{"id":5824,"date":"2025-06-11T11:39:55","date_gmt":"2025-06-11T16:39:55","guid":{"rendered":"https:\/\/vetaffairs.la.gov\/?page_id=5824"},"modified":"2025-06-30T16:54:55","modified_gmt":"2025-06-30T21:54:55","slug":"don-xin-chon-cat-truoc-khi-can-thiet","status":"publish","type":"page","link":"https:\/\/vetaffairs.la.gov\/vi\/don-xin-chon-cat-truoc-khi-can-thiet","title":{"rendered":"\u0110\u01a1n xin ti\u1ec1n h\u1ed7 tr\u1ee3\/ch\u00f4n c\u1ea5t"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"5824\" class=\"elementor elementor-5824\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-04f07ed e-flex e-con-boxed e-con e-parent\" data-id=\"04f07ed\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-88c4289 elementor-widget elementor-widget-heading\" data-id=\"88c4289\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Ti\u1ec1n nhu c\u1ea7u (Tr\u01b0\u1edbc khi ch\u1ebft)<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-45d78e4 li-styling elementor-widget elementor-widget-text-editor\" data-id=\"45d78e4\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>N\u1ebfu b\u1ea1n s\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y tr\u01b0\u1edbc khi ng\u01b0\u1eddi th\u00e2n qua \u0111\u1eddi, b\u1ea1n s\u1ebd ch\u1ecdn n\u00fat &quot;Nhu c\u1ea7u Tr\u01b0\u1edbc&quot;. N\u00fat n\u00e0y cho ph\u00e9p b\u1ea1n ch\u1ec9 \u0111i\u1ec1n nh\u1eefng ph\u1ea7n c\u1ea7n thi\u1ebft c\u1ee7a \u0111\u01a1n \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n. \u0110\u00e2y kh\u00f4ng ph\u1ea3i l\u00e0 y\u00eau c\u1ea7u b\u1eaft bu\u1ed9c \u0111\u1ec3 \u0111\u01b0\u1ee3c ch\u00f4n c\u1ea5t t\u1ea1i ngh\u0129a trang c\u1ee7a ch\u00fang t\u00f4i, nh\u01b0ng b\u1ea1n c\u00f3 th\u1ec3 l\u00e0m \u0111i\u1ec1u n\u00e0y tr\u01b0\u1edbc khi qua \u0111\u1eddi n\u1ebfu b\u1ea1n kh\u00f4ng ch\u1eafc ch\u1eafn v\u1ec1 vi\u1ec7c m\u00ecnh c\u00f3 \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n \u0111\u1ec3 \u0111\u01b0\u1ee3c ch\u00f4n c\u1ea5t t\u1ea1i ngh\u0129a trang c\u1ef1u chi\u1ebfn binh c\u1ee7a ti\u1ec3u bang Louisiana hay kh\u00f4ng.<\/p><ul><li><strong>Th\u00f4ng tin v\u1ec1 C\u1ef1u chi\u1ebfn binh v\u00e0 Qu\u00e2n \u0111\u1ed9i<\/strong> \u2013 \u0110\u00e2y ch\u1ec9 l\u00e0 th\u00f4ng tin v\u1ec1 c\u1ef1u chi\u1ebfn binh. B\u1ea1n kh\u00f4ng c\u1ea7n ph\u1ea3i ngh\u1ec9 h\u01b0u m\u1edbi \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n, nh\u01b0ng c\u00e2u h\u1ecfi n\u00e0y gi\u00fap ch\u00fang t\u00f4i x\u00e1c minh r\u1eb1ng ch\u00fang t\u00f4i c\u00f3 \u0111\u1ea7y \u0111\u1ee7 th\u00f4ng tin c\u1ea7n thi\u1ebft v\u1ec1 qu\u00e1 tr\u00ecnh ph\u1ee5c v\u1ee5 c\u1ee7a c\u1ef1u chi\u1ebfn binh. C\u00f3 m\u1ed9t ch\u1ed7 \u0111\u1ec3 \u0111\u00e1nh d\u1ea5u b\u1ea5t k\u1ef3 th\u00f4ng tin b\u1ed5 sung n\u00e0o m\u00e0 b\u1ea1n cho r\u1eb1ng ch\u00fang t\u00f4i c\u00f3 th\u1ec3 c\u1ea7n \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111i\u1ec1u ki\u1ec7n tham gia.<\/li><li><strong>C\u00e1c tr\u01b0\u1eddng b\u1eaft bu\u1ed9c<\/strong> \u2013 C\u1ea7n cung c\u1ea5p m\u1ed9t s\u1ed1 th\u00f4ng tin nh\u1ea5t \u0111\u1ecbnh v\u1ec1 c\u1ef1u chi\u1ebfn binh \u0111\u1ec3 n\u1ed9p m\u1eabu \u0111\u01a1n n\u00e0y. N\u1ebfu tr\u01b0\u1eddng \u0111\u01b0\u1ee3c t\u00f4 m\u00e0u \u0110\u1ece th\u00ec \u0111\u00f3 l\u00e0 th\u00f4ng tin b\u1eaft bu\u1ed9c.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1463b50 elementor-widget elementor-widget-heading\" data-id=\"1463b50\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Ch\u00f4n c\u1ea5t (Sau khi ch\u1ebft)<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-751739f li-styling elementor-widget elementor-widget-text-editor\" data-id=\"751739f\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>N\u1ebfu ai \u0111\u00f3 \u0111\u00e3 qua \u0111\u1eddi v\u00e0 \u0111\u00e3 ho\u1eb7c \u0111ang trong qu\u00e1 tr\u00ecnh h\u1ecfa t\u00e1ng, ng\u01b0\u1eddi s\u1eafp x\u1ebfp vi\u1ec7c ch\u00f4n c\u1ea5t s\u1ebd \u0111i\u1ec1n v\u00e0o m\u1eabu \u0111\u01a1n n\u00e0y b\u1eb1ng c\u00e1ch ch\u1ecdn n\u00fat &quot;An t\u00e1ng&quot;. Ph\u1ea7n \u0111\u1ea7u ti\u00ean l\u00e0 th\u00f4ng tin v\u1ec1 ng\u01b0\u1eddi \u0111\u00e3 qua \u0111\u1eddi. N\u1ebfu h\u1ecd l\u00e0 c\u1ef1u chi\u1ebfn binh, khi b\u1ea1n ch\u1ecdn n\u00fat &quot;C\u1ef1u chi\u1ebfn binh&quot;, th\u00f4ng tin c\u01a1 b\u1ea3n c\u1ee7a h\u1ecd s\u1ebd \u0111\u01b0\u1ee3c sao ch\u00e9p v\u00e0o ph\u1ea7n th\u00f4ng tin c\u1ef1u chi\u1ebfn binh. N\u1ebfu ng\u01b0\u1eddi \u0111\u00e3 qua \u0111\u1eddi l\u00e0 ng\u01b0\u1eddi ph\u1ee5 thu\u1ed9c, b\u1ea1n s\u1ebd c\u1ea7n \u0111i\u1ec1n \u0111\u1ea7y \u0111\u1ee7 ph\u1ea7n &quot;C\u1ef1u chi\u1ebfn binh&quot;.<\/p><ul><li><strong>Th\u00f4ng tin v\u1ec1 C\u1ef1u chi\u1ebfn binh v\u00e0 Qu\u00e2n \u0111\u1ed9i<\/strong> \u2013 \u0110\u00e2y ch\u1ec9 l\u00e0 th\u00f4ng tin v\u1ec1 c\u1ef1u chi\u1ebfn binh. B\u1ea1n kh\u00f4ng c\u1ea7n ph\u1ea3i ngh\u1ec9 h\u01b0u m\u1edbi \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n, nh\u01b0ng c\u00e2u h\u1ecfi n\u00e0y gi\u00fap ch\u00fang t\u00f4i x\u00e1c minh r\u1eb1ng ch\u00fang t\u00f4i c\u00f3 \u0111\u1ea7y \u0111\u1ee7 th\u00f4ng tin c\u1ea7n thi\u1ebft v\u1ec1 qu\u00e1 tr\u00ecnh ph\u1ee5c v\u1ee5 c\u1ee7a c\u1ef1u chi\u1ebfn binh. C\u00f3 m\u1ed9t ch\u1ed7 \u0111\u1ec3 b\u1ea1n \u0111\u00e1nh d\u1ea5u b\u1ea5t k\u1ef3 th\u00f4ng tin b\u1ed5 sung n\u00e0o m\u00e0 b\u1ea1n cho l\u00e0 ch\u00fang t\u00f4i c\u00f3 th\u1ec3 c\u1ea7n \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111i\u1ec1u ki\u1ec7n tham gia.<\/li><li><strong>Th\u00f4ng tin li\u00ean l\u1ea1c<\/strong> \u2013 Ch\u00fang t\u00f4i ch\u1ec9 c\u1ea7n th\u00f4ng tin v\u1ec1 Nh\u00e0 tang l\u1ec5 n\u1ebfu h\u1ecd tham gia v\u00e0o vi\u1ec7c ch\u00f4n c\u1ea5t. Ch\u00fang t\u00f4i c\u1ea7n th\u00f4ng tin v\u1ec1 th\u00e0nh vi\u00ean gia \u0111\u00ecnh \u0111\u01b0\u1ee3c li\u1ec7t k\u00ea l\u00e0 Ng\u01b0\u1eddi li\u00ean h\u1ec7 gia \u0111\u00ecnh, n\u1ebfu ng\u01b0\u1eddi n\u00e0y kh\u00f4ng ph\u1ea3i l\u00e0 ng\u01b0\u1eddi th\u00e2n h\u1ee3p ph\u00e1p, ch\u00fang t\u00f4i s\u1ebd c\u1ea7n th\u00f4ng tin li\u00ean l\u1ea1c c\u1ee7a ng\u01b0\u1eddi th\u00e2n h\u1ee3p ph\u00e1p theo th\u1ee9 t\u1ef1 sau: V\u1ee3\/ch\u1ed3ng \u0111\u00e3 k\u1ebft h\u00f4n h\u1ee3p ph\u00e1p, Con ru\u1ed9t ho\u1eb7c con nu\u00f4i, Cha m\u1eb9, Anh ch\u1ecb em ru\u1ed9t, Gia \u0111\u00ecnh m\u1edf r\u1ed9ng.