{"id":11,"date":"2026-05-28T20:53:57","date_gmt":"2026-05-28T20:53:57","guid":{"rendered":"https:\/\/www.ameci.cl\/declaracion-salud\/?page_id=11"},"modified":"2026-06-01T17:08:30","modified_gmt":"2026-06-01T17:08:30","slug":"declaracion-de-salud","status":"publish","type":"page","link":"https:\/\/www.ameci.cl\/declaracion-salud\/","title":{"rendered":""},"content":{"rendered":"\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/www.ameci.cl\/declaracion-salud\/wp-content\/uploads\/2026\/05\/LOGO_AMECI2.png\" alt=\"\"\/><\/figure>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\" style=\"margin-top:var(--wp--preset--spacing--20);margin-bottom:var(--wp--preset--spacing--20)\"\/>\n\n\n<div class='fluentform ff-default fluentform_wrapper_3 ffs_default_wrap'><form data-form_id=\"3\" id=\"fluentform_3\" class=\"frm-fluent-form fluent_form_3 ff-el-form-top ff_form_instance_3_1 ff-form-loading ffs_default\" data-form_instance=\"ff_form_instance_3_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Formulario para declaracion de salud<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='11' \/><input type=\"hidden\" id=\"_fluentform_3_fluentformnonce\" name=\"_fluentform_3_fluentformnonce\" value=\"f2248da4f0\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/declaracion-salud\/wp-json\/wp\/v2\/pages\/11\" \/><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-3_1\" ><h1 style=\"text-align: center\"><strong>DECLARACI\u00d3N DE SALUD DEL TRABAJADOR<\/strong><\/h1><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-3_2\" ><h2 style=\"text-align: left\"><strong>1.- IDENTIFICACI\u00d3N DEL TRABAJADOR<\/strong><\/h2><\/div><div data-name=\"ff_cn_id_1\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 45.11%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_text_7' id='label_ff_3_input_text_7' aria-label=\"Nombre completo:\">Nombre completo:<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_7\" class=\"ff-el-form-control\" data-name=\"input_text_7\" id=\"ff_3_input_text_7\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_cargo' id='label_ff_3_input_cargo' aria-label=\"Cargo:\">Cargo:<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_cargo\" class=\"ff-el-form-control\" data-name=\"input_cargo\" id=\"ff_3_input_cargo\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 54.89%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_mask' id='label_ff_3_input_mask' aria-label=\"Rut:\">Rut:<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_mask\" data-mask=\"99.999.999-*\" class=\"ff-el-form-control\" placeholder=\"99.999.999-9\" data-name=\"input_mask\" id=\"ff_3_input_mask\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_fecha_ingreso' id='label_ff_3_input_fecha_ingreso' aria-label=\"Fecha de ingreso\">Fecha de ingreso<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_fecha_ingreso\" data-mask=\"00\/00\/0000\" class=\"ff-el-form-control\" placeholder=\"dd-mm-aaaa\" data-name=\"input_fecha_ingreso\" id=\"ff_3_input_fecha_ingreso\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-3_3\" ><h2 style=\"text-align: left\"><strong>2.- ANTECEDENTES MEDICOS: Ha tenido o tiene alg\u00fan s\u00edntoma o enfermedad como las descritas a continuaci\u00f3n<\/strong><\/h2><\/div><div data-name=\"ff_cn_id_2\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 88.49%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"1.- Disminuci\u00f3n de visi\u00f3n\">1.- Disminuci\u00f3n de visi\u00f3n<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_1_a99d098e23c1f43693b7acf04bc455de'><input  type=\"radio\" name=\"input_1\" data-name=\"input_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_1_a99d098e23c1f43693b7acf04bc455de' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_1_f6dbc00119f713400d14f01247f8c503'><input  type=\"radio\" name=\"input_1\" data-name=\"input_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_1_f6dbc00119f713400d14f01247f8c503' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 11.51%;'><\/div><\/div><div data-name=\"ff_cn_id_3\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 90%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"2.- \u00bfDisminuci\u00f3n de la audici\u00f3n\">2.- \u00bfDisminuci\u00f3n de la audici\u00f3n<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_2_9acafb0fed1476f11d91502bb7099ee9'><input  type=\"radio\" name=\"input_2\" data-name=\"input_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_2_9acafb0fed1476f11d91502bb7099ee9' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_2_cf803e4d2548cfa9891e93fd537f4ffe'><input  type=\"radio\" name=\"input_2\" data-name=\"input_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_2_cf803e4d2548cfa9891e93fd537f4ffe' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 10%;'><\/div><\/div><div data-name=\"ff_cn_id_4\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 90%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"3.- Diabetes\">3.- Diabetes<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_3_b20ea3fb3ab70b3a77103c5134645694'><input  type=\"radio\" name=\"input_3\" data-name=\"input_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_3_b20ea3fb3ab70b3a77103c5134645694' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_3_686ed3bdd6bdbc605936617ff75b9bec'><input  type=\"radio\" name=\"input_3\" data-name=\"input_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_3_686ed3bdd6bdbc605936617ff75b9bec' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 10%;'><\/div><\/div><div data-name=\"ff_cn_id_5\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"4.