{"id":1914,"date":"2026-06-26T14:11:01","date_gmt":"2026-06-26T14:11:01","guid":{"rendered":"https:\/\/airmedical.com\/?page_id=1914"},"modified":"2026-09-29T12:17:54","modified_gmt":"2026-09-29T12:17:54","slug":"reservar-avion-ambulancia","status":"publish","type":"page","link":"https:\/\/airmedical.com\/es\/reservar-avion-ambulancia\/","title":{"rendered":"Reservar Avi\u00f3n Ambulancia"},"content":{"rendered":"<div class=\"et_pb_section_0 et_pb_section et_section_regular et_block_section\">\n<div class=\"et_pb_row_0 et_pb_row et_flex_row\">\n<div class=\"et_pb_column_0 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_24_24 et_flex_column_24_24_tablet et_flex_column_24_24_phone\">\n<div class=\"et_pb_text_0 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><h1>Reservar Avi\u00f3n Ambulancia<\/h1>\n<p style=\"text-align: center;\"><strong>Coordinaci\u00f3n clara. Planificaci\u00f3n cuidadosa. Comunicaci\u00f3n serena.<\/strong><\/p>\n<p>Use esta p\u00e1gina cuando est\u00e9 listo para enviar una solicitud de reserva de avi\u00f3n ambulancia para un traslado gestionado por Air Medical Transport.<\/p>\n<p><strong>Air Medical Transport ofrece gesti\u00f3n completa de traslados de cama a cama en avi\u00f3n ambulancia.<\/strong><\/p>\n<p>Air Medical Transport se enfoca en la gesti\u00f3n de traslados en avi\u00f3n ambulancia de pago privado.<\/p>\n<p>Nuestros Especialistas en Coordinaci\u00f3n de Traslados en Avi\u00f3n Ambulancia gestionan cada caso a trav\u00e9s de operadores seleccionados de avi\u00f3n ambulancia con certificaci\u00f3n FAA Part 135 y\/o EASA.<\/p>\n<p>Los m\u00e9dicos tratantes del paciente gu\u00edan las decisiones cl\u00ednicas.<\/p>\n<p>Nuestro equipo utiliza la informaci\u00f3n proporcionada para revisar requisitos de reserva y los pr\u00f3ximos pasos necesarios para avanzar con claridad.<a href=\"tel:+1-832-872-2222\"><\/a><\/p>\n<\/div><\/div>\n\n<div class=\"et_pb_row_1 et_pb_row et_pb_row_nested et_flex_row\">\n<div class=\"et_pb_column_1 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_24_24 et_flex_column_24_24_tablet et_flex_column_24_24_phone\">\n<div class=\"et_pb_text_1 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><p style=\"text-align: center;\"><strong>Los Especialistas en Coordinaci\u00f3n de Traslados en Avi\u00f3n Ambulancia est\u00e1n disponibles 24\/7 para orientar preguntas de reserva.<\/strong><\/p>\n<p style=\"text-align: center;\"><strong>USA y Canad\u00e1:<\/strong> <a href=\"tel:+1-800-872-6667\">+1-800-872-6667<\/a><br \/><strong>Internacional:<\/strong> <a href=\"tel:+1-832-872-2222\">+1-832-872-2222<\/a><\/p>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n\n<div class=\"et_pb_section_1 et_pb_section et_section_regular et_block_section\">\n<div class=\"et_pb_row_2 et_pb_row et_flex_row\">\n<div class=\"et_pb_column_2 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_24_24 et_flex_column_24_24_tablet et_flex_column_24_24_phone\">\n<div class=\"et_pb_text_2 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><h2>Antes de comenzar<\/h2>\n<\/div><\/div>\n\n<div class=\"et_pb_text_3 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><div style=\"text-align: center;\"><strong>Este es un formulario estructurado de reserva. Solo se requiere la informaci\u00f3n esencial.<\/strong><\/div>\n<div style=\"text-align: center;\"><strong><\/strong><\/div>\n<div><span>Proporcionar datos precisos del paciente, fecha solicitada del traslado, contactos de centros hospitalarios, informaci\u00f3n de destino, informaci\u00f3n de pasajeros, documentos y datos del pagador ayuda a nuestro equipo a revisar la solicitud de reserva con claridad y evitar demoras prevenibles.<\/span><span><\/span><\/div>\n<div><span><\/span><\/div>\n<\/div><\/div>\n\n<div class=\"et_pb_text_4 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><div>\n<div><strong>Descargue el formulario de reserva o complete el formulario de solicitud de reserva a continuaci\u00f3n cuando est\u00e9 listo para enviar los detalles del traslado para revisi\u00f3n.<\/strong><\/div>\n<\/div>\n<\/div><\/div>\n\n<div class=\"et_pb_module et_pb_button_module_wrapper et_pb_button_0_wrapper\"><a class=\"et_pb_button_0 et_pb_button et_pb_bg_layout_light et_pb_module et_flex_module\" href=\"https:\/\/airmedical.com\/wp-content\/uploads\/2026\/07\/2.-Detalles-Para-Reserva-Rellenable.pdf\" target=\"_blank\">Descargar formulario de reserva<\/a><\/div>\n\n<div class=\"et_pb_row_3 et_pb_row et_pb_row_nested et_flex_row\">\n<div class=\"et_pb_column_3 et_pb_column et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_12_24 et_flex_column_12_24_tablet et_flex_column_24_24_phone\">\n<div class=\"et_pb_text_5 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><h2 style=\"margin-top: 0; margin-bottom: 0px;\">Solicitar Cotizaci\u00f3n<\/h2>\n<p>Si a\u00fan no tiene una cotizaci\u00f3n, comience con.<\/p>\n<\/div><\/div>\n\n<div class=\"et_pb_column_4 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_24_24 et_flex_column_24_24_tablet et_flex_column_24_24_phone\">\n<div class=\"et_pb_module et_pb_button_module_wrapper et_pb_button_1_wrapper preset--module--divi-button--d9f5dd98-2ac7-489a-a45e-44397923f485_wrapper\"><a class=\"et_pb_button_1 et_pb_button et_pb_bg_layout_light et_pb_module et_flex_module preset--module--divi-button--d9f5dd98-2ac7-489a-a45e-44397923f485\" href=\"https:\/\/airmedical.com\/es\/cotizacion-avion-ambulancia\/\">COTIZACI\u00d3N<\/a><\/div>\n<\/div>\n<\/div>\n\n<div class=\"et_pb_column_5 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_12_24 et_flex_column_12_24_tablet et_flex_column_24_24_phone\">\n<div class=\"et_pb_text_6 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><h2 style=\"margin-top: 0; margin-bottom: 0px;\">Pagar en L\u00ednea<\/h2>\n<p><span>Las instrucciones de pago por transferencia bancaria se incluyen con cada cotizaci\u00f3n. Si prefiere pagar o completar una autorizaci\u00f3n aprobada de tarjeta de cr\u00e9dito en l\u00ednea, utilice el siguiente enlace:<\/span><\/p>\n<\/div><\/div>\n\n<div class=\"et_pb_column_6 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_24_24 et_flex_column_24_24_tablet et_flex_column_24_24_phone\">\n<div class=\"et_pb_module et_pb_button_module_wrapper et_pb_button_2_wrapper preset--module--divi-button--d9f5dd98-2ac7-489a-a45e-44397923f485_wrapper\"><a class=\"et_pb_button_2 et_pb_button et_pb_bg_layout_light et_pb_module et_flex_module preset--module--divi-button--d9f5dd98-2ac7-489a-a45e-44397923f485\" href=\"https:\/\/airmedical.com\/es\/pago-en-linea\/\">PAGAR EN L\u00cdNEA<\/a><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n\n<div class=\"et_pb_row_4 et_pb_row et_flex_row\">\n<div class=\"et_pb_column_7 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_24_24 et_flex_column_24_24_tablet et_flex_column_24_24_phone\">\n<div class=\"et_pb_text_7 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><p style=\"text-align: center;\"><em><strong>Disponibles 24\/7 para preguntas sensibles al tiempo sobre avi\u00f3n ambulancia y planificaci\u00f3n del traslado.<\/strong><\/em><\/p>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n\n<div class=\"et_pb_section_2 et_pb_section et_section_regular et_block_section\">\n<div class=\"et_pb_row_5 et_pb_row et_flex_row pa-bullet-list-1\">\n<div class=\"et_pb_column_8 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_24_24 et_flex_column_24_24_tablet et_flex_column_24_24_phone\">\n<div class=\"et_pb_text_8 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><h2>Qu\u00e9 esperar<\/h2>\n<\/div><\/div>\n\n<div class=\"et_pb_text_9 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><ul>\n<li>Esta p\u00e1gina es \u00fanicamente para solicitudes de reserva de avi\u00f3n ambulancia.<\/li>\n<li>Cada solicitud es revisada individualmente por un Especialista en Coordinaci\u00f3n de Traslados en Avi\u00f3n Ambulancia.<\/li>\n<\/ul>\n<p>Las opciones de traslado en avi\u00f3n ambulancia son espec\u00edficas para cada caso y permanecen sujetas a disponibilidad de aeronave, tripulaci\u00f3n de vuelo y personal m\u00e9dico al momento de la reserva, junto con la condici\u00f3n del paciente, el criterio del m\u00e9dico tratante, la ruta, el clima, la documentaci\u00f3n, los aeropuertos adecuados, los requisitos de pago y los requisitos regulatorios aplicables. Los traslados internacionales o intercontinentales tambi\u00e9n pueden depender de aduanas, permisos de aterrizaje, permisos de sobrevuelo y autorizaciones espec\u00edficas de cada pa\u00eds.<\/p>\n<p>Cuando sea posible, env\u00ede las solicitudes de reserva con la mayor anticipaci\u00f3n pr\u00e1ctica. Los tiempos m\u00e1s cortos tambi\u00e9n pueden revisarse, pero la aeronave, la tripulaci\u00f3n de vuelo, el personal m\u00e9dico, la ruta, el clima, la documentaci\u00f3n, los permisos aplicables y la finalizaci\u00f3n del pago o preautorizaci\u00f3n de tarjeta de cr\u00e9dito pueden afectar las opciones de programaci\u00f3n, especialmente en traslados internacionales o intercontinentales de larga distancia.<\/p>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n\n<div class=\"et_pb_section_3 et_pb_section et_section_regular et_flex_section\">\n<div class=\"et_pb_row_6 et_pb_row et_flex_row\">\n<div class=\"et_pb_column_9 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_24_24 et_flex_column_24_24_tablet et_flex_column_24_24_phone\">\n<div class=\"et_pb_text_10 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><h2>Formulario de reserva de avi\u00f3n ambulancia<\/h2>\n<\/div><\/div>\n<\/div>\n<\/div>\n\n<div class=\"et_pb_row_7 et_pb_row et_flex_row\">\n<div class=\"et_pb_column_10 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_24_24 et_flex_column_24_24_tablet et_flex_column_24_24_phone\">\n<div class=\"et_pb_code_0 et_pb_code et_pb_module\"><div class=\"et_pb_code_inner\"><div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_4_container\" data-token=\"992c09f12d4d16554b8d29b0d93daaa9\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_bookingrequest\" data-token=\"992c09f12d4d16554b8d29b0d93daaa9\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">RESERVAR AVI\u00d3N AMBULANCIA<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"4\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_4\" id=\"frm_hide_fields_4\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"bookingrequest\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_4\" name=\"frm_submit_entry_4\" value=\"e8743b5271\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/es\/wp-json\/wp\/v2\/pages\/1914\" \/><div id=\"frm_field_47_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Informaci\u00f3n de contacto<\/h3>\r\n\r\n\r\n<div id=\"frm_field_48_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4 frm_first\">\r\n    <label for=\"field_j2v5a\" id=\"field_j2v5a_label\" class=\"frm_primary_label\">Nombre de contacto\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_j2v5a\" name=\"item_meta[48]\" value=\"\"  data-sectionid=\"47\"  placeholder=\"Nombre y apellidos\" data-reqmsg=\"Este campo es obligatorio.