{"id":467,"date":"2022-07-29T11:13:02","date_gmt":"2022-07-29T10:13:02","guid":{"rendered":"https:\/\/mes-formulaires.cpamcentre.fr\/?page_id=467"},"modified":"2022-07-29T11:22:21","modified_gmt":"2022-07-29T10:22:21","slug":"signaler-une-incivilite-externe","status":"publish","type":"page","link":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/signaler-une-incivilite-externe\/","title":{"rendered":"Signaler une incivilit\u00e9 externe"},"content":{"rendered":"\n<p>Vous souhaitez signaler une incivilit\u00e9 survenue avec l&rsquo;un de nos publics externes (assur\u00e9, professionnel de sant\u00e9 &#8230;), merci pour cela compl\u00e9tez le formulaire ci-dessous.<\/p>\n\n\n\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f466-o1\" lang=\"fr-FR\" dir=\"ltr\" data-wpcf7-id=\"466\">\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\/467#wpcf7-f466-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=\"466\" \/>\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-f466-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;\">Signaler une incivilit\u00e9 externe\n\t\t\t<\/h3>\n\t\t<\/div>\n\t\t<div class=\"colonne\">\n\t\t\t<p>Type d'incivilit\u00e9* :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"type\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"type[]\" value=\"Incident mineur\" \/><span class=\"wpcf7-list-item-label\">Incident mineur<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"type[]\" value=\"Incident majeur\" \/><span class=\"wpcf7-list-item-label\">Incident majeur<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"colonne\">\n\t\t\t<p>Nom \/ Pr\u00e9nom * :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"nomprenom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" 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* :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><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=\"email\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"colonne\">\n\t\t\t<p>Service* :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"service\"><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=\"service\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"colonne\">\n\t\t\t<p>Pr\u00e9cisez le lieu o\u00f9 s'est produit l'incident (nom du point d'accueil par exemple)* :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"lieu\"><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=\"lieu\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"colonne\">\n\t\t\t<p>Date de l'incivilit\u00e9 :<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>Nom \/ Pr\u00e9nom de la personne concern\u00e9e (Assur\u00e9, PS...) :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"personneconcernee\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"personneconcernee\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"colonne\">\n\t\t\t<p>NIR de l'assur\u00e9 concern\u00e9 :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"NIR\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"NIR\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"colonne\">\n\t\t\t<p>Compte-rendu de l'\u00e9v\u00e9nement* :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"CRevenement\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"CRevenement\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"colonne\">\n\t\t\t<p>D\u00e9sirez-vous qu'un courrier de la Direction soit adress\u00e9 \u00e0 l'auteur de l'incivilit\u00e9 :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"courrieridr\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"courrieridr[]\" value=\"Oui\" \/><span class=\"wpcf7-list-item-label\">Oui<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"courrieridr[]\" value=\"Non\" \/><span class=\"wpcf7-list-item-label\">Non<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<!-- FIN : 1 LIGNE\/1 COLONNE -------------------------------------------------------------------------------------------------------------------------->\n\t<table>\n\t\t<tr>\n\t\t\t<td>\n\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=\"1159230963\" \/><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\/1159230963.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<\/p>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t<\/table>\n\n<!-- CODE BOUTON --------------------------------------------------------------------------------------------------------------------------------------->\n\t<div class=\"rang-form\">\n\t\t<div class=\"colonne\">\n\t\t\t<p>&nbsp;<br \/>\n<input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Envoyer\" \/>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<!-- FIN CODE BOUTON ----------------------------------------------------------------------------------------------------------------------------------->\n<\/div>\n<!--fin de formulaire-responsive--><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=\"5\"\/><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>Vous souhaitez signaler une incivilit\u00e9 survenue avec l&rsquo;un de nos publics externes (assur\u00e9, professionnel de sant\u00e9 &#8230;), merci pour cela compl\u00e9tez le formulaire ci-dessous.<\/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-467","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/pages\/467"}],"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=467"}],"version-history":[{"count":2,"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/pages\/467\/revisions"}],"predecessor-version":[{"id":473,"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/pages\/467\/revisions\/473"}],"wp:attachment":[{"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/media?parent=467"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}