{"id":1556,"date":"2024-03-03T07:58:46","date_gmt":"2024-03-03T07:58:46","guid":{"rendered":"https:\/\/www.ffbogotafc.online\/?page_id=1556"},"modified":"2025-01-16T00:38:07","modified_gmt":"2025-01-16T00:38:07","slug":"ff-bogota-fc-ficha-medica-2024","status":"publish","type":"page","link":"https:\/\/www.ffbogotafc.online\/index.php\/ff-bogota-fc-ficha-medica-2024\/","title":{"rendered":"FICHA M\u00c9DICA 2025"},"content":{"rendered":"\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"642\" height=\"658\" src=\"https:\/\/www.ffbogotafc.online\/wp-content\/uploads\/2024\/03\/Screenshot_20240303-0252262.png\" alt=\"\" class=\"wp-image-1557\" srcset=\"https:\/\/www.ffbogotafc.online\/wp-content\/uploads\/2024\/03\/Screenshot_20240303-0252262.png 642w, https:\/\/www.ffbogotafc.online\/wp-content\/uploads\/2024\/03\/Screenshot_20240303-0252262-293x300.png 293w, https:\/\/www.ffbogotafc.online\/wp-content\/uploads\/2024\/03\/Screenshot_20240303-0252262-59x60.png 59w\" sizes=\"auto, (max-width: 642px) 100vw, 642px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div class=\"forminator-guttenberg\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-1561 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-1561\" data-uid=\"69f269ab38c58\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-1561\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-1561 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"1561\"\n\t\t\t\tenctype=\"multipart\/form-data\" data-color-option=\"default\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"69f269ab38c58\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"section-1\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Datos del jugador<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_69f269ab38c58\" id=\"forminator-field-name-1_69f269ab38c58-label\" class=\"forminator-label\">Nombre <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"\" id=\"forminator-field-name-1_69f269ab38c58\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-2_69f269ab38c58\" id=\"forminator-field-name-2_69f269ab38c58-label\" class=\"forminator-label\">APELLIDOS <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2\" value=\"\" placeholder=\"\" id=\"forminator-field-name-2_69f269ab38c58\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-4 \"><label for=\"forminator-field-date-1\" id=\"forminator-field-date-1-label\" class=\"forminator-label\">Fecha de nacimiento <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-date-input\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-1-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-month_69f269ab38c58\" class=\"forminator-label\">Mes <span class=\"forminator-required\">*<\/span><\/label><input type=\"number\" min=\"1\" max=\"12\" name=\"date-1-month\" value=\"\" placeholder=\"Ejemplo: 01\" id=\"forminator-field-date-1-month_69f269ab38c58\" class=\"forminator-input\" data-field=\"month\" data-format=\"mm\/dd\/yy\" data-parent=\"date-1\" \/><\/div><\/div><div id=\"date-1-day\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-day_69f269ab38c58\" class=\"forminator-label\">D\u00eda <span class=\"forminator-required\">*<\/span><\/label><input type=\"number\" min=\"1\" max=\"31\" name=\"date-1-day\" value=\"\" placeholder=\"Ejemplo: 01\" id=\"forminator-field-date-1-day_69f269ab38c58\" class=\"forminator-input\" data-field=\"day\" data-format=\"mm\/dd\/yy\" data-parent=\"date-1\" \/><\/div><\/div><div id=\"date-1-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-year_69f269ab38c58\" class=\"forminator-label\">A\u00f1o <span class=\"forminator-required\">*<\/span><\/label><input type=\"number\" min=\"1\" name=\"date-1-year\" placeholder=\"Ejemplo: 2000\" id=\"forminator-field-date-1-year_69f269ab38c58\" class=\"forminator-input\" data-field=\"year\" value=\"\" data-format=\"mm\/dd\/yy\" data-parent=\"date-1\" \/><\/div><\/div><\/div><\/div><\/div><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-4 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-69f269ab38c58-label\"><span id=\"forminator-radiogroup-radio-1-69f269ab38c58-label\" class=\"forminator-label\">Documento de identidad <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-69f269ab38c58\" class=\"forminator-radio\" title=\"Registro civil\"><input type=\"radio\" name=\"radio-1\" value=\"one\" id=\"forminator-field-radio-1-1-69f269ab38c58\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Registro civil<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-69f269ab38c58\" class=\"forminator-radio\" title=\"Tarjeta de identidad\"><input type=\"radio\" name=\"radio-1\" value=\"two\" id=\"forminator-field-radio-1-2-69f269ab38c58\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Tarjeta