{"id":2651,"date":"2024-02-01T13:42:44","date_gmt":"2024-02-01T12:42:44","guid":{"rendered":"https:\/\/043arts.nl\/?post_type=praktijkinformatie&#038;p=2651"},"modified":"2026-01-08T22:15:53","modified_gmt":"2026-01-08T21:15:53","slug":"inschrijven","status":"publish","type":"praktijkinformatie","link":"https:\/\/huisartsen.gcschalkwijk.nl\/tr\/praktijkinformatie\/inschrijven\/","title":{"rendered":"Inschrijven"},"content":{"rendered":"<style>.elementor-2651 .elementor-element.elementor-element-3077fb4b{--display:flex;--min-height:140px;--flex-direction:row;--container-widget-width:calc( ( 1 - var( --container-widget-flex-grow ) ) * 100% );--container-widget-height:100%;--container-widget-flex-grow:1;--container-widget-align-self:stretch;--flex-wrap-mobile:wrap;--justify-content:center;--align-items:center;--gap:10px 10px;--row-gap:10px;--column-gap:10px;--overlay-opacity:0.65;--padding-top:0px;--padding-bottom:0px;--padding-left:0px;--padding-right:0px;}.elementor-2651 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.elementor-element.elementor-element-6999473{--margin-top:20px;--margin-bottom:0px;--margin-left:0px;--margin-right:0px;--padding-top:0px;--padding-bottom:0px;--padding-left:0px;--padding-right:0px;}.elementor-2651 .elementor-element.elementor-element-2139077f .elementor-heading-title{font-size:24px;}.elementor-2651 .elementor-element.elementor-element-506f27a5{font-size:var( --e-global-typography-text-font-size );}}@media(min-width:768px){.elementor-2651 .elementor-element.elementor-element-3077fb4b{--content-width:1170px;}.elementor-2651 .elementor-element.elementor-element-29583863{--content-width:1170px;}}@media(max-width:1024px) and (min-width:768px){.elementor-2651 .elementor-element.elementor-element-4d260348{--width:100%;}.elementor-2651 .elementor-element.elementor-element-6999473{--width:100%;}}<\/style>\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"2651\" class=\"elementor elementor-2651\" data-elementor-post-type=\"praktijkinformatie\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3077fb4b e-flex e-con-boxed e-con e-parent\" data-id=\"3077fb4b\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-68a7f10 elementor-widget elementor-widget-heading\" data-id=\"68a7f10\" 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\">Inschrijven<\/h2>\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-29583863 e-flex e-con-boxed e-con e-parent\" data-id=\"29583863\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-4d260348 e-con-full e-flex e-con e-child\" data-id=\"4d260348\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-6999473 e-con-full e-flex e-con e-child\" data-id=\"6999473\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2139077f elementor-widget elementor-widget-heading\" data-id=\"2139077f\" 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\">Inschrijven<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-506f27a5 elementor-widget elementor-widget-text-editor\" data-id=\"506f27a5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Bewoners die net in Haarlem zijn komen wonen en vallen onder\u00a0postcodegebied 2034 t\/m 2037\u00a0kunnen ingeschreven worden.<\/p><p>Aan de hand van het volgende <strong><a href=\"https:\/\/huisartsen.gcschalkwijk.nl\/wp-content\/uploads\/2026\/01\/20241007-Inschrijfformulier-patient.pdf\">formulier<\/a><\/strong> kunnen \u2018\u2019nieuwe\u2019\u2019 bewoners zich inschrijven, graag het desbetreffende \u00a0gebruiken.<\/p><p>Het inschrijfformulier kunt u inleveren bij de assistenten op de 2e of 3e etage, hierna zal de assistente u verder uitleg geven.