\" aria-required=\"true\" data-invmsg=\"El texto no es v\u00e1lido.\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_49_container\" class=\"frm_form_field form-field  frm_top_container frm4\">\r\n\t<label for=\"field_ieg4r\" id=\"field_ieg4r_label\" class=\"frm_primary_label\">Relaci\u00f3n con el paciente\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t\t\t<select name=\"item_meta[49]\" id=\"field_ieg4r\"  data-sectionid=\"47\"  data-invmsg=\"Relaci\u00f3n con el paciente no es v\u00e1lido.\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Self (patient)\">Paciente<\/option><option  value=\"Spouse \/ Partner\">C\u00f3nyuge \/ pareja<\/option><option  value=\"Parent\">Padre \/ madre<\/option><option  value=\"Child\">Hijo \/ hija<\/option><option  value=\"Other family member\">Otro familiar<\/option><option  value=\"Friend\">Amigo<\/option><option  value=\"Case manager\">Gestor de caso<\/option><option  value=\"Social worker\">Trabajador social<\/option><option  value=\"Nurse\">Enfermero\/a<\/option><option  value=\"Physician\">M\u00e9dico<\/option><option  value=\"Facility staff\">Personal del centro<\/option><option  value=\"Embassy \/ patient liaison\">Embajada \/ enlace de paciente<\/option><option  value=\"Other\">Otro<\/option>\t<\/select>\n\t\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_50_container\" class=\"frm_form_field form-field  frm_top_container frm4\">\r\n    <label for=\"field_4a5pe\" id=\"field_4a5pe_label\" class=\"frm_primary_label\">Organizaci\u00f3n o centro m\u00e9dico\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_4a5pe\" name=\"item_meta[50]\" value=\"\"  data-sectionid=\"47\"  data-invmsg=\"El texto no es v\u00e1lido.\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_51_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm3 frm_first\">\r\n    <label for=\"field_tjz9y\" id=\"field_tjz9y_label\" class=\"frm_primary_label\">Tel\u00e9fono\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_tjz9y\" name=\"item_meta[51]\" value=\"\"  data-sectionid=\"47\"  placeholder=\"+C\u00f3digo de pa\u00eds (c\u00f3digo de \u00e1rea) #\" data-reqmsg=\"Tel\u00e9fono es obligatorio.\" aria-required=\"true\" data-invmsg=\"Tel\u00e9fono no es v\u00e1lido\" class=\"frm-intl-tel-input\" aria-invalid=\"false\" pattern=\"\\+?\\d{1,4}[\\s\\-]?(?:\\(\\d{1,3}\\)[\\s\\-]?)?\\d{1,4}[\\s\\-]?\\d{1,4}[\\s\\-]?\\d{1,4}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_52_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n    <label for=\"field_xt8zb\" id=\"field_xt8zb_label\" class=\"frm_primary_label\">M\u00f3vil \/ WhatsApp\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_xt8zb\" name=\"item_meta[52]\" value=\"\"  data-sectionid=\"47\"  placeholder=\"+C\u00f3digo de pa\u00eds (c\u00f3digo de \u00e1rea) #\" data-invmsg=\"El n\u00famero de tel\u00e9fono no es v\u00e1lido.\" class=\"frm-intl-tel-input\" aria-invalid=\"false\" pattern=\"\\+?\\d{1,4}[\\s\\-]?(?:\\(\\d{1,3}\\)[\\s\\-]?)?\\d{1,4}[\\s\\-]?\\d{1,4}[\\s\\-]?\\d{1,4}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_53_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm3\">\r\n    <label for=\"field_cghse\" id=\"field_cghse_label\" class=\"frm_primary_label\">Correo electr\u00f3nico\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_cghse\" name=\"item_meta[53]\" value=\"\"  data-sectionid=\"47\"  data-reqmsg=\"Este campo es obligatorio.\" aria-required=\"true\" data-invmsg=\"Correo electr\u00f3nico no es v\u00e1lido\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_54_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n    <label for=\"field_8spm6\" id=\"field_8spm6_label\" class=\"frm_primary_label\">N\u00famero de caso o referencia\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_8spm6\" name=\"item_meta[54]\" value=\"\"  data-sectionid=\"47\"  data-invmsg=\"El texto no es v\u00e1lido.\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_56_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Informaci\u00f3n del paciente<\/h3>\r\n\r\n\r\n<div id=\"frm_field_57_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4 frm_first\">\r\n    <label for=\"field_p4b48\" id=\"field_p4b48_label\" class=\"frm_primary_label\">Nombre del paciente\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_p4b48\" name=\"item_meta[57]\" value=\"\"  data-sectionid=\"56\"  placeholder=\"Nombre completo\" data-reqmsg=\"Este campo es obligatorio.\" aria-required=\"true\" data-invmsg=\"El texto no es v\u00e1lido.\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_58_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm3\">\r\n    <label for=\"field_8hvl6\" id=\"field_8hvl6_label\" class=\"frm_primary_label\">Fecha de nacimiento\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_8hvl6\" name=\"item_meta[58]\" value=\"\"  data-sectionid=\"56\"  style=\"width:50%\" maxlength=\"10\" data-reqmsg=\"Este campo es obligatorio.\" aria-required=\"true\" data-invmsg=\"La fecha no es v\u00e1lida.\" class=\"frm_date auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_59_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm3\">\r\n    <label for=\"field_1sv3y\" id=\"field_1sv3y_label\" class=\"frm_primary_label\">Fecha solicitada del traslado\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_1sv3y\" name=\"item_meta[59]\" value=\"\"  data-sectionid=\"56\"  style=\"width:50%\" maxlength=\"10\" data-reqmsg=\"Este campo es obligatorio.\" aria-required=\"true\" data-invmsg=\"La fecha no es v\u00e1lida.\" class=\"frm_date auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_60_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm2\">\r\n    <label for=\"field_sgpxu\" id=\"field_sgpxu_label\" class=\"frm_primary_label\">Estatura (cm o ft\/in)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_sgpxu\" name=\"item_meta[60]\" value=\"\"  data-sectionid=\"56\"  style=\"width:50%\" data-reqmsg=\"Este campo es obligatorio.\" aria-required=\"true\" data-invmsg=\"El texto no es v\u00e1lido.\" class=\"auto_width\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_61_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm3 frm_first\">\r\n    <label for=\"field_emven\" id=\"field_emven_label\" class=\"frm_primary_label\">Peso (kg o lb)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_emven\" name=\"item_meta[61]\" value=\"\"  data-sectionid=\"56\"  style=\"width:50%\" data-reqmsg=\"Peso (kg o lb) es obligatorio.\" aria-required=\"true\" data-invmsg=\"El texto no es v\u00e1lido.\" class=\"auto_width\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_62_container\" class=\"frm_form_field  frm9 frm_html_container form-field\">\n<p><em><span style=\"color: #000000\"><strong>Nota: Para pacientes con un peso de 300 lb (136 kg)<\/strong> o m\u00e1s, complete nuestro <\/span> <span style=\"text-decoration: underline\"><a href=\"https:\/\/ambulanceworldwide.com\/wp-content\/uploads\/2026\/07\/3.-Evaluacion-para-Transportes-Bariatricos-Rellenable.pdf\" target=\"_blank\" rel=\"noopener\">Formulario de Evaluaci\u00f3n para Transporte Bari\u00e1trico<\/a><\/span> <span style=\"color: #000000\"> para ayudarnos a determinar la opci\u00f3n de transporte m\u00e1s segura y adecuada.<\/span> <\/em><\/p>\n<\/div>\n<div id=\"frm_field_63_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_iecy4\" id=\"field_iecy4_label\" class=\"frm_primary_label\">Diagn\u00f3stico \/ detalles m\u00e9dicos\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[63]\" id=\"field_iecy4\" rows=\"5\"  data-sectionid=\"56\"  data-reqmsg=\"Este campo es obligatorio.\" aria-required=\"true\" data-invmsg=\"Diagn\u00f3stico \/ detalles m\u00e9dicos no es v\u00e1lido\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_64_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first\">\r\n    <label for=\"field_nad6m\" id=\"field_nad6m_label\" class=\"frm_primary_label\">\u00bfIncluir traslado de cama a cama en esta solicitud de reserva?\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[64]\" id=\"field_nad6m\"  data-sectionid=\"56\"  data-reqmsg=\"Este campo es obligatorio.\" aria-required=\"true\" data-invmsg=\"\u00bfIncluir traslado de cama a cama en esta solicitud de reserva? no es v\u00e1lido.\" class=\"auto_width\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Yes, include ground transportation at origin and destination\">S\u00ed, incluir traslado terrestre en origen y destino<\/option><option  value=\"No, fixed-wing air ambulance only\">No, solo avi\u00f3n ambulancia<\/option><option  value=\"Not sure \/ need guidance\">No estoy seguro \/ necesito orientaci\u00f3n<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_66_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Informaci\u00f3n de pasajeros (si est\u00e1 aprobado)<\/h3>\r\n\r\n\r\n<div id=\"frm_field_67_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first vertical_radio\">\r\n\t<div  id=\"field_cj00v_label\" class=\"frm_primary_label\">\u00bfAlg\u00fan familiar o pasajero aprobado viajar\u00e1 con el paciente?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_cj00v_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_67-66-0\">\t\t\t<label  for=\"field_cj00v-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[67]\" id=\"field_cj00v-0\" value=\"Yes\"\n\t\t data-sectionid=\"66\"  data-frmval=\"No\" data-invmsg=\"\u00bfAlg\u00fan familiar o pasajero aprobado viajar\u00e1 con el paciente? no es v\u00e1lido.\" aria-describedby=\"frm_desc_field_cj00v\"   \/> S\u00ed<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_67-66-1\">\t\t\t<label  for=\"field_cj00v-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[67]\" id=\"field_cj00v-1\" value=\"No\"\n\t\t data-sectionid=\"66\"  data-frmval=\"No\" data-invmsg=\"\u00bfAlg\u00fan familiar o pasajero aprobado viajar\u00e1 con el paciente? no es v\u00e1lido.\"  checked=\"checked\" aria-describedby=\"frm_desc_field_cj00v\" \/> No<\/label><\/div>\n<\/div>\r\n\t<div class=\"frm_description\" id=\"frm_desc_field_cj00v\">El viaje de pasajeros se revisa seg\u00fan las necesidades del paciente, la configuraci\u00f3n de la aeronave, l\u00edmites de peso, ruta y requisitos del operador seleccionado.<\/div>\r\n\t\r\n<\/div>\n<div id=\"frm_field_68_container\" class=\"frm_form_field  frm12 frm_first frm_html_container form-field\"><strong>Pasajero 1<\/strong><\/div>\n<div id=\"frm_field_69_container\" class=\"frm_form_field form-field  frm_top_container frm3 frm_first\">\r\n    <label for=\"field_6r3ak\" id=\"field_6r3ak_label\" class=\"frm_primary_label\">Nombre\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_6r3ak\" name=\"item_meta[69]\" value=\"\"  data-sectionid=\"66\"  placeholder=\"Nombre completo\" data-invmsg=\"El texto no es v\u00e1lido.\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_70_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n    <label for=\"field_pni0p\" id=\"field_pni0p_label\" class=\"frm_primary_label\">Relaci\u00f3n\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_pni0p\" name=\"item_meta[70]\" value=\"\"  data-sectionid=\"66\"  data-invmsg=\"El texto no es v\u00e1lido.