Plan de comunicaci贸n familiar en emergencias

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aplicaci贸n m贸vil de FEMA: Tome el control de los desastres</span> </a> </li> <li class=" usa-nav__submenu-item "> <a href="/es/herramientas"> <span>Kit de Herramientas para Promover la Preparaci贸n en los Medios Sociales</span> </a> </li> <li class=" usa-nav__submenu-item "> <a href="/es/calendario"> <span>Calendario Nacional Estacional de Mensajes sobre la Preparaci贸n</span> </a> </li> <li class=" usa-nav__submenu-item "> <a href="/es/publicaciones"> <span>Publicaciones</span> </a> </li> <li class=" usa-nav__submenu-item "> <a href="/es/medios-sociales"> <span>Medios Sociales</span> </a> </li> <li class=" usa-nav__submenu-item "> <a href="/es/videos"> <span>Videos sobre la Preparaci贸n</span> </a> </li> <li class=" usa-nav__submenu-item "> <a href="/es/acerca-de-la-campana-de-ready"> <span>Acerca de la campa帽a de Ready</span> </a> </li> <li class=" usa-nav__submenu-item "> <a href="/es/webform/contact-us"> <span>Cont谩ctenos</span> </a> </li> <li class=" usa-nav__submenu-item "> <a href="/local"> <span>Local Emergency Management Information</span> </a> </li> </ul> </li> </ul> <div id="block-mobileusasearch" class="block block-block-content block-block-contentae77392d-3dd5-4935-9a46-f81972e53157"> <div class="layout layout--onecol"> <div class="layout__region layout__region--content"> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><div class="mobile-usa-search"/></div> </div> </div> </div> </div> <div class="usa-nav__secondary"> <div class="region region-secondary-menu"> <div class="usa-nav-secondary"> <ul class="usa-nav__secondary-links"> <li class="usa-nav__secondary-item"> <a href="/es/acerca-de-la-campana-de-ready"> Acerca de la campa帽a de Ready </a> </li> <li class="usa-nav__secondary-item"> <a href="/es/webform/contact-us"> Cont谩ctenos </a> </li> </ul> </div> <div id="block-desktopusasearch" class="block block-block-content block-block-content8ab8e57c-75da-43cf-9111-3c89f0fd9fec"> <div class="layout layout--onecol"> <div class="layout__region layout__region--content"> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><div class="desktop-usa-search"/></div> </div> </div> </div> </div> </div> </div> </nav> </header> <div tabindex="-1" id="main-content"></div> <section class="usa-hero"> </section> <main class="usa-section"> <div class="grid-container"> <div class="grid-row grid-gap"> <div class="grid-col-12"> </div> </div> <div class="grid-row grid-gap main-content-grid"> <aside class="desktop:grid-col-3 aside-sidebar_first"> <div class="region region-sidebar-first"> <ul class="usa-sidenav"> <li class="usa-sidenav__item"> <a href="/es/mantengase-informado"> <span>Desastres y Emergencias</span> </a> </li> <li class="usa-sidenav__item"> <a href="/es/haga-un-plan" class="usa-current"> <span>Haga un Plan</span> </a> <ul class="usa-sidenav__sublist"> <li class="usa-sidenav__item"> <a href="/es/haga-un-plan" class="usa-current"> <span>Haga un Plan</span> </a> <ul class="usa-sidenav__sublist"> <li class="usa-sidenav__item"> <a href="/es/plan-form" class="usa-current"> <span>Make a Plan Form </span> </a> </li> </ul> </li> <li class="usa-sidenav__item"> <a href="/es/kit"> <span>Prepare un kit de suministros</span> </a> </li> <li class="usa-sidenav__item"> <a href="/es/low-and-no-cost"> <span>Preparaci贸n a bajo o ning煤n costo</span> </a> </li> <li class="usa-sidenav__item"> <a href="/es/registros-vitales"> <span>Preparaci贸n Financiera</span> </a> </li> <li class="usa-sidenav__item"> <a href="/es/use-la-tecnologia-para-estar-preparado"> <span>Use la Tecnolog铆a para Estar Preparado</span> </a> </li> <li class="usa-sidenav__item"> <a href="/es/cuidado-de-los-animales"> <span>Mascotas y Animales</span> </a> </li> <li class="usa-sidenav__item"> <a href="/es/summer-ready"> <span>#SummerReady </span> </a> </li> <li class="usa-sidenav__item"> <a href="/es/winter-ready"> <span>#WinterReady</span> </a> </li> <li class="usa-sidenav__item"> <a href="/es/evacuacion"> <span>Evacuaci贸n</span> </a> </li> <li class="usa-sidenav__item"> <a href="/es/refugio"> <span>Refugio</span> </a> </li> <li class="usa-sidenav__item"> <a href="/es/habilidades-relacionadas-con-la-seguridad"> <span>Habilidades de Seguridad</span> </a> </li> <li class="usa-sidenav__item"> <a href="/es/planifique-distintos-lugares"> <span>Planifique Distintos Lugares</span> </a> </li> <li class="usa-sidenav__item"> <a href="/es/home-fire-escape-plan"> <span>Plan de escape en caso de un incendio en el hogar</span> </a> </li> <li class="usa-sidenav__item"> <a href="/es/preparacion-en-los-campus-universitarios"> <span>Preparaci贸n en los Campus Universitarios</span> </a> </li> </ul> </li> <li class="usa-sidenav__item"> <a href="/es/communities"> <span>Comunidades Ready</span> </a> </li> <li class="usa-sidenav__item"> <a href="/es/business"> <span>Listo Negocios </span> </a> </li> <li