{"id":2517,"date":"2022-10-23T13:10:19","date_gmt":"2022-10-23T13:10:19","guid":{"rendered":"http:\/\/www.camerapil.com\/?page_id=2517"},"modified":"2025-09-28T11:51:50","modified_gmt":"2025-09-28T11:51:50","slug":"digitaal-aanvraagformulier","status":"publish","type":"page","link":"https:\/\/camerapil.com\/index.php\/digitaal-aanvraagformulier\/","title":{"rendered":"Digitaal aanvraagformulier"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2517\" class=\"elementor elementor-2517\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-490282b elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"490282b\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-8694be6\" data-id=\"8694be6\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2366d49 elementor-widget__width-initial elementor-invisible elementor-widget elementor-widget-text-editor\" data-id=\"2366d49\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeIn&quot;,&quot;_animation_delay&quot;:600}\" 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<h1><b>Digitaal aanvraagformulier<\/b><\/h1>\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-99d3d1e elementor-widget elementor-widget-text-editor\" data-id=\"99d3d1e\" 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>Op deze pagina kunt u digitaal de aanvraag voor een videocapsule endoscopieonderzoek indienen. Om u zo goed mogelijk van dienst te zijn, wordt u verzocht alle velden zo compleet mogelijk in te vullen.<\/p><p>Een veilige verwerking van de gegevens wordt gegarandeerd, zie hiervoor ook de <a href=\"https:\/\/camerapil.com\/index.php\/privacy-policy\/\">privacyverklaring<\/a>.<\/p><p>Na het invullen en verzenden van de digitale aanvraag zal een kopie van de aanvraag naar het door u ingevulde e-mailadres verzonden worden.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-035f9fc elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"035f9fc\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-815d89b\" data-id=\"815d89b\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-f41fe64 elementor-widget__width-auto elementor-widget elementor-widget-wpforms\" data-id=\"f41fe64\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"wpforms-container \" id=\"wpforms-2787\"><form id=\"wpforms-form-2787\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"2787\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/2517\" data-token=\"9ad29a4abb899c4a0a25a0a6a1923545\" data-token-time=\"1775250761\"><noscript class=\"wpforms-error-noscript\">Schakel JavaScript in je browser in om dit formulier in te vullen.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-2787-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><label class=\"wpforms-field-label\">Naam pati\u00ebnt <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-2787-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" required><label for=\"wpforms-2787-field_1\" class=\"wpforms-field-sublabel after\">Voornaam<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-2787-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" required><label for=\"wpforms-2787-field_1-last\" class=\"wpforms-field-sublabel after\">Achternaam<\/label><\/div><\/div><\/div><div id=\"wpforms-2787-field_26-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-2787-field_26\">Adres pati\u00ebnt <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2787-field_26\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][26]\" required><\/div><div id=\"wpforms-2787-field_27-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-2787-field_27\">Postcode <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2787-field_27\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][27]\" required><\/div><div id=\"wpforms-2787-field_28-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-2787-field_28\">Woonplaats <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2787-field_28\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][28]\" required><\/div><div id=\"wpforms-2787-field_31-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-2787-field_31\">Geboortedatum pati\u00ebnt <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2787-field_31\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][31]\" required><\/div><div id=\"wpforms-2787-field_3-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-2787-field_3\">Pati\u00ebntnummer <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2787-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" required><\/div><div id=\"wpforms-2787-field_4-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"4\"><label class=\"wpforms-field-label\">Geslacht pati\u00ebnt <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2787-field_4\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2787-field_4_1\" name=\"wpforms[fields][4]\" value=\"vrouw\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2787-field_4_1\">vrouw<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2787-field_4_2\" name=\"wpforms[fields][4]\" value=\"man\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2787-field_4_2\">man<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-2787-field_4_3\" name=\"wpforms[fields][4]\" value=\"anders\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2787-field_4_3\">anders<\/label><\/li><\/ul><\/div><div id=\"wpforms-2787-field_2-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-2787-field_2\">Telefoonnummer pati\u00ebnt <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-2787-field_2\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][2]\" step=\"any\" required><\/div><div id=\"wpforms-2787-field_5-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-2787-field_5\">Telefoonnummer pati\u00ebnt (thuis)<\/label><input type=\"number\" id=\"wpforms-2787-field_5\" class=\"wpforms-field-small\" name=\"wpforms[fields][5]\" step=\"any\" ><\/div><div id=\"wpforms-2787-field_7-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-2787-field_7\">E-mailadres pati\u00ebnt<\/label><input type=\"text\" id=\"wpforms-2787-field_7\" class=\"wpforms-field-medium\" name=\"wpforms[fields][7]\" ><\/div><div id=\"wpforms-2787-field_6-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-2787-field_6\">Telefoonnummer aanvrager<\/label><input type=\"number\" id=\"wpforms-2787-field_6\" class=\"wpforms-field-medium\" name=\"wpforms[fields][6]\" step=\"any\" ><\/div><div id=\"wpforms-2787-field_8-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-2787-field_8\">E-mailadres aanvrager <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2787-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" required><\/div><div id=\"wpforms-2787-field_9-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"9\"><label class=\"wpforms-field-label\">Waar dient het onderzoek plaats te vinden? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2787-field_9\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2787-field_9_1\" name=\"wpforms[fields][9]\" value=\"Bij pati\u00ebnt thuis\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2787-field_9_1\">Bij pati\u00ebnt thuis<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2787-field_9_2\" name=\"wpforms[fields][9]\" value=\"Klinisch\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2787-field_9_2\">Klinisch<\/label><\/li><\/ul><\/div><div id=\"wpforms-2787-field_10-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-2787-field_10\">Indien klinisch, waar is de pati\u00ebnt opgenomen?<\/label><textarea id=\"wpforms-2787-field_10\" class=\"wpforms-field-small\" name=\"wpforms[fields][10]\" ><\/textarea><\/div><div id=\"wpforms-2787-field_32-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"32\"><label class=\"wpforms-field-label\">Indicatie VCE<\/label><ul id=\"wpforms-2787-field_32\"><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2787-field_32_4\" name=\"wpforms[fields][32][]\" value=\"Analyse ijzergebrek\/ occult bloedverlies\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2787-field_32_4\">Analyse ijzergebrek\/ occult bloedverlies<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-2787-field_32_17\" name=\"wpforms[fields][32][]\" value=\"Nadere analyse van afwijking op radiologie-onderzoek\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2787-field_32_17\">Nadere analyse van afwijking op radiologie-onderzoek<\/label><\/li><li class=\"choice-24 depth-1\"><input type=\"checkbox\" id=\"wpforms-2787-field_32_24\" name=\"wpforms[fields][32][]\" value=\"Overt bloeding\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2787-field_32_24\">Overt bloeding<\/label><\/li><li class=\"choice-23 depth-1\"><input type=\"checkbox\" id=\"wpforms-2787-field_32_23\" name=\"wpforms[fields][32][]\" value=\"Analyse chronische diarree\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2787-field_32_23\">Analyse chronische diarree<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-2787-field_32_6\" name=\"wpforms[fields][32][]\" value=\"M. Crohn: verdenking\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2787-field_32_6\">M. Crohn: verdenking<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-2787-field_32_15\" name=\"wpforms[fields][32][]\" value=\"Analyse non-responsieve coeliakie\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2787-field_32_15\">Analyse non-responsieve coeliakie<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-2787-field_32_7\" name=\"wpforms[fields][32][]\" value=\"M. Crohn: follow up\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2787-field_32_7\">M. Crohn: follow up<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-2787-field_32_22\" name=\"wpforms[fields][32][]\" value=\"Follow up poliepen\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2787-field_32_22\">Follow up poliepen<\/label><\/li><li class=\"choice-25 depth-1\"><input type=\"checkbox\" id=\"wpforms-2787-field_32_25\" name=\"wpforms[fields][32][]\" value=\"Rendu-Osler-Weber\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2787-field_32_25\">Rendu-Osler-Weber<\/label><\/li><li class=\"choice-26 depth-1\"><input type=\"checkbox\" id=\"wpforms-2787-field_32_26\" name=\"wpforms[fields][32][]\" value=\"Overige (namelijk):\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2787-field_32_26\">Overige (namelijk):<\/label><\/li><\/ul><\/div><div id=\"wpforms-2787-field_11-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-2787-field_11\">Indicatie overig -toelichting<\/label><textarea id=\"wpforms-2787-field_11\" class=\"wpforms-field-small\" name=\"wpforms[fields][11]\" ><\/textarea><\/div><div id=\"wpforms-2787-field_12-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-2787-field_12\">Relevante voorgeschiedenis<\/label><textarea id=\"wpforms-2787-field_12\" class=\"wpforms-field-small\" name=\"wpforms[fields][12]\" ><\/textarea><div class=\"wpforms-field-description\">Van belang zijn evt.: Diabetespati\u00ebnt, operaties tractus digestivus, cardiologische problematiek (antistolling, pacemaker, interne defibrillator, klepafwijkingen), slik- of passagestoornissen.<\/div><\/div>\t\t<div id=\"wpforms-2787-field_20-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"20\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-2787-field_20\" >Woonplaats de Is<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-2787-field_20\" class=\"wpforms-field-medium\" name=\"wpforms[fields][20]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-2787-field_21-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"21\"><label class=\"wpforms-field-label\">Is er sprake van diabetes?  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2787-field_21\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2787-field_21_1\" name=\"wpforms[fields][21]\" value=\"ja\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2787-field_21_1\">ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2787-field_21_2\" name=\"wpforms[fields][21]\" value=\"nee\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2787-field_21_2\">nee<\/label><\/li><\/ul><\/div><div id=\"wpforms-2787-field_13-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-2787-field_13\">Klinische data<\/label><textarea id=\"wpforms-2787-field_13\" class=\"wpforms-field-small\" name=\"wpforms[fields][13]\" ><\/textarea><\/div><div id=\"wpforms-2787-field_14-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-2787-field_14\">Relevante labuitslagen<\/label><textarea id=\"wpforms-2787-field_14\" class=\"wpforms-field-small\" name=\"wpforms[fields][14]\" ><\/textarea><\/div><div id=\"wpforms-2787-field_15-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-2787-field_15\">Medicatiegebruik<\/label><textarea id=\"wpforms-2787-field_15\" class=\"wpforms-field-small\" name=\"wpforms[fields][15]\" ><\/textarea><div class=\"wpforms-field-description\">Van belang zijn evt.: NSAID (preparaat en frequentie), antistolling, ijzerpreparaten, opiaten, CA-antagonisten, psychofarmaca.