{"id":790,"date":"2023-05-30T17:45:38","date_gmt":"2023-05-30T20:45:38","guid":{"rendered":"https:\/\/imagemdental.com\/requisicao\/?page_id=790"},"modified":"2023-06-26T18:18:04","modified_gmt":"2023-06-26T21:18:04","slug":"teste","status":"publish","type":"page","link":"https:\/\/imagemdental.com\/requisicao\/","title":{"rendered":""},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"790\" class=\"elementor elementor-790\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-4c9819bb elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"4c9819bb\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-61bf789f\" data-id=\"61bf789f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-1bac1136 elementor-widget elementor-widget-text-editor\" data-id=\"1bac1136\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.7.3 - 29-08-2022 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#818a91;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#818a91;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<!-- wp:paragraph -->\n<div class=\"container\">\n    <div class=\"form-model\" id=\"form-dental\">\n        <form action=\"https:\/\/imagemdental.com\/requisicao\/baixar-requisicao\/pdf\/index.php\" method=\"POST\" id=\"cadastro-form\"  target=\"_blank\">\n            <fieldset class=\"topo-form\">\n                <div class=\"row\">\n                    <div class=\"col-12 col-md-6\">\n                        <h2>Requisi\u00e7\u00f5es<\/h2>\n                    <\/div>\n                    <div class=\"col-12 col-md-6\">\n                        <div class=\"fields-data d-flex align-items-center justify-content-end\">\n                            <div>\n                                <label>Dia<\/label>\n                                <input type=\"text\" name=\"dia\" id=\"dia\" value=\"06\">\n                            <\/div>\n                            <div>\n                                <label>M\u00eas<\/label>\n                                <input type=\"text\" name=\"mes\" id=\"mes\" value=\"05\">\n                            <\/div>\n                            <div>\n                                <label>Ano<\/label>\n                                <input type=\"text\" name=\"ano\" id=\"ano\" value=\"2026\">\n                            <\/div>\n                        <\/div>\n                    <\/div>\n                <\/div>\n            <\/fieldset>\n            <fieldset class=\"inputs-text\">\n                <div class=\"row\">\n                    <div class=\"col-12 col-md-12\">\n                        <div class=\"title-section\">\n                            <h3>Paciente<\/h3>\n                        <\/div>\n                    <\/div>\n                    <div class=\"col-12 col-md-4\">\n                        <label>Nome<\/label>\n                        <input type=\"text\" name=\"nome-paciente\" id=\"nome-paciente\" placeholder=\"Nome completo\">\n                    <\/div>\n                    <div class=\"col-12 col-md-3\">\n                        <label>Celular<\/label>\n                        <input type=\"text\" name=\"celular-paciente\" id=\"celular-paciente\" placeholder=\"Celular\">\n                    <\/div>\n                    <div class=\"col-12 col-md-2\">\n                        <label>Data de nascimento<\/label>\n                        <input type=\"text\" name=\"nasc-paciente\" id=\"nasc-paciente\" placeholder=\"Data de nascimento\" onkeyup=\"$(this).mask('00\/00\/0000')\">\n                    <\/div>\n                    <div class=\"col-12 col-md-3\">\n                        <label>E-mail<\/label>\n                        <input type=\"text\" name=\"email-paciente\" id=\"email-paciente\" placeholder=\"E-mail\">\n                    <\/div>\n                <\/div>\n            <\/fieldset>\n            <fieldset class=\"inputs-text\">\n                <div class=\"row\">\n                    <div class=\"col-12 col-md-12\">\n                        <div class=\"title-section\">\n                            <h3>Dentista Solicitante<\/h3>\n                        <\/div>\n                    <\/div>\n                    <div class=\"col-12 col-md-5\">\n                        <label>Nome<\/label>\n                        <input type=\"text\" name=\"nome-cirurgiao\" id=\"nome-cirurgiao\" placeholder=\"Nome completo\">\n                    <\/div>\n                    <div class=\"col-12 col-md-3\">\n                        <label>Telefone<\/label>\n                        <input type=\"text\" name=\"telefone-cirurgiao\" id=\"telefone-cirurgiao\" placeholder=\"Telefone\">\n                    <\/div>\n                    <div class=\"col-12 col-md-4\">\n                        <label>E-mail<\/label>\n                        <input type=\"text\" name=\"email-cirurgiao\" id=\"email-cirurgiao\" placeholder=\"E-mail\">\n                    <\/div>\n                <\/div>\n            <\/fieldset>\n            <fieldset class=\"tipo-exame\">\n                <div class=\"row\">\n                    <div class=\"col-12 col-md-12\">\n                        <div class=\"title-section\">\n                            <h3>Exame<\/h3>\n                        <\/div>\n                    <\/div>\n                    <div class=\"col-12 col-md-3 text-center\">\n                        <input type=\"radio\" name=\"exame-1\" id=\"exame-1\" value=\"checked\">\n                        <label for=\"exame-1\">Exame Inicial<\/label>\n                    <\/div>\n                    <div class=\"col-12 col-md-6 text-center\">\n                        <input type=\"radio\" name=\"exame-2\" id=\"exame-2\" value=\"checked\">\n                        <label for=\"exame-2\">Exame de Acompanhamento<\/label>\n                    <\/div>\n                    <div class=\"col-12 col-md-3 text-center\">\n                        <input type=\"radio\" name=\"exame-3\" id=\"exame-3\" value=\"checked\">\n                        <label for=\"exame-3\">Exame Final<\/label>\n                    <\/div>\n                <\/div>\n            <\/fieldset>\n            <fieldset class=\"inputs-checkbox\">\n                <div class=\"row\">\n                    <div class=\"col-12 col-md-12\">\n                        <div class=\"title-section\">\n                            <h3>Exames Solicitados<\/h3>\n                        <\/div>\n                    <\/div>\n                    <div class=\"col-12 col-md-4\">\n                        <div>\n                            <input type=\"checkbox\" name=\"periapical-digital\" id=\"periapical-digital\" value=\"checked\">\n                            <label for=\"periapical-digital\"><strong>Periapical Digital<\/strong><\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"dentes-assinalados\" id=\"dentes-assinalados\" value=\"checked\">\n                            <label for=\"dentes-assinalados\">Dentes Assinalados<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"checkup\" id=\"checkup\" value=\"checked\">\n                            <label for=\"checkup\">Check-up<\/label>\n                        <\/div>\n                    <\/div>\n                    <div class=\"col-12 col-md-4\">\n                        <div>\n                            <input type=\"checkbox\" name=\"interproximal\" id=\"interproximal\" value=\"checked\">\n                            <label for=\"interproximal\"><strong>Interproximal<\/strong><\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"premolares-d\" id=\"premolares-d\" value=\"checked\">\n                            <label for=\"premolares-d\">Pr\u00e9 Molares (D)<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"premolares-e\" id=\"premolares-e\" value=\"checked\">\n                            <label for=\"premolares-e\">Pr\u00e9 Molares (E)<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"molares-d\" id=\"molares-d\" value=\"checked\">\n                            <label for=\"molares-d\">Molares (D)<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"molares-e\" id=\"molares-e\" value=\"checked\">\n                            <label for=\"molares-e\">Molares (E)<\/label>\n                        <\/div>\n                    <\/div>\n                    <div class=\"col-12 col-md-4\">\n                        <div>\n                            <input type=\"checkbox\" name=\"panoramica-digital\" id=\"panoramica-digital\" value=\"checked\">\n                            <label for=\"panoramica-digital\"><strong>Panor\u00e2mica Digital<\/strong><\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"padrao\" id=\"padrao\" value=\"checked\">\n                            <label for=\"padrao\">Padr\u00e3o<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"medidas-implante\" id=\"medidas-implante\" value=\"checked\">\n                            <label for=\"medidas-implante\">Com medidas para implante<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"avaliar-implante\" id=\"avaliar-implante\" value=\"checked\">\n                            <label for=\"avaliar-implante\">Avaliar Implante<\/label>\n                        <\/div>\n                    <\/div>\n                <\/div>\n                <div class=\"row\">\n                    <div class=\"col-12 col-md-6\">\n                        <div>\n                            <h4>Denti\u00e7\u00e3o Permanente<\/h4>\n                        <\/div>\n                        <div class=\"denticao-permanente\">\n                            <div class=\"dentes-superiores\">\n                            <span><input type=\"checkbox\" name=\"denticao_permanente_18\" id=\"denticao-permanente-18\" value=\"checked\"><label for=\"denticao-permanente-18\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_17\" id=\"denticao-permanente-17\" value=\"checked\"><label for=\"denticao-permanente-17\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_16\" id=\"denticao-permanente-16\" value=\"checked\"><label for=\"denticao-permanente-16\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_15\" id=\"denticao-permanente-15\" value=\"checked\"><label