de identidad<\/span><\/label><label id=\"forminator-field-radio-1-label-3\" for=\"forminator-field-radio-1-3-69f269ab38c58\" class=\"forminator-radio\" title=\"C\u00e9dula de extranjer\u00eda\"><input type=\"radio\" name=\"radio-1\" value=\"C\u00e9dula-de-extranjer\u00eda\" id=\"forminator-field-radio-1-3-69f269ab38c58\" aria-labelledby=\"forminator-field-radio-1-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">C\u00e9dula de extranjer\u00eda<\/span><\/label><label id=\"forminator-field-radio-1-label-4\" for=\"forminator-field-radio-1-4-69f269ab38c58\" class=\"forminator-radio\" title=\"Pasaporte\"><input type=\"radio\" name=\"radio-1\" value=\"Pasaporte\" id=\"forminator-field-radio-1-4-69f269ab38c58\" aria-labelledby=\"forminator-field-radio-1-label-4\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Pasaporte<\/span><\/label><\/div><\/div><div id=\"number-1\" class=\"forminator-field-number forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-1_69f269ab38c58\" id=\"forminator-field-number-1_69f269ab38c58-label\" class=\"forminator-label\">N\u00famero del documento de identidad <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-1\" value=\"\" placeholder=\"\" id=\"forminator-field-number-1_69f269ab38c58\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"9999999999999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_69f269ab38c58\" id=\"forminator-field-text-1_69f269ab38c58-label\" class=\"forminator-label\">EPS <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_69f269ab38c58\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"upload-1\" class=\"forminator-field-upload forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-1_69f269ab38c58\" id=\"forminator-field-upload-1_69f269ab38c58-label\" class=\"forminator-label\">Adjuntar archivo en PDF de certificado de afiliaci\u00f3n de EPS <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-file-upload \" data-element=\"upload-1_69f269ab38c58\"><input type=\"file\" name=\"upload-1\" id=\"forminator-field-upload-1_69f269ab38c58\" class=\"forminator-input-file-required do-validate\" accept=\".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.webp,.ico,.heic,.asf,.asx,.wmv,.wmx,.wm,.avi,.divx,.flv,.mov,.qt,.mpeg,.mpg,.mpe,.mp4,.m4v,.ogv,.webm,.mkv,.3gp,.3gpp,.3g2,.3gp2,.txt,.asc,.c,.cc,.h,.srt,.csv,.tsv,.ics,.rtx,.vtt,.mp3,.m4a,.m4b,.aac,.ra,.ram,.wav,.ogg,.oga,.flac,.mid,.midi,.wma,.wax,.mka,.rtf,.pdf,.class,.tar,.zip,.gz,.gzip,.7z,.psd,.xcf,.doc,.pot,.pps,.ppt,.wri,.xla,.xls,.xlt,.xlw,.mdb,.mpp,.docx,.docm,.dotx,.dotm,.xlsx,.xlsm,.xlsb,.xltx,.xltm,.xlam,.pptx,.pptm,.ppsx,.ppsm,.potx,.potm,.ppam,.sldx,.sldm,.onetoc,.onetoc2,.onetmp,.onepkg,.oxps,.xps,.odt,.odp,.ods,.odg,.odc,.odb,.odf,.wp,.wpd,.key,.numbers,.pages\" tabindex=\"-1\"><button id=\"forminator-field-upload-1_69f269ab38c58_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-1_69f269ab38c58\">Elegir archivo<\/button><span data-empty-text=\"Ning\u00fan archivo seleccionado\">Ning\u00fan archivo seleccionado<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Eliminar el archivo subido<\/span><\/button><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-4\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-1561__field--select-4_69f269ab38c58\" id=\"forminator-form-1561__field--select-4_69f269ab38c58-label\" class=\"forminator-label\">Plan de vacunas completo <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-1561__field--select-4_69f269ab38c58\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-4\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Tiene plan de vacunas completo\" data-search=\"false\" data-search-placeholder=\"Tiene plan de vacunas completo\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1561__field--select-4_69f269ab38c58-label\"><option value=\"\"  >Tiene plan de vacunas completo<\/option><option value=\"one\"  data-calculation=\"0\">SI<\/option><option value=\"two\"  data-calculation=\"0\">NO<\/option><\/select><\/div><\/div><div id=\"upload-2\" class=\"forminator-field-upload forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-2_69f269ab38c58\" id=\"forminator-field-upload-2_69f269ab38c58-label\" class=\"forminator-label\">Adjuntar archivo en PDF de carnet de vacunas <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-file-upload \" data-element=\"upload-2_69f269ab38c58\"><input type=\"file\" name=\"upload-2\" id=\"forminator-field-upload-2_69f269ab38c58\" class=\"forminator-input-file-required do-validate\" accept=\".