<\/div><\/div><div id=\"wpforms-2787-field_22-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"22\"><label class=\"wpforms-field-label\">Gebruikt de pati\u00ebnt ijzerpreparaten (oraal)? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2787-field_22\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2787-field_22_1\" name=\"wpforms[fields][22]\" value=\"Ja\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2787-field_22_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2787-field_22_2\" name=\"wpforms[fields][22]\" value=\"Nee\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2787-field_22_2\">Nee<\/label><\/li><\/ul><\/div><div id=\"wpforms-2787-field_16-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-2787-field_16\">Uitslagen beeldvormend onderzoek<\/label><textarea id=\"wpforms-2787-field_16\" class=\"wpforms-field-small\" name=\"wpforms[fields][16]\" ><\/textarea><div class=\"wpforms-field-description\">Push-entroscopie, duodenumbiopten, coeliakie-serologie, terminaal ileum ge\u00efntubeerd, etc.<\/div><\/div><div id=\"wpforms-2787-field_19-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-3-columns\" data-field-id=\"19\"><label class=\"wpforms-field-label\">Onderzoeksverslag separaat verzonden:<\/label><ul id=\"wpforms-2787-field_19\" class=\"wpforms-randomize\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2787-field_19_1\" name=\"wpforms[fields][19][]\" value=\"Verslag laatste coloscopie\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2787-field_19_1\">Verslag laatste coloscopie<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-2787-field_19_2\" name=\"wpforms[fields][19][]\" value=\"Verslag laatste gastroscopie\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2787-field_19_2\">Verslag laatste gastroscopie<\/label><\/li><\/ul><div class=\"wpforms-field-description\">Bijlage(s) mailen naar:  gerda@camerapil.nl ovv pati\u00ebntgegevens.<\/div><\/div><div id=\"wpforms-2787-field_17-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-2787-field_17\">Opmerkingen:<\/label><textarea id=\"wpforms-2787-field_17\" class=\"wpforms-field-small\" name=\"wpforms[fields][17]\" ><\/textarea><\/div><div id=\"wpforms-2787-field_18-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-3-columns\" data-field-id=\"18\"><label class=\"wpforms-field-label\">Wat is de urgentie van de aanvraag?<\/label><ul id=\"wpforms-2787-field_18\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2787-field_18_1\" name=\"wpforms[fields][18]\" value=\"Spoed\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2787-field_18_1\">Spoed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2787-field_18_2\" name=\"wpforms[fields][18]\" value=\"Binnen 1-3 weken\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2787-field_18_2\">Binnen 1-3 weken<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-2787-field_18_3\" name=\"wpforms[fields][18]\" value=\"Geen spoed, in overleg met pati\u00ebnt\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2787-field_18_3\">Geen spoed, in overleg met pati\u00ebnt<\/label><\/li><\/ul><\/div><div id=\"wpforms-2787-field_23-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-2787-field_23\">Waar moet de uitslag naar verzonden worden? <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2787-field_23\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][23]\" required><div class=\"wpforms-field-description\">Naam en e-mailadres<\/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-2787-field_20-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-2787-field_20-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-2787-field_20-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\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"2787\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/camerapil.com\/index.php\/wp-json\/wp\/v2\/pages\/2517\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-2787\" class=\"wpforms-submit\" data-alt-text=\"Verzenden...\" data-submit-text=\"Verzend\" aria-live=\"assertive\" value=\"wpforms-submit\">Verzend<\/button><img decoding=\"async\" src=\"https:\/\/camerapil.com\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Aan het laden\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Digitaal aanvraagformulier Op deze pagina kunt u digitaal de aanvraag voor een videocapsule endoscopieonderzoek indienen. Om u zo goed mogelijk van dienst te zijn, wordt u verzocht alle velden zo compleet mogelijk in te vullen. Een veilige verwerking van de gegevens wordt gegarandeerd, zie hiervoor ook de privacyverklaring. Na het invullen en verzenden van de [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-2517","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/camerapil.com\/index.php\/wp-json\/wp\/v2\/pages\/2517","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/camerapil.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/camerapil.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/camerapil.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/camerapil.com\/index.php\/wp-json\/wp\/v2\/comments?post=2517"}],"version-history":[{"count":43,"href":"https:\/\/camerapil.com\/index.php\/wp-json\/wp\/v2\/pages\/2517\/revisions"}],"predecessor-version":[{"id":3159,"href":"https:\/\/camerapil.com\/index.php\/wp-json\/wp\/v2\/pages\/2517\/revisions\/3159"}],"wp:attachment":[{"href":"https:\/\/camerapil.com\/index.php\/wp-json\/wp\/v2\/media?parent=2517"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}