- Secuela de accidentes y\/o enfermedades no laborales\">4.- Secuela de accidentes y\/o enfermedades no laborales<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_4_7f097bbf6b9b7beaad8e48ac25d09155'><input  type=\"radio\" name=\"input_4\" data-name=\"input_4\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_4_7f097bbf6b9b7beaad8e48ac25d09155' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_4_52b6ed5e76c546c939d572ea8350870a'><input  type=\"radio\" name=\"input_4\" data-name=\"input_4\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_4_52b6ed5e76c546c939d572ea8350870a' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_texto_4' id='label_ff_3_input_texto_4' aria-label=\"\u00bfCual?\">\u00bfCual?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_texto_4\" class=\"ff-el-form-control\" data-name=\"input_texto_4\" id=\"ff_3_input_texto_4\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_6\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 90%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"5.- Epilepsia\">5.- Epilepsia<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_5_884b0e227e124e0942ca241825bdde38'><input  type=\"radio\" name=\"input_5\" data-name=\"input_5\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_5_884b0e227e124e0942ca241825bdde38' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_5_9ee58db95bf83850502b415c3e1ee3af'><input  type=\"radio\" name=\"input_5\" data-name=\"input_5\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_5_9ee58db95bf83850502b415c3e1ee3af' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 10%;'><\/div><\/div><div data-name=\"ff_cn_id_7\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 90%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"6.- V\u00e9rtigo\">6.- V\u00e9rtigo<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_6_e1134d3c60b1378771497ae2d274d82b'><input  type=\"radio\" name=\"input_6\" data-name=\"input_6\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_6_e1134d3c60b1378771497ae2d274d82b' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_6_f31d57e202c0778b19b55a8b487646d1'><input  type=\"radio\" name=\"input_6\" data-name=\"input_6\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_6_f31d57e202c0778b19b55a8b487646d1' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 10%;'><\/div><\/div><div data-name=\"ff_cn_id_8\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 90%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"7.- Tumor o c\u00e1ncer\">7.- Tumor o c\u00e1ncer<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_7_8b9f48fe19214d4dbaf985c3da7b495b'><input  type=\"radio\" name=\"input_7\" data-name=\"input_7\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_7_8b9f48fe19214d4dbaf985c3da7b495b' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_7_b94dc58e5952853f5dc3d9216abe6cf2'><input  type=\"radio\" name=\"input_7\" data-name=\"input_7\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_7_b94dc58e5952853f5dc3d9216abe6cf2' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 10%;'><\/div><\/div><div data-name=\"ff_cn_id_9\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"8.- Antecedentes cardiovasculares\">8.- Antecedentes cardiovasculares<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_8_d219ddf3e3f5178bd2c79d4c6349fbf5'><input  type=\"radio\" name=\"input_8\" data-name=\"input_8\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_8_d219ddf3e3f5178bd2c79d4c6349fbf5' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_8_0b3c47654aedb19ef14a56cf44e216ca'><input  type=\"radio\" name=\"input_8\" data-name=\"input_8\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_8_0b3c47654aedb19ef14a56cf44e216ca' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_texto_8' id='label_ff_3_input_texto_8' aria-label=\"\u00bfCual?\">\u00bfCual?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_texto_8\" class=\"ff-el-form-control\" data-name=\"input_texto_8\" id=\"ff_3_input_texto_8\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_10\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"9.- Antecedentes de tipo respiratorio\">9.- Antecedentes de tipo respiratorio<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_9_70f9dc9b8ffeebd8b1c666260cc25621'><input  type=\"radio\" name=\"input_9\" data-name=\"input_9\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_9_70f9dc9b8ffeebd8b1c666260cc25621' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_9_50f0b0067f26f6f432cc231df08b6668'><input  type=\"radio\" name=\"input_9\" data-name=\"input_9\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_9_50f0b0067f26f6f432cc231df08b6668' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_texto_9' id='label_ff_3_input_texto_9' aria-label=\"\u00bfCual?\">\u00bfCual?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_texto_9\" class=\"ff-el-form-control\" data-name=\"input_texto_9\" id=\"ff_3_input_texto_9\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_11\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"10.- \u00bfConsume alg\u00fan medicamento?\">10.- \u00bfConsume alg\u00fan medicamento?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_10_7251f596df87bee131619afbf336e483'><input  type=\"radio\" name=\"input_10\" data-name=\"input_10\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_10_7251f596df87bee131619afbf336e483' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_10_6120e4d6f6536cc8a11cc6c2e75d909f'><input  type=\"radio\" name=\"input_10\" data-name=\"input_10\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_10_6120e4d6f6536cc8a11cc6c2e75d909f' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_texto_10' id='label_ff_3_input_texto_10' aria-label=\"\u00bfCual?