Requisi\u00e7\u00e3o Online - Radi Radiologia<\/title>\r\n<style>\r\nbody { font-family: Arial, sans-serif; background-color: #ffffff; color: #333; margin: 0; padding: 20px; }\r\nform { background: #fff; border: 2px solid #6f8cc4; border-radius: 12px; padding: 25px; box-shadow: 0 4px 10px rgba(0,0,0,0.05); max-width: 800px; margin: auto; }\r\nh2 { text-align: center; color: #6f8cc4; margin-bottom: 15px; }\r\nlabel { display: block; margin-top: 15px; font-weight: bold; color: #333; }\r\ninput[type=\"text\"], input[type=\"tel\"], input[type=\"date\"], select, textarea { width: 100%; padding: 10px; border: 1px solid #ccc; border-radius: 8px; margin-top: 5px; font-size: 14px; box-sizing: border-box; }\r\ntextarea { resize: vertical; }\r\n.radio-group, .checkbox-group { margin-top: 10px; }\r\n.radio-group label, .checkbox-group label { font-weight: normal; margin-right: 15px; }\r\n.alert { color: #c0392b; background: #fce4e4; border-left: 5px solid #c0392b; padding: 10px; margin-top: 10px; border-radius: 8px; }\r\n.divisor { margin: 25px 0 15px 0; border-bottom: 2px solid #6f8cc4; }\r\nbutton { background-color: #6f8cc4; color: white; border: none; border-radius: 8px; padding: 12px 20px; font-size: 16px; cursor: pointer; margin-top: 25px; width: 100%; }\r\nbutton:hover { background-color: #5b78ac; }\r\n.dentes-container { display: flex; flex-wrap: wrap; gap: 8px; margin-top: 10px; }\r\n.dente { width: 40px; text-align: center; }\r\n.arcada-titulo { font-weight: bold; color: #6f8cc4; margin-top: 10px; }\r\n@media (max-width: 600px) { .dente { width: 35px; font-size: 13px; } button { font-size: 14px; } }\r\n<\/style>\r\n<\/head>\r\n<body>\r\n\r\n<form id=\"requisicaoForm\" action=\"https:\/\/formsubmit.co\/central@radiradiologia.com.br\" method=\"POST\">\r\n <input type=\"hidden\" name=\"_cc\" value=\"relacionamento@radiradiologia.com.br,relacionamento2@radiradiologia.com.br,felipe@radiradiologia.com.br,admin@radiradiologia.com.br\">\r\n <input type=\"hidden\" name=\"_subject\" value=\"Requisi\u00e7\u00e3o Online - Radi Radiologia\">\r\n <input type=\"hidden\" name=\"_captcha\" value=\"false\">\r\n <input type=\"hidden\" name=\"_next\" value=\"https:\/\/radiradiologia.com.br\/index.php\/obrigado\/\/\">\r\n\r\n <h2>Requisi\u00e7\u00e3o Online - Radi Radiologia<\/h2>\r\n\r\n <label>Nome do Paciente<\/label>\r\n <input type=\"text\" id=\"nomePaciente\" name=\"nomePaciente\" required>\r\n\r\n <label>Telefone do Paciente<\/label>\r\n <input type=\"tel\" id=\"telefonePaciente\" name=\"telefonePaciente\" required>\r\n\r\n <label>CPF do Paciente<\/label>\r\n <input type=\"text\" id=\"cpfPaciente\" name=\"cpfPaciente\" placeholder=\"Somente n\u00fameros\">\r\n\r\n <label>Data de Nascimento<\/label>\r\n <input type=\"date\" id=\"nascimentoPaciente\" name=\"nascimentoPaciente\">\r\n\r\n <div id=\"responsavelContainer\" style=\"display:none;\">\r\n <label>Nome do Respons\u00e1vel<\/label>\r\n <input type=\"text\" id=\"responsavelNome\" name=\"responsavelNome\">\r\n <\/div>\r\n\r\n <label>Nome do Dentista<\/label>\r\n <input type=\"text\" id=\"nomeDentista\" name=\"nomeDentista\" required>\r\n\r\n <label>CRO do Dentista<\/label>\r\n <input type=\"text\" id=\"croDentista\" name=\"croDentista\" required>\r\n\r\n <label>Tipo de Atendimento<\/label>\r\n <div class=\"radio-group\">\r\n <label><input type=\"radio\" name=\"tipo\" value=\"Indica\u00e7\u00e3o Dentista\"> Indica\u00e7\u00e3o Dentista<\/label>\r\n <label><input type=\"radio\" name=\"tipo\" value=\"Particular\"> Particular<\/label>\r\n <label><input type=\"radio\" name=\"tipo\" value=\"Conv\u00eanio\" id=\"convenioRadio\"> Conv\u00eanio<\/label>\r\n <\/div>\r\n <div id=\"alertConvenio\" class=\"alert\" style=\"display:none;\">\r\n Aten\u00e7\u00e3o: \u00e9 necess\u00e1rio apresentar receitu\u00e1rio atualizado com carimbo e assinatura.