for=\"denticao-permanente-15\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_14\" id=\"denticao-permanente-14\" value=\"checked\"><label for=\"denticao-permanente-14\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_13\" id=\"denticao-permanente-13\" value=\"checked\"><label for=\"denticao-permanente-13\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_12\" id=\"denticao-permanente-12\" value=\"checked\"><label for=\"denticao-permanente-12\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_11\" id=\"denticao-permanente-11\" value=\"checked\"><label for=\"denticao-permanente-11\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_21\" id=\"denticao-permanente-21\" value=\"checked\"><label for=\"denticao-permanente-21\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_22\" id=\"denticao-permanente-22\" value=\"checked\"><label for=\"denticao-permanente-22\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_23\" id=\"denticao-permanente-23\" value=\"checked\"><label for=\"denticao-permanente-23\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_24\" id=\"denticao-permanente-24\" value=\"checked\"><label for=\"denticao-permanente-24\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_25\" id=\"denticao-permanente-25\" value=\"checked\"><label for=\"denticao-permanente-25\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_26\" id=\"denticao-permanente-26\" value=\"checked\"><label for=\"denticao-permanente-26\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_27\" id=\"denticao-permanente-27\" value=\"checked\"><label for=\"denticao-permanente-27\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_28\" id=\"denticao-permanente-28\" value=\"checked\"><label for=\"denticao-permanente-28\"><\/label><\/span>                            <\/div>\n                            <div class=\"imagem-dentes\">\n                                <span><input type=\"checkbox\" name=\"denticao_permanente_48\" id=\"denticao-permanente-48\" value=\"checked\"><label for=\"denticao-permanente-48\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_47\" id=\"denticao-permanente-47\" value=\"checked\"><label for=\"denticao-permanente-47\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_46\" id=\"denticao-permanente-46\" value=\"checked\"><label for=\"denticao-permanente-46\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_45\" id=\"denticao-permanente-45\" value=\"checked\"><label for=\"denticao-permanente-45\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_44\" id=\"denticao-permanente-44\" value=\"checked\"><label for=\"denticao-permanente-44\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_43\" id=\"denticao-permanente-43\" value=\"checked\"><label for=\"denticao-permanente-43\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_42\" id=\"denticao-permanente-42\" value=\"checked\"><label for=\"denticao-permanente-42\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_41\" id=\"denticao-permanente-41\" value=\"checked\"><label for=\"denticao-permanente-41\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_31\" id=\"denticao-permanente-31\" value=\"checked\"><label for=\"denticao-permanente-31\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_32\" id=\"denticao-permanente-32\" value=\"checked\"><label for=\"denticao-permanente-32\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_33\" id=\"denticao-permanente-33\" value=\"checked\"><label for=\"denticao-permanente-33\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_34\" id=\"denticao-permanente-34\" value=\"checked\"><label for=\"denticao-permanente-34\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_35\" id=\"denticao-permanente-35\" value=\"checked\"><label for=\"denticao-permanente-35\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_36\" id=\"denticao-permanente-36\" value=\"checked\"><label for=\"denticao-permanente-36\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_37\" id=\"denticao-permanente-37\" value=\"checked\"><label for=\"denticao-permanente-37\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_permanente_38\" id=\"denticao-permanente-38\" value=\"checked\"><label for=\"denticao-permanente-38\"><\/label><\/span>                            <\/div>\n                            \n                        <\/div>\n                    <\/div>\n                    <div class=\"col-12 col-md-6\">\n                        <div>\n                            <h4>Denti\u00e7\u00e3o Dec\u00eddua<\/h4>\n                        <\/div>\n                        <div class=\"denticao-decidua\">\n                            <div class=\"dentes-superiores\">\n                            <span><input type=\"checkbox\" name=\"denticao_decidua_55\" id=\"denticao_decidua_55\" value=\"checked\"><label for=\"denticao_decidua_55\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_decidua_54\" id=\"denticao_decidua_54\" value=\"checked\"><label