<\/li><li><strong>Th\u00f4ng tin v\u1ec1 l\u1ec5 an t\u00e1ng\/tang l\u1ec5<\/strong> \u2013 Qu\u00fd kh\u00e1ch s\u1ebd ch\u1ecdn \u0111\u1ecba \u0111i\u1ec3m h\u1ecfa t\u00e1ng d\u1ef1a tr\u00ean khu v\u1ef1c qu\u00fd kh\u00e1ch l\u1ef1a ch\u1ecdn (t\u00f9y thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng s\u1eb5n c\u00f3 t\u1ea1i ngh\u0129a trang \u0111\u00f3). Vui l\u00f2ng \u0111\u1ecdc k\u1ef9 c\u00e1c l\u1ef1a ch\u1ecdn d\u1ecbch v\u1ee5 c\u1ea7n thi\u1ebft tr\u01b0\u1edbc khi quy\u1ebft \u0111\u1ecbnh. Ngh\u0129a trang c\u1ee7a ch\u00fang t\u00f4i s\u1ebd s\u1eed d\u1ee5ng nh\u1eefng l\u1ef1a ch\u1ecdn n\u00e0y khi l\u00ean l\u1ecbch d\u1ecbch v\u1ee5 \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o \u0111\u1ed9i ng\u0169 nh\u00e2n vi\u00ean v\u00e0 thi\u1ebft l\u1eadp d\u1ecbch v\u1ee5 t\u1ed1t nh\u1ea5t cho l\u1ef1a ch\u1ecdn c\u1ee7a qu\u00fd kh\u00e1ch.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ff6065e elementor-hidden-desktop elementor-hidden-tablet elementor-hidden-mobile elementor-widget elementor-widget-heading\" data-id=\"ff6065e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">N\u1ed9p \u0111\u01a1n t\u1ea1i \u0111\u00e2y:<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7d683d0 elementor-widget elementor-widget-shortcode\" data-id=\"7d683d0\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 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3.68342 8.09763 4.31658 7.70711 4.70711C7.31658 5.09763 6.68342 5.09763 6.29289 4.70711L4 2.41421L1.70711 4.70711C1.31658 5.09763 0.683417 5.09763 0.292893 4.70711C-0.0976311 4.31658 -0.097631 3.68342 0.292893 3.29289L3.29289 0.292893C3.48043 0.105357 3.73478 0 4 0ZM0.292893 9.29289C0.683417 8.90237 1.31658 8.90237 1.70711 9.29289L4 11.5858L6.29289 9.29289C6.68342 8.90237 7.31658 8.90237 7.70711 9.29289C8.09763 9.68342 8.09763 10.3166 7.70711 10.7071L4.70711 13.7071C4.31658 14.0976 3.68342 14.0976 3.29289 13.7071L0.292893 10.7071C-0.0976311 10.3166 -0.0976311 9.68342 0.292893 9.29289Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-select: url(\"data:image\/svg+xml,%3Csvg width='10' height='6' viewBox='0 0 10 6' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M0.292893 0.292893C0.683417 -0.097631 1.31658 -0.097631 1.70711 0.292893L5 3.58579L8.29289 0.292893C8.68342 -0.0976311 9.31658 -0.0976311 9.70711 0.292893C10.0976 0.683417 10.0976 1.31658 9.70711 1.70711L5.70711 5.70711C5.31658 6.09763 4.68342 6.09763 4.29289 5.70711L0.292893 1.70711C-0.0976311 1.31658 -0.0976311 0.683418 0.292893 0.292893Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-search: url(\"data:image\/svg+xml,%3Csvg width='640' height='640' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath d='M256 128c-70.692 0-128 57.308-128 128 0 70.691 57.308 128 128 128 70.691 0 128-57.309 128-128 0-70.692-57.309-128-128-128zM64 256c0-106.039 85.961-192 192-192s192 85.961 192 192c0 41.466-13.146 79.863-35.498 111.248l154.125 154.125c12.496 12.496 12.496 32.758 0 45.254s-32.758 12.496-45.254 0L367.248 412.502C335.862 434.854 297.467 448 256 448c-106.039 0-192-85.962-192-192z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-label-space-y-secondary: var(--gf-label-space-y-md-secondary);--gf-ctrl-border-color: #686e77;--gf-ctrl-size: var(--gf-ctrl-size-md);--gf-ctrl-label-color-primary: #112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style>\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_7' class='pre-need-burial-form' action='\/vi\/wp-json\/wp\/v2\/pages\/5824' data-formid='7' novalidate data-trp-original-action=\"\/vi\/wp-json\/wp\/v2\/pages\/5824\">\t\t\t\t\t<div style=\"display: none !important;\" class=\"akismet-fields-container gf_invisible\" data-prefix=\"ak_\">\n\t\t\t\t\t\t<label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label>\n\t\t\t\t\t\t<input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"244\" \/>\n\t\t\t\t\t\t<script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n\n\t\t\t\t\t<\/div><div class='gf_invisible ginput_recaptchav3'  data-tabindex='0'><input id=\"input_df8b6ef7a247864f4a1525b8e90df45e\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_df8b6ef7a247864f4a1525b8e90df45e\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_7_59\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2>N\u1ed9p \u0111\u01a1n t\u1ea1i \u0111\u00e2y:<\/h2><\/div><fieldset id=\"field_7_3\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full form-choice-buttons gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >B\u1ea1n \u0111ang y\u00eau c\u1ea7u \u0111i\u1ec1u g\u00ec?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Y\u00eau c\u1ea7u)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_3'>\n\t\t\t<div class='gchoice gchoice_7_3_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Pre-Need (Before Death)'  id='choice_7_3_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_3_0' id='label_7_3_0' class='gform-field-label gform-field-label--type-inline'>Ti\u1ec1n nhu c\u1ea7u (Tr\u01b0\u1edbc khi ch\u1ebft)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_3_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Burial (After Death)'  id='choice_7_3_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_3_1' id='label_7_3_1' class='gform-field-label gform-field-label--type-inline'>Ch\u00f4n c\u1ea5t (Sau khi ch\u1ebft)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_7_60\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full cemetery-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Vui l\u00f2ng ch\u1ecdn ngh\u0129a trang b\u1ea1n mu\u1ed1n:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Y\u00eau c\u1ea7u)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_60'>\n\t\t\t<div class='gchoice gchoice_7_60_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='Central Louisiana Veterans Cemetery'  id='choice_7_60_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_60_0' id='label_7_60_0' class='gform-field-label gform-field-label--type-inline'>Ngh\u0129a trang C\u1ef1u chi\u1ebfn binh Trung Louisiana<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_60_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='Northeast Louisiana Veterans Cemetery'  