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.webp,.ico,.heic,.asf,.asx,.wmv,.wmx,.wm,.avi,.divx,.flv,.mov,.qt,.mpeg,.mpg,.mpe,.mp4,.m4v,.ogv,.webm,.mkv,.3gp,.3gpp,.3g2,.3gp2,.txt,.asc,.c,.cc,.h,.srt,.csv,.tsv,.ics,.rtx,.vtt,.mp3,.m4a,.m4b,.aac,.ra,.ram,.wav,.ogg,.oga,.flac,.mid,.midi,.wma,.wax,.mka,.rtf,.pdf,.class,.tar,.zip,.gz,.gzip,.7z,.psd,.xcf,.doc,.pot,.pps,.ppt,.wri,.xla,.xls,.xlt,.xlw,.mdb,.mpp,.docx,.docm,.dotx,.dotm,.xlsx,.xlsm,.xlsb,.xltx,.xltm,.xlam,.pptx,.pptm,.ppsx,.ppsm,.potx,.potm,.ppam,.sldx,.sldm,.onetoc,.onetoc2,.onetmp,.onepkg,.oxps,.xps,.odt,.odp,.ods,.odg,.odc,.odb,.odf,.wp,.wpd,.key,.numbers,.pages\" tabindex=\"-1\"><button id=\"forminator-field-upload-2_69f269ab38c58_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-2_69f269ab38c58\">Elegir archivo<\/button><span data-empty-text=\"Ning\u00fan archivo seleccionado\">Ning\u00fan archivo seleccionado<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Eliminar el archivo subido<\/span><\/button><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-2\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Antecedentes m\u00e9dicos del jugador<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-1561__field--select-1_69f269ab38c58\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-label\" class=\"forminator-label\">Seleccionar<\/label><div class=\"forminator-multiselect\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-label\"><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-1-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-1\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"one\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-1\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-1-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Patolog\u00edas card\u00edacas<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-2-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-2\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"two\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-2\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-2-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Presi\u00f3n arterial elevada<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-3-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-3\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"Obesidad\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-3\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-3-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Obesidad<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-4-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-4\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"Asma-bronquial\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-4\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-4-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Asma bronquial<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-5-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-5\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"P\u00e9rdida-de-conciencia\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-5\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-5-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>P\u00e9rdida de conciencia<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-6-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-6\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"Convulsiones\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-6\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-6-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Convulsiones<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-7-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-7\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"Traumatismo-de-cr\u00e1neo\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-7\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-7-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Traumatismo de cr\u00e1neo<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-8-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-8\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"Diabetes\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-8\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-8-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Diabetes<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-9-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-9\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"Alteraciones-sangu\u00edneas\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-9\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-9-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Alteraciones