\">\u00bfCual?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_texto_10\" class=\"ff-el-form-control\" data-name=\"input_texto_10\" id=\"ff_3_input_texto_10\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_12\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"11.- \u00bfPosee antecedentes de tipo al\u00e9rgico?\">11.- \u00bfPosee antecedentes de tipo al\u00e9rgico?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_11_c9b2a51a402e723dadbdeff279b62c11'><input  type=\"radio\" name=\"input_11\" data-name=\"input_11\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_11_c9b2a51a402e723dadbdeff279b62c11' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_11_3768b977388acd78284b9b202621f231'><input  type=\"radio\" name=\"input_11\" data-name=\"input_11\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_11_3768b977388acd78284b9b202621f231' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_texto_11' id='label_ff_3_input_texto_11' aria-label=\"\u00bfCual?\">\u00bfCual?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_texto_11\" class=\"ff-el-form-control\" data-name=\"input_texto_11\" id=\"ff_3_input_texto_11\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_13\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"12.- \u00bfHa sido alguna vez operado?\">12.- \u00bfHa sido alguna vez operado?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_8896b8eff83352c3183f883bc3c36464'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_radio_8896b8eff83352c3183f883bc3c36464' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_f37257388979d4f8b3ae052b4132a792'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_radio_f37257388979d4f8b3ae052b4132a792' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_text' id='label_ff_3_input_text' aria-label=\"Se\u00f1ale\">Se\u00f1ale<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" data-name=\"input_text\" id=\"ff_3_input_text\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_14\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"13.- \u00bfSufre de alguna enfermedad cr\u00f3nica? (Lumbago, Tendinitis, etc.)\">13.- \u00bfSufre de alguna enfermedad cr\u00f3nica? (Lumbago, Tendinitis, etc.)<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_1d8865d947799aa2b89a0a560a374230'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_radio_2_1d8865d947799aa2b89a0a560a374230' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_88d1f37ac5c410e52d9aef57e7b7ed44'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_radio_2_88d1f37ac5c410e52d9aef57e7b7ed44' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_text_2' id='label_ff_3_input_text_2' aria-label=\"\u00bfCu\u00e1l?\">\u00bfCu\u00e1l?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_2\" class=\"ff-el-form-control\" data-name=\"input_text_2\" id=\"ff_3_input_text_2\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_15\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"14.- \u00bfSufre de presi\u00f3n arterial? (Hipertensi\u00f3n, etc.)\">14.- \u00bfSufre de presi\u00f3n arterial? (Hipertensi\u00f3n, etc.)<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1_4127040193acb6521db1a8aa32a268eb'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_radio_1_4127040193acb6521db1a8aa32a268eb' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1_365af5ae125e4543c365093c668873bb'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_radio_1_365af5ae125e4543c365093c668873bb' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_text_1' id='label_ff_3_input_text_1' aria-label=\"Se\u00f1ale\">Se\u00f1ale<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_1\" class=\"ff-el-form-control\" data-name=\"input_text_1\" id=\"ff_3_input_text_1\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_16\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"15.- \u00bfConsume o ha consumido Alcohol?\">15.- \u00bfConsume o ha consumido Alcohol?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_5_831bb70fd16985c749e709f58e0093d1'><input  type=\"radio\" name=\"input_radio_5\" data-name=\"input_radio_5\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_radio_5_831bb70fd16985c749e709f58e0093d1' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_5_c89caab564e8a45a725980169c955e09'><input  type=\"radio\" name=\"input_radio_5\" data-name=\"input_radio_5\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_radio_5_c89caab564e8a45a725980169c955e09' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00bfCon que frecuencia?\">\u00bfCon que frecuencia?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_7_8ba45288f14d77b85e4da51fba693e3b'><input  type=\"radio\" name=\"input_radio_7\" data-name=\"input_radio_7\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Todos los dias\"  id='input_radio_7_8ba45288f14d77b85e4da51fba693e3b' aria-label='Todos los dias' aria-invalid='false' aria-required=true> <span>Todos los dias<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_7_92be3ae70f45a5f7c1d744e8b5a10246'><input  type=\"radio\" name=\"input_radio_7\" data-name=\"input_radio_7\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"En ocasiones\"  id='input_radio_7_92be3ae70f45a5f7c1d744e8b5a10246' aria-label='En ocasiones' aria-invalid='false' aria-required=true> <span>En ocasiones<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_7_c3d170b47a9404b996d8f630238e89c6'><input  type=\"radio\" name=\"input_radio_7\" data-name=\"input_radio_7\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Rara vez\"  id='input_radio_7_c3d170b47a9404b996d8f630238e89c6' aria-label='Rara vez' aria-invalid='false' aria-required=true> <span>Rara vez<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00bfCuanto consume?