{"id":7058,"date":"2025-09-19T17:07:50","date_gmt":"2025-09-19T15:07:50","guid":{"rendered":"https:\/\/www.pezz.ch\/?page_id=7058"},"modified":"2026-10-03T14:28:02","modified_gmt":"2026-10-03T12:28:02","slug":"ueberweisungsformular","status":"publish","type":"page","link":"https:\/\/www.pezz.ch\/en\/fuer-fachpersonen\/ueberweisungsformular\/","title":{"rendered":"REFERRAL FORM"},"content":{"rendered":"<div class=\"brz brz-root__container brz-reset-all brz-root__container-page\" >\n<section id=\"rODdglC3WEo4_rODdglC3WEo4\" class=\"brz-section brz-css-d-ynf0il brz-css-ww6dg1\">\n<div class=\"brz-section__content brz-section--fullWidth brz-css-d-oh3bvl brz-css-afhxlx\" data-brz-custom-id=\"moZk7EjQ_OsL\">\n<div class=\"brz-bg\">\n<div class=\"brz-bg-image\"><\/div>\n<div class=\"brz-bg-shape brz-bg-shape__bottom\"><\/div>\n<\/div>\n<div class=\"brz-container brz-css-d-x9rvyp brz-css-opnuqk\">\n<div id=\"\" class=\"brz-css-d-1wonu5h brz-css-r-18yxudy brz-css-13jb9hh brz-wrapper\">\n<div class=\"brz-spacer brz-css-d-d4vxpd brz-css-108zjsm\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<section id=\"ueberweisungsformular\" data-brz-id=\"vEM2uF0HC21w_vEM2uF0HC21w\" class=\"brz-section brz-css-d-ynf0il brz-css-1opp98n\">\n<div class=\"brz-section__content brz-section--boxed brz-css-d-oh3bvl brz-css-19gpxh9\" data-brz-custom-id=\"tA1ba50DGr3N\">\n<div class=\"brz-bg\">\n<div class=\"brz-bg-color\"><\/div>\n<\/div>\n<div class=\"brz-container brz-css-d-x9rvyp brz-css-zzre7d\">\n<div id=\"\" class=\"brz-css-d-1wonu5h brz-css-1utaqvr brz-wrapper\">\n<div class=\"brz-wp__breadcrumbs brz-css-d-15grfgd brz-css-1tot0mu\" data-brz-custom-id=\"b4XHtR2qSgn2\">\n<div style=\"min-height:20px\"><\/div>\n<\/div>\n<\/div>\n<div id=\"\" class=\"brz-css-d-1wonu5h brz-css-rwryu9 brz-wrapper\">\n<div class=\"brz-rich-text brz-rich-text__custom brz-css-d-1ehz5mr brz-css-24wzc0\" data-brz-custom-id=\"ayDFHP_rXHYJ\">\n<div data-brz-translate-text=\"1\">\n<h1 class=\"brz-tp-lg-heading1 brz-css-1s508a2\" data-uniq-id=\"s5XWr\" data-generated-css=\"brz-css-nwbuj\"><span class=\"brz-cp-color8\" style=\"color: rgba(var(--brz-global-color8),1);\">\u00dcBERWEISUNGSFORMULAR<\/span><\/h1>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"brz-row__container brz-css-d-w3a52u brz-css-1gn8ran\" data-brz-custom-id=\"uEJLsBYRjDmi\">\n<div class=\"brz-row brz-css-d-1n95ksq brz-css-r-1xc399q brz-css-14ujnsu\">\n<div class=\"brz-columns brz-css-d-j7y22h brz-css-mr84wm\" data-brz-custom-id=\"mG5iN5fEPBLQ\">\n<div class=\"brz-column__items brz-css-d-v5w42e brz-css-16y6qxd\">\n<div id=\"\" class=\"brz-css-d-1wonu5h brz-css-b9xdej brz-wrapper\">\n<div class=\"brz-rich-text brz-rich-text__custom brz-css-d-1ehz5mr brz-css-4ra928\" data-brz-custom-id=\"ja3yUN1J19bs\">\n<div data-brz-translate-text=\"1\">\n<p class=\"brz-tp-lg-paragraph brz-css-1wkli4b\" data-uniq-id=\"jFYZX\" data-generated-css=\"brz-css-1wkli4b\"><span style=\"color: rgba(var(--brz-global-color8),1);\" class=\"brz-cp-color8\">Liebe zuweisende \u00c4rztinnen und \u00c4rzte<\/span><\/p>\n<p class=\"brz-tp-lg-paragraph brz-css-1wkli4b\" data-uniq-id=\"jFYZX\" data-generated-css=\"brz-css-1wkli4b\"><span style=\"color: rgba(var(--brz-global-color8),1);\" class=\"brz-cp-color8\">Bitte verwendet f\u00fcr Eure Zuweisungen das untenstehende Formular. Es kann auch von der MPA anhand der Krankengeschichte ausgef\u00fcllt werden. Die Angaben helfen uns, Dringlichkeit, Zeitbedarf und notwendige Untersuchungen bereits vor dem Termin einzusch\u00e4tzen und das Kind der am besten geeigneten \u00c4rztin oder dem am besten geeigneten Arzt im PEZZ zuzuweisen.<\/span><\/p>\n<p class=\"brz-tp-lg-paragraph brz-css-1wkli4b\" data-uniq-id=\"jFYZX\" data-generated-css=\"brz-css-1wkli4b\"><span style=\"color: rgba(var(--brz-global-color8),1);\" class=\"brz-cp-color8\">Berichte, Wachstumskurven und weitere Unterlagen k\u00f6nnen direkt im Formular hochgeladen werden.