{"has_data":"Y","return_html":"<div class=\"ori-form donate-ori-form\">\n<div class=\"row\">\n        <div class=\"col-sm-3 form-column\">\n            <label for=\"donor_name\">\n                <span class=\"alert-text\">\uff0a<\/span>\u59d3 \u540d&nbsp;:\n            <\/label>\n        <\/div>\n        <div class=\"col-sm-6\">\n            <input type=\"text\" class=\"form-control\" id=\"donor_name\" name=\"donor_name\" value=\"\u8cb7\u6dd1\u9234\" autocomplete=\"name\" placeholder=\"\u8acb\u586b\u5beb\u771f\u5be6\u59d3\u540d\" \/>\n        <\/div>\n        <div class=\"col-sm-offset-3 col-sm-9 note\">\n            (\u8acb\u586b\u5beb\u771f\u5be6\u59d3\u540d)\n        <\/div>\n    <\/div>\n    <div class=\"row normal_donate_type\">\n        <div class=\"col-sm-3 form-column\">\n            <label for=\"\">\n                <span class=\"alert-text\">\uff0a<\/span>\u570b\u7c4d\u5225&nbsp;:\n            <\/label>\n        <\/div>\n        <div class=\"col-sm-6\">\n                            <div class=\"radio\">\n                    <label for=\"donor_country_type_1\">\n                        <input type=\"radio\" id=\"donor_country_type_1\" name=\"donor_country_type\" value=\"1\" checked \/>\n                        \u672c\u570b\u7c4d                    <\/label>\n                <\/div>\n                            <div class=\"radio\">\n                    <label for=\"donor_country_type_2\">\n                        <input type=\"radio\" id=\"donor_country_type_2\" name=\"donor_country_type\" value=\"2\"  \/>\n                        \u5916\u570b\u7c4d                    <\/label>\n                <\/div>\n                    <\/div>\n    <\/div>\n    <div class=\"row  normal_donate_type\">\n        <div class=\"col-sm-3 form-column\">\n            <label for=\"donor_no\">\n                <span class=\"alert-text\">\uff0a<\/span><div id=\"donor_no_label\">\u8eab\u5206\u8b49\/\u7d71\u4e00\u7de8\u865f<\/div>&nbsp;:\n            <\/label>\n        <\/div>\n        <div class=\"col-sm-6\">\n            <input type=\"text\" class=\"form-control\" id=\"donor_no\" name=\"donor_no\" value=\"\" placeholder=\"\u8acb\u586b\u5beb\u8eab\u5206\u8b49\/\u7d71\u4e00\u7de8\u865f\"\/>\n        <\/div>\n        <div class=\"col-sm-offset-3 col-sm-9 note\">\n            (\u5883\u5916\u4eba\u58eb\u8acb\u586b\u5beb\u8b77\u7167\u865f\u78bc(Passport No.)\u6216\u82f1\u6587 ID )\n        <\/div>\n    <\/div>\n    <div class=\"row\">\n        <div class=\"col-sm-3 form-column\">\n            <label for=\"donor_email\">\n                <span class=\"alert-text alert-text-email\">\uff0a<\/span>E-mail&nbsp;:\n            <\/label>\n        <\/div>\n        <div class=\"col-sm-6\">\n            <input type=\"text\" class=\"form-control\" id=\"donor_email\" name=\"donor_email\" value=\"jalotaiwan@gmail.com\" placeholder=\"\u7bc4\u4f8b\uff1aabc@gmail.com\" autocomplete=\"email\"\/>\n        <\/div>\n        <div class=\"col-sm-offset-3 col-sm-9 note\">\n            (\u4ee5\u6b64\u4fe1\u7bb1\u767c\u9001\u6350\u6b3e\u72c0\u6cc1\u901a\u77e5\uff0c\u82e5\u672a\u6536\u5230\u901a\u77e5\u4fe1\u8acb\u5148\u81f3\u5783\u573e\u90f5\u4ef6\u4e2d\u67e5\u8a62\u3002)\n        <\/div>\n    <\/div>\n    <div class=\"row normal_donate_type\">\n        <div class=\"col-sm-3 form-column\">\n            <label for=\"donor_birthday\">\n                \u751f&nbsp;\u65e5&nbsp;:\n            <\/label>\n        <\/div>\n        <div class=\"col-sm-6\">\n            <input class=\"form-control\" type=\"text\" name=\"donor_birthday\" id=\"donor_birthday\" value=\"2019-01-01\" autocomplete=\"off\" placeholder=\"\u586b\u5beb\u683c\u5f0f:1992-01-01\" data-date-start-view=\"decade\">\n        <\/div>\n    <\/div>\n    <div class=\"row\">\n        <div class=\"col-sm-3 form-column\">\n            <label for=\"donor_phone\">\n                <span class=\"alert-text\">\uff0a<\/span>\u884c\u52d5\u96fb\u8a71&nbsp;:\n            <\/label>\n        <\/div>\n        <div class=\"col-sm-6\">\n            <input type=\"text\" class=\"form-control\" id=\"donor_phone\" name=\"donor_phone\" value=\"0911***648\" autocomplete=\"tel\" placeholder=\"\u7bc4\u4f8b\uff1a0910123456\" \/>\n        <\/div>\n    <\/div>\n    <div class=\"row normal_donate_type\">\n        <div class=\"col-sm-3 form-column\">\n            <label for=\"donor_h_tel\">\n                \u806f\u7d61\u96fb\u8a71(H)&nbsp;:\n            <\/label>\n        <\/div>\n        <div class=\"col-sm-6\">\n            <input type=\"text\" class=\"form-control\" id=\"donor_h_tel\" name=\"donor_h_tel\" value=\"\" autocomplete=\"tel\" placeholder=\"\u7bc4\u4f8b: 02-12345678\" \/>\n        <\/div>\n    <\/div>\n    <div class=\"row normal_donate_type\">\n        <div class=\"col-sm-3 form-column\">\n            <label for=\"donor_o_tel\">\n                \u806f\u7d61\u96fb\u8a71(O)&nbsp;:\n            <\/label>\n        <\/div>\n        <div class=\"col-sm-6\">\n            <input type=\"text\" class=\"form-control\" id=\"donor_o_tel\" name=\"donor_o_tel\" value=\"\" autocomplete=\"tel\" placeholder=\"\u7bc4\u4f8b: 02-12345678\" \/>\n        <\/div>\n        <div class=\"col-sm-offset-3 col-sm-9 note\">\n                (\u96fb\u8a71\u8acb\u81f3\u5c11\u586b\u4e00\u500b)\n        <\/div>\n    <\/div>\n    <div class=\"row  normal_donate_type\">\n        <div class=\"col-sm-3 form-column\">\n            <label for=\"donor_address\">\n                <span class=\"alert-text\">\uff0a<\/span>\u5730\u5740&nbsp;:\n            <\/label>\n        <\/div>\n        <div class=\"col-sm-3 xs-mt\">\n            <select title=\"\" name=\"donor_address_city\" id=\"donor_address_city\"  class=\"form-control\" aria-label=\"\u7e23\u5e02><option value=\"\"  >\u8acb\u9078\u64c7...