\">\u00bfCuanto consume?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_8_435cd3b5fff7eb9b6de3bc3cabb29c8a'><input  type=\"radio\" name=\"input_radio_8\" data-name=\"input_radio_8\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Mas de 3 vasos\"  id='input_radio_8_435cd3b5fff7eb9b6de3bc3cabb29c8a' aria-label='Mas de 3 vasos' aria-invalid='false' aria-required=true> <span>Mas de 3 vasos<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_8_962e0d5a78111a810db38b92d8b7bb0a'><input  type=\"radio\" name=\"input_radio_8\" data-name=\"input_radio_8\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"De 2 a 3 vasos\"  id='input_radio_8_962e0d5a78111a810db38b92d8b7bb0a' aria-label='De 2 a 3 vasos' aria-invalid='false' aria-required=true> <span>De 2 a 3 vasos<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_8_de38a868658e3681f54f1291adfc7492'><input  type=\"radio\" name=\"input_radio_8\" data-name=\"input_radio_8\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Solo 1 vaso\"  id='input_radio_8_de38a868658e3681f54f1291adfc7492' aria-label='Solo 1 vaso' aria-invalid='false' aria-required=true> <span>Solo 1 vaso<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_17\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"16.- \u00bfEs usted fumador?\">16.- \u00bfEs usted fumador?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_4_da902b134d0eb4648e59d52d33274edc'><input  type=\"radio\" name=\"input_radio_4\" data-name=\"input_radio_4\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_radio_4_da902b134d0eb4648e59d52d33274edc' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_4_856be54a66138da317cc059f2b6ea81c'><input  type=\"radio\" name=\"input_radio_4\" data-name=\"input_radio_4\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_radio_4_856be54a66138da317cc059f2b6ea81c' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_text_4' id='label_ff_3_input_text_4' aria-label=\"\u00bfCuanto fuma al dia?\">\u00bfCuanto fuma al dia?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_4\" class=\"ff-el-form-control\" data-name=\"input_text_4\" id=\"ff_3_input_text_4\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_18\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"17.- \u00bfConsume o ha consumido drogas (marihuana, coca\u00edna, pasta base, etc.)?\">17.- \u00bfConsume o ha consumido drogas (marihuana, coca\u00edna, pasta base, etc.)?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_6e66a37ba4ddaa6b4b4dc95e4a58ac55'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_radio_3_6e66a37ba4ddaa6b4b4dc95e4a58ac55' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_fa717d19848e035ac6ca462c78527e43'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_radio_3_fa717d19848e035ac6ca462c78527e43' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_text_3' id='label_ff_3_input_text_3' aria-label=\"\u00bfCual?\">\u00bfCual?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_3\" class=\"ff-el-form-control\" data-name=\"input_text_3\" id=\"ff_3_input_text_3\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-3_4\" ><h2 style=\"text-align: left\"><strong>3.- PATOLOG\u00cdAS DE ORIGEN LABORAL<\/strong><\/h2><\/div><div data-name=\"ff_cn_id_19\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00bfHa sido evaluado por enfermedad profesional?\">\u00bfHa sido evaluado por enfermedad profesional?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_hsepep_57b50bda7987bb05042eac275287d699'><input  type=\"radio\" name=\"input_hsepep\" data-name=\"input_hsepep\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_hsepep_57b50bda7987bb05042eac275287d699' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_hsepep_b7c414163b17deeba1e90f01cffaf759'><input  type=\"radio\" name=\"input_hsepep\" data-name=\"input_hsepep\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_hsepep_b7c414163b17deeba1e90f01cffaf759' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_anio' id='label_ff_3_input_anio' aria-label=\"A\u00f1o\">A\u00f1o<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_anio\" class=\"ff-el-form-control\" data-name=\"input_anio\" id=\"ff_3_input_anio\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_empresa' id='label_ff_3_input_empresa' aria-label=\"Empresa\">Empresa<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_empresa\" class=\"ff-el-form-control\" data-name=\"input_empresa\" id=\"ff_3_input_empresa\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_20\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00bfHa sufrido alg\u00fan accidente?\">\u00bfHa sufrido alg\u00fan accidente?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_hsac_f3f0cf110c665625801be725ecfa6f8f'><input  type=\"radio\" name=\"input_hsac\" data-name=\"input_hsac\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_hsac_f3f0cf110c665625801be725ecfa6f8f' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_hsac_b78c231079f64e3cbbab289adb316f17'><input  type=\"radio\" name=\"input_hsac\" data-name=\"input_hsac\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_hsac_b78c231079f64e3cbbab289adb316f17' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_cual' id='label_ff_3_input_cual' aria-label=\"\u00bfCual?\">\u00bfCual?