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<title>Caps facil@teranet Desenvolvimento LTDA.</title>
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</head>
<body>
<div class="wrapper">
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<div class="sidebar-wrapper">
<div class="logo">
<a href="#" class="simple-text">
CAPS FACIL
</a>
</div>
<ul class="nav">
<li class="active">
<a href="dashboard.html">
<i class="pe-7s-graph"></i>
<p>Dashboard</p>
</a>
</li>
<li>
<a href="user.html">
<i class="pe-7s-user"></i>
<p>Administradores</p>
</a>
</li>
<li>
<a href="table.html">
<i class="pe-7s-note2"></i>
<p>Lista de Pacientes</p>
</a>
</li>
<a href="notifications.html">
<i class="pe-7s-bell"></i>
<p>Notificaçoes</p>
</a>
</li>
</ul>
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</div>
<div class="main-panel">
<nav class="navbar navbar-default navbar-fixed">
<div class="container-fluid">
<div class="navbar-header">
<button type="button" class="navbar-toggle" data-toggle="collapse" data-target="#navigation-example-2">
<span class="sr-only">Serviços de Navegação</span>
<span class="icon-bar"></span>
<span class="icon-bar"></span>
<span class="icon-bar"></span>
</button>
<a class="navbar-brand" href="#">FICHA DE ACOLHIMENTO</a>
</div>
<div class="collapse navbar-collapse">
<ul class="nav navbar-nav navbar-left">
<li>
<a href="#" class="dropdown-toggle" data-toggle="dropdown">
<i class="fa fa-dashboard"></i>
<p class="hidden-lg hidden-md">Dashboard</p>
</a>
</li>
<li class="dropdown">
<a href="#" class="dropdown-toggle" data-toggle="dropdown">
<i class="fa fa-globe"></i>
<b class="caret hidden-lg hidden-md"></b>
<p class="hidden-lg hidden-md">
5 Notifications
<b class="caret"></b>
</p>
</a>
<ul class="dropdown-menu">
<li><a href="#">Notification 1</a></li>
<li><a href="#">Notification 2</a></li>
<li><a href="#">Notification 3</a></li>
<li><a href="#">Notification 4</a></li>
<li><a href="#">Another notification</a></li>
</ul>
</li>
<li>
<a href="">
<i class="fa fa-search"></i>
<p class="hidden-lg hidden-md">Search</p>
</a>
</li>
</ul>
<ul class="nav navbar-nav navbar-right">
<li>
<a href="">
<p>Account</p>
</a>
</li>
<li class="dropdown">
<a href="#" class="dropdown-toggle" data-toggle="dropdown">
<p>
+Info
<b class="caret"></b>
</p>
</a>
<ul class="dropdown-menu">
<li><a href="#">Action</a></li>
<li><a href="#">Another action</a></li>
<li><a href="#">Something</a></li>
<li><a href="#">Another action</a></li>
<li><a href="#">Something</a></li>
<li class="divider"></li>
<li><a href="#">Separated link</a></li>
</ul>
</li>
<li>
<a href="#">
<p>Sair</p>
</a>
</li>
<li class="separator hidden-lg"></li>
</ul>
</div>
</div>
</nav>
<div class="content">
<div class="container-fluid">
<div class="row">
<form class="form-horizontal">
<fieldset>
<div class="panel panel-primary">
<div class="panel-heading">REGISTRO DE ATENDIMENTO EM SAÚDE MENTAL</div>
<div class="panel-body">
<div class="form-group">
<div class="col-md-11 control-label">
<p class="help-block">
<h11>*</h11>
Campo Obrigatório </p>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-2 control-label" for="Nome">Pontuario
<h11>N*</h11>
</label>
<div class="col-md-4">
<input id="Npontuario" name="Nome"Npontuario="" class="form-control input-md" required type="text">
</div>
<label class="col-md-1 control-label" for="Dataemissaop">Data
<h11>*</h11>
</label>
<div class="col-md-2">
<input id="Dataemissaop" name="Dataemissaop" placeholder="DD/MM/AAAA" class="form-control input-md" required type="text" maxlength="10" OnKeyPress="formatar('##/##/####', this)" onBlur="showhide()">
</div>
</div>
<!--------------------------------------------------------------------->
<!---->
<!-- Text input-->
<div class="form-group">
<label class="col-md-2 control-label" for="Nome">Nome
<h11>*</h11>
</label>
<div class="col-md-8">
<input id="Nome" name="Nome" placeholder="" class="form-control input-md" required type="text">
</div>
</div>
<!--------------------------------------------------------------------->
<!---->
<div class="form-group">
<label class="col-md-2 control-label" for="Nomedopai">Nome do Pai
<h11>*</h11>
</label>
<div class="col-md-8">
<input id="Nomedopai" name="Nomedopai" placeholder="" class="form-control input-md" required type="text">
</div>
</div>
