{"id":13,"date":"2023-04-17T17:17:56","date_gmt":"2023-04-17T17:17:56","guid":{"rendered":"https:\/\/app.lux-solution.de\/g2dsj8ya\/?page_id=13"},"modified":"2025-02-05T10:23:36","modified_gmt":"2025-02-05T09:23:36","slug":"anamnesebogen","status":"publish","type":"page","link":"https:\/\/app.lux-solution.de\/g2dsj8ya\/anamnesebogen\/","title":{"rendered":"AnamnesebogPraxisen"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"13\" class=\"elementor elementor-13\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-769ce46 e-flex e-con-boxed e-con e-parent\" data-id=\"769ce46\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-865b752 e-flex e-con-boxed e-con e-child\" data-id=\"865b752\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5c1faf5 elementor-widget elementor-widget-heading\" data-id=\"5c1faf5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Gyn\u00e4kologisches Kompetenzzentrum<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div data-dce-title-color=\"#7A7A7A\" class=\"elementor-element elementor-element-ccd9842 elementor-widget elementor-widget-heading\" data-id=\"ccd9842\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-heading-title elementor-size-default\">Frau Dr. Eberhardt<\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div data-dce-title-color=\"#7A7A7A\" class=\"elementor-element elementor-element-48e8afb elementor-widget elementor-widget-heading\" data-id=\"48e8afb\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-heading-title elementor-size-default\">Martinistra\u00dfe 79<\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div data-dce-title-color=\"#7A7A7A\" class=\"elementor-element elementor-element-b2e8666 elementor-widget elementor-widget-heading\" data-id=\"b2e8666\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-heading-title elementor-size-default\">49080 Osnbabr\u00fcck<\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div data-dce-title-color=\"#7A7A7A\" class=\"elementor-element elementor-element-72e5471 elementor-widget elementor-widget-heading\" data-id=\"72e5471\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-heading-title elementor-size-default\"><a href=\"\">Tel:+49 541 668886-0<\/a><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div data-dce-title-color=\"#7A7A7A\" class=\"elementor-element elementor-element-c36d0c0 elementor-widget elementor-widget-heading\" data-id=\"c36d0c0\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-heading-title elementor-size-default\"><a href=\"\">info@frauenaerztin-os.de<\/a><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-bb03741 e-flex e-con-boxed e-con e-child\" data-id=\"bb03741\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3183029 dce_masking-none elementor-widget elementor-widget-image\" data-id=\"3183029\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"111\" height=\"111\" src=\"https:\/\/app.lux-solution.de\/g2dsj8ya\/wp-content\/uploads\/sites\/4\/2023\/04\/frauenaerztin-osnabrueck-geburtshilfe-kirsten-eberhardt-logo.png\" class=\"attachment-large size-large wp-image-21\" alt=\"\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-a7db405 e-flex e-con-boxed e-con e-child\" data-id=\"a7db405\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-628127e elementor-icon-list--layout-inline elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"628127e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items elementor-inline-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item elementor-inline-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"?lang=de\">\n\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">DEUTSCH<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item elementor-inline-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"?lang=en\">\n\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">ENGLISH<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-13a24a19 e-flex e-con-boxed e-con e-parent\" data-id=\"13a24a19\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-22a2060 elementor-widget elementor-widget-heading\" data-id=\"22a2060\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Anamnesebogen<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div data-dce-field-description=\"{&quot;fields&quot;:[{&quot;custom_id&quot;:&quot;geburtsdatum&quot;,&quot;position&quot;:&quot;elementor-field-label&quot;,&quot;description&quot;:&quot;Sie k\\u00f6nnen Ihr Geburtstagsdatum direkt eingeben.&quot;,&quot;description_text&quot;:&quot;Sie k\\u00f6nnen Ihr Geburtstagsdatum direkt eingeben.&quot;,&quot;tooltip&quot;:true,&quot;tooltip_position&quot;:&quot;top&quot;},{&quot;custom_id&quot;:&quot;impfungen&quot;,&quot;position&quot;:&quot;elementor-field-label&quot;,&quot;description&quot;:&quot;Sie k\\u00f6nnen gerne Ihr gelbes Impfbuch zu Ihrem Termin mitbringen.&quot;,&quot;description_text&quot;:&quot;Sie k\\u00f6nnen gerne Ihr gelbes Impfbuch zu Ihrem Termin mitbringen.&quot;,&quot;tooltip&quot;:true,&quot;tooltip_position&quot;:&quot;top&quot;}]}\" class=\"elementor-element elementor-element-67a8a968 elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"67a8a968\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;N\\u00e4chster&quot;,&quot;step_previous_label&quot;:&quot;Voriger&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;,&quot;label_icon_size&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;field_icon_size&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]}}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"dce-conditions-js-error-notice elementor-message elementor-message-danger\" style=\"display: none;\">A problem was detected in the following Form. Submitting it could result in errors. Please contact the site administrator.