\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_71_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n    <label for=\"field_tzqhy\" id=\"field_tzqhy_label\" class=\"frm_primary_label\">Fecha de nacimiento\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_tzqhy\" name=\"item_meta[71]\" value=\"\"  data-sectionid=\"66\"  style=\"width:35%\" maxlength=\"10\" data-invmsg=\"La fecha no es v\u00e1lida.\" class=\"frm_date auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_72_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n    <label for=\"field_3pdcu\" id=\"field_3pdcu_label\" class=\"frm_primary_label\">Peso (kg o lb)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_3pdcu\" name=\"item_meta[72]\" value=\"\"  data-sectionid=\"66\"  style=\"width:35%\" data-invmsg=\"El texto no es v\u00e1lido.\" class=\"auto_width\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_73_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_half\">\r\n\t<label for=\"field_4xfz4\" id=\"field_4xfz4_label\" class=\"frm_primary_label\">Pasajeros adicionales\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t\t\t<select name=\"item_meta[73]\" id=\"field_4xfz4\"  data-sectionid=\"66\"  data-frmval=\"None\" data-invmsg=\"Pasajeros adicionales no es v\u00e1lido.\" aria-invalid=\"false\"  >\n\t\t<option  value=\"None\" selected='selected'>Ninguno<\/option><option  value=\"Add Passenger 2\">Agregar pasajero 2<\/option><option  value=\"Add Passenger 2 and 3\">Agregar pasajeros 2 y 3<\/option>\t<\/select>\n\t\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_74_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p><strong>Pasajero 2 <\/strong><\/p>\n<\/div>\n<div id=\"frm_field_75_container\" class=\"frm_form_field form-field  frm_top_container frm3 frm_first\">\r\n    <label for=\"field_hcc2l\" id=\"field_hcc2l_label\" class=\"frm_primary_label\">Nombre\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_hcc2l\" name=\"item_meta[75]\" value=\"\"  data-sectionid=\"66\"  placeholder=\"Nombre completo\" data-invmsg=\"El texto no es v\u00e1lido.\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_76_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n    <label for=\"field_kx8vc\" id=\"field_kx8vc_label\" class=\"frm_primary_label\">Relaci\u00f3n\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_kx8vc\" name=\"item_meta[76]\" value=\"\"  data-sectionid=\"66\"  data-invmsg=\"El texto no es v\u00e1lido.\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_77_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n    <label for=\"field_axnfa\" id=\"field_axnfa_label\" class=\"frm_primary_label\">Fecha de nacimiento\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_axnfa\" name=\"item_meta[77]\" value=\"\"  data-sectionid=\"66\"  style=\"width:35%\" maxlength=\"10\" data-invmsg=\"La fecha no es v\u00e1lida.\" class=\"frm_date auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_78_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n    <label for=\"field_o27m5\" id=\"field_o27m5_label\" class=\"frm_primary_label\">Peso (kg o lb)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_o27m5\" name=\"item_meta[78]\" value=\"\"  data-sectionid=\"66\"  style=\"width:35%\" data-invmsg=\"El texto no es v\u00e1lido.\" class=\"auto_width\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_79_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p><strong>Pasajero 3<\/strong><\/p>\n<\/div>\n<div id=\"frm_field_80_container\" class=\"frm_form_field form-field  frm_top_container frm3 frm_first\">\r\n    <label for=\"field_uaap5\" id=\"field_uaap5_label\" class=\"frm_primary_label\">Nombre\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_uaap5\" name=\"item_meta[80]\" value=\"\"  data-sectionid=\"66\"  placeholder=\"Nombre completo\" data-invmsg=\"El texto no es v\u00e1lido.\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_81_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n    <label for=\"field_11xg6\" id=\"field_11xg6_label\" class=\"frm_primary_label\">Relaci\u00f3n\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_11xg6\" name=\"item_meta[81]\" value=\"\"  data-sectionid=\"66\"  data-invmsg=\"El texto no es v\u00e1lido.\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_82_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n    <label for=\"field_hbjuz\" id=\"field_hbjuz_label\" class=\"frm_primary_label\">Fecha de nacimiento\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_hbjuz\" name=\"item_meta[82]\" value=\"\"  data-sectionid=\"66\"  style=\"width:35%\" maxlength=\"10\" data-invmsg=\"La fecha no es v\u00e1lida.\" class=\"frm_date auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_83_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n    <label for=\"field_m051p\" id=\"field_m051p_label\" class=\"frm_primary_label\">Peso (kg o lb)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_m051p\" name=\"item_meta[83]\" value=\"\"  data-sectionid=\"66\"  style=\"width:35%\" data-invmsg=\"El texto no es v\u00e1lido.\" class=\"auto_width\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_85_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Ubicaci\u00f3n de origen y contactos<\/h3>\r\n\r\n\r\n<div id=\"frm_field_86_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first\">\r\n    <label for=\"field_orcix\" id=\"field_orcix_label\" class=\"frm_primary_label\">Tipo de centro o ubicaci\u00f3n\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[86]\" id=\"field_orcix\"  data-frmval=\"Hospital\" data-reqmsg=\"Este campo es obligatorio.\" aria-required=\"true\" data-invmsg=\"Tipo de centro o ubicaci\u00f3n no es v\u00e1lido.\" class=\"auto_width\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Hospital\" selected='selected'>Hospital<\/option><option  value=\"Rehabilitation Center\">Centro de rehabilitaci\u00f3n<\/option><option  value=\"Nursing Facility\">Centro de enfermer\u00eda<\/option><option  value=\"Residence\">Residencia<\/option><option  value=\"Other\">Otro<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_87_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first\">\r\n\t<div  id=\"field_nd2u8_label\" class=\"frm_primary_label\">Ubicaci\u00f3n y direcci\u00f3n\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<fieldset aria-labelledby=\"field_nd2u8_label\">\n<legend class=\"frm_screen_reader frm_hidden\">\n\tUbicaci\u00f3n y direcci\u00f3n<\/legend>\n<div class=\"frm_combo_inputs_container\">\n<div id=\"frm_field_87-line1_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_nd2u8_line1\" class=\"frm_screen_reader frm_hidden\">\n\t\tUbicaci\u00f3n y direcci\u00f3n\t<\/label>\n\t\t<input type=\"text\" id=\"field_nd2u8_line1\" value=\"\" name=\"item_meta[87][line1]\"  placeholder=\"Ingrese una ubicaci\u00f3n\" data-placeholder=\"Ingrese una ubicaci\u00f3n\" data-sectionid=\"85\"  data-reqmsg=\"Ubicaci\u00f3n y direcci\u00f3n es obligatorio.\" aria-required=\"true\" data-invmsg=\"Ubicaci\u00f3n y direcci\u00f3n no es v\u00e1lido\" aria-invalid=\"false\" data-geoautocomplete=\"1\" data-geofieldid=\"87\" data-geoisaddress=\"1\"   autocomplete=\"address-line1\" \/>\n\t<\/div>\n<div id=\"frm_field_87-line2_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_nd2u8_line2\" class=\"frm_screen_reader frm_hidden\">\n\t\tUbicaci\u00f3n y direcci\u00f3n\t<\/label>\n\t\t<input type=\"text\" id=\"field_nd2u8_line2\" value=\"\" name=\"item_meta[87][line2]\"  placeholder=\"\" data-placeholder=\"\" data-sectionid=\"85\"  data-reqmsg=\"Ubicaci\u00f3n y direcci\u00f3n es obligatorio.\" aria-required=\"true\" data-invmsg=\"Ubicaci\u00f3n y direcci\u00f3n no es v\u00e1lido\" class=\"frm_optional\" aria-invalid=\"false\" data-geoautocomplete=\"1\" data-geofieldid=\"87\" data-geoisaddress=\"1\"   autocomplete=\"address-line2\" \/>\n\t<\/div>\n<div id=\"frm_field_87-city_container\" class=\"frm_form_field form-field frm_third frm_first\">\n\t<label for=\"field_nd2u8_city\" class=\"frm_screen_reader frm_hidden\">\n\t\tCiudad\t<\/label>\n\t\t<input type=\"text\" id=\"field_nd2u8_city\" value=\"\" name=\"item_meta[87][city]\"  placeholder=\"\" data-placeholder=\"\" data-sectionid=\"85\"  data-reqmsg=\"Ubicaci\u00f3n y direcci\u00f3n es obligatorio.\" aria-required=\"true\" data-invmsg=\"Ubicaci\u00f3n y direcci\u00f3n no es v\u00e1lido\" aria-invalid=\"false\" data-geoautocomplete=\"1\" data-geofieldid=\"87\" data-geoisaddress=\"1\"   autocomplete=\"address-level2\" \/>\n\t<div class=\"frm_description\">Ciudad<\/div><\/div>\n<div id=\"frm_field_87-state_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_nd2u8_state\" class=\"frm_screen_reader frm_hidden\">\n\t\tEstado \/ provincia\t<\/label>\n\t\t<input type=\"text\" id=\"field_nd2u8_state\" value=\"\" name=\"item_meta[87][state]\"  placeholder=\"\" data-placeholder=\"\" data-sectionid=\"85\"  data-reqmsg=\"Ubicaci\u00f3n y direcci\u00f3n es obligatorio.\" aria-required=\"true\" data-invmsg=\"Ubicaci\u00f3n y direcci\u00f3n no es v\u00e1lido\" aria-invalid=\"false\" data-geoautocomplete=\"1\" data-geofieldid=\"87\" data-geoisaddress=\"1\"   autocomplete=\"address-level1\" \/>\n\t<div class=\"frm_description\">Estado \/ provincia<\/div><\/div>\n<div id=\"frm_field_87-zip_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_nd2u8_zip\" class=\"frm_screen_reader frm_hidden\">\n\t\tC\u00f3digo postal\t<\/label>\n\t\t<input type=\"text\" id=\"field_nd2u8_zip\" value=\"\" name=\"item_meta[87][zip]\"  placeholder=\"\" data-placeholder=\"\" data-sectionid=\"85\"  data-reqmsg=\"Ubicaci\u00f3n y direcci\u00f3n es obligatorio.\" aria-required=\"true\" data-invmsg=\"Ubicaci\u00f3n y direcci\u00f3n no es v\u00e1lido\" aria-invalid=\"false\" data-geoautocomplete=\"1\" data-geofieldid=\"87\" data-geoisaddress=\"1\"   autocomplete=\"postal-code\" \/>\n\t<div class=\"frm_description\">C\u00f3digo postal<\/div><\/div>\n<div id=\"frm_field_87-country_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_nd2u8_country\" class=\"frm_screen_reader frm_hidden\">\n\t\tPa\u00eds\t<\/label>\n\t\t\t<select name=\"item_meta[87][country]\" id=\"field_nd2u8_country\"  placeholder=\"\" data-placeholder=\"\" data-sectionid=\"85\"  data-reqmsg=\"Ubicaci\u00f3n y direcci\u00f3n es obligatorio.