&nbsp;<\/span><\/p>\n<p class=\"brz-tp-lg-paragraph brz-css-1wkli4b\" data-uniq-id=\"jFYZX\" data-generated-css=\"brz-css-1wkli4b\"><span style=\"color: rgba(var(--brz-global-color8),1);\" class=\"brz-cp-color8\">Mit herzlichem Dank f\u00fcr Eure Unterst\u00fctzung und besten Gr\u00fcssen<\/span><\/p>\n<p class=\"brz-tp-lg-paragraph brz-css-1wkli4b\" data-uniq-id=\"wR7nn\" data-generated-css=\"brz-css-1wkli4b\"><span style=\"color: rgba(var(--brz-global-color8),1);\" class=\"brz-cp-color8\">Urs Eiholzer<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div id=\"\" class=\"brz-css-d-1wonu5h brz-css-nsenvh brz-wrapper\">\n<div class=\"brz-rich-text brz-rich-text__custom brz-css-d-1ehz5mr brz-css-ibw5yr\" data-brz-custom-id=\"rMwVgI8LUcod\">\n<div data-brz-translate-text=\"1\">\n<p class=\"brz-tp-lg-paragraph brz-css-1wkli4b\" data-generated-css=\"brz-css-1wkli4b\" data-uniq-id=\"eAiVj\"><a class=\"link--upload brz-cp-color5\" style=\"color: rgba(var(--brz-global-color5),1);\" href=\"https:\/\/www.pezz.ch\/wp-content\/uploads\/2025\/09\/Ueberweisungsformular_fuer_Aerzte.pdf\" data-brz-link-type=\"upload\">\u00dcberweisungsformular (pdf)<\/a><\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"brz-row__container brz-css-d-w3a52u brz-css-16euiup\" data-brz-custom-id=\"veS3P2fHHb1o\">\n<div class=\"brz-row brz-css-d-1n95ksq brz-css-r-1xc399q brz-css-1ucz2dd\">\n<div class=\"brz-columns brz-css-d-j7y22h brz-css-1dez5fb\" data-brz-custom-id=\"gCK7m7VawJUb\">\n<div class=\"brz-bg\">\n<div class=\"brz-bg-color\"><\/div>\n<\/div>\n<div class=\"brz-column__items brz-css-d-v5w42e brz-css-xgay11\">\n<div id=\"\" class=\"brz-css-d-1wonu5h brz-css-1wyadsz brz-wrapper\">\n<div class=\"brz-wp-shortcode brz-css-d-19rsjz0 brz-css-hlb0k8\" data-brz-custom-id=\"z_q7kuXwGUXM\">\n<div><div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-12475\"><form id=\"wpforms-form-12475\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"12475\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/en\/wp-json\/wp\/v2\/pages\/7058?wpforms_form_id=12475\" data-token=\"3c504563a31d377a84a700f2f372ef57\" data-token-time=\"1791297187\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\">\t\t<div id=\"wpforms-12475-field_1-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"1\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-12475-field_1\" >Strasse (in (TT.<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-12475-field_1\" class=\"wpforms-field-medium\" name=\"wpforms[fields][1]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-12475-field_7-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"7\"><h3 class=\"wpforms-field-label\">\n\t\t\t\tAngaben zum Kind\/ Patient\n\t\t\t<\/h3><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-12475-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-12475-field_11\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-12475-field_11\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][11]\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-12475-field_73-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"73\"><label class=\"wpforms-field-label\" for=\"wpforms-12475-field_73\">Vorname <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-12475-field_73\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][73]\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-12475-field_8-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-12475-field_8\">Geschlecht <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-12475-field_8\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][8]\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-12475-field_66-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"66\"><label class=\"wpforms-field-label\" for=\"wpforms-12475-field_66\">Geburtsdatum <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-12475-field_66\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][66]\" placeholder=\"TT.MM.JJJJ\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-12475-field_74-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"74\"><label class=\"wpforms-field-label\" for=\"wpforms-12475-field_74\">Eltern<\/label><input type=\"text\" id=\"wpforms-12475-field_74\" class=\"wpforms-field-large\" name=\"wpforms[fields][74]\" ><div class=\"wpforms-field-description\">Mutter oder Vater<\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-12475-field_77-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"77\"><label class=\"wpforms-field-label\" for=\"wpforms-12475-field_77\">Telefon <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-12475-field_77\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][77]\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-12475-field_75-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"75\"><label class=\"wpforms-field-label\" for=\"wpforms-12475-field_75\">Strasse Nr<\/label><input type=\"text\" id=\"wpforms-12475-field_75\" class=\"wpforms-field-large\" name=\"wpforms[fields][75]\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-12475-field_76-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"76\"><label class=\"wpforms-field-label\" for=\"wpforms-12475-field_76\">PLZ Ort<\/label><input type=\"text\" id=\"wpforms-12475-field_76\" class=\"wpforms-field-large\" name=\"wpforms[fields][76]\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-12475-field_78-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"78\"><label class=\"wpforms-field-label\" for=\"wpforms-12475-field_78\">E-Mail<\/label><input type=\"email\" id=\"wpforms-12475-field_78\" class=\"wpforms-field-large\" name=\"wpforms[fields][78]\" spellcheck=\"false\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-12475-field_63-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"63\"><label class=\"wpforms-field-label\" for=\"wpforms-12475-field_63\">Schwangerschaftswoche bei Geburt<\/label><input type=\"text\" id=\"wpforms-12475-field_63\" class=\"wpforms-field-large\" name=\"wpforms[fields][63]\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-12475-field_64-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"64\"><label class=\"wpforms-field-label\" for=\"wpforms-12475-field_64\">Geburtsgewicht (in kg)<\/label><input type=\"text\" id=\"wpforms-12475-field_64\" class=\"wpforms-field-large\" name=\"wpforms[fields][64]\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-12475-field_65-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"65\"><label class=\"wpforms-field-label\" for=\"wpforms-12475-field_65\">Geburtsgr\u00f6sse (in cm)<\/label><input type=\"text\" id=\"wpforms-12475-field_65\" class=\"wpforms-field-large\" name=\"wpforms[fields][65]\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-12475-field_52-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"52\"><label class=\"wpforms-field-label\" for=\"wpforms-12475-field_52\">Gr\u00f6sse der Mutter<\/label><input type=\"text\" id=\"wpforms-12475-field_52\" class=\"wpforms-field-large\" name=\"wpforms[fields][52]\" ><div class=\"wpforms-field-description\">in cm<\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-12475-field_53-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"53\"><label class=\"wpforms-field-label\" for=\"wpforms-12475-field_53\">Gr\u00f6sse des Vaters<\/label><input type=\"text\" id=\"wpforms-12475-field_53\" class=\"wpforms-field-large\" name=\"wpforms[fields][53]\" ><div class=\"wpforms-field-description\">in cm<\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-12475-field_94-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"94\"><label class=\"wpforms-field-label\" for=\"wpforms-12475-field_94\">Krankenkasse<\/label><input type=\"text\" id=\"wpforms-12475-field_94\" class=\"wpforms-field-large\" name=\"wpforms[fields][94]\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-12475-field_80-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"80\"><label class=\"wpforms-field-label\" for=\"wpforms-12475-field_80\">Krankenkassennummer<\/label><input type=\"text\" id=\"wpforms-12475-field_80\" class=\"wpforms-field-large\" name=\"wpforms[fields][80]\" placeholder=\"8075...