<!--------------------------------------------------------------------->
<!---->
<div class="form-group">
<label class="col-md-2 control-label" for="Nomedamae">Nome da Mae
<h11>*</h11>
</label>
<div class="col-md-8">
<input id="Nomedama" name="Nomedama" placeholder="" class="form-control input-md" required type="text">
</div>
</div>
<!--------------------------------------------------------------------->
<!---->
<!-- Text input-->
<div class="form-group">
<label class="col-md-2 control-label" for="cpf">CPF
<h11>*</h11>
</label>
<div class="col-md-4">
<div class="input-group"> <span class="input-group-addon">
<label class="radio-inline" for="radios-0">
<input type="radio" name="cpf" id="cpf" value="Nao" onclick="desabilita('enc_cpf')" required>
Não </label>
<label class="radio-inline" for="radios-1">
<input type="radio" name="cpf" id="cpf" value="sim" onclick="habilita('enc_cpf')">
Sim </label>
</span>
<input id="cpf" name="cpf" placeholder="Apenas números" class="form-control input-md" required type="text" maxlength="11" pattern="[0-9]+$">
</div>
</div>
<!--------------------------------------------------------------------->
<!---->
<label class="col-md-1 control-label" for="raca">Raça
<h11>*</h11>
</label>
<div class="col-md-3">
<input id="raca" name="raca" placeholder="" class="form-control input-md" required type="text">
</div>
<!--------------------------------------------------------------------->
<!---->
</div>
<!--------------------------------------------------------------------->
<!---->
<div class="form-group">
<label class="col-md-2 control-label" for="rg">_RG
<h11>*</h11>
</label>
<div class="col-md-4">
<div class="input-group"> <span class="input-group-addon">
<label class="radio-inline" for="radios-0">
<input type="radio" name="rg" id="rg" value="Nao" onclick="desabilita('enc_rg')" required>
Não </label>
<label class="radio-inline" for="radios-1">
<input type="radio" name="rg" id="rg" value="sim" onclick="habilita('enc_rg')">
Sim </label>
</span>
<input id="enc_rg" name="rg" class="form-control" type="text" placeholder="Apenas números" >
</div>
</div>
<!--------------------------------------------------------------------->
<!---->
<label class="col-md-1 control-label" for="dataemissao">Emissao RG
<h11>*</h11>
</label>
<div class="col-md-2">
<input id="dataemissao" name="dataemissao" placeholder="DD/MM/AAAA" class="form-control input-md" required type="text" maxlength="10" OnKeyPress="formatar('##/##/####', this)" onBlur="showhide()">
</div>
<div class="col-md-2">
<div class="input-group"> <span class="input-group-addon">UF</span>
<input id="UF" name="UF" placeholder="UF" class="form-control input-md" required type="text">
</div>
</div>
</div>
<!--------------------------------------------------------------------->
<!---->
<div class="form-group">
<label class="col-md-2 control-label" for="dataemissao">Religiao
<h11>*</h11>
</label>
<div class="col-md-3">
<input type="text" class="form-control" placeholder=".col-xs-3">
</div>
<label class="col-md-2 control-label" for="dataemissao">Naturalidade
<h11>*</h11>
</label>
<div class="col-md-2">
<input type="text" class="form-control" placeholder=".col-xs-3">
</div>
<div class="col-md-2">
<div class="input-group"> <span class="input-group-addon">UF</span>
<input id="UF" name="UF" placeholder="UF" class="form-control input-md" required type="text">
</div>
</div>
</div>
<div class="form-group">
<label class="col-md-2 control-label" for="dataemissao">Cartao SUS
<h11>*</h11>
</label>
<div class="col-md-2" for="Complemento">
<input type="text" class="form-control" placeholder=".col-xs-3">
</div>
<!--------------------------------------------------------------------->
<!---->
<!-- Multiple Radios (inline) -->
<label class="col-md-2 control-label" for="radios">Sexo <h11>*</h11></label>
<div class="col-md-4">
<label required="" class="radio-inline" for="radios-0" >
<input name="sexo" id="sexo" value="feminino" type="radio" required>
Feminino
</label>
<label class="radio-inline" for="radios-1">
<input name="sexo" id="sexo" value="masculino" type="radio">
Masculino
</label>
</div>
</div>
<!--------------------------------------------------------------------->
<!---->
<div class="form-group">
<label class="col-md-2 control-label" for="Nome">Data de Nascimento