\" aria-required=\"true\" data-invmsg=\"Ubicaci\u00f3n y direcci\u00f3n no es v\u00e1lido\" aria-invalid=\"false\" data-geoautocomplete=\"1\" data-geofieldid=\"87\" data-geoisaddress=\"1\"   autocomplete=\"country-name\">\n\t\t\t<option value=\"\" class=\"\">\n\t\t\t\t\t\t\t<\/option>\n\t\t\t<option  value=\"Afganist\u00e1n\">Afganist\u00e1n<\/option><option  value=\"Albania\" data-code=\"AL\">Albania<\/option><option  value=\"Alemania\">Alemania<\/option><option  value=\"Andorra\" data-code=\"AD\">Andorra<\/option><option  value=\"Angola\" data-code=\"AO\">Angola<\/option><option  value=\"Anguila\">Anguila<\/option><option  value=\"Antigua y Barbuda\">Antigua y Barbuda<\/option><option  value=\"Ant\u00e1rtica\">Ant\u00e1rtica<\/option><option  value=\"Argelia\">Argelia<\/option><option  value=\"Argentina\" data-code=\"AR\">Argentina<\/option><option  value=\"Armenia\" data-code=\"AM\">Armenia<\/option><option  value=\"Aruba\" data-code=\"AW\">Aruba<\/option><option  value=\"Australia\" data-code=\"AU\">Australia<\/option><option  value=\"Austria\" data-code=\"AT\">Austria<\/option><option  value=\"Azerbaiy\u00e1n\">Azerbaiy\u00e1n<\/option><option  value=\"Bahamas\" data-code=\"BS\">Bahamas<\/option><option  value=\"Bangladesh\" data-code=\"BD\">Bangladesh<\/option><option  value=\"Barbados\" data-code=\"BB\">Barbados<\/option><option  value=\"Bar\u00e9in\">Bar\u00e9in<\/option><option  value=\"Belize\" data-code=\"BZ\">Belize<\/option><option  value=\"Ben\u00edn\">Ben\u00edn<\/option><option  value=\"Bermudas\">Bermudas<\/option><option  value=\"Bielorrusia\">Bielorrusia<\/option><option  value=\"Bolivia\" data-code=\"BO\">Bolivia<\/option><option  value=\"Bonaire, San Eustaquio y Saba\">Bonaire, San Eustaquio y Saba<\/option><option  value=\"Bosnia y Herzegovina\">Bosnia y Herzegovina<\/option><option  value=\"Botsuana\">Botsuana<\/option><option  value=\"Brasil\">Brasil<\/option><option  value=\"Brun\u00e9i\">Brun\u00e9i<\/option><option  value=\"Bulgaria\" data-code=\"BG\">Bulgaria<\/option><option  value=\"Burkina Faso\" data-code=\"BF\">Burkina Faso<\/option><option  value=\"Burundi\" data-code=\"BI\">Burundi<\/option><option  value=\"But\u00e1n\">But\u00e1n<\/option><option  value=\"B\u00e9lgica\">B\u00e9lgica<\/option><option  value=\"Cabo Verde\">Cabo Verde<\/option><option  value=\"Camboya\">Camboya<\/option><option  value=\"Camer\u00fan\">Camer\u00fan<\/option><option  value=\"Canad\u00e1\">Canad\u00e1<\/option><option  value=\"Chad\" data-code=\"TD\">Chad<\/option><option  value=\"Chile\" data-code=\"CL\">Chile<\/option><option  value=\"China\" data-code=\"CN\">China<\/option><option  value=\"Chipre\">Chipre<\/option><option  value=\"Ciudad del Vaticano\">Ciudad del Vaticano<\/option><option  value=\"Colombia\" data-code=\"CO\">Colombia<\/option><option  value=\"Comoras\">Comoras<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Corea del Norte\">Corea del Norte<\/option><option  value=\"Corea del Sur\">Corea del Sur<\/option><option  value=\"Costa Rica\" data-code=\"CR\">Costa Rica<\/option><option  value=\"Costa de Marfil\">Costa de Marfil<\/option><option  value=\"Croacia\">Croacia<\/option><option  value=\"Cuba\" data-code=\"CU\">Cuba<\/option><option  value=\"Curazao\">Curazao<\/option><option  value=\"Dinamarca\">Dinamarca<\/option><option  value=\"Dominica\" data-code=\"DM\">Dominica<\/option><option  value=\"Ecuador\" data-code=\"EC\">Ecuador<\/option><option  value=\"Egipto\">Egipto<\/option><option  value=\"El Salvador\" data-code=\"SV\">El Salvador<\/option><option  value=\"Emiratos \u00c1rabes Unidos\">Emiratos \u00c1rabes Unidos<\/option><option  value=\"Eritrea\" data-code=\"ER\">Eritrea<\/option><option  value=\"Eslovaquia\">Eslovaquia<\/option><option  value=\"Eslovenia\">Eslovenia<\/option><option  value=\"Espa\u00f1a\">Espa\u00f1a<\/option><option  value=\"Estados Unidos\">Estados Unidos<\/option><option  value=\"Estonia\" data-code=\"EE\">Estonia<\/option><option  value=\"Etiop\u00eda\">Etiop\u00eda<\/option><option  value=\"Fiji\" data-code=\"FJ\">Fiji<\/option><option  value=\"Filipinas\">Filipinas<\/option><option  value=\"Finlandia\">Finlandia<\/option><option  value=\"Francia\">Francia<\/option><option  value=\"Gab\u00f3n\">Gab\u00f3n<\/option><option  value=\"Gambia\" data-code=\"GM\">Gambia<\/option><option  value=\"Georgia\" data-code=\"GE\">Georgia<\/option><option  value=\"Ghana\" data-code=\"GH\">Ghana<\/option><option  value=\"Gibraltar\" data-code=\"GI\">Gibraltar<\/option><option  value=\"Granada\">Granada<\/option><option  value=\"Grecia\">Grecia<\/option><option  value=\"Groenlandia\">Groenlandia<\/option><option  value=\"Guadalupe\">Guadalupe<\/option><option  value=\"Guam\" data-code=\"GU\">Guam<\/option><option  value=\"Guatemala\" data-code=\"GT\">Guatemala<\/option><option  value=\"Guayana Francesa\">Guayana Francesa<\/option><option  value=\"Guernsey\" data-code=\"GG\">Guernsey<\/option><option  value=\"Guinea\" data-code=\"GN\">Guinea<\/option><option  value=\"Guinea Ecuatorial\">Guinea Ecuatorial<\/option><option  value=\"Guinea-Bis\u00e1u\">Guinea-Bis\u00e1u<\/option><option  value=\"Guyana\" data-code=\"GY\">Guyana<\/option><option  value=\"Hait\u00ed\">Hait\u00ed<\/option><option  value=\"Honduras\" data-code=\"HN\">Honduras<\/option><option  value=\"Hong Kong\" data-code=\"HK\">Hong Kong<\/option><option  value=\"Hungr\u00eda\">Hungr\u00eda<\/option><option  value=\"India\" data-code=\"IN\">India<\/option><option  value=\"Indonesia\" data-code=\"ID\">Indonesia<\/option><option  value=\"Iraq\" data-code=\"IQ\">Iraq<\/option><option  value=\"Irlanda\">Irlanda<\/option><option  value=\"Ir\u00e1n\">Ir\u00e1n<\/option><option  value=\"Isla Bouvet\">Isla Bouvet<\/option><option  value=\"Isla Norfolk\">Isla Norfolk<\/option><option  value=\"Isla de Man\">Isla de Man<\/option><option  value=\"Isla de Navidad\">Isla de Navidad<\/option><option  value=\"Islandia\">Islandia<\/option><option  value=\"Islas Aland\">Islas Aland<\/option><option  value=\"Islas Caim\u00e1n\">Islas Caim\u00e1n<\/option><option  value=\"Islas Cocos (Keeling)\">Islas Cocos (Keeling)<\/option><option  value=\"Islas Cook\">Islas Cook<\/option><option  value=\"Islas Feroe\">Islas Feroe<\/option><option  value=\"Islas Georgias del Sur y Sandwich del Sur\">Islas Georgias del Sur y Sandwich del Sur<\/option><option  value=\"Islas Heard y McDonald\">Islas Heard y McDonald<\/option><option  value=\"Islas Malvinas (Falkland)\">Islas Malvinas (Falkland)<\/option><option  value=\"Islas Marianas del Norte\">Islas Marianas del Norte<\/option><option  value=\"Islas Marshall\">Islas Marshall<\/option><option  value=\"Islas Salom\u00f3n\">Islas Salom\u00f3n<\/option><option  value=\"Islas Turcas y Caicos\">Islas Turcas y Caicos<\/option><option  value=\"Islas Ultramarinas Menores de los Estados Unidos\">Islas Ultramarinas Menores de los Estados Unidos<\/option><option  value=\"Islas V\u00edrgenes  EE.UU.\">Islas V\u00edrgenes  EE.UU.<\/option><option  value=\"Islas V\u00edrgenes Brit\u00e1nicas\">Islas V\u00edrgenes Brit\u00e1nicas<\/option><option  value=\"Israel\" data-code=\"IL\">Israel<\/option><option  value=\"Italia\">Italia<\/option><option  value=\"Jamaica\" data-code=\"JM\">Jamaica<\/option><option  value=\"Jap\u00f3n\">Jap\u00f3n<\/option><option  value=\"Jersey\" data-code=\"JE\">Jersey<\/option><option  value=\"Jordania\">Jordania<\/option><option  value=\"Katar\">Katar<\/option><option  value=\"Kazajist\u00e1n\">Kazajist\u00e1n<\/option><option  value=\"Kenia\">Kenia<\/option><option  value=\"Kirguist\u00e1n\">Kirguist\u00e1n<\/option><option  value=\"Kiribati\" data-code=\"KI\">Kiribati<\/option><option  value=\"Kosovo\" data-code=\"XK\">Kosovo<\/option><option  value=\"Kuwait\" data-code=\"KW\">Kuwait<\/option><option  value=\"Laos\" data-code=\"LA\">Laos<\/option><option  value=\"Lesoto\">Lesoto<\/option><option  value=\"Letonia\">Letonia<\/option><option  value=\"Liberia\" data-code=\"LR\">Liberia<\/option><option  value=\"Libia\">Libia<\/option><option  value=\"Liechtenstein\" data-code=\"LI\">Liechtenstein<\/option><option  value=\"Lituania\">Lituania<\/option><option  value=\"Luxemburgo\">Luxemburgo<\/option><option  value=\"L\u00edbano\">L\u00edbano<\/option><option  value=\"Macao\" data-code=\"MO\">Macao<\/option><option  value=\"Madagascar\" data-code=\"MG\">Madagascar<\/option><option  value=\"Malasia\">Malasia<\/option><option  value=\"Malaui\">Malaui<\/option><option  value=\"Maldivas\">Maldivas<\/option><option  value=\"Mali\" data-code=\"ML\">Mali<\/option><option  value=\"Malta\" data-code=\"MT\">Malta<\/option><option  value=\"Marruecos\">Marruecos<\/option><option  value=\"Martinica\">Martinica<\/option><option  value=\"Mauricio\">Mauricio<\/option><option  value=\"Mauritania\" data-code=\"MR\">Mauritania<\/option><option  value=\"Mayotte\" data-code=\"YT\">Mayotte<\/option><option  value=\"Micronesia\" data-code=\"FM\">Micronesia<\/option><option  value=\"Moldava\">Moldava<\/option><option  value=\"Mongolia\" data-code=\"MN\">Mongolia<\/option><option  value=\"Montenegro\" data-code=\"ME\">Montenegro<\/option><option  value=\"Montserrat\" data-code=\"MS\">Montserrat<\/option><option  value=\"Mozambique\" data-code=\"MZ\">Mozambique<\/option><option  value=\"Myanmar\" data-code=\"MM\">Myanmar<\/option><option  value=\"M\u00e9xico\">M\u00e9xico<\/option><option  value=\"M\u00f3naco\">M\u00f3naco<\/option><option  value=\"Namibia\" data-code=\"NA\">Namibia<\/option><option  value=\"Nauru\" data-code=\"NR\">Nauru<\/option><option  value=\"Nepal\" data-code=\"NP\">Nepal<\/option><option  value=\"Nicaragua\" data-code=\"NI\">Nicaragua<\/option><option  value=\"Nigeria\" data-code=\"NG\">Nigeria<\/option><option  value=\"Niue\" data-code=\"NU\">Niue<\/option><option  value=\"Noruega\">Noruega<\/option><option  value=\"Nueva Caledonia\">Nueva Caledonia<\/option><option  value=\"Nueva Zelanda \">Nueva Zelanda <\/option><option  value=\"N\u00edger\">N\u00edger<\/option><option  value=\"Om\u00e1n\">Om\u00e1n<\/option><option  value=\"Pakist\u00e1n\">Pakist\u00e1n<\/option><option  value=\"Palau\" data-code=\"PW\">Palau<\/option><option  value=\"Palestina\">Palestina<\/option><option  value=\"Panam\u00e1\">Panam\u00e1<\/option><option  value=\"Pap\u00faa Nueva Guinea\">Pap\u00faa Nueva Guinea<\/option><option  value=\"Paraguay\" data-code=\"PY\">Paraguay<\/option><option  value=\"Pa\u00edses Bajos\">Pa\u00edses Bajos<\/option><option  value=\"Per\u00fa\">Per\u00fa<\/option><option  value=\"Pitcairn\" data-code=\"PN\">Pitcairn<\/option><option  value=\"Polinesia Francesa\">Polinesia Francesa<\/option><option  value=\"Polonia\">Polonia<\/option><option  value=\"Portugal\" data-code=\"PT\">Portugal<\/option><option  value=\"Puerto Rico\" data-code=\"PR\">Puerto Rico<\/option><option  value=\"Reino Unido\">Reino Unido<\/option><option  value=\"Rep\u00fablica Central de \u00c1frica \">Rep\u00fablica Central de \u00c1frica <\/option><option  value=\"Rep\u00fablica Checa\">Rep\u00fablica Checa<\/option><option  value=\"Rep\u00fablica Dominicana\">Rep\u00fablica Dominicana<\/option><option  value=\"Rep\u00fablica de Macedonia\">Rep\u00fablica de Macedonia<\/option><option  value=\"Reuni\u00f3n\">Reuni\u00f3n<\/option><option  value=\"Ruanda\">Ruanda<\/option><option  value=\"Ruman\u00eda\">Ruman\u00eda<\/option><option  value=\"Rusia\">Rusia<\/option><option  value=\"Sahara Occidental\">Sahara Occidental<\/option><option  value=\"Saint Kitts y Nevis\">Saint Kitts y Nevis<\/option><option  value=\"Samoa\" data-code=\"WS\">Samoa<\/option><option  value=\"Samoa Americana\">Samoa Americana<\/option><option  value=\"San Bartolom\u00e9\">San Bartolom\u00e9<\/option><option  value=\"San Marino\" data-code=\"SM\">San Marino<\/option><option  