{"id":16,"date":"2016-09-13T14:20:10","date_gmt":"2016-09-13T14:20:10","guid":{"rendered":"http:\/\/wp.forum-sk.at\/?page_id=16"},"modified":"2024-07-09T14:44:32","modified_gmt":"2024-07-09T12:44:32","slug":"patientenanfrage","status":"publish","type":"page","link":"https:\/\/www.forum-sk.at\/seltene_krankheiten\/patientenanfrage\/","title":{"rendered":"Patientenanfrage"},"content":{"rendered":"<p>Als Arzt oder Betroffener k\u00f6nnen Sie sich hier mit Ihrer fallbezogenen Anfrage an uns wenden.<\/p>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f454-o1\" lang=\"de-DE\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/seltene_krankheiten\/wp-json\/wp\/v2\/pages\/16#wpcf7-f454-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Kontaktformular\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"454\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.8.7\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"de_DE\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f454-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/div>\n<div style=\"width:500px;\">\n\t<p><strong>Pers\u00f6nliche Angaben <\/strong>\n\t<\/p>\n\t<p><label>Anrede:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-24\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"menu-24\"><option value=\"Herr\">Herr<\/option><option value=\"Frau\">Frau<\/option><\/select><\/span><\/label><br \/>\n<label>Name: *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span><\/label><br \/>\n<label>Vorname: *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-firstname\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-firstname\" \/><\/span><\/label><br \/>\n<label>Geburtsdatum: z.B. 01.12.1970 *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"date\" \/><\/span><\/label><br \/>\n<label>Stra\u00dfe:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-street\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-street\" \/><\/span><\/label><br \/>\n<label>Postleitzahl:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-zip\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-zip\" \/><\/span><\/label><br \/>\n<label>Ort:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-city\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-city\" \/><\/span><\/label><br \/>\n<label> Email: *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" 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><\/label><br \/>\n<label>Telefonnummer: *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tel-121\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"tel-121\" \/><\/span><\/label>\n\t<\/p>\n\t<p><strong>Informationen zum Krankheitsbild <\/strong><br \/>\n<label> Um welche Beschwerden geht es? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-235\"><textarea cols=\"40\" rows=\"4\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-235\"><\/textarea><\/span><\/label>\n\t<\/p>\n\t<p><label>Wer ist betroffen? Wenn Sie nicht selbst betroffen sind, in welchem Verh\u00e4ltnis stehen Sie zu der\/dem Erkrankten? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-236\"><textarea cols=\"40\" rows=\"4\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-236\"><\/textarea><\/span><\/label>\n\t<\/p>\n\t<p><label>Welche Diagnose\/n wurde\/n gestellt? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-237\"><textarea cols=\"40\" rows=\"4\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-237\"><\/textarea><\/span><\/label>\n\t<\/p>\n\t<p><label>Waren Sie (bzw. die\/der Betroffene) wegen der Krankheit an einer Universit\u00e4ts-Klinik, einem Landeskrankenhaus oder einer anderen Spezialklinik in Betreuung? *<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-652\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-652\" value=\"ja\" \/><span class=\"wpcf7-list-item-label\">ja<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-652\" value=\"nein\" \/><span class=\"wpcf7-list-item-label\">nein<\/span><\/span><\/span><\/span>\n\t<\/p>\n\t<p><label>Wenn ja, teilen Sie bitte mit, in welcher Einrichtung bereits \u00e4rztliche Untersuchungen stattgefunden haben.