{"id":37512,"date":"2026-09-13T18:48:51","date_gmt":"2026-09-13T16:48:51","guid":{"rendered":"https:\/\/espacehealth.ch\/?page_id=37512"},"modified":"2026-09-13T18:48:56","modified_gmt":"2026-09-13T16:48:56","slug":"formular-spitex-anmeldung","status":"publish","type":"page","link":"https:\/\/espacehealth.ch\/fr\/formular-spitex-anmeldung\/","title":{"rendered":"Formular Spitex Anmeldung"},"content":{"rendered":"\r\n<section  class=\"scroll-mt-middle-header-height bg-white \">\r\n    <div class=\"section-inner-wrapper  limited-width\">\r\n                            <div class=\"section-body  \">\r\n                \n<style id=\"wpforms-css-vars-37510\">\n\t\t\t\t#wpforms-37510 {\n\t\t\t\t--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-container-save-resume wpforms-render-modern\" id=\"wpforms-37510\"><form id=\"wpforms-form-37510\" class=\"wpforms-validate wpforms-form\" data-formid=\"37510\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/fr\/wp-json\/wp\/v2\/pages\/37512?wpforms_form_id=37510\" data-token=\"0764ac99efa414f015876f2486b0abe4\" data-token-time=\"1789359447\"><noscript class=\"wpforms-error-noscript\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/div><div class=\"wpforms-page-indicator circles\" data-indicator=\"circles\" data-indicator-color=\"#00346c\" data-scroll=\"1\" role=\"progressbar\" aria-valuenow=\"1\" aria-valuemin=\"1\" aria-valuemax=\"5\" tabindex=\"-1\" data-allow-page-navigation=\"1\"><div class=\"wpforms-page-indicator-page active wpforms-page-indicator-page-1\" data-page=\"1\" role=\"button\" tabindex=\"0\" aria-label=\"Go to page 1\"><span class=\"wpforms-page-indicator-page-number\" style=\"background-color:#00346c\" data-page=\"1\">1<\/span><\/div><div class=\"wpforms-page-indicator-page  wpforms-page-indicator-page-2\" data-page=\"2\" role=\"button\" tabindex=\"0\" aria-label=\"Go to page 2\"><span class=\"wpforms-page-indicator-page-number\"  data-page=\"2\">2<\/span><\/div><div class=\"wpforms-page-indicator-page  wpforms-page-indicator-page-3\" data-page=\"3\" role=\"button\" tabindex=\"0\" aria-label=\"Go to page 3\"><span class=\"wpforms-page-indicator-page-number\"  data-page=\"3\">3<\/span><\/div><div class=\"wpforms-page-indicator-page  wpforms-page-indicator-page-4\" data-page=\"4\" role=\"button\" tabindex=\"0\" aria-label=\"Go to page 4\"><span class=\"wpforms-page-indicator-page-number\"  data-page=\"4\">4<\/span><\/div><div class=\"wpforms-page-indicator-page  wpforms-page-indicator-page-5\" data-page=\"5\" role=\"button\" tabindex=\"0\" aria-label=\"Go to page 5\"><span class=\"wpforms-page-indicator-page-number\"  data-page=\"5\">5<\/span><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-37510-field_33-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"33\"><\/div><div id=\"wpforms-37510-field_1-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"1\"><fieldset><legend class=\"wpforms-field-label\">Worum geht es? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-37510-field_1\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-37510-field_1_1\" name=\"wpforms[fields][1]\" value=\"Ich m\u00f6chte mich (oder eine andere Person) f\u00fcr Spitex-Leistungen anmelden\" aria-errormessage=\"wpforms-37510-field_1_1-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-37510-field_1_1\">Ich m\u00f6chte mich (oder eine andere Person) f\u00fcr Spitex-Leistungen anmelden<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-37510-field_1_2\" name=\"wpforms[fields][1]\" value=\"Ich habe eine allgemeine Anfrage\" aria-errormessage=\"wpforms-37510-field_1_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-37510-field_1_2\">Ich habe eine allgemeine Anfrage<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-37510-field_2-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-modern\" data-field-type=\"select\" data-field-id=\"2\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-37510-field_2\">Bei welcher Spitex m\u00f6chten Sie sich anmelden? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-37510-field_2\" class=\"wpforms-field-large wpforms-field-required choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-large\" data-search-enabled=\"\" name=\"wpforms[fields][2]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Bitte w\u00e4hlen<\/option><option value=\"BEMO Spitex Muri\"  class=\"choice-1 depth-1\"  >BEMO Spitex Muri<\/option><option value=\"BEMO Spitex Rohrbach\"  class=\"choice-2 depth-1\"  >BEMO Spitex Rohrbach<\/option><option value=\"BEMO Spitex Burgdorf\"  class=\"choice-3 depth-1\"  >BEMO Spitex Burgdorf<\/option><\/select><div id=\"wpforms-37510-field_2-description\" class=\"wpforms-field-description\">Diese Liste wird automatisch aus den gepflegten Spitex-Standorten bef\u00fcllt (siehe inc\/spitex-anmeldung-form.php).