{"id":461,"date":"2022-07-29T10:26:17","date_gmt":"2022-07-29T09:26:17","guid":{"rendered":"https:\/\/mes-formulaires.cpamcentre.fr\/?page_id=461"},"modified":"2022-07-29T10:26:17","modified_gmt":"2022-07-29T09:26:17","slug":"demande-de-travaux-gestion-du-risque","status":"publish","type":"page","link":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/demande-de-travaux-gestion-du-risque\/","title":{"rendered":"Demande de travaux Gestion du risque"},"content":{"rendered":"\n<p>Ces demandes sont trait\u00e9es par la CPAM37 merci par avance pour votre pr\u00e9cision dans l&rsquo;\u00e9nonc\u00e9 de votre demande.<\/p>\n\n\n\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f460-o1\" lang=\"fr-FR\" dir=\"ltr\" data-wpcf7-id=\"460\">\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\/461#wpcf7-f460-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulaire de contact\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"460\" \/>\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-f460-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<div id=\"formulaire-responsive\" class=\"clearfix\">\n\n\n<!-- CODE A COPIER : : 1 LIGNE\/1 COLONNE -------------------------------------------------------------------------------------------------------------->\n\t<div class=\"rang-form\">\n\t\t<div class=\"colonne\">\n\t\t\t<h3 style=\"padding-top:0;margin-top:0;\">Identification du demandeur\n\t\t\t<\/h3>\n\t\t<\/div>\n\t\t<div class=\"colonne\">\n\t\t\t<p>Nom Pr\u00e9nom du demandeur* :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"nomprenom\"><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=\"nomprenom\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"colonne\">\n\t\t\t<p>Email du destinataire du r\u00e9sultat* :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"emaildestinataire\"><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=\"emaildestinataire\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"colonne\">\n\t\t\t<p>T\u00e9l\u00e9phone du demandeur* :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tl\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"tl\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<!-- FIN : 1 LIGNE\/1 COLONNE -------------------------------------------------------------------------------------------------------------------------->\n\n<!-- CODE A COPIER : : 1 LIGNE\/1 COLONNE -------------------------------------------------------------------------------------------------------------->\n\t<div class=\"rang-form\">\n\t\t<div class=\"colonne\">\n\t\t\t<h3 style=\"padding-top:0;margin-top:0;\">Objet de la demande\n\t\t\t<\/h3>\n\t\t<\/div>\n\t\t<p>Les crit\u00e8res que vous souhaitez voir appara\u00eetre dans vos r\u00e9sultats (ex : matricule de l'assur\u00e9, nom du prescripteur, montant rembours\u00e9...)\n\t\t<\/p>\n\t\t<div class=\"colonne\">\n\t\t\t<p>Demande* :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"demande\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"demande\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"colonne\">\n\t\t\t<p>P\u00e9riode d'\u00e9tude* :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"periode\"><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=\"periode\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"colonne\">\n\t\t\t<p>Date* :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"dateetude\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"dateetude\"><option value=\"\">&#8212;Veuillez choisir une option&#8212;<\/option><option value=\"Non sp\u00e9cifi\u00e9e\">Non sp\u00e9cifi\u00e9e<\/option><option value=\"Date de soins\">Date de soins<\/option><option value=\"Date de mandatement\">Date de mandatement<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"colonne\">\n\t\t\t<p>R\u00e9sultat (\u00e9l\u00e9ments \u00e0 faire apparaitre dans le r\u00e9sultat de la requ\u00eate)* :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"resultat\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"resultat\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"colonne\">\n\t\t\t<p>Date butoir* :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"colonne\">\n\t\t\t<p>Observations :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"observations\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"observations\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"colonne\">\n\t\t\t<p>Joindre un document :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"PJ\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".jpg,.jpeg,.doc,.docx,.xlsx,.xls,.csv\" aria-invalid=\"false\" type=\"file\" name=\"PJ\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p>Pour joindre un autre fichier \u00e0 votre demande, merci de l'adresser par e-mail \u00e0 l'adresse suivante <A HREF=\"mailto:stateureka@cpam-blois.cnamts.fr\">stateureka@cpam-blois.cnamts.fr<\/a>\n\t\t<\/p>\n\t\t<table>\n\t\t\t<tr>\n\t\t\t\t<td>\n\t\t\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=\"588319563\" \/><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\/588319563.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\t\t<\/p>\n\t\t\t\t<\/td>\n\t\t\t<\/tr>\n\t\t<\/table>\n\n\n<!-- CODE BOUTON --------------------------------------------------------------------------------------------------------------------------------------->\n\t\t<div class=\"rang-form\">\n\t\t\t<div class=\"colonne\">\n\t\t\t\t<p>&nbsp;<br \/>\n<input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Envoyer\" \/>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n<!-- FIN CODE BOUTON ----------------------------------------------------------------------------------------------------------------------------------->\n\t<\/div>\n<!--fin de formulaire-responsive-->\n<\/div><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=\"179\"\/><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>Ces demandes sont trait\u00e9es par la CPAM37 merci par avance pour votre pr\u00e9cision dans l&rsquo;\u00e9nonc\u00e9 de votre demande.<\/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-461","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/pages\/461"}],"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=461"}],"version-history":[{"count":1,"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/pages\/461\/revisions"}],"predecessor-version":[{"id":462,"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/pages\/461\/revisions\/462"}],"wp:attachment":[{"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/media?parent=461"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}