{"id":2736,"date":"2021-03-16T11:35:57","date_gmt":"2021-03-16T09:35:57","guid":{"rendered":"http:\/\/www.viamedsalud.com\/hospital-bahia-de-cadiz\/?page_id=2736"},"modified":"2021-08-27T13:27:58","modified_gmt":"2021-08-27T11:27:58","slug":"formulario-de-baja","status":"publish","type":"page","link":"https:\/\/www.viamedsalud.com\/hospital-bahia-de-cadiz\/politica-de-privacidad\/formulario-de-baja\/","title":{"rendered":"Formulario de baja"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1248px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f2732-o1\" lang=\"es-ES\" dir=\"ltr\" data-wpcf7-id=\"2732\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/hospital-bahia-de-cadiz\/wp-json\/wp\/v2\/pages\/2736#wpcf7-f2732-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulario de contacto\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"2732\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"es_ES\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f2732-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/><input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:2732,&quot;conditions&quot;:[{&quot;then_field&quot;:&quot;group-792&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;selectcontacto&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Email&quot;}]},{&quot;then_field&quot;:&quot;telefono&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;selectcontacto&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Tel\\u00e9fono&quot;}]},{&quot;then_field&quot;:&quot;-1&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;-1&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;&quot;}]}],&quot;settings&quot;:{&quot;animation&quot;:&quot;yes&quot;,&quot;animation_intime&quot;:200,&quot;animation_outtime&quot;:200,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:false,&quot;notice_dismissed_rollback-cf7-5.7.6&quot;:true}}\" \/><input type=\"hidden\" name=\"_wpcf7dtx_version\" value=\"5.0.5\" \/>\n<\/fieldset>\n<div id=\"hide\">\n\t<h3 style=\"color: #1d537a;\">Rellene este formulario para dar de baja sus datos\n\t<\/h3>\n\t<p> Por favor facilite en este formulario los mismos datos que facilit\u00f3 al convertirse en paciente del hospital.\n\t<\/p>\n\t<div class=\"formMedio\">\n\t\t<p><label for=\"Hospital_Viamed\">Hospital Viamed de referencia *<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"cod_subcen\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"cod_subcen\"><option value=\"\">&#8212;Por favor, elige una opci\u00f3n&#8212;<\/option><option value=\"Hospital Viamed Los Manzanos\">Hospital Viamed Los Manzanos<\/option><option value=\"Hospital Viamed Santa \u00c1ngela de la Cruz\">Hospital Viamed Santa \u00c1ngela de la Cruz<\/option><option value=\"Hospital Viamed Bah\u00eda de C\u00e1diz\">Hospital Viamed Bah\u00eda de C\u00e1diz<\/option><option value=\"Hospital Viamed Santiago\">Hospital Viamed Santiago<\/option><option value=\"Hospital Viamed Montecanal\">Hospital Viamed Montecanal<\/option><option value=\"Hospital Viamed Monegal\">Hospital Viamed Monegal<\/option><option value=\"Hospital Viamed Novo\">Hospital Viamed Novo<\/option><option value=\"Hospital Viamed San Jos\u00e9\">Hospital Viamed San Jos\u00e9<\/option><option value=\"Hospital Viamed Nuestra Se\u00f1ora Virgen del Carmen\">Hospital Viamed Nuestra Se\u00f1ora Virgen del Carmen<\/option><option value=\"Residencia Viamed Los Jazmines\">Residencia Viamed Los Jazmines<\/option><option value=\"Hospital Viamed Santa Elena\">Hospital Viamed Santa Elena<\/option><option value=\"Hospital Viamed Fuensanta\">Hospital Viamed Fuensanta<\/option><option value=\"Hospital Viamed Alxen\">Hospital Viamed Alxen<\/option><option value=\"Hospital Viamed F\u00e1tima\">Hospital Viamed F\u00e1tima<\/option><\/select><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"formMedio Siguiente hidden\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"tu@email.com\" value=\"\" type=\"email\" name=\"email\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"formMedio\">\n\t\t<p><label for=\"Nombre\">Apellido *<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"nombre\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Primer apellido en may\u00fasculas\" value=\"\" type=\"text\" name=\"nombre\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"formMedio Siguiente\">\n\t\t<p><label for=\"Fecha_de_nacimiento\">Fecha de nacimiento *<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"fecha-nacimiento\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"fecha-nacimiento\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"formEntero\">\n\t\t<p>Necesitamos