sangu\u00edneas<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-10-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-10\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"Afecciones-auditivas\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-10\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-10-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Afecciones auditivas<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-11-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-11\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"Fracturas,-luxaciones,-lesiones-ligamentarias\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-11\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-11-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Fracturas, luxaciones, lesiones ligamentarias<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-12-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-12\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"Otros-problemas-\u00f3seos-o-de-articulaciones\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-12\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-12-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Otros problemas \u00f3seos o de articulaciones<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-13-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-13\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"Cirug\u00edas\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-13\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-13-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Cirug\u00edas<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-14-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-14\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"Internaciones\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-14\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-14-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Internaciones<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-15-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-15\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"Enfermedades-infecciosas-en-los-2-\u00faltimos-meses\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-15\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-15-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Enfermedades infecciosas en los 2 \u00faltimos meses<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-16-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-16\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"Ausencia-o-disfunci\u00f3n-org\u00e1nica\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-16\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-16-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Ausencia o disfunci\u00f3n org\u00e1nica<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-17-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-17\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"Alergia\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-17\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-17-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Alergia<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-18-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-18\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"Alteraciones-en-la-voz\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-18\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-18-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Alteraciones en la voz<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-19-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-19\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"Tos-cr\u00f3nica\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-19\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-19-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Tos cr\u00f3nica<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-20-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-20\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"Medicamento-habitual\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-20\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-20-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Medicamento habitual<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-21-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-21\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"Alergia-a-alg\u00fan-medicamento\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-21\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-21-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Alergia a alg\u00fan medicamento<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-22-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-22\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"Consumo-de-vitaminas\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-22\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-22-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Consumo