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7940980 elementor-widget 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.jet-form-builder-progress-pages__item--wrapper.active-page .jet-form-builder-progress-pages__item{font-size:var( --e-global-typography-806d809-font-size );line-height:var( --e-global-typography-806d809-line-height );letter-spacing:var( --e-global-typography-806d809-letter-spacing );word-spacing:var( --e-global-typography-806d809-word-spacing );}}@media(max-width:767px){.elementor-3332 .elementor-element.elementor-element-1251d6c .jet-form-builder-progress-pages__item--wrapper.active-page .jet-form-builder-progress-pages__item{font-size:var( --e-global-typography-806d809-font-size );line-height:var( --e-global-typography-806d809-line-height );letter-spacing:var( --e-global-typography-806d809-letter-spacing );word-spacing:var( --e-global-typography-806d809-word-spacing );}}<\/style>\t\t<div data-elementor-type=\"jet-engine-component\" data-elementor-id=\"3332\" class=\"elementor elementor-3332 jet-listing-grid--3332 jet-component-instance-9070\" data-elementor-post-type=\"jet-engine\" style=\"\">\n\t\t\t\t<div class=\"elementor-element elementor-element-201f4e5c e-flex e-con-boxed e-con e-parent\" data-id=\"201f4e5c\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1251d6c jedv-enabled--yes elementor-widget elementor-widget-jet-form-builder-form\" data-id=\"1251d6c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"jet-form-builder-form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<link rel='stylesheet' id='wp-block-library-css' href='https:\/\/huisartsen.gcschalkwijk.nl\/wp-includes\/css\/dist\/block-library\/style.min.css?ver=557a60ae955563b29e0bdbab89a9fe10' media='all' \/>\n<style id=\"jet-form-builder-2701-inline-css\"><\/style><form  class=\"jet-form-builder layout-column submit-type-ajax\" action=\"https:\/\/huisartsen.gcschalkwijk.nl\/tr\/wp-json\/wp\/v2\/praktijkinformatie\/2651\/?NaAUiG=QdewooC1QJ&amp;method=reload\" method=\"POST\" data-form-id=\"2701\" data-layout=\"column\" enctype=\"multipart\/form-data\" data-clear=\"1\" novalidate=\"null\" ssr_validation_method=\"rest\">\r\n<input type=\"hidden\" name=\"_jfb_current_render_states[]\" value=\"DEFAULT.STATE\" data-jfb-sync \/><input type=\"hidden\" class=\"jet-form-builder__field hidden-field\" name=\"_jet_engine_booking_form_id\" data-field-name=\"_jet_engine_booking_form_id\" value=\"2701\">\n<input type=\"hidden\" class=\"jet-form-builder__field hidden-field\" name=\"_jet_engine_refer\" data-field-name=\"_jet_engine_refer\" value=\"https:\/\/huisartsen.gcschalkwijk.nl\/tr\/wp-json\/wp\/v2\/praktijkinformatie\/2651\/\">\n<input type=\"hidden\" class=\"jet-form-builder__field hidden-field\" name=\"__queried_post_id\" data-field-name=\"__queried_post_id\" value=\"2651\">\n<div class=\"jet-form-builder-progress-pages jfb-progress-type--default jet-form-builder-progress-pages--global\" data-type=\"default\">\t<div class=\"jet-form-builder-progress-pages__item--wrapper active-page\" data-page=\"1\">\n\t\t<div class=\"jet-form-builder-progress-pages__item\">\n\t\t\t<div class=\"jet-form-builder-progress-pages__item--circle\">1<\/div>\n\t\t\t<div class=\"jet-form-builder-progress-pages__item--label\"> <\/div>\n\t\t<\/div>\n\t\t\t\t\t<div class=\"jet-form-builder-progress-pages__separator\"><\/div>\n\t\t\t<\/div>\n\t\t<div class=\"jet-form-builder-progress-pages__item--wrapper\" data-page=\"2\">\n\t\t<div class=\"jet-form-builder-progress-pages__item\">\n\t\t\t<div class=\"jet-form-builder-progress-pages__item--circle\">2<\/div>\n\t\t\t<div class=\"jet-form-builder-progress-pages__item--label\"> <\/div>\n\t\t<\/div>\n\t\t\t\t\t<div class=\"jet-form-builder-progress-pages__separator\"><\/div>\n\t\t\t<\/div>\n\t\t<div class=\"jet-form-builder-progress-pages__item--wrapper\" data-page=\"3\">\n\t\t<div class=\"jet-form-builder-progress-pages__item\">\n\t\t\t<div class=\"jet-form-builder-progress-pages__item--circle\">3<\/div>\n\t\t\t<div class=\"jet-form-builder-progress-pages__item--label\"> <\/div>\n\t\t<\/div>\n\t\t\t\t\t<div class=\"jet-form-builder-progress-pages__separator\"><\/div>\n\t\t\t<\/div>\n\t\t<div class=\"jet-form-builder-progress-pages__item--wrapper\" data-page=\"4\">\n\t\t<div class=\"jet-form-builder-progress-pages__item\">\n\t\t\t<div class=\"jet-form-builder-progress-pages__item--circle\">4<\/div>\n\t\t\t<div class=\"jet-form-builder-progress-pages__item--label\"> <\/div>\n\t\t<\/div>\n\t\t\t\t\t<div