{"id":1270,"date":"2023-07-20T13:16:28","date_gmt":"2023-07-20T11:16:28","guid":{"rendered":"https:\/\/app.lux-solution.de\/lorkkfr\/?page_id=1270"},"modified":"2026-03-30T01:33:21","modified_gmt":"2026-03-29T23:33:21","slug":"op-anmeldung","status":"publish","type":"page","link":"https:\/\/app.lux-solution.de\/lorkkfr\/op-anmeldung\/","title":{"rendered":"OP Anmeldung"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1270\" class=\"elementor elementor-1270\" 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\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-caa8795 e-flex e-con-boxed e-con e-child\" data-id=\"caa8795\" 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-44e3258 e-flex e-con-boxed e-con e-child\" data-id=\"44e3258\" 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-444d8e1 elementor-widget elementor-widget-heading\" data-id=\"444d8e1\" 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\">Loretto-Krankenhaus Freiburg<\/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-6ddfdad elementor-widget elementor-widget-heading\" data-id=\"6ddfdad\" 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\">Klinik f\u00fcr Urologie<\/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-86bfb6d elementor-widget elementor-widget-heading\" data-id=\"86bfb6d\" 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\"><b>OP-Management<\/b><\/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-b339d16 elementor-widget elementor-widget-heading\" data-id=\"b339d16\" 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:+491608418268\" target=\"_blank\">Tel.: 0160 8418 268<\/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-c9e1adf elementor-widget elementor-widget-heading\" data-id=\"c9e1adf\" 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=\"mailto:LOK-UROOPPlanung@artemed.de%20\">LOK-UROOPPlanung@artemed.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-e6a61a8 e-flex e-con-boxed e-con e-child\" data-id=\"e6a61a8\" 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-fdc0fae dce_masking-none elementor-widget elementor-widget-image\" data-id=\"fdc0fae\" 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=\"400\" height=\"67\" src=\"https:\/\/app.lux-solution.de\/lorkkfr\/wp-content\/uploads\/sites\/31\/2025\/07\/csm_LOK_Logo_weiss_pfade_2023_2896620915.webp\" class=\"attachment-large size-large wp-image-6599\" alt=\"\" srcset=\"https:\/\/app.lux-solution.de\/lorkkfr\/wp-content\/uploads\/sites\/31\/2025\/07\/csm_LOK_Logo_weiss_pfade_2023_2896620915.webp 400w, https:\/\/app.lux-solution.de\/lorkkfr\/wp-content\/uploads\/sites\/31\/2025\/07\/csm_LOK_Logo_weiss_pfade_2023_2896620915-300x50.webp 300w\" sizes=\"(max-width: 400px) 100vw, 400px\" \/>\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\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-fd4ba40 e-flex e-con-boxed e-con e-child\" data-id=\"fd4ba40\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ff73bf5 elementor-widget elementor-widget-html\" data-id=\"ff73bf5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<script>\r\ndocument.addEventListener(\"DOMContentLoaded\", function () {\r\n  const emailField = document.querySelector('[name=\"form_fields[praxisemail]\"]'); \/\/ Name anpassen!\r\n  \r\n  if (!emailField) return;\r\n\r\n  emailField.addEventListener(\"blur\", function () {\r\n    const email = emailField.value.trim();\r\n    if (!email) return;\r\n\r\n    fetch(\"https:\/\/app.lux-solution.de\/wp-json\/lux\/v1\/check-email\/\", {\r\n      method: \"POST\",\r\n      headers: { \"Content-Type\": \"application\/json\" },\r\n 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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=\"OP Planung\" aria-label=\"OP Planung\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"1270\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"0dc4e4c\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Loretto-Klinik Artemed Freiburg\" \/>\n\n\t\t\t\n\t\t\t<div data-field-conditions=\"[{&quot;id&quot;:&quot;versichertzusatz&quot;,&quot;condition&quot;:&quot;(versichert == &#039;Gesetzlich&#039;)&quot;,&quot;mode&quot;:&quot;show&quot;,&quot;disableOnly&quot;:false},{&quot;id&quot;:&quot;versichertprivatarzt&quot;,&quot;condition&quot;:&quot;(versichert == 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elementor-field-group-name elementor-col-100\">\n\t\t\t\t\t<style>\n  \/* Verstecke den gesamten Inhalt der Seite standardm\u00e4\u00dfig *\/\n  body {\n    visibility: hidden;\n    opacity: 0;\n    transition: opacity 0.3s ease-in-out; \/* Sanfte \u00dcberblendung *\/\n  }\n<\/style>\n\n<script>\n  document.addEventListener(\"DOMContentLoaded\", function() {\n    \/\/ Zeigt den Inhalt der Seite, nachdem das DOM vollst\u00e4ndig geladen wurde\n    document.body.style.visibility = \"visible\";\n    document.body.style.opacity = \"1\";\n  });\n<\/script>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_bdd569e elementor-col-100\">\n\t\t\t\t\t<script>\n    document.addEventListener(\"DOMContentLoaded\", function() {\n        var form = document.querySelector('.elementor-form');\n        if (form) {\n            form.setAttribute('autocomplete', 'off');\n        }\n    });\n<\/script>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_e5f40bf elementor-col-100\">\n\t\t\t\t\t<center><b style=\"font-size:25px;\">OP-ANMELDUNG<\/b><br\/>- KLINIK F\u00dcR UROLOGIE -<br><br><br\/>\n<b style=\"background-color:#B62B30;color:#fff;padding:10px;\">Nur f\u00fcr \u00c4rzte und medizinisches Fachpersonal bestimmt.