<\/option><option value=\"\u81fa\u5317\u5e02\" selected=\"selected\">\u81fa\u5317\u5e02<\/option><option value=\"\u65b0\u5317\u5e02\" >\u65b0\u5317\u5e02<\/option><option value=\"\u57fa\u9686\u5e02\" >\u57fa\u9686\u5e02<\/option><option value=\"\u6843\u5712\u5e02\" >\u6843\u5712\u5e02<\/option><option value=\"\u65b0\u7af9\u5e02\" >\u65b0\u7af9\u5e02<\/option><option value=\"\u65b0\u7af9\u7e23\" >\u65b0\u7af9\u7e23<\/option><option value=\"\u82d7\u6817\u7e23\" >\u82d7\u6817\u7e23<\/option><option value=\"\u81fa\u4e2d\u5e02\" >\u81fa\u4e2d\u5e02<\/option><option value=\"\u5f70\u5316\u7e23\" >\u5f70\u5316\u7e23<\/option><option value=\"\u5357\u6295\u7e23\" >\u5357\u6295\u7e23<\/option><option value=\"\u96f2\u6797\u7e23\" >\u96f2\u6797\u7e23<\/option><option value=\"\u5609\u7fa9\u5e02\" >\u5609\u7fa9\u5e02<\/option><option value=\"\u5609\u7fa9\u7e23\" >\u5609\u7fa9\u7e23<\/option><option value=\"\u81fa\u5357\u5e02\" >\u81fa\u5357\u5e02<\/option><option value=\"\u9ad8\u96c4\u5e02\" >\u9ad8\u96c4\u5e02<\/option><option value=\"\u5c4f\u6771\u7e23\" >\u5c4f\u6771\u7e23<\/option><option value=\"\u5b9c\u862d\u7e23\" >\u5b9c\u862d\u7e23<\/option><option value=\"\u82b1\u84ee\u7e23\" >\u82b1\u84ee\u7e23<\/option><option value=\"\u81fa\u6771\u7e23\" >\u81fa\u6771\u7e23<\/option><option value=\"\u6f8e\u6e56\u7e23\" >\u6f8e\u6e56\u7e23<\/option><option value=\"\u91d1\u9580\u7e23\" >\u91d1\u9580\u7e23<\/option><option value=\"\u9023\u6c5f\u7e23\" >\u9023\u6c5f\u7e23<\/option><\/select>        <\/div>\n        <div class=\"col-sm-3 xs-mt\">\n            <span id=\"selectAddressAreaSp\">\n                <select name=\"donor_address_area\" id=\"donor_address_area\" class=\"form-control\" data-default_area=\"\u4e2d\u6b63\u5340\" aria-label=\"\u5340\u57df\">\n                  <option value=\"\">\u8acb\u9078\u64c7...<\/option>\n                <\/select>\n            <\/span>\n        <\/div>\n    <\/div>\n    <div class=\"row  normal_donate_type\">\n        <div class=\"col-sm-offset-3 col-sm-6\">\n            <input title=\"\" class=\"form-control\" name=\"donor_address\" id=\"donor_address\" type=\"text\" value=\"\u57d4\u9802\u8def292\u865f\" placeholder=\"\u8acb\u586b\u5beb\u8def\u8857\u865f\u6a13\" data-original-title=\"\u8acb\u586b\u5beb\u8def\u8857\u865f\u6a13\" aria-label=\"\u8def\u8857\u865f\u6a13\" autocomplete=\"street-address\" \/>\n        <\/div>\n    <\/div>\n<\/div>\n\n<!-- \u6536\u64da\u8cc7\u6599 -->\n<div class=\"form-title donate-form-title normal_donate_type\">\n    <span>\u6536\u64da\u8cc7\u6599<\/span>\n    <div class=\"title-note\">\u6350\u6b3e\u8cc7\u6599\u6703\u7d71\u4e00\u4e0a\u50b3\u570b\u7a05\u5c40\uff0c\u5efa\u8b70\u5927\u5bb6\u4e0d\u7d22\u53d6\u6536\u64da\uff0c\u74b0\u4fdd\u611b\u5730\u7403<\/div>\n<\/div>\n<div class=\"ori-form donate-ori-form normal_donate_type\">\n    <div class=\"row\">\n        <div