214 lines
13 KiB
HTML
214 lines
13 KiB
HTML
<!DOCTYPE html>
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<html lang="pt-br">
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<head>
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<meta charset="UTF-8">
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<meta name="viewport" content="width=device-width, initial-scale=1.0">
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<title>Cadastro de Médico</title>
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<link rel="stylesheet" href="./addMedico.css">
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<link rel="stylesheet" href="/Squad-21/clinicApp/global.css">
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<link rel="preconnect" href="https://fonts.googleapis.com">
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<link rel="preconnect" href="https://fonts.gstatic.com" crossorigin>
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<link href="https://fonts.googleapis.com/css2?family=Poppins:wght@300" rel="stylesheet">
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<link rel="stylesheet" href="/Squad-21/clinicApp/assets/style/bootstrap.css">
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</head>
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<body>
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<main>
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<div class="flex">
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<section class="section-main">
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<nav class="nav">
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</nav>
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<div class="full-page-form-container">
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<div class="form-card">
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<h2>Dados do Paciente</h2>
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<form id="cadastro-form">
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<div class="form-grid">
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<div class="form-group"><label for="nome">Nome *</label><input type="text" id="nome"
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required></div>
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<div class="form-group"><label for="nomeSocial">Nome Social</label><input type="text"
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id="nomeSocial"></div>
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<div class="form-group">
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<label for="cpf">CPF *</label>
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<input type="text" id="cpf" placeholder="000.000.000-00" required>
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</div>
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<div class="form-group">
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<label for="cpf">CRM *</label>
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<input type="text" id="cpf" placeholder="000.000.000-00" required>
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</div>
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<div class="form-group">
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<label for="outrosDocs">Outros documentos de identidade</label>
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<select id="outrosDocs">
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<option value="">Selecione</option>
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<option value="Passaporte">Passaporte</option>
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<option value="CNH">CNH</option>
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</select>
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</div>
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<div class="form-group"><label for="numDoc">Número do documento</label><input
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type="text" id="numDoc" placeholder="Número do documento"></div>
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<div class="form-group">
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<label for="sexo">Sexo *</label>
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<select id="sexo" name="sexo" required>
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<option value="">Selecione</option>
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<option value="Masculino">Masculino</option>
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<option value="Feminino">Feminino</option>
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<option value="Feminino">Prefiro Não Informar</option>
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</select>
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</div>
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<div class="form-group"><label for="dataNascimento">Data de Nascimento *</label><input
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type="date" id="dataNascimento" required></div>
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<div class="form-group">
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<label for="etnia">Etnia</label>
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<select id="etnia">
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<option value="">Selecione</option>
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<option value="branca">Branca</option>
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<option value="preta">Preta</option>
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<option value="parda">Parda</option>
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<option value="amarela">Amarela</option>
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<option value="indigena">Indígena</option>
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</select>
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</div>
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<div class="form-group">
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<label for="raca">Raça</label>
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<select id="raca">
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<option value="">Selecione</option>
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<option value="branca">Branca</option>
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<option value="preta">Preta</option>
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<option value="parda">Parda</option>
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<option value="amarela">Amarela</option>
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<option value="indigena">Indígena</option>
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</select>
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</div>
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<div class="form-group">
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<label for="naturalidade">Naturalidade</label>
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<input type="text" id="naturalidade">
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</div>
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<div class="form-group">
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<label for="nacionalidade">Nacionalidade</label>
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<input type="text" id="nacionalidade">
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</div>
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<div class="form-group"><label for="profissao">Profissão</label><input type="text"
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id="profissao"></div>
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<div class="form-group">
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<label for="estadoCivil">Estado Civil</label>
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<select id="estadoCivil">
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<option value="">Selecione</option>
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<option value="solteiro">Solteiro(a)</option>
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<option value="casado">Casado(a)</option>
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<option value="divorciado">Divorciado(a)</option>
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<option value="viuvo">Viúvo(a)</option>
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<option value="separado">Separado(a)</option>
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</select>
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</div>
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<div class="form-group">
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<label for="nomeMae">Nome da mãe</label>
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<input type="text" id="nomeMae">
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</div>
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<div class="form-group">
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<label for="nomePai">Nome do pai</label>
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<input type="text" id="nomePai">
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</div>
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<div class="form-group">
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<label for="nomeEsposo">Nome do(a) esposo(a)</label>
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<input type="text" id="nomeEsposo">
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</div>
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</div>
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<div class="section-divider">Endereço</div>
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<div class="form-grid">
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<div class="form-group">
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<label for="cep">CEP *</label>
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<input type="text" id="cep" required placeholder="00000-000">
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</div>
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<div class="form-group span-2">
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<label for="endereco">Endereço</label>
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<input type="text" id="endereco">
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</div>
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<div class="form-group">
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<label for="numero">Número</label>
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<input type="text" id="numero">
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</div>
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<div class="form-group">
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<label for="complemento">Complemento</label>
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<input type="text" id="complemento">
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</div>
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<div class="form-group">
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<label for="bairro">Bairro</label>
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<input type="text" id="bairro">
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</div>
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<div class="form-group">
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<label for="cidade">Cidade</label>
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<input type="text" id="cidade">
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</div>
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<div class="form-group">
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<label for="estado">Estado
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<label>
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<select id="estado">
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<option value="">Selecione</option>
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<option value="AC">Acre</option>
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<option value="AL">Alagoas</option>
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<option value="AP">Amapá</option>
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<option value="AM">Amazonas</option>
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<option value="BA">Bahia</option>
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<option value="CE">Ceará</option>
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<option value="DF">Distrito Federal</option>
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<option value="ES">Espírito Santo</option>
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<option value="GO">Goiás</option>
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<option value="MA">Maranhão</option>
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<option value="MT">Mato Grosso</option>
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<option value="MS">Mato Grosso do Sul</option>
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<option value="MG">Minas Gerais</option>
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<option value="PA">Pará</option>
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<option value="PB">Paraíba</option>
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<option value="PR">Paraná</option>
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<option value="PE">Pernambuco</option>
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<option value="PI">Piauí</option>
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<option value="RJ">Rio de Janeiro</option>
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<option value="RN">Rio Grande do Norte</option>
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<option value="RS">Rio Grande do Sul</option>
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<option value="RO">Rondônia</option>
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<option value="RR">Roraima</option>
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<option value="SC">Santa Catarina</option>
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<option value="SP">São Paulo</option>
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<option value="SE">Sergipe</option>
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<option value="TO">Tocantins</option>
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</select>
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</div>
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</div>
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<div class="section-divider">Contato</div>
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<div class="form-grid">
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<div class="form-group">
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<label for="email">E-mail *</label>
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<input type="email" id="email" required placeholder="email@hotmail.com">
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</div>
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<div class="form-group">
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<label for="celular">Celular *</label>
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<input type="text" id="celular" placeholder="(00) 00000-0000" required>
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</div>
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<div class="form-group">
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<label for="telefone1">Telefone</label>
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<input type="text" id="telefone1" placeholder="(00) 0000-0000">
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</div>
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</div>
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<div class="form-actions">
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<button type="submit" class="btn btn-save">Salvar</button>
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<a href="../crud-medico.html" class="btn btn-cancel">Voltar</a>
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</div>
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</form>
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</div>
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</div>
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</section>
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</div>
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</main>
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<script src="https://cdn.jsdelivr.net/npm/inputmask@5.0.9/dist/inputmask.min.js"></script>
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<script defer src="/Squad-21/clinicApp/pages-visao-clinica/medicos/addMedico/addMedico.js"></script>
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</body>
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</html> |