{"id":2800,"date":"2021-10-20T11:38:41","date_gmt":"2021-10-20T11:38:41","guid":{"rendered":"https:\/\/support.mrdm.com\/?post_type=account&#038;p=2800"},"modified":"2023-02-21T17:07:32","modified_gmt":"2023-02-21T16:07:32","slug":"account-aanvragen","status":"publish","type":"account","link":"https:\/\/support.mrdm.com\/nl\/account\/ik-wil-een-account\/account-aanvragen\/","title":{"rendered":"Account aanvraagformulier"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f2799-o1\" lang=\"nl-NL\" dir=\"ltr\" data-wpcf7-id=\"2799\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/nl\/wp-json\/wp\/v2\/account\/2800#wpcf7-f2799-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contactformulier\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"2799\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"nl_NL\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f2799-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/><input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:2799,&quot;conditions&quot;:[{&quot;then_field&quot;:&quot;requestor-is-not-contact&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;contactpersoon&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Ik ben geen contactpersoon&quot;}]},{&quot;then_field&quot;:&quot;requestor-is-contact&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;contactpersoon&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Ik ben contactpersoon&quot;}]},{&quot;then_field&quot;:&quot;unknown-contact&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;contactpersoon&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Weet ik niet&quot;}]},{&quot;then_field&quot;:&quot;known-contact&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;contactpersoon&quot;,&quot;operator&quot;:&quot;not equals&quot;,&quot;if_value&quot;:&quot;Weet ik niet&quot;}]},{&quot;then_field&quot;:&quot;deelnemer-1&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-1-naam&quot;,&quot;operator&quot;:&quot;not equals&quot;,&quot;if_value&quot;:&quot;&quot;}]},{&quot;then_field&quot;:&quot;deelnemer-2&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-2-naam&quot;,&quot;operator&quot;:&quot;not equals&quot;,&quot;if_value&quot;:&quot;&quot;}]},{&quot;then_field&quot;:&quot;deelnemer-3&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-3-naam&quot;,&quot;operator&quot;:&quot;not equals&quot;,&quot;if_value&quot;:&quot;&quot;}]},{&quot;then_field&quot;:&quot;deelnemer-4&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-4-naam&quot;,&quot;operator&quot;:&quot;not equals&quot;,&quot;if_value&quot;:&quot;&quot;}]},{&quot;then_field&quot;:&quot;deelnemer-5&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-5-naam&quot;,&quot;operator&quot;:&quot;not equals&quot;,&quot;if_value&quot;:&quot;&quot;}]},{&quot;then_field&quot;:&quot;deelnemer-6&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-6-naam&quot;,&quot;operator&quot;:&quot;not equals&quot;,&quot;if_value&quot;:&quot;&quot;}]},{&quot;then_field&quot;:&quot;deelnemer-7&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-7-naam&quot;,&quot;operator&quot;:&quot;not equals&quot;,&quot;if_value&quot;:&quot;&quot;}]},{&quot;then_field&quot;:&quot;deelnemer-8&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-8-naam&quot;,&quot;operator&quot;:&quot;not equals&quot;,&quot;if_value&quot;:&quot;&quot;}]},{&quot;then_field&quot;:&quot;deelnemer-9&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-9-naam&quot;,&quot;operator&quot;:&quot;not equals&quot;,&quot;if_value&quot;:&quot;&quot;}]},{&quot;then_field&quot;:&quot;deelnemer-10&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-10-naam&quot;,&quot;operator&quot;:&quot;not equals&quot;,&quot;if_value&quot;:&quot;&quot;}]},{&quot;then_field&quot;:&quot;group-dn-1-functie-anders&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-1-functie&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Anders&quot;}]},{&quot;then_field&quot;:&quot;group-dn-2-functie-anders&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-2-functie&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Anders&quot;}]},{&quot;then_field&quot;:&quot;group-dn-3-functie-anders&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-3-functie&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Anders&quot;}]},{&quot;then_field&quot;:&quot;group-dn-4-functie-anders&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-4-functie&