class=\"col-sm-3 form-column\">\n            <label for=\"\">\n                <span class=\"alert-text\">\uff0a<\/span>\u6350\u6b3e\u6536\u64da\u4e0a\u50b3\u570b\u7a05\u5c40&nbsp;:\n            <\/label>\n        <\/div>\n        <div class=\"col-sm-6\">\n            <div class=\"radio\">\n                <label for=\"agree_mode_1\">\n                    <input type=\"radio\" id=\"agree_mode_1\" name=\"agree_mode\" value=\"1\"  >\n                    \u662f\n                <\/label>\n            <\/div>\n            <div class=\"radio\">\n                <label for=\"agree_mode_0\">\n                    <input type=\"radio\" id=\"agree_mode_0\" name=\"agree_mode\" value=\"0\" checked>\n                    \u4e0d\u4e0a\u50b3\u570b\u7a05\u5c40\n                <\/label>\n            <\/div>\n        <\/div>\n    <\/div>\n    <div class=\"row\">\n        <div class=\"col-sm-3 form-column\">\n            <label for=\"invoice_name\">\n                <span class=\"alert-text\">\uff0a<\/span>\u6536\u64da\u62ac\u982d&nbsp;:\n            <\/label>\n        <\/div>\n        <div class=\"col-sm-6\">\n            <input type=\"text\" class=\"form-control\" id=\"invoice_name\" name=\"invoice_name\" value=\"\u8cb7\u6dd1\u9234\" autocomplete=\"name\" placeholder=\"\u8acb\u586b\u5beb\u6536\u64da\u62ac\u982d\" \/>\n        <\/div>\n        <div class=\"col-sm-3 xs-mt\">\n            <button type=\"button\" id=\"sameAsDonorNameBtn\" class=\"submit-button samewith-btn donate-btn-color\">\u540c\u6350\u6b3e\u4eba\u59d3\u540d<\/button>\n        <\/div>\n    <\/div>\n    <div class=\"row\">\n        <div class=\"col-sm-3 form-column\">\n            <label for=\"invoice_donor_no\">\n                <span class=\"alert-text agree_text\">\uff0a<\/span>\u8eab\u4efd\u8b49\/\u7d71\u4e00\u7de8\u865f&nbsp;:\n            <\/label>\n        <\/div>\n        <div class=\"col-sm-6\">\n            <input type=\"text\" class=\"form-control\" id=\"invoice_donor_no\" name=\"invoice_donor_no\" value=\"J123456789\" placeholder=\"\u8acb\u586b\u5beb\u8eab\u4efd\u8b49\/\u7d71\u4e00\u7de8\u865f\" \/>\n        <\/div>\n        <div class=\"col-sm-3 xs-mt\">\n            <button type=\"button\" id=\"sameAsDonorIdBtn\" class=\"submit-button samewith-btn donate-btn-color\">\u540c\u6350\u6b3e\u4eba\u8eab\u5206\u8b49<\/button>\n        <\/div>\n    <\/div>\n    <div class=\"row\">\n        <div class=\"col-sm-3 form-column\">\n            <label for=\"\">\n                <span class=\"alert-text\">\uff0a<\/span>\u6536\u64da\u5bc4\u767c\u65b9\u5f0f&nbsp;:\n            <\/label>\n        <\/div>\n        <div class=\"col-sm-6\">\n                        <div class=\"radio\">\n                <label for=\"rec_type_1\">\n                    <input type=\"radio\" id=\"rec_type_1\" name=\"rec_type\" value=\"1\" checked>\n                    \u514d\u5bc4\u6536\u64da                <\/label>\n            <\/div>\n                        <div class=\"radio\">\n                <label for=\"rec_type_4\">\n                    <input type=\"radio\" id=\"rec_type_4\" name=\"rec_type\" value=\"4\" >\n                    \u5e74\u5bc4\u6536\u64da(\u9694\u5e74\u56db\u6708\u524d\u5bc4\u767c)                <\/label>\n            <\/div>\n                        <div class=\"radio\">\n                <label for=\"rec_type_2\">\n                    <input type=\"radio\" id=\"rec_type_2\" name=\"rec_type\" value=\"2\" >\n                    \u6bcf\u6b21\u5bc4\u767c                <\/label>\n            <\/div>\n                    <\/div>\n    <\/div>\n    <div class=\"row\">\n        <div class=\"col-sm-3 form-column\">\n            <label for=\"\">\n                <span class=\"alert-text\">\uff0a<\/span>\u516c\u958b\u5fb5\u4fe1&nbsp;:\n            <\/label>\n        <\/div>\n        <div class=\"col-sm-6\">\n            <div class=\"radio\">\n                <label for=\"display_donor_name_1\">\n                    <input type=\"radio\" id=\"display_donor_name_1\" name=\"display_donor_name\" value=\"1\"  >\n                    \u516c\u958b\n                <\/label>\n            <\/div>\n            <div class=\"radio\">\n                <label for=\"display_donor_name_0\">\n                    <input type=\"radio\" id=\"display_donor_name_0\" name=\"display_donor_name\" value=\"0\" checked>\n                    \u4e0d\u540c\u610f\u516c\u958b\n                <\/label>\n            <\/div>\n        <\/div>\n        <div class=\"col-sm-12 note display-note\">\n            <div class=\"field field-name-body field-type-text-with-summary field-label-hidden\">\r\n<div class=\"field-items\">\r\n<div class=\"field-item even\">\r\n<h1>\u3010\u91cd\u8981\u516c\u544a\u3011\u8ca1\u5718\u6cd5\u4eba\u6cd5\u7b2c25\u689d\uff1a\u6350\u6b3e\u8005\u516c\u958b\u5fb5\u4fe1\u76f8\u95dc\u8aaa\u660e<\/h1>\r\n<p>&nbsp;<\/p>\r\n<p>\u89aa\u611b\u7684\u6350\u6b3e\u4eba\u60a8\u597d\uff1a<\/p>\r\n<p>\u4f9d\u64da<a href=\"https:\/\/law.moj.gov.tw\/LawClass\/LawAll.aspx?pcode=I0020030\">\u300a\u8ca1\u5718\u6cd5\u4eba\u6cd5\u300b<\/a>\u7b2c25\u689d\u7b2c3\u9805\u7b2c2\u6b3e\uff0c\u8ca1\u5718\u6cd5\u4eba\u61c9\u4e3b\u52d5\u516c\u958b\uff1a<strong>\u300c\u524d\u4e00\u5e74\u5ea6\u4e4b\u63a5\u53d7\u88dc\u52a9\u3001\u6350\u8d08\u540d\u55ae\u6e05\u518a\u53ca\u652f\u4ed8\u734e\u52a9\u3001\u6350\u8d08\u540d\u55ae\u6e05\u518a\uff0c\u4e14\u50c5\u516c\u958b\u5176\u88dc\u52a9\u3001\u6350\u8d08\u8005\u53ca\u53d7\u734e\u52a9\u3001\u6350\u8d08\u8005\u4e4b\u59d3\u540d\u6216\u540d\u7a31\u53ca\u88dc\uff08\u734e\uff09\u52a9\u3001\u6350\u8d08\u91d1\u984d\u3002\u4f46\u88dc\u52a9\u3001\u6350\u8d08\u8005\u6216\u53d7\u734e\u52a9\u3001\u6350\u8d08\u8005\u4e8b\u5148\u4ee5\u66f8\u9762\u8868\u793a\u53cd\u5c0d\uff0c\u6216\u516c\u958b\u5c07\u59a8\u7919\u6216\u56b4\u91cd\u5f71\u97ff\u8ca1\u5718\u6cd5\u4eba\u904b\u4f5c\uff0c\u4e14\u7d93\u4e3b\u7ba1\u6a5f\u95dc\u540c\u610f\u8005\uff0c\u4e0d\u516c\u958b\u4e4b\u3002\u300d<\/strong><\/p>\r\n<p>\u4f9d\u6cd5\uff0c\u672c\u6703\u9700\u4e3b\u52d5\u516c\u958b\u6350\u6b3e\u8005\u8cc7\u8a0a\uff1b\u5018\u82e5\u6350\u6b3e\u4eba\u4e0d\u540c\u610f\u5c07\u6350\u6b3e\u8005\u59d3\u540d\u516c\u958b\u63ed\u9732\uff0c\u8acb\u4e0b\u8f09<strong><span