id='choice_7_60_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_60_1' id='label_7_60_1' class='gform-field-label gform-field-label--type-inline'>Ngh\u0129a trang C\u1ef1u chi\u1ebfn binh \u0110\u00f4ng B\u1eafc Louisiana<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_60_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='Northwest Louisiana Veterans Cemetery'  id='choice_7_60_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_60_2' id='label_7_60_2' class='gform-field-label gform-field-label--type-inline'>Ngh\u0129a trang C\u1ef1u chi\u1ebfn binh T\u00e2y B\u1eafc Louisiana<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_60_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='Southeast Louisiana Veterans Cemetery'  id='choice_7_60_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_60_3' id='label_7_60_3' class='gform-field-label gform-field-label--type-inline'>Ngh\u0129a trang C\u1ef1u chi\u1ebfn binh \u0110\u00f4ng Nam Louisiana<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_60_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='Southwest Louisiana Veterans Cemetery'  id='choice_7_60_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_60_4' id='label_7_60_4' class='gform-field-label gform-field-label--type-inline'>Ngh\u0129a trang C\u1ef1u chi\u1ebfn binh T\u00e2y Nam Louisiana<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_7_4\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full section-title gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2>Th\u00f4ng tin ng\u01b0\u1eddi qu\u00e1 c\u1ed1<\/h2><\/div><fieldset id=\"field_7_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >T\u00ean<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Y\u00eau c\u1ea7u)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name has_suffix gf_name_has_4 ginput_container_name gform-grid-row' id='input_7_1'>\n                            \n                            <span id='input_7_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_7_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_1_3' class='gform-field-label gform-field-label--type-sub'>\u0110\u1ea7u ti\u00ean<\/label>\n                                                <\/span>\n                            <span id='input_7_1_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.4' id='input_7_1_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_7_1_4' class='gform-field-label gform-field-label--type-sub'>\u1ede gi\u1eefa<\/label>\n                                                <\/span>\n                            <span id='input_7_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_7_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_1_6' class='gform-field-label gform-field-label--type-sub'>Cu\u1ed1i c\u00f9ng<\/label>\n                                                <\/span>\n                            <span id='input_7_1_8_container' class='name_suffix  gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.8' id='input_7_1_8' value=''   aria-required='false'     \/>\n                                                    <label for='input_7_1_8' class='gform-field-label gform-field-label--type-sub'>H\u1eadu t\u1ed1<\/label>\n                                                <\/span>\n                        <\/div><\/fieldset><div id=\"field_7_7\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_7'>S\u1ed1 An sinh X\u00e3 h\u1ed9i<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Y\u00eau c\u1ea7u)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_7_7' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_7\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_7'>\u0110\u1ecbnh d\u1ea1ng: 123-45-6789<\/div><\/div><div id=\"field_7_8\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-third field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_8'>Ng\u00e0y m\u1ea5t<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_8' id='input_7_8' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_7_8_date_format gfield_description_7_8\" aria-invalid=\"false\" \/>\n                            <span id='input_7_8_date_format' class='screen-reader-text'>MM g\u1ea1ch ch\u00e9o DD g\u1ea1ch ch\u00e9o YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_7_8' class='gform_hidden' value='https:\/\/vetaffairs.la.gov\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><div class='gfield_description' id='gfield_description_7_8'>\u0110\u1ecbnh d\u1ea1ng: mm\/dd\/yyyy<\/div><\/div><div id=\"field_7_9\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_9'>Ng\u00e0y sinh<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Y\u00eau c\u1ea7u)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_9' id='input_7_9' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_7_9_date_format gfield_description_7_9\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_7_9_date_format' class='screen-reader-text'>MM g\u1ea1ch ch\u00e9o DD g\u1ea1ch ch\u00e9o YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_7_9' class='gform_hidden' value='https:\/\/vetaffairs.la.gov\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><div class='gfield_description' id='gfield_description_7_9'>\u0110\u1ecbnh d\u1ea1ng: mm\/dd\/yyyy<\/div><\/div><fieldset id=\"field_7_10\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half male-female-buttons field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Nam ho\u1eb7c N\u1eef<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_10'>\n\t\t\t<div class='gchoice gchoice_7_10_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Male'  id='choice_7_10_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_10_0' id='label_7_10_0' class='gform-field-label gform-field-label--type-inline'>Nam gi\u1edbi<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_10_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Female'  id='choice_7_10_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_10_1' id='label_7_10_1' class='gform-field-label gform-field-label--type-inline'>N\u1eef gi\u1edbi<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_7_11\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half vet-dep-buttons gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >C\u1ef1u chi\u1ebfn binh hay ng\u01b0\u1eddi ph\u1ee5 thu\u1ed9c? N\u1ebfu l\u00e0 ng\u01b0\u1eddi ph\u1ee5 thu\u1ed9c, c\u00f3 th\u1ec3 s\u1ebd ph\u1ea3i tr\u1ea3 ph\u00ed v\u00e0o ng\u00e0y ch\u00f4n c\u1ea5t.