class=\"jet-form-builder-progress-pages__separator\"><\/div>\n\t\t\t<\/div>\n\t\t<div class=\"jet-form-builder-progress-pages__item--wrapper\" data-page=\"5\">\n\t\t<div class=\"jet-form-builder-progress-pages__item\">\n\t\t\t<div class=\"jet-form-builder-progress-pages__item--circle\">5<\/div>\n\t\t\t<div class=\"jet-form-builder-progress-pages__item--label\">Last Page<\/div>\n\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div><div class=\"jet-form-builder-page \" data-page=\"1\" data-page-offset=\"75\">\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"voornaam\">Voornaam <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"voornaam\" id=\"voornaam\" type=\"text\" data-field-name=\"voornaam\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_5vQfesnC\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"voorletters\">Voorletters <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"voorletters\" id=\"voorletters\" type=\"text\" data-field-name=\"voorletters\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_SNdvwBkG\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"achternaam\">Achternaam <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"achternaam\" id=\"achternaam\" type=\"text\" data-field-name=\"achternaam\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_xaGJomUq\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"meisjesnaam\">Meisjesnaam<\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input name=\"meisjesnaam\" id=\"meisjesnaam\" type=\"text\" data-field-name=\"meisjesnaam\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_4bo6RiZk\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"email\">E-mailadres <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"email\" id=\"email\" type=\"email\" data-field-name=\"email\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_43910J5I\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"telefoonnummer\">Telefoonnummer <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"telefoonnummer\" id=\"telefoonnummer\" type=\"text\" data-field-name=\"telefoonnummer\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_1pJaz8Lk\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n\n<div class=\"wp-block-jet-engine-container jet-container jet-container--content-direction-horizontal jet-container--content-align-flex-start jet-container--content-justify-flex-end wp-block-jet-engine-container\"><div class=\"jet-container__overlay   \" style=\"opacity:0.5\"><\/div><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-submit-field\" >\n\t<div data-type=\"next\" class=\"jet-form-builder__action-button-wrapper\">\n\t<button class=\"jet-form-builder__action-button jet-form-builder__next-page\" type=\"button\" data-jfb-conditional=\"[{&quot;page_state&quot;:&quot;active&quot;}]\" data-jfb-func=\"disable\">Volgende<\/button>\n\t<\/div>\n\t\n<\/div><\/div>\n\n\n<div class=\"jet-form-builder__next-page-wrap\">\n\t\t\t<\/div>\n<\/div>\n<div class=\"jet-form-builder-page jet-form-builder-page--hidden\" data-page=\"2\" data-page-offset=\"75\">\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"geslacht\">Geslacht <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"geslacht\" data-field-name=\"geslacht\" id=\"geslacht\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"man\" >Man<\/option><option value=\"vrouw\" >Vrouw<\/option><option value=\"X\" >X<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"geboortedatum\">Geboortedatum <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"geboortedatum\" id=\"geboortedatum\" type=\"text\" data-field-name=\"geboortedatum\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_DLVuTsFO\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"geboorteplaats\">Geboorteplaats <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"geboorteplaats\" id=\"geboorteplaats\" type=\"text\" data-field-name=\"geboorteplaats\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_1NLGV2mu\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"noodcontact_naam\">Noodcontact naam<\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input