<\/div><\/div><div id=\"wpforms-37510-field_3-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-modern\" data-field-type=\"select\" data-field-id=\"3\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-37510-field_3\">Betrifft Ihre Anfrage eine bestimmte Spitex?<\/label><select id=\"wpforms-37510-field_3\" class=\"wpforms-field-large choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-large\" data-search-enabled=\"\" name=\"wpforms[fields][3]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Bitte w\u00e4hlen (optional)<\/option><option value=\"BEMO Spitex Muri\"  class=\"choice-1 depth-1\"  >BEMO Spitex Muri<\/option><option value=\"BEMO Spitex Rohrbach\"  class=\"choice-2 depth-1\"  >BEMO Spitex Rohrbach<\/option><option value=\"BEMO Spitex Burgdorf\"  class=\"choice-3 depth-1\"  >BEMO Spitex Burgdorf<\/option><option value=\"Betrifft keinen bestimmten Standort\"  class=\"choice-4 depth-1\"  >Betrifft keinen bestimmten Standort<\/option><\/select><div id=\"wpforms-37510-field_3-description\" class=\"wpforms-field-description\">Diese Liste wird automatisch aus den gepflegten Spitex-Standorten bef\u00fcllt (siehe inc\/spitex-anmeldung-form.php).<\/div><\/div><div id=\"wpforms-37510-field_32-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"32\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"1\" data-formid=\"37510\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Weiter<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/espacehealth.ch\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-page-button-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/span><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Speichern und sp\u00e4ter fortsetzen<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-37510-field_5-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"5\"><fieldset><legend class=\"wpforms-field-label\">Melden Sie sich selbst an oder f\u00fcr eine andere Person? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-37510-field_5\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-37510-field_5_1\" name=\"wpforms[fields][5]\" value=\"F\u00fcr mich selbst\" aria-errormessage=\"wpforms-37510-field_5_1-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-37510-field_5_1\">F\u00fcr mich selbst<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-37510-field_5_2\" name=\"wpforms[fields][5]\" value=\"F\u00fcr eine andere Person (z. B. Angeh\u00f6rige\/r, als \u00c4rztin\/Arzt, Spital oder Institution)\" aria-errormessage=\"wpforms-37510-field_5_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-37510-field_5_2\">F\u00fcr eine andere Person (z. B. Angeh\u00f6rige\/r, als \u00c4rztin\/Arzt, Spital oder Institution)<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-37510-field_6-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-3-columns\" data-field-type=\"radio\" data-field-id=\"6\"><fieldset><legend class=\"wpforms-field-label\">Anrede <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-37510-field_6\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-37510-field_6_1\" name=\"wpforms[fields][6]\" value=\"Frau\" aria-errormessage=\"wpforms-37510-field_6_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-37510-field_6_1\">Frau<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-37510-field_6_2\" name=\"wpforms[fields][6]\" value=\"Herr\" aria-errormessage=\"wpforms-37510-field_6_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-37510-field_6_2\">Herr<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-37510-field_6_3\" name=\"wpforms[fields][6]\" value=\"Keine Angabe\" aria-errormessage=\"wpforms-37510-field_6_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-37510-field_6_3\">Keine Angabe<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-37510-field_7-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-37510-field_7\">Vorname <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-37510-field_7\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][7]\" aria-errormessage=\"wpforms-37510-field_7-error\" required><\/div><div id=\"wpforms-37510-field_8-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-37510-field_8\">Nachname <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-37510-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" aria-errormessage=\"wpforms-37510-field_8-error\" required><\/div>\t\t<div id=\"wpforms-37510-field_4-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"4\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-37510-field_4\" >Nachname Sie eine<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-37510-field_4\" class=\"wpforms-field-medium\" name=\"wpforms[fields][4]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-37510-field_9-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"9\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-37510-field_9\">Ihre