class="usa-sidenav__item"> <a href="https://www.ready.gov/es/kids"> <span>Ni帽os</span> </a> </li> <li class="usa-sidenav__item"> <a href="/es/recursos"> <span>Recursos</span> </a> </li> </ul> </div> </aside> <div class="region-content desktop:grid-col-fill"> <div class="region region-content"> <div data-drupal-messages-fallback class="hidden"></div> <div id="block-makeaplanlanguageblockspanish" class="block block-block-content block-block-content5cbdaab2-0cdc-4be8-92c5-bc836cc2eaff"> <div class="layout layout--onecol"> <div class="layout__region layout__region--content"> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><div class="translations-available"> 聽聽 <img src="/profiles/readyd8_gov/themes/uswds_ready/img/world-icon-black.png" alt="world globe"> 聽聽 <ul><li><span class="translation-first"><span><a href="/es/plan-form">Espanol</a></span></span></li> <li><span><a href="/plan-form">English</a></span></li> </ul></div></div> </div> </div> </div> <div id="block-planformprivacyblockspanish" class="block block-block-content block-block-contentcfdc4df9-1a2a-41b0-ac87-76c388d976aa"> <div class="layout layout--onecol"> <div class="layout__region layout__region--content"> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p><em><strong>La informaci贸n que proporcion贸 no es guardada, almacenada ni compartida por ninguna agencia gubernamental.</strong></em></p> </div> </div> </div> </div> <div id="block-uswds-ready-ready2017-system-main" class="block block-system block-system-main-block"> <form class="makeaplan-form usa-form" data-drupal-selector="makeaplan-form" action="/es/plan-form" method="post" id="makeaplan-form" accept-charset="UTF-8"> <p>Es posible que no est茅n juntos cuando ocurra un desastre, por lo cual es importante saber c贸mo se comunicar谩n si se separan. Utilice este formulario para crear un plan de comunicaci贸n familiar en emergencias que puede enviar a trav茅s de correo electr贸nico en formato PDF luego de llenarlo.</p><h2>INFORMACI脫N DEL HOGAR</h2> <div data-drupal-selector="edit-household" class="js-form-item form-item"> <table id="household-values--2" class="field-multiple-table responsive-enabled usa-table" data-striping="1"> <thead> <tr> <th colspan="2" class="field-label" scope="row"><h4 class="label"></h4></th> <th>Ordenar</th> </tr> </thead> <tbody> <tr class="draggable odd" scope="row"> <td class="field-multiple-drag paragraph-bullet"></td> <td><div class="usa-form-group js-form-item form-item js-form-type-tel form-item-household-0-household-phone js-form-item-household-0-household-phone"> <label for="edit-household-0-household-phone" class="usa-label">Tel茅fono del hogar: <span class="usa-hint">(opcional)</span></label> <input data-drupal-selector="edit-household-0-household-phone" pattern="[0-9]{3}-[0-9]{3}-[0-9]{4}" type="tel" id="edit-household-0-household-phone" name="household[0][household_phone]" value="" size="30" maxlength="128" placeholder="123-456-7890" class="form-tel" /> </div> <div class="usa-form-group js-form-item form-item js-form-type-textarea form-item-household-0-household-address js-form-item-household-0-household-address"> <label for="edit-household-0-household-address" class="usa-label">Direcci贸n: <span class="usa-hint">(opcional)</span></label> <div class="form-textarea-wrapper"> <textarea data-drupal-selector="edit-household-0-household-address" id="edit-household-0-household-address" name="household[0][household_address]" rows="5" cols="60" class="form-textarea usa-textarea resize-vertical"></textarea> </div> </div> </td> <td class="delta-order"><div class="usa-form-group js-form-item form-item js-form-type-select form-item-household-0--weight js-form-item-household-0--weight form-no-label"> <label for="edit-household-0-weight" class="usa-label visually-hidden">Peso para la fila 1 <span class="usa-hint">(opcional)</span></label> <select data-drupal-selector="edit-household-0-weight" class="household-delta-order form-select usa-select" id="edit-household-0-weight" name="household[0][_weight]"><option value="0" selected="selected">0</option></select> </div> </td> </tr> </tbody> </table> </div> <h2>MIEMBROS DE LA FAMILIA</h2><p>Incluya la informaci贸n de cada miembro de su familia.