{"id":3033,"date":"2021-10-25T20:30:10","date_gmt":"2021-10-25T20:30:10","guid":{"rendered":"http:\/\/diabetologie-dietzenbach.de\/?page_id=3033"},"modified":"2021-11-01T10:06:07","modified_gmt":"2021-11-01T10:06:07","slug":"ueberweisungswunsch","status":"publish","type":"page","link":"http:\/\/diabetologie-dietzenbach.de\/?page_id=3033","title":{"rendered":"\u00dcberweisungswunsch"},"content":{"rendered":"[vc_row][vc_column][vc_column_text]<p><\/p>\n<h3><span style=\"color: #000000;\">Um Ihnen unn\u00f6tige Wartezeit beim Anfordern von \u00dcberweisungs\u00ad\u00adformularen zu ersparen, k\u00f6nnen Sie unser untenstehendes Formular f\u00fcr \u00dcberweisungs\u00ad\u00adw\u00fcnsche nutzen. Wenn Sie Mitglied einer gesetzlichen Krankenkasse sind, muss in diesem Quartal die Krankenversicherungskarte bereits einmal eingelesen sein.\u00a0<\/h3>\n<h3><span style=\"color: #000000;\">Die angeforderten \u00dcberweisungen k\u00f6nnen Sie am jeweiligen Folgetag ab 15 Uhr pers\u00f6nlich bei uns in der Praxis abholen.<\/h3>\n<p><\/p>\n<p><\/p>\n<div class=\"wp-block-contact-form-7-contact-form-selector\">\u00a0<\/div>[\/vc_column_text][\/vc_column][\/vc_row]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f3035-o1\" lang=\"de-DE\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F3033#wpcf7-f3035-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Kontaktformular\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"3035\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.7.7\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"de_DE\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f3035-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<p>Sind Sie Bestandspatient?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-662\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-662\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-662\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/span><\/span><\/span>\n<\/p>\n<p>[group group-935]\n<\/p>\n<p>Wie sind Sie versichert?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-a\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-a\" value=\"Privat\" \/><span class=\"wpcf7-list-item-label\">Privat<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-a\" value=\"Gesetzlich\" \/><span class=\"wpcf7-list-item-label\">Gesetzlich<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Welche Medikamente nehmen Sie zur Zeit?<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-c\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-c\"><\/textarea><\/span>\n<\/p>\n<p>An welche Vorerkrankungen erinnern Sie sich?<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-e\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-e\"><\/textarea><\/span>\n<\/p>\n<p>[\/group]\n<\/p>\n<p>Anrede<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Anrede\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Anrede\"><option value=\"\">&#8211; Bitte ausw\u00e4hlen &#8211;<\/option><option value=\"Herr\">Herr<\/option><option value=\"Frau\">Frau<\/option><\/select><\/span>\n<\/p>\n<p>Vorname<span class=\"wpcf7-form-control-wrap\" data-name=\"text-830\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-830\" \/><\/span>\n<\/p>\n<p>Nachname<span class=\"wpcf7-form-control-wrap\" data-name=\"text-80\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-80\" \/><\/span>\n<\/p>\n<p>Geburtsdatum (zur Authentifizierung)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-761\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-761\" \/><\/span>\n<\/p>\n<p>E-Mail<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span>\n<\/p>\n<p> Telefon<span class=\"wpcf7-form-control-wrap\" data-name=\"tel-54\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-required wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"tel-54\" \/><\/span>\n<\/p>\n<p> Ich w\u00fcsche eine \u00dcberweisung zum:<span class=\"wpcf7-form-control-wrap\" data-name=\"text-225\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-225\" \/><\/span>\n<\/p>\n<p> \u00dcberweisungsgrund:<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-232\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-232\"><\/textarea><\/span>\n<\/p>\n<p>\n\t<font size=\"1\">(Bitte kurze Begr\u00fcndung des medizinischen Sachverhaltes eingeben)\n\t<\/font>\n<\/p>\n<p> Wie k\u00f6nnen wir Sie am besten erreichen?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-959\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"menu-959\"><option value=\"Telefon\">Telefon<\/option><option value=\"E-Mail\">E-Mail<\/option><\/select><\/span>\n<\/p>\n<p>\n\t<font size=\"1\">(Wir sind bem\u00fcht, Ihre Anfrage innerhalb von 2 Arbeitstagen zu beantworten. Sollten Sie dringend eine \u00dcberweisung ben\u00f6tigen bitten wir um telefonische Mitteilung.)\n\t<\/font>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-391\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"checkbox-391[]\" value=\"Hiermit erkl\u00e4re ich mich einverstanden, dass oben angef\u00fchrte Daten zum Zwecke meiner medizinischen Behandlung verarbeitet werden.\" \/><span class=\"wpcf7-list-item-label\">Hiermit erkl\u00e4re ich mich einverstanden, dass oben angef\u00fchrte Daten zum Zwecke meiner medizinischen Behandlung verarbeitet werden.<\/span><\/span><\/span><\/span>\n<\/p>\n<p><input class=\"wpcf7-form-control has-spinner wpcf7-submit\" type=\"submit\" value=\"Senden\" \/>\n<\/p><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"166\"\/><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n\/* ]]> *\/\n<\/script>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n[vc_row][vc_column][vc_column_text]<\/div>\n[\/vc_column_text][\/vc_column][\/vc_row]","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column][vc_column_text] Um Ihnen unn\u00f6tige Wartezeit beim Anfordern von \u00dcberweisungs\u00ad\u00adformularen zu ersparen, k\u00f6nnen Sie unser untenstehendes Formular f\u00fcr \u00dcberweisungs\u00ad\u00adw\u00fcnsche nutzen. Wenn Sie Mitglied einer gesetzlichen Krankenkasse sind, muss in diesem Quartal die Krankenversicherungskarte bereits einmal eingelesen sein.\u00a0 Die angeforderten \u00dcberweisungen k\u00f6nnen Sie am jeweiligen Folgetag ab 15 Uhr pers\u00f6nlich bei uns in der Praxis abholen. 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