<\/div>\t\t\t<script>\n\t\t\tsetTimeout(function() {\n\t\t\t\tlet el = document.querySelector(\".dce-conditions-js-error-notice\");\n\t\t\t\tif (el)\n\t\t\t\t\tel.style.display = \"block\";\n\t\t\t}, 6000);\n\t\t\t<\/script>\t\t<form class=\"elementor-form\" method=\"post\" name=\"Anamnese\" aria-label=\"Anamnese\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"13\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"67a8a968\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Eberhardt Osnabr\u00fcck\" \/>\n\n\t\t\t\n\t\t\t<div data-field-conditions=\"[{&quot;id&quot;:&quot;datum_krebsvorsorge&quot;,&quot;condition&quot;:&quot;(frage_krebsvorsorge==&#039;JA&#039;)&quot;,&quot;mode&quot;:&quot;show&quot;,&quot;disableOnly&quot;:false},{&quot;id&quot;:&quot;befund_krebsvorsorge&quot;,&quot;condition&quot;:&quot;(frage_krebsvorsorge==&#039;JA&#039;)&quot;,&quot;mode&quot;:&quot;show&quot;,&quot;disableOnly&quot;:false},{&quot;id&quot;:&quot;wann_mammographie&quot;,&quot;condition&quot;:&quot;(frage_mammographie==&#039;JA&#039;)&quot;,&quot;mode&quot;:&quot;show&quot;,&quot;disableOnly&quot;:false},{&quot;id&quot;:&quot;befund_mammographie&quot;,&quot;condition&quot;:&quot;(frage_mammographie==&#039;JA&#039;)&quot;,&quot;mode&quot;:&quot;show&quot;,&quot;disableOnly&quot;:false},{&quot;id&quot;:&quot;wann_koloskopie&quot;,&quot;condition&quot;:&quot;(frage_koloskopie==&#039;JA&#039;)&quot;,&quot;mode&quot;:&quot;show&quot;,&quot;disableOnly&quot;:false},{&quot;id&quot;:&quot;befund_koloskopie&quot;,&quot;condition&quot;:&quot;(frage_koloskopie==&#039;JA&#039;)&quot;,&quot;mode&quot;:&quot;show&quot;,&quot;disableOnly&quot;:false},{&quot;id&quot;:&quot;welche_beschwerden&quot;,&quot;condition&quot;:&quot;(frage_beschwerden==&#039;JA&#039;)&quot;,&quot;mode&quot;:&quot;show&quot;,&quot;disableOnly&quot;:false},{&quot;id&quot;:&quot;kinderwunsch_seit&quot;,&quot;condition&quot;:&quot;(kinderwunsch==&#039;JA&#039;)&quot;,&quot;mode&quot;:&quot;show&quot;,&quot;disableOnly&quot;:false},{&quot;id&quot;:&quot;datum_letzte_periode&quot;,&quot;condition&quot;:&quot;(schwangerschaft==&#039;JA&#039;)&quot;,&quot;mode&quot;:&quot;show&quot;,&quot;disableOnly&quot;:false},{&quot;id&quot;:&quot;allergie_auf&quot;,&quot;condition&quot;:&quot;(allergie==&#039;JA&#039;)&quot;,&quot;mode&quot;:&quot;show&quot;,&quot;disableOnly&quot;:false},{&quot;id&quot;:&quot;menge_rauchen&quot;,&quot;condition&quot;:&quot;(rauchen==&#039;JA&#039;)&quot;,&quot;mode&quot;:&quot;show&quot;,&quot;disableOnly&quot;:false},{&quot;id&quot;:&quot;menge_alkohol&quot;,&quot;condition&quot;:&quot;(alkohol==&#039;JA&#039;)&quot;,&quot;mode&quot;:&quot;show&quot;,&quot;disableOnly&quot;:false},{&quot;id&quot;:&quot;sonst_konsum&quot;,&quot;condition&quot;:&quot;(frage_konsum==&#039;JA&#039;)&quot;,&quot;mode&quot;:&quot;show&quot;,&quot;disableOnly&quot;:false}]\" 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class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_c1227ad elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Pers\u00f6nliche Daten\" data-previousButton=\"\" data-nextButton=\"weiter, zu &quot;Medizinsche Fragen&quot; \" data-iconUrl=\"\" data-iconLibrary=\"far fa-arrow-alt-circle-right\" data-icon=\"\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-geschlecht elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-geschlecht\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeschlecht\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Frau\" id=\"form-field-geschlecht-0\" name=\"form_fields[geschlecht]\"> <label for=\"form-field-geschlecht-0\">Frau<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Mann\" id=\"form-field-geschlecht-1\" name=\"form_fields[geschlecht]\"> <label for=\"form-field-geschlecht-1\">Mann<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Divers\" id=\"form-field-geschlecht-2\" name=\"form_fields[geschlecht]\"> <label for=\"form-field-geschlecht-2\">Divers<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tName\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-vorname elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-vorname\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tVorname\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[vorname]\" id=\"form-field-vorname\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Vorname\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-geburtsdatum elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-geburtsdatum\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeburtsdatum\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[geburtsdatum]\" id=\"form-field-geburtsdatum\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"z.B. 23.06.1977\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-telefon elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-telefon\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTelefon\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[telefon]\" id=\"form-field-telefon\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Telefon\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-25 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tE-Mail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"E-Mail\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-beruf elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-beruf\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIhr Beruf\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[beruf]\" id=\"form-field-beruf\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Zurzeit ausgeb\u00fcbte berufliche T\u00e4tigkeit\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-hausarzt elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-hausarzt\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIhr Hausarzt\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[hausarzt]\" id=\"form-field-hausarzt\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Name, Ort\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-strasse elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-strasse\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tStra\u00dfe\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[strasse]\" id=\"form-field-strasse\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Stra\u00dfe\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-hausnummer elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-hausnummer\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHausnummer\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[hausnummer]\" id=\"form-field-hausnummer\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Hausnummer\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-plz elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-plz\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPostleitzahl\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[plz]\" id=\"form-field-plz\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Postleitzahl\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-wohnort elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-wohnort\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWohnort\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[wohnort]\" id=\"form-field-wohnort\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Ort\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-groesse elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-groesse\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tK\u00f6rpergr\u00f6\u00dfe in cm\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[groesse]\" id=\"form-field-groesse\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"K\u00f6rpergr\u00f6\u00dfe\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-gewicht elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-gewicht\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tK\u00f6rpergewicht in kg\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[gewicht]\" id=\"form-field-gewicht\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Gewicht\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-erste_periode elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-erste_periode\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWie alt waren Sie bei der ersten Regelblutung?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[erste_periode]\" id=\"form-field-erste_periode\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"erste Periode mit (Alter)\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-letzte_periode elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-letzte_periode\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIn welchem Alter hatten Sie Ihre letzte Regelblutung?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[letzte_periode]\" id=\"form-field-letzte_periode\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"keine Periode mehr mit (Alter)\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_c8201dd elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Medizinische Fragen\" data-previousButton=\"zur\u00fcck &quot;Pers\u00f6nliche Daten&quot;\" data-nextButton=\"weiter, zu &quot;Geburten | Kinderwunsch | Allergien&quot;\" data-iconUrl=\"\" data-iconLibrary=\"far fa-arrow-alt-circle-right\" data-icon=\"\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-impfungen elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-impfungen\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWann waren Ihre letzten Impfungen\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[impfungen]\" id=\"form-field-impfungen\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"z.B. HPV-Impfung 2014, Corona-Impfung 2021, etc.\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-frage_krebsvorsorge elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-frage_krebsvorsorge\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHatten Sie eine Krebsvorsorgeuntersuchung?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NEIN\" id=\"form-field-frage_krebsvorsorge-0\" name=\"form_fields[frage_krebsvorsorge]\"> <label for=\"form-field-frage_krebsvorsorge-0\">NEIN<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"JA\" id=\"form-field-frage_krebsvorsorge-1\" name=\"form_fields[frage_krebsvorsorge]\"> <label for=\"form-field-frage_krebsvorsorge-1\">JA<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-datum_krebsvorsorge elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-datum_krebsvorsorge\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWann war die letzte Krebsvorsorgeuntersuchtung?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[datum_krebsvorsorge]\" id=\"form-field-datum_krebsvorsorge\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-befund_krebsvorsorge elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-befund_krebsvorsorge\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMit welchem Befund?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[befund_krebsvorsorge]\" id=\"form-field-befund_krebsvorsorge\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"z.B. ohne Befund\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-frage_mammographie elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-frage_mammographie\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHatten Sie eine Mammographie (Brustuntersuchung)?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NEIN\" id=\"form-field-frage_mammographie-0\" name=\"form_fields[frage_mammographie]\"> <label for=\"form-field-frage_mammographie-0\">NEIN<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"JA\" id=\"form-field-frage_mammographie-1\" name=\"form_fields[frage_mammographie]\"> <label for=\"form-field-frage_mammographie-1\">JA<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-wann_mammographie elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-wann_mammographie\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWann war die letzte Mammographie?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[wann_mammographie]\" id=\"form-field-wann_mammographie\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"z.B. 2018\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-befund_mammographie elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-befund_mammographie\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMit welchem Befund?