I was able to solve it, it was not in the best shape, if you want to position yourself for improvement, thank you ...
JavaScript:
<script type="text/javascript">
function devolveid(id, name) {
document.getElementById('id_request').value = id;
document.getElementById('name_request').value = name;
$('#modalCidade').modal('hide');
}
</script>
Test Inputs:
<input type="text" id="id_request" name="id_request" value="" />
<input type="text" id="name_request" name="name_request" value="" />
<button type="button" class="btn btn-info btn-sm" data-toggle="modal" data-target="#modalCidade">Abrir Modal</button>
Modal:
<div id="modalCidade" class="modal fade" role="dialog" data-backdrop="static">
<div class="modal-dialog modal-lg">
<!-- Modal content-->
<div class="modal-content">
<div class="modal-header">
<button type="button" class="close" data-dismiss="modal">×</button>
<h1>{{ trans('adminlte_lang::message.title') }} - Selecione uma cidade</h1>
</div>
<div class="modal-body">
<div id="TableExt" style="box-shadow: 1px 1px 6px silver; padding: 20px; background-color: white;">
<div class="row">
<div class="col-xs-12">
<table class="table table-bordered table-hover dt-responsive">
<thead>
<tr>
<th>NOME</th>
<th>AÇÃO</th>
</tr>
</thead>
<tbody>
@foreach($empresas as $e)
<tr>
<td hidden>{{$e->name}}</td>
<td>
<button type="button" class="btn-link" onclick="devolveid('{{$e->id}}', '{{$e->name}}')">{{$e->name}}</button>
</td>
</tr>
@endforeach
</tbody>
</table>
</div>
</div>
</div>
</div>
<div class="modal-footer">
<button type="button" class="btn btn-primary" data-dismiss="modal" onclick="newDoc()">Fechar</button>
</div>
</div>
</div>
</div>