{"id":3703,"date":"2021-04-29T09:58:12","date_gmt":"2021-04-29T07:58:12","guid":{"rendered":"https:\/\/www.clinicarinologica.com\/?page_id=3703"},"modified":"2021-04-29T09:58:20","modified_gmt":"2021-04-29T07:58:20","slug":"formulario-covid","status":"publish","type":"page","link":"https:\/\/www.clinicarinologica.com\/es\/formulario-covid\/","title":{"rendered":"Formulario COVID"},"content":{"rendered":"[vc_row el_class=\u00bbmolts_marges\u00bb][vc_column width=\u00bb1\/4&#8243;][vc_column_text el_class=\u00bbmedium_text\u00bb]Responsabilidad para prevenir el Covid-19[\/vc_column_text][\/vc_column][vc_column width=\u00bb3\/4&#8243;][vc_column_text el_class=\u00bbmedium_text\u00bb]Buenas pr\u00e1cticas en la Cl\u00ednica Rinol\u00f2gica\r\n[\/vc_column_text][vc_column_text]A causa de la situaci\u00f3n en la que nos encontramos y siguiendo todos los protocolos necesarios para la prevenci\u00f3n de contagios, debemos formularle la siguientes preguntas.\r\n\r\nPor favor, responda a cada pregunta y, al finalizar, h\u00e1ganos llegar el formulario, haciendo clic en el bot\u00f3n enviar.\r\n\r\n<strong>Para garantizar la salud de los pacientes y del equipo, no se atender\u00e1n visitas presenciales de personas que no hayan completado y enviado el formulario:<\/strong>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=\u00bb.vc_custom_1619682825149{padding-top: 40px !important;padding-bottom: 100px !important;}\u00bb][vc_column width=\u00bb1\/4&#8243;][\/vc_column][vc_column width=\u00bb3\/4&#8243;]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f2534-o1\" lang=\"ca\" dir=\"ltr\" data-wpcf7-id=\"2534\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/es\/wp-json\/wp\/v2\/pages\/3703#wpcf7-f2534-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulari de contacte\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"2534\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"ca\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f2534-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<p><label> Nombre y apellidos<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-nom\"><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=\"text-nom\" \/><\/span>\n<\/p>\n<p><label>DNI<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-dni\"><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=\"text-dni\" \/><\/span>\n<\/p>\n<p><label> \u00bfTiene fiebre o ha tenido en los \u00faltimos 14 d\u00edas (temperatura >37,5)? <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-24\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-24\" value=\"S\u00ed\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">S\u00ed<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-24\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span><br \/>\n<label> \u00bfHa tenido tos o cualquier otro signo respiratorio en los \u00faltimos 14 d\u00edas? <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-25\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-25\" value=\"S\u00ed\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">S\u00ed<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-25\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span><br \/>\n<label> \u00bfHa tenido o tiene diarrea u otras molestias digestivas en los \u00faltimos 14 d\u00edas? <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-26\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-26\" value=\"S\u00ed\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">S\u00ed<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-26\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span><br \/>\n<label> \u00bfTiene o ha tenido sensaci\u00f3n de mucho cansancio o malestar en los \u00faltimos 14 d\u00edas? <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-27\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-27\" value=\"S\u00ed\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">S\u00ed<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-27\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span><br \/>\n<label> \u00bfHa notado una p\u00e9rdida del sentido del gusto y del olfato en los \u00faltimos 14 d\u00edas? <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-28\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-28\" value=\"S\u00ed\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">S\u00ed<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-28\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span><br \/>\n<label> \u00bfHa estado en contacto o conviviendo con alguna persona sospechosa o confirmada de coronavirus? <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-29\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-29\" value=\"S\u00ed\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">S\u00ed<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-29\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span><br \/>\n<label> \u00bfHa pasado la enfermedad de la