{"id":665,"date":"2023-12-14T19:15:42","date_gmt":"2023-12-14T19:15:42","guid":{"rendered":"https:\/\/www.dr-haenselmann.de\/?page_id=665"},"modified":"2023-12-14T19:15:42","modified_gmt":"2023-12-14T19:15:42","slug":"ueberweisung-anfordern","status":"publish","type":"page","link":"https:\/\/www.dr-haenselmann.de\/index.php\/ueberweisung-anfordern\/","title":{"rendered":"\u00dcberweisung anfordern"},"content":{"rendered":"<form  class=\"kaliforms-form-container bootstrap-wrapper rounded-borders input-with-bg \" data-form-id=\"663\" style=\"opacity:0\"><h3>\u00dcberweisungsanforderung<\/h3><div id=\"kaliforms-global-error-message-663\" class=\"global-error-message\">Da ist wohl etwas schiefgelaufen<\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><span  data-internal-id=\"freetext0\" type=\"freeText\" id=\"Begruessung\" name=\"freeText\">Hier k\u00f6nnen Sie \u00dcberweisungen anfordern.<\/span><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-6 \"><label  for=\"first-name\">Vorname <span class=\"kali-required-mark\">*<\/span><\/label><input  data-internal-id=\"textbox2\" type=\"text\" id=\"first-name\" name=\"Vorname\" data-properties.type=\"text\" required ><\/div><div class=\"col-12 col-md-6 \"><label  for=\"last-name\">Nachname <span class=\"kali-required-mark\">*<\/span><\/label><input  data-internal-id=\"textbox3\" type=\"text\" id=\"last-name\" name=\"Nachname\" data-properties.type=\"text\" required ><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-6 \"><label  for=\"email\">Email <span class=\"kali-required-mark\">*<\/span><\/label><input  data-internal-id=\"textbox4\" type=\"text\" id=\"email\" name=\"email\" data-properties.type=\"text\" required ><\/div><div class=\"col-12 col-md-6 \"><label  for=\"date7\">Geburtsdatum <span class=\"kali-required-mark\">*<\/span><\/label><input data-internal-id=\"date7\" type=\"date\" id=\"date7\" name=\"Geburtsdatum\"required  class=\"input\"><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><label  for=\"telephone8\">Telefon (f\u00fcr R\u00fcckfragen) <span class=\"kali-required-mark\">*<\/span><\/label><input  data-internal-id=\"telephone8\" type=\"tel\" id=\"telephone8\" name=\"Telefon\"required  data-format=\"international\"  class=\"input\"><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><label  for=\"message\">Fachbereich <span class=\"kali-required-mark\">*<\/span><\/label><textarea  data-internal-id=\"textarea5\" type=\"textarea\" id=\"message\" name=\"Fachbereich\"required  rows=\"1\" class=\"input\"><\/textarea><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><label  for=\"textarea19\">Grund der \u00dcberweisung <span class=\"kali-required-mark\">*<\/span><\/label><textarea  data-internal-id=\"textarea19\" type=\"textarea\" id=\"textarea19\" name=\"Uberweisungsgrund\"required  rows=\"2\" class=\"input\"><\/textarea><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><label class=\"checkbox-label\"><input  data-internal-id=\"gdpr15\" type=\"checkbox\" id=\"gdpr15\" name=\"gdpr72\" required value=\"yes\" \/><span style=\"position:relative;bottom:3px\"><span class=\"kali-required-mark\">*<\/span> Ich bin Patient der Praxis Dres. H\u00e4nselmann<\/span><\/label><small>\u00dcberweisungen f\u00fcr Vertretungspatienten sind leider nicht m\u00f6glich.<\/small><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><label class=\"checkbox-label\"><input  data-internal-id=\"gdpr18\" type=\"checkbox\" id=\"gdpr18\" name=\"gdpr18\" required value=\"yes\" \/><span style=\"position:relative;bottom:3px\"><span class=\"kali-required-mark\">*<\/span> Ich habe im aktuellen Quartal meine Versichertenkarte bereits in der Praxis vorgelegt oder eine elektronische Ersatzbescheinigung zugesandt<\/span><\/label><small>Ein neues Quartal beginnt jeweils zum 1. Januar, 1. April, 1. Juli und 1. Oktober.<\/small><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><label class=\"checkbox-label\"><input  data-internal-id=\"gdpr14\" type=\"checkbox\" id=\"gdpr14\" name=\"gdpr\" required value=\"yes\" \/><span style=\"position:relative;bottom:3px\"><span class=\"kali-required-mark\">*<\/span> Ich erkl\u00e4re mich damit einverstanden, dass die eingegebenen Daten zur Bearbeitung meines Anliegens verwendet werden<\/span><\/label><small>Weitere Informationen und Widerrufshinweise finden Sie in der Datenschutzerkl\u00e4rung. Eine Kopie dieser Nachricht wird an Ihre E-Mail-Adresse geschickt.<\/small><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><span  data-internal-id=\"freetext10\" type=\"freeText\" id=\"Hinweis\" name=\"Hinweis\">Bitte haben Sie Verst\u00e4ndnis daf\u00fcr, dass wir mindestens einen Werktag f\u00fcr die Bearbeitung ben\u00f6tigen.<\/span><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><input  data-internal-id=\"submitbutton6\" type=\"submit\" id=\"submit\" data-style=\"default\"  class=\"input\" value=\"\u00dcberweisung anfordern\" ><\/div><\/div><label class=\"khpfield\" for=\"kf-name-field\"><input class=\"khpfield\" id=\"kf-name-field\" name=\"kf-name-field\" autocomplete=\"off\" type=\"textbox\" \/><\/label><label class=\"khpfield\" for=\"kf-email-field\"><input class=\"khpfield\" id=\"kf-email-field\" name=\"kf-email-field\" autocomplete=\"off\" type=\"textbox\" \/><\/label><input type=\"hidden\" name=\"ip_address\" readonly value=\"216.73.217.43\" \/><!-- This form was built using Kali Forms --><\/form>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-665","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.dr-haenselmann.de\/index.php\/wp-json\/wp\/v2\/pages\/665","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.dr-haenselmann.de\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.dr-haenselmann.de\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.dr-haenselmann.de\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.dr-haenselmann.de\/index.php\/wp-json\/wp\/v2\/comments?post=665"}],"version-history":[{"count":3,"href":"https:\/\/www.dr-haenselmann.de\/index.php\/wp-json\/wp\/v2\/pages\/665\/revisions"}],"predecessor-version":[{"id":736,"href":"https:\/\/www.dr-haenselmann.de\/index.php\/wp-json\/wp\/v2\/pages\/665\/revisions\/736"}],"wp:attachment":[{"href":"https:\/\/www.dr-haenselmann.de\/index.php\/wp-json\/wp\/v2\/media?parent=665"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}