de vitaminas<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-23-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-23\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"Trastornos-de-piel\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-23\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-23-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Trastornos de piel<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-24-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-24\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"Uso-de-anteojos\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-24\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-24-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Uso de anteojos<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-25-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-25\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"Trastornos-odontol\u00f3gico\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-25\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-25-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Trastornos odontol\u00f3gico<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-26-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-26\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"Covid-19\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-26\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-26-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Covid-19<\/label><label id=\"forminator-form-1561__field--select-1_69f269ab38c58-27-label\" for=\"forminator-form-1561__field--select-1_69f269ab38c58-27\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-1[]\" value=\"Ninguna-de-las-anteriores\" id=\"forminator-form-1561__field--select-1_69f269ab38c58-27\" aria-labelledby=\"forminator-form-1561__field--select-1_69f269ab38c58-27-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Ninguna de las anteriores<\/label><input type='hidden' name='select-1-multiselect-default-values' class='multiselect-default-values' value='' \/><\/div><\/div><\/div><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_69f269ab38c58\" id=\"forminator-field-textarea-1_69f269ab38c58-label\" class=\"forminator-label\">En caso afirmativo en una o varias opciones especificar<\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_69f269ab38c58\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-5\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Covid-19<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-4 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-69f269ab38c58-label\"><span id=\"forminator-radiogroup-radio-2-69f269ab38c58-label\" class=\"forminator-label\">El jugador tuvo COVID-19? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-69f269ab38c58\" class=\"forminator-radio\" title=\"SI\"><input type=\"radio\" name=\"radio-2\" value=\"one\" id=\"forminator-field-radio-2-1-69f269ab38c58\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">SI<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-69f269ab38c58\" class=\"forminator-radio\" title=\"NO\"><input type=\"radio\" name=\"radio-2\" value=\"two\" id=\"forminator-field-radio-2-2-69f269ab38c58\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">NO<\/span><\/label><\/div><\/div><div id=\"radio-3\" class=\"forminator-field-radio forminator-col forminator-col-4 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-3-69f269ab38c58-label\"><span id=\"forminator-radiogroup-radio-3-69f269ab38c58-label\" class=\"forminator-label\">Vacunaci\u00f3n de COVID-19 <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-3-label-1\" for=\"forminator-field-radio-3-1-69f269ab38c58\" class=\"forminator-radio\" title=\"SI\"><input type=\"radio\" name=\"radio-3\" value=\"one\" id=\"forminator-field-radio-3-1-69f269ab38c58\" aria-labelledby=\"forminator-field-radio-3-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">SI<\/span><\/label><label id=\"forminator-field-radio-3-label-2\" for=\"forminator-field-radio-3-2-69f269ab38c58\" class=\"forminator-radio\" title=\"NO\"><input type=\"radio\" name=\"radio-3\" value=\"two\" id=\"forminator-field-radio-3-2-69f269ab38c58\" aria-labelledby=\"forminator-field-radio-3-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">NO<\/span><\/label><\/div><\/div><div id=\"number-2\" class=\"forminator-field-number forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-2_69f269ab38c58\" id=\"forminator-field-number-2_69f269ab38c58-label\" class=\"forminator-label\">N\u00famero