| 2377
| <![CDATA[<input class="form-control" name="nome" id="nome" type="text" />]]>
|
| 2382
| <![CDATA[<input type="text" class="form-control datapicker" name="data_nasc" id="data_nasc" placeholder="Insira a data">]]>
|
| 2400
| <![CDATA[<input type="radio" name="sex" value="M">]]>
|
| 2404
| <![CDATA[<input type="radio" name="sex" value="F">]]>
|
| 2412
| <![CDATA[<input class="form-control" name="rg" id="rg" type="text" />]]>
|
| 2417
| <![CDATA[<input class="form-control" name="cpf" id="cpf" type="text" />]]>
|
| 2422
| <![CDATA[<input class="form-control" onblur="BuscaCep(this.value)" name="cep" id="cep" type="text" />]]>
|
| 2427
| <![CDATA[<input class="form-control" name="endereco" id="endereco" type="text" />]]>
|
| 2432
| <![CDATA[<input class="form-control" name="bairro" id="bairro" type="text" />]]>
|
| 2437
| <![CDATA[<input class="form-control" name="numero" id="numero" type="text" />]]>
|
| 2442
| <![CDATA[<input class="form-control" name="cidade" id="cidade" type="text" />]]>
|
| 2481
| <![CDATA[<input class="form-control" name="telefone" id="telefone" type="text" />]]>
|
| 2486
| <![CDATA[<input class="form-control" name="celular" id="celular" type="text" />]]>
|
| 2491
| <![CDATA[<input class="form-control" name="falarcom" id="falarcom" type="text" />]]>
|
| 2496
| <![CDATA[<input class="form-control" name="email" id="email" type="email" />]]>
|
| 2515
| <![CDATA[<input class="form-control" name="nomepai" id="nomepai" type="text" />]]>
|
| 2520
| <![CDATA[<input class="form-control" name="nomemae" id="nomemae" type="text" />]]>
|
| 2539
| <![CDATA[<input type="radio" name="trabalha" value="1">]]>
|
| 2543
| <![CDATA[<input type="radio" name="trabalha" value="0">]]>
|
| 2551
| <![CDATA[<input class="form-control" name="ondetrabalha" id="ondetrabalha" type="text" />]]>
|
| 2558
| <![CDATA[<input type="checkbox" name="chk_auditiva" value="1">]]>
|
| 2562
| <![CDATA[<input type="checkbox" name="chk_visual" value="1">]]>
|
| 2566
| <![CDATA[<input type="checkbox" name="chk_intelectual" value="1">]]>
|
| 2570
| <![CDATA[<input type="checkbox" name="chk_fisica" value="1">]]>
|
| 2574
| <![CDATA[<input type="checkbox" name="chk_outros" value="1">]]>
|
| 2582
| <![CDATA[<input class="form-control" name="outradeficiencia" id="outradeficiencia" type="text" />]]>
|
| 2587
| <![CDATA[<input class="form-control" name="tempodeficiencia" id="tempodeficiencia" type="text" />]]>
|
| 2594
| <![CDATA[<input type="checkbox" name="chk_pc" value="1">]]>
|
| 2598
| <![CDATA[<input type="checkbox" name="chk_tea" value="1">]]>
|
| 2602
| <![CDATA[<input type="checkbox" name="chk_sindromes" value="1">]]>
|
| 2610
| <![CDATA[<input class="form-control" name="sindromes" id="sindromes" type="text" />]]>
|
| 2617
| <![CDATA[<input type="radio" name="recurso" value="1">]]>
|
| 2621
| <![CDATA[<input type="radio" name="recurso" value="0">]]>
|
| 2631
| <![CDATA[<input type="checkbox" name="chk_cadeira" value="1">]]>
|
| 2635
| <![CDATA[<input type="checkbox" name="chk_andador" value="1">]]>
|
| 2639
| <![CDATA[<input type="checkbox" name="chk_bengala" value="1">]]>
|
| 2643
| <![CDATA[<input type="checkbox" name="chk_cao" value="1">]]>
|
| 2647
| <![CDATA[<input type="checkbox" name="chk_aparelho" value="1">]]>
|
| 2651
| <![CDATA[<input type="checkbox" name="chk_outrorecurso" value="1">]]>
|
| 2659
| <![CDATA[<input class="form-control" name="outrorecurso" id="outrorecurso" type="text" />]]>
|
| 2666
| <![CDATA[<input type="radio" name="acompanhamento" value="1">]]>
|
| 2670
| <![CDATA[<input type="radio" name="acompanhamento" value="0">]]>
|
| 2680
| <![CDATA[<input type="checkbox" name="chk_fisio" value="1">]]>
|
| 2684
| <![CDATA[<input type="checkbox" name="chk_fono" value="1">]]>
|
| 2688
| <![CDATA[<input type="checkbox" name="chk_terapeuta" value="1">]]>
|
| 2692
| <![CDATA[<input type="checkbox" name="chk_psico" value="1">]]>
|
| 2696
| <![CDATA[<input type="checkbox" name="chk_outroacompanhamento" value="1">]]>
|
| 2707
| <![CDATA[<input class="form-control" name="outroacompanhamento" id="outroacompanhamento" type="text" />]]>
|
| 2712
| <![CDATA[<input class="form-control" name="ondeacompanhamento" id="ondeacompanhamento" type="text" />]]>
|
| 2719
| <![CDATA[<input type="radio" name="medicamento" value="1">]]>
|
| 2723
| <![CDATA[<input type="radio" name="medicamento" value="0">]]>
|
| 2731
| <![CDATA[<input class="form-control" name="qualmedicamento" id="qualmedicamento" type="text" />]]>
|
| 2738
| <![CDATA[<input type="radio" name="beneficio" value="1">]]>
|
| 2742
| <![CDATA[<input type="radio" name="beneficio" value="0">]]>
|
| 2750
| <![CDATA[<input class="form-control" name="qualbeneficio" id="qualbeneficio" type="text" />]]>
|
| 2757
| <![CDATA[<input type="radio" name="instituicao" value="1">]]>
|
| 2761
| <![CDATA[<input type="radio" name="instituicao" value="0">]]>
|
| 2769
| <![CDATA[<input class="form-control" name="qualinstituicao" id="qualinstituicao" type="text" />]]>
|
