{"id":39349,"date":"2016-02-17T13:56:46","date_gmt":"2016-02-17T13:56:46","guid":{"rendered":"http:\/\/pwmhosting.ca\/paylan\/fr\/?page_id=39349"},"modified":"2016-02-17T17:48:52","modified_gmt":"2016-02-17T17:48:52","slug":"order","status":"publish","type":"page","link":"https:\/\/www.pharmapaylan.com\/fr\/order\/","title":{"rendered":"Commande"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f39442-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"39442\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/fr\/wp-json\/wp\/v2\/pages\/39349#wpcf7-f39442-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"39442\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f39442-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"form-item\">\n\t<p><label>Nom de la Pharmacie<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"full-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=\"full-name\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"form-item\">\n\t<p><label>Numero de t\u00e9l\u00e9phone <\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"phone-number\"><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=\"phone-number\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"form-item\">\n\t<p><label>Fax<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"fax\"><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=\"fax\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"form-item\">\n\t<p><label>Courriel<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"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=\"email\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"form-item\">\n\t<p><label>Num\u00e9ro de patient<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"Patient\"><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=\"Patient\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"form-item\">\n\t<p><label>Num\u00e9ro de RAMQ<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"ramq\"><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=\"ramq\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"form-item\">\n\t<p><label>Sorte de m\u00e9dicament<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"item\"><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=\"item\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"form-item\">\n\t<p><label>La commande doit \u00eatre pr\u00eat<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"order-ready\"><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=\"order-ready\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"form-item\">\n\t<p><label>T\u00e9l\u00e9chargez votre prescription<\/label>\n\t<\/p>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"upload\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".pdf,.txt,.gif,.png,.jpg,.jpe\" aria-invalid=\"false\" type=\"file\" name=\"upload\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"form-item\">\n\t<p><label>Insurance<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"PatientInsurance\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"PatientInsurance\" value=\"RAMQ\" \/><span class=\"wpcf7-list-item-label\">RAMQ<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"PatientInsurance\" value=\"Private\" \/><span class=\"wpcf7-list-item-label\">Private<\/span><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<div class=\"form-item\">\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"shipping\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"shipping\" value=\"Livraison\" \/><span class=\"wpcf7-list-item-label\">Livraison<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"shipping\" value=\"Passera\" \/><span class=\"wpcf7-list-item-label\">Passera<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"shipping\" value=\"Dicom\" \/><span class=\"wpcf7-list-item-label\">Dicom<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"shipping\" value=\"Puro\" \/><span class=\"wpcf7-list-item-label\">Puro<\/span><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<div class=\"form-item\">\n\t<p><label>Message<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"message\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"message\"><\/textarea><\/span>\n\t<\/p>\n<\/div>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Soumettre\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":39305,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-39349","page","type-page","status-publish","has-post-thumbnail","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.pharmapaylan.com\/fr\/wp-json\/wp\/v2\/pages\/39349","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.pharmapaylan.com\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.pharmapaylan.com\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.pharmapaylan.com\/fr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.pharmapaylan.com\/fr\/wp-json\/wp\/v2\/comments?post=39349"}],"version-history":[{"count":3,"href":"https:\/\/www.pharmapaylan.com\/fr\/wp-json\/wp\/v2\/pages\/39349\/revisions"}],"predecessor-version":[{"id":39443,"href":"https:\/\/www.pharmapaylan.com\/fr\/wp-json\/wp\/v2\/pages\/39349\/revisions\/39443"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.pharmapaylan.com\/fr\/wp-json\/wp\/v2\/media\/39305"}],"wp:attachment":[{"href":"https:\/\/www.pharmapaylan.com\/fr\/wp-json\/wp\/v2\/media?parent=39349"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}