for=\"denticao_decidua_54\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_decidua_53\" id=\"denticao_decidua_53\" value=\"checked\"><label for=\"denticao_decidua_53\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_decidua_52\" id=\"denticao_decidua_52\" value=\"checked\"><label for=\"denticao_decidua_52\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_decidua_51\" id=\"denticao_decidua_51\" value=\"checked\"><label for=\"denticao_decidua_51\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_decidua_61\" id=\"denticao_decidua_61\" value=\"checked\"><label for=\"denticao_decidua_61\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_decidua_62\" id=\"denticao_decidua_62\" value=\"checked\"><label for=\"denticao_decidua_62\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_decidua_63\" id=\"denticao_decidua_63\" value=\"checked\"><label for=\"denticao_decidua_63\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_decidua_64\" id=\"denticao_decidua_64\" value=\"checked\"><label for=\"denticao_decidua_64\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_decidua_65\" id=\"denticao_decidua_65\" value=\"checked\"><label for=\"denticao_decidua_65\"><\/label><\/span>                            <\/div>\n                            <div class=\"imagem-dentes\">\n                            <span><input type=\"checkbox\" name=\"denticao_decidua_85\" id=\"denticao_decidua_85\" value=\"checked\"><label for=\"denticao_decidua_85\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_decidua_84\" id=\"denticao_decidua_84\" value=\"checked\"><label for=\"denticao_decidua_84\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_decidua_83\" id=\"denticao_decidua_83\" value=\"checked\"><label for=\"denticao_decidua_83\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_decidua_82\" id=\"denticao_decidua_82\" value=\"checked\"><label for=\"denticao_decidua_82\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_decidua_81\" id=\"denticao_decidua_81\" value=\"checked\"><label for=\"denticao_decidua_81\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_decidua_71\" id=\"denticao_decidua_71\" value=\"checked\"><label for=\"denticao_decidua_71\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_decidua_72\" id=\"denticao_decidua_72\" value=\"checked\"><label for=\"denticao_decidua_72\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_decidua_73\" id=\"denticao_decidua_73\" value=\"checked\"><label for=\"denticao_decidua_73\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_decidua_74\" id=\"denticao_decidua_74\" value=\"checked\"><label for=\"denticao_decidua_74\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_decidua_75\" id=\"denticao_decidua_75\" value=\"checked\"><label for=\"denticao_decidua_75\"><\/label><\/span>                            <\/div>\n                        <\/div>\n                    <\/div>\n                <\/div>\n            <\/fieldset>\n            <fieldset class=\"inputs-checkbox\">\n                <div class=\"row\">\n                    <div class=\"col-12 col-md-4\">\n                        <div>\n                            <input type=\"checkbox\" name=\"atm\" id=\"atm\" value=\"checked\">\n                            <label for=\"atm\"><strong>ATM <small>(Boca aberta e Boca fechada)<\/small><\/strong><\/label>\n                        <\/div>\n                        <div style=\"margin-bottom:30px;\">\n                            <input type=\"checkbox\" name=\"disfuncao-dor\" id=\"disfuncao-dor\" value=\"checked\">\n                            <label for=\"disfuncao-dor\">Disfun\u00e7\u00e3o\/Dor<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"tecnicas-localizacao\" id=\"tecnicas-localizacao\" value=\"checked\">\n                            <label for=\"tecnicas-localizacao\"><strong>T\u00e9cnicas de localiza\u00e7\u00e3o<\/strong><\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"dentes-n-irrompidos\" id=\"dentes-n-irrompidos\" value=\"checked\">\n                            <label for=\"dentes-n-irrompidos\">Dentes n\u00e3o *irrompidos<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"com-analise\" id=\"com-analise\" value=\"checked\">\n                            <label for=\"com-analise\">Com an\u00e1lise<\/label>\n                        <\/div>\n                        <div class=\"text-input\">\n                            <input type=\"text\" name=\"regiao\" id=\"regiao\" placeholder=\"Informe a regi\u00e3o...