<\/b><br\/><br\/><br\/><\/center>\n<br\/><br\/>\n\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_4c61a4d elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Anfragetyp\" data-previousButton=\"zur\u00fcck\" data-nextButton=\"zum Formular\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_686b8d8 elementor-col-100\">\n\t\t\t\t\t<b>Praxis\/Einweiser*in<\/b>\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-praxis elementor-col-25 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-praxis\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPraxis\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[praxis]\" id=\"form-field-praxis\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" 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-praxisarzt elementor-col-25 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-praxisarzt\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEinweiser*in\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[praxisarzt]\" id=\"form-field-praxisarzt\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" 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-praxisemail elementor-col-25 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-praxisemail\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPraxis E-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=\"text\" name=\"form_fields[praxisemail]\" id=\"form-field-praxisemail\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" 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-praxistelefon elementor-col-25 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-praxistelefon\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPraxis direkte Tel.-Durchwahl\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[praxistelefon]\" id=\"form-field-praxistelefon\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" 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-html elementor-field-group elementor-column elementor-field-group-field_bc3b062 elementor-col-100\">\n\t\t\t\t\t<hr>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_ea17835 elementor-col-100\">\n\t\t\t\t\t<b>Informationen zum\/zur Patient*in<\/b>\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\tAnrede\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=\"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=\"Herr\" id=\"form-field-geschlecht-1\" name=\"form_fields[geschlecht]\"> <label for=\"form-field-geschlecht-1\">Herr<\/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-vorname elementor-col-25 elementor-field-required\">\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\" 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-name elementor-col-25 elementor-field-required\">\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\" 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-geburtsdatum elementor-col-25 elementor-field-required\">\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\tGeb.-Datum\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\" 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-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\">\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\tPLZ\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\">\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\">\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 elementor-field-required\">\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\tMobil\/Tel. Nr.\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\" 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-email elementor-field-group elementor-column elementor-field-group-email elementor-col-25\">\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\">\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-versichert elementor-col-25 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-versichert\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tVersichert\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=\"Gesetzlich\" id=\"form-field-versichert-0\" name=\"form_fields[versichert]\" required=\"required\"> <label for=\"form-field-versichert-0\">Gesetzlich<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Privat\" id=\"form-field-versichert-1\" name=\"form_fields[versichert]\" required=\"required\"> <label for=\"form-field-versichert-1\">Privat<\/label><\/span><\/div>\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-versichertzusatz elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-versichertzusatz\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHat Patient eine Zusatzversicherung f\u00fcr den station\u00e4ren Bereich?