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<!DOCTYPE html>
<html lang="pt-br">
<meta name="description" content="">
<meta name="keywords" content="">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Document</title>
<style>
html,
body {
min-width: 15px;
}
.container {
display: flex;
justify-content: center;
align-items: center;
font-family: arial;
font-size: 16px;
}
.form_row {
position: relative;
border-radius: 5px;
background-color: #f9fafc;
padding: 30px;
}
.form_row h2 {
text-align: center;
}
.form_row input:focus {
outline: none;
}
.form_row label {
font-size: 20px;
}
.form_row input {
box-shadow: 0 5px 25px 0 rgba(30, 30, 30, 0.15);
/* appearance: none; */
border-color: transparent;
font-size: 18px;
}
.form_row input::placeholder {
/* font-weight: bold; */
/* opacity: 0.5; */
opacity: 1.5;
color: #079c7e;
}
.form_row fieldset {
border: 2px solid black;
border-radius: 8px;
padding: 20px;
}
.form_row legend {
font-size: 20px;
}
.form_row input[type=text] {
color: #079c7e;
border-radius: 4px;
border: none;
width: 100%;
padding: 5px 20px;
/* margin: 8px 0; */
box-sizing: border-box;
}
.form_row input[type=number] {
color: #079c7e;
border-radius: 4px;
border: none;
width: 100%;
padding: 5px 20px;
/* margin: 8px 0; */
box-sizing: border-box;
}
.form_row input[type=date] {
color: #079c7e;
padding: 5px 20px;
border-radius: 4px;
border: none;
/* margin: 8px 0; */
box-sizing: border-box;
}
input[type='radio']:after {
width: 15px;
height: 15px;
border-radius: 15px;
top: -2px;
left: -1px;
position: relative;
background-color: #d1d3d1;
content: '';
display: inline-block;
visibility: visible;
border: 2px solid white;
}
input[type='radio']:checked:after {
width: 15px;
height: 15px;
border-radius: 15px;
top: -2px;
left: -1px;
position: relative;
background-color: #079c7e;
content: '';
display: inline-block;
visibility: visible;
border: 2px solid white;
}
.form_row input[type=submit] {
width: 100%;
background-color: #079c7e;
cursor: pointer;
padding: 13px 35px;
border-radius: 5px;
border: none;
color: white !important;
font-size: 16px;
font-weight: 500;
text-transform: uppercase;
margin: 20px 0px 20px;
}
.row {
position: relative;
/* border: 1px red solid; */
margin: 6px 0 16px 0;
}
.col-1 {
width: 20%;
/* border: 1px black solid; */
margin: 1px 0 10px 0;
}
.col-2 {
/* border: 1px black solid; */
margin: 1px 0 10px 0;
}
.col-3 {
width: 60%;
/* border: 1px black solid; */
margin: 1px 0 10px 0;
}
.col-4 {
width: 80%;
/* border: 1px black solid; */
margin: 1px 0 10px 0;
}
.col-5 {
width: 100%;
/* border: 1px black solid; */
margin: 1px 0 10px 0;
}
@media screen and (min-width : 320px) {
.form_row {
width: 80%;
}
.col-1 {
width: 60%;
}
.col-2 {
width: 100%;
}
}
@media screen and (min-width : 414px) {
.container {
width: min-width !important;
}
.form_row {
width: 70%;
}
.col-1 {
width: 40%;
}
.col-2 {
width: 100%;
}
}
@media screen and (min-width : 1000px) {
.form_row {
width: 65%;
}
.col-1 {
width: 20%;
}
.col-2 {
width: 40%;
}
}
@media screen and (min-width : 1024px) {
.form_row {
width: 50%;
}
.col-1 {
width: 20%;
}
.col-2 {
width: 40%;
}
}
@media screen and (min-width : 1520px) {
.form_row {
width: 40%;
}
.col-1 {
width: 20%;
}
.col-2 {
width: 40%;
}
}
</style>
</head>
<body>
<div class="container">
<form action="" class="form_row" name="frmPaciente" id="frmPaciente">
<div class="row">
<div class="col-5">
<h2>Cadastro de Paciente</h2>
</div>
</div>
<div class="row">
<div class="col-1">
<label for="nome">Nome</label>
</div>
<div class="col-5">
<input type="text" name="nome" id="nome" autocomplete="off">
</div>
</div>
<div class="row">
<div class="col-2">
<label for="dataNascimento">Data de Nascimento</label>
</div>
<div class="col-1">
<input type="date" name="dataNascimento" id="dataNascimento">
</div>
</div>
<div class="row">
<div class="col-5">
<fieldset>
<legend>Gênero</legend>
<input type="radio" id="homem" name="genero" value="1">
<label for="homem">Masculino</label><br>
<input type="radio" id="mulher" name="genero" value="2">
<label for="mulher">Feminino</label><br>
<input type="radio" id="outro" name="genero" value="3">
<label for="outro">Outro</label>
</fieldset>
</div>