\">\n                        <\/div>\n                    <\/div>\n                    <div class=\"col-12 col-md-4\">\n                        <div>\n                            <input type=\"checkbox\" name=\"telerradiografia\" id=\"telerradiografia\" value=\"checked\">\n                            <label for=\"telerradiografia\"><strong>Telerradiografia Digital<\/strong><\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"lateral\" id=\"lateral\" value=\"checked\">\n                            <label for=\"lateral\">Lateral<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"frontal\" id=\"frontal\" value=\"checked\">\n                            <label for=\"frontal\">Frontal<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"t-com-analise\" id=\"t-com-analise\" value=\"checked\">\n                            <label for=\"t-com-analise\">Com an\u00e1lise<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"t-sem-analise\" id=\"t-sem-analise\" value=\"checked\">\n                            <label for=\"t-sem-analise\">Sem an\u00e1lise<\/label>\n                        <\/div>\n                        <div class=\"textarea\">\n                            <textarea name=\"observacoes\" id=\"observacoes\" placeholder=\"Insira as suas observa\u00e7\u00f5es...\"><\/textarea>\n                        <\/div>\n                    <\/div>\n                    <div class=\"col-12 col-md-4\">\n                        <div>\n                            <input type=\"checkbox\" name=\"foto-escaneamento\" id=\"foto-escaneamento\" value=\"checked\">\n                            <label for=\"foto-escaneamento\"><strong>Fotos\/Escaneamento\/Modelo<\/strong><\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"extrabucal\" id=\"extrabucal\" value=\"checked\">\n                            <label for=\"extrabucal\">Extrabucal foto<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"intrabucal\" id=\"intrabucal\" value=\"checked\">\n                            <label for=\"intrabucal\">Intrabucal foto<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"protocolo-estetico\" id=\"protocolo-estetico\" value=\"checked\">\n                            <label for=\"protocolo-estetico\">Protoloco est\u00e9tico<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"escaneamento-intra\" id=\"escaneamento-intra\" value=\"checked\">\n                            <label for=\"escaneamento-intra\">Escaneamento Intraoral<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"modelo-3d\" id=\"modelo-3d\" value=\"checked\">\n                            <label for=\"modelo-3d\">Modelo 3D impresso<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"modelo-gesso\" id=\"modelo-gesso\" value=\"checked\">\n                            <label for=\"modelo-gesso\">Modelo em gesso<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"outros\" id=\"outros\" value=\"checked\">\n                            <label for=\"outros\">Outros<\/label>\n                        <\/div>\n                    <\/div>\n                <\/div>\n            <\/fieldset>\n            <fieldset class=\"inputs-checkbox docs\">\n                <div class=\"row\">\n                    <div class=\"col-12 col-md-12\">\n                        <h4>Documenta\u00e7\u00e3o Ortord\u00f4ntica<\/h4>\n                    <\/div>\n                    <div class=\"col-12 col-md-12\">\n                        <div>\n                            <input type=\"checkbox\" name=\"doc01\" id=\"doc01\" value=\"checked\">\n                            <label for=\"doc01\">Doc. Tipo I &#8211; Pan + Tele + Modelo em gesso + Fotos<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"doc02\" id=\"doc02\" value=\"checked\">\n                            <label for=\"doc02\">Doc. Tipo II &#8211; Pan + Periapicai incisivos + Tele + Modelo em gesso + Fotos<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"doc03\" id=\"doc03\" value=\"checked\">\n                            <label for=\"doc03\">Doc. Tipo III &#8211; Pan + Periapicai incisivos + Interproximais + Tele + Modelo em gesso + Fotos<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"doc04\" id=\"doc04\" value=\"checked\">\n                            <label for=\"doc04\">Doc. Tipo IV &#8211; Pan + Check Up Periapical + Tele + Modelo em gesso + Fotos<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"doc05\" id=\"doc05\" value=\"checked\">\n                            <label for=\"doc05\">Doc. Tipo V &#8211; Pan + Check Up Periapical + Interproximais + Tele + Modelo em gesso + Fotos<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"doc06\" id=\"doc06\" value=\"checked\">\n                            <label for=\"doc06\">Doc. Est\u00e9tica &#8211; Check Up Periapical + Interproximais + Modelo em gesso + Fotos<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"doc07\" id=\"doc07\" value=\"checked\">\n                            <label for=\"doc07\">Substituir modelo em gesso por escaneamento intraoral + Modelo em impressora 3D<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"doc08\" id=\"doc08\" value=\"checked\">\n                            <label for=\"doc08\">Substituir modelo em gesso por escaneamento intraoral (sem modelo em impressora 3D)<\/label>\n                        <\/div>\n                    <\/div>\n                <\/div>\n            <\/fieldset>\n            <fieldset class=\"inputs-checkbox docs\">\n                <div class=\"row\">\n                    <div class=\"col-12 col-md-12\">\n                        <h4>Tomografia computadorizada<\/h4>\n                    <\/div>\n                    <div class=\"col-12 