<h11>*</h11>
</label>
<div class="col-md-2">
<input id="dtnasc" name="dtnasc" placeholder="DD/MM/AAAA" class="form-control input-md" required type="text" maxlength="10" OnKeyPress="formatar('##/##/####', this)" onBlur="showhide()">
</div>
<!--------------------------------------------------------------------->
<!----> <!--------------------------------------------------------------------->
<!---->
<!-- Prepended text-->
<label class="col-md-1 control-label" for="prependedtext">Telefone Contato<h11>*</h11>
</label>
<div class="col-md-2">
<div class="input-group"> <span class="input-group-addon"><i class="glyphicon glyphicon-earphone"></i></span>
<input id="prependedtext" name="prependedtext" class="form-control" placeholder="XX XXXXX-XXXX" required type="text" maxlength="13" pattern="\[0-9]{2}\ [0-9]{4,6}-[0-9]{3,4}$"
OnKeyPress="formatar('## #####-####', this)">
</div>
</div>
<label class="col-md-1 control-label" for="prependedtext">Telefone Recado<h11>*</h11>
</label>
<div class="col-md-2">
<div class="input-group"> <span class="input-group-addon"><i class="glyphicon glyphicon-earphone"></i></span>
<input id="prependedtext" name="prependedtext" class="form-control" placeholder="XX XXXXX-XXXX" required type="text" maxlength="13" pattern="\[0-9]{2}\ [0-9]{4,6}-[0-9]{3,4}$"
OnKeyPress="formatar('## #####-####', this)">
</div>
</div>
<!--------------------------------------------------------------------->
<!---->
</div>
<!-- Prepended text-->
<div class="form-group">
<label class="col-md-2 control-label" for="prependedtext">Email
<h11>*</h11>
</label>
<div class="col-md-5">
<div class="input-group"> <span class="input-group-addon"><i class="glyphicon glyphicon-envelope"></i></span>
<input id="prependedtext" name="prependedtext" class="form-control" placeholder="email@email.com" required type="text" pattern="[a-z0-9._%+-]+@[a-z0-9.-]+\.[a-z]{2,4}$" >
</div>
</div>
</div>
<!-- Search input-->
<div class="form-group">
<label class="col-md-2 control-label" for="CEP">CEP
<h11>*</h11>
</label>
<div class="col-md-2">
<input id="cep" name="cep" placeholder="Apenas números" class="form-control input-md" required value="" type="search" maxlength="8" pattern="[0-9]+$">
</div>
<div class="col-md-2">
<button type="button" class="btn btn-primary" onclick="pesquisacep(cep.value)">Pesquisar</button>
</div>
</div>
<!-- Prepended text-->
<div class="form-group">
<label class="col-md-2 control-label" for="prependedtext">Endereço</label>
<div class="col-md-4">
<div class="input-group"> <span class="input-group-addon">Rua</span>
<input id="rua" name="rua" class="form-control" placeholder="" required readonly type="text">
</div>
</div>
<div class="col-md-2">
<div class="input-group"> <span class="input-group-addon">Nº
<h11>*</h11>
</span>
<input id="numero" name="numero" class="form-control" placeholder="" required type="text">
</div>
</div>
<div class="col-md-3">
<div class="input-group"> <span class="input-group-addon">Bairro</span>
<input id="bairro" name="bairro" class="form-control" placeholder="" required readonly type="text">
</div>
</div>
</div>
<div class="form-group">
<label class="col-md-2 control-label" for="prependedtext"></label>
<div class="col-md-4">
<div class="input-group"> <span class="input-group-addon">Cidade</span>
<input id="cidade" name="cidade" class="form-control" placeholder="" required readonly="readonly" type="text">
</div>
</div>
<div class="col-md-2">
<div class="input-group"> <span class="input-group-addon">Estado</span>
<input id="estado" name="estado" class="form-control" placeholder="" required readonly="readonly" type="text">
</div>
</div>
</div>
<!-- text area -->
<div class="form-group">
<label class="col-md-2 control-label" for="prependedtext">Complemento</label>
<div class="col-md-8">
<textarea class="form-control" rows="5"></textarea>
</div>
</div>
<!-- input type text -->
<div class="form-group">
<label class="col-md-2 control-label" for="prependedtext">Ponto de referencia</label>
<div class="col-md-8">
<input type="text" class="form-control" placeholder="Entrada de texto">
</div>
</div>
<!-- Select Basic -->
<div class="form-group">
<label class="col-md-2 control-label" for="Estado Civil">Estado Civil
<h11>*</h11>
</label>
<div class="col-md-2">