</p><div id="names-add-more-wrapper"> <div data-drupal-selector="edit-names" class="js-form-item form-item"> <table id="names-values--2" class="field-multiple-table responsive-enabled usa-table" data-striping="1"> <thead> <tr> <th colspan="2" class="field-label" scope="row"><h4 class="label"></h4></th> <th>Ordenar</th> </tr> </thead> <tbody> <tr class="draggable odd" scope="row"> <td class="field-multiple-drag"></td> <td><div class="usa-form-group js-form-item form-item js-form-type-textfield form-item-names-0-name js-form-item-names-0-name"> <label for="edit-names-0-name" class="usa-label">Nombre: <span class="usa-hint">(opcional)</span></label> <input data-drupal-selector="edit-names-0-name" type="text" id="edit-names-0-name" name="names[0][name]" value="" size="60" maxlength="128" class="form-text usa-input" /> </div> <div class="usa-form-group js-form-item form-item js-form-type-tel form-item-names-0-mobile js-form-item-names-0-mobile"> <label for="edit-names-0-mobile" class="usa-label">N煤mero de celular: <span class="usa-hint">(opcional)</span></label> <input data-drupal-selector="edit-names-0-mobile" pattern="[0-9]{3}-[0-9]{3}-[0-9]{4}" type="tel" id="edit-names-0-mobile" name="names[0][mobile]" value="" size="30" maxlength="128" placeholder="123-456-7890" class="form-tel" /> </div> <div class="usa-form-group js-form-item form-item js-form-type-textfield form-item-names-0-other-social js-form-item-names-0-other-social"> <label for="edit-names-0-other-social" class="usa-label">Otro n煤mero o redes sociales: <span class="usa-hint">(opcional)</span></label> <input data-drupal-selector="edit-names-0-other-social" type="text" id="edit-names-0-other-social" name="names[0][other_social]" value="" size="60" maxlength="128" class="form-text usa-input" /> </div> <div class="usa-form-group js-form-item form-item js-form-type-email form-item-names-0-email js-form-item-names-0-email"> <label for="edit-names-0-email" class="usa-label">Correo electr贸nico: <span class="usa-hint">(opcional)</span></label> <input data-drupal-selector="edit-names-0-email" type="email" id="edit-names-0-email" name="names[0][email]" value="" size="60" maxlength="254" class="form-email usa-input" /> </div> <div class="usa-form-group js-form-item form-item js-form-type-textarea form-item-names-0-other-medical js-form-item-names-0-other-medical"> <label for="edit-names-0-other-medical" class="usa-label">Informaci贸n importante m茅dica u otra: <span class="usa-hint">(opcional)</span></label> <div class="form-textarea-wrapper"> <textarea data-drupal-selector="edit-names-0-other-medical" id="edit-names-0-other-medical" name="names[0][other_medical]" rows="5" cols="30" class="form-textarea usa-textarea resize-vertical"></textarea> </div> </div> </td> <td class="delta-order"><div class="usa-form-group js-form-item form-item js-form-type-select form-item-names-0--weight js-form-item-names-0--weight form-no-label"> <label for="edit-names-0-weight" class="usa-label visually-hidden">Peso para la fila 1 <span class="usa-hint">(opcional)</span></label> <select data-drupal-selector="edit-names-0-weight" class="names-delta-order form-select usa-select" id="edit-names-0-weight" name="names[0][_weight]"><option value="0" selected="selected">0</option></select> </div> </td> </tr> </tbody> </table> <div class="clearfix"><input class="multivalue-add-more-submit button js-form-submit form-submit usa-button" data-drupal-selector="edit-names-add-more" formnovalidate="formnovalidate" type="submit" id="edit-names-add-more" name="names_add_more" value="A帽adir otro nombre" /> </div> </div> </div><h2>PLANES DE EMERGENCIA</h2><p>Incluya la informaci贸n de escuelas, cuido infantil, cuidadores y lugares de empleo.</p><div id="emergency-plans-add-more-wrapper"> <div data-drupal-selector="edit-emergency-plans" class="js-form-item form-item"> <table id="emergency-plans-values--2" class="field-multiple-table responsive-enabled usa-table" data-striping="1"> <thead> <tr> <th colspan="2" class="field-label" scope="row"><h4 class="label"></h4></th> <th>Ordenar</th> </tr> </thead> <tbody> <tr class="draggable odd" scope="row"> <td class="field-multiple-drag"></td> <td><div class="usa-form-group js-form-item form-item js-form-type-textfield form-item-emergency-plans-0-emergency-name js-form-item-emergency-plans-0-emergency-name"> <label for="edit-emergency-plans-0-emergency-name" class="usa-label">Nombre: <span class="usa-hint">(opcional)</span></label> <input data-drupal-selector="edit-emergency-plans-0-emergency-name" type="text" id="edit-emergency-plans-0-emergency-name" name="emergency_plans[0][emergency_name]" value="" size="60" maxlength="128" class="form-text usa-input" /> </div> <div class="usa-form-group js-form-item form-item js-form-type-textarea form-item-emergency-plans-0-emergency-address js-form-item-emergency-plans-0-emergency-address"> <label for="edit-emergency-plans-0-emergency-address" class="usa-label">Direcci贸n: <span class="usa-hint">(opcional)</span></label> <div class="form-textarea-wrapper"> <textarea data-drupal-selector="edit-emergency-plans-0-emergency-address" id="edit-emergency-plans-0-emergency-address" name="emergency_plans[0][emergency_address]" rows="5" cols="30" class="form-textarea usa-textarea resize-vertical"></textarea> </div> </div> <div class="usa-form-group js-form-item form-item js-form-type-tel form-item-emergency-plans-0-emergency-hotline js-form-item-emergency-plans-0-emergency-hotline"> <label for="edit-emergency-plans-0-emergency-hotline" class="usa-label">N煤mero de emergencia: <span class="usa-hint">(opcional)</span></label> <input