{"id":229,"date":"2017-03-08T08:06:47","date_gmt":"2017-03-08T07:06:47","guid":{"rendered":"http:\/\/www.jc.dk\/?page_id=229"},"modified":"2021-09-07T11:36:39","modified_gmt":"2021-09-07T09:36:39","slug":"rodbehandlinger","status":"publish","type":"page","link":"https:\/\/www.tandkvalitet.dk\/index.php\/kontakt-os\/extern-kirurgi\/rodbehandlinger\/","title":{"rendered":"Henvisninger"},"content":{"rendered":"<p>Tandl\u00e6ger kan her oversende informationer vedr\u00f8rende patienter, som skal i behandling hos os med rodbehandling. Udfyld formularen og v\u00e6lg evt. r\u00f8ntgenfotos og andet, som skal vedl\u00e6gges sagen. Nogle af felterne er kr\u00e6vede felter, og skulle du mangle at indtaste i \u00e9t eller flere af disse, s\u00e5 kan formularen ikke sendes. Du m\u00e5 s\u00e5 lige f\u00e5 det sidste fyldt ud og gennemf\u00f8re afsendelsen. Der sendes en kopi til den mailadresse, du indtaster i formularen.<\/p>\n<p>Alle informationer sendes krypteret via vores SSL-forbindelse.<\/p>\n<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-3307\"><form id=\"wpforms-form-3307\" class=\"wpforms-validate wpforms-form\" data-formid=\"3307\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/229?wpforms_form_id=3307\" data-token=\"262dfb0aebc4571d48a8ad0ae91d3b48\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-3307-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-3307-field_12\">CVR Nr. <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3307-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" required><\/div><div id=\"wpforms-3307-field_14-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-3307-field_14\">Patientens fulde navn* <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3307-field_14\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][14]\" required><\/div><div id=\"wpforms-3307-field_5-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-3307-field_5\">Adresse <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3307-field_5\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][5]\" required><\/div><div id=\"wpforms-3307-field_6-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-3307-field_6\">Postnr <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3307-field_6\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][6]\" required><\/div><div id=\"wpforms-3307-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-3307-field_1\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-3307-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" required><\/div><div id=\"wpforms-3307-field_18-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-3307-field_18\">Telefon<\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-two-fifths\"><input type=\"text\" id=\"wpforms-3307-field_18\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][18][first]\" placeholder=\"privat\" ><label for=\"wpforms-3307-field_18\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-fifth\"><input type=\"text\" id=\"wpforms-3307-field_18-middle\" class=\"wpforms-field-name-middle\" name=\"wpforms[fields][18][middle]\" placeholder=\"arbejde\" ><label for=\"wpforms-3307-field_18-middle\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Middle<\/label><\/div><div class=\"wpforms-field-row-block wpforms-two-fifths\"><input type=\"text\" id=\"wpforms-3307-field_18-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][18][last]\" placeholder=\"Mobiltelefon\" ><label for=\"wpforms-3307-field_18-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-3307-field_19-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-3307-field_19\">Patientens diagnose <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-3307-field_19\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][19]\" required><\/textarea><\/div><div id=\"wpforms-3307-field_13-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-3307-field_13\">Angiv <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-3307-field_13\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][13][first]\" placeholder=\"tand\" required><label for=\"wpforms-3307-field_13\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-3307-field_13-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][13][last]\" placeholder=\"Region\" required><label for=\"wpforms-3307-field_13-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-3307-field_21-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-3307-field_21\">F\u00f8lgende behandlinger \u00f8nskes udf\u00f8rt<\/label><ul id=\"wpforms-3307-field_21\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3307-field_21_1\" name=\"wpforms[fields][21][]\" value=\"Implantatbehandling\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3307-field_21_1\">Implantatbehandling<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-3307-field_21_2\" name=\"wpforms[fields][21][]\" value=\"Amotio\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3307-field_21_2\">Amotio<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-3307-field_21_3\" name=\"wpforms[fields][21][]\" value=\"Rodspidsamputation\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3307-field_21_3\">Rodspidsamputation<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-3307-field_21_4\" name=\"wpforms[fields][21][]\" value=\"Kirurgisk behandling\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3307-field_21_4\">Kirurgisk behandling<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-3307-field_21_5\" name=\"wpforms[fields][21][]\" value=\"Endodonti\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3307-field_21_5\">Endodonti<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-3307-field_21_6\" name=\"wpforms[fields][21][]\" value=\"Andet\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3307-field_21_6\">Andet<\/label><\/li><\/ul><\/div><div id=\"wpforms-3307-field_22-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-3307-field_22\">Beskrivelse<\/label><input type=\"text\" id=\"wpforms-3307-field_22\" class=\"wpforms-field-medium\" name=\"wpforms[fields][22]\" placeholder=\"kriv selv en forklarende tekst her....