\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-versichertzusatz-0\" name=\"form_fields[versichertzusatz]\"> <label for=\"form-field-versichertzusatz-0\">NEIN<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"JA\" id=\"form-field-versichertzusatz-1\" name=\"form_fields[versichertzusatz]\"> <label for=\"form-field-versichertzusatz-1\">JA<\/label><\/span><\/div>\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-versichertprivatarzt elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-versichertprivatarzt\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWahlleistung Chefarzt?\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-versichertprivatarzt-0\" name=\"form_fields[versichertprivatarzt]\"> <label for=\"form-field-versichertprivatarzt-0\">NEIN<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"JA\" id=\"form-field-versichertprivatarzt-1\" name=\"form_fields[versichertprivatarzt]\"> <label for=\"form-field-versichertprivatarzt-1\">JA<\/label><\/span><\/div>\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-versichertprivatzimmer elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-versichertprivatzimmer\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWahlleistung Zimmer?\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=\"Standard\" id=\"form-field-versichertprivatzimmer-0\" name=\"form_fields[versichertprivatzimmer]\"> <label for=\"form-field-versichertprivatzimmer-0\">Standard<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"2-Bett\" id=\"form-field-versichertprivatzimmer-1\" name=\"form_fields[versichertprivatzimmer]\"> <label for=\"form-field-versichertprivatzimmer-1\">2-Bett<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1-Bett\" id=\"form-field-versichertprivatzimmer-2\" name=\"form_fields[versichertprivatzimmer]\"> <label for=\"form-field-versichertprivatzimmer-2\">1-Bett<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_efff223 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_5469340 elementor-col-100\">\n\t\t\t\t\t<hr>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-diagnose elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-diagnose\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<b>Urologische Diagnose(n)<\/b>\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[diagnose]\" id=\"form-field-diagnose\" rows=\"4\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-operation elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-operation\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<b>Geplante Operation<\/b>\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-eicon-caret-down\" viewBox=\"0 0 571.4 571.4\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M571 393Q571 407 561 418L311 668Q300 679 286 679T261 668L11 418Q0 407 0 393T11 368 36 357H536Q550 357 561 368T571 393Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[operation]\" id=\"form-field-operation\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"-- Men\u00fcauswahl h\u00e4ufige Operationen --\">-- Men\u00fcauswahl h\u00e4ufige Operationen --<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ablatio testis wegen Hodentumor\">Ablatio testis wegen Hodentumor<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"ATOMS\">ATOMS<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Blasensteinentfernung (transurethral)\">Blasensteinentfernung (transurethral)<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Botulinumtoxininjektion in die Harnblase\">Botulinumtoxininjektion in die Harnblase<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Boutonni\u00e8re\">Boutonni\u00e8re<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"DJ-Auslassversuch (Entfernung Ureterschiene)\">DJ-Auslassversuch (Entfernung Ureterschiene)<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"DJ-Einlage (Ureterschiene)\">DJ-Einlage (Ureterschiene)<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"DJ-Wechsel (Ureterschienenwechsel)\">DJ-Wechsel (Ureterschienenwechsel)<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Extrakorporale Sto\u00dfwellenlithotripsie (ESWL) \">Extrakorporale Sto\u00dfwellenlithotripsie (ESWL) <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Harnleiterteilresektion\">Harnleiterteilresektion<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Harnr\u00f6hrenrekonstruktion\">Harnr\u00f6hrenrekonstruktion<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Harnleiterrekonstruktion\">Harnleiterrekonstruktion<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Hodenfreilegung\">Hodenfreilegung<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Hydrozele\">Hydrozele<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Implantation