{"id":128,"date":"2023-10-12T15:14:21","date_gmt":"2023-10-12T13:14:21","guid":{"rendered":"http:\/\/praxisgundheim.de\/home\/?page_id=128"},"modified":"2023-10-12T15:14:21","modified_gmt":"2023-10-12T13:14:21","slug":"rezept-anfrage","status":"publish","type":"page","link":"https:\/\/praxisgundheim.de\/home\/?page_id=128","title":{"rendered":"Rezept Anfrage"},"content":{"rendered":"<style id=\"wpforms-css-vars-root\">\n\t\t\t\t:root {\n\t\t\t\t\t--wpforms-field-border-radius: 3px;\n--wpforms-field-background-color: #ffffff;\n--wpforms-field-border-color: rgba( 0, 0, 0, 0.25 );\n--wpforms-field-text-color: rgba( 0, 0, 0, 0.7 );\n--wpforms-label-color: rgba( 0, 0, 0, 0.85 );\n--wpforms-label-sublabel-color: rgba( 0, 0, 0, 0.55 );\n--wpforms-label-error-color: #d63637;\n--wpforms-button-border-radius: 3px;\n--wpforms-button-background-color: #066aab;\n--wpforms-button-text-color: #ffffff;\n--wpforms-page-break-color: #066aab;\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n\n\t\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-6f6783b3-f89e-4950-9b10-afd383a93bc3 wpforms-render-modern\" id=\"wpforms-116\"><form id=\"wpforms-form-116\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"116\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/home\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F128\" data-token=\"dec461c8814700898d7d541f2ac1d063\"><noscript class=\"wpforms-error-noscript\">Bitte aktiviere JavaScript in deinem Browser, um dieses Formular fertigzustellen.<\/noscript><div class=\"wpforms-hidden\" id=\"wpforms-error-noscript\">Bitte aktiviere JavaScript in deinem Browser, um dieses Formular fertigzustellen.<\/div><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#066aab\" data-scroll=\"1\" role=\"progressbar\" aria-valuenow=\"1\" aria-valuemin=\"1\" aria-valuemax=\"2\" tabindex=\"-1\"><span class=\"wpforms-page-indicator-page-title\" ><\/span><span class=\"wpforms-page-indicator-page-title-sep\" style=\"display:none;\"> &#8211; <\/span><span class=\"wpforms-page-indicator-steps\">Schritt <span class=\"wpforms-page-indicator-steps-current\">1<\/span> von 2<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:50%;background-color:#066aab\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-116-field_20-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"20\"><\/div><div id=\"wpforms-116-field_7-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"7\"><fieldset><legend class=\"wpforms-field-label\">Patienten Name: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-116-field_7\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][7][first]\" aria-errormessage=\"wpforms-116-field_7-error\" aria-describedby=\"wpforms-116-field_7-description\" required><label for=\"wpforms-116-field_7\" class=\"wpforms-field-sublabel after \">Vorname<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-116-field_7-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][7][last]\" aria-errormessage=\"wpforms-116-field_7-last-error\" aria-describedby=\"wpforms-116-field_7-description\" required><label for=\"wpforms-116-field_7-last\" class=\"wpforms-field-sublabel after \">Nachname<\/label><\/div><\/div><div id=\"wpforms-116-field_7-description\" class=\"wpforms-field-description\">Bitte geben Sie hier Ihren Vor- und Nachnamen ein, wie er auf Ihrer Krankenversichertenkarte aufgef\u00fchrt ist.<\/div><\/fieldset><\/div><div id=\"wpforms-116-field_23-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"23\"><fieldset><legend class=\"wpforms-field-label\">Geburtsdatum: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][23][date][d]\" id=\"wpforms-116-field_23-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\" aria-label=\"Tag\"  required><option value=\"\" class=\"placeholder\" selected disabled>TT<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" 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>12<\/option><\/select><select name=\"wpforms[fields][23][date][y]\" id=\"wpforms-116-field_23-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\" aria-label=\"Jahr\"  required><option value=\"\" class=\"placeholder\" selected disabled>JJJJ<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" 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>1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/fieldset><\/div><div id=\"wpforms-116-field_8-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-116-field_8\">E-Mail: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-116-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" spellcheck=\"false\" aria-errormessage=\"wpforms-116-field_8-error\" aria-describedby=\"wpforms-116-field_8-description\" required><div 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class=\"wpforms-field wpforms-field-text\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-116-field_15\">Medikament #1: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-116-field_15\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][15]\" aria-errormessage=\"wpforms-116-field_15-error\" aria-describedby=\"wpforms-116-field_15-description\" required><div id=\"wpforms-116-field_15-description\" class=\"wpforms-field-description\">Bitte geben Sie hier den Namen des Medikaments, die Dosierung und die Anzahl der Tabletten ein. Wenn Sie mehr als drei Medikamente anfragen m\u00f6chten, senden Sie bitte eine zus\u00e4tzliche Anfrage.