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[befund_mammographie]\" id=\"form-field-befund_mammographie\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"z.B. ohne Befund\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-frage_koloskopie elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-frage_koloskopie\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHatten Sie eine Koloskopie (Darmspiegelung)?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NEIN\" id=\"form-field-frage_koloskopie-0\" name=\"form_fields[frage_koloskopie]\"> <label for=\"form-field-frage_koloskopie-0\">NEIN<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"JA\" id=\"form-field-frage_koloskopie-1\" name=\"form_fields[frage_koloskopie]\"> <label for=\"form-field-frage_koloskopie-1\">JA<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-wann_koloskopie elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-wann_koloskopie\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWann war die Koloskopie?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[wann_koloskopie]\" id=\"form-field-wann_koloskopie\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"z.B. 2018\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-befund_koloskopie elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-befund_koloskopie\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMit welchem Befund?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[befund_koloskopie]\" id=\"form-field-befund_koloskopie\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"z.B. ohne Befund\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-frage_beschwerden elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-frage_beschwerden\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHaben Sie derzeit Beschwerden?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NEIN\" id=\"form-field-frage_beschwerden-0\" name=\"form_fields[frage_beschwerden]\"> <label for=\"form-field-frage_beschwerden-0\">NEIN<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"JA\" id=\"form-field-frage_beschwerden-1\" name=\"form_fields[frage_beschwerden]\"> <label for=\"form-field-frage_beschwerden-1\">JA<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-welche_beschwerden elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-welche_beschwerden\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWelche Beschwerden und seit wann?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[welche_beschwerden]\" id=\"form-field-welche_beschwerden\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"z.B. starke Regelschmerzen seit 2 Monaten\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-verhuetung elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-verhuetung\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tVerh\u00fctungsmethoden die bisher angewendet wurden:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[verhuetung]\" id=\"form-field-verhuetung\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"z.B. Pille, Pflaster, Ring, Spirale, 3-Monats-Spritze, Sterilisation, Kondom etc.\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-medikamente elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-medikamente\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMedikamente, die regelm\u00e4\u00dfig\/zurzeit eingenommen werden\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[medikamente]\" id=\"form-field-medikamente\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"z.B. Pille, Blutdruck, Schilddr\u00fcse, etc.\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-erkrankungen elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-erkrankungen\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEigene Erkrankungen\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[erkrankungen]\" id=\"form-field-erkrankungen\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"z.B. Bluthochdruck, Diabetes, Herz-, Leber -, Nieren-, Krebserkrankungen etc.\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-ernste_erkrankungen elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-ernste_erkrankungen\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tErnsthafte Erkrankungen in der Familie\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[ernste_erkrankungen]\" id=\"form-field-ernste_erkrankungen\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"z.B. Brustkrebs, Darmkrebs, Erbkrankheiten, etc.\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-gerinnungsstoerung elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-gerinnungsstoerung\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGerinnungsst\u00f6rungen bei Ihnen oder in ihrer Familie\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[gerinnungsstoerung]\" id=\"form-field-gerinnungsstoerung\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"z.B. Faktor-5-Leiden, Bluterkrankheit, etc.\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-allg_operationen elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-allg_operationen\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAllgemeine Operationen\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[allg_operationen]\" id=\"form-field-allg_operationen\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"z.B. Blinddarmentfernung, Gallensteine, Zahnoperationen etc.\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-gyn_operationen elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-gyn_operationen\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGyn\u00e4kologische Operationen\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[gyn_operationen]\" id=\"form-field-gyn_operationen\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"z.B. Bauchspiegelung, Geb\u00e4rmutterentfernung etc.