k\u00fcnstlicher Harnr\u00f6hrenschlie\u00dfmuskel\">Implantation k\u00fcnstlicher Harnr\u00f6hrenschlie\u00dfmuskel<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"MJ Wechsel\">MJ Wechsel<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nephrektomie\">Nephrektomie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nephrostomie Wechsel\">Nephrostomie Wechsel<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nephrostomie Anlage\">Nephrostomie Anlage<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nephroureterektomie\">Nephroureterektomie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nierenbeckenplastik - roboterassisitiert\">Nierenbeckenplastik - roboterassisitiert<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Operative Korrektur Hodenhochstand\">Operative Korrektur Hodenhochstand<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Operative Korrektur Hypospadie\">Operative Korrektur Hypospadie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Organerhaltende Nierentumorresektion\">Organerhaltende Nierentumorresektion<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Penektomie\">Penektomie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Perkutane Nephrolithotomie (PCNL) zur Steinentfernung\">Perkutane Nephrolithotomie (PCNL) zur Steinentfernung<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Prostatastanze\">Prostatastanze<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Prostatastanze mit MRT-Fusion\">Prostatastanze mit MRT-Fusion<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Prostata Laserenukleation (HoLEP)\">Prostata Laserenukleation (HoLEP)<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Robotische radikale Prostatektomie\">Robotische radikale Prostatektomie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Spermatozele\">Spermatozele<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"TUR-B (Transurethrale Resektion der  Harnblase)\">TUR-B (Transurethrale Resektion der  Harnblase)<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"TUR-Blasenhals\">TUR-Blasenhals<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"TUR-P \/ TUE-P (Transurethrale Resektion der Prostata)\">TUR-P \/ TUE-P (Transurethrale Resektion der Prostata)<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Urethrotomie\">Urethrotomie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"URS (Harnleiterspiegelung) zur Diagnostik\">URS (Harnleiterspiegelung) zur Diagnostik<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"URS (Harnleiterspiegelung) zur Steinentfernung\">URS (Harnleiterspiegelung) zur Steinentfernung<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Varikozele\">Varikozele<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Zirkumzision\">Zirkumzision<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Zystektomie mit entsprechender Harnableitung\">Zystektomie mit entsprechender Harnableitung<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Zystoskopie\">Zystoskopie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"** Andere Operation **\">** Andere Operation **<\/option>\n\t\t\t\t\t\t\t<\/select>\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-text elementor-field-group elementor-column elementor-field-group-andere_operation elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-andere_operation\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<b>Andere Operation<\/b>\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[andere_operation]\" id=\"form-field-andere_operation\" 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-hodentumormarker elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-hodentumormarker\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<b>Hodentumormarker<\/b>\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-hodentumormarker-0\" name=\"form_fields[hodentumormarker]\" required=\"required\"> <label for=\"form-field-hodentumormarker-0\">NEIN<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"JA\" id=\"form-field-hodentumormarker-1\" name=\"form_fields[hodentumormarker]\" required=\"required\"> <label for=\"form-field-hodentumormarker-1\">JA<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_db3cc3d elementor-col-100\">\n\t\t\t\t\t<b style=\"background-color:#B62B30;color:#fff;padding:10px;\">Hinweis:<\/b> Geben Sie dem Patienten bitte den MRT-Befund und die CD mit.\n\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-staging elementor-col-20 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-staging\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<b>Staging?