{"id":226,"date":"2019-08-22T15:34:34","date_gmt":"2019-08-22T14:34:34","guid":{"rendered":"https:\/\/mes-formulaires.cpamcentre.fr\/?page_id=226"},"modified":"2019-08-22T15:34:34","modified_gmt":"2019-08-22T14:34:34","slug":"signalement-rct-interne","status":"publish","type":"page","link":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/signalement-rct-interne\/","title":{"rendered":"Signaler un accident caus\u00e9 par un tiers"},"content":{"rendered":"<p style=\"text-align: justify;\">Afin de signaler un accident caus\u00e9 par un tiers, compl\u00e9tez le formulaire ci-dessous en indiquant les informations relatives \u00e0 la victime de l&rsquo;accident.<\/p>\n<hr \/>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f227-o1\" lang=\"fr-FR\" dir=\"ltr\" data-wpcf7-id=\"227\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/226#wpcf7-f227-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulaire de contact\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"227\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.0.6\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"fr_FR\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f227-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<table border=0>\n\t<tr>\n\t\t<td>\n\t\t\t<h4 style=\"padding-top:0;margin-top:0;\">Agent r\u00e9alisant le signalement\n\t\t\t<\/h4>\n\t\t<\/td>\n\t\t<td>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Nom*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"nomAg\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nomAg\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Pr\u00e9nom*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"prenomAg\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"prenomAg\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Adresse mail*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"mail\"><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\" value=\"\" type=\"email\" name=\"mail\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Service*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"service\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"service\"><option value=\"\">&#8212;Veuillez choisir une option&#8212;<\/option><option value=\"Acc\u00e8s aux droits\">Acc\u00e8s aux droits<\/option><option value=\"Accompagnement en sant\u00e9\">Accompagnement en sant\u00e9<\/option><option value=\"Appui \u00e0 la performance, statistiques\">Appui \u00e0 la performance, statistiques<\/option><option value=\"Centre d\u2019examen de sant\u00e9\/IRSA\">Centre d\u2019examen de sant\u00e9\/IRSA<\/option><option value=\"Communication\">Communication<\/option><option value=\"Comptabilit\u00e9\">Comptabilit\u00e9<\/option><option value=\"Contr\u00f4le interne\">Contr\u00f4le interne<\/option><option value=\"Direction\">Direction<\/option><option value=\"Documentation\">Documentation<\/option><option value=\"Flux entrants et sortants\">Flux entrants et sortants<\/option><option value=\"Frais de sant\u00e9\">Frais de sant\u00e9<\/option><option value=\"Informatique\">Informatique<\/option><option value=\"Juridique et lutte contre la fraude\">Juridique et lutte contre la fraude<\/option><option value=\"Logistique\">Logistique<\/option><option value=\"Recours contre tiers\">Recours contre tiers<\/option><option value=\"Relation client\">Relation client<\/option><option value=\"Relations avec les professionnels de sant\u00e9\">Relations avec les professionnels de sant\u00e9<\/option><option value=\"Ressources Humaines\">Ressources Humaines<\/option><option value=\"Revenus de remplacements\">Revenus de remplacements<\/option><option value=\"Secr\u00e9tariat de direction\">Secr\u00e9tariat de direction<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<h4>Identification de la victime de l\u2019accident\n\t\t\t<\/h4>\n\t\t<\/td>\n\t\t<td>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Nom*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"nomAss\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nomAss\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Pr\u00e9nom*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"prenomAss\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"prenomAss\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>NIR*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"nirAss\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nirAss\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Date de l'accident*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"dateAcc\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"dateAcc\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n<table>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Commentaire<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"commentaire\"><textarea cols=\"118\" rows=\"5\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"commentaire\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n<table>\n\t<tr>\n\t\t<td>\n\t\t\t<p><b>Merci de saisir le code affich\u00e9 ci-dessous pour valider votre envoi : <\/b><br \/>\n<input type=\"hidden\" name=\"_wpcf7_captcha_challenge_captcha-170\" value=\"895087842\" \/><img decoding=\"async\" class=\"wpcf7-form-control wpcf7-captchac wpcf7-captcha-captcha-170\" width=\"72\" height=\"24\" alt=\"captcha\" src=\"https:\/\/mes-formulaires.cpamcentre.fr\/wp-content\/uploads\/wpcf7_captcha\/895087842.png\" \/><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"captcha-170\"><input size=\"4\" maxlength=\"4\" class=\"wpcf7-form-control wpcf7-captchar\" autocomplete=\"off\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"captcha-170\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n<table>\n\t<tr>\n\t\t<td style=\"padding:0;margin:0;\">\n\t\t\t<p align=center><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Envoyer\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"128\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>Afin de signaler un accident caus\u00e9 par un tiers, compl\u00e9tez le formulaire ci-dessous en indiquant les informations relatives \u00e0 la victime de l&rsquo;accident.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-226","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/pages\/226"}],"collection":[{"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/comments?post=226"}],"version-history":[{"count":2,"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/pages\/226\/revisions"}],"predecessor-version":[{"id":653,"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/pages\/226\/revisions\/653"}],"wp:attachment":[{"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/media?parent=226"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}