+<input id="quantity" name="quantity" value="${mpx[quantity]}" placeholder="$(l10n quantity)">
+<textarea id="remidy" name="remidy" placeholder="$(l10n remidy)">${mpx[remidy]}</textarea>
+<input id="quantity_weekly" name="quantity_weekly" value="${mpx[quantity_weekly]}" placeholder="$(l10n quantity_weekly)">
+
+<label for="quantity1">$(l10n quantity)</label>
+<label for="remidy1">$(l10n remidy)</label>
+<label for="quantity_weekly1">$(l10n quantity_weekly)</label>
+<input id="quantity1" name="quantity1" value="${mpx[quantity1]}" placeholder="$(l10n quantity)">
+<textarea id="remidy1" name="remidy1" placeholder="$(l10n remidy)">${mpx[remidy1]}</textarea>
+<input id="quantity_weekly1" name="quantity_weekly1" value="${mpx[quantity_weekly1]}" placeholder="$(l10n quantity_weekly)">