col-md-6\">\n                        <div class=\"d-flex\">\n                            <div>\n                                <input type=\"checkbox\" name=\"com-guia\" id=\"com-guia\" value=\"checked\">\n                                <label for=\"com-guia\"><strong>Com guia<\/strong><\/label>\n                            <\/div>\n                            <div>\n                                <input type=\"checkbox\" name=\"sem-guia\" id=\"sem-guia\" value=\"checked\">\n                                <label for=\"sem-guia\"><strong>Sem guia<\/strong><\/label>\n                            <\/div>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"implante\" id=\"implante\" value=\"checked\">\n                            <label for=\"implante\">Implante<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"dentes-nao-irrompidos\" id=\"dentes-nao-irrompidos\" value=\"checked\">\n                            <label for=\"dentes-nao-irrompidos\">Dentes n\u00e3o irrompidos<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"fratura\" id=\"fratura\" value=\"checked\">\n                            <label for=\"fratura\">Fratura \/perfura\u00e7\u00e3o radicular\/Endodontia<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"molares\" id=\"molares\" value=\"checked\">\n                            <label for=\"molares\">*3 molares &#8211; rela\u00e7\u00e3o com o canal mandibular\/seio maxilares<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"protocolo-tecidos\" id=\"protocolo-tecidos\" value=\"checked\">\n                            <label for=\"protocolo-tecidos\">Protocolo de tecidos moles<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"vestibular\" id=\"vestibular\" value=\"checked\">\n                            <label for=\"vestibular\">Vestibular<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"palatino\" id=\"palatino\" value=\"checked\">\n                            <label for=\"palatino\">Palatino \/ Lingual<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"area-doadora\" id=\"area-doadora\" value=\"checked\">\n                            <label for=\"area-doadora\">\u00c1rea doadora para enxerto<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"patalogica\" id=\"patalogica\" value=\"checked\">\n                            <label for=\"patalogica\">\u00c1rea patal\u00f3gica<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"especificacao-abaixo\" id=\"especificacao-abaixo\" value=\"checked\">\n                            <label for=\"especificacao-abaixo\">Especifica\u00e7\u00e3o abaixo<\/label>\n                        <\/div>\n                    <\/div>\n                    <div class=\"col-12 col-md-6\">\n                        <div>\n                            <div class=\"denticao\">\n                                <div class=\"superiores\">\n                                    <span><input type=\"checkbox\" name=\"denticao_18\" id=\"denticao_18\" value=\"checked\"><label for=\"denticao_18\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_17\" id=\"denticao_17\" value=\"checked\"><label for=\"denticao_17\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_16\" id=\"denticao_16\" value=\"checked\"><label for=\"denticao_16\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_15\" id=\"denticao_15\" value=\"checked\"><label for=\"denticao_15\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_14\" id=\"denticao_14\" value=\"checked\"><label for=\"denticao_14\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_13\" id=\"denticao_13\" value=\"checked\"><label for=\"denticao_13\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_12\" id=\"denticao_12\" value=\"checked\"><label for=\"denticao_12\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_11\" id=\"denticao_11\" value=\"checked\"><label for=\"denticao_11\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_21\" id=\"denticao_21\" value=\"checked\"><label for=\"denticao_21\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_22\" id=\"denticao_22\" value=\"checked\"><label for=\"denticao_22\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_23\" id=\"denticao_23\" value=\"checked\"><label for=\"denticao_23\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_24\" id=\"denticao_24\" value=\"checked\"><label for=\"denticao_24\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_25\" id=\"denticao_25\" value=\"checked\"><label for=\"denticao_25\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_26\" id=\"denticao_26\" value=\"checked\"><label for=\"denticao_26\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_27\" id=\"denticao_27\" value=\"checked\"><label for=\"denticao_27\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_28\" id=\"denticao_28\" value=\"checked\"><label for=\"denticao_28\"><\/label><\/span>                                <\/div>\n                                <div class=\"imagem-dentes\">\n                                    <span><input type=\"checkbox\" name=\"denticao_48\" id=\"denticao_48\" value=\"checked\"><label