{"id":689,"date":"2024-11-23T19:34:48","date_gmt":"2024-11-23T19:34:48","guid":{"rendered":"https:\/\/euroetika.com\/en\/?page_id=689"},"modified":"2025-05-15T15:53:41","modified_gmt":"2025-05-15T15:53:41","slug":"health-professional-friend-family-member-or-caregiver","status":"publish","type":"page","link":"https:\/\/euroetika.com\/en\/pharmacovigilance\/health-professional-friend-family-member-or-caregiver\/","title":{"rendered":"Health professional, Friend, family member or caregiver"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"689\" class=\"elementor elementor-689\" data-elementor-settings=\"{&quot;ha_cmc_init_switcher&quot;:&quot;no&quot;}\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4476ccc e-flex e-con-boxed e-con e-parent\" data-id=\"4476ccc\" data-element_type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-34566bd elementor-widget elementor-widget-jet-breadcrumbs\" data-id=\"34566bd\" data-element_type=\"widget\" data-widget_type=\"jet-breadcrumbs.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-jet-breadcrumbs jet-blocks\">\n\t\t<div class=\"jet-breadcrumbs\">\n\t\t<div class=\"jet-breadcrumbs__content\">\n\t\t<div class=\"jet-breadcrumbs__wrap\"><div class=\"jet-breadcrumbs__item\"><a href=\"https:\/\/euroetika.com\/en\/\" class=\"jet-breadcrumbs__item-link is-home\" rel=\"home\" title=\"Home\">Home<\/a><\/div>\n\t\t<\/div>\n\t\t<\/div>\n\t\t<\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-229019a e-flex e-con-boxed e-con e-parent\" data-id=\"229019a\" data-element_type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-30e46ba e-con-full e-flex e-con e-child\" data-id=\"30e46ba\" data-element_type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-495f32b elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"495f32b\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Formulario para profesional de la salud, amigo, familiar o cuidador<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c744bb7 elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"c744bb7\" data-element_type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Siguiente&quot;,&quot;step_previous_label&quot;:&quot;Anterior&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Profesional de la salud, Amigo, familiar o cuidador)\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"689\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"c744bb7\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"\" \/>\n\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_24a4f35 elementor-col-100\">\n\t\t\t\t\t<span class=\"form\">Datos del solicitante<\/span>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNombre de quien notifica*\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Escribe el nombre del paciente\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_361eb23 elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_361eb23\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDocumento de identidad\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_361eb23]\" id=\"form-field-field_361eb23\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Ej: 1033123456\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_94c66bd elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_94c66bd\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCorreo electr\u00f3nico\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[field_94c66bd]\" id=\"form-field-field_94c66bd\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Ej: pedro@hotmail.com\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_6aca85c elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6aca85c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTel\u00e9fono de contacto\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_6aca85c]\" id=\"form-field-field_6aca85c\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Ej: 3101234567\" required=\"required\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_5c39837 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5c39837\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tProfesi\u00f3n\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_5c39837]\" id=\"form-field-field_5c39837\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Ej: Ingeniero, M\u00e9dico, Abogado\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_d3926ee elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d3926ee\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tInstituci\u00f3n\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_d3926ee]\" id=\"form-field-field_d3926ee\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"\u00bfD\u00f3nde trabajas o estudias?\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_884430d elementor-col-100\">\n\t\t\t\t\t<span class=\"form\">Datos del paciente<\/span>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_161dd37 elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_161dd37\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNombre del paciente*\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_161dd37]\" id=\"form-field-field_161dd37\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Escribe el nombre del paciente\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_4137bbb elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4137bbb\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDocumento de identidad\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_4137bbb]\" id=\"form-field-field_4137bbb\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Ej: 1033123456\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_4aebf63 elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4aebf63\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTel\u00e9fono de contacto*\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_4aebf63]\" id=\"form-field-field_4aebf63\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Ej: 3101234567\" required=\"required\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_b73401a elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b73401a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCorreo electr\u00f3nico*\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_b73401a]\" id=\"form-field-field_b73401a\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Ej: pedro@hotmail.com\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_289bc45 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_289bc45\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPa\u00eds\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_289bc45]\" id=\"form-field-field_289bc45\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Ej: Colombia, M\u00e9xico\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_4ccf0a8 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4ccf0a8\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCiudad\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_4ccf0a8]\" id=\"form-field-field_4ccf0a8\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Ej: Bogot\u00e1, Medell\u00edn\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_b554b90 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b554b90\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMedicamento o producto\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_b554b90]\" id=\"form-field-field_b554b90\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Escribe el nombre del medicamento o producto\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_11eb9eb elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_11eb9eb\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tRegistro sanitario\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_11eb9eb]\" id=\"form-field-field_11eb9eb\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Lo encuentras en el empaque del producto y por lo general est\u00e1 referido como registro Invima\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_6e397ed elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6e397ed\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tN\u00famero de Lote\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_6e397ed]\" id=\"form-field-field_6e397ed\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Indica el n\u00famero de lote\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_659d143 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_659d143\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFecha de inicio del evento adverso\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_659d143]\" id=\"form-field-field_659d143\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Ej: 18\/09\/2024\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-message elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-message\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDescripci\u00f3n del evento adverso*\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[message]\" id=\"form-field-message\" rows=\"2\" placeholder=\"Describe lo acontecido de forma clara y completa\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group elementor-column elementor-field-group-field_89e8230 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_89e8230\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCargar archivo pdf o jpg con evidencias del evento (Opcional)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[field_89e8230]\" id=\"form-field-field_89e8230\" class=\"elementor-field elementor-size-sm  elementor-upload-field\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_6b20d17 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_6b20d17]\" id=\"form-field-field_6b20d17\" class=\"elementor-field elementor-size-sm  elementor-acceptance-field\" required=\"required\" checked=\"checked\">\n\t\t\t\t<label for=\"form-field-field_6b20d17\">Acepto las <a href=\"\/politicas-de-privacidad\/\" target=\"blank\">politicas de privacidad<\/a>\n<\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text\">\n\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_5989a29]\" id=\"form-field-field_5989a29\" class=\"elementor-field elementor-size-sm \" style=\"display:none !important;\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-recaptcha_v3 elementor-field-group elementor-column elementor-field-group-field_c98c2fd elementor-col-100 recaptcha_v3-bottomright\">\n\t\t\t\t\t<div class=\"elementor-field\" id=\"form-field-field_c98c2fd\"><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Enviar mensaje<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Home Formulario para profesional de la salud, amigo, familiar o cuidador<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":678,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-689","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/euroetika.com\/en\/wp-json\/wp\/v2\/pages\/689","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/euroetika.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/euroetika.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/euroetika.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/euroetika.com\/en\/wp-json\/wp\/v2\/comments?post=689"}],"version-history":[{"count":23,"href":"https:\/\/euroetika.com\/en\/wp-json\/wp\/v2\/pages\/689\/revisions"}],"predecessor-version":[{"id":1630,"href":"https:\/\/euroetika.com\/en\/wp-json\/wp\/v2\/pages\/689\/revisions\/1630"}],"up":[{"embeddable":true,"href":"https:\/\/euroetika.com\/en\/wp-json\/wp\/v2\/pages\/678"}],"wp:attachment":[{"href":"https:\/\/euroetika.com\/en\/wp-json\/wp\/v2\/media?parent=689"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}