name=\"noodcontact_naam\" id=\"noodcontact_naam\" type=\"text\" data-field-name=\"noodcontact_naam\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_c8srFtuw\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"noodcontact_telefoonnummer\">Noodcontact mobiel nummer<\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input name=\"noodcontact_telefoonnummer\" id=\"noodcontact_telefoonnummer\" type=\"text\" data-field-name=\"noodcontact_telefoonnummer\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_C4rYZDga\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n\n<div class=\"wp-block-jet-engine-container jet-container jet-container--content-direction-horizontal jet-container--content-align-flex-start jet-container--content-justify-space-between wp-block-jet-engine-container\"><div class=\"jet-container__overlay   \" style=\"opacity:0.5\"><\/div><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-submit-field\" >\n\t<div data-type=\"prev\" class=\"jet-form-builder__action-button-wrapper\">\n\t<button class=\"jet-form-builder__action-button jet-form-builder__prev-page\" type=\"button\">Vorige<\/button>\n\t<\/div>\n\t\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-submit-field\" >\n\t<div data-type=\"next\" class=\"jet-form-builder__action-button-wrapper\">\n\t<button class=\"jet-form-builder__action-button jet-form-builder__next-page\" type=\"button\" data-jfb-conditional=\"[{&quot;page_state&quot;:&quot;active&quot;}]\" data-jfb-func=\"disable\">Volgende<\/button>\n\t<\/div>\n\t\n<\/div><\/div>\n\n\n<div class=\"jet-form-builder__next-page-wrap\">\n\t\t\t<\/div>\n<\/div>\n<div class=\"jet-form-builder-page jet-form-builder-page--hidden\" data-page=\"3\" data-page-offset=\"75\">\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"straat\">Straatnaam <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"straat\" id=\"straat\" type=\"text\" data-field-name=\"straat\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_anox01QY\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"huisnummer\">Huisnummer <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"huisnummer\" id=\"huisnummer\" type=\"text\" data-field-name=\"huisnummer\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_PifC4ub0\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"huisnummer_toevoeging\">Toevoeging<\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input name=\"huisnummer_toevoeging\" id=\"huisnummer_toevoeging\" type=\"text\" data-field-name=\"huisnummer_toevoeging\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_QIZ64Ysu\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"postcode\">Postcode <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"postcode\" id=\"postcode\" type=\"text\" data-field-name=\"postcode\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_XwuVsI23\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"plaats\">Plaats <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"plaats\" id=\"plaats\" type=\"text\" data-field-name=\"plaats\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_gQ83FOlE\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n\n<div class=\"wp-block-jet-engine-container jet-container jet-container--content-direction-horizontal jet-container--content-align-flex-start jet-container--content-justify-space-between wp-block-jet-engine-container\"><div class=\"jet-container__overlay   \" style=\"opacity:0.5\"><\/div><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-submit-field\" >\n\t<div data-type=\"prev\" class=\"jet-form-builder__action-button-wrapper\">\n\t<button class=\"jet-form-builder__action-button jet-form-builder__prev-page\" type=\"button\">Vorige<\/button>\n\t<\/div>\n\t\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-submit-field\" >\n\t<div data-type=\"next\" class=\"jet-form-builder__action-button-wrapper\">\n\t<button class=\"jet-form-builder__action-button jet-form-builder__next-page\" type=\"button\" data-jfb-conditional=\"[{&quot;page_state&quot;:&quot;active&quot;}]\" data-jfb-func=\"disable\">Volgende<\/button>\n\t<\/div>\n\t\n<\/div><\/div>\n\n\n<div