for=\"denticao_48\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_47\" id=\"denticao_47\" value=\"checked\"><label for=\"denticao_47\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_46\" id=\"denticao_46\" value=\"checked\"><label for=\"denticao_46\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_45\" id=\"denticao_45\" value=\"checked\"><label for=\"denticao_45\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_44\" id=\"denticao_44\" value=\"checked\"><label for=\"denticao_44\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_43\" id=\"denticao_43\" value=\"checked\"><label for=\"denticao_43\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_42\" id=\"denticao_42\" value=\"checked\"><label for=\"denticao_42\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_41\" id=\"denticao_41\" value=\"checked\"><label for=\"denticao_41\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_31\" id=\"denticao_31\" value=\"checked\"><label for=\"denticao_31\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_32\" id=\"denticao_32\" value=\"checked\"><label for=\"denticao_32\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_33\" id=\"denticao_33\" value=\"checked\"><label for=\"denticao_33\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_34\" id=\"denticao_34\" value=\"checked\"><label for=\"denticao_34\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_35\" id=\"denticao_35\" value=\"checked\"><label for=\"denticao_35\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_36\" id=\"denticao_36\" value=\"checked\"><label for=\"denticao_36\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_37\" id=\"denticao_37\" value=\"checked\"><label for=\"denticao_37\"><\/label><\/span><span><input type=\"checkbox\" name=\"denticao_38\" id=\"denticao_38\" value=\"checked\"><label for=\"denticao_38\"><\/label><\/span>                                <\/div>\n                            <\/div>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"regiao-interesse\" id=\"regiao-interesse\" value=\"checked\">\n                            <label for=\"regiao-interesse\">Regi\u00e3o de interesse<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"regiao-assinalada\" id=\"regiao-assinalada\" value=\"checked\">\n                            <label for=\"regiao-assinalada\">Regi\u00e3o Assinalada<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"maxila\" id=\"maxila\" value=\"checked\">\n                            <label for=\"maxila\">Maxila<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"mandibula\" id=\"mandibula\" value=\"checked\">\n                            <label for=\"mandibula\">Mand\u00edbula<\/label>\n                        <\/div>\n                        <div>\n                            <input type=\"checkbox\" name=\"atm-2\" id=\"atm-2\" value=\"checked\">\n                            <label for=\"atm-2\">ATM<\/label>\n                        <\/div>\n                    <\/div>\n                <\/div>\n            <\/fieldset>\n            <fieldset class=\"observacoes\">\n                <div class=\"row\">\n                    <div class=\"col-12 col-md-12\">\n                        <textarea name=\"observacoes-final\" id=\"observacoes-final\" placeholder=\"Insira as suas observa\u00e7\u00f5es...\"><\/textarea>\n                    <\/div>\n                <\/div>\n            <\/fieldset>\n            <fieldset class=\"submissao-area\">\n                <div class=\"row\">\n                    <div class=\"col-12 col-md-6\">\n                        <button class=\"btn-submissao\" id=\"enviar-form\">Enviar Requisi\u00e7\u00e3o<\/button>\n                    <\/div>\n                    <div class=\"col-12 col-md-6\">\n                        <button class=\"btn-submissao\" id=\"baixar-requisicao\">Baixar Requisi\u00e7\u00e3o<\/button>\n                    <\/div>\n                <\/div>\n            <\/fieldset>\n        <\/form>\n    <\/div>\n<\/div>\n<div class=\"resposta-form\"><\/div>\n<!-- \/wp:paragraph -->\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-790","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/imagemdental.com\/requisicao\/index.php\/wp-json\/wp\/v2\/pages\/790","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/imagemdental.com\/requisicao\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/imagemdental.com\/requisicao\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/imagemdental.com\/requisicao\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/imagemdental.com\/requisicao\/index.php\/wp-json\/wp\/v2\/comments?post=790"}],"version-history":[{"count":8,"href":"https:\/\/imagemdental.com\/requisicao\/index.php\/wp-json\/wp\/v2\/pages\/790\/revisions"}],"predecessor-version":[{"id":936,"href":"https:\/\/imagemdental.com\/requisicao\/index.php\/wp-json\/wp\/v2\/pages\/790\/revisions\/936"}],"wp:attachment":[{"href":"https:\/\/imagemdental.com\/requisicao\/index.php\/wp-json\/wp\/v2\/media?parent=790"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}