{"id":6263,"date":"2024-09-13T15:05:00","date_gmt":"2024-09-13T13:05:00","guid":{"rendered":"https:\/\/www.serveisclinics.com\/haz-una-admision-por-tuberculosis-en-etoda\/"},"modified":"2026-09-12T12:32:25","modified_gmt":"2026-09-12T10:32:25","slug":"haz-una-admision-por-tuberculosis-en-etoda","status":"publish","type":"page","link":"https:\/\/www.serveisclinics.com\/es\/haz-una-admision-por-tuberculosis-en-etoda\/","title":{"rendered":"Realiza un ingreso ETODA TB"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"6263\" class=\"elementor elementor-6263 elementor-2210\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2445a27 e-flex e-con-boxed e-con e-child\" data-id=\"2445a27\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7234bbb elementor-widget elementor-widget-heading\" data-id=\"7234bbb\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.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\">Realiza un ingreso<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-807919e e-flex e-con-boxed e-con e-parent\" data-id=\"807919e\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a10e6c1 bold elementor-widget elementor-widget-heading\" data-id=\"a10e6c1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Formulario ETODA \u2013 Caso de Tuberculosis<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-e424b23 e-flex e-con-boxed e-con e-parent\" data-id=\"e424b23\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-83d72b1 elementor-widget elementor-widget-shortcode\" data-id=\"83d72b1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f7012-o1\" lang=\"es-ES\" dir=\"ltr\" data-wpcf7-id=\"7012\">\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\/6263#wpcf7-f7012-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulario de contacto\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"7012\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.7\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"es_ES\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f7012-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/><input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:7012,&quot;conditions&quot;:[{&quot;then_field&quot;:&quot;conditional-group-factors-risc&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;factors-risc&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Otros&quot;}]},{&quot;then_field&quot;:&quot;conditional-group-resistencies&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;resistencies&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;S\\u00ed&quot;}]},{&quot;then_field&quot;:&quot;conditional-group-aillament&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;aillament&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;S\\u00ed&quot;}]},{&quot;then_field&quot;:&quot;group-info-adicional&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;mostrar-camps-opcionals&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;1&quot;}]}],&quot;settings&quot;:{&quot;animation&quot;:&quot;yes&quot;,&quot;animation_intime&quot;:200,&quot;animation_outtime&quot;:200,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:false,&quot;repeater_remove_button&quot;:&quot;bottom&quot;,&quot;notice_dismissed_rollback-cf7-5.9.7&quot;:true}}\" \/><input type=\"hidden\" name=\"_uacf7_hidden_conditional_fields\" value=\"\" \/>\n<\/fieldset>\n\t\t\t\t<style>\n\t\t\t\t\t.uacf7-uacf7style-7012 label {\n\t\t\t\t\t\tcolor: #000000;background-color: #ffffff;font-size: 16px;font-family: Ruda;font-style: normal;font-weight: 500;margin-top: 20px;margin-bottom: 15px;\t\t\t\t\t}\n\n\t\t\t\t\t.uacf7-uacf7style-7012 input[type=\"email\"],\n\t\t\t\t\t.uacf7-uacf7style-7012 