value=\"San Mart\u00edn (parte francesa)\">San Mart\u00edn (parte francesa)<\/option><option  value=\"San Mart\u00edn\u200b (parte holandesa)\">San Mart\u00edn\u200b (parte holandesa)<\/option><option  value=\"San Pedro y Miquel\u00f3n\">San Pedro y Miquel\u00f3n<\/option><option  value=\"San Vicente y las Granadinas \">San Vicente y las Granadinas <\/option><option  value=\"Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a\">Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option  value=\"Santa Luc\u00eda\">Santa Luc\u00eda<\/option><option  value=\"Santa Sede\">Santa Sede<\/option><option  value=\"Santo Tom\u00e9 y Pr\u00edncipe\">Santo Tom\u00e9 y Pr\u00edncipe<\/option><option  value=\"Saud\u00ed Arabia\">Saud\u00ed Arabia<\/option><option  value=\"Senegal\" data-code=\"SN\">Senegal<\/option><option  value=\"Serbia\" data-code=\"RS\">Serbia<\/option><option  value=\"Seychelles\" data-code=\"SC\">Seychelles<\/option><option  value=\"Sierra Leona\">Sierra Leona<\/option><option  value=\"Singapur\">Singapur<\/option><option  value=\"Siria\">Siria<\/option><option  value=\"Somalia\" data-code=\"SO\">Somalia<\/option><option  value=\"Sri Lanka\" data-code=\"LK\">Sri Lanka<\/option><option  value=\"Suazilandia\">Suazilandia<\/option><option  value=\"Sud\u00e1frica\">Sud\u00e1frica<\/option><option  value=\"Sud\u00e1n\">Sud\u00e1n<\/option><option  value=\"Sud\u00e1n del sur\">Sud\u00e1n del sur<\/option><option  value=\"Suecia\">Suecia<\/option><option  value=\"Suiza\">Suiza<\/option><option  value=\"Surinam\">Surinam<\/option><option  value=\"Svalbard y Jan Mayen\">Svalbard y Jan Mayen<\/option><option  value=\"Tailandia\">Tailandia<\/option><option  value=\"Taiw\u00e1n\">Taiw\u00e1n<\/option><option  value=\"Tanzania\" data-code=\"TZ\">Tanzania<\/option><option  value=\"Tayikist\u00e1n\">Tayikist\u00e1n<\/option><option  value=\"Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico\">Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option  value=\"Territorios Australes Franceses\">Territorios Australes Franceses<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Togo\" data-code=\"TG\">Togo<\/option><option  value=\"Tokelau\" data-code=\"TK\">Tokelau<\/option><option  value=\"Tonga\" data-code=\"TO\">Tonga<\/option><option  value=\"Trinidad y Tobago\">Trinidad y Tobago<\/option><option  value=\"Turkmenist\u00e1n\">Turkmenist\u00e1n<\/option><option  value=\"Turqu\u00eda\">Turqu\u00eda<\/option><option  value=\"Tuvalu\" data-code=\"TV\">Tuvalu<\/option><option  value=\"T\u00fanez\">T\u00fanez<\/option><option  value=\"Ucrania\">Ucrania<\/option><option  value=\"Uganda\" data-code=\"UG\">Uganda<\/option><option  value=\"Uruguay\" data-code=\"UY\">Uruguay<\/option><option  value=\"Uzbekist\u00e1n\">Uzbekist\u00e1n<\/option><option  value=\"Vanuatu\" data-code=\"VU\">Vanuatu<\/option><option  value=\"Venezuela\" data-code=\"VE\">Venezuela<\/option><option  value=\"Vietnam\" data-code=\"VN\">Vietnam<\/option><option  value=\"Wallis y Futuna\">Wallis y Futuna<\/option><option  value=\"Yemen\" data-code=\"YE\">Yemen<\/option><option  value=\"Yibuti\">Yibuti<\/option><option  value=\"Zambia\" data-code=\"ZM\">Zambia<\/option><option  value=\"Zimbabue\">Zimbabue<\/option>\t\t<\/select>\n\t<div class=\"frm_description\">Pa\u00eds<\/div><\/div>\n<div id=\"frm_field_87-state_abbreviation_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_nd2u8_state_abbreviation\" class=\"frm_screen_reader frm_hidden\">\n\t\tUbicaci\u00f3n y direcci\u00f3n\t<\/label>\n\t\t<input type=\"hidden\" id=\"field_nd2u8_state_abbreviation\" value=\"\" name=\"item_meta[87][state_abbreviation]\"  placeholder=\"\" data-placeholder=\"\" data-sectionid=\"85\"  data-reqmsg=\"Ubicaci\u00f3n y direcci\u00f3n es obligatorio.\" aria-required=\"true\" data-invmsg=\"Ubicaci\u00f3n y direcci\u00f3n no es v\u00e1lido\" class=\"frm_optional\" aria-invalid=\"false\" data-geoautocomplete=\"1\" data-geofieldid=\"87\" data-geoisaddress=\"1\"   \/>\n\t<\/div>\n<\/div>\n<\/fieldset>\n\r\n\t\r\n\t<input id=\"geo-lat-87\" name=\"geo_lat[87]\" class=\"frm-geo-lat\" type=\"hidden\" value=\"\"><input id=\"geo-lng-87\" name=\"geo_lng[87]\" class=\"frm-geo-lng\" type=\"hidden\" value=\"\">\r\n<\/div>\n<div id=\"frm_field_88_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_4gue8\" id=\"field_4gue8_label\" class=\"frm_primary_label\">Nombre del m\u00e9dico tratante \/ contacto principal\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_4gue8\" name=\"item_meta[88]\" value=\"\"  data-sectionid=\"85\"  data-invmsg=\"El texto no es v\u00e1lido.\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_89_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_dgvqw\" id=\"field_dgvqw_label\" class=\"frm_primary_label\">Tel\u00e9fono del m\u00e9dico tratante \/ contacto principal\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_dgvqw\" name=\"item_meta[89]\" value=\"\"  data-sectionid=\"85\"  placeholder=\"+C\u00f3digo de pa\u00eds (c\u00f3digo de \u00e1rea) #\" data-invmsg=\"El n\u00famero de tel\u00e9fono no es v\u00e1lido.\" class=\"frm-intl-tel-input\" aria-invalid=\"false\" pattern=\"\\+?\\d{1,4}[\\s\\-]?(?:\\(\\d{1,3}\\)[\\s\\-]?)?\\d{1,4}[\\s\\-]?\\d{1,4}[\\s\\-]?\\d{1,4}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_90_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_ouawq\" id=\"field_ouawq_label\" class=\"frm_primary_label\">Nombre de contacto secundario\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_ouawq\" name=\"item_meta[90]\" value=\"\"  data-sectionid=\"85\"  data-invmsg=\"El texto no es v\u00e1lido.\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_91_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_zt227\" id=\"field_zt227_label\" class=\"frm_primary_label\">Tel\u00e9fono de contacto secundario\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_zt227\" name=\"item_meta[91]\" value=\"\"  data-sectionid=\"85\"  placeholder=\"+C\u00f3digo de pa\u00eds (c\u00f3digo de \u00e1rea) #\" data-invmsg=\"El n\u00famero de tel\u00e9fono no es v\u00e1lido.\" class=\"frm-intl-tel-input\" aria-invalid=\"false\" pattern=\"\\+?\\d{1,4}[\\s\\-]?(?:\\(\\d{1,3}\\)[\\s\\-]?)?\\d{1,4}[\\s\\-]?\\d{1,4}[\\s\\-]?\\d{1,4}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_92_container\" class=\"frm_form_field form-field  frm_top_container frm3 frm_first\">\r\n\t<label for=\"field_ki3eb\" id=\"field_ki3eb_label\" class=\"frm_primary_label\">Nombre de estaci\u00f3n de enfermer\u00eda\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_ki3eb\" name=\"item_meta[92]\" value=\"\"  data-sectionid=\"85\"  data-invmsg=\"Nombre de estaci\u00f3n de enfermer\u00eda no es v\u00e1lido.\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_93_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n    <label for=\"field_xjf34\" id=\"field_xjf34_label\" class=\"frm_primary_label\">Tel\u00e9fono de estaci\u00f3n de enfermer\u00eda\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_xjf34\" name=\"item_meta[93]\" value=\"\"  data-sectionid=\"85\"  placeholder=\"+C\u00f3digo de pa\u00eds (c\u00f3digo de \u00e1rea) #\" data-invmsg=\"El n\u00famero de tel\u00e9fono no es v\u00e1lido.\" class=\"frm-intl-tel-input\" aria-invalid=\"false\" pattern=\"\\+?\\d{1,4}[\\s\\-]?(?:\\(\\d{1,3}\\)[\\s\\-]?)?\\d{1,4}[\\s\\-]?\\d{1,4}[\\s\\-]?\\d{1,4}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_94_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm3\">\r\n    <label for=\"field_1vqtj\" id=\"field_1vqtj_label\" class=\"frm_primary_label\">Tel\u00e9fono del centro\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_1vqtj\" name=\"item_meta[94]\" value=\"\"  data-sectionid=\"85\"  placeholder=\"+C\u00f3digo de pa\u00eds (c\u00f3digo de \u00e1rea) #\" data-reqmsg=\"Tel\u00e9fono del centro es obligatorio.\" aria-required=\"true\" data-invmsg=\"El n\u00famero de tel\u00e9fono no es v\u00e1lido.\" class=\"frm-intl-tel-input\" aria-invalid=\"false\" pattern=\"\\+?\\d{1,4}[\\s\\-]?(?:\\(\\d{1,3}\\)[\\s\\-]?)?\\d{1,4}[\\s\\-]?\\d{1,4}[\\s\\-]?\\d{1,4}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_95_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n    <label for=\"field_o6lb0\" id=\"field_o6lb0_label\" class=\"frm_primary_label\">Piso y habitaci\u00f3n\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_o6lb0\" name=\"item_meta[95]\" value=\"\"  data-sectionid=\"85\"  style=\"width:40%\" data-invmsg=\"El texto no es v\u00e1lido.\" class=\"auto_width\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_97_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Ubicaci\u00f3n de destino y contactos<\/h3>\r\n\r\n\r\n<div id=\"frm_field_98_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first\">\r\n    <label for=\"field_mplzv\" id=\"field_mplzv_label\" class=\"frm_primary_label\">Tipo de centro o ubicaci\u00f3n\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[98]\" id=\"field_mplzv\"  data-sectionid=\"97\"  data-frmval=\"Hospital\" data-reqmsg=\"Este campo es obligatorio.\" aria-required=\"true\" data-invmsg=\"Tipo de centro o ubicaci\u00f3n no es v\u00e1lido.\" class=\"auto_width\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Hospital\" selected='selected'>Hospital<\/option><option  value=\"Rehabilitation Center\">Centro de rehabilitaci\u00f3n<\/option><option  value=\"Nursing Facility\">Centro de enfermer\u00eda<\/option><option  value=\"Residence\">Residencia<\/option><option  value=\"Other\">Otro<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_99_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first\">\r\n\t<div  id=\"field_dfjjm_label\" class=\"frm_primary_label\">Ubicaci\u00f3n y direcci\u00f3n\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<fieldset aria-labelledby=\"field_dfjjm_label\">\n<legend class=\"frm_screen_reader frm_hidden\">\n\tUbicaci\u00f3n y direcci\u00f3n<\/legend>\n<div class=\"frm_combo_inputs_container\">\n<div id=\"frm_field_99-line1_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_dfjjm_line1\" class=\"frm_screen_reader frm_hidden\">\n\t\tUbicaci\u00f3n y direcci\u00f3n\t<\/label>\n\t\t<input type=\"text\" id=\"field_dfjjm_line1\" value=\"\" name=\"item_meta[99][line1]\"  placeholder=\"Ingrese una ubicaci\u00f3n\" data-placeholder=\"Ingrese una ubicaci\u00f3n\" data-sectionid=\"97\"  data-reqmsg=\"Ubicaci\u00f3n y direcci\u00f3n es obligatorio.\" aria-required=\"true\" data-invmsg=\"Ubicaci\u00f3n y direcci\u00f3n no es v\u00e1lido\" aria-invalid=\"false\" data-geoautocomplete=\"1\" data-geofieldid=\"99\" data-geoisaddress=\"1\"   autocomplete=\"address-line1\" \/>\n\t<\/div>\n<div id=\"frm_field_99-line2_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_dfjjm_line2\" class=\"frm_screen_reader frm_hidden\">\n\t\tUbicaci\u00f3n y direcci\u00f3n\t<\/label>\n\t\t<input type=\"text\" id=\"field_dfjjm_line2\" value=\"\" name=\"item_meta[99][line2]\"  placeholder=\"\" data-placeholder=\"\" data-sectionid=\"97\"  data-reqmsg=\"Ubicaci\u00f3n y direcci\u00f3n es obligatorio.