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Anders&quot;}]},{&quot;then_field&quot;:&quot;group-dn-5-functie-anders&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-5-functie&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Anders&quot;}]},{&quot;then_field&quot;:&quot;group-dn-6-functie-anders&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-6-functie&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Anders&quot;}]},{&quot;then_field&quot;:&quot;group-dn-7-functie-anders&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-7-functie&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Anders&quot;}]},{&quot;then_field&quot;:&quot;group-dn-8-functie-anders&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-8-functie&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Anders&quot;}]},{&quot;then_field&quot;:&quot;group-dn-9-functie-anders&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-9-functie&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Anders&quot;}]},{&quot;then_field&quot;:&quot;group-dn-10-functie-anders&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-10-functie&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Anders&quot;}]},{&quot;then_field&quot;:&quot;dn-1-codman&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-1-type-codman&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Codman&quot;}]},{&quot;then_field&quot;:&quot;dn-2-codman&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-2-type-codman&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Codman&quot;}]},{&quot;then_field&quot;:&quot;dn-3-codman&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-3-type-codman&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Codman&quot;}]},{&quot;then_field&quot;:&quot;dn-4-codman&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-4-type-codman&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Codman&quot;}]},{&quot;then_field&quot;:&quot;dn-5-codman&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-5-type-codman&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Codman&quot;}]},{&quot;then_field&quot;:&quot;dn-6-codman&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-6-type-codman&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Codman&quot;}]},{&quot;then_field&quot;:&quot;dn-7-codman&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-7-type-codman&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Codman&quot;}]},{&quot;then_field&quot;:&quot;dn-8-codman&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-8-type-codman&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Codman&quot;}]},{&quot;then_field&quot;:&quot;dn-9-codman&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-9-type-codman&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Codman&quot;}]},{&quot;then_field&quot;:&quot;dn-10-codman&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dn-10-type-codman&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Codman&quot;}]},{&quot;then_field&quot;:&quot;chirurg&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;registratie&quot;,&quot;operator&quot;:&quot;equals (regex)&quot;,&quot;if_value&quot;:&quot;dbir&quot;}]},{&quot;then_field&quot;:&quot;chirurg-gegevens&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;chirurg-toevoegen&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Ja&quot;}]},{&quot;then_field&quot;:&quot;diz&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;registratie&quot;,&quot;operator&quot;:&quot;equals (regex)&quot;,&quot;if_value&quot;:&quot;dasa&quot;}]}],&quot;settings&quot;:{&quot;animation&quot;:&quot;no&quot;,&quot;animation_intime&quot;:&quot;200&quot;,&quot;animation_outtime&quot;:&quot;200&quot;,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:&quot;&quot;,&quot;notice_dismissed_rollback-cf7-5.5.6&quot;:true,&quot;notice_dismissed_rollback-cf7-5.6&quot;:true,&quot;notice_dismissed_rollback-cf7-5.6.4&quot;:true,&quot;notice_dismissed_rollback-cf7-5.7.4&quot;:true,&quot;notice_dismissed_rollback-cf7-5.8.6&quot;:true,&quot;notice_dismissed_rollback-cf7-5.9.7&quot;:true}}\" \/>\n<\/fieldset>\n<div class=\"block\">\n<div class=\"inner\">\n\n  <h4>Registratie(s)<\/h4>\n  <div class=\"field checkbox dropdown horizontal\">\n    <label>Voor welke registratie(s) wilt u een account aanvragen?