input[type=\"number\"],\n\t\t\t\t\t.uacf7-uacf7style-7012 input[type=\"password\"],\n\t\t\t\t\t.uacf7-uacf7style-7012 input[type=\"search\"],\n\t\t\t\t\t.uacf7-uacf7style-7012 input[type=\"tel\"],\n\t\t\t\t\t.uacf7-uacf7style-7012 input[type=\"text\"],\n\t\t\t\t\t.uacf7-uacf7style-7012 input[type=\"url\"],\n\t\t\t\t\t.uacf7-uacf7style-7012 input[type=\"date\"],\n\t\t\t\t\t.uacf7-uacf7style-7012 input[type=\"radio\"],\n\t\t\t\t\t.uacf7-uacf7style-7012 input[type=\"checkbox\"],\n\t\t\t\t\t.uacf7-uacf7style-7012 select,\n\t\t\t\t\t.uacf7-uacf7style-7012 textarea {\n\t\t\t\t\t\tcolor: #000000;font-size: 16px;font-family: Ruda;font-style: normal;font-weight: normal;border-width: 1px !important;border-color: #1e73be !important;border-style: solid!important;border-radius: 5px;margin-top: 20px;margin-bottom: 15px;\t\t\t\t\t}\n\n\t\t\t\t\t.uacf7-uacf7style-7012 .wpcf7-radio span,\n\t\t\t\t\t.uacf7-uacf7style-7012 .wpcf7-checkbox span {\n\t\t\t\t\t\tcolor: #000000;font-size: 16px;font-family: Ruda;font-style: normal;font-weight: normal;\t\t\t\t\t}\n\n\t\t\t\t\t.uacf7-uacf7style-7012 textarea {\n\t\t\t\t\t\t\t\t\t\t\t}\n\n\t\t\t\t\t.wpcf7-form-control-wrap select {\n\t\t\t\t\t\twidth: 100%;\n\t\t\t\t\t}\n\n\t\t\t\t\t.uacf7-uacf7style-7012 input[type=\"submit\"] {\n\t\t\t\t\t\tcolor: #ffffff;background-color: #1e73be;font-size: 16px;font-family: Ruda;font-style: normal;font-weight: normal;border-width: 1px;border-color: #1e73be;border-style: solid;border-radius: 5px;margin-top: 20px;margin-bottom: 15px;\t\t\t\t\t}\n\n\t\t\t\t\t.uacf7-uacf7style-7012 input[type=\"submit\"]:hover {\n\t\t\t\t\t\tcolor: #000000;background-color: #ffffff;border-color: #1e73be;\t\t\t\t\t}\n\n\t\t\t\t\t\t\t\t\t<\/style>\n\n\t\t\t\t<div class=\"uacf7-uacf7style uacf7-uacf7style-7012\"><div class=\"uacf7-form-wrapper-container uacf7-form-7012  uacf7-uacf7style uacf7-uacf7style-7012\"><label style=\"font-size: 20px;font-weight: 600\">Datos del solicitante<\/label>\n\n<div class=\"uacf7-row\">\n<div class=\"uacf7-col-4\"> \n<label>Fecha de solicitud de ingreso*:\n<span class=\"wpcf7-form-control-wrap\" data-name=\"data-solicitud-ingres\"><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=\"data-solicitud-ingres\" \/><\/span><\/label>\n\n<label> Tel\u00e9fono de contacto de la persona que solicita el ingreso*:\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"telefon-solicitant\"><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=\"telefon-solicitant\" \/><\/span> <\/label>\n <\/div>\n\n<div class=\"uacf7-col-4\"> \n<label> Persona que solicita el ingreso*:\n<span class=\"wpcf7-form-control-wrap\" data-name=\"nom-solicitant\"><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=\"nom-solicitant\" \/><\/span> <\/label>\n\n<label> Correo electr\u00f3nico de la persona que solicita el ingreso*:\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"correu-solicitant\"><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=\"correu-solicitant\" \/><\/span> <\/label>\n <\/div>\n\n<div class=\"uacf7-col-4\"> \n<label> Hospital o centro de referencia*:\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"centre-referencia\"><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=\"centre-referencia\" \/><\/span> <\/label>\n <\/div>\n<\/div>\n\n\n\n<label style=\"font-size: 20px;font-weight: 600;margin-top:20px\">Datos del paciente<\/label>\n\n<div class=\"uacf7-row\">\n<div class=\"uacf7-col-4\"> \n<label>Nombre y apellidos*:\n<span class=\"wpcf7-form-control-wrap\" data-name=\"nom-pacient\"><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=\"nom-pacient\" \/><\/span><\/label>\n\n<label>Tel\u00e9fono*:\n<span