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Y\u00eau c\u1ea7u)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_11'>\n\t\t\t<div class='gchoice gchoice_7_11_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='Veteran'  id='choice_7_11_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_11_0' id='label_7_11_0' class='gform-field-label gform-field-label--type-inline'>C\u1ef1u chi\u1ebfn binh<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_11_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='Dependent'  id='choice_7_11_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_11_1' id='label_7_11_1' class='gform-field-label gform-field-label--type-inline'>S\u1ef1 ph\u1ee5 thu\u1ed9c<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_7_13\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half marriage-status-buttons gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >T\u00ecnh tr\u1ea1ng h\u00f4n nh\u00e2n<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Y\u00eau c\u1ea7u)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_13'>\n\t\t\t<div class='gchoice gchoice_7_13_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Never Married'  id='choice_7_13_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_13_0' id='label_7_13_0' class='gform-field-label gform-field-label--type-inline'>Ch\u01b0a bao gi\u1edd k\u1ebft h\u00f4n<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_13_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Married'  id='choice_7_13_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_13_1' id='label_7_13_1' class='gform-field-label gform-field-label--type-inline'>\u0110\u00e3 c\u01b0\u1edbi<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_13_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Divorced'  id='choice_7_13_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_13_2' id='label_7_13_2' class='gform-field-label gform-field-label--type-inline'>\u0110\u00e3 ly h\u00f4n<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_13_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Widowed'  id='choice_7_13_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_13_3' id='label_7_13_3' class='gform-field-label gform-field-label--type-inline'>G\u00f3a ch\u1ed3ng<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_7_14\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half if-married-buttons gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >N\u1ebfu \u0111\u00e3 k\u1ebft h\u00f4n, v\u1ee3\/ch\u1ed3ng c\u00f2n s\u1ed1ng c\u00f3 ph\u1ea3i l\u00e0 c\u1ef1u chi\u1ebfn binh kh\u00f4ng? N\u1ebfu c\u00f3, vui l\u00f2ng g\u1eedi l\u1ea1i gi\u1ea5y t\u1edd xu\u1ea5t ng\u0169 k\u00e8m theo m\u1eabu \u0111\u01a1n n\u00e0y.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Y\u00eau c\u1ea7u)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_14'>\n\t\t\t<div class='gchoice gchoice_7_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Yes'  id='choice_7_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_14_0' id='label_7_14_0' class='gform-field-label gform-field-label--type-inline'>\u0110\u00fang<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='No'  id='choice_7_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_14_1' id='label_7_14_1' class='gform-field-label gform-field-label--type-inline'>KH\u00d4NG<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_7_51\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full sub-text gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>N\u01a1i c\u01b0 tr\u00fa \u0111\u01b0\u1ee3c ghi nh\u1eadn t\u1ea1i th\u1eddi \u0111i\u1ec3m t\u1eed vong<\/p><\/div><div id=\"field_7_52\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_52'>M\u00e3 b\u01b0u ch\u00ednh<\/label><div class='ginput_container ginput_container_text'><input name='input_52' id='input_7_52' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_53\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_53'>Th\u00e0nh ph\u1ed1<\/label><div class='ginput_container ginput_container_text'><input name='input_53' id='input_7_53' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_54\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_54'>Gi\u00e1o x\u1ee9\/Qu\u1eadn<\/label><div class='ginput_container ginput_container_text'><input name='input_54' id='input_7_54' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_55\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_55'>T\u00ecnh tr\u1ea1ng<\/label><div class='ginput_container ginput_container_text'><input name='input_55' id='input_7_55' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_7_57\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half buried-buttons gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >C\u00f3 v\u1ee3\/ch\u1ed3ng ho\u1eb7c ng\u01b0\u1eddi ph\u1ee5 thu\u1ed9c n\u00e0o \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u00f4n c\u1ea5t t\u1ea1i ngh\u0129a trang n\u00e0y kh\u00f4ng?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Y\u00eau c\u1ea7u)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_57'>\n\t\t\t<div class='gchoice gchoice_7_57_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='Yes'  id='choice_7_57_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_57_0' id='label_7_57_0' class='gform-field-label gform-field-label--type-inline'>\u0110\u00fang<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_57_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='No'  id='choice_7_57_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_57_1' id='label_7_57_1' class='gform-field-label gform-field-label--type-inline'>KH\u00d4NG<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_7_58\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_58'>N\u1ebfu c\u00f3, vui l\u00f2ng nh\u1eadp t\u00ean<\/label><div class='ginput_container ginput_container_text'><input name='input_58' id='input_7_58' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_15\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full section-title gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2>Th\u00f4ng tin v\u1ec1 C\u1ef1u chi\u1ebfn binh v\u00e0 Qu\u00e2n \u0111\u1ed9i<\/h2><\/div><fieldset id=\"field_7_16\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >T\u00ean