORYLAND MEDICAL CENTER "> BAYELSA - YENAGOA - GLORYLAND MEDICAL CENTER </option> <option value=" BAYELSA - YENAGOA - ST. PETERS HOSPITAL "> BAYELSA - YENAGOA - ST. PETERS HOSPITAL </option> <option value=" RIVERS - EGBEMA - FOUNDATION CLINIC "> RIVERS - EGBEMA - FOUNDATION CLINIC </option> <option value=" RIVERS - ELEKAHAI - CORBAN MEDICALS LIMITED "> RIVERS - ELEKAHAI - CORBAN MEDICALS LIMITED </option> <option value=" RIVERS - ELEME - FAMO CLINIC "> RIVERS - ELEME - FAMO CLINIC </option> <option value=" RIVERS - ELEME - MEDICAL CENTRE ONNE "> RIVERS - ELEME - MEDICAL CENTRE ONNE </option> <option value=" RIVERS - GRA - PONYX HOSPITALS LTD "> RIVERS - GRA - PONYX HOSPITALS LTD </option> <option value=" RIVERS - OBIGBO - QUEEN OF PEACE HOSPITAL AND MATERNITY "> RIVERS - OBIGBO - QUEEN OF PEACE HOSPITAL AND MATERNITY </option> <option value=" RIVERS - OMOKU - GBEYE HOSPITAL & MATERNITY "> RIVERS - OMOKU - GBEYE HOSPITAL & MATERNITY </option> <option value=" RIVERS - PORT HARCOURT - GARRISON CLINIC "> RIVERS - PORT HARCOURT - GARRISON CLINIC </option> <option value=" RIVERS - PORT HARCOURT - KRISANY MEDICAL CENTRE "> RIVERS - PORT HARCOURT - KRISANY MEDICAL CENTRE </option> <option value=" RIVERS - PORT HARCOURT - KRYSTAL CLINIC "> RIVERS - PORT HARCOURT - KRYSTAL CLINIC </option> <option value=" RIVERS - PORT HARCOURT - OFURE SPECIALISTS CLINIC "> RIVERS - PORT HARCOURT - OFURE SPECIALISTS CLINIC </option> <option value=" RIVERS - PORT HARCOURT - ANCHOR HOSPITAL "> RIVERS - PORT HARCOURT - ANCHOR HOSPITAL </option> <option value=" RIVERS - PORT HARCOURT - PAMO CLINICS "> RIVERS - PORT HARCOURT - PAMO CLINICS </option> <option value=" RIVERS - RUKPOKWU - BONMARIA HOSPITAL LTD. "> RIVERS - RUKPOKWU - BONMARIA HOSPITAL LTD. </option> <option value=" RIVERS - RUMUODOMAYA - AMAZING GRACE CLINIC "> RIVERS - RUMUODOMAYA - AMAZING GRACE CLINIC </option> <option value=" RIVERS - RUMUOKWUTA - BENOK-HEROES HOSPITAL "> RIVERS - RUMUOKWUTA - BENOK-HEROES HOSPITAL </option> <option value=" RIVERS - TRANS AMADI - OLUNWA MEDICAL CENTRE "> RIVERS - TRANS AMADI - OLUNWA MEDICAL CENTRE </option> <option value=" RIVERS - TRANS-WOJI - THE SHIELD CLINICS "> RIVERS - TRANS-WOJI - THE SHIELD CLINICS </option> <option value=" RIVERS - WOJI - ST. MARY MOTHER OF MERCY HOSPITALS "> RIVERS - WOJI - ST. MARY MOTHER OF MERCY HOSPITALS </option> <option value=" CROSS RIVERS - ABAKPA OGOJA - SANTA MARIA CLINIC AND MATERNITY "> CROSS RIVERS - ABAKPA OGOJA - SANTA MARIA CLINIC AND MATERNITY </option> <option value=" CROSS RIVERS - AKAMKPA - USY MEDICALS CONSULTING ROOM "> CROSS RIVERS - AKAMKPA - USY MEDICALS CONSULTING ROOM </option> <option value=" CROSS RIVERS - CALABAR - CITY CLINIC "> CROSS RIVERS - CALABAR - CITY CLINIC </option> <option value=" CROSS RIVERS - CALABAR - FAITH FOUNDATION SPECIALIST CLINIC "> CROSS RIVERS - CALABAR - FAITH FOUNDATION SPECIALIST CLINIC </option> <option value=" CROSS RIVERS - CALABAR - MT. ZION MEDICAL CENTRE "> CROSS RIVERS - CALABAR - MT. ZION MEDICAL CENTRE </option> <option value=" CROSS RIVERS - CALABAR - VICTORIA ITAM SPECIALIST HOSPITAL "> CROSS RIVERS - CALABAR - VICTORIA ITAM SPECIALIST HOSPITAL </option> <option value=" CROSS RIVERS - CALABAR - IKPEME MEDICAL CENTER "> CROSS RIVERS - CALABAR - IKPEME MEDICAL CENTER </option> <option value=" CROSS RIVERS - CALABAR - MT. ZION MEDICAL CENTER "> CROSS RIVERS - CALABAR - MT. ZION MEDICAL CENTER </option> <option value=" CROSS RIVERS - CALABAR - HANNAH FOUNDATION CLINIC & TRAUMA CENTER "> CROSS RIVERS - CALABAR - HANNAH FOUNDATION CLINIC & TRAUMA CENTER </option> <option value=" CROSS RIVERS - CALABAR - CALABAR WOMEN & CHILDREN HOSPITAL "> CROSS RIVERS - CALABAR - CALABAR WOMEN & CHILDREN HOSPITAL </option> <option value=" CROSS RIVERS - CALABAR - LUCIAMA MEMORIAL SPECIALIST HOSPITAL "> CROSS RIVERS - CALABAR - LUCIAMA MEMORIAL SPECIALIST HOSPITAL </option> <option value=" CROSS RIVERS - CALABAR - ARUBAH SPECIALIST HOSPITAL "> CROSS RIVERS - CALABAR - ARUBAH SPECIALIST HOSPITAL </option> <option value=" CROSS RIVERS - IKOM - COUNTY SPECIALIST HOSPITAL "> CROSS RIVERS - IKOM - COUNTY SPECIALIST HOSPITAL </option> <option value=" CROSS RIVERS - OBUBRA - EYABA MEMORIAL CLINIC "> CROSS RIVERS - OBUBRA - EYABA MEMORIAL CLINIC </option> <option value=" CROSS RIVERS - OBUDU - SACRED HEART CATHOLIC HOSPITAL "> CROSS RIVERS - OBUDU - SACRED HEART CATHOLIC HOSPITAL </option> <option value=" CROSS RIVERS - OGADA - EKANA MEDICAL CENTRE, OGADA, OBUBRA "> CROSS RIVERS - OGADA - EKANA MEDICAL CENTRE, OGADA, OBUBRA </option> <option value=" CROSS RIVERS - UGEP - DANEX MEDICAL CENTRE "> CROSS RIVERS - UGEP - DANEX MEDICAL CENTRE </option> <option value=" SOKOTO - SOKOTO - FREEHAND SPECIALIST HOSPITAL "> SOKOTO - SOKOTO - FREEHAND SPECIALIST HOSPITAL </option> <option value=" SOKOTO - SOKOTO - HUSSAINI MEDICAL CENTRE "> SOKOTO - SOKOTO - HUSSAINI MEDICAL CENTRE </option> <option value=" SOKOTO - SOKOTO - MADALLA LAFIYA SPECIAL CLINIC LTD "> SOKOTO - SOKOTO - MADALLA LAFIYA SPECIAL CLINIC LTD </option> <option value=" SOKOTO - SOKOTO - SAHEL SPECIALIST HOSPITAL "> SOKOTO - SOKOTO - SAHEL SPECIALIST HOSPITAL </option> <option value=" SOKOTO - SOKOTO - GASKIYA OPTICAL SERVICES AND EYE CLINIC "> SOKOTO - SOKOTO - GASKIYA OPTICAL SERVICES AND EYE CLINIC </option> <option value=" SOKOTO - SOKOTO - SHEPHERD SPECIALIST CLINIC - SOKOTO "> SOKOTO - SOKOTO - SHEPHERD SPECIALIST CLINIC - SOKOTO </option> <option value=" SOKOTO - SOKOTO - Citi Premier Mother And Child Hospital "> SOKOTO - SOKOTO - Citi Premier Mother And Child Hospital </option> <option value=" SOKOTO - SOKOTO - Gaskiya Optical Services And Eye Clinic "> SOKOTO - SOKOTO - Gaskiya Optical Services And Eye Clinic </option> <option value=" diagnostic - diagnostic - diagnostic "> diagnostic - diagnostic - diagnostic </option> <option value=" LAGOS - AGEGE - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> LAGOS - AGEGE - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" LAGOS - AJEGUNLE - CLINIX HEALTHCARE "> LAGOS - AJEGUNLE - CLINIX HEALTHCARE </option> <option value=" LAGOS - AJEGUNLE - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> LAGOS - AJEGUNLE - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" LAGOS - AMUWO ODOFIN - CLINIX HEALTHCARE "> LAGOS - AMUWO ODOFIN - CLINIX HEALTHCARE </option> <option value=" LAGOS - BADAGRY - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> LAGOS - BADAGRY - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" LAGOS - EBUTE METTA - CLINA-LANCET LABORATORIES NIG LTD "> LAGOS - EBUTE METTA - CLINA-LANCET LABORATORIES NIG LTD </option> <option value=" LAGOS - IKEJA - CLINA-LANCET LABORATORIES NIG LTD "> LAGOS - IKEJA - CLINA-LANCET LABORATORIES NIG LTD </option> <option value=" LAGOS - IKEJA - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> LAGOS - IKEJA - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" LAGOS - IKORODU - CLINIX HEALTHCARE "> LAGOS - IKORODU - CLINIX HEALTHCARE </option> <option value=" LAGOS - IKORODU - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> LAGOS - IKORODU - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" LAGOS - IKOTUN - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> LAGOS - IKOTUN - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" LAGOS - ILUPEJU - CLINIX HEALTHCARE "> LAGOS - ILUPEJU - CLINIX HEALTHCARE </option> <option value=" LAGOS - LAGOS ISLAND - CLINA-LANCET LABORATORIES NIG LTD "> LAGOS - LAGOS ISLAND - CLINA-LANCET LABORATORIES NIG LTD </option> <option value=" LAGOS - LEKKI - MECURE DIAGNOSTICS "> LAGOS - LEKKI - MECURE DIAGNOSTICS </option> <option value=" LAGOS - OSHODI EXPRESSWAY - MECURE DIAGNOSTICS "> LAGOS - OSHODI EXPRESSWAY - MECURE DIAGNOSTICS </option> <option value=" LAGOS - SURULERE - CLINA-LANCET LABORATORIES NIG LTD "> LAGOS - SURULERE - CLINA-LANCET LABORATORIES NIG LTD </option> <option value=" LAGOS - SURULERE - FOREMOST RADIOLOGY CONSULTANTS LIMITED "> LAGOS - SURULERE - FOREMOST RADIOLOGY CONSULTANTS LIMITED </option> <option value=" LAGOS - VICTORIA ISLAND - CLINA-LANCET LABORATORIES NIG LTD "> LAGOS - VICTORIA ISLAND - CLINA-LANCET LABORATORIES NIG LTD </option> <option value=" LAGOS - VICTORIA ISLAND - CRESTVIEW RADIOLOGY LIMITED "> LAGOS - VICTORIA ISLAND - CRESTVIEW RADIOLOGY LIMITED </option> <option value=" LAGOS - VICTORIA ISLAND - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> LAGOS - VICTORIA ISLAND - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" OGUN - ABEOKUTA - CLINIX HEALTHCARE "> OGUN - ABEOKUTA - CLINIX HEALTHCARE </option> <option value=" OGUN - ABEOKUTA - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> OGUN - ABEOKUTA - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" OYO - BODIJA - MECURE DIAGNOSTICS "> OYO - BODIJA - MECURE DIAGNOSTICS </option> <option value=" OYO - MOKOLA - CLINA-LANCET LABORATORIES NIG LTD "> OYO - MOKOLA - CLINA-LANCET LABORATORIES NIG LTD </option> <option value=" OYO - MOKOLA - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> OYO - MOKOLA - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" OSUN - OSOGBO - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> OSUN - OSOGBO - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" ONDO - ONDO - MECURE DIAGNOSTICS "> ONDO - ONDO - MECURE DIAGNOSTICS </option> <option value=" ONDO - AKURE - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> ONDO - AKURE - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" KWARA - ILORIN - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> KWARA - ILORIN - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" KADUNA - KADUNA - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> KADUNA - KADUNA - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" KANO - KANO - MECURE DIAGNOSTICS "> KANO - KANO - MECURE DIAGNOSTICS </option> <option value=" KANO - KANO - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> KANO - KANO - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" KANO - SABON GARI - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> KANO - SABON GARI - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" PLATEAU - JOS - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> PLATEAU - JOS - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" BORNO - MAIDUGURI - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> BORNO - MAIDUGURI - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" ABIA - ABA - MECURE DIAGNOSTICS "> ABIA - ABA - MECURE DIAGNOSTICS </option> <option value=" ABIA - UMUAHIA - MECURE DIAGNOSTICS "> ABIA - UMUAHIA - MECURE DIAGNOSTICS </option> <option value=" EDO - BENIN - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> EDO - BENIN - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" DELTA - WARRI - CLINA-LANCET LABORATORIES NIG LTD "> DELTA - WARRI - CLINA-LANCET LABORATORIES NIG LTD </option> <option value=" RIVERS - D/LINE - CLINA-LANCET LABORATORIES NIG LTD "> RIVERS - D/LINE - CLINA-LANCET LABORATORIES NIG LTD </option> <option value=" RIVERS - OLD GRA - UNION DIAGNOSTIC & CLINICAL SERVICES PLC "> RIVERS - OLD GRA - UNION DIAGNOSTIC & CLINICAL SERVICES PLC </option> <option value=" ent - ent - ent "> ent - ent - ent </option> <option value=" LAGOS - AJAH - AMARA MEDICARE "> LAGOS - AJAH - AMARA MEDICARE </option> <option value=" LAGOS - IKOYI - AMARA MEDICARE "> LAGOS - IKOYI - AMARA MEDICARE </option> <option value=" goldc - goldc - goldc "> goldc - goldc - goldc </option> <option value=" LAGOS - FESTAC TOWN - GOLDEN CROSS INFIRMARY (HOSPITAL AND MATERNITY) "> LAGOS - FESTAC TOWN - GOLDEN CROSS INFIRMARY (HOSPITAL AND MATERNITY) </option> <option value=" dental - dental - dental "> dental - dental - dental </option> <option value=" LAGOS - AJAH VGC - SMILEY DENTAL CARE, VGC "> LAGOS - AJAH VGC - SMILEY DENTAL CARE, VGC </option> <option value=" LAGOS - ANTHONY VILLAGE - DENTAL PLUS "> LAGOS - ANTHONY VILLAGE - DENTAL PLUS </option> <option value=" LAGOS - FESTAC TOWN - RABBONI DENTAL CLINIC "> LAGOS - FESTAC TOWN - RABBONI DENTAL CLINIC </option> <option value=" LAGOS - IKEJA - MICHEL DENTAL CLINIC "> LAGOS - IKEJA - MICHEL DENTAL CLINIC </option> <option value=" LAGOS - IKEJA - SNOW WHITE DENTAL CLINIC "> LAGOS - IKEJA - SNOW WHITE DENTAL CLINIC </option> <option value=" LAGOS - IKORODU - DIVINE DENTAL HOME "> LAGOS - IKORODU - DIVINE DENTAL HOME </option> <option value=" LAGOS - IKORODU - SOLACE DENTAL CLINIC "> LAGOS - IKORODU - SOLACE DENTAL CLINIC </option> <option value=" LAGOS - IKOYI - AMARA MEDICARE CLINIC "> LAGOS - IKOYI - AMARA MEDICARE CLINIC </option> <option value=" LAGOS - IKOYI - SKKY DENTAL SERVICES LIMITED "> LAGOS - IKOYI - SKKY DENTAL SERVICES LIMITED </option> <option value=" LAGOS - KETU - SOLACE DENTAL CLINICS "> LAGOS - KETU - SOLACE DENTAL CLINICS </option> <option value=" LAGOS - LEKKI - CALENS DENTAL CLINIC "> LAGOS - LEKKI - CALENS DENTAL CLINIC </option> <option value=" LAGOS - LEKKI - CALENS DENTAL CLINIC "> LAGOS - LEKKI - CALENS DENTAL CLINIC </option> <option value=" LAGOS - SURULERE - IWOSAN DENTAL CLINIC "> LAGOS - SURULERE - IWOSAN DENTAL CLINIC </option> <option value=" LAGOS - SURULERE - SMILEY DENTAL CARE, SURULERE "> LAGOS - SURULERE - SMILEY DENTAL CARE, SURULERE </option> <option value=" LAGOS - VGC - AMARA MEDICARE CLINIC "> LAGOS - VGC - AMARA MEDICARE CLINIC </option> <option value=" LAGOS - VICTORIA ISLAND - DENTAL PLUS "> LAGOS - VICTORIA ISLAND - DENTAL PLUS </option> <option value=" LAGOS - VICTORIA ISLAND - DIVINE DENTAL HOME "> LAGOS - VICTORIA ISLAND - DIVINE DENTAL HOME </option> <option value=" OGUN - SANGO -OTA - Smilepride Dental Clinic "> OGUN - SANGO -OTA - Smilepride Dental Clinic </option> <option value=" OYO - AGODI - MODOT DENTAL CLINIC "> OYO - AGODI - MODOT DENTAL CLINIC </option> <option value=" FCT (ABUJA) - WUSE - CALENS DENTAL CLINIC "> FCT (ABUJA) - WUSE - CALENS DENTAL CLINIC </option> <option value=" ENUGU - INDEPENDENCE LAYOUT - PEARL DENTAL CLINIC & BRACES CENTER "> ENUGU - INDEPENDENCE LAYOUT - PEARL DENTAL CLINIC & BRACES CENTER </option> <option value=" RIVERS - D/LINE - ESTEEM DENTAL CLINIC "> RIVERS - D/LINE - ESTEEM DENTAL CLINIC </option> <option value=" optical - optical - optical "> optical - optical - optical </option> <option value=" LAGOS - AGEGE - HEPHZIBAH EYE CARE "> LAGOS - AGEGE - HEPHZIBAH EYE CARE </option> <option value=" LAGOS - AJAH - HEPHZIBAH EYE CARE "> LAGOS - AJAH - HEPHZIBAH EYE CARE </option> <option value=" LAGOS - AMUWO ODOFIN - HEPHZIBAH EYE CARE "> LAGOS - AMUWO ODOFIN - HEPHZIBAH EYE CARE </option> <option value=" LAGOS - EBUTE METTA - VIEW POINT SPECIALIST EYE CENTRE "> LAGOS - EBUTE METTA - VIEW POINT SPECIALIST EYE CENTRE </option> <option value=" LAGOS - IKEJA - CATHEM EYE CENTRE "> LAGOS - IKEJA - CATHEM EYE CENTRE </option> <option value=" LAGOS - IKEJA - EYESPEC OPTICALS "> LAGOS - IKEJA - EYESPEC OPTICALS </option> <option value=" LAGOS - IKEJA - HEPHZIBAH EYE CARE "> LAGOS - IKEJA - HEPHZIBAH EYE CARE </option> <option value=" LAGOS - IKEJA - PEAK EYE CARE "> LAGOS - IKEJA - PEAK EYE CARE </option> <option value=" LAGOS - IKEJA - PERFECT EYES "> LAGOS - IKEJA - PERFECT EYES </option> <option value=" LAGOS - IKOYI - AMARA MEDICARE "> LAGOS - IKOYI - AMARA MEDICARE </option> <option value=" LAGOS - IKOYI - KRYSTAL OPTICAL LIMITED "> LAGOS - IKOYI - KRYSTAL OPTICAL LIMITED </option> <option