<\/label>\n    <div class=\"checkbox-dropdown-field\">Selecteer een registratie(s)<\/div>\n    <div class=\"checkbox-dropdown-options\"><span class=\"wpcf7-form-control-wrap\" data-name=\"registratie\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,codman,integrations,amsm,swab\" \/><span class=\"wpcf7-list-item-label\">AMSM (Antimicrobial stewardship)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,downloads,batch,born,vsbn\" \/><span class=\"wpcf7-list-item-label\">BORN (Brandwonden)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,transparency,integrations,codman,data-verification,medical-questions,daci,dica\" \/><span class=\"wpcf7-list-item-label\">DACI (halsslagader interventies)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,transparency,codman,medical-questions,dasa,dica\" \/><span class=\"wpcf7-list-item-label\">DASA (beroertezorg)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,transparency,integrations,codman,proms,data-verification,medical-questions,dato,dica\" \/><span class=\"wpcf7-list-item-label\">DATO (obesitas)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,transparency,codman,data-verification,dbir,dica\" \/><span class=\"wpcf7-list-item-label\">DBIR (borstimplantaten)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,downloads,batch,data-verification,dbir-suppliers,dica\" \/><span class=\"wpcf7-list-item-label\">DBIR-Suppliers<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,transparency,integrations,codman,proms,data-verification,medical-questions,dcra,dica\" \/><span class=\"wpcf7-list-item-label\">DCRA (darmkanker)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,integrations,data-verification,medical-questions,dcra-r,dica\" \/><span class=\"wpcf7-list-item-label\">DCRA-R<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,downloads,codman,self-service-portal,integrations,dgda,dica\" \/><span class=\"wpcf7-list-item-label\">DGDA (galsteenlijden)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,downloads,batch,codman,integrations,data-verification,medical-questions,dgea,dica\" \/><span class=\"wpcf7-list-item-label\">DGEA (kijkonderzoek maag\/darm\/lever)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,transparency,codman,proms,data-verification,medical-questions,integrations,dgoa,dica\" \/><span class=\"wpcf7-list-item-label\">DGOA (gynaecologische oncologie)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,data-verification,medical-questions,dgoa-r,dica\" \/><span class=\"wpcf7-list-item-label\">DGOA-R<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,transparency,integrations,codman,data-verification,dhba,dica\" \/><span class=\"wpcf7-list-item-label\">DHBA (lever- en galwegen)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,transparency,integrations,codman,proms,data-verification,medical-questions,dhfa,dica\" \/><span class=\"wpcf7-list-item-label\">DHFA (heupfractuur)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,transparency,codman,proms,data-verification,medical-questions,integrations,dhna,dica\" \/><span class=\"wpcf7-list-item-label\">DHNA (hoofd-hals oncologie)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,downloads,integrations,diha,dica\" \/><span class=\"wpcf7-list-item-label\">DIHA (liesbreuk)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,transparency,codman,data-verification,medical-questions,integrations,dlca-l,dica\" \/><span class=\"wpcf7-list-item-label\">DLCA-L<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,transparency,integrations,codman,data-verification,medical-questions,dlca-r,dica\" \/><span class=\"wpcf7-list-item-label\">DLCA-R<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,downloads,dataentry,batch,transparency,codman,data-verification,self-service-portal,integrations,dlca-s,dica\" \/><span class=\"wpcf7-list-item-label\">DLCA-S<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,codman,batch,integrations,medical-questions,dma,dica\" \/><span class=\"wpcf7-list-item-label\">DMA (geneesmiddelen)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,transparency,codman,proms,data-verification,medical-questions,integrations,dmtr,dica\" \/><span class=\"wpcf7-list-item-label\">DMTR (melanoom)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,codman,proms,data-verification,medical-questions,integrations,dnma,dica\" \/><span class=\"wpcf7-list-item-label\">DNMA (neuromodulatie)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,downloads,dataentry,batch,integrations,dpa,dica\" \/><span class=\"wpcf7-list-item-label\">DPA (prostaatkanker)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,data-verification,integrations,dpaa,dica\" \/><span class=\"wpcf7-list-item-label\">DPAA (perioperatieve anesthesiologie)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,batch,transparency,codman,integrations,data-verification,medical-questions,dpard,dica\" \/><span class=\"wpcf7-list-item-label\">DPARD (diabetes)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,transparency,codman,data-verification,medical-questions,integrations,dpca,dica\" \/><span class=\"wpcf7-list-item-label\">DPCA (alvleesklierkanker)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,batch,codman,proms,data-verification,integrations,dppa,dica\" \/><span class=\"wpcf7-list-item-label\">DPPA (pijn en palliatieve zorg)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,batch,codman,draim,niv\" \/><span class=\"wpcf7-list-item-label\">DRAIM (Acute interne geneeskunde)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,codman,data-verification,drce,dica\" \/><span class=\"wpcf7-list-item-label\">DRCE (complicaties kijkonderzoek)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,transparency,integrations,codman,data-verification,medical-questions,dsaa,dica\" \/><span class=\"wpcf7-list-item-label\">DSAA (aorta interventies)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,transparency,integrations,codman,proms,data-verification,medical-questions,duca,dica\" \/><span class=\"wpcf7-list-item-label\">DUCA (maag- en slokdarmkanker)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,self-service-portal,downloads,dataentry,medical-questions,ehr,sein\" \/><span class=\"wpcf7-list-item-label\">EHR (European Hypersomnolence Registry)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,codman,data-verification,epsa,dica\" \/><span class=\"wpcf7-list-item-label\">EPSA (kinderchirurgie)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,downloads,dataentry,batch,hemoned\" \/><span class=\"wpcf7-list-item-label\">HemoNED (Hemofilie)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,transparency,integrations,codman,proms,data-verification,medical-questions,nbca,dica\" \/><span class=\"wpcf7-list-item-label\">NBCA (borstkanker)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,codman,dataentry,batch,integrations,data-verification,medical-questions,data-exports,nbca-r,dica\" \/><span class=\"wpcf7-list-item-label\">NBCA-R<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,downloads,batch,dataentry,nbr-r3,vsbn\" \/><span class=\"wpcf7-list-item-label\">NBR-R3 (Brandwonden)<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"registratie[]\" value=\"sign-up,account,self-service-portal,batch,downloads,dataentry,codman,pice\" \/><span class=\"wpcf7-list-item-label\">PICE (Pediatrische Intensive Care)<\/span><\/label><\/span><\/span><\/span><\/div>\n    <div class=\"checkbox-dropdown-overlay\"><\/div>\n  <\/div>\n\n<div data-id=\"diz\" data-orig_data_id=\"diz\"  class=\"\" data-class=\"wpcf7cf_group\"><p>Wanneer u zich aanmeld voor de DASA registratie meldt u zich ook automatisch aan voor DIZ \"DICA Informatie op Ziekenhuisniveau\", hier moeten een aantal vragen worden beantwoord op ziekenhuisniveau gerelateerd aan de DASA registratie.<\/p><\/div>\n\n<\/div>\n<\/div>\n\n<!-- Aanvrager -->\n<div class=\"block\">\n<div class=\"inner\">\n\n  <h4>Uw gegevens<\/h4>\n\n  <div class=\"field\">\n    <label>Uw naam<\/label>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"aanvragen-naam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Naam\" value=\"\" type=\"text\" name=\"aanvragen-naam\" \/><\/span>\n  <\/div>\n\n  <div class=\"field\">\n    <label>Uw e-mailadres<\/label>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"aanvrager-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email light\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"E-mailadres\" value=\"\" type=\"email\" name=\"aanvrager-email\" \/><\/span>\n  <\/div>\n\n<\/div>\n<\/div>\n<!-- Aanvrager -->\n\n\n<!-- Contactpersoon -->\n<div class=\"block\">\n<div class=\"inner\">\n\n  <h4>Contactpersoon<\/h4>\n  <p>Voor elke registratie heeft een organisatie een contactpersoon. De contactpersoon kan een account aanvragen voor andere gebruikers.