c\u1ef1u chi\u1ebfn binh<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Y\u00eau c\u1ea7u)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name has_suffix gf_name_has_4 ginput_container_name gform-grid-row' id='input_7_16'>\n                            \n                            <span id='input_7_16_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_16.3' id='input_7_16_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_16_3' class='gform-field-label gform-field-label--type-sub'>\u0110\u1ea7u ti\u00ean<\/label>\n                                                <\/span>\n                            <span id='input_7_16_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_16.4' id='input_7_16_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_7_16_4' class='gform-field-label gform-field-label--type-sub'>\u1ede gi\u1eefa<\/label>\n                                                <\/span>\n                            <span id='input_7_16_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_16.6' id='input_7_16_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_16_6' class='gform-field-label gform-field-label--type-sub'>Cu\u1ed1i c\u00f9ng<\/label>\n                                                <\/span>\n                            <span id='input_7_16_8_container' class='name_suffix  gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_16.8' id='input_7_16_8' value=''   aria-required='false'     \/>\n                                                    <label for='input_7_16_8' class='gform-field-label gform-field-label--type-sub'>H\u1eadu t\u1ed1<\/label>\n                                                <\/span>\n                        <\/div><\/fieldset><div id=\"field_7_17\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_17'>S\u1ed1 An sinh X\u00e3 h\u1ed9i<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Y\u00eau c\u1ea7u)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_7_17' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_17\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_17'>\u0110\u1ecbnh d\u1ea1ng: 123-45-6789<\/div><\/div><fieldset id=\"field_7_56\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third male-female-buttons field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Nam ho\u1eb7c N\u1eef<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_56'>\n\t\t\t<div class='gchoice gchoice_7_56_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='Male'  id='choice_7_56_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_56_0' id='label_7_56_0' class='gform-field-label gform-field-label--type-inline'>Nam gi\u1edbi<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_56_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='Female'  id='choice_7_56_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_56_1' id='label_7_56_1' class='gform-field-label gform-field-label--type-inline'>N\u1eef gi\u1edbi<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_7_18\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-third field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_18'>Ng\u00e0y sinh<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_18' id='input_7_18' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_7_18_date_format gfield_description_7_18\" aria-invalid=\"false\" \/>\n                            <span id='input_7_18_date_format' class='screen-reader-text'>MM g\u1ea1ch ch\u00e9o DD g\u1ea1ch ch\u00e9o YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_7_18' class='gform_hidden' value='https:\/\/vetaffairs.la.gov\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><div class='gfield_description' id='gfield_description_7_18'>\u0110\u1ecbnh d\u1ea1ng: mm\/dd\/yyyy<\/div><\/div><div id=\"field_7_19\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_19'>Ng\u00e0nh d\u1ecbch v\u1ee5<\/label><div class='ginput_container ginput_container_select'><select name='input_19' id='input_7_19' class='large gfield_select'     aria-invalid=\"false\" ><option value='Army' >Qu\u00e2n \u0111\u1ed9i<\/option><option value='Marine Corps' >Th\u1ee7y qu\u00e2n l\u1ee5c chi\u1ebfn<\/option><option value='Navy' >H\u1ea3i qu\u00e2n<\/option><option value='Air Force' >Kh\u00f4ng qu\u00e2n<\/option><option value='Space Force' >L\u1ef1c l\u01b0\u1ee3ng Kh\u00f4ng gian<\/option><option value='Coast Guard' >C\u1ea3nh s\u00e1t bi\u1ec3n<\/option><option value='National Guard\/Reserve' >V\u1ec7 binh Qu\u1ed1c gia\/D\u1ef1 b\u1ecb<\/option><\/select><\/div><\/div><div id=\"field_7_20\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_20'>C\u1ea5p b\u1eadc cao nh\u1ea5t \u0111\u00e3 n\u1eafm gi\u1eef<\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_7_20' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_61\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_61'>N\u0103m nh\u1eadp ng\u0169<\/label><div class='ginput_container ginput_container_text'><input name='input_61' id='input_7_61' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_62\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_62'>N\u0103m r\u1eddi kh\u1ecfi d\u1ecbch v\u1ee5<\/label><div class='ginput_container ginput_container_text'><input name='input_62' id='input_7_62' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_7_23\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full retired-buttons gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u0110\u00e3 ngh\u1ec9 h\u01b0u (h\u01a1n 20 n\u0103m)? Gi\u1ea5y t\u1edd xu\u1ea5t ng\u0169 ph\u1ea3i kh\u1edbp v\u1edbi th\u00f4ng tin n\u00e0y.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Y\u00eau c\u1ea7u)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_23'>\n\t\t\t<div class='gchoice gchoice_7_23_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='Yes'  id='choice_7_23_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_23_0' id='label_7_23_0' class='gform-field-label gform-field-label--type-inline'>\u0110\u00fang<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_23_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='No'  id='choice_7_23_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_23_1' id='label_7_23_1' class='gform-field-label gform-field-label--type-inline'>KH\u00d4NG<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_7_25\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_25'>Ngh\u0129a trang c\u1ea7n bi\u1ebft th\u00eam th\u00f4ng tin n\u00e0o v\u1ec1 ngh\u0129a v\u1ee5 c\u1ee7a c\u1ef1u chi\u1ebfn binh kh\u00f4ng?