Funktion \/ Beziehung<\/label><input type=\"text\" id=\"wpforms-37510-field_9\" class=\"wpforms-field-medium\" name=\"wpforms[fields][9]\" placeholder=\"z. B. Tochter, Haus\u00e4rztin, Spitalsozialdienst\" aria-errormessage=\"wpforms-37510-field_9-error\" ><\/div><div id=\"wpforms-37510-field_10-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"10\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-37510-field_10\">Praxis, Spital oder Institution<\/label><input type=\"text\" id=\"wpforms-37510-field_10\" class=\"wpforms-field-medium\" name=\"wpforms[fields][10]\" aria-errormessage=\"wpforms-37510-field_10-error\" ><\/div><div id=\"wpforms-37510-field_11-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-37510-field_11\">Telefonnummer <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-37510-field_11\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][11]\" aria-label=\"Telefonnummer\" aria-errormessage=\"wpforms-37510-field_11-error\" required><\/div><div id=\"wpforms-37510-field_12-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-37510-field_12\">E-Mail-Adresse <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-37510-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" spellcheck=\"false\" aria-errormessage=\"wpforms-37510-field_12-error\" required><\/div><div id=\"wpforms-37510-field_13-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"13\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"2\" data-formid=\"37510\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Zur\u00fcck<\/button><\/span><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"2\" data-formid=\"37510\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Weiter<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/espacehealth.ch\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-page-button-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/span><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Speichern und sp\u00e4ter fortsetzen<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3  \" data-page=\"3\" style=\"display:none;\"><div id=\"wpforms-37510-field_14-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"14\"><div id=\"wpforms-37510-field_14\" aria-errormessage=\"wpforms-37510-field_14-error\"><p>Diese Seite betrifft nur Anmeldungen f\u00fcr eine andere Person. Melden Sie sich f\u00fcr sich selbst an, klicken Sie einfach auf \u00abWeiter\u00bb.<\/p><\/div><\/div><div id=\"wpforms-37510-field_15-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-3-columns wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"radio\" data-field-id=\"15\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Anrede der Klientin\/des Klienten<\/legend><ul id=\"wpforms-37510-field_15\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-37510-field_15_1\" name=\"wpforms[fields][15]\" value=\"Frau\" aria-errormessage=\"wpforms-37510-field_15_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-37510-field_15_1\">Frau<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-37510-field_15_2\" name=\"wpforms[fields][15]\" value=\"Herr\" aria-errormessage=\"wpforms-37510-field_15_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-37510-field_15_2\">Herr<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-37510-field_15_3\" name=\"wpforms[fields][15]\" value=\"Keine Angabe\" aria-errormessage=\"wpforms-37510-field_15_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-37510-field_15_3\">Keine Angabe<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-37510-field_16-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"16\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-37510-field_16\">Vorname der Klientin\/des Klienten<\/label><input type=\"text\" id=\"wpforms-37510-field_16\" class=\"wpforms-field-medium\" name=\"wpforms[fields][16]\" aria-errormessage=\"wpforms-37510-field_16-error\" ><\/div><div id=\"wpforms-37510-field_17-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"17\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-37510-field_17\">Nachname der Klientin\/des Klienten<\/label><input type=\"text\" id=\"wpforms-37510-field_17\" class=\"wpforms-field-medium\" name=\"wpforms[fields][17]\" aria-errormessage=\"wpforms-37510-field_17-error\" ><\/div><div id=\"wpforms-37510-field_18-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"18\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-37510-field_18\">Adresse<\/label><input type=\"text\" id=\"wpforms-37510-field_18\" class=\"wpforms-field-medium\" name=\"wpforms[fields][18]\" aria-errormessage=\"wpforms-37510-field_18-error\" ><\/div><div id=\"wpforms-37510-field_19-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"19\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-37510-field_19\">PLZ<\/label><input