{"id":464,"date":"2022-07-29T10:37:35","date_gmt":"2022-07-29T09:37:35","guid":{"rendered":"https:\/\/mes-formulaires.cpamcentre.fr\/?page_id=464"},"modified":"2024-03-22T10:11:32","modified_gmt":"2024-03-22T09:11:32","slug":"demande-de-travaux-statistiques-suivi-de-production","status":"publish","type":"page","link":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/demande-de-travaux-statistiques-suivi-de-production\/","title":{"rendered":"Demande de travaux statistiques &#8211; suivi de production"},"content":{"rendered":"\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f463-o1\" lang=\"fr-FR\" dir=\"ltr\" data-wpcf7-id=\"463\">\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\/464#wpcf7-f463-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=\"463\" \/>\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-f463-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<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>R\u00e9sultats (\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:service_appui_a_la_performance.cpam-blois@assurance-maladie.fr\">service_appui_a_la_performance.cpam-blois@assurance-maladie.fr<\/a>\n\t\t<\/p>\n\t\t<div class=\"rang-form\">\n\t\t\t<table>\n\t\t\t\t<tr>\n\t\t\t\t\t<td>\n\t\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=\"3145080038\" \/><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\/3145080038.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\t<\/p>\n\t\t\t\t\t<\/td>\n\t\t\t\t<\/tr>\n\t\t\t<\/table>\n\t\t<\/div>\n\t<\/div>\n<!-- FIN : 1 LIGNE\/1 COLONNE 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value=\"161\"\/><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\n\n\n<p> 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