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_25' id='input_7_25' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_7_26\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half crime-buttons gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Ng\u01b0\u1eddi \u0111\u00e3 khu\u1ea5t ho\u1eb7c c\u1ef1u chi\u1ebfn binh \u0111\u00e3 t\u1eebng b\u1ecb k\u1ebft \u00e1n v\u1ec1 t\u1ed9i ph\u1ea1m c\u1ea5p ti\u1ec3u bang ho\u1eb7c li\u00ean bang m\u00e0 h\u00ecnh ph\u1ea1t c\u00f3 th\u1ec3 l\u00e0 t\u00f9 chung th\u00e2n ch\u01b0a?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Y\u00eau c\u1ea7u)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_26'>\n\t\t\t<div class='gchoice gchoice_7_26_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Yes'  id='choice_7_26_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_26_0' id='label_7_26_0' class='gform-field-label gform-field-label--type-inline'>\u0110\u00fang<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_26_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='No'  id='choice_7_26_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_26_1' id='label_7_26_1' class='gform-field-label gform-field-label--type-inline'>KH\u00d4NG<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_7_27\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full section-title gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2>Th\u00f4ng tin li\u00ean h\u1ec7 \u0111\u1ec3 l\u00ean l\u1ecbch (Ph\u1ea3i l\u00e0 nh\u00e0 tang l\u1ec5 n\u1ebfu ch\u00f4n c\u1ea5t trong quan t\u00e0i)<\/h2><\/div><div id=\"field_7_28\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_28'>Nh\u00e0 tang l\u1ec5 (B\u1eaft bu\u1ed9c n\u1ebfu c\u00f3 quan t\u00e0i)<\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_7_28' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_29\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_29'>Ng\u01b0\u1eddi li\u00ean h\u1ec7<\/label><div class='ginput_container ginput_container_text'><input name='input_29' id='input_7_29' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_30\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-quarter field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_30'>\u0110i\u1ec7n tho\u1ea1i<\/label><div class='ginput_container ginput_container_phone'><input name='input_30' id='input_7_30' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_7_30\"  \/><\/div><div class='gfield_description' id='gfield_description_7_30'>\u0110\u1ecbnh d\u1ea1ng: (123) 456-7890<\/div><\/div><div id=\"field_7_31\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-quarter field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_31'>E-mail<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_31' id='input_7_31' type='email' value='' class='large'     aria-invalid=\"false\" aria-describedby=\"gfield_description_7_31\" \/>\n                        <\/div><div class='gfield_description' id='gfield_description_7_31'>\u0110\u1ecbnh d\u1ea1ng: username@domain.com<\/div><\/div><div id=\"field_7_32\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_32'>T\u00ean li\u00ean l\u1ea1c gia \u0111\u00ecnh<\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_7_32' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_33\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_33'>M\u1ed1i quan h\u1ec7<\/label><div class='ginput_container ginput_container_select'><select name='input_33' id='input_7_33' class='large gfield_select'     aria-invalid=\"false\" ><option value='Spouse' >V\u1ee3 ch\u1ed3ng<\/option><option value='Son' >Con trai<\/option><option value='Daughter' >Con g\u00e1i<\/option><option value='Mother' >M\u1eb9<\/option><option value='Father' >B\u1ed1<\/option><option value='Sibling' >Anh em ru\u1ed9t<\/option><option value='Next of Kin' >Ng\u01b0\u1eddi th\u00e2n<\/option><option value='Other' >Kh\u00e1c<\/option><\/select><\/div><\/div><div id=\"field_7_34\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-quarter field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_34'>S\u1ed1 \u0111i\u1ec7n tho\u1ea1i li\u00ean l\u1ea1c gia \u0111\u00ecnh<\/label><div class='ginput_container ginput_container_phone'><input name='input_34' id='input_7_34' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_7_34\" autocomplete=\"tel\" \/><\/div><div class='gfield_description' id='gfield_description_7_34'>\u0110\u1ecbnh d\u1ea1ng: (123) 456-7890<\/div><\/div><div id=\"field_7_35\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-quarter gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_35'>Email li\u00ean h\u1ec7 gia \u0111\u00ecnh<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Y\u00eau c\u1ea7u)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_35' id='input_7_35' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_7_35\" autocomplete=\"email\"\/>\n                        <\/div><div class='gfield_description' id='gfield_description_7_35'>\u0110\u1ecbnh d\u1ea1ng: username@domain.com<\/div><\/div><div id=\"field_7_36\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_36'>T\u00ean ng\u01b0\u1eddi th\u00e2n h\u1ee3p ph\u00e1p (N\u1ebfu kh\u00e1c v\u1edbi t\u00ean tr\u00ean)<\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_7_36' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_37\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_37'>M\u1ed1i quan h\u1ec7<\/label><div class='ginput_container ginput_container_select'><select name='input_37' id='input_7_37' class='large gfield_select'     aria-invalid=\"false\" ><option value='Spouse' >V\u1ee3 ch\u1ed3ng<\/option><option value='Son' >Con trai<\/option><option value='Daughter' >Con g\u00e1i<\/option><option value='Mother' >M\u1eb9<\/option><option value='Father' >B\u1ed1<\/option><option value='Sibling' >Anh em ru\u1ed9t<\/option><option value='Next of Kin' >Ng\u01b0\u1eddi th\u00e2n<\/option><\/select><\/div><\/div><div id=\"field_7_48\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-third field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_48'>\u0110i\u1ec7n tho\u1ea1i<\/label><div class='ginput_container ginput_container_phone'><input