value=" LAGOS - IKOYI - ULTIMATE EYE CLINIC "> LAGOS - IKOYI - ULTIMATE EYE CLINIC </option> <option value=" LAGOS - ISOLO - HAVILAH EYE CLINIC & OPTICAL SERVICES LIMITED "> LAGOS - ISOLO - HAVILAH EYE CLINIC & OPTICAL SERVICES LIMITED </option> <option value=" LAGOS - LAGOS ISLAND - FARATORI EYE CENTRE "> LAGOS - LAGOS ISLAND - FARATORI EYE CENTRE </option> <option value=" LAGOS - LAGOS ISLAND - TRUVISION LIMITED "> LAGOS - LAGOS ISLAND - TRUVISION LIMITED </option> <option value=" LAGOS - LEKKI - BOOST OPTICALS LIMITED "> LAGOS - LEKKI - BOOST OPTICALS LIMITED </option> <option value=" LAGOS - LEKKI - PHOENIX EYE CLINIC LTD "> LAGOS - LEKKI - PHOENIX EYE CLINIC LTD </option> <option value=" LAGOS - OGBA - FORST EYE CLINIC & OPTICAL SERVICES "> LAGOS - OGBA - FORST EYE CLINIC & OPTICAL SERVICES </option> <option value=" LAGOS - SANGOTEDO - HEPHZIBAH EYE CARE "> LAGOS - SANGOTEDO - HEPHZIBAH EYE CARE </option> <option value=" LAGOS - SANGOTEDO - PHOENIX EYE CLINIC LTD "> LAGOS - SANGOTEDO - PHOENIX EYE CLINIC LTD </option> <option value=" LAGOS - SURULERE - PHOENIX EYE CLINIC LTD "> LAGOS - SURULERE - PHOENIX EYE CLINIC LTD </option> <option value=" LAGOS - SURULERE - SMILEY OPTICAL SERVICES "> LAGOS - SURULERE - SMILEY OPTICAL SERVICES </option> <option value=" LAGOS - SURULERE - VIEW PLUS OPTICAL LIMITED "> LAGOS - SURULERE - VIEW PLUS OPTICAL LIMITED </option> <option value=" LAGOS - VGC - AMARA MEDICARE "> LAGOS - VGC - AMARA MEDICARE </option> <option value=" LAGOS - VICTORIA ISLAND - HEPHZIBAH EYE CARE "> LAGOS - VICTORIA ISLAND - HEPHZIBAH EYE CARE </option> <option value=" OGUN - ABEOKUTA - METRO EYE CLINIC - ABEOKUTA "> OGUN - ABEOKUTA - METRO EYE CLINIC - ABEOKUTA </option> <option value=" OGUN - AGBARA - FORST EYE CLINIC & OPTICAL SERVICES "> OGUN - AGBARA - FORST EYE CLINIC & OPTICAL SERVICES </option> <option value=" OGUN - IJEBU- ODE - METRO EYE CLINIC, OGUN "> OGUN - IJEBU- ODE - METRO EYE CLINIC, OGUN </option> <option value=" OGUN - SANGO-OTA - Metro Eye Clinic - Ota Ogun State "> OGUN - SANGO-OTA - Metro Eye Clinic - Ota Ogun State </option> <option value=" OYO - OLUYOLE ESTATE - HEPHZIBAH EYE CARE "> OYO - OLUYOLE ESTATE - HEPHZIBAH EYE CARE </option> <option value=" FCT (ABUJA) - JABI - LOCUS EYE CLINIC "> FCT (ABUJA) - JABI - LOCUS EYE CLINIC </option> <option value=" FCT (ABUJA) - WUSE - DE-LENS OPHTHALMICS "> FCT (ABUJA) - WUSE - DE-LENS OPHTHALMICS </option> <option value=" KADUNA - KADUNA - THELISH EYE CLINIC "> KADUNA - KADUNA - THELISH EYE CLINIC </option> <option value=" KADUNA - ZARIA - LORRY B EYE CLINIC "> KADUNA - ZARIA - LORRY B EYE CLINIC </option> <option value=" KANO - GYADI - FIRST OPTICIANS EYE CLINIC "> KANO - GYADI - FIRST OPTICIANS EYE CLINIC </option> <option value=" KANO - KANO - ECWA EYE HOSPITAL "> KANO - KANO - ECWA EYE HOSPITAL </option> <option value=" KANO - KANO - MAKKAH SPECIALIST EYE HOSPITAL "> KANO - KANO - MAKKAH SPECIALIST EYE HOSPITAL </option> <option value=" KANO - KANO - RAYSIGHT EYE CLINIC "> KANO - KANO - RAYSIGHT EYE CLINIC </option> <option value=" KANO - KANO - THE SMILE SHOP LTD "> KANO - KANO - THE SMILE SHOP LTD </option> <option value=" ENUGU - UWANI - NIGER OPTICAL SERVICES co (NIG) LTD "> ENUGU - UWANI - NIGER OPTICAL SERVICES co (NIG) LTD </option> <option value=" DELTA - WARRI - ABELO EYE CLINIC "> DELTA - WARRI - ABELO EYE CLINIC </option> <option value=" AKWA IBOM - UYO - HEPHZIBAH EYE CARE "> AKWA IBOM - UYO - HEPHZIBAH EYE CARE </option>';