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_cual\" class=\"ff-el-form-control\" data-name=\"input_cual\" id=\"ff_3_input_cual\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_mlesiones' id='label_ff_3_input_mlesiones' aria-label=\"Mencione Lesiones\">Mencione Lesiones<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_mlesiones\" class=\"ff-el-form-control\" data-name=\"input_mlesiones\" id=\"ff_3_input_mlesiones\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_21\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group has-conditions  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00bfEl accidente fue dentro del trabajo?\">\u00bfEl accidente fue dentro del trabajo?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_eafddt_f5ae586aa50957e0befc70666abe03ae'><input  type=\"radio\" name=\"input_eafddt\" data-name=\"input_eafddt\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_eafddt_f5ae586aa50957e0befc70666abe03ae' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_eafddt_29ed71f69a3f9feb3e223076d62f4f32'><input  type=\"radio\" name=\"input_eafddt\" data-name=\"input_eafddt\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_eafddt_29ed71f69a3f9feb3e223076d62f4f32' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_anio_eafddt' id='label_ff_3_input_anio_eafddt' aria-label=\"A\u00f1o\">A\u00f1o<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_anio_eafddt\" class=\"ff-el-form-control\" data-name=\"input_anio_eafddt\" id=\"ff_3_input_anio_eafddt\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_eafddt_empresa' id='label_ff_3_input_eafddt_empresa' aria-label=\"Empresa\">Empresa<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_eafddt_empresa\" class=\"ff-el-form-control\" data-name=\"input_eafddt_empresa\" id=\"ff_3_input_eafddt_empresa\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_22\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 49.55%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00bfHa trabajado anteriormente expuesto a agentes de riesgo?\">\u00bfHa trabajado anteriormente expuesto a agentes de riesgo?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_htaeaadr_9be759f3dcfc4c3fc4affb7be56b7954'><input  type=\"radio\" name=\"input_htaeaadr\" data-name=\"input_htaeaadr\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_htaeaadr_9be759f3dcfc4c3fc4affb7be56b7954' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_htaeaadr_2c432172c548cf9c1d3aee57fecc07b0'><input  type=\"radio\" name=\"input_htaeaadr\" data-name=\"input_htaeaadr\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_htaeaadr_2c432172c548cf9c1d3aee57fecc07b0' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50.45%;'><div class='ff-el-group has-conditions  ff_list_2col'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Selecciona la\/las opci\u00f3n\/es\">Selecciona la\/las opci\u00f3n\/es<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_htaeaadr_2003ef9103b086f2d61d4421c9a65a44'><input  type=\"checkbox\" name=\"checkbox_htaeaadr[]\" data-name=\"checkbox_htaeaadr\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Ruido\"  id='checkbox_htaeaadr_2003ef9103b086f2d61d4421c9a65a44' aria-label='Ruido' aria-invalid='false' aria-required=true> <span>Ruido<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_htaeaadr_8b09e3de421316cdb7735bbf04589af7'><input  type=\"checkbox\" name=\"checkbox_htaeaadr[]\" data-name=\"checkbox_htaeaadr\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Polvo (S\u00edlice, madera, cemento, etc.)\"  id='checkbox_htaeaadr_8b09e3de421316cdb7735bbf04589af7' aria-label='Polvo (S\u00edlice, madera, cemento, etc.)' aria-invalid='false' aria-required=true> <span>Polvo (S\u00edlice, madera, cemento, etc.)<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_htaeaadr_9a8a8fd362f23d5662c02e3c4aa2d639'><input  type=\"checkbox\" name=\"checkbox_htaeaadr[]\" data-name=\"checkbox_htaeaadr\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Sustancias qu\u00edmicas\"  id='checkbox_htaeaadr_9a8a8fd362f23d5662c02e3c4aa2d639' aria-label='Sustancias qu\u00edmicas' aria-invalid='false' aria-required=true> <span>Sustancias qu\u00edmicas<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_htaeaadr_098ee31692443e1049a0cd337caf000a'><input  type=\"checkbox\" name=\"checkbox_htaeaadr[]\" data-name=\"checkbox_htaeaadr\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Vibraciones\"  id='checkbox_htaeaadr_098ee31692443e1049a0cd337caf000a' aria-label='Vibraciones' aria-invalid='false' aria-required=true> <span>Vibraciones<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_htaeaadr_e25abc1a261a56613ee5e1a2ffd14f34'><input  type=\"checkbox\" name=\"checkbox_htaeaadr[]\" data-name=\"checkbox_htaeaadr\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Radiaci\u00f3n UV\"  id='checkbox_htaeaadr_e25abc1a261a56613ee5e1a2ffd14f34' aria-label='Radiaci\u00f3n UV' aria-invalid='false' aria-required=true> <span>Radiaci\u00f3n UV<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_htaeaadr_5d2c39286c122b3dd67a238f11480163'><input  type=\"checkbox\" name=\"checkbox_htaeaadr[]\" data-name=\"checkbox_htaeaadr\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Trabajo en altura geogr\u00e1fica\"  id='checkbox_htaeaadr_5d2c39286c122b3dd67a238f11480163' aria-label='Trabajo en altura geogr\u00e1fica' aria-invalid='false' aria-required=true> <span>Trabajo en altura geogr\u00e1fica<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_htaeaadr_f50913b007975c47e68ce1125320ac87'><input  type=\"checkbox\" name=\"checkbox_htaeaadr[]\" data-name=\"checkbox_htaeaadr\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Otro\"  id='checkbox_htaeaadr_f50913b007975c47e68ce1125320ac87' aria-label='Otro' aria-invalid='false' aria-required=true> <span>Otro<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_texto_htaeaadr' id='label_ff_3_input_texto_htaeaadr' aria-label=\"\u00bfCuales?