{"id":34969,"date":"2024-06-29T13:20:41","date_gmt":"2024-06-29T13:20:41","guid":{"rendered":"https:\/\/theme-dev.cmsmasters.net\/physiozen\/?page_id=34969"},"modified":"2025-09-09T21:57:26","modified_gmt":"2025-09-09T21:57:26","slug":"inschrijven","status":"publish","type":"page","link":"https:\/\/huisartslincolnpark.nl\/index.php\/inschrijven\/","title":{"rendered":"Inschrijven"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"34969\" class=\"elementor elementor-34969\">\n\t\t\t\t<div class=\"elementor-element elementor-element-232757f e-flex e-con-boxed cmsmasters-block-default e-con e-parent\" data-id=\"232757f\" 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-0f6eea5 cmsmasters-block-default cmsmasters-sticky-default elementor-widget elementor-widget-heading\" data-id=\"0f6eea5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Archieven<\/h1>\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-97e634d e-flex e-con-boxed cmsmasters-block-default e-con e-parent\" data-id=\"97e634d\" 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-49ff1cb cmsmasters-block-default cmsmasters-sticky-default elementor-widget elementor-widget-spacer\" data-id=\"49ff1cb\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a6d533a cmsmasters-block-default cmsmasters-sticky-default elementor-widget elementor-widget-cmsmasters-forminator\" data-id=\"a6d533a\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;form_list&quot;:&quot;39928&quot;}\" data-widget_type=\"cmsmasters-forminator.default\">\n\t\t\t\t\t<div class=\"elementor-widget-cmsmasters-contact-form__wrapper elementor-widget-cmsmasters-contact-form cmsmasters-default-color cmsmasters-default-font\" id=\"cmsmasters-widget-form-a6d533a\">\r\n\t\t\t<div class=\"elementor-widget-cmsmasters-contact-form__inner\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-39928 forminator-design--default forminator-custom forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-39928\" data-uid=\"6ad5345aeb17a\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-39928\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-39928 forminator-design--default forminator-custom forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"39928\"\n\t\t\t\t data-color-option=\"default\" data-design=\"default\" data-grid=\"custom\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6ad5345aeb17a\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"Naam\" id=\"forminator-field-name-1_6ad5345aeb17a\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><input type=\"text\" name=\"name-2\" value=\"\" placeholder=\"Alle voornamen\" id=\"forminator-field-name-2_6ad5345aeb17a\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-1\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><input name=\"number-1\" value=\"\" placeholder=\"BSN\" id=\"forminator-field-number-1_6ad5345aeb17a\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"8\" max=\"9\" \/><\/div><\/div><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"Geboortedatum\" id=\"forminator-field-date-1-picker_6ad5345aeb17a\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd-mm-yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"(Mobiel) telefoonnummer\" id=\"forminator-field-phone-1_6ad5345aeb17a\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" 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data-multiple=\"false\"><div id=\"address-1-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><input type=\"text\" name=\"address-1-zip\" placeholder=\"Postcode\" id=\"forminator-field-address-1-zip_6ad5345aeb17a\" class=\"forminator-input\" autocomplete=\"postal-code\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-4\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><input type=\"text\" name=\"name-4\" value=\"\" placeholder=\"Zorgverzekeraar\" id=\"forminator-field-name-4_6ad5345aeb17a\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><div id=\"number-2\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><input name=\"number-2\" value=\"\" placeholder=\"Verzekeringsnumer\" id=\"forminator-field-number-2_6ad5345aeb17a\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"15\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-5\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><input type=\"text\" name=\"name-5\" value=\"\" placeholder=\"Naam vorige huisarts(praktijk) en plaats\" id=\"forminator-field-name-5_6ad5345aeb17a\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-6ad5345aeb17a-label\" aria-describedby=\"forminator-radiogroup-radio-1-6ad5345aeb17a-description\"><span id=\"forminator-radiogroup-radio-1-6ad5345aeb17a-label\" class=\"forminator-label\">Mijngezondheid.net (MGN) <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-6ad5345aeb17a\" class=\"forminator-radio forminator-radio-inline\" title=\"Ja\"><input type=\"radio\" name=\"radio-1\" value=\"one\" id=\"forminator-field-radio-1-1-6ad5345aeb17a\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-1-6ad5345aeb17a-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Ja<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-6ad5345aeb17a\" class=\"forminator-radio forminator-radio-inline\" title=\"Nee\"><input type=\"radio\" name=\"radio-1\" value=\"two\" id=\"forminator-field-radio-1-2-6ad5345aeb17a\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-1-6ad5345aeb17a-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Nee<\/span><\/label><span id=\"forminator-radiogroup-radio-1-6ad5345aeb17a-description\" class=\"forminator-description\">U gaat akkoord dat u via digiD uw eigen medisch dossier online kan inzien, online afspraken kan maken en email consulten kunt sturen.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-6ad5345aeb17a-label\" aria-describedby=\"forminator-radiogroup-radio-2-6ad5345aeb17a-description\"><span id=\"forminator-radiogroup-radio-2-6ad5345aeb17a-label\" class=\"forminator-label\">Mitz <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-6ad5345aeb17a\" class=\"forminator-radio forminator-radio-inline\" title=\"Ja\"><input type=\"radio\" name=\"radio-2\" value=\"one\" id=\"forminator-field-radio-2-1-6ad5345aeb17a\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-2-6ad5345aeb17a-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Ja<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-6ad5345aeb17a\" class=\"forminator-radio forminator-radio-inline\" title=\"Nee\"><input type=\"radio\" name=\"radio-2\" value=\"two\" id=\"forminator-field-radio-2-2-6ad5345aeb17a\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-2-6ad5345aeb17a-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Nee<\/span><\/label><span id=\"forminator-radiogroup-radio-2-6ad5345aeb17a-description\" class=\"forminator-description\">Voor het elektronisch delen van medische gegevens is vaak toestemming van de pati\u00ebnt nodig. 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