de dosis <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-2\" value=\"\" placeholder=\"\" id=\"forminator-field-number-2_69f269ab38c58\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"3\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-4\" class=\"forminator-field-radio forminator-col forminator-col-6 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-4-69f269ab38c58-label\"><span id=\"forminator-radiogroup-radio-4-69f269ab38c58-label\" class=\"forminator-label\">Secuelas <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-4-label-1\" for=\"forminator-field-radio-4-1-69f269ab38c58\" class=\"forminator-radio\" title=\"SI\"><input type=\"radio\" name=\"radio-4\" value=\"one\" id=\"forminator-field-radio-4-1-69f269ab38c58\" aria-labelledby=\"forminator-field-radio-4-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">SI<\/span><\/label><label id=\"forminator-field-radio-4-label-2\" for=\"forminator-field-radio-4-2-69f269ab38c58\" class=\"forminator-radio\" title=\"NO\"><input type=\"radio\" name=\"radio-4\" value=\"two\" id=\"forminator-field-radio-4-2-69f269ab38c58\" aria-labelledby=\"forminator-field-radio-4-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">NO<\/span><\/label><\/div><\/div><div id=\"radio-5\" class=\"forminator-field-radio forminator-col forminator-col-6 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-5-69f269ab38c58-label\"><span id=\"forminator-radiogroup-radio-5-69f269ab38c58-label\" class=\"forminator-label\">Limitaciones para realizar ejercicio f\u00edsico <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-5-label-1\" for=\"forminator-field-radio-5-1-69f269ab38c58\" class=\"forminator-radio\" title=\"SI\"><input type=\"radio\" name=\"radio-5\" value=\"one\" id=\"forminator-field-radio-5-1-69f269ab38c58\" aria-labelledby=\"forminator-field-radio-5-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">SI<\/span><\/label><label id=\"forminator-field-radio-5-label-2\" for=\"forminator-field-radio-5-2-69f269ab38c58\" class=\"forminator-radio\" title=\"NO\"><input type=\"radio\" name=\"radio-5\" value=\"two\" id=\"forminator-field-radio-5-2-69f269ab38c58\" aria-labelledby=\"forminator-field-radio-5-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">NO<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-4\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Al realizar actividad f\u00edsica ha sufrido ...<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-3\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-1561__field--select-3_69f269ab38c58\" id=\"forminator-form-1561__field--select-3_69f269ab38c58-label\" class=\"forminator-label\">Seleccionar<\/label><select  id=\"forminator-form-1561__field--select-3_69f269ab38c58\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-3\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Antes durante o despu\u00e9s de la realizaci\u00f3n de ejercicio f\u00edsico, en alguna oportunidad, tu hijo ha padecido:\" data-search=\"false\" data-search-placeholder=\"Antes durante o despu\u00e9s de la realizaci\u00f3n de ejercicio f\u00edsico, en alguna oportunidad, tu hijo ha padecido:\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1561__field--select-3_69f269ab38c58-label\"><option value=\"\"  >Antes durante o despu\u00e9s de la realizaci\u00f3n de ejercicio f\u00edsico, en alguna oportunidad, tu hijo ha padecido:<\/option><option value=\"one\"  data-calculation=\"0\">Mareos<\/option><option value=\"two\"  data-calculation=\"0\">Desmayos<\/option><option value=\"Dolor-fuerte-de-pecho\"  data-calculation=\"0\">Dolor fuerte de pecho<\/option><option value=\"M\u00e1s-cansancio-que-sus-compa\u00f1eros-as\"  data-calculation=\"0\">M\u00e1s cansancio que sus compa\u00f1eros\/as<\/option><option value=\"Palpitaciones\"  data-calculation=\"0\">Palpitaciones<\/option><option value=\"Dificultad-para-respirar\"  data-calculation=\"0\">Dificultad para respirar<\/option><option value=\"Ninguna-de-las-anteriores\"  data-calculation=\"0\">Ninguna de las anteriores<\/option><\/select><\/div><\/div><div id=\"textarea-3\" class=\"forminator-field-textarea forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_69f269ab38c58\" id=\"forminator-field-textarea-3_69f269ab38c58-label\" class=\"forminator-label\">Otros (especificar):<\/label><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_69f269ab38c58\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-4\" class=\"forminator-field-textarea forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-4_69f269ab38c58\" id=\"forminator-field-textarea-4_69f269ab38c58-label\" class=\"forminator-label\">En caso de respuesta afirmativa a limitaciones f\u00edsicas o secuelas a raiz de padecer COVID-19 , especificar.