<\/b>\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-staging-0\" name=\"form_fields[staging]\" required=\"required\"> <label for=\"form-field-staging-0\">NEIN<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"JA\" id=\"form-field-staging-1\" name=\"form_fields[staging]\" required=\"required\"> <label for=\"form-field-staging-1\">JA<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group elementor-column elementor-field-group-staging_ct elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-staging_ct\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<b>CT<\/b>\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[staging_ct]\" id=\"form-field-staging_ct\" class=\"elementor-field elementor-size-sm  elementor-upload-field\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group elementor-column elementor-field-group-staging_petct elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-staging_petct\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<b>PSMA PET-CT<\/b>\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[staging_petct]\" id=\"form-field-staging_petct\" class=\"elementor-field elementor-size-sm  elementor-upload-field\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group elementor-column elementor-field-group-staging_szinti elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-staging_szinti\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<b>Knochenszintigraphie<\/b>\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[staging_szinti]\" id=\"form-field-staging_szinti\" class=\"elementor-field elementor-size-sm  elementor-upload-field\">\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-psawert elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-psawert\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<b>PSA-Wert<\/b>\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[psawert]\" id=\"form-field-psawert\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" 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-prostatavolumen elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-prostatavolumen\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<b>TUR-P\/TUE-P:<\/b> Prostatavolumen\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[prostatavolumen]\" id=\"form-field-prostatavolumen\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" 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-gleasonscore elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-gleasonscore\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<b>GLEASON Score:<\/b>\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[gleasonscore]\" id=\"form-field-gleasonscore\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" 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-html elementor-field-group elementor-column elementor-field-group-field_df64198 elementor-col-100\">\n\t\t\t\t\t<div style=\"background-color: #C00A26; color: white; padding: 20px; text-align: center;\">\n    Bitte laden Sie die originale Histologie hoch (bei Upload der Befunde).\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_08964b8 elementor-col-100\">\n\t\t\t\t\t<hr>\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-dringlichkeit elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-dringlichkeit\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<b>Dringlichkeit der Operation:<\/b>\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-dringlichkeit-0\" name=\"form_fields[dringlichkeit]\"> <label for=\"form-field-dringlichkeit-0\">NEIN<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"JA\" id=\"form-field-dringlichkeit-1\" name=\"form_fields[dringlichkeit]\"> <label for=\"form-field-dringlichkeit-1\">JA<\/label><\/span><\/div>\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-antikoagulation_wahl elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-antikoagulation_wahl\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<b>Antikoagulation<\/b>\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-antikoagulation_wahl-0\" name=\"form_fields[antikoagulation_wahl]\" required=\"required\"> <label for=\"form-field-antikoagulation_wahl-0\">NEIN<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"JA\" id=\"form-field-antikoagulation_wahl-1\" name=\"form_fields[antikoagulation_wahl]\" required=\"required\"> <label for=\"form-field-antikoagulation_wahl-1\">JA<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-antikoagulation elementor-col-100\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Marcumar\" id=\"form-field-antikoagulation-0\" name=\"form_fields[antikoagulation][]\"> <label for=\"form-field-antikoagulation-0\">Marcumar<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Eliquis (Apixaban)\" id=\"form-field-antikoagulation-1\" name=\"form_fields[antikoagulation][]\"> <label for=\"form-field-antikoagulation-1\">Eliquis (Apixaban)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Pradaxa (Dabigatran)\" id=\"form-field-antikoagulation-2\" name=\"form_fields[antikoagulation][]\"> <label for=\"form-field-antikoagulation-2\">Pradaxa (Dabigatran)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Xarelto (Rivaroxaban)\" id=\"form-field-antikoagulation-3\" name=\"form_fields[antikoagulation][]\"> <label