\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_3ad6e12 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Geburten | Kinderwunsch | Allergien\" data-previousButton=\"zur\u00fcck, zu &quot;Medizinische Fragen&quot;\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"far fa-arrow-alt-circle-right\" data-icon=\"\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-geburten elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-geburten\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeburten\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[geburten]\" id=\"form-field-geburten\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Datum, Art, Komplikationen, Geburtsgewicht\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-fehlgeburten elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-fehlgeburten\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFehlgeburten\/ Schwangerschaftsabbr\u00fcche \/ Eileiterschwangerschaften:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[fehlgeburten]\" id=\"form-field-fehlgeburten\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-kinderwunsch elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-kinderwunsch\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBesteht bei Ihnen derzeit Kinderwunsch?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NEIN\" id=\"form-field-kinderwunsch-0\" name=\"form_fields[kinderwunsch]\"> <label for=\"form-field-kinderwunsch-0\">NEIN<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"JA\" id=\"form-field-kinderwunsch-1\" name=\"form_fields[kinderwunsch]\"> <label for=\"form-field-kinderwunsch-1\">JA<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-kinderwunsch_seit elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-kinderwunsch_seit\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tKinderwunsch seit\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[kinderwunsch_seit]\" id=\"form-field-kinderwunsch_seit\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Jahr\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-schwangerschaft elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-schwangerschaft\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBesteht derzeit eine Schwangerschaft, oder vermuten Sie schwanger zu sein?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NEIN\" id=\"form-field-schwangerschaft-0\" name=\"form_fields[schwangerschaft]\"> <label for=\"form-field-schwangerschaft-0\">NEIN<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"JA\" id=\"form-field-schwangerschaft-1\" name=\"form_fields[schwangerschaft]\"> <label for=\"form-field-schwangerschaft-1\">JA<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-datum_letzte_periode elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-datum_letzte_periode\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tfalls ja, wann war der 1. Tag der letzten Periode?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[datum_letzte_periode]\" id=\"form-field-datum_letzte_periode\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Jahr\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-allergie elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-allergie\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAllergische Reaktionen auf folgende Stoffe (z.B. Penicillin, Jod, Pflaster etc.)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NEIN\" id=\"form-field-allergie-0\" name=\"form_fields[allergie]\"> <label for=\"form-field-allergie-0\">NEIN<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"JA\" id=\"form-field-allergie-1\" name=\"form_fields[allergie]\"> <label for=\"form-field-allergie-1\">JA<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-allergie_auf elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-allergie_auf\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAllergische Reaktion auf...\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[allergie_auf]\" id=\"form-field-allergie_auf\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-rauchen elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-rauchen\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tRauchen Sie?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NEIN\" id=\"form-field-rauchen-0\" name=\"form_fields[rauchen]\"> <label for=\"form-field-rauchen-0\">NEIN<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"JA\" id=\"form-field-rauchen-1\" name=\"form_fields[rauchen]\"> <label for=\"form-field-rauchen-1\">JA<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-menge_rauchen elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-menge_rauchen\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\twieviel rauchen Sie pro Tag?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[menge_rauchen]\" id=\"form-field-menge_rauchen\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-alkohol elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-alkohol\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTrinken Sie Alkohol?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NEIN\" id=\"form-field-alkohol-0\" name=\"form_fields[alkohol]\"> <label for=\"form-field-alkohol-0\">NEIN<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"JA\" id=\"form-field-alkohol-1\" name=\"form_fields[alkohol]\"> <label for=\"form-field-alkohol-1\">JA<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-menge_alkohol elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-menge_alkohol\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\twieviel trinken Sie pro Tag?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[menge_alkohol]\" id=\"form-field-menge_alkohol\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-frage_konsum elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-frage_konsum\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tKonsumieren Sie sonstige Dinge?