data-drupal-selector="edit-emergency-plans-0-emergency-hotline" pattern="[0-9]{3}-[0-9]{3}-[0-9]{4}" type="tel" id="edit-emergency-plans-0-emergency-hotline" name="emergency_plans[0][emergency_hotline]" value="" size="30" maxlength="128" placeholder="123-456-7890" class="form-tel" /> </div> <div class="usa-form-group js-form-item form-item js-form-type-textfield form-item-emergency-plans-0-emergency-website js-form-item-emergency-plans-0-emergency-website"> <label for="edit-emergency-plans-0-emergency-website" class="usa-label">P谩gina web: <span class="usa-hint">(opcional)</span></label> <input data-drupal-selector="edit-emergency-plans-0-emergency-website" type="text" id="edit-emergency-plans-0-emergency-website" name="emergency_plans[0][emergency_website]" value="" size="60" maxlength="128" class="form-text usa-input" /> </div> <div class="usa-form-group js-form-item form-item js-form-type-textarea form-item-emergency-plans-0-emergency-plan js-form-item-emergency-plans-0-emergency-plan"> <label for="edit-emergency-plans-0-emergency-plan" class="usa-label">Plan de emergencia/Qui茅n puede recoger: <span class="usa-hint">(opcional)</span></label> <div class="form-textarea-wrapper"> <textarea data-drupal-selector="edit-emergency-plans-0-emergency-plan" id="edit-emergency-plans-0-emergency-plan" name="emergency_plans[0][emergency_plan]" rows="5" cols="30" class="form-textarea usa-textarea resize-vertical"></textarea> </div> </div> </td> <td class="delta-order"><div class="usa-form-group js-form-item form-item js-form-type-select form-item-emergency-plans-0--weight js-form-item-emergency-plans-0--weight form-no-label"> <label for="edit-emergency-plans-0-weight" class="usa-label visually-hidden">Peso para la fila 1 <span class="usa-hint">(opcional)</span></label> <select data-drupal-selector="edit-emergency-plans-0-weight" class="emergency_plans-delta-order form-select usa-select" id="edit-emergency-plans-0-weight" name="emergency_plans[0][_weight]"><option value="0" selected="selected">0</option></select> </div> </td> </tr> </tbody> </table> <div class="clearfix"><input class="multivalue-add-more-submit button js-form-submit form-submit usa-button" data-drupal-selector="edit-emergency-plans-add-more" formnovalidate="formnovalidate" type="submit" id="edit-emergency-plans-add-more" name="emergency_plans_add_more" value="A帽adir otro plan de emergencia" /> </div> </div> </div><h2>CONTACTO DE EMERGENCIA</h2><div id="emergency-contact-add-more-wrapper"> <div data-drupal-selector="edit-emergency-contact" class="js-form-item form-item"> <table id="emergency-contact-values--2" class="field-multiple-table responsive-enabled usa-table" data-striping="1"> <thead> <tr> <th colspan="2" class="field-label" scope="row"><h4 class="label"></h4></th> <th>Ordenar</th> </tr> </thead> <tbody> <tr class="draggable odd" scope="row"> <td class="field-multiple-drag"></td> <td><div class="usa-form-group js-form-item form-item js-form-type-textfield form-item-emergency-contact-0-contact-name js-form-item-emergency-contact-0-contact-name"> <label for="edit-emergency-contact-0-contact-name" class="usa-label">Nombre: <span class="usa-hint">(opcional)</span></label> <input data-drupal-selector="edit-emergency-contact-0-contact-name" type="text" id="edit-emergency-contact-0-contact-name" name="emergency_contact[0][contact_name]" value="" size="60" maxlength="128" class="form-text usa-input" /> </div> <div class="usa-form-group js-form-item form-item js-form-type-tel form-item-emergency-contact-0-contact-mobile js-form-item-emergency-contact-0-contact-mobile"> <label for="edit-emergency-contact-0-contact-mobile" class="usa-label">N煤mero de celular: <span class="usa-hint">(opcional)</span></label> <input data-drupal-selector="edit-emergency-contact-0-contact-mobile" pattern="[0-9]{3}-[0-9]{3}-[0-9]{4}" type="tel" id="edit-emergency-contact-0-contact-mobile" name="emergency_contact[0][contact_mobile]" value="" size="30" maxlength="128" placeholder="123-456-7890" class="form-tel" /> </div> <div class="usa-form-group js-form-item form-item js-form-type-tel form-item-emergency-contact-0-contact-home js-form-item-emergency-contact-0-contact-home"> <label for="edit-emergency-contact-0-contact-home" class="usa-label">Tel茅fono del hogar: <span class="usa-hint">(opcional)</span></label> <input data-drupal-selector="edit-emergency-contact-0-contact-home" pattern="[0-9]{3}-[0-9]{3}-[0-9]{4}" type="tel" id="edit-emergency-contact-0-contact-home" name="emergency_contact[0][contact_home]" value="" size="30" maxlength="128" placeholder="123-456-7890" class="form-tel" /> </div> <div class="usa-form-group js-form-item form-item js-form-type-email form-item-emergency-contact-0-contact-email js-form-item-emergency-contact-0-contact-email"> <label for="edit-emergency-contact-0-contact-email" class="usa-label">Correo electr贸nico: <span class="usa-hint">(opcional)</span></label> <input