\">\u00bfCuales?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_texto_htaeaadr\" class=\"ff-el-form-control\" data-name=\"input_texto_htaeaadr\" id=\"ff_3_input_texto_htaeaadr\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_23\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00bfHa participado en alg\u00fan programa de vigilancia de salud ocupacional?\">\u00bfHa participado en alg\u00fan programa de vigilancia de salud ocupacional?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_hpeapdvdso_c216312c654df671ac14a06c938bf288'><input  type=\"radio\" name=\"input_hpeapdvdso\" data-name=\"input_hpeapdvdso\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_hpeapdvdso_c216312c654df671ac14a06c938bf288' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_hpeapdvdso_72f09318edceab84a1cd113dd42e009d'><input  type=\"radio\" name=\"input_hpeapdvdso\" data-name=\"input_hpeapdvdso\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_hpeapdvdso_72f09318edceab84a1cd113dd42e009d' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_anio_eafddt_2' id='label_ff_3_input_anio_eafddt_2' aria-label=\"\u00bfCu\u00e1l?\">\u00bfCu\u00e1l?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_anio_eafddt_2\" class=\"ff-el-form-control\" data-name=\"input_anio_eafddt_2\" id=\"ff_3_input_anio_eafddt_2\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_24\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00bfLe han diagnosticado alguna enfermedad relacionada con su trabajo?\">\u00bfLe han diagnosticado alguna enfermedad relacionada con su trabajo?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_eafddt_3_19f3d2b70adfe9f70f726558107defa6'><input  type=\"radio\" name=\"input_eafddt_3\" data-name=\"input_eafddt_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_eafddt_3_19f3d2b70adfe9f70f726558107defa6' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_eafddt_3_ee2795de7d45adf46af55fd405872201'><input  type=\"radio\" name=\"input_eafddt_3\" data-name=\"input_eafddt_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_eafddt_3_ee2795de7d45adf46af55fd405872201' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_cual_lhdaercst' id='label_ff_3_input_cual_lhdaercst' aria-label=\"\u00bfCu\u00e1l?\">\u00bfCu\u00e1l?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_cual_lhdaercst\" class=\"ff-el-form-control\" data-name=\"input_cual_lhdaercst\" id=\"ff_3_input_cual_lhdaercst\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_25\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 49.96%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00bfPosee alguna restricci\u00f3n m\u00e9dica para realizar actividades laborales?\">\u00bfPosee alguna restricci\u00f3n m\u00e9dica para realizar actividades laborales?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_parmpral_6b9113c35471c89f2e8080a363a9849f'><input  type=\"radio\" name=\"input_parmpral\" data-name=\"input_parmpral\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_parmpral_6b9113c35471c89f2e8080a363a9849f' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_parmpral_8fff0766181fa84a65279325ce231988'><input  type=\"radio\" name=\"input_parmpral\" data-name=\"input_parmpral\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_parmpral_8fff0766181fa84a65279325ce231988' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50.04%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_indique_parmpral' id='label_ff_3_input_indique_parmpral' aria-label=\"Indique\">Indique<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_indique_parmpral\" class=\"ff-el-form-control\" data-name=\"input_indique_parmpral\" id=\"ff_3_input_indique_parmpral\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_26\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 49.69%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00bfHa sufrido anteriormente alg\u00fan accidente del trabajo o enfermedad profesional calificada por el organismo administrador?\">\u00bfHa sufrido anteriormente alg\u00fan accidente del trabajo o enfermedad profesional calificada por el organismo administrador?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_hsaaadtoepcpeoa_4f663ea046f9c35c3461c53e5f2a3462'><input  type=\"radio\" name=\"input_hsaaadtoepcpeoa\" data-name=\"input_hsaaadtoepcpeoa\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_hsaaadtoepcpeoa_4f663ea046f9c35c3461c53e5f2a3462' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_hsaaadtoepcpeoa_4498506110fab5ebad607925d72f765c'><input  type=\"radio\" name=\"input_hsaaadtoepcpeoa\" data-name=\"input_hsaaadtoepcpeoa\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_hsaaadtoepcpeoa_4498506110fab5ebad607925d72f765c' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50.31%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_detalle_hsaaadtoepcpeoa' id='label_ff_3_input_detalle_hsaaadtoepcpeoa' aria-label=\"Detalle\">Detalle<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_detalle_hsaaadtoepcpeoa\" class=\"ff-el-form-control\" data-name=\"input_detalle_hsaaadtoepcpeoa\" id=\"ff_3_input_detalle_hsaaadtoepcpeoa\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_27\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 49.69%;'><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00bfHa sido evaluado m\u00e9dicamente por exposici\u00f3n a ruido, s\u00edlice, sustancias qu\u00edmicas u otros agentes ocupacionales?\">\u00bfHa sido evaluado m\u00e9dicamente por exposici\u00f3n a ruido, s\u00edlice, sustancias qu\u00edmicas u otros agentes ocupacionales?