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Privacy Statement | Jazz Pharmaceuticals

<!DOCTYPE html> <html lang="en" dir="ltr"> <head> <meta charset="utf-8" /> <script type="text/javascript" id="Cookiebot" src="https://consent.cookiebot.com/uc.js" data-cbid="b2af057f-17ce-4f4e-8887-9bfcbdd91701" data-blockingmode="auto" async="async"></script> <meta name="Generator" content="Drupal 9 (https://www.drupal.org)" /> <meta name="MobileOptimized" content="width" /> <meta name="HandheldFriendly" content="true" /> <meta name="viewport" content="width=device-width, initial-scale=1.0" /> <meta name="description" content="Jazz has developed this Privacy Policy to summarize how we collect, maintain and use personally identifiable information through our Internet sites." /> <link rel="icon" href="/sites/jazzpharmaceuticals/themes/jazztheme/favicon.ico" type="image/vnd.microsoft.icon" /> <link rel="canonical" href="https://www.jazzpharma.com/privacy-statement" /> <link rel="shortlink" href="https://www.jazzpharma.com/node/796" /> <title>Privacy Statement | Jazz Pharmaceuticals</title> <link rel="stylesheet" media="all" href="/sites/jazzpharmaceuticals/files/css/css_HYmdnhLDZygL-74tfrcRRWA8zWa6q3BLEkfWPf6Z8eA.css" /> <link rel="stylesheet" media="all" href="/sites/jazzpharmaceuticals/files/css/css_71Nj6xyNICz_M4AnAqaMq26Wwiop57-jJ2gxwLpnu5Y.css" /> <meta charset="utf-8" /> <meta http-equiv="Content-Type" content="text/html, charset=utf-8" /> <meta name="viewport" content="width=device-width, initial-scale=1" /> <meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1" /><script type="text/javascript">(window.NREUM||(NREUM={})).init={ajax:{deny_list:["bam.nr-data.net"]}};(window.NREUM||(NREUM={})).loader_config={licenseKey:"0a076d1c81",applicationID:"1521664745"};;/*! 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id="jazzforms-form-msi" accept-charset="UTF-8"> <div id="attentionPopup" class="popup-wrapper"> <div class="popup-bg" onclick="JazzFormsMSICloseAttentionPopup();"></div> <div class="popup "> <a class="close popupclosebutton" href="#" onclick="JazzFormsMSICloseAttentionPopup(); return false;"></a> <div class="inner"> <p class="text-center">ATTENZIONE: La richiesta di informazioni di carattere medico – scientifico è riservata ai SOLI professionisti sanitari (medici, farmacisti ospedalieri). Con la compilazione dei dati professionali nella finestra che apparirà premendo il bottone sottostate l’Utente dichiara di essere un professionista sanitario e si impegna a fornire dati completi e veritieri. </p> <div class="btn-line text-center"> <a href="#" class="btn btn-primary" id="continueLeavingLinkIt" onclick="JazzFormsMSISwitchPopups(); return false;">Ho letto e capito l’avviso sopra contenuto</a></div> </div> </div> </div> <div id="contact-popup-it" class="popup-wrapper alt-style-form "> <div class="popup-bg" onclick="JazzFormsMSIClosePopup();"></div> <div class="popup"> <a class="close" href="#" onclick="JazzFormsMSIClosePopup(); return false;"></a> <div class="inner"> <span class="aftersubmit" id="msisuccess" style="display: none;"><p class="text-center"><br/><br/>Grazie per aver contattato Jazz Pharmaceuticals Corporate Development &amp; Partnering<br/><br/><br/><br/><br/></p></span> <span class="aftersubmit" id="msierror" style="display: none;"><p class="text-center"><br/><br/>Errore nell'invio dell'e-mail. Si prega di contattare l'amministrazione del sito<br/><br/><br/><br/><br/></p></span> <span class="msibeforesubmit"> <div class="contact-form pt-0"> <div class="row"> <div class="col-12 col-md-6 form-row"> <label class="form-label">Nome</label> <div class="js-form-item form-item js-form-type-textfield form-item-nome js-form-item-nome form-no-label"> <input class="textField form-text required" data-drupal-selector="edit-nome" type="text" id="edit-nome" name="nome" value="" size="60" maxlength="128" required="required" aria-required="true" /> </div> </div> <div class="col-12 col-md-6 form-row"> <label class="form-label">Cognome</label> <div class="js-form-item form-item js-form-type-textfield form-item-cognome js-form-item-cognome form-no-label"> <input class="textField form-text required" data-drupal-selector="edit-cognome" type="text" id="edit-cognome" name="cognome" value="" size="60" maxlength="128" required="required" aria-required="true" /> </div> </div> <div