name='input_48' id='input_7_48' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_7_48\"  \/><\/div><div class='gfield_description' id='gfield_description_7_48'>\u0110\u1ecbnh d\u1ea1ng: (123) 456-7890<\/div><\/div><fieldset id=\"field_7_38\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >\u0110\u1ecba ch\u1ec9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Y\u00eau c\u1ea7u)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_7_38' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_7_38_1_container' >\n                                        <input type='text' name='input_38.1' id='input_7_38_1' value=''    aria-required='true'   autocomplete=\"address-line1\" \/>\n                                        <label for='input_7_38_1' id='input_7_38_1_label' class='gform-field-label gform-field-label--type-sub'>\u0110\u1ecba ch\u1ec9 \u0111\u01b0\u1eddng ph\u1ed1<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_7_38_3_container' >\n                                    <input type='text' name='input_38.3' id='input_7_38_3' value=''    aria-required='true'   autocomplete=\"address-level2\" \/>\n                                    <label for='input_7_38_3' id='input_7_38_3_label' class='gform-field-label gform-field-label--type-sub'>Th\u00e0nh ph\u1ed1<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_7_38_4_container' >\n                                        <select name='input_38.4' id='input_7_38_4'     aria-required='true'   autocomplete=\"address-level1\" ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >Samoa thu\u1ed9c M\u1ef9<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >Qu\u1eadn Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' selected='selected'>Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >B\u1eafc Carolina<\/option><option value='North Dakota' >B\u1eafc Dakota<\/option><option value='Northern Mariana Islands' >Qu\u1ea7n \u0111\u1ea3o B\u1eafc Mariana<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >\u0110\u1ea3o Rhode<\/option><option value='South Carolina' >Nam Carolina<\/option><option value='South Dakota' >Nam Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >Qu\u1ea7n \u0111\u1ea3o Virgin thu\u1ed9c Hoa K\u1ef3<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >T\u00e2y Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >L\u1ef1c l\u01b0\u1ee3ng v\u0169 trang Ch\u00e2u M\u1ef9<\/option><option value='Armed Forces Europe' >L\u1ef1c l\u01b0\u1ee3ng v\u0169 trang Ch\u00e2u \u00c2u<\/option><option value='Armed Forces Pacific' >L\u1ef1c l\u01b0\u1ee3ng v\u0169 trang Th\u00e1i B\u00ecnh D\u01b0\u01a1ng<\/option><\/select>\n                                        <label for='input_7_38_4' id='input_7_38_4_label' class='gform-field-label gform-field-label--type-sub'>T\u00ecnh tr\u1ea1ng<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_7_38_5_container' >\n                                    <input type='text' name='input_38.5' id='input_7_38_5' value=''    aria-required='true'   autocomplete=\"postal-code\" \/>\n                                    <label for='input_7_38_5' id='input_7_38_5_label' class='gform-field-label gform-field-label--type-sub'>M\u00e3 b\u01b0u ch\u00ednh<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_38.6' id='input_7_38_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_7_39\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full section-title gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2>Th\u00f4ng tin v\u1ec1 l\u1ec5 an t\u00e1ng\/tang l\u1ec5<\/h2><\/div><fieldset id=\"field_7_40\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half interment-types-checkboxes field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >C\u00e1c lo\u1ea1i ch\u00f4n c\u1ea5t (Ch\u1ecdn m\u1ed9t)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_7_40'><div class='gchoice gchoice_7_40_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.1' type='checkbox'  value='Casket (In ground)'  id='choice_7_40_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_40_1' id='label_7_40_1' class='gform-field-label gform-field-label--type-inline'>Quan t\u00e0i (\u0110\u1ea5t)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_7_40_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.2' type='checkbox'  value='Columbarium Wall (Niche\/Cremains)'  id='choice_7_40_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_40_2' id='label_7_40_2' class='gform-field-label gform-field-label--type-inline'>T\u01b0\u1eddng Columbarium (Ng\u00f3c ng\u00e1ch\/H\u1ecfa t\u00e1ng)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_7_40_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.3' type='checkbox'  value='In-Ground Burial (Cremains)'  id='choice_7_40_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_40_3' id='label_7_40_3' class='gform-field-label gform-field-label--type-inline'>Ch\u00f4n c\u1ea5t d\u01b0\u1edbi \u0111\u1ea5t (H\u1ecfa t\u00e1ng)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_7_40_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.4' type='checkbox'  value='Scatter Garden (Memorial Wall)'  id='choice_7_40_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_40_4' id='label_7_40_4' class='gform-field-label gform-field-label--type-inline'>V\u01b0\u1eddn r\u1ea3i r\u00e1c (T\u01b0\u1eddng t\u01b0\u1edfng ni\u1ec7m)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_7_42\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_42'>N\u1ebfu quan t\u00e0i r\u1ed9ng h\u01a1n 28&quot;, h\u00e3y \u0111i\u1ec1n s\u1ed1 \u0111o<\/label><div class='ginput_container ginput_container_text'><input name='input_42' id='input_7_42' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_7_44\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half spouse-burial-buttons field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Trong t\u01b0\u01a1ng lai, v\u1ee3\/ch\u1ed3ng c\u00f3 \u0111\u01b0\u1ee3c ch\u00f4n c\u1ea5t c\u00f9ng ng\u01b0\u1eddi \u0111\u00e3 khu\u1ea5t kh\u00f4ng?