\" ><\/div><div id=\"wpforms-3307-field_23-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-3307-field_23\">Har patienten smerter ? <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-3307-field_23\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][23]\" required=\"required\"><option value=\"Ja, akutte\" >Ja, akutte<\/option><option value=\"Ja, moderate\" >Ja, moderate<\/option><option value=\"Nej\" >Nej<\/option><\/select><\/div><div id=\"wpforms-3307-field_24-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-3-columns\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-3307-field_24\">Indkaldelse<\/label><ul id=\"wpforms-3307-field_24\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3307-field_24_1\" name=\"wpforms[fields][24][]\" value=\"Implantatbehandling\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3307-field_24_1\">Implantatbehandling<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-3307-field_24_2\" name=\"wpforms[fields][24][]\" value=\"Amotio\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3307-field_24_2\">Amotio<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-3307-field_24_3\" name=\"wpforms[fields][24][]\" value=\"Rodspidsamputation\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3307-field_24_3\">Rodspidsamputation<\/label><\/li><\/ul><\/div><div id=\"wpforms-3307-field_25-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-3307-field_25\">Vedh\u00e6ft r\u00f8ntgenbilleder<\/label><div class=\"wpforms-uploader\"\n\tdata-field-id=\"25\"\n\tdata-form-id=\"3307\"\n\tdata-input-name=\"wpforms_3307_25\"\n\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,heif,heics,heifs,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,vtt,mp3,m4a,m4b,aac,ra,ram,wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages\"\n\tdata-max-size=\"268435456\"\n\tdata-max-file-number=\"1\"\n\tdata-post-max-size=\"268435456\"\n    data-max-parallel-uploads=\"4\"\n    data-parallel-uploads=\"true\"\n\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" class=\"\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"#B1B1B1\" aria-hidden=\"true\"><path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path><\/svg>\n\t\t<span class=\"modern-title\">\n\t\t\tClick or drag a file to this area to upload.\t\t<\/span>\n\n\t\t\t<\/div>\n<\/div>\n<input type=\"text\" class=\"dropzone-input\"\n\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\tid=\"wpforms-3307-field_25\"\n\tname=\"wpforms_3307_25\" >\n<\/div><div id=\"wpforms-3307-field_26-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-3307-field_26\">Faktura sendes til<\/label><select id=\"wpforms-3307-field_26\" class=\"wpforms-field-medium\" name=\"wpforms[fields][26]\"><option value=\"V\u00e6lg her\" >V\u00e6lg her<\/option><option value=\"Henvisende tandl\u00e6ge\" >Henvisende tandl\u00e6ge<\/option><option value=\"Patienten selv\" >Patienten selv<\/option><\/select><\/div><div id=\"wpforms-3307-field_28-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"28\"><h3 id=\"wpforms-3307-field_28\" name=\"wpforms[fields][28]\">Henvisende tandl\u00e6ge<\/h3><\/div><div id=\"wpforms-3307-field_27-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-3307-field_27\">Tandl\u00e6gens navn <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3307-field_27\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][27]\" required><\/div><div id=\"wpforms-3307-field_29-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-3307-field_29\">Tandl\u00e6gens adresse <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3307-field_29\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][29]\" required><\/div><div id=\"wpforms-3307-field_30-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"30\"><label class=\"wpforms-field-label\" for=\"wpforms-3307-field_30\">Postnr \/By <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3307-field_30\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][30]\" required><\/div><div id=\"wpforms-3307-field_31-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-3307-field_31\">Klinikkens telefonnummer <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-3307-field_31\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][31]\" required><\/div><div id=\"wpforms-3307-field_32-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"32\"><label class=\"wpforms-field-label\" for=\"wpforms-3307-field_32\">Klinikkens e-mail adresse <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-3307-field_32\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][32]\" required><\/div><div id=\"wpforms-3307-field_33-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-3307-field_33\">Ved offentlig klinik anf\u00f8res EAN nummer<\/label><input type=\"text\" id=\"wpforms-3307-field_33\" class=\"wpforms-field-medium\" name=\"wpforms[fields][33]\" ><\/div><\/div><div class=\"wpforms-recaptcha-container wpforms-is-recaptcha\" ><div class=\"g-recaptcha\" data-sitekey=\"6Lf4ZU4cAAAAAONhuBHBMj8UerbhfvaZc13MbDNP\"><\/div><input type=\"text\" name=\"g-recaptcha-hidden\" class=\"wpforms-recaptcha-hidden\" style=\"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;\" required><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"3307\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"1\"><button type=\"submit\" name=\"wpforms[submit]\" class=\"wpforms-submit \" id=\"wpforms-submit-3307\" value=\"wpforms-submit\" aria-live=\"assertive\" data-alt-text=\"Sending...\" data-submit-text=\"Send informationerne\">Send informationerne<\/button><\/div><\/form><\/div>  <!-- .wpforms-container -->\n","protected":false},"excerpt":{"rendered":"<p>Tandl\u00e6ger kan her oversende informationer vedr\u00f8rende patienter, som skal i behandling hos os med rodbehandling. Udfyld formularen og v\u00e6lg evt. r\u00f8ntgenfotos og andet, som skal vedl\u00e6gges sagen. Nogle af felterne er kr\u00e6vede felter, og skulle du mangle at indtaste i \u00e9t eller flere af disse, s\u00e5 kan formularen ikke sendes. &hellip;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":111,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-229","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.tandkvalitet.dk\/index.php\/wp-json\/wp\/v2\/pages\/229","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.tandkvalitet.dk\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.tandkvalitet.dk\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.tandkvalitet.dk\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.tandkvalitet.dk\/index.php\/wp-json\/wp\/v2\/comments?post=229"}],"version-history":[{"count":7,"href":"https:\/\/www.tandkvalitet.dk\/index.php\/wp-json\/wp\/v2\/pages\/229\/revisions"}],"predecessor-version":[{"id":3312,"href":"https:\/\/www.tandkvalitet.dk\/index.php\/wp-json\/wp\/v2\/pages\/229\/revisions\/3312"}],"up":[{"embeddable":true,"href":"https:\/\/www.tandkvalitet.dk\/index.php\/wp-json\/wp\/v2\/pages\/111"}],"wp:attachment":[{"href":"https:\/\/www.tandkvalitet.dk\/index.php\/wp-json\/wp\/v2\/media?parent=229"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}