</div>
<div class="row">
<div class="col-1">
<label for="sus">Cartão SUS</label>
</div>
<div class="col-3">
<input type="number" name="cartaoSUS" id="cartaoSUS" placeholder="000000000000000"
autocomplete="off">
</div>
</div>
<div class="row">
<div class="col-5">
<fieldset>
<legend>Agendamento Fixo</legend>
<input type="radio" id="Sim" name="agendamentoFixo" value="1">
<label for="Sim">Sim</label><br>
<input type="radio" id="Não" name="agendamentoFixo" value="2" checked>
<label for="Não">Não</label>
</fieldset>
</div>
</div>
<div class="row">
<div class="col-1">
<label for="telefone">Telefone</label>
</div>
<div class="col-2">
<input type="text" name="telefone" id="telefone" placeholder="+55(00) 00000-0000"
autocomplete="off">
</div>
</div>
<div class="row">
<div class="col-1">
<label for="rua">Rua</label>
</div>
<div class="col-5">
<input type="text" name="rua" id="rua" autocomplete="off">
</div>
</div>
<div class="row">
<div class="col-1">
<label for="numero">Número</label>
</div>
<div class="col-1">
<input type="number" name="numero" id="numero">
</div>
</div>
<div class="row">
<div class="col-1">
<label for="complemento">Complemento</label>
</div>
<div class="col-4">
<input type="text" name="complemento" id="complemento" autocomplete="off">
</div>
</div>
<div class="row">
<div class="col-2">
<label for="pontoReferencia">Ponto de Referência</label>
</div>
<div class="col-4">
<input type="text" name="pontoReferencia" id="pontoReferencia" autocomplete="off">
</div>
</div>
<div class="row">
<div class="col-5">
<input type="submit" value="Confirmar">
</div>
</div>
</form>
</div>
</body>
</html>
<script>
"use strict";
const alpha = /[^A-Za-z\u00C0-\u00FF\s\b]/g;
const alphaNumeric = /[^A-Za-z0-9\u00C0-\u00FF._-\s\b]/g;
function maskPhone(text) {
const cleanText = text.replace(/\D/g, "");
const numbers = (cleanText.substring(0, 2) === "55") ? cleanText.substring(2, 13).split("") : cleanText.split("");
let formatted = `+55(${numbers.slice(0, 2).join("")})`;
if (numbers.length > 2)
formatted += ` ${numbers.slice(2, 7).join("")}`;
if (numbers.length > 7)
formatted += `-${numbers.slice(7, 13).join("")}`;
return formatted;
}
function replaceCharacter(text, regex) {
return text.replace(regex, "");
}
function maximumCharacters(text, size) {
return (text.length > size) ? text.slice(0, size) : text;
}
// Immediately-Invoked Function Expression (IIFE)
; (atlas => {
const name = atlas.document.getElementById("nome");
const phone = atlas.document.getElementById("telefone");
const card = atlas.document.getElementById("cartaoSUS");
const street = atlas.document.getElementById("rua");
const number = atlas.document.getElementById("numero");
const complement = atlas.document.getElementById("complemento")
const reference = atlas.document.getElementById("pontoReferencia")
name.focus();
name.addEventListener("input", event => {
event.target.value = atlas.maximum(event.target.value, 50);
event.target.value = atlas.replace(event.target.value, atlas.alpha);
});
phone.addEventListener("input", event => {
if (event.inputType === "insertText") {
event.target.value = atlas.mask(event.target.value)
}
});
card.addEventListener('input', event => event.target.value = atlas.maximum(event.target.value, 15));
street.addEventListener("input", event => {
event.target.value = atlas.maximum(event.target.value, 50);
event.target.value = atlas.replace(event.target.value, atlas.alphaNumeric);
});
number.addEventListener("input", event => event.target.value = atlas.maximum(event.target.value, 5));
complement.addEventListener("input", event => {
event.target.value = atlas.maximum(event.target.value, 40);
event.target.value = atlas.replace(event.target.value, atlas.alphaNumeric);
});
reference.addEventListener("input", event => {
event.target.value = atlas.maximum(event.target.value, 40);
event.target.value = atlas.replace(event.target.value, atlas.alphaNumeric);
});
atlas.window.addEventListener('beforeunload', event => {
console.log("Atlas sendo encerrado");
});
})({
document,
window,
"alpha": alpha,
"alphaNumeric": alphaNumeric,
"mask": maskPhone,
"replace": replaceCharacter,
"maximum": maximumCharacters
})
</script>