document.getElementById('input_30').addEventListener('change', function() {
	var patrq = this.value;
	document.getElementById('input_31').innerHTML= plntpa+plnbandd;
	document.getElementById('input_58').innerHTML= plntpa+plnbandd;
	document.getElementById('input_90').innerHTML= plntpa+plnbandd;
	document.getElementById('input_92').innerHTML= plntpa+plnbandd;
	document.getElementById('input_94').innerHTML= plntpa+plnbandd;
	document.getElementById('input_96').innerHTML= plntpa+plnbandd;
	if (patrq =='Platinum Plan') {
		document.getElementById('input_31').innerHTML= plnbanda+plnbandb+plnbandc+plnbandd;
	document.getElementById('input_58').innerHTML= plnbanda+plnbandb+plnbandc+plnbandd;
	document.getElementById('input_90').innerHTML= plnbanda+plnbandb+plnbandc+plnbandd;
	document.getElementById('input_92').innerHTML= plnbanda+plnbandb+plnbandc+plnbandd;
	document.getElementById('input_94').innerHTML= plnbanda+plnbandb+plnbandc+plnbandd;
	document.getElementById('input_96').innerHTML= plnbanda+plnbandb+plnbandc+plnbandd;
	}else if (patrq.trim() =='Diamond Plan'){
		document.getElementById('input_31').innerHTML= plnbanda+plnbandb+plnbandc+plnbandd;
	document.getElementById('input_58').innerHTML= plnbanda+plnbandb+plnbandc+plnbandd;
	document.getElementById('input_90').innerHTML= plnbanda+plnbandb+plnbandc+plnbandd;
	document.getElementById('input_92').innerHTML= plnbanda+plnbandb+plnbandc+plnbandd;
	document.getElementById('input_94').innerHTML= plnbanda+plnbandb+plnbandc+plnbandd;
	document.getElementById('input_96').innerHTML= plnbanda+plnbandb+plnbandc+plnbandd;
	}else if (patrq.trim() =='Gold Plus Plan'){
		document.getElementById('input_31').innerHTML= plntpa+plnbandb+plnbandc+plnbandd;
	document.getElementById('input_58').innerHTML= plntpa+plnbandb+plnbandc+plnbandd;
	document.getElementById('input_90').innerHTML= plntpa+plnbandb+plnbandc+plnbandd;
	document.getElementById('input_92').innerHTML= plntpa+plnbandb+plnbandc+plnbandd;
	document.getElementById('input_94').innerHTML= plntpa+plnbandb+plnbandc+plnbandd;
	document.getElementById('input_96').innerHTML= plntpa+plnbandb+plnbandc+plnbandd;
	}else if (patrq.trim() =='Gold Plan'){
		document.getElementById('input_31').innerHTML= plntpa+plnbandc+plnbandd;
	document.getElementById('input_58').innerHTML= plntpa+plnbandc+plnbandd;
	document.getElementById('input_90').innerHTML= plntpa+plnbandc+plnbandd;
	document.getElementById('input_92').innerHTML= plntpa+plnbandc+plnbandd;
	document.getElementById('input_94').innerHTML= plntpa+plnbandc+plnbandd;
	document.getElementById('input_96').innerHTML= plntpa+plnbandc+plnbandd;
	}else if (patrq.trim() =='TPA'){