class=\"wpcf7-form-control-wrap\" data-name=\"telefon-pacient\"><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=\"telefon-pacient\" \/><\/span><\/label>\n\n<label>Provincia*:\n<span class=\"wpcf7-form-control-wrap\" data-name=\"provicia-pacient\"><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=\"provicia-pacient\" \/><\/span><\/label>\n <\/div>\n\n<div class=\"uacf7-col-4\"> \n<label>Sexo*:\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Sexe-pacient\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Sexe-pacient\"><option value=\"\">&#8212;Por favor, elige una opci\u00f3n&#8212;<\/option><option value=\"Hombre\">Hombre<\/option><option value=\"Mujer\">Mujer<\/option><\/select><\/span><\/label>\n\n<label>Direcci\u00f3n en el momento del ingreso*:\n<span class=\"wpcf7-form-control-wrap\" data-name=\"direccio-moment-ingres-pacient\"><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=\"direccio-moment-ingres-pacient\" \/><\/span><\/label>\n\n<label>Pa\u00eds de nacimiento*:\n\t\t<span id=\"uacf7_country_select\" class=\"wpcf7-form-control-wrap pais-neixament\">\n\n\t\t\t<input id=\"uacf7_countries_pais-neixament\" type=\"text\" aria-required=\"true\" aria-invalid=\"false\" name=\"pais-neixament\" class=\"wpcf7-form-control wpcf7-uacf7_country_dropdown wpcf7-validates-as-required uacf7_country_dropdown_with_flag\">\n\n\t\t\t<span><\/span>\n\n\t\t\t<div style=\"display:none;\">\n\t\t\t\t<input type=\"hidden\" id=\"uacf7_countries_pais-neixament_code\" data-countrycodeinput=\"1\" readonly=\"readonly\" placeholder=\"Selected country code will appear here\" \/>\n\t\t\t<\/div>\n\n\t\t<\/span>\n\t\t<\/label>\n <\/div>\n\n<div class=\"uacf7-col-4\"> \n<label>Edad*:\n<span class=\"wpcf7-form-control-wrap\" data-name=\"edat-pacient\"><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=\"edat-pacient\" \/><\/span><\/label>\n\n<label>Municipio*:\n<span class=\"wpcf7-form-control-wrap\" data-name=\"municipi-pacient\"><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=\"municipi-pacient\" \/><\/span><\/label>\n <\/div>\n<\/div>\n\n\n<label style=\"font-size: 20px;font-weight: 600;margin-top:20px\">Datos m\u00e9dicos<\/label>\n\n<div class=\"uacf7-row\">\n<div class=\"uacf7-col-4\"> \n<label>Forma de TBC*:\n<span class=\"wpcf7-form-control-wrap\" data-name=\"forma-TB\"><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=\"forma-TB\" \/><\/span><\/label>\n\n<label>Pauta recomendada*:\n<span class=\"wpcf7-form-control-wrap\" data-name=\"pauta-recomenada\"><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=\"pauta-recomenada\" \/><\/span><\/label>\n <\/div>\n\n<div class=\"uacf7-col-4\"> \n<label>Fecha de inicio del tratamiento*:\n<span class=\"wpcf7-form-control-wrap\" data-name=\"data-inici-tractament\"><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=\"data-inici-tractament\" \/><\/span><\/label>\n\n<label>Resistencias*:\n<span class=\"wpcf7-form-control-wrap\" data-name=\"resistencies\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"resistencies\"><option value=\"\">&#8212;Por favor, elige una opci\u00f3n&#8212;<\/option><option value=\"S\u00ed\">S\u00ed<\/option><option value=\"No\">No<\/option><\/select><\/span><\/label>\n\n <\/div>\n\n<div class=\"uacf7-col-4\"> \n<label>Requiere aislamiento*\n<span class=\"wpcf7-form-control-wrap\" data-name=\"aillament\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"aillament\"><option value=\"\">&#8212;Por favor, elige una opci\u00f3n&#8212;<\/option><option value=\"S\u00ed\">S\u00ed<\/option><option value=\"No\">No<\/option><\/select><\/span><\/label>\n\n <\/div>\n<\/div>\n\n<div data-id=\"conditional-group-aillament\" data-orig_data_id=\"conditional-group-aillament\" class=\"\" data-class=\"wpcf7cf_group\">\n<label> D\u00edas