{"id":507,"date":"2023-03-29T12:56:39","date_gmt":"2023-03-29T10:56:39","guid":{"rendered":"https:\/\/websilver.pl\/?page_id=507"},"modified":"2023-03-29T12:58:26","modified_gmt":"2023-03-29T10:58:26","slug":"formularz-mozliwosc-przyjecia-pensjonariusza-2-2-2-2","status":"publish","type":"page","link":"https:\/\/websilver.pl\/index.php\/formularz-mozliwosc-przyjecia-pensjonariusza-2-2-2-2\/","title":{"rendered":"Formularz WS03 &#8211; za\u015bwiadczenie psychologa"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"507\" class=\"elementor elementor-507\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-1df6664 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"1df6664\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-e9a54f9\" data-id=\"e9a54f9\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-48a6e9b elementor-widget elementor-widget-shortcode\" data-id=\"48a6e9b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f506-o1\" lang=\"pl-PL\" dir=\"ltr\" data-wpcf7-id=\"506\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/507#wpcf7-f506-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formularz kontaktowy\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"506\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"pl_PL\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f506-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<p><b>Formularz WS03 - <\/b> za\u015bwiadczenie psychologa\n<\/p>\n<p><mark>Niniejszy dokument jest dokumentem informacyjnym o stanie zdrowia pensjonariusza.<\/mark>\n<\/p>\n<p>1. Imi\u0119 i nazwisko pensjonariusza <i>(pole wymagane)<\/i>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span>\n<\/p>\n<p>2. Stwierdza si\u0119 upo\u015bledzenie umys\u0142owe w stopniu <i>(pole wymagane)<\/i>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"stopien\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"stopien\"><\/textarea><\/span>\n<\/p>\n<p> IQ <i>(pole wymagane)<\/i>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"iq\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"iq\"><\/textarea><\/span>\n<\/p>\n<p>3. Charakterystyka osoby ubiegaj\u0105cej si\u0119 o przyj\u0119cie do domu opieki pod wzgl\u0119dem intelektualnym\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"intelekt\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"intelekt\"><\/textarea><\/span><br \/>\nCharakterystyka osoby ubiegaj\u0105cej si\u0119 o przyj\u0119cie do domu opieki pod wzgl\u0119dem emocjonalnym\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"emocje\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"emocje\"><\/textarea><\/span><br \/>\nCharakterystyka osoby ubiegaj\u0105cej si\u0119 o przyj\u0119cie do domu opieki pod wzgl\u0119dem spo\u0142ecznym\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"spolecznie\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"spolecznie\"><\/textarea><\/span>\n<\/p>\n<p>4. Najbardziej charakterystyczne cechy osobowo\u015bci i zachowa\u0144\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"emocje\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"emocje\"><\/textarea><\/span>\n<\/p>\n<p>5. Czy osoba ubiegaj\u0105ca si\u0119 o przyj\u0119cie do domu opieki pozostawa\u0142a lub pozostaje<br \/>\npod opiek\u0105 psychiatryczn\u0105, je\u017celi tak, to z jakiego powodu?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"opieka_psychiatryczna\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"opieka_psychiatryczna\"><\/textarea><\/span>\n<\/p>\n<p> Czy by\u0142a z tego powodu hospitalizowana, je\u015bli tak, to jak d\u0142ugo?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"hospitalizacja\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"hospitalizacja\"><\/textarea><\/span>\n<\/p>\n<p>6. Przebieg dotychczasowej rehabilitacji\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"rehabilitacja\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"rehabilitacja\"><\/textarea><\/span>\n<\/p>\n<p>7. Psycholog (ewentualnie lekarz ) prowadz\u0105cy (imi\u0119 i nazwisko, adres, numer telefonu)\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"psycholog\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"psycholog\"><\/textarea><\/span>\n<\/p>\n<p>8. Uwagi uzupe\u0142niaj\u0105ce i zalecenia psychologa\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"uwagi\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"uwagi\"><\/textarea><\/span>\n<\/p>\n<p>9. Tw\u00f3j adres e-mail <i>(pole wymagane)<\/i>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span>\n<\/p>\n<p><mark>Wszelkie uwagi i korespondencj\u0119 prosimy o wysy\u0142anie na adres e-mail podany w sekcji Kontakty w serwisie www.websilver.pl<\/mark>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Wy\u015blij\" \/>\n<\/p><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"226\"\/><script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-507","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/websilver.pl\/index.php\/wp-json\/wp\/v2\/pages\/507","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/websilver.pl\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/websilver.pl\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/websilver.pl\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/websilver.pl\/index.php\/wp-json\/wp\/v2\/comments?post=507"}],"version-history":[{"count":3,"href":"https:\/\/websilver.pl\/index.php\/wp-json\/wp\/v2\/pages\/507\/revisions"}],"predecessor-version":[{"id":510,"href":"https:\/\/websilver.pl\/index.php\/wp-json\/wp\/v2\/pages\/507\/revisions\/510"}],"wp:attachment":[{"href":"https:\/\/websilver.pl\/index.php\/wp-json\/wp\/v2\/media?parent=507"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}