208
| <![CDATA[<input type="text" placeholder="NOME COMPLETO:" name="nome" class="form-control" required="" autofocus="">]]>
|
212
| <![CDATA[<input type="text" placeholder="ENDEREÃO:" name="endereco" class="form-control" required="" >]]>
|
216
| <![CDATA[<input type="number" placeholder="NÃMERO:" name="numero" class="form-control" required="" >]]>
|
220
| <![CDATA[<input type="text" placeholder="BAIRRO:" name="bairro" class="form-control" required="" >]]>
|
224
| <![CDATA[<input type="text" placeholder="CNS: (CARTEIRA NACIONAL DE SAÃDE)" name="cns" class="form-control" required="">]]>
|
228
| <![CDATA[<input type="text" placeholder="CPF:" name="cpf" class="form-control" required="" onkeydown="javascript: fMasc( this, mCPF );">]]>
|
232
| <![CDATA[<input type="text" placeholder="DATA DE NASCIMENTO:" name="datanascimento" class="form-control data" required="" id="data" onkeypress="mascaraData( this, event )">]]>
|
244
| <![CDATA[<input type="number" placeholder="FONE:" name="fone" class="form-control" required="">]]>
|
248
| <![CDATA[<input type="text" placeholder="E-MAIL:" name="email" class="form-control" required="">]]>
|
252
| <![CDATA[<input placeholder="LOCAL DE TRABALHO:" type="text" name="local" class="form-control" required="">]]>
|
256
| <![CDATA[<input placeholder="FUNÃÃO:" type="text" name="funcao" class="form-control" required="">]]>
|
307
| <![CDATA[<input placeholder="Outros:" type="text" name="outros" class="form-control" >]]>
|
236
| <![CDATA[<select name="sexo" style="background: #fff; color:#000; padding: 3px;" required="" >
<option >Selecione</option>
<option value="MASCULINO">Masculino</option>
<option value="FEMENINO">Femenino</option>
</select>]]>
|
266
| <![CDATA[<select name="diabetes" style="background: #fff; color:#000; padding: 3px;" required="" >
<option >Selecione</option>
<option value="SIM">Sim</option>
<option value="NÃO">Não</option>
</select>]]>
|
274
| <![CDATA[<select name="hipertensao" style="background: #fff; color:#000; padding: 3px;" required="" >
<option >Selecione</option>
<option value="SIM">Sim</option>
<option value="NÃO">Não</option>
</select>]]>
|
282
| <![CDATA[<select name="gestante" style="background: #fff; color:#000; padding: 3px;" required="" >
<option >Selecione</option>
<option value="SIM">Sim</option>
<option value="NÃO">Não</option>
<option value="NÃO SE APLICA">Não se Aplica</option>
</select>]]>
|
291
| <![CDATA[<select name="asma" style="background: #fff; color:#000; padding: 3px;" required="" >
<option >Selecione</option>
<option value="SIM">Sim</option>
<option value="NÃO">Não</option>
</select>]]>
|
299
| <![CDATA[<select name="autoeimune" style="background: #fff; color:#000; padding: 3px;" required="" >
<option >Selecione</option>
<option value="SIM">Sim</option>
<option value="NÃO">Não</option>
</select>]]>
|