\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><\/div><\/div><\/div><\/div><div id=\"wpforms-12475-field_67-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"67\"><h3 class=\"wpforms-field-label\">\n\t\t\t\tBisherige Gr\u00f6ssen\u2010 und Gewichtsmessungen Datum (TT. MM. JJJJ), Gr\u00f6sse (in cm), Gewicht (in kg)\n\t\t\t<\/h3><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-12475-field_81-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"81\"><label class=\"wpforms-field-label\" for=\"wpforms-12475-field_81\">Wachstumsdaten <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-12475-field_81\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][81]\" required><\/textarea><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-12475-field_93-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"93\"><label class=\"wpforms-field-label\" for=\"wpforms-12475-field_93\">Kommentar zur \u00dcberweisung<\/label><textarea id=\"wpforms-12475-field_93\" class=\"wpforms-field-large\" name=\"wpforms[fields][93]\" ><\/textarea><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-12475-field_95-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"95\"><label class=\"wpforms-field-label\" for=\"wpforms-12475-field_95\">\u00dcberweisender Arzt<\/label><textarea id=\"wpforms-12475-field_95\" class=\"wpforms-field-large\" name=\"wpforms[fields][95]\" ><\/textarea><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-12475-field_59-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-type=\"file-upload\" data-field-id=\"59\"><label class=\"wpforms-field-label\" for=\"wpforms-12475-field_59\">Handr\u00f6ntgenbild<\/label><div\n\t\tclass=\"wpforms-uploader \"\n\t\tdata-field-id=\"59\"\n\t\tdata-form-id=\"12475\"\n\t\tdata-input-name=\"wpforms_12475_59\"\n\t\tdata-extensions=\"pdf,jpg,jpeg,png,webp\"\n\t\tdata-max-size=\"15728640\"\n\t\tdata-max-file-number=\"3\"\n\t\tdata-post-max-size=\"268435456\"\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\">You can upload up to 3 files.<\/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-12475-field_59\"\n\t\tname=\"wpforms_12475_59\" \t\tvalue=\"\">\n<\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-12475-field_60-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-type=\"file-upload\" data-field-id=\"60\"><label class=\"wpforms-field-label\" for=\"wpforms-12475-field_60\">Wachstumskurve<\/label><div\n\t\tclass=\"wpforms-uploader \"\n\t\tdata-field-id=\"60\"\n\t\tdata-form-id=\"12475\"\n\t\tdata-input-name=\"wpforms_12475_60\"\n\t\tdata-extensions=\"pdf,jpg,jpeg,png,webp\"\n\t\tdata-max-size=\"15728640\"\n\t\tdata-max-file-number=\"3\"\n\t\tdata-post-max-size=\"268435456\"\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; 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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\">You can upload up to 5 files.<\/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-12475-field_62\"\n\t\tname=\"wpforms_12475_62\" \t\tvalue=\"\">\n<\/div><\/div><\/div><\/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-12475-field_1-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-12475-field_1-container input { visibility: hidden; 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Es kann auch von der MPA anhand der Krankengeschichte ausgef\u00fcllt werden. 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