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_44'>\n\t\t\t<div class='gchoice gchoice_7_44_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='Yes'  id='choice_7_44_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_44_0' id='label_7_44_0' class='gform-field-label gform-field-label--type-inline'>\u0110\u00fang<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_44_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='No'  id='choice_7_44_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_44_1' id='label_7_44_1' class='gform-field-label gform-field-label--type-inline'>KH\u00d4NG<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_7_45\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half spouse-burial-yes-buttons field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >N\u1ebfu c\u00f3, ng\u01b0\u1eddi ph\u1ed1i ng\u1eabu ti\u1ebfp theo s\u1ebd l\u00e0<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_45'>\n\t\t\t<div class='gchoice gchoice_7_45_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_45' type='radio' value='Casketed'  id='choice_7_45_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_45_0' id='label_7_45_0' class='gform-field-label gform-field-label--type-inline'>\u0110\u00e3 \u0111\u00f3ng h\u1ed9p<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_45_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_45' type='radio' value='Cremated'  id='choice_7_45_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_45_1' id='label_7_45_1' class='gform-field-label gform-field-label--type-inline'>H\u1ecfa t\u00e1ng<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_45_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_45' type='radio' value='Undecided'  id='choice_7_45_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_45_2' id='label_7_45_2' class='gform-field-label gform-field-label--type-inline'>Ch\u01b0a quy\u1ebft \u0111\u1ecbnh<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_7_46\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full services-requested-checkboxes field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >C\u00e1c d\u1ecbch v\u1ee5 \u0111\u01b0\u1ee3c y\u00eau c\u1ea7u t\u1ea1i Ngh\u0129a trang (Kh\u00f4ng t\u1ed5 ch\u1ee9c tang l\u1ec5 t\u1ea1i ngh\u0129a trang)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_7_46'><div class='gchoice gchoice_7_46_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.1' type='checkbox'  value='Very brief committal service with honors at committal shelter'  id='choice_7_46_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_46_1' id='label_7_46_1' class='gform-field-label gform-field-label--type-inline'>L\u1ec5 an t\u00e1ng r\u1ea5t ng\u1eafn g\u1ecdn v\u1edbi s\u1ef1 vinh danh t\u1ea1i n\u01a1i an t\u00e1ng<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_7_46_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.2' type='checkbox'  value='Brief committal service only (No honors)'  id='choice_7_46_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_46_2' id='label_7_46_2' class='gform-field-label gform-field-label--type-inline'>Ch\u1ec9 c\u00f3 d\u1ecbch v\u1ee5 cam k\u1ebft ng\u1eafn g\u1ecdn (Kh\u00f4ng c\u00f3 danh d\u1ef1)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_7_46_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.3' type='checkbox'  value='Honors only (Veteran)'  id='choice_7_46_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_46_3' id='label_7_46_3' class='gform-field-label gform-field-label--type-inline'>Ch\u1ec9 d\u00e0nh cho danh d\u1ef1 (C\u1ef1u chi\u1ebfn binh)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_7_46_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.4' type='checkbox'  value='Direct burial (Not using shelter)'  id='choice_7_46_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_46_4' id='label_7_46_4' class='gform-field-label gform-field-label--type-inline'>Ch\u00f4n c\u1ea5t tr\u1ef1c ti\u1ebfp (Kh\u00f4ng s\u1eed d\u1ee5ng n\u01a1i tr\u00fa \u1ea9n)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_7_63\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_7_63'>Gi\u1ea5y t\u1edd xu\u1ea5t vi\u1ec7n (DD-214, Th\u1ebb h\u01b0u tr\u00ed, v.v.)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Y\u00eau c\u1ea7u)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_7_63' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_7_63&quot;,&quot;container&quot;:&quot;gform_multifile_upload_7_63&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_7_63&quot;,&quot;filelist&quot;:&quot;gform_preview_7_63&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/?gf_page=3e476ed529d9fa4&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;pdf,jpg&quot;}],&quot;max_file_size&quot;:&quot;134217728b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:7,&quot;field_id&quot;:63,&quot;_gform_file_upload_nonce_7_63&quot;:&quot;114c2b3063&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_7_63&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_7_63' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Th\u1ea3 t\u1eadp tin v\u00e0o \u0111\u00e2y ho\u1eb7c <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_7_63' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_7_63 gfield_description_7_63\"  >Ch\u1ecdn t\u1eadp tin<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_7_63'>C\u00e1c lo\u1ea1i t\u1ec7p \u0111\u01b0\u1ee3c ch\u1ea5p nh\u1eadn: pdf, jpg, K\u00edch th\u01b0\u1edbc t\u1ec7p t\u1ed1i \u0111a: 128 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_7_63'><\/ul> <div id='gform_preview_7_63' class='ginput_preview_list'><\/div><\/div><div class='gfield_description' id='gfield_description_7_63'>B\u1ea5t k\u1ef3 th\u00f4ng tin n\u00e0o ch\u00fang t\u00f4i c\u1ea7n \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n<\/div><\/div><div id=\"field_7_47\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full bulleted-list gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><ul>\n<li>Nh\u00e0 tang l\u1ec5 c\u00f3 tr\u00e1ch nhi\u1ec7m y\u00eau c\u1ea7u nghi l\u1ec5 qu\u00e2n s\u1ef1 v\u00e0 cung c\u1ea5p c\u1edd ch\u00f4n c\u1ea5t<\/li>\n<li>Gi\u1ea5y ph\u00e9p v\u1eadn chuy\u1ec3n tang l\u1ec5 ph\u1ea3i \u0111i k\u00e8m v\u1edbi t\u1ea5t c\u1ea3 h\u00e0i c\u1ed1t trong quan t\u00e0i<\/li>\n<li>B\u1eb1ng c\u00e1ch g\u1eedi bi\u1ec3u m\u1eabu n\u00e0y, t\u00f4i ch\u1ea5p nh\u1eadn v\u00e0 \u0111\u1ed3ng \u00fd v\u1edbi t\u1ea5t c\u1ea3 c\u00e1c quy \u0111\u1ecbnh c\u1ee7a VA v\u1ec1 ch\u00f4n c\u1ea5t<\/li>\n<li>Nh\u00e0 tang l\u1ec5 c\u00f3 tr\u00e1ch nhi\u1ec7m 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