class=\"jet-form-builder__next-page-wrap\">\n\t\t\t<\/div>\n<\/div>\n<div class=\"jet-form-builder-page jet-form-builder-page--hidden\" data-page=\"4\" data-page-offset=\"75\">\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"bsn\">BSN <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"bsn\" id=\"bsn\" type=\"text\" data-field-name=\"bsn\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_Am8oFZhd\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"zorgverzekeraar\">Zorgverzekeraar <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"zorgverzekeraar\" id=\"zorgverzekeraar\" type=\"text\" data-field-name=\"zorgverzekeraar\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_Aip4g7qL\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"polisnummer\">Polisnummer <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"polisnummer\" id=\"polisnummer\" type=\"text\" data-field-name=\"polisnummer\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_P8HR2lKI\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"apotheek\">Apotheek (nieuwe) <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"apotheek\" id=\"apotheek\" type=\"text\" data-field-name=\"apotheek\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_vBlTfxhk\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vorige_huisarts\">Vorige huisarts <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"vorige_huisarts\" id=\"vorige_huisarts\" type=\"text\" data-field-name=\"vorige_huisarts\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_XSugI9DJ\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"plaatsnaam_vorige_huisarts\">Plaatsnaam vorige huisarts<\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input name=\"plaatsnaam_vorige_huisarts\" id=\"plaatsnaam_vorige_huisarts\" type=\"text\" data-field-name=\"plaatsnaam_vorige_huisarts\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_v2StUKTl\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-date-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"gewenste_inschrijfdatum\">Gewenste inschrijfdatum <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><input class=\"jet-form-builder__field date-field\" required=\"required\" name=\"gewenste_inschrijfdatum\" type=\"date\" data-field-name=\"gewenste_inschrijfdatum\" id=\"gewenste_inschrijfdatum\" data-jfb-sync=\"null\">\n<\/div>\n\n\n<div class=\"wp-block-jet-engine-container jet-container jet-container--content-direction-horizontal jet-container--content-align-flex-start jet-container--content-justify-space-between wp-block-jet-engine-container\"><div class=\"jet-container__overlay   \" style=\"opacity:0.5\"><\/div><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-submit-field\" >\n\t<div data-type=\"prev\" class=\"jet-form-builder__action-button-wrapper\">\n\t<button class=\"jet-form-builder__action-button jet-form-builder__prev-page\" type=\"button\">Vorige<\/button>\n\t<\/div>\n\t\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-submit-field\" >\n\t<div data-type=\"next\" class=\"jet-form-builder__action-button-wrapper\">\n\t<button class=\"jet-form-builder__action-button jet-form-builder__next-page\" type=\"button\" data-jfb-conditional=\"[{&quot;page_state&quot;:&quot;active&quot;}]\" data-jfb-func=\"disable\">Volgende<\/button>\n\t<\/div>\n\t\n<\/div><\/div>\n\n\n<div class=\"jet-form-builder__next-page-wrap\">\n\t\t\t<\/div>\n<\/div>\n<div class=\"jet-form-builder-page jet-form-builder-page--hidden\" data-page=\"5\" data-page-offset=\"75\">\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-textarea-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"opmerkingen\">Opmerkingen<\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<textarea class=\"jet-form-builder__field textarea-field\" name=\"opmerkingen\" data-field-name=\"opmerkingen\" id=\"opmerkingen\" data-jfb-sync=\"null\"><\/textarea>\n\t<\/div>\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Ik ga akkoord met inschrijving bij deze