{"id":1673,"date":"2023-07-18T14:19:35","date_gmt":"2023-07-18T12:19:35","guid":{"rendered":"https:\/\/test.nkal.nl\/?page_id=1673"},"modified":"2023-07-18T14:49:01","modified_gmt":"2023-07-18T12:49:01","slug":"verwijsformulierlongartshuisarts","status":"publish","type":"page","link":"https:\/\/test.nkal.nl\/index.php\/home\/professionals\/verwijzen\/verwijsformulierlongartshuisarts\/","title":{"rendered":"Verwijsformulier longarts \/ huisarts"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1673\" class=\"elementor elementor-1673\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-ef8cd84 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"ef8cd84\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-f906273\" data-id=\"f906273\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a27e2f1 elementor-widget elementor-widget-heading\" data-id=\"a27e2f1\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.14.0 - 26-06-2023 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h2 class=\"elementor-heading-title elementor-size-default\">Verwijsformulier longarts \/ huisarts<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bbd2eb9 elementor-widget elementor-widget-wp-widget-wpforms-widget\" data-id=\"bbd2eb9\" data-element_type=\"widget\" data-widget_type=\"wp-widget-wpforms-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<div class=\"wpforms-container \" id=\"wpforms-1149\"><form id=\"wpforms-form-1149\" class=\"wpforms-validate wpforms-form\" data-formid=\"1149\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/1673\" data-token=\"647422ef2a5d7d9b19f631b718124f14\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-1149-field_1-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-1149-field_1\">Type <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1149-field_1\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1149-field_1_1\" name=\"wpforms[fields][1]\" value=\"Verwijzing (reguliere zorg)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1149-field_1_1\">Verwijzing (reguliere zorg)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1149-field_1_2\" name=\"wpforms[fields][1]\" value=\"Expertise\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1149-field_1_2\">Expertise<\/label><\/li><\/ul><\/div><div id=\"wpforms-1149-field_5-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-1149-field_5\">Naam <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1149-field_5\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][5]\" required><\/div><div id=\"wpforms-1149-field_6-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-1149-field_6\">Adres <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1149-field_6\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][6]\" required><\/div><div id=\"wpforms-1149-field_7-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-1149-field_7\">Postcode <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1149-field_7\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][7]\" required><\/div><div id=\"wpforms-1149-field_8-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-1149-field_8\">Telefoonnummer <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1149-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" required><\/div><div id=\"wpforms-1149-field_16-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-1149-field_16\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1149-field_16\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][16]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-1149-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-1149-field_10\">Functie <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1149-field_10\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][10]\" required><\/div><div id=\"wpforms-1149-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-1149-field_11\">AGB-code <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1149-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" required><\/div><div id=\"wpforms-1149-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-1149-field_12\">Instelling \/ Arbodienst <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1149-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" required><\/div><div id=\"wpforms-1149-field_13-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-1149-field_13\">AGB-code Instelling <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1149-field_13\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][13]\" required><\/div><div id=\"wpforms-1149-field_18-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-1149-field_18\">Naam pati\u00ebnt <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1149-field_18\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][18]\" required><\/div><div id=\"wpforms-1149-field_19-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-1149-field_19\">Geboortedatum pati\u00ebnt <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1149-field_19\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][19]\" required><\/div><div id=\"wpforms-1149-field_31-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-1149-field_31\">Geslacht pati\u00ebnt<\/label><ul id=\"wpforms-1149-field_31\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1149-field_31_1\" name=\"wpforms[fields][31]\" value=\"Man\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1149-field_31_1\">Man<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1149-field_31_2\" name=\"wpforms[fields][31]\" value=\"Vrouw\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1149-field_31_2\">Vrouw<\/label><\/li><\/ul><\/div><div id=\"wpforms-1149-field_20-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-1149-field_20\">Adres pati\u00ebnt <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1149-field_20\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][20]\" required><\/div><div id=\"wpforms-1149-field_21-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-1149-field_21\">Postcode pati\u00ebnt <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1149-field_21\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][21]\" required><\/div><div id=\"wpforms-1149-field_22-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-1149-field_22\">Woonplaats pati\u00ebnt <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1149-field_22\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][22]\" required><\/div><div id=\"wpforms-1149-field_23-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-1149-field_23\">Email pati\u00ebnt <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1149-field_23\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][23]\" required><\/div><div id=\"wpforms-1149-field_24-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-1149-field_24\">Telefoonnummer pati\u00ebnt<\/label><input type=\"text\" id=\"wpforms-1149-field_24\" class=\"wpforms-field-medium\" name=\"wpforms[fields][24]\" ><\/div><div id=\"wpforms-1149-field_25-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-1149-field_25\">Functie pati\u00ebnt <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1149-field_25\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][25]\" required><\/div><div id=\"wpforms-1149-field_26-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-1149-field_26\">Werkgever pati\u00ebnt <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1149-field_26\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][26]\" required><\/div><div id=\"wpforms-1149-field_29-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-1149-field_29\">Vraagstelling <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-1149-field_29\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][29]\" required><\/textarea><\/div><div id=\"wpforms-1149-field_30-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"30\"><label class=\"wpforms-field-label\" for=\"wpforms-1149-field_30\">Verplicht <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1149-field_30\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1149-field_30_1\" name=\"wpforms[fields][30][]\" value=\"Pati\u00ebnt is op de hoogte dat de kosten door NKAL zullen worden gedeclareerd bij de zorgverzekeraar\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1149-field_30_1\">Pati\u00ebnt is op de hoogte dat de kosten door NKAL zullen worden gedeclareerd bij de zorgverzekeraar<\/label><\/li><\/ul><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-field wpforms-field-hp\"><label for=\"wpforms-1149-field-hp\" class=\"wpforms-field-label\">Comment<\/label><input type=\"text\" name=\"wpforms[hp]\" id=\"wpforms-1149-field-hp\" class=\"wpforms-field-medium\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"1149\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"1\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1149\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Versturen\" aria-live=\"assertive\" value=\"wpforms-submit\">Versturen<\/button><\/div><\/form><\/div>  <!-- .wpforms-container -->\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Verwijsformulier longarts \/ huisarts<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":1120,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","footnotes":""},"class_list":["post-1673","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/test.nkal.nl\/index.php\/wp-json\/wp\/v2\/pages\/1673","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/test.nkal.nl\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/test.nkal.nl\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/test.nkal.nl\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/test.nkal.nl\/index.php\/wp-json\/wp\/v2\/comments?post=1673"}],"version-history":[{"count":9,"href":"https:\/\/test.nkal.nl\/index.php\/wp-json\/wp\/v2\/pages\/1673\/revisions"}],"predecessor-version":[{"id":1690,"href":"https:\/\/test.nkal.nl\/index.php\/wp-json\/wp\/v2\/pages\/1673\/revisions\/1690"}],"up":[{"embeddable":true,"href":"https:\/\/test.nkal.nl\/index.php\/wp-json\/wp\/v2\/pages\/1120"}],"wp:attachment":[{"href":"https:\/\/test.nkal.nl\/index.php\/wp-json\/wp\/v2\/media?parent=1673"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}