{"id":7387,"date":"2020-12-30T14:23:33","date_gmt":"2020-12-30T19:23:33","guid":{"rendered":"https:\/\/clinicasanantonio.org\/?page_id=7387"},"modified":"2024-03-09T19:04:35","modified_gmt":"2024-03-10T00:04:35","slug":"patient-info","status":"publish","type":"page","link":"https:\/\/clinicasanantonio.org\/en\/patient-info\/","title":{"rendered":"Patient information"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"7387\" class=\"elementor elementor-7387\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-3e87dca elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"3e87dca\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-4a674c3\" data-id=\"4a674c3\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7305740 elementor-widget elementor-widget-theme-post-title elementor-page-title elementor-widget-heading\" data-id=\"7305740\" data-element_type=\"widget\" data-widget_type=\"theme-post-title.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Informaci\u00f3n del paciente<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d10f8bd elementor-icon-list--layout-inline elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"d10f8bd\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items elementor-inline-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item elementor-inline-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/clinicasanantonio.org\/en\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-home\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Home<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item elementor-inline-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-angle-double-right\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Informaci\u00f3n del paciente<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-be7023a elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"be7023a\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-fd63416\" data-id=\"fd63416\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c71c965 elementor-widget elementor-widget-heading\" data-id=\"c71c965\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-heading-title elementor-size-default\">Cl\u00ednica San Antonio PLLC<\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a0f0d7d elementor-widget elementor-widget-heading\" data-id=\"a0f0d7d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-heading-title elementor-size-default\">Complete el siguiente formulario con la informaci\u00f3n del paciente<\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9e8a8af elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"9e8a8af\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9b57ea6 elementor-widget elementor-widget-form\" data-id=\"9b57ea6\" data-element_type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Siguiente&quot;,&quot;step_previous_label&quot;:&quot;Anterior&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Contact form\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"7387\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"9b57ea6\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"\" \/>\n\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_0fd5aa3 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Informaci\u00f3n del paciente\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_b5052e1 elementor-col-100\">\n\t\t\t\t\tDatos Demogr\u00e1ficos del Paciente\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-surname elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-surname\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tApellido del paciente\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[surname]\" id=\"form-field-surname\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Apellido del paciente\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPrimer nombre\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Primer nombre\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-address elementor-col-40 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-address\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDirecci\u00f3n (Calle y Cuadra)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[address]\" id=\"form-field-address\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Direcci\u00f3n (Calle y Cuadra)\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-city elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-city\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCiudad\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[city]\" id=\"form-field-city\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Ciudad\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-zipcode elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-zipcode\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tC\u00f3digo postal\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[zipcode]\" id=\"form-field-zipcode\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"C\u00f3digo postal\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-mphone elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-mphone\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTel\u00e9fono M\u00f3vil\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[mphone]\" id=\"form-field-mphone\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Tel\u00e9fono M\u00f3vil\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEmail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Email\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-marital elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-marital\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEstado civil\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[marital]\" id=\"form-field-marital\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"Soltero\">Soltero<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Casado\">Casado<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Divorciado\">Divorciado<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Viudo\">Viudo<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-dbirth elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-dbirth\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFecha de Nacimiento\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[dbirth]\" id=\"form-field-dbirth\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field\" placeholder=\"Fecha de Nacimiento\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-pcpname elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-pcpname\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNombre del M\u00e9dico de Atenci\u00f3n Primaria\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[pcpname]\" id=\"form-field-pcpname\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Nombre del M\u00e9dico de Atenci\u00f3n Primaria\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-pcpn_phone elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-pcpn_phone\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTel\u00e9fono #\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[pcpn_phone]\" id=\"form-field-pcpn_phone\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Tel\u00e9fono #\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-emergency_contact elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-emergency_contact\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tContacto de emergencia\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[emergency_contact]\" id=\"form-field-emergency_contact\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Contacto de emergencia\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-ec_phone elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-ec_phone\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTel\u00e9fono #\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[ec_phone]\" id=\"form-field-ec_phone\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Tel\u00e9fono #\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-how_about elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-how_about\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t\u00bfC\u00f3mo se enter\u00f3 del m\u00e9dico que est\u00e1 viendo hoy?