\r\n <\/div>\r\n\r\n <label>Unidade<\/label>\r\n <select id=\"unidade\" name=\"unidade\" required>\r\n <option value=\"\">Selecione uma unidade<\/option>\r\n <option>Santana - Rua Ezequiel Freire, 566 Santana, SP<\/option>\r\n <option>Tatuap\u00e9 - Rua Tuiuti, 2396 Tatuap\u00e9, SP<\/option>\r\n <option>Vergueiro - Rua Tamandar\u00e9, 1044 Liberdade, SP<\/option>\r\n <option>Lapa - Rua Albion, 42 Lapa, SP<\/option>\r\n <option>Cidade Dutra - Rua N. Sra. da Nazar\u00e9, 119 Cidade Dutra, SP<\/option>\r\n <option>Santo Amaro - Av. Santo Amaro, 7217 Santo Amaro, SP<\/option>\r\n <option>Jardim \u00c2ngela - Est. do M Boi Mirim, 3636 Jd Imbe, SP<\/option>\r\n <\/select>\r\n\r\n <div class=\"divisor\"><\/div>\r\n\r\n <label>Exame a ser realizado<\/label>\r\n <select id=\"exame\" name=\"exame\" required>\r\n <option value=\"\">Selecione o exame<\/option>\r\n <option>Panor\u00e2mica<\/option>\r\n <option>Telerradiografia<\/option>\r\n <option>Radiografia Periapical Unit\u00e1rio<\/option>\r\n <option>Periapicais (Arcos Dent\u00e1rios)<\/option>\r\n <option>Radiografia Intrabucal (Jogo de Interproximais)<\/option>\r\n <option>Radiografia Oclusal<\/option>\r\n <option>Documenta\u00e7\u00e3o<\/option>\r\n <option>Tomografia<\/option>\r\n <option>Escaneamento<\/option>\r\n <\/select>\r\n\r\n <div id=\"campoArcadaPeriapical\" style=\"display:none;\">\r\n <label>Selecione a Arcada<\/label>\r\n <div class=\"radio-group\">\r\n <label><input type=\"radio\" name=\"arcadaPeriapical\" value=\"Superior\"> Arcada Superior<\/label>\r\n <label><input type=\"radio\" name=\"arcadaPeriapical\" value=\"Inferior\"> Arcada Inferior<\/label>\r\n <\/div>\r\n <div id=\"selecaoDentes\" style=\"display:none;\">\r\n <div class=\"arcada-titulo\">Selecione os dentes<\/div>\r\n <div class=\"arcada-titulo\">Arcada Superior<\/div>\r\n <div class=\"dentes-container\" id=\"arcadaSuperior\"><\/div>\r\n <div class=\"arcada-titulo\">Arcada Inferior<\/div>\r\n <div class=\"dentes-container\" id=\"arcadaInferior\"><\/div>\r\n <\/div>\r\n <\/div>\r\n\r\n <div id=\"campoTomografia\" style=\"display:none;\">\r\n <label>Informe a arcada e os dentes<\/label>\r\n <textarea id=\"tomografiaDetalhes\" name=\"tomografiaDetalhes\" rows=\"3\" placeholder=\"Ex.: Arcada Superior - dentes 16, 15...\"><\/textarea>\r\n <\/div>\r\n\r\n <div id=\"campoDocumentacao\" style=\"display:none;\">\r\n <label>Op\u00e7\u00e3o<\/label>\r\n <div class=\"radio-group\">\r\n <label><input type=\"radio\" name=\"docOption\" value=\"Fotos com oclusais\"> Fotos com oclusais<\/label>\r\n <label><input type=\"radio\" name=\"docOption\" value=\"Fotos sem oclusais\"> Fotos sem oclusais<\/label>\r\n <\/div>\r\n <\/div>\r\n\r\n <div id=\"campoEscaneamento\" style=\"display:none;\">\r\n <label>Tipo de Escaneamento<\/label>\r\n <div class=\"radio-group\">\r\n <label><input type=\"radio\" name=\"escaneamento\" value=\"Invisalign\" id=\"invisalignRadio\"> Invisalign<\/label>\r\n <label><input type=\"radio\" name=\"escaneamento\" value=\"STL\" id=\"stlRadio\"> STL<\/label>\r\n <\/div>\r\n <div id=\"campoInvisalign\" style=\"display:none;\">\r\n <label>Dr(a). Favor informar sua IDS por gentileza<\/label>\r\n <input type=\"text\" id=\"invisalignIDS\" name=\"invisalignIDS\" style=\"height:48px;\">\r\n <\/div>\r\n <\/div>\r\n\r\n <div class=\"alert\">\r\n Pedimos agendamento de todos os exames, exceto Panor\u00e2mica.