de aislamiento recomendados:\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-dies-aillament\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-dies-aillament\" \/><\/span><\/label><\/div>\n\n<div data-id=\"conditional-group-resistencies\" data-orig_data_id=\"conditional-group-resistencies\" class=\"\" data-class=\"wpcf7cf_group\">\n<label>Qu\u00e9 resistencia:\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-resistencia\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-resistencia\" \/><\/span><\/label><\/div>\n\n<label>Factores de riesgo*\n<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"factors-risc\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"factors-risc[]\" value=\"VIH\" \/><span class=\"wpcf7-list-item-label\">VIH<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"factors-risc[]\" value=\"Diabetes\" \/><span class=\"wpcf7-list-item-label\">Diabetes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"factors-risc[]\" value=\"Alcoholismo\" \/><span class=\"wpcf7-list-item-label\">Alcoholismo<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"factors-risc[]\" value=\"Abuso de drogas\" \/><span class=\"wpcf7-list-item-label\">Abuso de drogas<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"factors-risc[]\" value=\"Tabaquismo\" \/><span class=\"wpcf7-list-item-label\">Tabaquismo<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"factors-risc[]\" value=\"Tratamiento inmunosupresor\" \/><span class=\"wpcf7-list-item-label\">Tratamiento inmunosupresor<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"factors-risc[]\" value=\"Otros\" \/><span class=\"wpcf7-list-item-label\">Otros<\/span><\/label><\/span><\/span><\/span>\n<div data-id=\"conditional-group-factors-risc\" data-orig_data_id=\"conditional-group-factors-risc\" class=\"\" data-class=\"wpcf7cf_group\">\n\n<label>Especificar otros:\n<span class=\"wpcf7-form-control-wrap\" data-name=\"factors-risc-altres\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"factors-risc-altres\" \/><\/span><\/label><\/div>\n\n<label>Comentarios\n<span class=\"wpcf7-form-control-wrap\" data-name=\"comentaris\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"comentaris\"><\/textarea><\/span><\/label>\n\n\n<label style=\"margin-left:-15px\"><span class=\"wpcf7-form-control-wrap\" data-name=\"mostrar-camps-opcionals\"><span class=\"wpcf7-form-control wpcf7-acceptance optional\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"mostrar-camps-opcionals\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">A\u00f1adir informaci\u00f3n adicional.<\/span><\/label><\/span><\/span><\/span><\/label>\n<div data-id=\"group-info-adicional\" data-orig_data_id=\"group-info-adicional\" class=\"\" data-class=\"wpcf7cf_group\">\n\n<label style=\"font-size: 20px;font-weight: 600\">Datos del solicitante<\/label>\n\n<label> Otros tel\u00e9fonos de inter\u00e9s (Especialistas):\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"telefons-interes\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"telefons-interes\" \/><\/span> <\/label>\n\n\n<label style=\"font-size: 20px;font-weight: 600;margin-top:20px\">Datos del paciente<\/label>\n<div class=\"uacf7-row\">\n<div class=\"uacf7-col-4\"> \n<label>CIP:\n<span class=\"wpcf7-form-control-wrap\" data-name=\"cip-pacient\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"cip-pacient\" \/><\/span><\/label>\n\n\n<label>Fecha de llegada a vivir a Espa\u00f1a:\n<span class=\"wpcf7-form-control-wrap\" data-name=\"data-arribada-espanya-pacient\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"data-arribada-espanya-pacient\" \/><\/span><\/label>\n <\/div>\n\n<div class=\"uacf7-col-4\"> \n<label>Otros tel\u00e9fonos:\n<span class=\"wpcf7-form-control-wrap\" data-name=\"altres-telefons-pacient\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"altres-telefons-pacient\" \/><\/span><\/label>\n <\/div>\n\n<div class=\"uacf7-col-4\"> \n<label>Pa\u00eds de origen (Pa\u00eds del que ha venido recientemente):\n\t\t<span id=\"uacf7_country_select\" class=\"wpcf7-form-control-wrap pais-origen-pacient\">\n\n\t\t\t<input id=\"uacf7_countries_pais-origen-pacient\" type=\"text\" aria-invalid=\"false\" name=\"pais-origen-pacient\" class=\"wpcf7-form-control wpcf7-uacf7_country_dropdown uacf7_country_dropdown_with_flag\">\n\n\t\t\t<span><\/span>\n\n\t\t\t<div style=\"display:none;\">\n\t\t\t\t<input type=\"hidden\" id=\"uacf7_countries_pais-origen-pacient_code\" data-countrycodeinput=\"1\" readonly=\"readonly\" placeholder=\"Selected country code will appear here\" \/>\n\t\t\t<\/div>\n\n\t\t<\/span>\n\t\t<\/label>\n <\/div>\n<\/div>\n\n\n\n\n\n\n\n<label style=\"font-size: 20px;font-weight: 600;margin-top:20px\">Datos m\u00e9dicos<\/label>\n<div class=\"uacf7-row\">\n<div class=\"uacf7-col-6\"> <label>Fecha de inicio de los s\u00edntomas:\n<span class=\"wpcf7-form-control-wrap\" data-name=\"data-inici-simptomes\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"data-inici-simptomes\" \/><\/span><\/label> \n<\/div>\n<div class=\"uacf7-col-6\"> \n\n<label>Alergia y\/o intolerancia a alg\u00fan medicamento\n<span class=\"wpcf7-form-control-wrap\" data-name=\"alergia-intolerancia-medicament\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"alergia-intolerancia-medicament\" \/><\/span><\/label> <\/div>\n<\/div>\n\n\n\n\n<label style=\"font-size: 20px;font-weight: 600;margin-top:20px\">Datos sociales<\/label>\n\n<div class=\"uacf7-row\">\n<div class=\"uacf7-col-4\"> \n<label>Barrera idiom\u00e1tica\n<span class=\"wpcf7-form-control-wrap\" data-name=\"barrera-idiomatica\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"barrera-idiomatica\"><option value=\"\">&#8212;Por favor, elige una opci\u00f3n&#8212;<\/option><option value=\"Total\">Total<\/option><option value=\"Parcial\">Parcial<\/option><option value=\"Nula\">Nula<\/option><\/select><\/span><\/label>\n\n<label>Domicilio:\n<span class=\"wpcf7-form-control-wrap\" data-name=\"domicili\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"domicili\"><option value=\"\">&#8212;Por favor, elige una opci\u00f3n&#8212;<\/option><option value=\"Domicilio fijo\">Domicilio fijo<\/option><option value=\"Sin domicilio fijo\">Sin domicilio fijo<\/option><option value=\"Sin hogar\">Sin hogar<\/option><\/select><\/span><\/label>\n <\/div>\n\n<div class=\"uacf7-col-4\"> \n<label>Situaci\u00f3n familiar:\n<span class=\"wpcf7-form-control-wrap\" data-name=\"situacio-familiar\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"situacio-familiar\" \/><\/span><\/label>\n <\/div>\n\n<div class=\"uacf7-col-4\"> \n<label>Situaci\u00f3n laboral:\n<span class=\"wpcf7-form-control-wrap\" data-name=\"situacio-laboral\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"situacio-laboral\" \/><\/span><\/label>\n <\/div>\n<\/div>\n\n<\/div>\n\n<label style=\"font-size: 20px;font-weight: 600;margin-top:20px\">Documentaci\u00f3n<\/label>\n\n<label>Informe m\u00e9dico*\n<span class=\"wpcf7-form-control-wrap\" data-name=\"file-informe-medic\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file wpcf7-validates-as-required\" accept=\"audio\/*,video\/*,image\/*\" aria-required=\"true\" aria-invalid=\"false\" type=\"file\" name=\"file-informe-medic\" \/><\/span><\/label>\n<label>DNI\n<span 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