<\/p>\n\n  <div class=\"field radio horizontal\">\n    <label>Contactpersoon<\/label>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"contactpersoon\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"contactpersoon\" value=\"Ik ben contactpersoon\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Ik ben contactpersoon<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"contactpersoon\" value=\"Ik ben geen contactpersoon\" \/><span class=\"wpcf7-list-item-label\">Ik ben geen contactpersoon<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"contactpersoon\" value=\"Weet ik niet\" \/><span class=\"wpcf7-list-item-label\">Weet ik niet<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n<div data-id=\"requestor-is-not-contact\" data-orig_data_id=\"requestor-is-not-contact\"  class=\"\" data-class=\"wpcf7cf_group\">\n  <div class=\"field\">\n    <label>Naam contactpersoon *<\/label>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"contactpersoon-naam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Naam\" value=\"\" type=\"text\" name=\"contactpersoon-naam\" \/><\/span>\n  <\/div>\n\n  <div class=\"field\">\n    <label>E-mailadres contactpersoon *<\/label>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"contactpersoon-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email light\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"E-mailadres\" value=\"\" type=\"email\" name=\"contactpersoon-email\" \/><\/span>\n  <\/div>\n<\/div>\n<div data-id=\"requestor-is-contact\" data-orig_data_id=\"requestor-is-contact\"  class=\"\" data-class=\"wpcf7cf_group\"><\/div>\n<div data-id=\"unknown-contact\" data-orig_data_id=\"unknown-contact\"  class=\"\" data-class=\"wpcf7cf_group\">\n<p>Weet u niet wie de contactpersoon is van de door u geselecteerde registratie neem dan contact op met de servicedesk: <a href=\"mailto:servicedesk@mrdm.nl\">servicedesk@mrdm.nl<\/a><\/p>\n<\/div>\n<\/div>\n<\/div>\n<!-- Contactpersoon -->\n\n\n<div data-id=\"known-contact\" data-orig_data_id=\"known-contact\"  class=\"\" data-class=\"wpcf7cf_group\">\n<!-- Organisatie -->\n<div class=\"block\">\n<div class=\"inner\">\n\n  <h4>Organisatie<\/h4>\n\n  <div class=\"field\">\n  <label>Uw instelling *<br \/>(Indien er meerdere locaties zijn, graag erbij vermelden voor welke locatie)<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"instelling\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Uw instelling\" value=\"\" type=\"text\" name=\"instelling\" \/><\/span>\n  <\/div>\n\n  <div class=\"field col-2\">\n  <label>Straatnaam<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"straatnaam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Straatnaam\" value=\"\" type=\"text\" name=\"straatnaam\" \/><\/span>\n  <\/div>\n\n  <div class=\"field col-2 last\">\n  <label>Nummer<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"nummer\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Nummer\" value=\"\" type=\"text\" name=\"nummer\" \/><\/span>\n  <\/div>\n\n  <div class=\"field col-2\">\n  <label>Postcode<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"postcode\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Postcode\" value=\"\" type=\"text\" name=\"postcode\" \/><\/span>\n  <\/div>\n\n  <div class=\"field col-2 last\">\n  <label>Plaats<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"plaats\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Plaats\" value=\"\" type=\"text\" name=\"plaats\" \/><\/span>\n  <\/div>\n\n  <div class=\"field\">\n  <label>AGB-code<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"agb-code\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"AGB-code\" value=\"\" type=\"text\" name=\"agb-code\" \/><\/span>\n  <\/div>\n\n<\/div>\n<\/div>\n<!-- Organisatie -->\n\n\n<!-- Deelnemers -->\n\n<div class=\"block\">\n<div class=\"inner\">\n\n  <h4>Deelnemers<\/h4>\n  <p>Voeg hier de deelnemers toe waarvoor u een account wilt aanvragen.<\/p>\n\n<\/div>\n\n<!-- Deelnemer 1 start -->\n<div data-id=\"deelnemer-1\" data-orig_data_id=\"deelnemer-1\"  class=\"\" data-class=\"wpcf7cf_group\"><\/div>\n<div class=\"inner block\">\n\n  <div class=\"field col-2\">\n  <label>Voornaam *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-1-naam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Voornaam\/voorletters\" value=\"\" type=\"text\" name=\"dn-1-naam\" \/><\/span>\n  <\/div>\n\n<div class=\"field col-2 last\">\n  <label>Achternaam *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-1-achternaam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Achternaam\" value=\"\" type=\"text\" name=\"dn-1-achternaam\" \/><\/span>\n  <\/div>\n\n<div