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NEIN\" id=\"form-field-frage_konsum-0\" name=\"form_fields[frage_konsum]\"> <label for=\"form-field-frage_konsum-0\">NEIN<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"JA\" id=\"form-field-frage_konsum-1\" name=\"form_fields[frage_konsum]\"> <label for=\"form-field-frage_konsum-1\">JA<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-sonst_konsum elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-sonst_konsum\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWas konsumieren Sie?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[sonst_konsum]\" id=\"form-field-sonst_konsum\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-dce_js_field elementor-field-group elementor-column elementor-field-group-field_c3024e4 elementor-col-100\">\n\t\t\t\t\t<input size=\"1\"type=\"dce_js_field text\" name=\"form_fields[field_c3024e4]\" id=\"form-field-field_c3024e4\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" data-field-code=\"return () =&gt; { return  getField(&quot;name&quot;) + &quot; &quot; + getField(&quot;vorname&quot;) + &quot;, &quot; + getField(&quot;geburtsdatum&quot;); };\" data-real-time=\"\" readonly=\"\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-datenschutz elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-datenschutz\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDatenschutz\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[datenschutz]\" id=\"form-field-datenschutz\" class=\"elementor-field elementor-size-sm  elementor-acceptance-field\" required=\"required\">\n\t\t\t\t<label for=\"form-field-datenschutz\">Ich stimme zu, dass meine Angaben aus dem Formular zur Anamnese erhoben und verarbeitet werden. Die Daten werden nur kurz auf unserem Server zum Versand gespeichert und danach gel\u00f6scht. Sie k\u00f6nnen Ihre Einwilligung jederzeit per E-Mail an info@frauenaerztin-os.de widerrufen. Detaillierte Informationen zum Umgang mit Nutzerdaten finden Sie in unserer Datenschutzerkl\u00e4rung.<\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-hidden elementor-field-group elementor-column elementor-field-group-datumzeit elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"hidden\" name=\"form_fields[datumzeit]\" id=\"form-field-datumzeit\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" value=\"07\/04\/2026 08:38\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-amount elementor-field-group elementor-column elementor-field-group-bmi elementor-col-100\">\n\t\t\t\t\t<input type=\"hidden\" name=\"form_fields[bmi]\" id=\"form-field-bmi\" class=\"elementor-field elementor-size-sm  dce-amount-hidden\" data-hide=\"yes\" data-field-expression=\" getField(&quot;gewicht&quot;)  \/ (( getField(&quot;groesse&quot;)  \/ 100) * ( getField(&quot;groesse&quot;)  \/ 100))\" data-text-before=\"\" data-text-after=\"\" data-should-round=\"yes\" data-round-precision=\"1\" data-refresh-on=\"input\" data-should-format=\"\" data-format-precision=\"\" style=\"display: none;\"><input size=\"1\"type=\"text\" class=\"dce-amount-visible elementor-field-textual\" readonly=\"\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Senden<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t<style>.elementor-element.elementor-element-67a8a968 .elementor-field-group { align-self: flex-start; }<\/style>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-87e3415 e-flex e-con-boxed e-con e-parent\" data-id=\"87e3415\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ffa81ce elementor-icon-list--layout-inline elementor-align-center elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"ffa81ce\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items elementor-inline-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item elementor-inline-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/frauenaerztin-os.de\/impressum\/\" target=\"_blank\">\n\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Impressum<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item elementor-inline-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/frauenaerztin-os.de\/datenschutz\/\" target=\"_blank\">\n\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Datenschutz<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item elementor-inline-item\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Nutzungsbedingungen<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-27ed6bc elementor-widget elementor-widget-shortcode\" data-id=\"27ed6bc\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\t\t<div data-elementor-type=\"container\" data-elementor-id=\"786\" class=\"elementor elementor-786\" data-elementor-post-type=\"elementor_library\">\n\t\t\t\t<div class=\"elementor-element elementor-element-329d47f1 e-flex e-con-boxed e-con e-parent\" data-id=\"329d47f1\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div data-dce-title-color=\"#7A7A7A\" class=\"elementor-element elementor-element-39528007 elementor-widget elementor-widget-heading\" data-id=\"39528007\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\"><a href=\"https:\/\/lux-digitalepraxis.de\" target=\"_blank\">\u00a9 2026 LUX Digitale Praxis<\/a><\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>DEUTSCH ENGLISH Anamnesebogen Impressum Datenschutz Nutzungsbedingungen<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-13","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/app.lux-solution.de\/g2dsj8ya\/wp-json\/wp\/v2\/pages\/13","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/app.lux-solution.de\/g2dsj8ya\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/app.lux-solution.de\/g2dsj8ya\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/app.lux-solution.de\/g2dsj8ya\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/app.lux-solution.de\/g2dsj8ya\/wp-json\/wp\/v2\/comments?post=13"}],"version-history":[{"count":382,"href":"https:\/\/app.lux-solution.de\/g2dsj8ya\/wp-json\/wp\/v2\/pages\/13\/revisions"}],"predecessor-version":[{"id":1641,"href":"https:\/\/app.lux-solution.de\/g2dsj8ya\/wp-json\/wp\/v2\/pages\/13\/revisions\/1641"}],"wp:attachment":[{"href":"https:\/\/app.lux-solution.de\/g2dsj8ya\/wp-json\/wp\/v2\/media?parent=13"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}