que cumplimente el email o tel\u00e9fono por el que nos hemos puesto en contacto con usted\n\t\t<\/p>\n\t<\/div>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"selectcontacto\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"selectcontacto\"><option value=\"\">Seleccione una de las opciones<\/option><option value=\"Email\">Email<\/option><option value=\"Tel\u00e9fono\">Tel\u00e9fono<\/option><\/select><\/span>\n\t<\/p>\n\t<div data-id=\"group-792\" data-orig_data_id=\"group-792\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t\t<div class=\"formEntero\">\n\t\t\t<p><label for=\"Email\">Email *<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"tu@email.com\" value=\"\" type=\"email\" name=\"email\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div data-id=\"telefono\" data-orig_data_id=\"telefono\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t\t<div class=\"formEntero Siguiente\">\n\t\t\t<p><label for=\"T\u00e9lefono\">T\u00e9lefono *<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"telefono\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"666777888\" value=\"\" type=\"text\" name=\"telefono\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"formEntero\">\n\t\t<p>\u00bfA qu\u00e9 servicio quiere darse de baja?* <span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-873\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-873[]\" value=\"Publicidad\" \/><span class=\"wpcf7-list-item-label\">Publicidad<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-873[]\" value=\"Citas\" \/><span class=\"wpcf7-list-item-label\">Citas<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-873[]\" value=\"Encuestas\" \/><span class=\"wpcf7-list-item-label\">Encuestas<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<p><b>Protecci\u00f3n de datos<\/b>: Sus datos ser\u00e1n tratados por Centros M\u00e9dicos Asistenciales de Medicina Integral S.L para tramitar la solicitud de ejercicio de derecho de oposici\u00f3n. Podr\u00e1 acceder, rectificar y suprimir los datos, as\u00ed como otros derechos, como se explica en la <a href=\"https:\/\/www.viamedsalud.com\/hospital-bahia-de-cadiz\/politica-de-privacidad\/\">Pol\u00edtica de privacidad<\/a>.\n\t<\/p>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"acceptance-92\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"acceptance-92\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">He le\u00eddo y acepto la <a href=\"https:\/\/www.viamedsalud.com\/hospital-bahia-de-cadiz\/politica-de-privacidad\/\">Pol\u00edtica de privacidad<\/a>.<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"ENVIAR\" \/>\n\t<\/p>\n<\/div><input type='hidden' class='wpcf7-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/><div class=\"fusion-alert alert custom alert-custom fusion-alert-center wpcf7-response-output awb-alert-native-link-color alert-dismissable awb-alert-close-boxed\" style=\"--awb-border-size:1px;--awb-border-top-left-radius:0px;--awb-border-top-right-radius:0px;--awb-border-bottom-left-radius:0px;--awb-border-bottom-right-radius:0px;\" role=\"alert\"><div class=\"fusion-alert-content-wrapper\"><span class=\"fusion-alert-content\"><\/span><\/div><button type=\"button\" class=\"close toggle-alert\" data-dismiss=\"alert\" aria-label=\"Close\">&times;<\/button><\/div>\n<\/form>\n<\/div>\n<script>\ndocument.addEventListener( 'wpcf7mailsent', function( event ) {\n\t$(\"#hide\").hide(0);\n}, false );\n\n<\/script><\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":3,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_joinchat":[],"footnotes":""},"class_list":["post-2736","page","type-page","status-publish","hentry"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.viamedsalud.com\/hospital-bahia-de-cadiz\/wp-json\/wp\/v2\/pages\/2736","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.viamedsalud.com\/hospital-bahia-de-cadiz\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.viamedsalud.com\/hospital-bahia-de-cadiz\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.viamedsalud.com\/hospital-bahia-de-cadiz\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.viamedsalud.com\/hospital-bahia-de-cadiz\/wp-json\/wp\/v2\/comments?post=2736"}],"version-history":[{"count":0,"href":"https:\/\/www.viamedsalud.com\/hospital-bahia-de-cadiz\/wp-json\/wp\/v2\/pages\/2736\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/www.viamedsalud.com\/hospital-bahia-de-cadiz\/wp-json\/wp\/v2\/pages\/3"}],"wp:attachment":[{"href":"https:\/\/www.viamedsalud.com\/hospital-bahia-de-cadiz\/wp-json\/wp\/v2\/media?parent=2736"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}