{"id":4431,"date":"2026-05-22T09:42:29","date_gmt":"2026-05-22T13:42:29","guid":{"rendered":"https:\/\/crsoriente.cl\/?p=4431"},"modified":"2026-05-22T09:42:30","modified_gmt":"2026-05-22T13:42:30","slug":"formulario-climaterio","status":"publish","type":"post","link":"https:\/\/crsoriente.cl\/?p=4431","title":{"rendered":"Formulario Climaterio"},"content":{"rendered":"<form  class=\"kaliforms-form-container bootstrap-wrapper rounded-borders input-with-bg \" data-form-id=\"4428\" style=\"opacity:0\"><div id=\"kaliforms-global-error-message-4428\" class=\"global-error-message\"><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><span  data-internal-id=\"freetext31\" type=\"freeText\" id=\"freeText31\" name=\"freeText\">Formulario dirigido a pacientes que se encuentran en control en la Unidad de Ginecolog\u00eda CRS por diagn\u00f3stico de climaterio, y que especialista les haya indicado un pr\u00f3ximo control con resultados de ex\u00e1menes (mamograf\u00eda), con el fin de programar un control telef\u00f3nico y disponer de la receta para el inicio de su tratamiento.<\/span><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12\"><label  for=\"divider30\">Datos Personales<\/label><hr \/><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-7 \"><label  for=\"textbox13\">RUT <span class=\"kali-required-mark\"><\/span><\/label><input  data-internal-id=\"textbox13\" type=\"text\" id=\"textbox13\" name=\"textbox_rut\" data-properties.type=\"text\"  placeholder=\"Ingrese su RUT\"required ><small>Ingrese 0 al inicio si es menor o igual a 9 millones<\/small><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><label  for=\"textbox3\">Nombre Completo <span class=\"kali-required-mark\"><\/span><\/label><input  data-internal-id=\"textbox3\" type=\"text\" id=\"textbox3\" name=\"textbox_nombre\" data-properties.type=\"text\"  placeholder=\"Ingrese su nombre\"required ><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-6 \"><label  for=\"telephone15\">Tel\u00e9fono de contacto actual <span class=\"kali-required-mark\"><\/span><\/label><input  data-internal-id=\"telephone15\" type=\"tel\" id=\"telephone15\" name=\"telefono_celular\"required  data-format=\"free\"  class=\"input\"><small>Aseg\u00farese de que el n\u00famero est\u00e9 activo para recibir WhatsApp o llamada telef\u00f3nica<\/small><\/div><div class=\"col-12 col-md-6 \"><label  for=\"telephone28\">Agregar aqu\u00ed tel\u00e9fono alternativo de contacto o recado<\/label><input  data-internal-id=\"telephone28\" type=\"tel\" id=\"telephone28\" name=\"telefono_contacto3\" placeholder=\"Registrar los 9 d\u00edgitos del n\u00famero de contacto\" data-format=\"free\"  class=\"input\"><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><label  for=\"email24\">Correo <span class=\"kali-required-mark\"><\/span><\/label><input  data-internal-id=\"email24\" type=\"email\" id=\"email24\" name=\"email\"required  class=\"input\"><small>Ingrese su correo<\/small><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12\"><label  for=\"divider3233\">Confirmaci\u00f3n de Requisitos<\/label><hr \/><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><label class=\"radio-label\" style=\"margin-bottom:15px;display:inline-block\">\u00bfTiene su mamograf\u00eda realizada y con el informe disponible? <span class=\"kali-required-mark\"><\/span><\/label><label class=\"radio-label\"><input  data-internal-id=\"radio34\" type=\"radio\" id=\"radio340\" name=\"r_tiene_mamo\" data-flow=\"vertical\" required  class=\"input\"  value=\"SI\">SI<\/label><label class=\"radio-label\"><input  data-internal-id=\"radio34\" type=\"radio\" id=\"radio341\" name=\"r_tiene_mamo\" data-flow=\"vertical\" required  class=\"input\"  value=\"NO\">NO<\/label><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><label  for=\"date35\">\u00bfFecha en que se realiz\u00f3 la mamograf\u00eda?<\/label><input data-internal-id=\"date35\" type=\"date\" id=\"date35\" name=\"f_fecha_mamo\" class=\"input\"><small>En caso que tenga una mamograf\u00eda anterior<\/small><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><input  data-internal-id=\"submitbutton5\" type=\"submit\" id=\"submitButton5\" data-style=\"default\"  name=\"submitButton5\" class=\"input\" value=\"Enviar\" ><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><span  data-internal-id=\"freetext7\" type=\"freeText\" id=\"freetext7\" name=\"freetext7\">N\u00famero de Central Telef\u00f3nica +56 2 2568 8200<\/span><\/div><\/div><!-- This form was built using Kali Forms --><\/form>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":8,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_uag_custom_page_level_css":"","footnotes":""},"categories":[1],"tags":[],"class_list":["post-4431","post","type-post","status-publish","format-standard","hentry","category-servicios-en-linea"],"uagb_featured_image_src":{"full":false,"thumbnail":false,"medium":false,"medium_large":false,"large":false,"1536x1536":false,"2048x2048":false,"form-edit-image-preview":false},"uagb_author_info":{"display_name":"crsweb","author_link":"https:\/\/crsoriente.cl\/?author=8"},"uagb_comment_info":0,"uagb_excerpt":null,"_links":{"self":[{"href":"https:\/\/crsoriente.cl\/index.php?rest_route=\/wp\/v2\/posts\/4431","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/crsoriente.cl\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/crsoriente.cl\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/crsoriente.cl\/index.php?rest_route=\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/crsoriente.cl\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=4431"}],"version-history":[{"count":1,"href":"https:\/\/crsoriente.cl\/index.php?rest_route=\/wp\/v2\/posts\/4431\/revisions"}],"predecessor-version":[{"id":4432,"href":"https:\/\/crsoriente.cl\/index.php?rest_route=\/wp\/v2\/posts\/4431\/revisions\/4432"}],"wp:attachment":[{"href":"https:\/\/crsoriente.cl\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=4431"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/crsoriente.cl\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=4431"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/crsoriente.cl\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=4431"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}