<select required id="Estado Civil" name="Estado Civil" class="form-control">
<option value=""></option>
<option value="Solteiro(a)">Solteiro(a)</option>
<option value="Casado(a)">Casado(a)</option>
<option value="Divorciado(a)">Divorciado(a)</option>
<option value="Viuvo(a)">Viuvo(a)</option>
</select>
</div>
<!-- Prepended checkbox -->
<label class="col-md-1 control-label" for="Filhos">Filhos
<h11>*</h11>
</label>
<div class="col-md-3">
<div class="input-group"> <span class="input-group-addon">
<label class="radio-inline" for="radios-0">
<input type="radio" name="filhos" id="filhos" value="nao" onclick="desabilita('filhos_qtd')" required>
Não </label>
<label class="radio-inline" for="radios-1">
<input type="radio" name="filhos" id="filhos" value="sim" onclick="habilita('filhos_qtd')">
Sim </label>
</span>
<input id="filhos_qtd" name="filhos_qtd" class="form-control" type="text" placeholder="Quantos?" pattern="[0-9]+$" >
</div>
</div>
</div>
<!-- Select Basic -->
<div class="form-group">
<label class="col-md-2 control-label" for="selectbasic">Escolaridade
<h11>*</h11>
</label>
<div class="col-md-3">
<select required id="escolaridade" name="escolaridade" class="form-control">
<option value=""></option>
<option value="Analfabeto">Analfabeto</option>
<option value="Fundamental Incompleto">Fundamental Incompleto</option>
<option value="Fundamental Completo">Fundamental Completo</option>
<option value="Médio Incompleto">Médio Incompleto</option>
<option value="Médio Completo">Médio Completo</option>
<option value="Superior Incompleto">Superior Incompleto</option>
<option value="Superior Completo">Superior Completo</option>
</select>
</div>
<!-- Text input-->
<label class="col-md-1 control-label" for="profissao">Profissão*
</label>
<div class="col-md-4">
<input id="profissao" name="profissao" type="text" placeholder="" class="form-control input-md" required>
</div>
</div>
<div class="form-group">
<label class="col-md-2 control-label" for="encaminhamento">Encaminhamento
<h11>*</h11>
</label>
<div class="col-md-8">
<div class="input-group"> <span class="input-group-addon">
<label class="radio-inline" for="radios-0">
<input type="radio" name="enc" id="enc" value="Nao" onclick="desabilita('enc_instituicao')" required>
Não </label>
<label class="radio-inline" for="radios-1">
<input type="radio" name="enc" id="enc" value="sim" onclick="habilita('enc_instituicao')">
Sim </label>
</span>
<input id="enc_instituicao" name="enc" class="form-control" type="text" placeholder="Instituição" >
</div>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-2 control-label" for="prependedtext">Diagnostico do encaminhamento</label>
<div class="col-md-8">
<textarea class="form-control" rows="5"></textarea>
</div>
</div>
<div id="newpost">
<div class="form-group">
<div class="col-md-3 control-label">
<h3>Responsável</h3>
</div>
</div>
<div class="form-group">
<label class="col-md-2 control-label" for="Nome">Nome
<h11>*</h11>
</label>
<div class="col-md-8">
<input id="Nome" name="Nome" placeholder="" class="form-control input-md" required type="text">
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-2 control-label" for="vinculo">Vinculo
<h11>*</h11>
</label>
<div class="col-md-2">
<input id="vinculo" name="vinculo" placeholder="" class="form-control input-md" required type="text" pattern="/^[A-Za-záàâãéèêíïóôõöúçñÁÀÂÃÉÈÍÏÓÔÕÖÚÇÑ ]+$/">
</div>
<label class="col-md-1 control-label" for="Nome">Nascimento
<h11>*</h11>
</label>
<div class="col-md-2">
<input id="dtnasc" name="dtnasc" placeholder="DD/MM/AAAA" class="form-control input-md" required type="text" maxlength="10" OnKeyPress="formatar('##/##/####', this)">
</div>
<!-- Multiple Radios (inline) -->
<label class="col-md-1 control-label" for="radios">Sexo
<h11>*</h11>
</label>
<div class="col-md-4">
<label required="" class="radio-inline" for="radios-0" >
<input name="sexo" id="sexo" value="feminino" type="radio" required>
Feminino </label>
<label class="radio-inline" for="radios-1">
<input name="sexo" id="sexo" value="masculino" type="radio">
Masculino </label>
</div>
</div>
<div class="form-group">
<label class="col-md-2 control-label" for="Estado Civil">Estado Civil
<h11>*</h11>
</label>
<div class="col-md-2">
<select required id="Estado Civil" name="Estado Civil" class="form-control">