COVID-19? <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-30\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-30\" value=\"S\u00ed\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">S\u00ed<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-30\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span><br \/>\n<label> \u00bfTrabaja o vive en una residencia de ancianos? <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-31\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-31\" value=\"S\u00ed\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">S\u00ed<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-31\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span><br \/>\n<label> En caso de haber pasado la enfermedad, \u00bfsigue usted en cuarentena? <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-32\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-32\" value=\"S\u00ed\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">S\u00ed<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-32\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span><br \/>\n<label>En los \u00faltimos 15 d\u00edas, \u00bfha recibido la vacuna del COVID-19?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-33\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-33\" value=\"S\u00ed\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">S\u00ed<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-33\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span><br \/>\n<label>\u00bfCu\u00e1ntas dosis ha recibido de la vacuna?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-166\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"menu-166\"><option value=\"0\">0<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><option value=\"5\">5<\/option><option value=\"6\">6<\/option><option value=\"7\">7<\/option><option value=\"8\">8<\/option><\/select><\/span>\n<\/p>\n<p><b>Para facilitar la visita presencial en la Cl\u00ednica Rinol\u00f2gica, es importante:<\/b>\n<\/p>\n<p>- Llegar puntual a la visita m\u00e9dica<br \/>\n- Venir sin acompa\u00f1ante, si no es estrictamente necesario<br \/>\n- Llevar la mascarilla correctamente puesta<br \/>\n- Respetar la distancia de 1,5 metros<br \/>\n- Facilitar la toma de temperatura, en la entrada<br \/>\n- Desinfectarse las manos con el gel que le aplicaremos<br \/>\n- Utilizar la sala de espera exterior, si el tiempo lo permite\n<\/p>\n<p><em>Los datos facilitados se utilizar\u00e1n exclusivamente como medida de prevenci\u00f3n de la salud y para facilitar la buena gesti\u00f3n de las visitas en la Cl\u00ednica Rinol\u00f2gica.<\/em>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"acceptance-751\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"acceptance-751\" value=\"1\" aria-invalid=\"false\" \/><\/span><\/span><\/span> He le\u00eddo y acepto la <a href=\"https:\/\/www.clinicarinologica.com\/es\/politica-de-privacidad\/\" target=\"_blank\">pol\u00edtica de privacidad<\/a>.\n<\/p>\n<p><label>Con fecha<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-385\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-385\" \/><\/span>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Enviar\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n[\/vc_column][\/vc_row]","protected":false},"excerpt":{"rendered":"[vc_row el_class=\u00bbmolts_marges\u00bb][vc_column width=\u00bb1\/4&#8243;][vc_column_text el_class=\u00bbmedium_text\u00bb]Responsabilidad para prevenir el Covid-19[\/vc_column_text][\/vc_column][vc_column width=\u00bb3\/4&#8243;][vc_column_text el_class=\u00bbmedium_text\u00bb]Buenas pr\u00e1cticas en la Cl\u00ednica Rinol\u00f2gica [\/vc_column_text][vc_column_text]A causa de la situaci\u00f3n en la que nos encontramos y siguiendo todos los protocolos necesarios para la prevenci\u00f3n de contagios, debemos formularle la siguientes preguntas. Por favor, responda a cada pregunta y, al finalizar, h\u00e1ganos llegar el formulario, haciendo&#8230; <a class=\"view-article\" href=\"https:\/\/www.clinicarinologica.com\/es\/formulario-covid\/\">Ver art\u00edculo<\/a>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-3703","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.clinicarinologica.com\/es\/wp-json\/wp\/v2\/pages\/3703","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.clinicarinologica.com\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.clinicarinologica.com\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.clinicarinologica.com\/es\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.clinicarinologica.com\/es\/wp-json\/wp\/v2\/comments?post=3703"}],"version-history":[{"count":2,"href":"https:\/\/www.clinicarinologica.com\/es\/wp-json\/wp\/v2\/pages\/3703\/revisions"}],"predecessor-version":[{"id":3705,"href":"https:\/\/www.clinicarinologica.com\/es\/wp-json\/wp\/v2\/pages\/3703\/revisions\/3705"}],"wp:attachment":[{"href":"https:\/\/www.clinicarinologica.com\/es\/wp-json\/wp\/v2\/media?parent=3703"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}