<\/label><textarea name=\"textarea-4\" placeholder=\"\" id=\"forminator-field-textarea-4_69f269ab38c58\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><div id=\"upload-4\" class=\"forminator-field-upload forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-4_69f269ab38c58\" id=\"forminator-field-upload-4_69f269ab38c58-label\" class=\"forminator-label\">Adjuntar archivo en PDF del carnet de vacunas COVID-19 <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-file-upload \" data-element=\"upload-4_69f269ab38c58\"><input type=\"file\" name=\"upload-4\" id=\"forminator-field-upload-4_69f269ab38c58\" class=\"forminator-input-file-required do-validate\" accept=\".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.webp,.ico,.heic,.asf,.asx,.wmv,.wmx,.wm,.avi,.divx,.flv,.mov,.qt,.mpeg,.mpg,.mpe,.mp4,.m4v,.ogv,.webm,.mkv,.3gp,.3gpp,.3g2,.3gp2,.txt,.asc,.c,.cc,.h,.srt,.csv,.tsv,.ics,.rtx,.vtt,.mp3,.m4a,.m4b,.aac,.ra,.ram,.wav,.ogg,.oga,.flac,.mid,.midi,.wma,.wax,.mka,.rtf,.pdf,.class,.tar,.zip,.gz,.gzip,.7z,.psd,.xcf,.doc,.pot,.pps,.ppt,.wri,.xla,.xls,.xlt,.xlw,.mdb,.mpp,.docx,.docm,.dotx,.dotm,.xlsx,.xlsm,.xlsb,.xltx,.xltm,.xlam,.pptx,.pptm,.ppsx,.ppsm,.potx,.potm,.ppam,.sldx,.sldm,.onetoc,.onetoc2,.onetmp,.onepkg,.oxps,.xps,.odt,.odp,.ods,.odg,.odc,.odb,.odf,.wp,.wpd,.key,.numbers,.pages\" tabindex=\"-1\"><button id=\"forminator-field-upload-4_69f269ab38c58_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-4_69f269ab38c58\">Elegir archivo<\/button><span data-empty-text=\"Ning\u00fan archivo seleccionado\">Ning\u00fan archivo seleccionado<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Eliminar el archivo subido<\/span><\/button><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-3\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Antecedentes familiares<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-1561__field--select-2_69f269ab38c58\" id=\"forminator-form-1561__field--select-2_69f269ab38c58-label\" class=\"forminator-label\">Seleccionar<\/label><div class=\"forminator-multiselect\" aria-labelledby=\"forminator-form-1561__field--select-2_69f269ab38c58-label\"><label id=\"forminator-form-1561__field--select-2_69f269ab38c58-1-label\" for=\"forminator-form-1561__field--select-2_69f269ab38c58-1\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-2[]\" value=\"one\" id=\"forminator-form-1561__field--select-2_69f269ab38c58-1\" aria-labelledby=\"forminator-form-1561__field--select-2_69f269ab38c58-1-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Problemas card\u00edacos<\/label><label id=\"forminator-form-1561__field--select-2_69f269ab38c58-2-label\" for=\"forminator-form-1561__field--select-2_69f269ab38c58-2\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-2[]\" value=\"two\" id=\"forminator-form-1561__field--select-2_69f269ab38c58-2\" aria-labelledby=\"forminator-form-1561__field--select-2_69f269ab38c58-2-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Obesidad<\/label><label id=\"forminator-form-1561__field--select-2_69f269ab38c58-3-label\" for=\"forminator-form-1561__field--select-2_69f269ab38c58-3\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-2[]\" value=\"Muerte-s\u00fabita-de-familiar-directo-menor-a-50-a\u00f1os\" id=\"forminator-form-1561__field--select-2_69f269ab38c58-3\" aria-labelledby=\"forminator-form-1561__field--select-2_69f269ab38c58-3-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Muerte s\u00fabita de familiar directo menor a 50 a\u00f1os<\/label><label id=\"forminator-form-1561__field--select-2_69f269ab38c58-4-label\" for=\"forminator-form-1561__field--select-2_69f269ab38c58-4\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-2[]\" value=\"Otras-patolog\u00edas\" id=\"forminator-form-1561__field--select-2_69f269ab38c58-4\" aria-labelledby=\"forminator-form-1561__field--select-2_69f269ab38c58-4-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Otras patolog\u00edas<\/label><label id=\"forminator-form-1561__field--select-2_69f269ab38c58-5-label\" for=\"forminator-form-1561__field--select-2_69f269ab38c58-5\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-2[]\" value=\"Diabetes\" id=\"forminator-form-1561__field--select-2_69f269ab38c58-5\" aria-labelledby=\"forminator-form-1561__field--select-2_69f269ab38c58-5-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Diabetes<\/label><label id=\"forminator-form-1561__field--select-2_69f269ab38c58-6-label\" for=\"forminator-form-1561__field--select-2_69f269ab38c58-6\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-2[]\" value=\"Colesterol-elevado\" id=\"forminator-form-1561__field--select-2_69f269ab38c58-6\" aria-labelledby=\"forminator-form-1561__field--select-2_69f269ab38c58-6-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Colesterol