\" aria-required=\"true\" data-invmsg=\"Ubicaci\u00f3n y direcci\u00f3n no es v\u00e1lido\" class=\"frm_optional\" aria-invalid=\"false\" data-geoautocomplete=\"1\" data-geofieldid=\"99\" data-geoisaddress=\"1\"   autocomplete=\"address-line2\" \/>\n\t<\/div>\n<div id=\"frm_field_99-city_container\" class=\"frm_form_field form-field frm_third frm_first\">\n\t<label for=\"field_dfjjm_city\" class=\"frm_screen_reader frm_hidden\">\n\t\tCiudad\t<\/label>\n\t\t<input type=\"text\" id=\"field_dfjjm_city\" value=\"\" name=\"item_meta[99][city]\"  placeholder=\"\" data-placeholder=\"\" data-sectionid=\"97\"  data-reqmsg=\"Ubicaci\u00f3n y direcci\u00f3n es obligatorio.\" aria-required=\"true\" data-invmsg=\"Ubicaci\u00f3n y direcci\u00f3n no es v\u00e1lido\" aria-invalid=\"false\" data-geoautocomplete=\"1\" data-geofieldid=\"99\" data-geoisaddress=\"1\"   autocomplete=\"address-level2\" \/>\n\t<div class=\"frm_description\">Ciudad<\/div><\/div>\n<div id=\"frm_field_99-state_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_dfjjm_state\" class=\"frm_screen_reader frm_hidden\">\n\t\tEstado \/ provincia \t<\/label>\n\t\t<input type=\"text\" id=\"field_dfjjm_state\" value=\"\" name=\"item_meta[99][state]\"  placeholder=\"\" data-placeholder=\"\" data-sectionid=\"97\"  data-reqmsg=\"Ubicaci\u00f3n y direcci\u00f3n es obligatorio.\" aria-required=\"true\" data-invmsg=\"Ubicaci\u00f3n y direcci\u00f3n no es v\u00e1lido\" aria-invalid=\"false\" data-geoautocomplete=\"1\" data-geofieldid=\"99\" data-geoisaddress=\"1\"   autocomplete=\"address-level1\" \/>\n\t<div class=\"frm_description\">Estado \/ provincia <\/div><\/div>\n<div id=\"frm_field_99-zip_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_dfjjm_zip\" class=\"frm_screen_reader frm_hidden\">\n\t\tC\u00f3digo postal\t<\/label>\n\t\t<input type=\"text\" id=\"field_dfjjm_zip\" value=\"\" name=\"item_meta[99][zip]\"  placeholder=\"\" data-placeholder=\"\" data-sectionid=\"97\"  data-reqmsg=\"Ubicaci\u00f3n y direcci\u00f3n es obligatorio.\" aria-required=\"true\" data-invmsg=\"Ubicaci\u00f3n y direcci\u00f3n no es v\u00e1lido\" aria-invalid=\"false\" data-geoautocomplete=\"1\" data-geofieldid=\"99\" data-geoisaddress=\"1\"   autocomplete=\"postal-code\" \/>\n\t<div class=\"frm_description\">C\u00f3digo postal<\/div><\/div>\n<div id=\"frm_field_99-country_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_dfjjm_country\" class=\"frm_screen_reader frm_hidden\">\n\t\tPa\u00eds\t<\/label>\n\t\t\t<select name=\"item_meta[99][country]\" id=\"field_dfjjm_country\"  placeholder=\"\" data-placeholder=\"\" data-sectionid=\"97\"  data-reqmsg=\"Ubicaci\u00f3n y direcci\u00f3n es obligatorio.\" aria-required=\"true\" data-invmsg=\"Ubicaci\u00f3n y direcci\u00f3n no es v\u00e1lido\" aria-invalid=\"false\" data-geoautocomplete=\"1\" data-geofieldid=\"99\" data-geoisaddress=\"1\"   autocomplete=\"country-name\">\n\t\t\t<option value=\"\" class=\"\">\n\t\t\t\t\t\t\t<\/option>\n\t\t\t<option  value=\"Afganist\u00e1n\">Afganist\u00e1n<\/option><option  value=\"Albania\" data-code=\"AL\">Albania<\/option><option  value=\"Alemania\">Alemania<\/option><option  value=\"Andorra\" data-code=\"AD\">Andorra<\/option><option  value=\"Angola\" data-code=\"AO\">Angola<\/option><option  value=\"Anguila\">Anguila<\/option><option  value=\"Antigua y Barbuda\">Antigua y Barbuda<\/option><option  value=\"Ant\u00e1rtica\">Ant\u00e1rtica<\/option><option  value=\"Argelia\">Argelia<\/option><option  value=\"Argentina\" data-code=\"AR\">Argentina<\/option><option  value=\"Armenia\" data-code=\"AM\">Armenia<\/option><option  value=\"Aruba\" data-code=\"AW\">Aruba<\/option><option  value=\"Australia\" data-code=\"AU\">Australia<\/option><option  value=\"Austria\" data-code=\"AT\">Austria<\/option><option  value=\"Azerbaiy\u00e1n\">Azerbaiy\u00e1n<\/option><option  value=\"Bahamas\" data-code=\"BS\">Bahamas<\/option><option  value=\"Bangladesh\" data-code=\"BD\">Bangladesh<\/option><option  value=\"Barbados\" data-code=\"BB\">Barbados<\/option><option  value=\"Bar\u00e9in\">Bar\u00e9in<\/option><option  value=\"Belize\" data-code=\"BZ\">Belize<\/option><option  value=\"Ben\u00edn\">Ben\u00edn<\/option><option  value=\"Bermudas\">Bermudas<\/option><option  value=\"Bielorrusia\">Bielorrusia<\/option><option  value=\"Bolivia\" data-code=\"BO\">Bolivia<\/option><option  value=\"Bonaire, San Eustaquio y Saba\">Bonaire, San Eustaquio y Saba<\/option><option  value=\"Bosnia y Herzegovina\">Bosnia y Herzegovina<\/option><option  value=\"Botsuana\">Botsuana<\/option><option  value=\"Brasil\">Brasil<\/option><option  value=\"Brun\u00e9i\">Brun\u00e9i<\/option><option  value=\"Bulgaria\" data-code=\"BG\">Bulgaria<\/option><option  value=\"Burkina Faso\" data-code=\"BF\">Burkina Faso<\/option><option  value=\"Burundi\" data-code=\"BI\">Burundi<\/option><option  value=\"But\u00e1n\">But\u00e1n<\/option><option  value=\"B\u00e9lgica\">B\u00e9lgica<\/option><option  value=\"Cabo Verde\">Cabo Verde<\/option><option  value=\"Camboya\">Camboya<\/option><option  value=\"Camer\u00fan\">Camer\u00fan<\/option><option  value=\"Canad\u00e1\">Canad\u00e1<\/option><option  value=\"Chad\" data-code=\"TD\">Chad<\/option><option  value=\"Chile\" data-code=\"CL\">Chile<\/option><option  value=\"China\" data-code=\"CN\">China<\/option><option  value=\"Chipre\">Chipre<\/option><option  value=\"Ciudad del Vaticano\">Ciudad del Vaticano<\/option><option  value=\"Colombia\" data-code=\"CO\">Colombia<\/option><option  value=\"Comoras\">Comoras<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Corea del Norte\">Corea del Norte<\/option><option  value=\"Corea del Sur\">Corea del Sur<\/option><option  value=\"Costa Rica\" data-code=\"CR\">Costa Rica<\/option><option  value=\"Costa de Marfil\">Costa de Marfil<\/option><option  value=\"Croacia\">Croacia<\/option><option  value=\"Cuba\" data-code=\"CU\">Cuba<\/option><option  value=\"Curazao\">Curazao<\/option><option  value=\"Dinamarca\">Dinamarca<\/option><option  value=\"Dominica\" data-code=\"DM\">Dominica<\/option><option  value=\"Ecuador\" data-code=\"EC\">Ecuador<\/option><option  value=\"Egipto\">Egipto<\/option><option  value=\"El Salvador\" data-code=\"SV\">El Salvador<\/option><option  value=\"Emiratos \u00c1rabes Unidos\">Emiratos \u00c1rabes Unidos<\/option><option  value=\"Eritrea\" data-code=\"ER\">Eritrea<\/option><option  value=\"Eslovaquia\">Eslovaquia<\/option><option  value=\"Eslovenia\">Eslovenia<\/option><option  value=\"Espa\u00f1a\">Espa\u00f1a<\/option><option  value=\"Estados Unidos\">Estados Unidos<\/option><option  value=\"Estonia\" data-code=\"EE\">Estonia<\/option><option  value=\"Etiop\u00eda\">Etiop\u00eda<\/option><option  value=\"Fiji\" data-code=\"FJ\">Fiji<\/option><option  value=\"Filipinas\">Filipinas<\/option><option  value=\"Finlandia\">Finlandia<\/option><option  value=\"Francia\">Francia<\/option><option  value=\"Gab\u00f3n\">Gab\u00f3n<\/option><option  value=\"Gambia\" data-code=\"GM\">Gambia<\/option><option  value=\"Georgia\" data-code=\"GE\">Georgia<\/option><option  value=\"Ghana\" data-code=\"GH\">Ghana<\/option><option  value=\"Gibraltar\" data-code=\"GI\">Gibraltar<\/option><option  value=\"Granada\">Granada<\/option><option  value=\"Grecia\">Grecia<\/option><option  value=\"Groenlandia\">Groenlandia<\/option><option  value=\"Guadalupe\">Guadalupe<\/option><option  value=\"Guam\" data-code=\"GU\">Guam<\/option><option  value=\"Guatemala\" data-code=\"GT\">Guatemala<\/option><option  value=\"Guayana Francesa\">Guayana Francesa<\/option><option  value=\"Guernsey\" data-code=\"GG\">Guernsey<\/option><option  value=\"Guinea\" data-code=\"GN\">Guinea<\/option><option  value=\"Guinea Ecuatorial\">Guinea Ecuatorial<\/option><option  value=\"Guinea-Bis\u00e1u\">Guinea-Bis\u00e1u<\/option><option  value=\"Guyana\" data-code=\"GY\">Guyana<\/option><option  value=\"Hait\u00ed\">Hait\u00ed<\/option><option  value=\"Honduras\" data-code=\"HN\">Honduras<\/option><option  value=\"Hong Kong\" data-code=\"HK\">Hong Kong<\/option><option  value=\"Hungr\u00eda\">Hungr\u00eda<\/option><option  value=\"India\" data-code=\"IN\">India<\/option><option  value=\"Indonesia\" data-code=\"ID\">Indonesia<\/option><option  value=\"Iraq\" data-code=\"IQ\">Iraq<\/option><option  value=\"Irlanda\">Irlanda<\/option><option  value=\"Ir\u00e1n\">Ir\u00e1n<\/option><option  value=\"Isla Bouvet\">Isla Bouvet<\/option><option  value=\"Isla Norfolk\">Isla Norfolk<\/option><option  value=\"Isla de Man\">Isla de Man<\/option><option  value=\"Isla de Navidad\">Isla de Navidad<\/option><option  value=\"Islandia\">Islandia<\/option><option  value=\"Islas Aland\">Islas Aland<\/option><option  value=\"Islas Caim\u00e1n\">Islas Caim\u00e1n<\/option><option  value=\"Islas Cocos (Keeling)\">Islas Cocos (Keeling)<\/option><option  value=\"Islas Cook\">Islas Cook<\/option><option  value=\"Islas Feroe\">Islas Feroe<\/option><option  value=\"Islas Georgias del Sur y Sandwich del Sur\">Islas Georgias del Sur y Sandwich del Sur<\/option><option  value=\"Islas Heard y McDonald\">Islas Heard y McDonald<\/option><option  value=\"Islas Malvinas (Falkland)\">Islas Malvinas (Falkland)<\/option><option  value=\"Islas Marianas del Norte\">Islas Marianas del Norte<\/option><option  value=\"Islas Marshall\">Islas Marshall<\/option><option  value=\"Islas Salom\u00f3n\">Islas Salom\u00f3n<\/option><option  value=\"Islas Turcas y Caicos\">Islas Turcas y Caicos<\/option><option  value=\"Islas Ultramarinas Menores de los Estados Unidos\">Islas Ultramarinas Menores de los Estados Unidos<\/option><option  value=\"Islas V\u00edrgenes  EE.UU.\">Islas V\u00edrgenes  EE.UU.