{"id":5557,"date":"2022-11-15T09:59:37","date_gmt":"2022-11-15T09:59:37","guid":{"rendered":"https:\/\/www.afecvigo.es\/web\/?page_id=5557"},"modified":"2022-11-21T12:41:14","modified_gmt":"2022-11-21T12:41:14","slug":"formulario-solicitud-colaborador-docente","status":"publish","type":"page","link":"https:\/\/www.afecvigo.es\/web\/?page_id=5557","title":{"rendered":"Formulario Solicitud Colaborador Docente"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"5557\" class=\"elementor elementor-5557\">\n\t\t\t\t\t\t<div class=\"elementor-inner\">\n\t\t\t\t<div class=\"elementor-section-wrap\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-88aa739 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"88aa739\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-e6ebba6\" data-id=\"e6ebba6\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c6c2777 hide_impreso elementor-widget elementor-widget-heading\" data-id=\"c6c2777\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Solicitude Colaborador Docente PAC<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-7a97989 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"7a97989\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-c2d4933 format_div\" data-id=\"c2d4933\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-f725531 format_div elementor-widget elementor-widget-shortcode\" data-id=\"f725531\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\"><div role=\"form\" class=\"wpcf7\" id=\"wpcf7-f4854-o1\" lang=\"gl-ES\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/web\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F5557#wpcf7-f4854-o1\" method=\"post\" class=\"wpcf7-form init\" novalidate=\"novalidate\" data-status=\"init\" id=\"formulario_imprimir\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"4854\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.6.4\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"gl_ES\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f4854-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<div class=\"col-md-12 format_div\" id=\"contenedor\">\n<h2 style=\"text-align: center;\" class=\"solo_impreso\"><strong>SOLICITUD COLABORADOR DOCENTE PAC<\/strong><\/h2>\n<table style=\"width: 100%; border-collapse:collapse; border-spacing:0; margin-left: auto; margin-right: auto;\">\n<tbody>\n<tr>\n<td style=\"width: 30%;border: solid 1px black; background-color: rgb(231, 231, 231);\">PAC de:<\/td>\n<td style=\"border: solid 1px black; padding-left: 15px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"nombre_pac\"><input type=\"text\" name=\"nombre_pac\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required sin_borde\" id=\"nombre_pac\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/td>\n<\/tr>\n<tr>\n<td  style=\"width: 30%;border: solid 1px black; background-color: rgb(231, 231, 231);\">Nombre y Apellidos:<\/td>\n<td style=\"border: solid 1px black; padding-left: 15px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"nombre_apellidos\"><input type=\"text\" name=\"nombre_apellidos\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required sin_borde\" id=\"nombre_apellidos\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/td>\n<\/tr>\n<tr>\n<td  style=\"width: 30%;border: solid 1px black; background-color: rgb(231, 231, 231);\">DNI:<\/td>\n<td style=\"border: solid 1px black; padding-left: 15px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"dni\"><input type=\"text\" name=\"dni\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required sin_borde\" id=\"dni\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/td>\n<\/tr>\n<tr>\n<td  style=\"width: 30%;border: solid 1px black; background-color: rgb(231, 231, 231);\">Direcci\u00f3n:<\/td>\n<td style=\"border: solid 1px black; padding-left: 15px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"direccion\"><input type=\"text\" name=\"direccion\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required sin_borde\" id=\"direccion\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/td>\n<\/tr>\n<tr>\n<td  style=\"width: 30%;border: solid 1px black; background-color: rgb(231, 231, 231);\">Tel\u00e9fono de contacto:<\/td>\n<td style=\"border: solid 1px black; padding-left: 15px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"tlf_contacto\"><input type=\"text\" name=\"tlf_contacto\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required sin_borde\" id=\"tlf_contacto\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/td>\n<\/tr>\n<tr>\n<td  style=\"width: 30%;border: solid 1px black; background-color: rgb(231, 231, 231);\">Tel\u00e9fono m\u00f3vil:<\/td>\n<td style=\"border: solid 1px black;padding-left: 15px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"tlf_movil\"><input type=\"text\" name=\"tlf_movil\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required sin_borde\" id=\"tlf_movil\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/td>\n<\/tr>\n<tr>\n<td  style=\"width: 30%;border: solid 1px black; background-color: rgb(231, 231, 231);\">Fecha Inicio Actividad Profesional en el PAC<\/td>\n<td style=\"border: solid 1px black; padding-left: 15px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"fecha_inicio\"><input type=\"date\" name=\"fecha_inicio\" value=\"\" class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date sin_borde\" id=\"fecha_inicio\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div style=\"width: 100%; margin-left: auto; margin-right: auto;\" class=\"hide_impreso\">\n        <input type=\"submit\" value=\"Imprimir y Enviar\" class=\"wpcf7-form-control has-spinner wpcf7-submit\" id=\"confirm_form\" \/>\n    <\/div>\n<div class=\"solo_impreso\">\n<table style=\"width: 100%; border-collapse:collapse; border-spacing:0; margin-left: auto; margin-right: auto;\">\n<tbody>\n<tr>\n<td style=\"border: solid 1px black; background-color: rgb(231, 231, 231);\">TITULACI\u00d3N<\/td>\n<td style=\"border: solid 1px black; text-align: center; background-color: rgb(231, 231, 231);\">SI<\/td>\n<td style=\"border: solid 1px black; text-align: center; background-color: rgb(231, 231, 231);\">NO<\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid 1px black;\">Especialista en Medicina de Familia y Comunitaria<\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>        <i>Puntos = 1<\/i><\/p>\n<div class=\"pagebreak\"> <\/div>\n<h2 style=\"text-align: center; margin-top: 25px;\">PERFIL CL\u00cdNICO<\/h2>\n<table style=\"width: 100%; border-collapse:collapse; border-spacing:0; margin-left: auto; margin-right: auto;\">\n<tbody>\n<tr>\n<td style=\"border: solid 1px black; background-color: rgb(231, 231, 231);\">Actividades de formaci\u00f3n continuada en \u00e1reas espec\u00edficas<\/td>\n<td style=\"border: solid 1px black; text-align: center; background-color: rgb(231, 231, 231);\">FECHA<\/td>\n<td style=\"border: solid 1px black; text-align: center; background-color: rgb(231, 231, 231);\">HORAS<\/td>\n<td style=\"border: solid 1px black; text-align: center; background-color: rgb(231, 231, 231);\">CR\u00c9DITOS<\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid 1px black;\">Curso de RCP Avanzada<\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid 1px black;\">Atenci\u00f3n al Politraumatizado<\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>        <i>1 Cr\u00e9dito = 1 Punto<br>20 horas = 1 Punto<\/i><\/p>\n<table style=\"width: 100%; border-collapse:collapse; border-spacing:0; margin-left: auto; margin-right: auto;\">\n<tbody>\n<tr>\n<td style=\"border: solid 1px black; background-color: rgb(231, 231, 231);\">Actividades de formaci\u00f3n continuada en el \u00e1rea cl\u00ednica<\/td>\n<td style=\"border: solid 1px black; text-align: center; background-color: rgb(231, 231, 231);\">FECHA<\/td>\n<td style=\"border: solid 1px black; text-align: center; background-color: rgb(231, 231, 231);\">HORAS<\/td>\n<td style=\"border: solid 1px black; text-align: center; background-color: rgb(231, 231, 231);\">CR\u00c9DITOS<\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>        <i>1 Cr\u00e9dito = 1 Punto<br>20 horas = 1 Punto<\/i><\/p>\n<table style=\"width: 100%; border-collapse:collapse; border-spacing:0; margin-left: auto; margin-right: auto;\">\n<tbody>\n<tr>\n<td style=\"border: solid 1px black; background-color: rgb(231, 231, 231);\">Otros M\u00e9ritos Cl\u00ednicos<\/td>\n<td style=\"border: solid 1px black; text-align: center; background-color: rgb(231, 231, 231);\">Si<\/td>\n<td style=\"border: solid 1px black; text-align: center; background-color: rgb(231, 231, 231);\">No<\/td>\n<td style=\"border: solid 1px black; text-align: center; background-color: rgb(231, 231, 231);\">Duraci\u00f3n (Semanas)<\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid 1px black;\">Estancias\/Reciclajes en otros centros cl\u00ednicos<\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid 1px black;\">Responsable de protocolos cl\u00ednicos en el PAC<\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid 1px black;\">Pertenecer a grupos de trabajo cl\u00ednicos<\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>        <i>Estancias\/Reciclajes - 1 semana = 0.5<br>Programa cl\u00ednico con evaluaci\u00f3n peri\u00f3dica = 1<br>Grupo de trabajo con participaci\u00f3n activa = 1<\/i>\n    <\/div>\n<div class=\"pagebreak\"> <\/div>\n<div class=\"solo_impreso\">\n<h2 style=\"text-align: center; margin-top: 25px;\">PERFIL DOCENTE<\/h2>\n<table style=\"width: 100%; border-collapse:collapse; border-spacing:0; margin-left: auto; margin-right: auto;\">\n<tbody>\n<tr>\n<td style=\"border: solid 1px black; background-color: rgb(231, 231, 231); width: 60%;\"><\/td>\n<td style=\"border: solid 1px black; text-align: center; background-color: rgb(231, 231, 231); width: 20%;\">Si<\/td>\n<td style=\"border: solid 1px black; text-align: center; background-color: rgb(231, 231, 231); width: 20%;\">No<\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid 1px black;\">Compromiso de Colaboraci\u00f3n Docente<\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid 1px black;\">Responsable de Docencia en el PAC<\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid 1px black;\">Evaluaci\u00f3n positiva de los residente*<\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<td style=\"border: solid 1px black;\"><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>        <strong>Compromiso de Colaboraci\u00f3n Docente (obligatorio)<\/strong><\/p>\n<ol>\n<li>Familiarizar al residente con las caracter\u00edsticas y organizaci\u00f3n interna del PAC<\/li>\n<li>Tutelar y facilitar la asunci\u00f3n progesiva de responsabilidad al residente<\/li>\n<li>Evaluar al residente<\/li>\n<li>Remitir informe a la UD sobre aspectos formativos y cuestiones rese\u00f1ables sobre el MIR<\/li>\n<\/ol>\n<p>        <i>Puntos = 1<\/i><br \/>\n        <strong>Responsable de Docencia del PAC<\/strong><br \/>\n        <i>Puntos = 1<\/i><br \/>\n        *S\u00f3lo Reacreditaci\u00f3n<\/p>\n<table style=\"width: 100%; border-collapse:collapse; border-spacing:0; margin-left: auto; margin-right: auto; margin-top: 30px;\">\n<tbody>\n<tr>\n<td style=\"border: solid 1px black; background-color: rgb(231, 231, 231); width: 60%;\"><\/td>\n<td style=\"border: solid 1px black; background-color: rgb(231, 231, 231); width: 40%; text-align: center;\">N\u00ba de Sesiones\/\u00daltimo A\u00f1o<\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid 1px black; width: 60%;\">Actividad como docente de PAC<\/td>\n<td style=\"border: solid 1px black; width: 40%;\"><\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid 1px black; background-color: rgb(231, 231, 231); width: 60%;\"><\/td>\n<td style=\"border: solid 1px black; background-color: rgb(231, 231, 231); width: 40%; text-align: center;\">Horas Lectivas \/ 2 \u00daltimos A\u00f1os<\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid 1px black; width: 60%;\">Actividad como docente fuera del PAC<\/td>\n<td style=\"border: solid 1px black; width: 40%;\"><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>        <i>3 sesiones \/ a\u00f1o = 1 Punto<br>Hora lectiva como profesor en los 2 \u00faltimos a\u00f1os = 0.1 Puntos<\/i><\/p>\n<p style=\"margin-bottom: 15px; margin-top: 65px;\">Fecha: .........\/....................\/.............<\/p>\n<table style=\"width: 40%; border-collapse:collapse; border-spacing:0;\">\n<tbody>\n<tr>\n<td style=\"border: solid 1px black; height: 140px; \"><\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid 1px black;\">Firmado: <\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div><\/form><\/div><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Solicitude Colaborador Docente PAC<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"plantilla_formulario.php","meta":{"footnotes":""},"class_list":["post-5557","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.afecvigo.es\/web\/index.php?rest_route=\/wp\/v2\/pages\/5557","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.afecvigo.es\/web\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.afecvigo.es\/web\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.afecvigo.es\/web\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.afecvigo.es\/web\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=5557"}],"version-history":[{"count":68,"href":"https:\/\/www.afecvigo.es\/web\/index.php?rest_route=\/wp\/v2\/pages\/5557\/revisions"}],"predecessor-version":[{"id":5696,"href":"https:\/\/www.afecvigo.es\/web\/index.php?rest_route=\/wp\/v2\/pages\/5557\/revisions\/5696"}],"wp:attachment":[{"href":"https:\/\/www.afecvigo.es\/web\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=5557"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}