data-drupal-selector="edit-emergency-contact-0-contact-email" type="email" id="edit-emergency-contact-0-contact-email" name="emergency_contact[0][contact_email]" value="" size="60" maxlength="254" class="form-email usa-input" /> </div> <div class="usa-form-group js-form-item form-item js-form-type-textarea form-item-emergency-contact-0-contact-address js-form-item-emergency-contact-0-contact-address"> <label for="edit-emergency-contact-0-contact-address" class="usa-label">Direcci贸n: <span class="usa-hint">(opcional)</span></label> <div class="form-textarea-wrapper"> <textarea data-drupal-selector="edit-emergency-contact-0-contact-address" id="edit-emergency-contact-0-contact-address" name="emergency_contact[0][contact_address]" rows="5" cols="30" class="form-textarea usa-textarea resize-vertical"></textarea> </div> </div> </td> <td class="delta-order"><div class="usa-form-group js-form-item form-item js-form-type-select form-item-emergency-contact-0--weight js-form-item-emergency-contact-0--weight form-no-label"> <label for="edit-emergency-contact-0-weight" class="usa-label visually-hidden">Peso para la fila 1 <span class="usa-hint">(opcional)</span></label> <select data-drupal-selector="edit-emergency-contact-0-weight" class="emergency_contact-delta-order form-select usa-select" id="edit-emergency-contact-0-weight" name="emergency_contact[0][_weight]"><option value="0" selected="selected">0</option></select> </div> </td> </tr> </tbody> </table> <div class="clearfix"><input class="multivalue-add-more-submit button js-form-submit form-submit usa-button" data-drupal-selector="edit-emergency-contact-add-more" formnovalidate="formnovalidate" type="submit" id="edit-emergency-contact-add-more" name="emergency_contact_add_more" value="A帽adir otro contacto de emergencia" /> </div> </div> </div><h2>LUGARES DE ENCUENTRO DESPU脡S DE EMERGENCIAS</h2><div id="emergency-meeting-places-add-more-wrapper"> <div data-drupal-selector="edit-emergency-meeting-places" class="js-form-item form-item"> <table id="emergency-meeting-places-values--2" class="field-multiple-table responsive-enabled usa-table" data-striping="1"> <thead> <tr> <th colspan="2" class="field-label" scope="row"><h4 class="label"></h4></th> <th>Ordenar</th> </tr> </thead> <tbody> <tr class="draggable odd" scope="row"> <td class="field-multiple-drag"></td> <td><div class="usa-form-group js-form-item form-item js-form-type-textarea form-item-emergency-meeting-places-0-location js-form-item-emergency-meeting-places-0-location"> <label for="edit-emergency-meeting-places-0-location" class="usa-label">Ubicaci贸n: <span class="usa-hint">(opcional)</span></label> <div class="form-textarea-wrapper"> <textarea data-drupal-selector="edit-emergency-meeting-places-0-location" id="edit-emergency-meeting-places-0-location" name="emergency_meeting_places[0][location]" rows="5" cols="60" class="form-textarea usa-textarea resize-vertical"></textarea> </div> </div> <div class="usa-form-group js-form-item form-item js-form-type-textarea form-item-emergency-meeting-places-0-instructions js-form-item-emergency-meeting-places-0-instructions"> <label for="edit-emergency-meeting-places-0-instructions" class="usa-label">Instrucciones: <span class="usa-hint">(opcional)</span></label> <div class="form-textarea-wrapper"> <textarea data-drupal-selector="edit-emergency-meeting-places-0-instructions" id="edit-emergency-meeting-places-0-instructions" name="emergency_meeting_places[0][instructions]" rows="5" cols="60" class="form-textarea usa-textarea resize-vertical"></textarea> </div> </div> </td> <td class="delta-order"><div class="usa-form-group js-form-item form-item js-form-type-select form-item-emergency-meeting-places-0--weight js-form-item-emergency-meeting-places-0--weight form-no-label"> <label for="edit-emergency-meeting-places-0-weight" class="usa-label visually-hidden">Peso para la fila 1 <span class="usa-hint">(opcional)</span></label> <select data-drupal-selector="edit-emergency-meeting-places-0-weight" class="emergency_meeting_places-delta-order form-select usa-select" id="edit-emergency-meeting-places-0-weight" name="emergency_meeting_places[0][_weight]"><option value="0" selected="selected">0</option></select> </div> </td> </tr> </tbody> </table> <div class="clearfix"><input class="multivalue-add-more-submit button js-form-submit form-submit usa-button" data-drupal-selector="edit-emergency-meeting-places-add-more" formnovalidate="formnovalidate" type="submit" id="edit-emergency-meeting-places-add-more" name="emergency_meeting_places_add_more" value="A帽adir otro lugar de encuentro despu茅s de emergencias" /> </div> </div> </div><h2>INFORMACI脫N M脡DICA</h2> <div data-drupal-selector="edit-medical" class="js-form-item form-item"> <table id="medical-values--2" class="field-multiple-table responsive-enabled usa-table" data-striping="1"> <thead> <tr> <th colspan="2" class="field-label" scope="row"><h4 class="label"></h4></th> <th>Ordenar</th> </tr> </thead> <tbody> <tr