praktijk. <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"toestemming_inschrijving\" value=\"Ja\" data-field-name=\"toestemming_inschrijving\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>Ja<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"toestemming_inschrijving\" value=\"Nee\" data-field-name=\"toestemming_inschrijving\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>Nee<\/span><\/label><\/div><\/div>\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Ik geef toestemming aan de praktijk om mijn dossier op te vragen bij mijn vorige huisarts \/ zorgverlener. <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"toestemming_vorige\" value=\"Ja\" data-field-name=\"toestemming_vorige\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>Ja<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"toestemming_vorige\" value=\"Nee\" data-field-name=\"toestemming_vorige\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>Nee<\/span><\/label><\/div><\/div>\n<\/div>\n\n<div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Ik geef toestemming om mijn medische gegevens uit te wisselen met zorgpartners zoals de spoedpost, ziekenhuis en apotheek. <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"toestemming_uitwisseling\" value=\"Ja\" data-field-name=\"toestemming_uitwisseling\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>Ja<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"toestemming_uitwisseling\" value=\"Nee\" data-field-name=\"toestemming_uitwisseling\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>Nee<\/span><\/label><\/div><\/div>\n<\/div>\n\n\n<div class=\"wp-block-jet-engine-container jet-container jet-container--content-direction-horizontal jet-container--content-align-flex-start jet-container--content-justify-space-between wp-block-jet-engine-container\"><div class=\"jet-container__overlay   \" style=\"opacity:0.5\"><\/div><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-submit-field\" >\n\t<div data-type=\"prev\" class=\"jet-form-builder__action-button-wrapper\">\n\t<button class=\"jet-form-builder__action-button jet-form-builder__prev-page\" type=\"button\">Vorige<\/button>\n\t<\/div>\n\t\n<\/div>\n\n<input type=\"hidden\" class=\"captcha-token\" name=\"_captcha_token\" value=\"\"\/><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-submit-field\" >\n\t<div data-type=\"submit\" class=\"jet-form-builder__action-button-wrapper jet-form-builder__submit-wrap\">\n\t<button class=\"jet-form-builder__action-button jet-form-builder__submit submit-type-ajax\" type=\"submit\">Verzenden<\/button>\n\t<\/div>\n\t\n<\/div><\/div>\n<\/div>\t<div class=\"jet-form-builder-messages-wrap\" data-form-id=\"2701\"><\/div>\n<\/form>\n\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\t\t\t\t<\/div>\n\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},"template":"elementor_header_footer","zichtbaarheid":[],"class_list":["post-2651","praktijkinformatie","type-praktijkinformatie","status-publish","has-post-thumbnail","hentry"],"_links":{"self":[{"href":"https:\/\/huisartsen.gcschalkwijk.nl\/tr\/wp-json\/wp\/v2\/praktijkinformatie\/2651","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/huisartsen.gcschalkwijk.nl\/tr\/wp-json\/wp\/v2\/praktijkinformatie"}],"about":[{"href":"https:\/\/huisartsen.gcschalkwijk.nl\/tr\/wp-json\/wp\/v2\/types\/praktijkinformatie"}],"version-history":[{"count":8,"href":"https:\/\/huisartsen.gcschalkwijk.nl\/tr\/wp-json\/wp\/v2\/praktijkinformatie\/2651\/revisions"}],"predecessor-version":[{"id":3555,"href":"https:\/\/huisartsen.gcschalkwijk.nl\/tr\/wp-json\/wp\/v2\/praktijkinformatie\/2651\/revisions\/3555"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/huisartsen.gcschalkwijk.nl\/tr\/wp-json\/wp\/v2\/media\/1041"}],"wp:attachment":[{"href":"https:\/\/huisartsen.gcschalkwijk.nl\/tr\/wp-json\/wp\/v2\/media?parent=2651"}],"wp:term":[{"taxonomy":"zichtbaarheid","embeddable":true,"href":"https:\/\/huisartsen.gcschalkwijk.nl\/tr\/wp-json\/wp\/v2\/zichtbaarheid?post=2651"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}