for=\"form-field-antikoagulation-3\">Xarelto (Rivaroxaban)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Lixiana (Edoxaban)\" id=\"form-field-antikoagulation-4\" name=\"form_fields[antikoagulation][]\"> <label for=\"form-field-antikoagulation-4\">Lixiana (Edoxaban)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Brilique (Ticagrelor)\" id=\"form-field-antikoagulation-5\" name=\"form_fields[antikoagulation][]\"> <label for=\"form-field-antikoagulation-5\">Brilique (Ticagrelor)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Plavix (Clopidogrel)\" id=\"form-field-antikoagulation-6\" name=\"form_fields[antikoagulation][]\"> <label for=\"form-field-antikoagulation-6\">Plavix (Clopidogrel)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Efient (Prasugrel)\" id=\"form-field-antikoagulation-7\" name=\"form_fields[antikoagulation][]\"> <label for=\"form-field-antikoagulation-7\">Efient (Prasugrel)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"ASS 100\" id=\"form-field-antikoagulation-8\" name=\"form_fields[antikoagulation][]\"> <label for=\"form-field-antikoagulation-8\">ASS 100<\/label><\/span><\/div>\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-bildgebung_wahl elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-bildgebung_wahl\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<b>Bildgebung wird Pratient:in mitgegeben<\/b>\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-bildgebung_wahl-0\" name=\"form_fields[bildgebung_wahl]\"> <label for=\"form-field-bildgebung_wahl-0\">NEIN<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"JA\" id=\"form-field-bildgebung_wahl-1\" name=\"form_fields[bildgebung_wahl]\"> <label for=\"form-field-bildgebung_wahl-1\">JA<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"NICHT NOTWENDIG\" id=\"form-field-bildgebung_wahl-2\" name=\"form_fields[bildgebung_wahl]\"> <label for=\"form-field-bildgebung_wahl-2\">NICHT NOTWENDIG<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-bildgebung elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-eicon-caret-down\" viewBox=\"0 0 571.4 571.4\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M571 393Q571 407 561 418L311 668Q300 679 286 679T261 668L11 418Q0 407 0 393T11 368 36 357H536Q550 357 561 368T571 393Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[bildgebung]\" id=\"form-field-bildgebung\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"--- bitte w\u00e4hlen ---\">--- bitte w\u00e4hlen ---<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"CD + schriftlicher Befund\">CD + schriftlicher Befund<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"QR-Code + schriftlicher Befund\">QR-Code + schriftlicher Befund<\/option>\n\t\t\t\t\t\t\t<\/select>\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-upload elementor-field-group elementor-column elementor-field-group-qrcode elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-qrcode\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBitte QR Code hochladen (nur PDF-Format)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[qrcode]\" id=\"form-field-qrcode\" class=\"elementor-field elementor-size-sm  elementor-upload-field\" data-maxsize=\"2\" data-maxsize-message=\"Diese Datei \u00fcbersteigt die maximale Dateigr\u00f6\u00dfe\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_e98e755 elementor-col-100\">\n\t\t\t\t\t<hr>\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-sonstiges_wahl elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-sonstiges_wahl\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<b>Relevante Begleiterkrankungen<\/b>\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-sonstiges_wahl-0\" name=\"form_fields[sonstiges_wahl]\"> <label for=\"form-field-sonstiges_wahl-0\">NEIN<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"JA\" id=\"form-field-sonstiges_wahl-1\" name=\"form_fields[sonstiges_wahl]\"> <label for=\"form-field-sonstiges_wahl-1\">JA<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-sonstiges elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-sonstiges\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tRelevante Begleiterkranknungen oder Vortherapien\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[sonstiges]\" id=\"form-field-sonstiges\" rows=\"4\" placeholder=\"Bei kardiologischen Vorerkrankungen bitte kardiologische Befunde angeben.\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_ff13995 elementor-col-100\">\n\t\t\t\t\t<b>Upload der Befunde<\/b><br>\nSie k\u00f6nnen hier bis zu <b>5 PDF-Dateien<\/b> mit insg. 15MB hochladen. Sollte die Kapazit\u00e4t in einem Fall nicht ausreichen, verwenden Sie bitte das Formular erneut.