<\/option><option  value=\"Islas V\u00edrgenes Brit\u00e1nicas\">Islas V\u00edrgenes Brit\u00e1nicas<\/option><option  value=\"Israel\" data-code=\"IL\">Israel<\/option><option  value=\"Italia\">Italia<\/option><option  value=\"Jamaica\" data-code=\"JM\">Jamaica<\/option><option  value=\"Jap\u00f3n\">Jap\u00f3n<\/option><option  value=\"Jersey\" data-code=\"JE\">Jersey<\/option><option  value=\"Jordania\">Jordania<\/option><option  value=\"Katar\">Katar<\/option><option  value=\"Kazajist\u00e1n\">Kazajist\u00e1n<\/option><option  value=\"Kenia\">Kenia<\/option><option  value=\"Kirguist\u00e1n\">Kirguist\u00e1n<\/option><option  value=\"Kiribati\" data-code=\"KI\">Kiribati<\/option><option  value=\"Kosovo\" data-code=\"XK\">Kosovo<\/option><option  value=\"Kuwait\" data-code=\"KW\">Kuwait<\/option><option  value=\"Laos\" data-code=\"LA\">Laos<\/option><option  value=\"Lesoto\">Lesoto<\/option><option  value=\"Letonia\">Letonia<\/option><option  value=\"Liberia\" data-code=\"LR\">Liberia<\/option><option  value=\"Libia\">Libia<\/option><option  value=\"Liechtenstein\" data-code=\"LI\">Liechtenstein<\/option><option  value=\"Lituania\">Lituania<\/option><option  value=\"Luxemburgo\">Luxemburgo<\/option><option  value=\"L\u00edbano\">L\u00edbano<\/option><option  value=\"Macao\" data-code=\"MO\">Macao<\/option><option  value=\"Madagascar\" data-code=\"MG\">Madagascar<\/option><option  value=\"Malasia\">Malasia<\/option><option  value=\"Malaui\">Malaui<\/option><option  value=\"Maldivas\">Maldivas<\/option><option  value=\"Mali\" data-code=\"ML\">Mali<\/option><option  value=\"Malta\" data-code=\"MT\">Malta<\/option><option  value=\"Marruecos\">Marruecos<\/option><option  value=\"Martinica\">Martinica<\/option><option  value=\"Mauricio\">Mauricio<\/option><option  value=\"Mauritania\" data-code=\"MR\">Mauritania<\/option><option  value=\"Mayotte\" data-code=\"YT\">Mayotte<\/option><option  value=\"Micronesia\" data-code=\"FM\">Micronesia<\/option><option  value=\"Moldava\">Moldava<\/option><option  value=\"Mongolia\" data-code=\"MN\">Mongolia<\/option><option  value=\"Montenegro\" data-code=\"ME\">Montenegro<\/option><option  value=\"Montserrat\" data-code=\"MS\">Montserrat<\/option><option  value=\"Mozambique\" data-code=\"MZ\">Mozambique<\/option><option  value=\"Myanmar\" data-code=\"MM\">Myanmar<\/option><option  value=\"M\u00e9xico\">M\u00e9xico<\/option><option  value=\"M\u00f3naco\">M\u00f3naco<\/option><option  value=\"Namibia\" data-code=\"NA\">Namibia<\/option><option  value=\"Nauru\" data-code=\"NR\">Nauru<\/option><option  value=\"Nepal\" data-code=\"NP\">Nepal<\/option><option  value=\"Nicaragua\" data-code=\"NI\">Nicaragua<\/option><option  value=\"Nigeria\" data-code=\"NG\">Nigeria<\/option><option  value=\"Niue\" data-code=\"NU\">Niue<\/option><option  value=\"Noruega\">Noruega<\/option><option  value=\"Nueva Caledonia\">Nueva Caledonia<\/option><option  value=\"Nueva Zelanda \">Nueva Zelanda <\/option><option  value=\"N\u00edger\">N\u00edger<\/option><option  value=\"Om\u00e1n\">Om\u00e1n<\/option><option  value=\"Pakist\u00e1n\">Pakist\u00e1n<\/option><option  value=\"Palau\" data-code=\"PW\">Palau<\/option><option  value=\"Palestina\">Palestina<\/option><option  value=\"Panam\u00e1\">Panam\u00e1<\/option><option  value=\"Pap\u00faa Nueva Guinea\">Pap\u00faa Nueva Guinea<\/option><option  value=\"Paraguay\" data-code=\"PY\">Paraguay<\/option><option  value=\"Pa\u00edses Bajos\">Pa\u00edses Bajos<\/option><option  value=\"Per\u00fa\">Per\u00fa<\/option><option  value=\"Pitcairn\" data-code=\"PN\">Pitcairn<\/option><option  value=\"Polinesia Francesa\">Polinesia Francesa<\/option><option  value=\"Polonia\">Polonia<\/option><option  value=\"Portugal\" data-code=\"PT\">Portugal<\/option><option  value=\"Puerto Rico\" data-code=\"PR\">Puerto Rico<\/option><option  value=\"Reino Unido\">Reino Unido<\/option><option  value=\"Rep\u00fablica Central de \u00c1frica \">Rep\u00fablica Central de \u00c1frica <\/option><option  value=\"Rep\u00fablica Checa\">Rep\u00fablica Checa<\/option><option  value=\"Rep\u00fablica Dominicana\">Rep\u00fablica Dominicana<\/option><option  value=\"Rep\u00fablica de Macedonia\">Rep\u00fablica de Macedonia<\/option><option  value=\"Reuni\u00f3n\">Reuni\u00f3n<\/option><option  value=\"Ruanda\">Ruanda<\/option><option  value=\"Ruman\u00eda\">Ruman\u00eda<\/option><option  value=\"Rusia\">Rusia<\/option><option  value=\"Sahara Occidental\">Sahara Occidental<\/option><option  value=\"Saint Kitts y Nevis\">Saint Kitts y Nevis<\/option><option  value=\"Samoa\" data-code=\"WS\">Samoa<\/option><option  value=\"Samoa Americana\">Samoa Americana<\/option><option  value=\"San Bartolom\u00e9\">San Bartolom\u00e9<\/option><option  value=\"San Marino\" data-code=\"SM\">San Marino<\/option><option  value=\"San Mart\u00edn (parte francesa)\">San Mart\u00edn (parte francesa)<\/option><option  value=\"San Mart\u00edn\u200b (parte holandesa)\">San Mart\u00edn\u200b (parte holandesa)<\/option><option  value=\"San Pedro y Miquel\u00f3n\">San Pedro y Miquel\u00f3n<\/option><option  value=\"San Vicente y las Granadinas \">San Vicente y las Granadinas <\/option><option  value=\"Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a\">Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option  value=\"Santa Luc\u00eda\">Santa Luc\u00eda<\/option><option  value=\"Santa Sede\">Santa Sede<\/option><option  value=\"Santo Tom\u00e9 y Pr\u00edncipe\">Santo Tom\u00e9 y Pr\u00edncipe<\/option><option  value=\"Saud\u00ed Arabia\">Saud\u00ed Arabia<\/option><option  value=\"Senegal\" data-code=\"SN\">Senegal<\/option><option  value=\"Serbia\" data-code=\"RS\">Serbia<\/option><option  value=\"Seychelles\" data-code=\"SC\">Seychelles<\/option><option  value=\"Sierra Leona\">Sierra Leona<\/option><option  value=\"Singapur\">Singapur<\/option><option  value=\"Siria\">Siria<\/option><option  value=\"Somalia\" data-code=\"SO\">Somalia<\/option><option  value=\"Sri Lanka\" data-code=\"LK\">Sri Lanka<\/option><option  value=\"Suazilandia\">Suazilandia<\/option><option  value=\"Sud\u00e1frica\">Sud\u00e1frica<\/option><option  value=\"Sud\u00e1n\">Sud\u00e1n<\/option><option  value=\"Sud\u00e1n del sur\">Sud\u00e1n del sur<\/option><option  value=\"Suecia\">Suecia<\/option><option  value=\"Suiza\">Suiza<\/option><option  value=\"Surinam\">Surinam<\/option><option  value=\"Svalbard y Jan Mayen\">Svalbard y Jan Mayen<\/option><option  value=\"Tailandia\">Tailandia<\/option><option  value=\"Taiw\u00e1n\">Taiw\u00e1n<\/option><option  value=\"Tanzania\" data-code=\"TZ\">Tanzania<\/option><option  value=\"Tayikist\u00e1n\">Tayikist\u00e1n<\/option><option  value=\"Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico\">Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option  value=\"Territorios Australes Franceses\">Territorios Australes Franceses<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Togo\" data-code=\"TG\">Togo<\/option><option  value=\"Tokelau\" data-code=\"TK\">Tokelau<\/option><option  value=\"Tonga\" data-code=\"TO\">Tonga<\/option><option  value=\"Trinidad y Tobago\">Trinidad y Tobago<\/option><option  value=\"Turkmenist\u00e1n\">Turkmenist\u00e1n<\/option><option  value=\"Turqu\u00eda\">Turqu\u00eda<\/option><option  value=\"Tuvalu\" data-code=\"TV\">Tuvalu<\/option><option  value=\"T\u00fanez\">T\u00fanez<\/option><option  value=\"Ucrania\">Ucrania<\/option><option  value=\"Uganda\" data-code=\"UG\">Uganda<\/option><option  value=\"Uruguay\" data-code=\"UY\">Uruguay<\/option><option  value=\"Uzbekist\u00e1n\">Uzbekist\u00e1n<\/option><option  value=\"Vanuatu\" data-code=\"VU\">Vanuatu<\/option><option  value=\"Venezuela\" data-code=\"VE\">Venezuela<\/option><option  value=\"Vietnam\" data-code=\"VN\">Vietnam<\/option><option  value=\"Wallis y Futuna\">Wallis y Futuna<\/option><option  value=\"Yemen\" data-code=\"YE\">Yemen<\/option><option  value=\"Yibuti\">Yibuti<\/option><option  value=\"Zambia\" data-code=\"ZM\">Zambia<\/option><option  value=\"Zimbabue\">Zimbabue<\/option>\t\t<\/select>\n\t<div class=\"frm_description\">Pa\u00eds<\/div><\/div>\n<div id=\"frm_field_99-state_abbreviation_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_dfjjm_state_abbreviation\" class=\"frm_screen_reader frm_hidden\">\n\t\tUbicaci\u00f3n y direcci\u00f3n\t<\/label>\n\t\t<input type=\"hidden\" id=\"field_dfjjm_state_abbreviation\" value=\"\" name=\"item_meta[99][state_abbreviation]\"  placeholder=\"\" data-placeholder=\"\" data-sectionid=\"97\"  data-reqmsg=\"Ubicaci\u00f3n y direcci\u00f3n es obligatorio.\" aria-required=\"true\" data-invmsg=\"Ubicaci\u00f3n y direcci\u00f3n no es v\u00e1lido\" class=\"frm_optional\" aria-invalid=\"false\" data-geoautocomplete=\"1\" data-geofieldid=\"99\" data-geoisaddress=\"1\"   \/>\n\t<\/div>\n<\/div>\n<\/fieldset>\n\r\n\t\r\n\t<input id=\"geo-lat-99\" name=\"geo_lat[99]\" class=\"frm-geo-lat\" type=\"hidden\" value=\"\"><input id=\"geo-lng-99\" name=\"geo_lng[99]\" class=\"frm-geo-lng\" type=\"hidden\" value=\"\">\r\n<\/div>\n<div id=\"frm_field_100_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_1i3ut\" id=\"field_1i3ut_label\" class=\"frm_primary_label\">Nombre de contacto receptor\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_1i3ut\" name=\"item_meta[100]\" value=\"\"  data-sectionid=\"97\"  data-invmsg=\"El texto no es v\u00e1lido.\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_101_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_udyer\" id=\"field_udyer_label\" class=\"frm_primary_label\">Tel\u00e9fono de contacto receptor\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_udyer\" name=\"item_meta[101]\" value=\"\"  data-sectionid=\"97\"  placeholder=\"+C\u00f3digo de pa\u00eds (c\u00f3digo de \u00e1rea) #\" data-invmsg=\"El n\u00famero de tel\u00e9fono no es v\u00e1lido.\" class=\"frm-intl-tel-input\" aria-invalid=\"false\" pattern=\"\\+?\\d{1,4}[\\s\\-]?(?:\\(\\d{1,3}\\)[\\s\\-]?)?\\d{1,4}[\\s\\-]?\\d{1,4}[\\s\\-]?\\d{1,4}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_102_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_bp8lv\" id=\"field_bp8lv_label\" class=\"frm_primary_label\">Nombre de contacto secundario\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_bp8lv\" name=\"item_meta[102]\" value=\"\"  data-sectionid=\"97\"  data-invmsg=\"El n\u00famero de tel\u00e9fono no es v\u00e1lido.\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_103_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_wf54c\" id=\"field_wf54c_label\" class=\"frm_primary_label\">Tel\u00e9fono de contacto secundario\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_wf54c\" name=\"item_meta[103]\" value=\"\"  data-sectionid=\"97\"  placeholder=\"+C\u00f3digo de pa\u00eds (c\u00f3digo de \u00e1rea) #\" data-invmsg=\"El n\u00famero de tel\u00e9fono no es v\u00e1lido.\" class=\"frm-intl-tel-input\" aria-invalid=\"false\" pattern=\"\\+?\\d{1,4}[\\s\\-]?(?:\\(\\d{1,3}\\)[\\s\\-]?)?\\d{1,4}[\\s\\-]?\\d{1,4}[\\s\\-]?\\d{1,4}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_104_container\" class=\"frm_form_field form-field  frm_top_container frm3 frm_first\">\r\n\t<label for=\"field_deaxb\" id=\"field_deaxb_label\" class=\"frm_primary_label\">Nombre de estaci\u00f3n de enfermer\u00eda\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_deaxb\" name=\"item_meta[104]\" value=\"\"  data-sectionid=\"97\"  data-invmsg=\"Nombre de estaci\u00f3n de enfermer\u00eda no es v\u00e1lido.\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_105_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n    <label for=\"field_axvs0\" id=\"field_axvs0_label\" class=\"frm_primary_label\">Tel\u00e9fono de estaci\u00f3n de enfermer\u00eda\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_axvs0\" name=\"item_meta[105]\" value=\"\"  data-sectionid=\"97\"  placeholder=\"+C\u00f3digo de pa\u00eds (c\u00f3digo de \u00e1rea) #\" data-invmsg=\"El n\u00famero de tel\u00e9fono no es v\u00e1lido.\" class=\"frm-intl-tel-input\" aria-invalid=\"false\" pattern=\"\\+?\\d{1,4}[\\s\\-]?(?:\\(\\d{1,3}\\)[\\s\\-]?)?\\d{1,4}[\\s\\-]?\\d{1,4}[\\s\\-]?\\d{1,4}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_106_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm3\">\r\n    <label for=\"field_e2y8z\" id=\"field_e2y8z_label\" class=\"frm_primary_label\">Tel\u00e9fono del centro\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_e2y8z\" name=\"item_meta[106]\" value=\"\"  data-sectionid=\"97\"  placeholder=\"+C\u00f3digo de pa\u00eds (c\u00f3digo de \u00e1rea) #\" data-reqmsg=\"Tel\u00e9fono del centro es obligatorio.