{"id":2870,"date":"2023-12-15T15:09:44","date_gmt":"2023-12-15T13:09:44","guid":{"rendered":"https:\/\/www.spitalpsihiatrieborsa.ro\/?page_id=2870"},"modified":"2023-12-15T15:14:49","modified_gmt":"2023-12-15T13:14:49","slug":"cereri-formulare-tipizate","status":"publish","type":"page","link":"https:\/\/www.spitalpsihiatrieborsa.ro\/?page_id=2870","title":{"rendered":"Cereri\/ formulare tipizate"},"content":{"rendered":"<p>Formular de inscriere pe lista de asteptare<\/p>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1258-o1\" lang=\"ro-RO\" dir=\"ltr\" data-wpcf7-id=\"1258\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F2870#wpcf7-f1258-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formular de contact\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1258\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"ro_RO\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1258-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<p><label> Nume si prenume pacient(obligatoriu)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"pacient-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"pacient-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> CNP pacient(obligatoriu)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"number-224\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"number-224\" \/><\/span> <\/label>\n<\/p>\n<p><label> Nume si prenume apartinator(obligatoriu)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> Varsta pacientului(obligatoriu)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"age\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"age\" \/><\/span> <\/label>\n<\/p>\n<p><label> Diagnostic pacient(obligatoriu)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"diagnostic\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"diagnostic\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><label> Domiciliu pacient(obligatoriu)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"domiciliu-pacient\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"domiciliu-pacient\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><label> Domiciliu apartinator(obligatoriu)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"domiciuliu-apartinator\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"domiciuliu-apartinator\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><label> Afectiuni somatice(obligatoriu)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"afectiuni-somatice\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"afectiuni-somatice\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><label> Statut periodic pacient - pus sub interdictie(obligatoriu)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"interdictie\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"interdictie\"><option value=\"Da\">Da<\/option><option value=\"Nu\">Nu<\/option><\/select><\/span><\/label>\n<\/p>\n<p><label> Num\u0103r de telefon(obligatoriu)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tel-360\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"tel-360\" \/><\/span><\/label>\n<\/p>\n<p><label> Emailul t\u0103u (obligatoriu)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span> <\/label>\n<\/p>\n<p>Alte date:<br \/>\nNota - daca nu exista apartinator campurile din sectiunea care prevede date ale apartinatorului se vor completa cu datele pacientului.\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Trimite\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>Formular de inscriere pe lista de asteptare<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-2870","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.spitalpsihiatrieborsa.ro\/index.php?rest_route=\/wp\/v2\/pages\/2870","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.spitalpsihiatrieborsa.ro\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.spitalpsihiatrieborsa.ro\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.spitalpsihiatrieborsa.ro\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.spitalpsihiatrieborsa.ro\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2870"}],"version-history":[{"count":3,"href":"https:\/\/www.spitalpsihiatrieborsa.ro\/index.php?rest_route=\/wp\/v2\/pages\/2870\/revisions"}],"predecessor-version":[{"id":2878,"href":"https:\/\/www.spitalpsihiatrieborsa.ro\/index.php?rest_route=\/wp\/v2\/pages\/2870\/revisions\/2878"}],"wp:attachment":[{"href":"https:\/\/www.spitalpsihiatrieborsa.ro\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2870"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}