\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group elementor-column elementor-field-group-my_file elementor-col-100\">\n\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[my_file][]\" id=\"form-field-my_file\" class=\"elementor-field elementor-size-sm  elementor-upload-field\" multiple=\"multiple\" data-maxsize=\"15\" data-maxsize-message=\"Diese Datei \u00fcbersteigt die maximale Dateigr\u00f6\u00dfe\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_8aaaa37 elementor-col-100\">\n\t\t\t\t\t<hr>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-anmerkungen elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-anmerkungen\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBesonderheiten\/Anmerkungen\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[anmerkungen]\" id=\"form-field-anmerkungen\" rows=\"4\" placeholder=\"Platz f\u00fcr Ihre Nachricht\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_b7bb279 elementor-col-100\">\n\t\t\t\t\t<hr>\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\t<b>Datenschutz<\/b>\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 best\u00e4tige hiermit, dass ich das Einverst\u00e4ndnis des\/der Patient*in zur \u00dcbermittlung seiner Daten per E-Mail zum Klinikum eingeholt und ihn \u00fcber die damit verbundenen Sicherheitsrisiken aufgekl\u00e4rt habe. Diese \u00dcbermittlung erfolgt auf ausdr\u00fccklichen Wunsch des\/der Patient*in.<\/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=\"19\/04\/2026 06:52\">\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-hidden elementor-field-group elementor-column elementor-field-group-token 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[token]\" id=\"form-field-token\" 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-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\">Formular absenden<\/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-0dc4e4c .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\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\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;position&quot;:&quot;fixed&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\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 class=\"elementor-element elementor-element-642dbe9 elementor-icon-list--layout-inline elementor-align-center elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"642dbe9\" 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:\/\/www.lorettokrankenhaus-freiburg.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:\/\/www.lorettokrankenhaus-freiburg.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<\/ul>\n\t\t\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-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<p class=\"elementor-heading-title elementor-size-default\"><a href=\"https:\/\/lux-digitalepraxis.de\" target=\"_blank\">\u00a9 2026 LUX Digitale Praxis<\/a><\/p>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ee36114 dce_masking-none elementor-widget elementor-widget-image\" data-id=\"ee36114\" 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\t<a href=\"https:\/\/lux-digitalepraxis.de\" target=\"_blank\">\n\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"877\" height=\"1024\" src=\"https:\/\/app.lux-solution.de\/lorkkfr\/wp-content\/uploads\/sites\/31\/2024\/06\/lux-x-877x1024.png\" class=\"attachment-large size-large wp-image-4332\" alt=\"\" srcset=\"https:\/\/app.lux-solution.de\/lorkkfr\/wp-content\/uploads\/sites\/31\/2024\/06\/lux-x-877x1024.png 877w, https:\/\/app.lux-solution.de\/lorkkfr\/wp-content\/uploads\/sites\/31\/2024\/06\/lux-x-257x300.png 257w, https:\/\/app.lux-solution.de\/lorkkfr\/wp-content\/uploads\/sites\/31\/2024\/06\/lux-x-768x897.png 768w, https:\/\/app.lux-solution.de\/lorkkfr\/wp-content\/uploads\/sites\/31\/2024\/06\/lux-x-1315x1536.png 1315w, https:\/\/app.lux-solution.de\/lorkkfr\/wp-content\/uploads\/sites\/31\/2024\/06\/lux-x-1754x2048.png 1754w\" sizes=\"(max-width: 877px) 100vw, 877px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\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\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>OP-Management Tel.: 0160 8418 268 LOK-UROOPPlanung@artemed.de<\/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-1270","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/app.lux-solution.de\/lorkkfr\/wp-json\/wp\/v2\/pages\/1270","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/app.lux-solution.de\/lorkkfr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/app.lux-solution.de\/lorkkfr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/app.lux-solution.de\/lorkkfr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/app.lux-solution.de\/lorkkfr\/wp-json\/wp\/v2\/comments?post=1270"}],"version-history":[{"count":857,"href":"https:\/\/app.lux-solution.de\/lorkkfr\/wp-json\/wp\/v2\/pages\/1270\/revisions"}],"predecessor-version":[{"id":7396,"href":"https:\/\/app.lux-solution.de\/lorkkfr\/wp-json\/wp\/v2\/pages\/1270\/revisions\/7396"}],"wp:attachment":[{"href":"https:\/\/app.lux-solution.de\/lorkkfr\/wp-json\/wp\/v2\/media?parent=1270"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}