class="col-12 col-md-6 form-row" style="position: absolute; left: -1000px;"> <label class="form-label">Nome</label> <div class="js-form-item form-item js-form-type-textfield form-item-minome js-form-item-minome form-no-label"> <input class="textField form-text" data-drupal-selector="edit-minome" type="text" id="edit-minome" name="minome" value="" size="60" maxlength="128" /> </div> </div> <div class="col-12 col-md-6 form-row"> <label class="form-label">Ospedale</label> <div class="js-form-item form-item js-form-type-textfield form-item-ospedale js-form-item-ospedale form-no-label"> <input class="textField form-text required" data-drupal-selector="edit-ospedale" type="text" id="edit-ospedale" name="ospedale" value="" size="60" maxlength="128" required="required" aria-required="true" /> </div> </div> <div class="col-12 col-md-6 form-row"> <label class="form-label">Indirizzo</label> <div class="js-form-item form-item js-form-type-textfield form-item-indirizzo js-form-item-indirizzo form-no-label"> <input class="textField form-text required" data-drupal-selector="edit-indirizzo" type="text" id="edit-indirizzo" name="indirizzo" value="" size="60" maxlength="128" required="required" aria-required="true" /> </div> </div> <div class="col-12 col-md-6 form-row"> <label class="form-label">Specializz.</label> <div class="js-form-item form-item js-form-type-textfield form-item-specializz js-form-item-specializz form-no-label"> <input class="textField form-text required" data-drupal-selector="edit-specializz" type="text" id="edit-specializz" name="specializz" value="" size="60" maxlength="128" required="required" aria-required="true" /> </div> </div> <div class="col-12 col-md-6 form-row"> <label class="form-label">N° Ordine</label> <div class="js-form-item form-item js-form-type-textfield form-item-n-ordine js-form-item-n-ordine form-no-label"> <input class="textField form-text required" data-drupal-selector="edit-n-ordine" type="text" id="edit-n-ordine" name="n_ordine" value="" size="60" maxlength="128" required="required" aria-required="true" /> </div> </div> <div class="col-12 col-md-6 form-row"> <label class="form-label">Ord. Prov.</label> <div class="js-form-item form-item js-form-type-textfield form-item-ord-prov js-form-item-ord-prov form-no-label"> <input class="textField form-text required" data-drupal-selector="edit-ord-prov" type="text" id="edit-ord-prov" name="ord_prov" value="" size="60" maxlength="128" required="required" aria-required="true" /> </div> </div> <div class="col-12 col-md-6 form-row"> <label class="form-label">E-mail</label> <div class="js-form-item form-item js-form-type-textfield form-item-email js-form-item-email form-no-label"> <input class="textField form-text required" data-drupal-selector="edit-email" type="text" id="edit-email" name="email" value="" size="60" maxlength="128" required="required" aria-required="true" /> </div> </div> <div class="col-12 col-md-6 form-row"> <label class="form-label">N. Telefono</label> <div class="js-form-item form-item js-form-type-textfield form-item-tel js-form-item-tel form-no-label"> <input class="textField form-text required" data-drupal-selector="edit-tel" type="text" id="edit-tel" name="tel" value="" size="60" maxlength="128" required="required" aria-required="true" /> </div> </div> </div> <div class="row mt-3"> <div class="col-auto mt-3 checkbox-wrapper"> <div class="js-form-item form-item js-form-type-checkbox form-item-medico js-form-item-medico form-no-label"> <input class="unregular-checkbox form-checkbox required" data-drupal-selector="edit-medico" type="checkbox" id="edit-medico" name="medico" value="1" required="required" aria-required="true" /> </div> <label class="label-checkbox">Medico</label> </div> <div class="col-auto mt-3 checkbox-wrapper"> <div class="js-form-item form-item js-form-type-checkbox form-item-farmacista-ospedaliero js-form-item-farmacista-ospedaliero form-no-label"> <input class="unregular-checkbox form-checkbox required" data-drupal-selector="edit-farmacista-ospedaliero" type="checkbox" id="edit-farmacista-ospedaliero" name="farmacista_ospedaliero" value="1" required="required" aria-required="true" /> </div> <label