elevado<\/label><label id=\"forminator-form-1561__field--select-2_69f269ab38c58-7-label\" for=\"forminator-form-1561__field--select-2_69f269ab38c58-7\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-2[]\" value=\"Tos-cr\u00f3nica\" id=\"forminator-form-1561__field--select-2_69f269ab38c58-7\" aria-labelledby=\"forminator-form-1561__field--select-2_69f269ab38c58-7-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Tos cr\u00f3nica<\/label><label id=\"forminator-form-1561__field--select-2_69f269ab38c58-8-label\" for=\"forminator-form-1561__field--select-2_69f269ab38c58-8\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-2[]\" value=\"Ninguna-de-las-anteriores\" id=\"forminator-form-1561__field--select-2_69f269ab38c58-8\" aria-labelledby=\"forminator-form-1561__field--select-2_69f269ab38c58-8-label\" data-calculation=\"0\"  data-hidden-behavior=\"zero\"  \/>Ninguna de las anteriores<\/label><input type='hidden' name='select-2-multiselect-default-values' class='multiselect-default-values' value='' \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"consent-1\" class=\"forminator-field-consent forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-consent-1_69f269ab38c58\" id=\"forminator-field-consent-1_69f269ab38c58-label\" class=\"forminator-label\">Declaraci\u00f3n jurada de veracidad <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-checkbox__wrapper\"><label id=\"forminator-field-consent-1_69f269ab38c58__label\" class=\"forminator-checkbox forminator-consent\" aria-labelledby=\"forminator-field-consent-1_69f269ab38c58-label\"><input type=\"checkbox\" name=\"consent-1\" id=\"forminator-field-consent-1_69f269ab38c58\" value=\"checked\" aria-labelledby=\"forminator-field-consent-1_69f269ab38c58-label\" aria-describedby=\"forminator-field-consent-1_69f269ab38c58__description\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-1_69f269ab38c58__description\" class=\"forminator-checkbox__label forminator-consent__label\"><div dir=\"auto\">Yo declaro en calidad de padres\/madres\/tutores legales del menor bajo la gravedad de juramento que la informaci\u00f3n que he brindado sobre la salud del hijo y de familiar&nbsp; es verdadera y comprobable.<\/div>\n<div dir=\"auto\">&nbsp;<\/div>\n<div dir=\"auto\">Asimismo, se comprometen a entregar los documentos que acrediten la veracidad de la informaci\u00f3n, en caso de que les sean solicitados por la entidad o instituci\u00f3n que requiera dicha informaci\u00f3n para fines de atenci\u00f3n, prevenci\u00f3n, diagn\u00f3stico, tratamiento, seguimiento o investigaci\u00f3n en salud.<\/div>\n<div dir=\"auto\">&nbsp;<\/div>\n<div dir=\"auto\">En caso de que se compruebe la falsedad de alguna de la informaci\u00f3n o documentos, aceptan las consecuencias legales que ello conlleve, tales como la anulaci\u00f3n de los beneficios, servicios o programas de salud que se hayan otorgado o solicitado, la exclusi\u00f3n de los mismos, la devoluci\u00f3n de los recursos p\u00fablicos o privados que se hayan utilizado o la imposici\u00f3n de sanciones administrativas, civiles o penales.<\/div>\n<div dir=\"auto\">&nbsp;<\/div>\n<div dir=\"auto\">&nbsp;<\/div><\/div><\/div><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Enviar mensaje<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"3737ce32ea\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/1556\" \/><input type=\"hidden\" name=\"form_id\" value=\"1561\"><input type=\"hidden\" name=\"page_id\" value=\"1556\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/www.ffbogotafc.online\/index.php\/ff-bogota-fc-ficha-medica-2024\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><\/div>\n","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-1556","page","type-page","status-publish","hentry"],"amp_enabled":true,"_links":{"self":[{"href":"https:\/\/www.ffbogotafc.online\/index.php\/wp-json\/wp\/v2\/pages\/1556","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ffbogotafc.online\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.ffbogotafc.online\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.ffbogotafc.online\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ffbogotafc.online\/index.php\/wp-json\/wp\/v2\/comments?post=1556"}],"version-history":[{"count":5,"href":"https:\/\/www.ffbogotafc.online\/index.php\/wp-json\/wp\/v2\/pages\/1556\/revisions"}],"predecessor-version":[{"id":2080,"href":"https:\/\/www.ffbogotafc.online\/index.php\/wp-json\/wp\/v2\/pages\/1556\/revisions\/2080"}],"wp:attachment":[{"href":"https:\/\/www.ffbogotafc.online\/index.php\/wp-json\/wp\/v2\/media?parent=1556"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}