		document.getElementById('input_31').innerHTML= plntpa+plnbanda+plnbandb+plnbandc+plnbandd;
	document.getElementById('input_58').innerHTML= plntpa+plnbanda+plnbandb+plnbandc+plnbandd;
	document.getElementById('input_90').innerHTML= plntpa+plnbanda+plnbandb+plnbandc+plnbandd;
	document.getElementById('input_92').innerHTML= plntpa+plnbanda+plnbandb+plnbandc+plnbandd;
	document.getElementById('input_94').innerHTML= plntpa+plnbanda+plnbandb+plnbandc+plnbandd;
	document.getElementById('input_96').innerHTML= plntpa+plnbanda+plnbandb+plnbandc+plnbandd;
	}
	var options = $('select#input_31 option');
    var arr = options.map(function(_, o) {
        return {
            t: $(o).text(),
            v: o.value
        };
    }).get();
    arr.sort(function(o1, o2) {
        return o1.t > o2.t ? 1 : o1.t < o2.t ? -1 : 0;
    });
    options.each(function(i, o) {
        console.log(i);
        o.value = arr[i].v;
        $(o).text(arr[i].t);
    });
 //2   
    var options = $('select#input_58 option');
    var arr = options.map(function(_, o) {
        return {
            t: $(o).text(),
            v: o.value
        };
    }).get();
    arr.sort(function(o1, o2) {
        return o1.t > o2.t ? 1 : o1.t < o2.t ? -1 : 0;
    });
    options.each(function(i, o) {
        console.log(i);
        o.value = arr[i].v;
        $(o).text(arr[i].t);
    });
    //3
    var options = $('select#input_90 option');
    var arr = options.map(function(_, o) {
        return {
            t: $(o).text(),
            v: o.value
        };
    }).get();
    arr.sort(function(o1, o2) {
        return o1.t > o2.t ? 1 : o1.t < o2.t ? -1 : 0;
    });
    options.each(function(i, o) {
        console.log(i);
        o.value = arr[i].v;
        $(o).text(arr[i].t);
    });
    //4
    var options = $('select#input_92 option');
    var arr = options.map(function(_, o) {
        return {
            t: $(o).text(),
            v: o.value
        };
    }).get();
    arr.sort(function(o1, o2) {
        return o1.t > o2.t ? 1 : o1.t < o2.t ? -1 : 0;
    });
    options.each(function(i, o) {
        console.log(i);
        o.value = arr[i].v;
        $(o).text(arr[i].t);
    });
    //5
    var options = $('select#input_94 option');
    var arr = options.map(function(_, o) {
        return {
            t: $(o).text(),
            v: o.value
        };
    }).get();
    arr.sort(function(o1, o2) {
        return o1.t > o2.t ? 1 : o1.t < o2.t ? -1 : 0;
    });
    options.each(function(i, o) {
        console.log(i);
        o.value = arr[i].v;
        $(o).text(arr[i].t);
    });
    //6
    var options = $('select#input_96 option');
    var arr = options.map(function(_, o) {
        return {
            t: $(o).text(),
            v: o.value
        };
    }).get();
    arr.sort(function(o1, o2) {
        return o1.t > o2.t ? 1 : o1.t < o2.t ? -1 : 0;
    });
    options.each(function(i, o) {
        console.log(i);
        o.value = arr[i].v;
        $(o).text(arr[i].t);
    });
});

</script>

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