body{
  font-size: 14px;
}
#form_header{
  margin: -40px 0 0;
}
#pediatric_image{
  float: left;
}
#pediatric_top_date{
  float: left;
  margin: 45px 0 0 20px;
}
#pediatric_top_date label,#pediatric_top_acct label{
  float: left;
}
#pediatric_top_date .date_divider{
  float: left;
}
#pediatric_top_date .form_text_input{
  width: 60px;
  min-height: 10px;
  float: left;
  border-style: solid;
}
#pediatric_top_acct{
  float: right;
  margin: 45px 0 0 0;
}
#pediatric_top_acct .form_text_input{
  width: 200px;
  min-height: 10px;
  float: left;
  border-style: solid;
}
.form_text_input {
    background-color: #efefef;
}
.left_box{
  width: 49%;
  float: left;
  margin: 10px 0 0 0;
}
.right_box{
  width: 49%;
  float: left;
  margin: 10px 0 0 2%;
}
.box_title_left{
  float: left;
  overflow: hidden;
  margin: 0 0 5px 0;
  font-weight: bold;
  font-size: 120%;
}
.box_title_right{
  float: right;
  margin: 0 0 5px 0;
}
.left_box_content,.right_box_content{
  border: 5px solid #000;
  box-sizing: border-box;
  padding: 5px;
  clear: both;
}
.form_box_label{
  display: inline-block;
  background-color: #000;
  color: #fff;
  padding: 0 9px;
  font-size: 200%;
  border-radius: 20px;
}
.form_text_input{
    background-color:#b7e5ff;
}
input[name="question_1"]{
  width: 69%;
}
input[name="question_4"]{
  width: 52.5%;
}
input[name="question_5"]{
  width: 10%;
}
input[name="question_6"]{
  width: 71%;
}
input[name="question_9"]{
  width: 35.5%;
}
input[name="question_10"]{
  width: 85%;
}
input[name="question_11"]{
  width: 52.5%;
}
input[name="question_12"]{
  width: 31.5%;
}
input[name="question_13"]{
  width: 84.5%;
}
input[name="question_14"]{
  width: 87%;
}
input[name="question_21"]{
  width: 77%;
}
input[name="question_22"]{
  width: 75.25%;
}
input[name="question_23"]{
  width: 89%;
}
input[name="question_24"]{
  width: 76%;
}
input[name="question_25"]{
  width: 96%;
}
input[name="question_26"]{
  width: 96.5%;
}
input[name="question_27"]{
  width: 80.5%;
}
input[name="question_28"]{
  width: 77%;
}
input[name="question_29"]{
  width: 88%;
}
input[name="question_30"]{
  width: 73.5%;
}
input[name="question_31"]{
  width: 96%;
}
input[name="question_32"]{
  width: 96.5%;
}
input[name="question_33"]{
  width: 69%;
}
input[name="question_34"]{
  width: 55%;
}
input[name="question_40"]{
  width: 64%;
}
input[name="question_41"]{
  width: 77.25%;
}
input[name="question_42"]{
  width: 75.25%;
}
input[name="question_43"]{
  width: 89%;
}
input[name="question_44"]{
  width: 76%;
}
input[name="question_45"]{
  width: 96.5%;
}
input[name="question_46"]{
  width: 96.5%;
}
input[name="question_47"]{
  width: 80.5%;
}
input[name="question_48"]{
  width: 77.5%;
}
input[name="question_49"]{
  width: 88.5%;
}
input[name="question_50"]{
  width: 74%;
}
input[name="question_51"]{
  width: 96.5%;
}
input[name="question_52"]{
  width: 66.5%;
}
input[name="question_53"]{
  width: 69%;
}
input[name="question_54"]{
  width: 55%;
}

input[name="question_59"]{
  width: 56%;
}
input[name="question_60"]{
  width: 71%;
}
input[name="question_61"]{
  width: 85.5%;
}
input[name="question_62"]{
  width: 96.5%;
}
input[name="question_63"]{
  width: 96.5%;
}
input[name="question_64"]{
  width: 96.5%;
}
@media print {
  @page {
    size: letter portrait;
    margin: 0.5cm;
  }
}