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Publicidad digital \/ Web\" id=\"form-field-how_about-0\" name=\"form_fields[how_about][]\"> <label for=\"form-field-how_about-0\">Publicidad digital \/ Web<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Amigo o Miembro de la Familia\" id=\"form-field-how_about-1\" name=\"form_fields[how_about][]\"> <label for=\"form-field-how_about-1\">Amigo o Miembro de la Familia<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Anuncio Publicitario \/ Postal\" id=\"form-field-how_about-2\" name=\"form_fields[how_about][]\"> <label for=\"form-field-how_about-2\">Anuncio Publicitario \/ Postal<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Programa Nuevos Vecinos\" id=\"form-field-how_about-3\" name=\"form_fields[how_about][]\"> <label for=\"form-field-how_about-3\">Programa Nuevos Vecinos<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Historia \/ Transmisi\u00f3n de noticias\" id=\"form-field-how_about-4\" name=\"form_fields[how_about][]\"> <label for=\"form-field-how_about-4\">Historia \/ Transmisi\u00f3n de noticias<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Anuncio de Peri\u00f3dico \/ Revista\" id=\"form-field-how_about-5\" name=\"form_fields[how_about][]\"> <label for=\"form-field-how_about-5\">Anuncio de Peri\u00f3dico \/ Revista<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Remisi\u00f3n del M\u00e9dico\" id=\"form-field-how_about-6\" name=\"form_fields[how_about][]\"> <label for=\"form-field-how_about-6\">Remisi\u00f3n del M\u00e9dico<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Comercial de Radio\" id=\"form-field-how_about-7\" name=\"form_fields[how_about][]\"> <label for=\"form-field-how_about-7\">Comercial de Radio<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Comercial de Televisi\u00f3n\" id=\"form-field-how_about-8\" name=\"form_fields[how_about][]\"> <label for=\"form-field-how_about-8\">Comercial de Televisi\u00f3n<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-step2 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Informaci\u00f3n del Responsable\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_426d76a elementor-col-100\">\n\t\t\t\t\tComplete esta secci\u00f3n solo si el paciente es menor de edad\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-minor_patient elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-minor_patient\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEl Paciente es menor de edad?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Marca esta casilla solo si el paciente es menor de edad\" id=\"form-field-minor_patient-0\" name=\"form_fields[minor_patient]\"> <label for=\"form-field-minor_patient-0\">Marca esta casilla solo si el paciente es menor de edad<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-rp_lastname elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-rp_lastname\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tApellido de la parte Responsable\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[rp_lastname]\" id=\"form-field-rp_lastname\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Apellido de la parte Responsable\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-rp_name elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-rp_name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPrimer nombre\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[rp_name]\" id=\"form-field-rp_name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Primer nombre\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-rp_address elementor-col-40\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-rp_address\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDirecci\u00f3n (Calle y Cuadra)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[rp_address]\" id=\"form-field-rp_address\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Direcci\u00f3n (Calle y Cuadra)\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-rp_city elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-rp_city\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCiudad\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[rp_city]\" id=\"form-field-rp_city\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Ciudad\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-rp_state elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-rp_state\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEstado\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[rp_state]\" id=\"form-field-rp_state\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Estado\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-rp_zipcode elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-rp_zipcode\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tC\u00f3digo Postal\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[rp_zipcode]\" id=\"form-field-rp_zipcode\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"C\u00f3digo Postal\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-rp_mphone elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-rp_mphone\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTel\u00e9fono M\u00f3vil\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[rp_mphone]\" id=\"form-field-rp_mphone\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Tel\u00e9fono M\u00f3vil\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-rp_email elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-rp_email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEmail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[rp_email]\" id=\"form-field-rp_email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Email\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-rp_sex elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-rp_sex\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSexo\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[rp_sex]\" id=\"form-field-rp_sex\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"Masculino\">Masculino<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Femenino\">Femenino<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Otro\">Otro<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-rp_dbirth elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-rp_dbirth\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFecha de Nacimiento\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[rp_dbirth]\" id=\"form-field-rp_dbirth\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field\" placeholder=\"Fecha de Nacimiento\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Enviar mensaje<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Home Cl\u00ednica San Antonio PLLC Complete el siguiente formulario con la informaci\u00f3n del paciente<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":40,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-7387","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/clinicasanantonio.org\/en\/wp-json\/wp\/v2\/pages\/7387","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/clinicasanantonio.org\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/clinicasanantonio.org\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/clinicasanantonio.org\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/clinicasanantonio.org\/en\/wp-json\/wp\/v2\/comments?post=7387"}],"version-history":[{"count":5,"href":"https:\/\/clinicasanantonio.org\/en\/wp-json\/wp\/v2\/pages\/7387\/revisions"}],"predecessor-version":[{"id":7737,"href":"https:\/\/clinicasanantonio.org\/en\/wp-json\/wp\/v2\/pages\/7387\/revisions\/7737"}],"wp:attachment":[{"href":"https:\/\/clinicasanantonio.org\/en\/wp-json\/wp\/v2\/media?parent=7387"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}