<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-241\"><textarea cols=\"40\" rows=\"4\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-241\"><\/textarea><\/span><\/label>\n\t<\/p>\n\t<p><label>Gibt es weitere Betroffene in der Familie? *<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-653\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-653\" value=\"ja\" \/><span class=\"wpcf7-list-item-label\">ja<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-653\" value=\"nein\" \/><span class=\"wpcf7-list-item-label\">nein<\/span><\/span><\/span><\/span>\n\t<\/p>\n\t<p><label>Wenn ja, machen Sie bitte hierzu genauere Angaben zu Personen und Diagnosen.<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-239\"><textarea cols=\"40\" rows=\"4\" maxlength=\"300\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-239\"><\/textarea><\/span><\/label>\n\t<\/p>\n\t<p><strong>Wie k\u00f6nnen wir Ihnen weiterhelfen?<\/strong><br \/>\n<label>Was genau ist Ihr Anliegen? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-240\"><textarea cols=\"40\" rows=\"4\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-240\"><\/textarea><\/span><\/label>\n\t<\/p>\n\t<p>Falls Sie uns Unterlagen zukommen lassen m\u00f6chten, k\u00f6nnen Sie diese hier hochladen:\n\t<\/p>\n\t<p>Datei 300kB maximal<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"file-942\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file 1\" id=\"1\" accept=\".pdf\" aria-invalid=\"false\" type=\"file\" name=\"file-942\" \/><\/span><br \/>\nDatei 300kB maximal<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"file-943\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file 1\" accept=\".pdf\" aria-invalid=\"false\" type=\"file\" name=\"file-943\" \/><\/span><br \/>\nDatei 300kB maximal<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"file-944\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file 1\" accept=\".pdf\" aria-invalid=\"false\" type=\"file\" name=\"file-944\" \/><\/span>\n\t<\/p>\n\t<p>Bitte f\u00fcllen Sie die mit * gekennzeichneten Felder in jedem Fall aus. Wir werden Ihr Anliegen im Zentrum fu\u0308r Seltene Krankheiten besprechen und uns per Email wieder bei Ihnen melden. Dies kann je nach Fragestellung einige Wochen dauern.\n\t<\/p>\n\t<p>Um die korrekte Verwendung dieses Formulares zu gew\u00e4hrleisten, bitten wir Sie, die Checkbox unten anzuklicken. Danke f\u00fcr Ihr Verst\u00e4ndnis.<br \/>\n\t<span class=\"wpcf7-form-control-wrap recaptcha\" data-name=\"recaptcha\"><span data-sitekey=\"6LeweSEUAAAAAN5z8scaV0R_OlCzJ8ZphJp4YSpy\" class=\"wpcf7-form-control wpcf7-recaptcha g-recaptcha\"><\/span>\r\n<noscript>\r\n\t<div class=\"grecaptcha-noscript\">\r\n\t\t<iframe loading=\"lazy\" src=\"https:\/\/www.google.com\/recaptcha\/api\/fallback?k=6LeweSEUAAAAAN5z8scaV0R_OlCzJ8ZphJp4YSpy\" frameborder=\"0\" scrolling=\"no\" width=\"310\" height=\"430\">\r\n\t\t<\/iframe>\r\n\t\t<textarea name=\"g-recaptcha-response\" rows=\"3\" cols=\"40\" placeholder=\"reCaptcha Response Here\">\r\n\t\t<\/textarea>\r\n\t<\/div>\r\n<\/noscript>\r\n<\/span>\n\t<\/p>\n\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"abschicken\" \/>\n\t<\/p>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>Als Arzt oder Betroffener k\u00f6nnen Sie sich hier mit Ihrer fallbezogenen Anfrage an uns wenden.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"_links":{"self":[{"href":"https:\/\/www.forum-sk.at\/seltene_krankheiten\/wp-json\/wp\/v2\/pages\/16"}],"collection":[{"href":"https:\/\/www.forum-sk.at\/seltene_krankheiten\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.forum-sk.at\/seltene_krankheiten\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.forum-sk.at\/seltene_krankheiten\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.forum-sk.at\/seltene_krankheiten\/wp-json\/wp\/v2\/comments?post=16"}],"version-history":[{"count":9,"href":"https:\/\/www.forum-sk.at\/seltene_krankheiten\/wp-json\/wp\/v2\/pages\/16\/revisions"}],"predecessor-version":[{"id":520,"href":"https:\/\/www.forum-sk.at\/seltene_krankheiten\/wp-json\/wp\/v2\/pages\/16\/revisions\/520"}],"wp:attachment":[{"href":"https:\/\/www.forum-sk.at\/seltene_krankheiten\/wp-json\/wp\/v2\/media?parent=16"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}