class="draggable odd" scope="row"> <td class="field-multiple-drag paragraph-bullet"></td> <td><div class="usa-form-group js-form-item form-item js-form-type-textfield form-item-medical-0-poison-control js-form-item-medical-0-poison-control form-disabled"> <label for="edit-medical-0-poison-control" class="usa-label">Poison Control (control de envenenamiento): <span class="usa-hint">(opcional)</span></label> <input data-drupal-selector="edit-medical-0-poison-control" disabled="disabled" type="text" id="edit-medical-0-poison-control" name="medical[0][poison_control]" value="1-800-222-1222" size="60" maxlength="128" class="form-text usa-input" /> </div> </td> <td class="delta-order"><div class="usa-form-group js-form-item form-item js-form-type-select form-item-medical-0--weight js-form-item-medical-0--weight form-no-label"> <label for="edit-medical-0-weight" class="usa-label visually-hidden">Peso para la fila 1 <span class="usa-hint">(opcional)</span></label> <select data-drupal-selector="edit-medical-0-weight" class="medical-delta-order form-select usa-select" id="edit-medical-0-weight" name="medical[0][_weight]"><option value="0" selected="selected">0</option></select> </div> </td> </tr> </tbody> </table> </div> <div id="doctor-add-more-wrapper"> <div data-drupal-selector="edit-doctor" class="js-form-item form-item"> <table id="doctor-values--2" class="field-multiple-table responsive-enabled usa-table" data-striping="1"> <thead> <tr> <th colspan="2" class="field-label" scope="row"><h4 class="label"></h4></th> <th>Ordenar</th> </tr> </thead> <tbody> <tr class="draggable odd" scope="row"> <td class="field-multiple-drag"></td> <td><div class="usa-form-group js-form-item form-item js-form-type-textfield form-item-doctor-0-doctor-name js-form-item-doctor-0-doctor-name"> <label for="edit-doctor-0-doctor-name" class="usa-label">Nombre del doctor: <span class="usa-hint">(opcional)</span></label> <input data-drupal-selector="edit-doctor-0-doctor-name" type="text" id="edit-doctor-0-doctor-name" name="doctor[0][doctor_name]" value="" size="60" maxlength="128" class="form-text usa-input" /> </div> <div class="usa-form-group js-form-item form-item js-form-type-tel form-item-doctor-0-doctor-phone js-form-item-doctor-0-doctor-phone"> <label for="edit-doctor-0-doctor-phone" class="usa-label">Tel茅fono del doctor #: <span class="usa-hint">(opcional)</span></label> <input data-drupal-selector="edit-doctor-0-doctor-phone" pattern="[0-9]{3}-[0-9]{3}-[0-9]{4}" type="tel" id="edit-doctor-0-doctor-phone" name="doctor[0][doctor_phone]" value="" size="30" maxlength="128" placeholder="123-456-7890" class="form-tel" /> </div> </td> <td class="delta-order"><div class="usa-form-group js-form-item form-item js-form-type-select form-item-doctor-0--weight js-form-item-doctor-0--weight form-no-label"> <label for="edit-doctor-0-weight" class="usa-label visually-hidden">Peso para la fila 1 <span class="usa-hint">(opcional)</span></label> <select data-drupal-selector="edit-doctor-0-weight" class="doctor-delta-order form-select usa-select" id="edit-doctor-0-weight" name="doctor[0][_weight]"><option value="0" selected="selected">0</option></select> </div> </td> </tr> </tbody> </table> <div class="clearfix"><input class="multivalue-add-more-submit button js-form-submit form-submit usa-button" data-drupal-selector="edit-doctor-add-more" formnovalidate="formnovalidate" type="submit" id="edit-doctor-add-more" name="doctor_add_more" value="Agregar otro nombre y tel茅fono de m茅dico" /> </div> </div> </div> <div data-drupal-selector="edit-medical2" class="js-form-item form-item"> <table id="medical2-values--2" class="field-multiple-table responsive-enabled usa-table" data-striping="1"> <thead> <tr> <th colspan="2" class="field-label" scope="row"><h4 class="label"></h4></th> <th>Ordenar</th> </tr> </thead> <tbody> <tr class="draggable odd" scope="row"> <td class="field-multiple-drag paragraph-bullet"></td> <td><div class="usa-form-group js-form-item form-item js-form-type-textfield form-item-medical2-0-pediatrician-name js-form-item-medical2-0-pediatrician-name"> <label for="edit-medical2-0-pediatrician-name" class="usa-label">Nombre del pediatra: <span class="usa-hint">(opcional)</span></label> <input data-drupal-selector="edit-medical2-0-pediatrician-name" type="text" id="edit-medical2-0-pediatrician-name" name="medical2[0][pediatrician_name]" value="" size="60" maxlength="128" class="form-text usa-input" /> </div> <div class="usa-form-group js-form-item form-item js-form-type-tel form-item-medical2-0-pediatrician-phone js-form-item-medical2-0-pediatrician-phone"> <label for="edit-medical2-0-pediatrician-phone" class="usa-label">Tel茅fono del pediatra #: <span class="usa-hint">(opcional)</span></label> <input data-drupal-selector="edit-medical2-0-pediatrician-phone" pattern="[0-9]{3}-[0-9]{3}-[0-9]{4}" type="tel" id="edit-medical2-0-pediatrician-phone" name="medical2[0][pediatrician_phone]" value="" size="30" maxlength="128" placeholder="123-456-7890" class="form-tel" /> </div> <div