class="label-checkbox">Farmacista Ospedaliero</label> </div> </div> <div class="row mt-3"> <div class="col-12"> Prodotto per il quale si richiede il contatto: </div> <div class="col-auto mt-3 checkbox-wrapper"> <div class="js-form-item form-item js-form-type-checkbox form-item-vyxeos js-form-item-vyxeos form-no-label"> <input class="unregular-checkbox form-checkbox required" data-drupal-selector="edit-vyxeos" type="checkbox" id="edit-vyxeos" name="vyxeos" value="1" required="required" aria-required="true" /> </div> <label class="label-checkbox">Vyxeos</label> </div> <div class="col-auto mt-3 checkbox-wrapper"> <div class="js-form-item form-item js-form-type-checkbox form-item-defitelio js-form-item-defitelio form-no-label"> <input class="unregular-checkbox form-checkbox required" data-drupal-selector="edit-defitelio" type="checkbox" id="edit-defitelio" name="defitelio" value="1" required="required" aria-required="true" /> </div> <label class="label-checkbox">Defitelio</label> </div> <div class="col-auto mt-3 checkbox-wrapper"> <div class="js-form-item form-item js-form-type-checkbox form-item-sunosi js-form-item-sunosi form-no-label"> <input class="unregular-checkbox form-checkbox required" data-drupal-selector="edit-sunosi" type="checkbox" id="edit-sunosi" name="sunosi" value="1" required="required" aria-required="true" /> </div> <label class="label-checkbox">Sunosi</label> </div> </div> <div class="row"> <div class="col-12 form-row"> <label class="form-label">Motivo richiesta contatto <small>(opzionale)</small>:</label> <div class="js-form-item form-item js-form-type-textarea form-item-motivo-contatto js-form-item-motivo-contatto form-no-label"> <div> <textarea class="textField form-textarea" data-drupal-selector="edit-motivo-contatto" id="edit-motivo-contatto" name="motivo_contatto" rows="5" cols="60"></textarea> </div> </div> </div> </div> <div class="row"> <div class="col-auto mt-3 checkbox-wrapper"> <div class="js-form-item form-item js-form-type-checkbox form-item-ricezione-informazione js-form-item-ricezione-informazione form-no-label"> <input class="unregular-checkbox form-checkbox required" data-drupal-selector="edit-ricezione-informazione" type="checkbox" id="edit-ricezione-informazione" name="ricezione_informazione" value="1" required="required" aria-required="true" /> </div> <label class="label-checkbox">Ricezione Informazione medico scientifica</label> </div> </div> <div class="row"> <div class="col-12 form-row mt-5"> <input class="btn btn-primary invio button js-form-submit form-submit" data-drupal-selector="edit-button-submit" type="submit" id="edit-button-submit" name="op" value="INVIO" /> </div> </div> <input autocomplete="off" data-drupal-selector="form-gudzaonprm8hcp6yqztcupdu-c7fxdjo4i6ffijttvo" type="hidden" name="form_build_id" value="form-gUDzaoNprM8Hcp6YQZTCUPDu-C7fXDjO4I6FFIJTTvo" /> <input data-drupal-selector="edit-jazzforms-form-msi" type="hidden" name="form_id" value="jazzforms_form_msi" /> </div> </span> </div> </div> </div> </form> <form class="reqprivform" data-drupal-selector="jazzforms-form-privacy" action="/privacy-statement" method="post" id="jazzforms-form-privacy" accept-charset="UTF-8"> <div id="requestPrivacyFormPopup" class="popup-wrapper alt-style-form"> <div class="popup-bg" onclick="hidePrivacyPopup();"></div> <div class="popup"> <div class="popup-header"> <a class="close" onclick="hidePrivacyPopup(); return false;"></a> <h2>Privacy Request Form</h2> </div> <div class="inner"> <span class="aftersubmit" id="prvsuccess" style="display: none;" ><p class="text-center py-5 mb-5">Thank you! We'll get back to you shortly.</p></span> <span class="aftersubmit" id="prverror" style="display: none">Error sending email. Please contact site administration</span> <span class="prvbeforesubmit"> <p>This page is intended for U.S. residents only. We are not accepting requests from individuals in states other than California, Washington and Nevada. If you are not a resident of any of these states, please do NOT continue.</p> <p>Please select and enter the required fields on the form below. We need this information to process your request and to take necessary steps to verify your identity. We will contact you if we need any additional information.