<option value=""></option>
<option value="Solteiro(a)">Solteiro(a)</option>
<option value="Casado(a)">Casado(a)</option>
<option value="Divorciado(a)">Divorciado(a)</option>
<option value="Viuvo(a)">Viuvo(a)</option>
</select>
</div>
<label class="col-md-1 control-label" for="Filhos">Filhos
<h11>*</h11>
</label>
<div class="col-md-3">
<div class="input-group"> <span class="input-group-addon">
<label class="radio-inline" for="radios-0">
<input type="radio" name="ofilhos" id="ofilhos" value="nao" onclick="desabilita('ofilhos_qtd')" required>
Não </label>
<label class="radio-inline" for="radios-1">
<input type="radio" name="ofilhos" id="ofilhos" value="sim" onclick="habilita('ofilhos_qtd')">
Sim </label>
</span>
<input id="ofilhos_qtd" name="ofilhos_qtd" class="form-control" type="text" placeholder="Quantos?" pattern="[0-9]+$" >
</div>
</div>
</div>
<div class="form-group">
<label class="col-md-2 control-label" for="selectbasic">Escolaridade
<h11>*</h11>
</label>
<div class="col-md-3">
<select required id="escolaridade" name="escolaridade" class="form-control">
<option value=""></option>
<option value="Analfabeto">Analfabeto</option>
<option value="Fundamental Incompleto">Fundamental Incompleto</option>
<option value="Fundamental Completo">Fundamental Completo</option>
<option value="Médio Incompleto">Médio Incompleto</option>
<option value="Médio Completo">Médio Completo</option>
<option value="Superior Incompleto">Superior Incompleto</option>
<option value="Superior Completo">Superior Completo</option>
</select>
</div>
<!-- Text input-->
<label class="col-md-1 control-label" for="profissao">Profissão
<h11>*</h11>
</label>
<div class="col-md-4">
<input id="profissao" name="profissao" type="text" placeholder="" class="form-control input-md" required>
</div>
</div>
<div class="form-group">
<label class="col-md-2 control-label" for="prependedtext">Telefone
<h11>*</h11>
</label>
<div class="col-md-2">
<div class="input-group"> <span class="input-group-addon"><i class="glyphicon glyphicon-earphone"></i></span>
<input id="prependedtext" name="prependedtext" class="form-control" placeholder="XX XXXXX-XXXX" required type="text" maxlength="13" pattern="\[0-9]{2}\ [0-9]{4,6}-[0-9]{3,4}$"
OnKeyPress="formatar('## #####-####', this)">
</div>
</div>
<label class="col-md-1 control-label" for="prependedtext">Telefone</label>
<div class="col-md-2">
<div class="input-group"> <span class="input-group-addon"><i class="glyphicon glyphicon-earphone"></i></span>
<input id="prependedtext" name="prependedtext" class="form-control" placeholder="XX XXXXX-XXXX" type="text" maxlength="13" pattern="\[0-9]{2}\ [0-9]{4,6}-[0-9]{3,4}$"
OnKeyPress="formatar('## #####-####', this)">
</div>
</div>
</div>
<div class="form-group">
<label class="col-md-2 control-label" for="prependedtext">Email
<h11>*</h11>
</label>
<div class="col-md-5">
<div class="input-group"> <span class="input-group-addon"><i class="glyphicon glyphicon-envelope"></i></span>
<input id="prependedtext" name="prependedtext" class="form-control" placeholder="email@email.com" required type="text" pattern="[a-z0-9._%+-]+@[a-z0-9.-]+\.[a-z]{2,4}$" >
</div>
</div>
</div>
</div>
<!-- Button (Double) -->
<div class="form-group">
<label class="col-md-2 control-label" for="Cadastrar"></label>
<div class="col-md-8">
<button id="Cadastrar" name="Cadastrar" class="btn btn-success" type="Submit">Cadastrar</button>
<button id="Cancelar" name="Cancelar" class="btn btn-danger" type="Reset">Cancelar</button>
</div>
</div>
</div>
</div>
</fieldset>
</form>
</div>
<div class="row"></div>
</div>
</div>
<footer class="footer">
<div class="container-fluid">
<p class="copyright pull-right">
© <script>document.write(new Date().getFullYear())</script> <a href="#">Caps Facil</a>, Teranet Desenvolvimento
</p>
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</footer>
</div>
</div>
</body>
<!-- Core JS Files -->
<script src="assets/js/jquery.3.2.1.min.js" type="text/javascript"></script>
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<!-- Charts Plugin -->
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},{
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timer: 4000
});
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</script>
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