class="usa-form-group js-form-item form-item js-form-type-textarea form-item-medical2-0-allergies js-form-item-medical2-0-allergies"> <label for="edit-medical2-0-allergies" class="usa-label">Informaci贸n sobre alergias y medicamentos recetados <span class="usa-hint">(opcional)</span></label> <div class="form-textarea-wrapper"> <textarea data-drupal-selector="edit-medical2-0-allergies" id="edit-medical2-0-allergies" name="medical2[0][allergies]" rows="5" cols="30" class="form-textarea usa-textarea resize-vertical"></textarea> </div> </div> </td> <td class="delta-order"><div class="usa-form-group js-form-item form-item js-form-type-select form-item-medical2-0--weight js-form-item-medical2-0--weight form-no-label"> <label for="edit-medical2-0-weight" class="usa-label visually-hidden">Peso para la fila 1 <span class="usa-hint">(opcional)</span></label> <select data-drupal-selector="edit-medical2-0-weight" class="medical2-delta-order form-select usa-select" id="edit-medical2-0-weight" name="medical2[0][_weight]"><option value="0" selected="selected">0</option></select> </div> </td> </tr> </tbody> </table> </div> <div id="insurance-add-more-wrapper"> <div data-drupal-selector="edit-insurance" class="js-form-item form-item"> <table id="insurance-values--2" class="field-multiple-table responsive-enabled usa-table" data-striping="1"> <thead> <tr> <th colspan="2" class="field-label" scope="row"><h4 class="label"></h4></th> <th>Ordenar</th> </tr> </thead> <tbody> <tr class="draggable odd" scope="row"> <td class="field-multiple-drag"></td> <td><div class="usa-form-group js-form-item form-item js-form-type-textfield form-item-insurance-0-insurance-name js-form-item-insurance-0-insurance-name"> <label for="edit-insurance-0-insurance-name" class="usa-label">Compa帽铆a de seguro de salud: <span class="usa-hint">(opcional)</span></label> <input data-drupal-selector="edit-insurance-0-insurance-name" type="text" id="edit-insurance-0-insurance-name" name="insurance[0][insurance_name]" value="" size="60" maxlength="128" class="form-text usa-input" /> </div> <div class="usa-form-group js-form-item form-item js-form-type-textfield form-item-insurance-0-insurance-policy js-form-item-insurance-0-insurance-policy"> <label for="edit-insurance-0-insurance-policy" class="usa-label">N煤mero de p贸liza de seguro de salud: <span class="usa-hint">(opcional)</span></label> <input data-drupal-selector="edit-insurance-0-insurance-policy" type="text" id="edit-insurance-0-insurance-policy" name="insurance[0][insurance_policy]" value="" size="60" maxlength="128" class="form-text usa-input" /> </div> </td> <td class="delta-order"><div class="usa-form-group js-form-item form-item js-form-type-select form-item-insurance-0--weight js-form-item-insurance-0--weight form-no-label"> <label for="edit-insurance-0-weight" class="usa-label visually-hidden">Peso para la fila 1 <span class="usa-hint">(opcional)</span></label> <select data-drupal-selector="edit-insurance-0-weight" class="insurance-delta-order form-select usa-select" id="edit-insurance-0-weight" name="insurance[0][_weight]"><option value="0" selected="selected">0</option></select> </div> </td> </tr> </tbody> </table> <div class="clearfix"><input class="multivalue-add-more-submit button js-form-submit form-submit usa-button" data-drupal-selector="edit-insurance-add-more" formnovalidate="formnovalidate" type="submit" id="edit-insurance-add-more" name="insurance_add_more" value="Agregar otro nombre y p贸liza de seguro" /> </div> </div> </div><div class="usa-form-group js-form-item form-item js-form-type-textarea form-item-device js-form-item-device"> <label for="edit-device" class="usa-label">Marca, modelo, proveedor y n煤mero de serie de cada dispositivo de asistencia <span class="usa-hint">(opcional)</span></label> <div class="form-textarea-wrapper"> <textarea data-drupal-selector="edit-device" id="edit-device" name="device" rows="5" cols="30" class="form-textarea usa-textarea resize-vertical"></textarea> </div> </div> <div data-drupal-selector="edit-medical3" class="js-form-item form-item"> <table id="medical3-values--2" class="field-multiple-table responsive-enabled usa-table" data-striping="1"> <thead> <tr> <th colspan="2" class="field-label" scope="row"><h4 class="label"></h4></th> <th>Ordenar</th> </tr> </thead> <tbody> <tr class="draggable odd" scope="row"> <td class="field-multiple-drag paragraph-bullet"></td> <td><div class="usa-form-group js-form-item form-item js-form-type-textfield form-item-medical3-0-veterinarian-name js-form-item-medical3-0-veterinarian-name"> <label for="edit-medical3-0-veterinarian-name" class="usa-label">Nombre del veterinario: <span class="usa-hint">(opcional)</span></label> <input