</p> <p>Please note that your rights may vary under applicable state privacy laws and may be subject to limitations.</p> <div class="contact-form"> <div class="row"> <div class="col-12"> <div>I am making this request for myself or on behalf of someone else <sup class="required">*</sup></div> <div class="row"> <div class="col-auto mt-3 checkbox-wrapper js-form-item form-item js-form-type-radio form-item-request-source js-form-item-request-source"> <input class="unregular-radio form-radio" data-drupal-selector="edit-request-source-myself" type="radio" id="edit-request-source-myself" name="request_source" value="Myself" /> <label for="edit-request-source-myself" class="label-checkbox option">Myself</label> </div> <div class="col-auto mt-3 checkbox-wrapper js-form-item form-item js-form-type-radio form-item-request-source js-form-item-request-source"> <input class="unregular-radio form-radio" data-drupal-selector="edit-request-source-on-behalf-of-someone-else" type="radio" id="edit-request-source-on-behalf-of-someone-else" name="request_source" value="On behalf of someone else" /> <label for="edit-request-source-on-behalf-of-someone-else" class="label-checkbox option">On behalf of someone else</label> </div> </div> <div class="form-row">Select request type <sup class="required">*</sup> </div> <div class="row"> <div class="col-auto mt-3 checkbox-wrapper js-form-item form-item js-form-type-radio form-item-request-type js-form-item-request-type"> <input class="unregular-radio form-radio" data-drupal-selector="edit-request-type-access-data" type="radio" id="edit-request-type-access-data" name="request_type" value="Access Data" /> <label for="edit-request-type-access-data" class="label-checkbox option">Access Data</label> </div> <div class="col-auto mt-3 checkbox-wrapper js-form-item form-item js-form-type-radio form-item-request-type js-form-item-request-type"> <input class="unregular-radio form-radio" data-drupal-selector="edit-request-type-correct-data" type="radio" id="edit-request-type-correct-data" name="request_type" value="Correct Data" /> <label for="edit-request-type-correct-data" class="label-checkbox option">Correct Data</label> </div> <div class="col-auto mt-3 checkbox-wrapper js-form-item form-item js-form-type-radio form-item-request-type js-form-item-request-type"> <input class="unregular-radio form-radio" data-drupal-selector="edit-request-type-deletion-request" type="radio" id="edit-request-type-deletion-request" name="request_type" value="Deletion request" /> <label for="edit-request-type-deletion-request" class="label-checkbox option">Deletion request</label> </div> <div class="col-auto mt-3 checkbox-wrapper js-form-item form-item js-form-type-radio form-item-request-type js-form-item-request-type"> <input class="unregular-radio form-radio" data-drupal-selector="edit-request-type-limit-the-use-of-my-sensitive-personal-information" type="radio" id="edit-request-type-limit-the-use-of-my-sensitive-personal-information" name="request_type" value="Limit the use of my sensitive personal information" /> <label for="edit-request-type-limit-the-use-of-my-sensitive-personal-information" class="label-checkbox option">Limit the use of my sensitive personal information</label> </div> <div class="col-auto mt-3 checkbox-wrapper js-form-item form-item js-form-type-radio form-item-request-type js-form-item-request-type"> <input class="unregular-radio form-radio" data-drupal-selector="edit-request-type-revoke-consent" type="radio" id="edit-request-type-revoke-consent" name="request_type" value="Revoke consent" /> <label for="edit-request-type-revoke-consent" class="label-checkbox option">Revoke consent</label> </div> </div> <div class="form-row">What is your relationship with Jazz Pharmaceuticals? <sup class="required">*</sup> </div> <div class="row"> <div class="col-auto mt-3 checkbox-wrapper js-form-item form-item js-form-type-radio form-item-i-am js-form-item-i-am"> <input class="unregular-radio form-radio" data-drupal-selector="edit-i-am-patientconsumer" type="radio" id="edit-i-am-patientconsumer" name="i_am" value="Patient/Consumer" /> <label for="edit-i-am-patientconsumer" class="label-checkbox option">Patient/Consumer</label> </div> <div class="col-auto mt-3 checkbox-wrapper js-form-item form-item js-form-type-radio