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  1. <!DOCTYPE html>
  2. <html lang="pt-br">
  3. <head>
  4.     <title>Pagina da Clinica</title>
  5.     <link rel="stylesheet" type="text/css" href="CSS/stylenovo.css">
  6.     <link href="https://fonts.googleapis.com/css?family=Rajdhani|Roboto:100&display=swap" rel="stylesheet">
  7.     <meta name="viewport" content="width=device-width, initial-scale=1.0" >
  8.     <meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no">
  9.     <meta charset="utf-8">
  10.     <link rel="stylesheet" href="https://stackpath.bootstrapcdn.com/bootstrap/4.4.1/css/bootstrap.min.css" integrity="sha384-Vkoo8x4CGsO3+Hhxv8T/Q5PaXtkKtu6ug5TOeNV6gBiFeWPGFN9MuhOf23Q9Ifjh" crossorigin="anonymous">
  11. </head>
  12.  
  13. <body id="corpo">
  14. <script src="https://code.jquery.com/jquery-3.4.1.slim.min.js" integrity="sha384-J6qa4849blE2+poT4WnyKhv5vZF5SrPo0iEjwBvKU7imGFAV0wwj1yYfoRSJoZ+n" crossorigin="anonymous"></script>
  15. <script src="https://cdn.jsdelivr.net/npm/popper.js@1.16.0/dist/umd/popper.min.js" integrity="sha384-Q6E9RHvbIyZFJoft+2mJbHaEWldlvI9IOYy5n3zV9zzTtmI3UksdQRVvoxMfooAo" crossorigin="anonymous"></script>
  16. <script src="https://stackpath.bootstrapcdn.com/bootstrap/4.4.1/js/bootstrap.min.js" integrity="sha384-wfSDF2E50Y2D1uUdj0O3uMBJnjuUD4Ih7YwaYd1iqfktj0Uod8GCExl3Og8ifwB6" crossorigin="anonymous"></script>
  17.  
  18.     <div class="cabeçalho">
  19.         <header><h1 style="font-size: 250%">CBD NA EPILEPSIA REFRATÁRIA</h1></header>
  20.         <h3 class="titulo-vis">Visita 01 </h3>
  21.         <hr class="hr-vis">
  22.     </div>
  23.     <hr class="hr1">
  24. <form>
  25.     <div class="tabela">
  26.     <h2 class="titulo">Identificação</h2>
  27.         <div class="formulario-block">
  28.                 <div class="linha">
  29.                  <label for="nome">Nome: </label>
  30.                  <input class="ipt" id="nome" autofocus title="Digite seu nome completo" type="text" name="nome" size="60" required >
  31.                 </div>
  32.                 <div class="linha">
  33.                  <label class="" for="vis1ptr">Prontuário: </label>
  34.                  <input class="ipt" id="vis1ptr" type="text" name="Prontuário">   
  35.                 </div>
  36.         </div>
  37.  
  38.         <div class="formulario-flex">
  39.             <div class="coluna"><!-- Coluna 1-->
  40.                
  41.                 <div class="linha">
  42.                  <label for="data-nasc">Data de Nascimento:</label>
  43.                  <input class="ipt" id="data-nasc" type="date" name="Data de Nascimento" >
  44.                 </div>
  45.                 <!-- <div class="linha">
  46.                  <label id="nat" for="vis1nat">Naturalidade:</label>
  47.                  <input id="vis1nat" class="ipt" type="text" name="Naturalidade">  
  48.                 </div>-->
  49.                 <div class="linha">
  50.                  <label id="end" for="vis1end">Endereço:</label>
  51.                  <input id="vis1end" class="ipt"  type="text" name="Endereço" size="60">
  52.                 </div>
  53.             </div>
  54.             <div class="coluna"><!-- Coluna 2-->
  55.                 <div class="linha">
  56.                  <label class="" for="idade"> Idade: </label>
  57.                  <input class="ipt" id="idade" type="number" name="Idade" min="0">
  58.                 </div>
  59.             </div>
  60.             <div class="coluna"><!-- Coluna 3-->
  61.                 <div id="ipt-sexo" class="">
  62.                  <label class="espc">Sexo:</label>
  63.                  <input id="vis1masc" class="iptr" type="radio" name="Sexo" value="1"><label for="vis1masc">Masculino</label>
  64.                  <input id="vis1fem" class="iptr" type="radio" name="Sexo" value="2"><label for="vis1fem">Feminino</label>
  65.                 </div>
  66.             </div>
  67.         </div>
  68.         <div class="formulario-block">
  69.             <div class="">
  70.                  <label id="end" for="vis1end">Endereço:</label>
  71.                  <input id="vis1end" class="ipt"  type="text" name="Endereço" size="60">
  72.                 </div>
  73.             <div class="formulario-flex">
  74.                 <label id="et">Etnia:</label>
  75.                  <input id="vis1pret" class="iptr" type="radio" name="Etnia" value="1"><label for="vis1pret">Preto</label>  
  76.                 <input id="vis1pard" class="iptr" type="radio" name="Etnia" value="2"><label for="vis1pard">Pardo</label>  
  77.                 <input id="vis1bran" class="iptr" type="radio" name="Etnia" value="3"><label for="vis1bran">Branco</label>  
  78.                 <input id="vis1ama" class="iptr" type="radio" name="Etnia" value="4"><label for="vis1ama">Amarelo</label>
  79.                 <input id="vis1ind" class="iptr" type="radio" name="Etnia" value="5"><label for="vis1ind">Indígena</label>
  80.             </div>
  81.         </div>
  82.        
  83.     </div>
  84. </form>
  85.     <footer> Todos os direitos reservados a Hawah Tecnologias</footer>
  86. </body>
  87. </html>
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