style=\"text-decoration: underline;\">\u4e0d\u540c\u610f\u300c\u6350\u6b3e\u8005\u59d3\u540d\u516c\u958b\u63ed\u9732\u300d\u8072\u660e\u66f8<\/span><\/strong>\uff0c\u7c3d\u540d\u56de\u50b3\u81f3\u672c\u6703\uff0c\u4ee5\u5229\u5f8c\u7e8c\u4f5c\u696d\u9032\u884c\u3002\u9078\u64c7\u4e0d\u516c\u958b\u59d3\u540d\u4e4b\u6350\u6b3e\u4eba\uff0c\u5c07\u4ee5\u300c\u5584\u5fc3\u4eba\u58eb\u300d\u65b9\u5f0f\u63ed\u9732\u3002\u672a\u63d0\u4f9b\u8072\u660e\u66f8\u4e4b\u6350\u6b3e\u4eba\uff0c\u5c07\u4f9d\u6cd5\u898f\u5b9a\u516c\u958b\u63ed\u9732\u6350\u6b3e\u8005\u59d3\u540d\u3002<\/p>\r\n<p>\u82e5\u6709\u76f8\u95dc\u7591\u554f\uff0c\u6b61\u8fce\u4f86\u96fb\u672c\u670303-578-4633#6224\u8a62\u554f\u3002<br \/>\u586b\u5beb\u5b8c\u7562\u5f8c\uff0c\u656c\u8acb\u52d9\u5fc5\u9078\u64c7\u4ee5\u4e0b\u5176\u4e00\u65b9\u5f0f\u56de\u8986\uff1a<br \/>1.\u50b3\u771f\u81f3\uff1a03-579-8433<br \/>2.\u6383\u63cf\u5f8cE-Mail\u81f3\uff1awangch@sjc.org.tw<br \/>3.\u90f5\u5bc4\u81f3\uff1a\u8ca1\u5718\u6cd5\u4eba\u65b0\u7af9\u5e02\u5929\u4e3b\u6559\u4ec1\u611b\u793e\u6703\u798f\u5229\u57fa\u91d1\u6703300047\u65b0\u7af9\u5e02\u6771\u5340\u6148\u7965\u8def2\u865f<\/p>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<div class=\"field field-name-field-attfiles field-type-file field-label-above\">\r\n<div class=\"field-label\">\u9644\u52a0\u6a94\u6848 :&nbsp;<\/div>\r\n<div class=\"field-items\">\r\n<div class=\"field-item even\"><span class=\"file\"><img class=\"file-icon\" title=\"application\/pdf\" src=\"https:\/\/www.hospice.org.tw\/modules\/file\/icons\/application-pdf.png\" alt=\"PDF icon\" \/>&nbsp;<a href=\"https:\/\/www.hospice.org.tw\/sites\/default\/files\/%E4%B8%8D%E5%90%8C%E6%84%8F%E3%80%8C%E6%8D%90%E6%AC%BE%E8%80%85%E5%A7%93%E5%90%8D%E5%85%AC%E9%96%8B%E6%8F%AD%E9%9C%B2%E3%80%8D%E8%81%B2%E6%98%8E%E6%9B%B8.pdf\" type=\"application\/pdf; length=552038\">\u4e0d\u540c\u610f\u300c\u6350\u6b3e\u8005\u59d3\u540d\u516c\u958b\u63ed\u9732\u300d\u8072\u660e\u66f8.pdf<\/a><\/span><\/div>\r\n<\/div>\r\n<\/div>        <\/div>\n    <\/div>\n    <div class=\"row\">\n        <div class=\"col-sm-3 form-column\">\n            <label for=\"dvr_note\">\n                \u5099 \u8a3b&nbsp;:\n            <\/label>\n        <\/div>\n        <div class=\"col-sm-6\">\n            <textarea name=\"dvr_note\" id=\"dvr_note\" class=\"form-control\" rows=\"5\" placeholder=\"\u8acb\u586b\u5beb\u5099\u8a3b\" ><\/textarea>\n        <\/div>\n    <\/div>\n<\/div>    "}