form-item-i-am js-form-item-i-am"> <input class="unregular-radio form-radio" data-drupal-selector="edit-i-am-health-care-professional" type="radio" id="edit-i-am-health-care-professional" name="i_am" value="Health Care Professional" /> <label for="edit-i-am-health-care-professional" class="label-checkbox option">Health Care Professional</label> </div> <div class="col-auto mt-3 checkbox-wrapper js-form-item form-item js-form-type-radio form-item-i-am js-form-item-i-am"> <input class="unregular-radio form-radio" data-drupal-selector="edit-i-am-contractorconsultant" type="radio" id="edit-i-am-contractorconsultant" name="i_am" value="Contractor/Consultant" /> <label for="edit-i-am-contractorconsultant" class="label-checkbox option">Contractor/Consultant</label> </div> <div class="col-auto mt-3 checkbox-wrapper js-form-item form-item js-form-type-radio form-item-i-am js-form-item-i-am"> <input class="unregular-radio form-radio" data-drupal-selector="edit-i-am-job-applicant" type="radio" id="edit-i-am-job-applicant" name="i_am" value="Job Applicant" /> <label for="edit-i-am-job-applicant" class="label-checkbox option">Job Applicant</label> </div> <div class="col-auto mt-3 checkbox-wrapper js-form-item form-item js-form-type-radio form-item-i-am js-form-item-i-am"> <input class="unregular-radio form-radio" data-drupal-selector="edit-i-am-former-employee" type="radio" id="edit-i-am-former-employee" name="i_am" value="Former Employee" /> <label for="edit-i-am-former-employee" class="label-checkbox option">Former Employee</label> </div> <div class="col-auto mt-3 checkbox-wrapper js-form-item form-item js-form-type-radio form-item-i-am js-form-item-i-am"> <input class="unregular-radio form-radio" data-drupal-selector="edit-i-am-other-please-describe-below" type="radio" id="edit-i-am-other-please-describe-below" name="i_am" value="Other: Please describe below" /> <label for="edit-i-am-other-please-describe-below" class="label-checkbox option">Other: Please describe below</label> </div> </div> <div class="row i_am_other" style="display: none;"> <div class="col-12 col-md-12 form-row"> <div class="js-form-item form-item js-form-type-textarea form-item-i-am-other js-form-item-i-am-other form-no-label"> <div> <textarea style="width: 100%; height: 70px;" data-drupal-selector="edit-i-am-other" id="edit-i-am-other" name="i_am_other" rows="5" cols="60" class="form-textarea"></textarea> </div> </div> </div> </div> <div class="iapatient mt-4" style="display: none;">Select Jazz Pharmaceuticals Product(s)<sup class="required">*</sup> </div> <div class="row iapatient" style="display: none;"> <div id="edit-products" class="form-checkboxes"><div class="col-12 col-md-12 form-row checkbox-wrapper js-form-item form-item js-form-type-checkbox form-item-products-epidiolex®-cannabidiol js-form-item-products-epidiolex®-cannabidiol"> <input class="unregular-checkbox products-checkbox form-checkbox" data-drupal-selector="edit-products-epidiolex-cannabidiol" type="checkbox" id="edit-products-epidiolex-cannabidiol" name="products[Epidiolex® (cannabidiol)]" value="Epidiolex® (cannabidiol)" /> <label for="edit-products-epidiolex-cannabidiol" class="option">Epidiolex® (cannabidiol)</label> </div> <div class="col-12 col-md-12 form-row checkbox-wrapper js-form-item form-item js-form-type-checkbox form-item-products-xyrem®-sodium-oxybate js-form-item-products-xyrem®-sodium-oxybate"> <input class="unregular-checkbox products-checkbox form-checkbox" data-drupal-selector="edit-products-xyrem-sodium-oxybate" type="checkbox" id="edit-products-xyrem-sodium-oxybate" name="products[Xyrem® (sodium oxybate)]" value="Xyrem® (sodium oxybate)" /> <label for="edit-products-xyrem-sodium-oxybate" class="option">Xyrem® (sodium oxybate)</label> </div> <div class="col-12 col-md-12 form-row checkbox-wrapper js-form-item form-item js-form-type-checkbox form-item-products-xywav™-calcium-magnesium-potassium-and-sodium-oxybates js-form-item-products-xywav™-calcium-magnesium-potassium-and-sodium-oxybates"> <input class="unregular-checkbox products-checkbox form-checkbox" data-drupal-selector="edit-products-xywav-calcium-magnesium-potassium-and-sodium-oxybates" type="checkbox" id="edit-products-xywav-calcium-magnesium-potassium-and-sodium-oxybates" name="products[Xywav™ (calcium, magnesium, potassium and sodium oxybates)]" value="Xywav™ (calcium, magnesium, potassium and sodium oxybates)" /> <label for="edit-products-xywav-calcium-magnesium-potassium-and-sodium-oxybates" class="option">Xywav™ (calcium, magnesium, potassium and sodium oxybates)</label> </div> <div class="col-12 col-md-12 form-row checkbox-wrapper js-form-item form-item js-form-type-checkbox form-item-products-defitelio®-defibrotide-sodium js-form-item-products-defitelio®-defibrotide-sodium"> <input class="unregular-checkbox products-checkbox form-checkbox" data-drupal-selector="edit-products-defitelio-defibrotide-sodium" type="checkbox" id="edit-products-defitelio-defibrotide-sodium" name="products[Defitelio® (defibrotide sodium)]" value="Defitelio® (defibrotide sodium)" /> <label for="edit-products-defitelio-defibrotide-sodium" class="option">Defitelio® (defibrotide sodium)</label> </div> <div class="col-12 col-md-12 form-row checkbox-wrapper js-form-item form-item js-form-type-checkbox form-item-products-rylaze™-asparaginase-erwinia-chrysanthemi-recombinant-rywn js-form-item-products-rylaze™-asparaginase-erwinia-chrysanthemi-recombinant-rywn"> <input class="unregular-checkbox products-checkbox form-checkbox" data-drupal-selector="edit-products-rylaze-asparaginase-erwinia-chrysanthemi-recombinant-rywn" type="checkbox" id="edit-products-rylaze-asparaginase-erwinia-chrysanthemi-recombinant-rywn" name="products[Rylaze™ (asparaginase erwinia chrysanthemi (recombinant)-rywn)]" value="Rylaze™ (asparaginase erwinia chrysanthemi (recombinant)-rywn)" /> <label for="edit-products-rylaze-asparaginase-erwinia-chrysanthemi-recombinant-rywn" class="option">Rylaze™ (asparaginase erwinia chrysanthemi (recombinant)-rywn)</label> </div> <div class="col-12 col-md-12 form-row checkbox-wrapper js-form-item form-item js-form-type-checkbox form-item-products-vyxeos®-daunorubicin-and-cytarabine js-form-item-products-vyxeos®-daunorubicin-and-cytarabine"> <input class="unregular-checkbox products-checkbox form-checkbox" data-drupal-selector="edit-products-vyxeos-daunorubicin-and-cytarabine" type="checkbox" id="edit-products-vyxeos-daunorubicin-and-cytarabine" name="products[Vyxeos® (daunorubicin and cytarabine)]" value="Vyxeos® (daunorubicin and cytarabine)" /> <label for="edit-products-vyxeos-daunorubicin-and-cytarabine" class="option">Vyxeos® (daunorubicin and cytarabine)</label> </div> <div class="col-12 col-md-12 form-row checkbox-wrapper js-form-item form-item js-form-type-checkbox form-item-products-zepzelca™-lurbinectedin js-form-item-products-zepzelca™-lurbinectedin"> <input class="unregular-checkbox products-checkbox form-checkbox" data-drupal-selector="edit-products-zepzelca-lurbinectedin" type="checkbox" id="edit-products-zepzelca-lurbinectedin" name="products[Zepzelca™ (lurbinectedin)]" value="Zepzelca™ (lurbinectedin)" /> <label for="edit-products-zepzelca-lurbinectedin" class="option">Zepzelca™ (lurbinectedin)</label> </div> </div> </div> <div class="row"> <div class="col-12 col-md-6 form-row"> <label class="form-label">First Name <sup class="required">*</sup></label> <div class="js-form-item form-item js-form-type-textfield form-item-first-name js-form-item-first-name form-no-label"> <input class="textField form-text" data-drupal-selector="edit-first-name" type="text" id="edit-first-name" name="first_name" value="" size="60" maxlength="128" /> </div> </div> <div class="col-12 col-md-6 form-row"> <label class="form-label">Last Name <sup class="required">*</sup></label> <div class="js-form-item form-item js-form-type-textfield form-item-last-name js-form-item-last-name form-no-label"> <input class="textField form-text" data-drupal-selector="edit-last-name" type="text" id="edit-last-name" name="last_name" value="" size="60" maxlength="128" /> </div> </div> <div class="col-12 col-md-6 form-row"> <label class="form-label">Date of Birth – (MM/DD/YYYY)<sup class="required">*</sup></label> <div class="js-form-item form-item js-form-type-textfield form-item-birthdate js-form-item-birthdate form-no-label"> <input class="textField form-text" placeholder="MM/DD/YYYY" data-drupal-selector="edit-birthdate" type="text" id="edit-birthdate" name="birthdate" value="" 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