<\/div><\/div><div id=\"wpforms-116-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-116-field_11\">Medikament #2:<\/label><input type=\"text\" id=\"wpforms-116-field_11\" class=\"wpforms-field-medium\" name=\"wpforms[fields][11]\" aria-errormessage=\"wpforms-116-field_11-error\" aria-describedby=\"wpforms-116-field_11-description\" ><div id=\"wpforms-116-field_11-description\" class=\"wpforms-field-description\">Bitte geben Sie hier den Namen des Medikaments, die Dosierung und die Anzahl der Tabletten ein. Wenn Sie mehr als drei Medikamente anfragen m\u00f6chten, senden Sie bitte eine zus\u00e4tzliche Anfrage.<\/div><\/div><div id=\"wpforms-116-field_16-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-116-field_16\">Medikament #3:<\/label><input type=\"text\" id=\"wpforms-116-field_16\" class=\"wpforms-field-medium\" name=\"wpforms[fields][16]\" aria-errormessage=\"wpforms-116-field_16-error\" aria-describedby=\"wpforms-116-field_16-description\" ><div id=\"wpforms-116-field_16-description\" class=\"wpforms-field-description\">Bitte geben Sie hier den Namen des Medikaments, die Dosierung und die Anzahl der Tabletten ein. Wenn Sie mehr als drei Medikamente anfragen m\u00f6chten, senden Sie bitte eine zus\u00e4tzliche Anfrage.<\/div><\/div><div id=\"wpforms-116-field_17-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-116-field_17\">Abholort: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-116-field_17\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][17]\" required=\"required\"><option value=\"Pers\u00f6nlich in der Praxis Gundheim abholen.\" >Pers\u00f6nlich in der Praxis Gundheim abholen.<\/option><option value=\"Sonnen-Apotheke (Fl\u00f6rsheim-Dalsheim)\" >Sonnen-Apotheke (Fl\u00f6rsheim-Dalsheim)<\/option><option value=\"Rheinberg-Apotheke (Osthofen)\" >Rheinberg-Apotheke (Osthofen)<\/option><option value=\"Seebach-Apotheke (Westhofen)\" >Seebach-Apotheke (Westhofen)<\/option><option value=\"Dalberg-Apotheke (Worms-Pfeddersheim)\" >Dalberg-Apotheke (Worms-Pfeddersheim)<\/option><option value=\"L\u00f6wen-Apotheke (Worms-Pfeddersheim)\" >L\u00f6wen-Apotheke (Worms-Pfeddersheim)<\/option><\/select><\/div><div id=\"wpforms-116-field_10-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-116-field_10\">Zus\u00e4tzliche Angaben:<\/label><textarea id=\"wpforms-116-field_10\" class=\"wpforms-field-medium\" name=\"wpforms[fields][10]\" aria-errormessage=\"wpforms-116-field_10-error\" aria-describedby=\"wpforms-116-field_10-description\" ><\/textarea><div id=\"wpforms-116-field_10-description\" class=\"wpforms-field-description\">Hier k\u00f6nnen Sie zus\u00e4tzliche Angaben und\/oder Informationen mitteilen.<\/div><\/div><div id=\"wpforms-116-field_19-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"19\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"1\" data-formid=\"116\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Weiter<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2 last \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-116-field_22-container\" class=\"wpforms-field wpforms-field-entry-preview\" data-field-id=\"22\"><div class=\"wpforms-entry-preview-updating-message\">Vorschau aktualisieren&#8230;<\/div><div class=\"wpforms-entry-preview-notice\" style=\"display: none;\"><strong>Dies ist eine Vorschau deiner \u00dcbermittlung. 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Du kannst auch zur\u00fcckgehen, um \u00c4nderungen vorzunehmen.<\/div><div class=\"wpforms-entry-preview-wrapper\" style=\"display: none;\"><\/div><\/div><div id=\"wpforms-116-field_21-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"21\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"2\" data-formid=\"116\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Zur\u00fcck<\/button><\/div><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" style=\"display:none;\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"116\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"1\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-116\" class=\"wpforms-submit\" data-alt-text=\"Senden\u2026\" data-submit-text=\"Absenden\" aria-live=\"assertive\" value=\"wpforms-submit\">Absenden<\/button><img decoding=\"async\" loading=\"lazy\" src=\"https:\/\/praxisgundheim.de\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Wird geladen\"><\/div><\/form><\/div>  <!-- .wpforms-container -->","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":""},"_links":{"self":[{"href":"https:\/\/praxisgundheim.de\/home\/index.php?rest_route=\/wp\/v2\/pages\/128"}],"collection":[{"href":"https:\/\/praxisgundheim.de\/home\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/praxisgundheim.de\/home\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/praxisgundheim.de\/home\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/praxisgundheim.de\/home\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=128"}],"version-history":[{"count":1,"href":"https:\/\/praxisgundheim.de\/home\/index.php?rest_route=\/wp\/v2\/pages\/128\/revisions"}],"predecessor-version":[{"id":129,"href":"https:\/\/praxisgundheim.de\/home\/index.php?rest_route=\/wp\/v2\/pages\/128\/revisions\/129"}],"wp:attachment":[{"href":"https:\/\/praxisgundheim.de\/home\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=128"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}