type=\"text\" id=\"wpforms-37510-field_19\" class=\"wpforms-field-small\" name=\"wpforms[fields][19]\" aria-errormessage=\"wpforms-37510-field_19-error\" ><\/div><div id=\"wpforms-37510-field_20-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"20\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-37510-field_20\">Ort<\/label><input type=\"text\" id=\"wpforms-37510-field_20\" class=\"wpforms-field-medium\" name=\"wpforms[fields][20]\" aria-errormessage=\"wpforms-37510-field_20-error\" ><\/div><div id=\"wpforms-37510-field_21-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"phone\" data-field-id=\"21\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-37510-field_21\">Telefonnummer (falls abweichend)<\/label><input type=\"tel\" id=\"wpforms-37510-field_21\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][21]\" aria-label=\"Telefonnummer (falls abweichend)\" aria-errormessage=\"wpforms-37510-field_21-error\" ><\/div><div id=\"wpforms-37510-field_22-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"date-time\" data-field-id=\"22\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-37510-field_22\">Geburtsdatum<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-37510-field_22\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][22][date]\" aria-errormessage=\"wpforms-37510-field_22-error\" ><a title=\"Effacer la date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Effacer la date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-37510-field_23-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"23\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"3\" data-formid=\"37510\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Zur\u00fcck<\/button><\/span><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"3\" data-formid=\"37510\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Weiter<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/espacehealth.ch\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-page-button-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/span><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Speichern und sp\u00e4ter fortsetzen<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-4  \" data-page=\"4\" style=\"display:none;\"><div id=\"wpforms-37510-field_24-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"24\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">In welchen Bereichen ben\u00f6tigen Sie Unterst\u00fctzung? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-37510-field_24\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-37510-field_24_1\" name=\"wpforms[fields][24][]\" value=\"Pflege\" aria-errormessage=\"wpforms-37510-field_24_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-37510-field_24_1\">Pflege<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-37510-field_24_2\" name=\"wpforms[fields][24][]\" value=\"Betreuung &amp; Begleitung\" aria-errormessage=\"wpforms-37510-field_24_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-37510-field_24_2\">Betreuung &amp; Begleitung<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-37510-field_24_3\" name=\"wpforms[fields][24][]\" value=\"Haushaltsunterst\u00fctzung\" aria-errormessage=\"wpforms-37510-field_24_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-37510-field_24_3\">Haushaltsunterst\u00fctzung<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-37510-field_24_4\" name=\"wpforms[fields][24][]\" value=\"Nachteins\u00e4tze &amp; Palliative Care\" aria-errormessage=\"wpforms-37510-field_24_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-37510-field_24_4\">Nachteins\u00e4tze &amp; Palliative Care<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-37510-field_24_5\" name=\"wpforms[fields][24][]\" value=\"Anderes\" aria-errormessage=\"wpforms-37510-field_24_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-37510-field_24_5\">Anderes<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-37510-field_25-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"textarea\" data-field-id=\"25\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-37510-field_25\">Beschreiben Sie kurz Ihren Bedarf<\/label><textarea id=\"wpforms-37510-field_25\" class=\"wpforms-field-large\" name=\"wpforms[fields][25]\" aria-errormessage=\"wpforms-37510-field_25-error\" ><\/textarea><\/div><div id=\"wpforms-37510-field_26-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"date-time\" data-field-id=\"26\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-37510-field_26\">Gew\u00fcnschter Termin f\u00fcr den Ersteinsatz (falls bekannt)<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-37510-field_26\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"d.m.Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][26][date]\" aria-errormessage=\"wpforms-37510-field_26-error\" ><a title=\"Effacer la date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Effacer la date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-37510-field_27-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-37510-field_27\">Ihre Nachricht <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-37510-field_27\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][27]\" aria-errormessage=\"wpforms-37510-field_27-error\" required><\/textarea><\/div><div id=\"wpforms-37510-field_34-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"34\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"4\" data-formid=\"37510\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Zur\u00fcck<\/button><\/span><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"4\" data-formid=\"37510\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Weiter<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/espacehealth.ch\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-page-button-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/span><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Speichern und sp\u00e4ter fortsetzen<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-5 last \" data-page=\"5\" style=\"display:none;\"><div id=\"wpforms-37510-field_29-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-type=\"file-upload\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-37510-field_29\">Dokumente hochladen (z. B. \u00e4rztliche Verordnung, Zuweisung, Rezept)<\/label><div\n\t\tclass=\"wpforms-uploader \"\n\t\tdata-field-id=\"29\"\n\t\tdata-form-id=\"37510\"\n\t\tdata-input-name=\"wpforms_37510_29\"\n\t\tdata-extensions=\"pdf,jpg,jpeg,png\"\n\t\tdata-max-size=\"10485760\"\n\t\tdata-max-file-number=\"5\"\n\t\tdata-post-max-size=\"102400000\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg  viewBox=\"0 0 640 640\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M352 173.3L352 384C352 401.7 337.7 416 320 416C302.3 416 288 401.7 288 384L288 173.3L246.6 214.7C234.1 227.2 213.8 227.2 201.3 214.7C188.8 202.2 188.8 181.9 201.3 169.4L297.3 73.4C309.8 60.9 330.1 60.9 342.6 73.4L438.6 169.4C451.1 181.9 451.1 202.2 438.6 214.7C426.1 227.2 405.8 227.2 393.3 214.7L352 173.3zM320 464C364.2 464 400 428.2 400 384L480 384C515.3 384 544 412.7 544 448L544 480C544 515.3 515.3 544 480 544L160 544C124.7 544 96 515.3 96 480L96 448C96 412.7 124.7 384 160 384L240 384C240 428.2 275.8 464 320 464zM464 488C477.3 488 488 477.3 488 464C488 450.7 477.3 440 464 440C450.7 440 440 450.7 440 464C440 477.3 450.7 488 464 488z\"\/>\n\t\t<\/svg>\n\n\t\t<span class=\"modern-title\">\n\t\t\t\t\t\t\tDrag &amp; Drop Files, \t\t\t\t<span>Choose Files to Upload<\/span>\n\t\t\t\t\t<\/span>\n\n\t\t\t\t\t<span class=\"modern-hint\">Vous pouvez t\u00e9l\u00e9verser jusqu\u2019\u00e0 5 fichiers.<\/span>\n\t\t\t<\/div>\n<\/div>\n\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\treadonly\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-37510-field_29\"\n\t\tname=\"wpforms_37510_29\" \t\tvalue=\"\">\n<div id=\"wpforms-37510-field_29-description\" class=\"wpforms-field-description\">Erlaubt: PDF, JPG, PNG. Maximal 3 Dateien, je 10 MB.<\/div><\/div><div id=\"wpforms-37510-field_30-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-3-columns\" data-field-type=\"radio\" data-field-id=\"30\"><fieldset><legend class=\"wpforms-field-label\">W\u00fcnschen Sie eine R\u00fcckmeldung? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-37510-field_30\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-37510-field_30_1\" name=\"wpforms[fields][30]\" value=\"Ja, per E-Mail\" aria-errormessage=\"wpforms-37510-field_30_1-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-37510-field_30_1\">Ja, per E-Mail<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-37510-field_30_2\" name=\"wpforms[fields][30]\" value=\"Ja, telefonisch\" aria-errormessage=\"wpforms-37510-field_30_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-37510-field_30_2\">Ja, telefonisch<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-37510-field_30_3\" name=\"wpforms[fields][30]\" value=\"Nein\" aria-errormessage=\"wpforms-37510-field_30_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-37510-field_30_3\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-37510-field_31-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"31\"><fieldset><legend class=\"wpforms-field-label\">Datenschutz <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-37510-field_31\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-37510-field_31_1\" name=\"wpforms[fields][31][]\" value=\"Ich bin einverstanden, dass meine Angaben zur Bearbeitung meiner Anfrage gem\u00e4ss Datenschutzerkl\u00e4rung verarbeitet werden.