\" aria-required=\"true\" data-invmsg=\"El n\u00famero de tel\u00e9fono no es v\u00e1lido.\" class=\"frm-intl-tel-input\" aria-invalid=\"false\" pattern=\"\\+?\\d{1,4}[\\s\\-]?(?:\\(\\d{1,3}\\)[\\s\\-]?)?\\d{1,4}[\\s\\-]?\\d{1,4}[\\s\\-]?\\d{1,4}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_107_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n    <label for=\"field_lhw8d\" id=\"field_lhw8d_label\" class=\"frm_primary_label\">Piso y habitaci\u00f3n \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_lhw8d\" name=\"item_meta[107]\" value=\"\"  data-sectionid=\"97\"  data-invmsg=\"El texto no es v\u00e1lido.\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_109_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Informaci\u00f3n del pagador<\/h3>\r\n\r\n\r\n<div id=\"frm_field_110_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p>Las instrucciones de pago por transferencia bancaria se incluyen con cada cotizaci\u00f3n. Complete el pago requerido o la preautorizaci\u00f3n aprobada seg\u00fan los requisitos de reserva. La reserva y los arreglos del traslado avanzan despu\u00e9s de que se completen, acrediten o preautoricen debidamente los pasos requeridos del acuerdo de transporte y pago. El pago puede completarse mediante transferencia bancaria o tarjeta de cr\u00e9dito, o, cuando el tiempo lo requiere, mediante preautorizaci\u00f3n de tarjeta de cr\u00e9dito con transferencia bancaria posterior.<\/p>\n<\/div>\n<div id=\"frm_field_111_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4 frm_first\">\r\n    <label for=\"field_7l7b6\" id=\"field_7l7b6_label\" class=\"frm_primary_label\">Nombre del pagador\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_7l7b6\" name=\"item_meta[111]\" value=\"\"  data-sectionid=\"109\"  placeholder=\"Nombre completo\" data-reqmsg=\"Este campo es obligatorio.\" aria-required=\"true\" data-invmsg=\"El texto no es v\u00e1lido.\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_112_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4\">\r\n    <label for=\"field_r5wgj\" id=\"field_r5wgj_label\" class=\"frm_primary_label\">Tel\u00e9fono del pagador\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_r5wgj\" name=\"item_meta[112]\" value=\"\"  data-sectionid=\"109\"  placeholder=\"+C\u00f3digo de pa\u00eds (c\u00f3digo de \u00e1rea) #\" data-reqmsg=\"Este campo es obligatorio.\" aria-required=\"true\" data-invmsg=\"El n\u00famero de tel\u00e9fono no es v\u00e1lido.\" class=\"frm-intl-tel-input\" aria-invalid=\"false\" pattern=\"\\+?\\d{1,4}[\\s\\-]?(?:\\(\\d{1,3}\\)[\\s\\-]?)?\\d{1,4}[\\s\\-]?\\d{1,4}[\\s\\-]?\\d{1,4}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_113_container\" class=\"frm_form_field form-field  frm_top_container frm4\">\r\n    <label for=\"field_sayt\" id=\"field_sayt_label\" class=\"frm_primary_label\">Correo electr\u00f3nico del pagador\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_sayt\" name=\"item_meta[113]\" value=\"\"  data-sectionid=\"109\"  data-invmsg=\"El correo electr\u00f3nico no es v\u00e1lido.\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_114_container\" class=\"frm_form_field form-field  frm_top_container frm8 frm_first\">\r\n    <label for=\"field_zfths\" id=\"field_zfths_label\" class=\"frm_primary_label\">Direcci\u00f3n de facturaci\u00f3n\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_zfths\" name=\"item_meta[114]\" value=\"\"  data-sectionid=\"109\"  data-invmsg=\"El texto no es v\u00e1lido.\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_115_container\" class=\"frm_form_field form-field  frm_top_container frm4\">\r\n    <label for=\"field_hqk9y\" id=\"field_hqk9y_label\" class=\"frm_primary_label\">M\u00e9todo de pago preferido\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_hqk9y\" name=\"item_meta[115]\" value=\"\"  data-sectionid=\"109\"  data-invmsg=\"El texto no es v\u00e1lido.\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_117_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\"><b>Instrucciones especiales y documentos<\/b><\/h3>\r\n\r\n\r\n<div id=\"frm_field_118_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n    <label for=\"field_n4xh7\" id=\"field_n4xh7_label\" class=\"frm_primary_label\">Instrucciones especiales\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[118]\" id=\"field_n4xh7\" rows=\"5\"  data-sectionid=\"117\"  data-invmsg=\"no es v\u00e1lido\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_119_container\" class=\"frm_form_field  frm_html_container form-field\">\n<hr \/>\n<p><strong>Cargas recomendadas, si est\u00e1n disponibles: <\/strong>Informe m\u00e9dico m\u00e1s reciente o notas de evoluci\u00f3n; resultados recientes de laboratorio o diagn\u00f3stico; resultados de pruebas, si son requeridos por el pa\u00eds de destino, el centro de origen, el centro receptor o la revisi\u00f3n m\u00e9dica del operador seleccionado; pasaporte(s) y visa(s), si corresponde; orden de no reanimaci\u00f3n extrahospitalaria (DNR), si corresponde<\/p>\n<\/div>\n<div id=\"frm_field_120_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n    <label for=\"field_22egf\" id=\"field_22egf_label\" class=\"frm_primary_label\">Cargue documentos aqu\u00ed o haga clic para cargar (se permiten m\u00faltiples archivos)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-sectionid=\"117\"  data-invmsg=\"La carga de archivos no es v\u00e1lida.\" class=\"auto_width\" aria-invalid=\"false\"   name=\"item_meta[120][]\"  value=\"\" data-frmfile=\"120\" \/>\n\n<div class=\"frm_dropzone frm_multi_upload frm_clearfix\" id=\"file120_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file120[]\" id=\"field_22egf\"\n\t\t\t data-frmfile=\"120\" multiple=\"multiple\"  data-sectionid=\"117\"  data-invmsg=\"La carga de archivos no es v\u00e1lida.\" class=\"auto_width\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix \"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewBox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewBox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"Cargue documentos aqu\u00ed o haga clic para cargar (se permiten m\u00faltiples archivos). Suelte un archivo aqu\u00ed o haga clic para cargar. Tama\u00f1o m\u00e1ximo del archivo: 10MB\">Suelte un archivo aqu\u00ed o haga clic para cargar<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"Cargue documentos aqu\u00ed o haga clic para cargar (se permiten m\u00faltiples archivos). Elegir archivo. Tama\u00f1o m\u00e1ximo del archivo: 10MB\">Elegir archivo<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Tama\u00f1o m\u00e1ximo del archivo: 10MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_122_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Gu\u00eda de equipaje<\/h3>\r\n\r\n\r\n<div id=\"frm_field_123_container\" class=\"frm_form_field  frm12 frm_first frm_html_container form-field\">\n<ul>\n<li class=\"frm_form_field frm_html_container form-field\">En la mayor\u00eda de los traslados en avi\u00f3n ambulancia, los pasajeros est\u00e1n limitados a equipaje de mano est\u00e1ndar y un art\u00edculo personal peque\u00f1o, porque la configuraci\u00f3n de cabina, el equipamiento m\u00e9dico, las necesidades del paciente, los l\u00edmites de peso y los requisitos de seguridad deben revisarse antes del viaje.<\/li>\n<li class=\"frm_form_field frm_html_container form-field\">Como referencia general, el equipaje de mano est\u00e1ndar suele no exceder 45 pulgadas lineales (22 x 14 x 9 in) o 113 cent\u00edmetros lineales (55 x 35 x 23 cm).<\/li>\n<li class=\"frm_form_field frm_html_container form-field\">Las asignaciones de equipaje var\u00edan seg\u00fan el tipo de aeronave, las necesidades del paciente, la configuraci\u00f3n de cabina, la ruta y los requisitos del operador seleccionado. El equipaje sobredimensionado o en exceso puede necesitar enviarse por separado y debe discutirse durante la planificaci\u00f3n.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div id=\"frm_field_128_container\" class=\"frm_form_field form-field \">\r\n\t<div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">RESERVAR AVI\u00d3N AMBULANCIA<\/button>\r\n\r\n<a href=\"#\" tabindex=\"0\" class=\"frm_start_over\" >EMPEZAR DE NUEVO<\/a>\r\n<\/div>\r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_133_container\">\n\t\t\t<label for=\"field_9lv8p\" >\n\t\t\t\tSi eres humano, deja este campo en blanco.\t\t\t<\/label>\n\t\t\t<input  id=\"field_9lv8p\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[133]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"VCxgLYP05rl3WOKTVh8xRdybNySsg6ex32NUg\/W7d8oDzCVE5W6XXYmIH3JSHZxn\" \/><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n\n<div class=\"et_pb_section_4 et_pb_section et_section_regular et_block_section\">\n<div class=\"et_pb_row_8 et_pb_row et_flex_row pa-bullet-list-1\">\n<div class=\"et_pb_column_11 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_24_24 et_flex_column_24_24_tablet et_flex_column_24_24_phone\">\n<div class=\"et_pb_text_11 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><h2>Despu\u00e9s de enviar la solicitud<\/h2>\n<\/div><\/div>\n\n<div class=\"et_pb_text_12 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><p><strong>Una vez recibida su solicitud de reserva:<\/strong><\/p>\n<ul>\n<li>Un Especialista en Coordinaci\u00f3n de Traslados en Avi\u00f3n Ambulancia revisa los detalles enviados, los requisitos del traslado, los documentos y las opciones disponibles de avi\u00f3n ambulancia.<\/li>\n<li>Si se necesitan detalles cl\u00ednicos o log\u00edsticos adicionales, un Especialista en Coordinaci\u00f3n de Traslados en Avi\u00f3n Ambulancia se lo indicar\u00e1.<\/li>\n<li>Se proporcionan pr\u00f3ximos pasos claros para documentaci\u00f3n, pago o preautorizaci\u00f3n, y programaci\u00f3n.<\/li>\n<\/ul>\n<p>Enviar esta solicitud de reserva no confirma el traslado. La reserva se confirma \u00fanicamente despu\u00e9s de completar la revisi\u00f3n requerida, documentaci\u00f3n, acuerdo y pasos financieros, sujeto a disponibilidad y revisi\u00f3n operativa al momento de la reserva.<\/p>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1914","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/airmedical.com\/es\/wp-json\/wp\/v2\/pages\/1914","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/airmedical.com\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/airmedical.com\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/airmedical.com\/es\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/airmedical.com\/es\/wp-json\/wp\/v2\/comments?post=1914"}],"version-history":[{"count":5,"href":"https:\/\/airmedical.com\/es\/wp-json\/wp\/v2\/pages\/1914\/revisions"}],"predecessor-version":[{"id":2282,"href":"https:\/\/airmedical.com\/es\/wp-json\/wp\/v2\/pages\/1914\/revisions\/2282"}],"wp:attachment":[{"href":"https:\/\/airmedical.com\/es\/wp-json\/wp\/v2\/media?parent=1914"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}