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_hsempearssquoao_0e71f754357c795e1bd859af39049619'><input  type=\"radio\" name=\"input_hsempearssquoao\" data-name=\"input_hsempearssquoao\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Si\"  id='input_hsempearssquoao_0e71f754357c795e1bd859af39049619' aria-label='Si' aria-invalid='false' aria-required=true> <span>Si<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_hsempearssquoao_1947dd48ada7dcdc8208413932298769'><input  type=\"radio\" name=\"input_hsempearssquoao\" data-name=\"input_hsempearssquoao\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No\"  id='input_hsempearssquoao_1947dd48ada7dcdc8208413932298769' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50.31%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_cfeae' id='label_ff_3_input_cfeae' aria-label=\"\u00bfCu\u00e1l fue el agente evaluado?\">\u00bfCu\u00e1l fue el agente evaluado?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_cfeae\" class=\"ff-el-form-control\" data-name=\"input_cfeae\" id=\"ff_3_input_cfeae\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_rdle' id='label_ff_3_input_rdle' aria-label=\"Resultado de la evaluaci\u00f3n\">Resultado de la evaluaci\u00f3n<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_rdle\" class=\"ff-el-form-control\" data-name=\"input_rdle\" id=\"ff_3_input_rdle\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_fopdce' id='label_ff_3_input_fopdce' aria-label=\"Frecuencia o periodicidad de control establecida\">Frecuencia o periodicidad de control establecida<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_fopdce\" class=\"ff-el-form-control\" data-name=\"input_fopdce\" id=\"ff_3_input_fopdce\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-3_5\" ><h4><i>Declaro que la informaci\u00f3n suministrada es totalmente verdadera, asumiendo toda responsabilidad en caso de omisi\u00f3n<\/i><\/h4><\/div><div class='ff-el-group ff-text-center ff_submit_btn_wrapper'><button type=\"submit\" class=\"ff-btn ff-btn-submit ff-btn-lg ff_btn_no_style\"  aria-label=\"Submit Form\">Submit Form<\/button><\/div><\/fieldset><\/form><div id='fluentform_3_errors' class='ff-errors-in-stack ff_form_instance_3_1 ff-form-loading_errors ff_form_instance_3_1_errors'><\/div><\/div>            <script type=\"text\/javascript\">\n                window.fluent_form_ff_form_instance_3_1 = {\"id\":\"3\",\"ajaxUrl\":\"https:\\\/\\\/www.ameci.cl\\\/declaracion-salud\\\/wp-admin\\\/admin-ajax.php\",\"settings\":{\"layout\":{\"labelPlacement\":\"top\",\"asteriskPlacement\":\"asterisk-right\",\"helpMessagePlacement\":\"with_label\",\"errorMessagePlacement\":\"inline\",\"cssClassName\":\"\"},\"restrictions\":{\"denyEmptySubmission\":{\"enabled\":false}}},\"form_instance\":\"ff_form_instance_3_1\",\"form_id_selector\":\"fluentform_3\",\"rules\":{\"input_text_7\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_cargo\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_mask\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_fecha_ingreso\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_1\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_2\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_3\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_4\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_texto_4\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_5\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_6\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_7\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_8\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_texto_8\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_9\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_texto_9\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_10\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_texto_10\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_11\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_texto_11\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_radio\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_text\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_radio_2\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_text_2\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_radio_1\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_text_1\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_radio_5\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_radio_7\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_radio_8\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_radio_4\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_text_4\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_radio_3\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_text_3\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_hsepep\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_anio\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_empresa\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_hsac\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_cual\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_mlesiones\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_eafddt\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_anio_eafddt\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_eafddt_empresa\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_htaeaadr\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"checkbox_htaeaadr\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_texto_htaeaadr\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_hpeapdvdso\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_anio_eafddt_2\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_eafddt_3\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_cual_lhdaercst\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_parmpral\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_indique_parmpral\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_hsaaadtoepcpeoa\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_detalle_hsaaadtoepcpeoa\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_hsempearssquoao\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_cfeae\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_rdle\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}},\"input_fopdce\":{\"required\":{\"value\":true,\"message\":\"Este