{"status":"success","response":"<div id=\"custom_forms\">\n\n<div class=\"report_row\" id=\"custom_field_row_1\"><h4>Establecimiento, organizaci\u00f3n o localizaci\u00f3n<span class='required'> *<\/span> <\/h4><input type=\"text\" name=\"custom_field[1]\" value=\"\" id=\"custom_field_1\" class=\"text custom_text\" \/><\/div><div class=\"report_row\" id=\"custom_field_row_2\"><h4>Tipo de movilizaci\u00f3n <\/h4><select name=\"custom_field[2]\" id=\"custom_field_2\">\n<option value=\"Toma\">Toma<\/option>\n<option value=\"Paro\">Paro<\/option>\n<option value=\"Jornada Reflexiva\">Jornada Reflexiva<\/option>\n<option value=\"Corte de Ruta\">Corte de Ruta<\/option>\n<option value=\"Ocupaci\u00f3n de Espacios P\u00fablicos\">Ocupaci\u00f3n de Espacios P\u00fablicos<\/option>\n<option value=\"Actividad Cultural\">Actividad Cultural<\/option>\n<option value=\"Otra\">Otra<\/option>\n<\/select><\/div><div class=\"report_row\" id=\"custom_field_row_3\"><h4>Fecha de inicio de la movilizaci\u00f3n <\/h4><input type=\"text\" name=\"custom_field[3]\" value=\"\"  id=\"custom_field_3\" class=\"text\" \/><script type=\"text\/javascript\">\n\t\t\t\t$(document).ready(function() {\n\t\t\t\t$(\"#custom_field_3\").datepicker({\n\t\t\t\tshowOn: \"both\",\n\t\t\t\tbuttonImage: \"https:\/\/c683652.ssl.cf2.rackcdn.com\/media\/img\/icon-calendar.gif\",\n\t\t\t\tbuttonImageOnly: true\n\t\t\t\t});\n\t\t\t\t});\n\t\t\t<\/script><\/div><div class=\"report_row\" id=\"custom_field_row_4\"><h4>Posici\u00f3n de las autoridades <\/h4><input type=\"text\" name=\"custom_field[4]\" value=\"\" id=\"custom_field_4\" class=\"text custom_text\" \/><\/div><div class=\"report_row\" id=\"custom_field_row_5\"><h4>Necesidades de apoyo <\/h4><input type=\"text\" name=\"custom_field[5]\" value=\"\" id=\"custom_field_5\" class=\"text custom_text\" \/><\/div><\/div>"}