\" aria-errormessage=\"wpforms-37510-field_31_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-37510-field_31_1\">Ich bin einverstanden, dass meine Angaben zur Bearbeitung meiner Anfrage gem\u00e4ss Datenschutzerkl\u00e4rung verarbeitet werden.<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-37510-field_28-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"28\"><\/div><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-37510-field_4-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-37510-field_4-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-37510-field_4-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" style=\"display:none;\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"37510\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/espacehealth.ch\/fr\/wp-json\/wp\/v2\/pages\/37512\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-37510\" class=\"wpforms-submit\" data-alt-text=\"Wird gesendet...\" data-submit-text=\"Anfrage absenden\" aria-live=\"assertive\" value=\"wpforms-submit\">Anfrage absenden<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Speichern und sp\u00e4ter fortsetzen<\/span><\/a><\/div><\/form><\/div>  <!-- .wpforms-container -->\n<div class=\"wpforms-save-resume-confirmation\" id=\"wpforms-save-resume-confirmation-37510\" style=\"display: none\">\n\n\t\n\t<div class=\"message\">\n\t\t<p>Dein Formulareintrag wurde gespeichert und es wurde ein eindeutiger Link erstellt, auf den du zugreifen kannst, um dieses Formular fortzusetzen.<\/p>\n<p>Gib deine E-Mail-Adresse ein, um den Link per E-Mail zu erhalten. Alternativ kannst du den Link unten kopieren und speichern.<\/p>\n<p>Bitte beachte, dass dieser Link nicht weitergegeben werden sollte und dass er in 30 Tagen abl\u00e4uft. Danach wird dein Formulareintrag gel\u00f6scht.<\/p>\n\t<\/div>\n\n\t<div class=\"wpforms-save-resume-actions\">\n\t\t\t\t\t<div class=\"wpforms-field\">\n\t\t\t\t<label class=\"wpforms-field-label wpforms-save-resume-label\">\n\t\t\t\t\tCopier le lien\t\t\t\t<\/label>\n\t\t\t\t<div class=\"wpforms-save-resume-shortcode-container\">\n\t\t\t\t\t<input type=\"text\" class=\"wpforms-save-resume-shortcode\" value=\"\" disabled \/>\n\t\t\t\t\t<span class=\"wpforms-save-resume-shortcode-copy\" title=\"Copier le lien pour reprendre dans le presse-papiers\">\n\t\t\t\t\t\t\t<span class=\"copy-icon\"><\/span>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\n\t\t\t\t\t<form class=\"wpforms-validate wpforms-form wpforms-save-resume-email-notification\" method=\"post\" action=\"\/fr\/wp-json\/wp\/v2\/pages\/37512\" data-token=\"57647ce679c33949715007f15db99cdf\">\n\t\t\t\t<div class=\"wpforms-field wpforms-field-email\">\n\t\t\t\t\t<label class=\"wpforms-field-label wpforms-save-resume-label\">\n\t\t\t\t\t\tE-mail\t\t\t\t\t\t<span class=\"wpforms-required-label\">*<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t\t\t<input type=\"email\" name=\"wpforms[save_resume_email]\" required>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"wpforms-submit-container\">\n\t\t\t\t\t<input type=\"hidden\" id=\"_wpnonce\" name=\"_wpnonce\" value=\"f6cd985987\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/fr\/wp-json\/wp\/v2\/pages\/37512\" \/>\t\t\t\t\t<input type=\"hidden\" name=\"wpforms[form_id]\" value=\"37510\">\n\t\t\t\t\t<input type=\"hidden\" name=\"wpforms[resume_hash]\" class=\"wpforms-save-resume-resume-hash\" value=\"\">\n\t\t\t\t\t<button type=\"submit\" name=\"wpforms[save-resume]\" class=\"wpforms-submit\" value=\"wpforms-submit\" disabled>\n\t\t\t\t\t\tEnvoyer le lien\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/form>\n\t\t\t<\/div>\n<\/div>\n\n\n            <\/div>\r\n            <\/div>\r\n<\/section>\r\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":37361,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_gspb_post_css":"","footnotes":""},"class_list":["post-37512","page","type-page","status-publish","has-post-thumbnail","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/espacehealth.ch\/fr\/wp-json\/wp\/v2\/pages\/37512","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/espacehealth.ch\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/espacehealth.ch\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/espacehealth.ch\/fr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/espacehealth.ch\/fr\/wp-json\/wp\/v2\/comments?post=37512"}],"version-history":[{"count":1,"href":"https:\/\/espacehealth.ch\/fr\/wp-json\/wp\/v2\/pages\/37512\/revisions"}],"predecessor-version":[{"id":37513,"href":"https:\/\/espacehealth.ch\/fr\/wp-json\/wp\/v2\/pages\/37512\/revisions\/37513"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/espacehealth.ch\/fr\/wp-json\/wp\/v2\/media\/37361"}],"wp:attachment":[{"href":"https:\/\/espacehealth.ch\/fr\/wp-json\/wp\/v2\/media?parent=37512"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}