data-drupal-selector="edit-medical3-0-veterinarian-name" type="text" id="edit-medical3-0-veterinarian-name" name="medical3[0][veterinarian_name]" value="" size="60" maxlength="128" class="form-text usa-input" /> </div> <div class="usa-form-group js-form-item form-item js-form-type-tel form-item-medical3-0-veterinarian-number js-form-item-medical3-0-veterinarian-number"> <label for="edit-medical3-0-veterinarian-number" class="usa-label">Tel茅fono del veterinario: <span class="usa-hint">(opcional)</span></label> <input data-drupal-selector="edit-medical3-0-veterinarian-number" pattern="[0-9]{3}-[0-9]{3}-[0-9]{4}" type="tel" id="edit-medical3-0-veterinarian-number" name="medical3[0][veterinarian_number]" value="" size="30" maxlength="128" placeholder="123-456-7890" class="form-tel" /> </div> <div class="usa-form-group js-form-item form-item js-form-type-textarea form-item-medical3-0-additional-information js-form-item-medical3-0-additional-information"> <label for="edit-medical3-0-additional-information" class="usa-label">Informaci贸n Adicional <span class="usa-hint">(opcional)</span></label> <div class="form-textarea-wrapper"> <textarea data-drupal-selector="edit-medical3-0-additional-information" id="edit-medical3-0-additional-information" name="medical3[0][additional_information]" rows="5" cols="60" class="form-textarea usa-textarea resize-vertical"></textarea> </div> </div> </td> <td class="delta-order"><div class="usa-form-group js-form-item form-item js-form-type-select form-item-medical3-0--weight js-form-item-medical3-0--weight form-no-label"> <label for="edit-medical3-0-weight" class="usa-label visually-hidden">Peso para la fila 1 <span class="usa-hint">(opcional)</span></label> <select data-drupal-selector="edit-medical3-0-weight" class="medical3-delta-order form-select usa-select" id="edit-medical3-0-weight" name="medical3[0][_weight]"><option value="0" selected="selected">0</option></select> </div> </td> </tr> </tbody> </table> </div> <h2>Enviar correo electr贸nico</h2> <div data-drupal-selector="edit-send-email" class="js-form-item form-item"> <table id="send-email-values--2" class="field-multiple-table responsive-enabled usa-table" data-striping="1"> <thead> <tr> <th colspan="2" class="field-label" scope="row"><h4 class="label"></h4></th> <th>Ordenar</th> </tr> </thead> <tbody> <tr class="draggable odd" scope="row"> <td class="field-multiple-drag paragraph-bullet"></td> <td><div class="usa-form-group js-form-item form-item js-form-type-email form-item-send-email-0-email-address js-form-item-send-email-0-email-address"> <label for="edit-send-email-0-email-address" class="usa-label">Direcci贸n de correo electr贸nico para enviar el informe generado en formato PDF a: <span class="usa-hint">(opcional)</span></label> <input data-drupal-selector="edit-send-email-0-email-address" type="email" id="edit-send-email-0-email-address" name="send_email[0][email_address]" value="" size="60" maxlength="254" class="form-email usa-input" /> </div> </td> <td class="delta-order"><div class="usa-form-group js-form-item form-item js-form-type-select form-item-send-email-0--weight js-form-item-send-email-0--weight form-no-label"> <label for="edit-send-email-0-weight" class="usa-label visually-hidden">Peso para la fila 1 <span class="usa-hint">(opcional)</span></label> <select data-drupal-selector="edit-send-email-0-weight" class="send_email-delta-order form-select usa-select" id="edit-send-email-0-weight" name="send_email[0][_weight]"><option value="0" selected="selected">0</option></select> </div> </td> </tr> </tbody> </table> </div> <input data-drupal-selector="form-7obndnxbkwlzcaqpogerzrz3p9muyaqkqda7ivsoksi" type="hidden" name="form_build_id" value="form-7oBNdnXbKwLZcAqPOGErZRz3P9mUyaqKQda7IvSOKsI" /> <input data-drupal-selector="edit-makeaplan-form" type="hidden" name="form_id" value="makeaplan_form" /> <input data-drupal-selector="edit-honeypot-time" type="hidden" name="honeypot_time" value="n7bS0Ona_JSitnn8uLY-KmqSBzX8lOFTC87wzgoI_8Q" /> <div data-drupal-selector="edit-actions" class="form-actions js-form-wrapper form-wrapper" id="edit-actions"><input data-drupal-selector="edit-submit" type="submit" id="edit-submit" name="op" value="Enviar formulario" class="button button--primary js-form-submit form-submit usa-button" /> </div> <div class="url-textfield js-form-wrapper form-wrapper" style="display: none !important;"><div class="usa-form-group js-form-item form-item js-form-type-textfield form-item-url js-form-item-url"> <label for="edit-url" class="usa-label">Deje este campo en blanco <span class="usa-hint">(opcional)</span></label> <input autocomplete="off" data-drupal-selector="edit-url" type="text" id="edit-url" name="url" value="" size="20" maxlength="128" class="form-text usa-input" /> </div> </div> </form> </div> </div> <div class="updated"><p>Last Updated: 11/23/2024</p></div> <p> <a href="#">Return to top</a> </p> </div> </div> </div> </main> <footer 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