campo es obligatorio\",\"global_message\":\"Este campo es obligatorio\",\"global\":true}}},\"debounce_time\":300,\"conditionals\":{\"input_texto_4\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_4\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_texto_8\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_8\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_texto_9\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_9\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_texto_10\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_10\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_texto_11\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_11\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_text\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_radio\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_text_2\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_radio_2\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_text_1\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_radio_1\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_radio_7\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_radio_5\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_radio_8\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_radio_5\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_text_4\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_radio_4\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_text_3\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_radio_3\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_anio\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_hsepep\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_empresa\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_hsepep\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_cual\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_hsac\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_mlesiones\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_hsac\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_eafddt\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_hsac\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_anio_eafddt\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_eafddt\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_eafddt_empresa\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_eafddt\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"checkbox_htaeaadr\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_htaeaadr\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_texto_htaeaadr\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"checkbox_htaeaadr\",\"value\":\"Otro\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_anio_eafddt_2\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_hpeapdvdso\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_cual_lhdaercst\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_eafddt_3\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_indique_parmpral\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_parmpral\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_detalle_hsaaadtoepcpeoa\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_hsaaadtoepcpeoa\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_cfeae\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_hsempearssquoao\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_rdle\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_hsempearssquoao\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]},\"input_fopdce\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_hsempearssquoao\",\"value\":\"Si\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]}},\"file_upload_settings\":[]};\n                            <\/script>\n            \n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"lienzo-blanco-2","meta":{"footnotes":""},"class_list":["post-11","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.ameci.cl\/declaracion-salud\/wp-json\/wp\/v2\/pages\/11","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ameci.cl\/declaracion-salud\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.ameci.cl\/declaracion-salud\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.ameci.cl\/declaracion-salud\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ameci.cl\/declaracion-salud\/wp-json\/wp\/v2\/comments?post=11"}],"version-history":[{"count":6,"href":"https:\/\/www.ameci.cl\/declaracion-salud\/wp-json\/wp\/v2\/pages\/11\/revisions"}],"predecessor-version":[{"id":23,"href":"https:\/\/www.ameci.cl\/declaracion-salud\/wp-json\/wp\/v2\/pages\/11\/revisions\/23"}],"wp:attachment":[{"href":"https:\/\/www.ameci.cl\/declaracion-salud\/wp-json\/wp\/v2\/media?parent=11"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}