\r\n <\/div>\r\n\r\n <div class=\"divisor\"><\/div>\r\n\r\n <p><strong>Central de Atendimento ao Paciente:<\/strong><br>\r\n (11) 3279-7500<br>\r\n WhatsApp (11) 95002-0446<\/p>\r\n\r\n <button type=\"submit\">ENVIAR<\/button>\r\n<\/form>\r\n\r\n<script>\r\n\/* ===== Fun\u00e7\u00f5es din\u00e2micas originais mantidas ===== *\/\r\nconst convenioRadio = document.getElementById('convenioRadio');\r\nconst alertConvenio = document.getElementById('alertConvenio');\r\nconst exame = document.getElementById('exame');\r\nconst campoArcadaPeriapical = document.getElementById('campoArcadaPeriapical');\r\nconst selecaoDentes = document.getElementById('selecaoDentes');\r\nconst campoTomografia = document.getElementById('campoTomografia');\r\nconst campoDocumentacao = document.getElementById('campoDocumentacao');\r\nconst campoEscaneamento = document.getElementById('campoEscaneamento');\r\nconst campoInvisalign = document.getElementById('campoInvisalign');\r\nconst nascimentoInput = document.getElementById('nascimentoPaciente');\r\nconst responsavelContainer = document.getElementById('responsavelContainer');\r\n\r\ndocument.querySelectorAll('input[name=\"tipo\"]').forEach(radio => {\r\n radio.addEventListener('change', () => { alertConvenio.style.display = convenioRadio.checked ? 'block' : 'none'; });\r\n});\r\n\r\nexame.addEventListener('change', () => {\r\n const valor = exame.value;\r\n campoArcadaPeriapical.style.display = valor === 'Radiografia Periapical Unit\u00e1rio' ? 'block' : 'none';\r\n campoTomografia.style.display = valor === 'Tomografia' ? 'block' : 'none';\r\n campoDocumentacao.style.display = valor === 'Documenta\u00e7\u00e3o' ? 'block' : 'none';\r\n campoEscaneamento.style.display = valor === 'Escaneamento' ? 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'block' : 'none';\r\n});\r\n\r\nconst arcadaSuperior = [18,17,16,15,14,13,12,11,21,22,23,24,25,26,27,28];\r\nconst arcadaInferior = [48,47,46,45,44,43,42,41,31,32,33,34,35,36,37,38];\r\nfunction gerarCheckboxes(containerId, dentes) {\r\n const c = document.getElementById(containerId);\r\n dentes.forEach(d => c.insertAdjacentHTML('beforeend', `<div class=\"dente\"><label><input type=\"checkbox\" name=\"${containerId}\" value=\"${d}\"> ${d}<\/label><\/div>`));\r\n}\r\ngerarCheckboxes('arcadaSuperior', arcadaSuperior);\r\ngerarCheckboxes('arcadaInferior', arcadaInferior);\r\n<\/script>\r\n\r\n<\/body>\r\n<\/html>\r\n\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<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>REQUISI\u00c7\u00c3O ONLINE Requisi\u00e7\u00e3o Online – Radi Radiologia Requisi\u00e7\u00e3o Online – Radi Radiologia Nome do Paciente Telefone do Paciente CPF do […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_canvas","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-3385","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/radiradiologia.com.br\/index.php\/wp-json\/wp\/v2\/pages\/3385","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/radiradiologia.com.br\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/radiradiologia.com.br\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/radiradiologia.com.br\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/radiradiologia.com.br\/index.php\/wp-json\/wp\/v2\/comments?post=3385"}],"version-history":[{"count":76,"href":"https:\/\/radiradiologia.com.br\/index.php\/wp-json\/wp\/v2\/pages\/3385\/revisions"}],"predecessor-version":[{"id":4284,"href":"https:\/\/radiradiologia.com.br\/index.php\/wp-json\/wp\/v2\/pages\/3385\/revisions\/4284"}],"wp:attachment":[{"href":"https:\/\/radiradiologia.com.br\/index.php\/wp-json\/wp\/v2\/media?parent=3385"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}