class=\"field radio horizontal\">\n  <label>Man\/Vrouw<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-1-man-vrouw\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"dn-1-man-vrouw\" value=\"Man\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Man<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"dn-1-man-vrouw\" value=\"Vrouw\" \/><span class=\"wpcf7-list-item-label\">Vrouw<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"dn-1-man-vrouw\" value=\"Neutraal\" \/><span class=\"wpcf7-list-item-label\">Neutraal<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n  <div class=\"field\">\n  <label>Functie *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-1-functie\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"dn-1-functie\"><option value=\"Analist\">Analist<\/option><option value=\"Arts\">Arts<\/option><option value=\"Kwaliteitsmedewerker\">Kwaliteitsmedewerker<\/option><option value=\"Management\">Management<\/option><option value=\"Ondersteunend\">Ondersteunend<\/option><option value=\"Paramedisch\">Paramedisch<\/option><option value=\"Verpleeger\">Verpleeger<\/option><option value=\"Anders\">Anders<\/option><\/select><\/span>\n  <div data-id=\"group-dn-1-functie-anders\" data-orig_data_id=\"group-dn-1-functie-anders\"  class=\"\" data-class=\"wpcf7cf_group\"><span class=\"wpcf7-form-control-wrap\" data-name=\"dn-1-functie-anders\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Functie\" value=\"\" type=\"text\" name=\"dn-1-functie-anders\" \/><\/span><\/div>\n  <\/div>\n\n\n  <div class=\"field col-2\">\n  <label>Telefoonnummer *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-1-telefoon\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Telefoonnummer\" value=\"\" type=\"text\" name=\"dn-1-telefoon\" \/><\/span>\n  <\/div>\n\n<div class=\"field col-2 last\">\n  <label>E-mailadres *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-1-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"E-mailadres\" value=\"\" type=\"text\" name=\"dn-1-email\" \/><\/span>\n  <\/div>\n\n<div class=\"field checkbox horizontal\">\n  <label>Account voor<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-1-type-dataentry\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-dataentry\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-1-type-dataentry[]\" value=\"DataEntry\" \/><span class=\"wpcf7-list-item-label\">DataEntry<\/span><\/label><\/span><\/span><\/span>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-1-type-batch\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-batch\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-1-type-batch[]\" value=\"Data Connect (Batch)\" \/><span class=\"wpcf7-list-item-label\">Data Connect (Batch)<\/span><\/label><\/span><\/span><\/span>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-1-type-codman\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-codman\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-1-type-codman[]\" value=\"Codman\" \/><span class=\"wpcf7-list-item-label\">Codman<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n<div data-id=\"dn-1-codman\" data-orig_data_id=\"dn-1-codman\"  class=\"\" data-class=\"wpcf7cf_group\">\n<div class=\"field checkbox horizontal\">\n  <label>Pati\u00ebnt inzage in Codman<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-1-codman-inzage\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-1-codman-inzage[]\" value=\"Volledige pati\u00ebnten inzage\" \/><span class=\"wpcf7-list-item-label\">Volledige pati\u00ebnten inzage<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n<\/div>\n\n\n <div class=\"field checkbox horizontal\">\n  <label>Contactpersoon<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-1-contactpersoon\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-1-contactpersoon[]\" value=\"Aanmelden als contactpersoon\" \/><span class=\"wpcf7-list-item-label\">Aanmelden als contactpersoon<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n\n<\/div><!-- Deelnemer 1 end -->\n\n\n\n\n<!-- Deelnemer 2 start -->\n<div data-id=\"deelnemer-2\" data-orig_data_id=\"deelnemer-2\"  class=\"\" data-class=\"wpcf7cf_group\"><\/div>\n<div class=\"inner block hidden\">\n\n  <div class=\"field col-2\">\n  <label>Voornaam *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-2-naam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Voornaam\/voorletters\" value=\"\" type=\"text\" name=\"dn-2-naam\" \/><\/span>\n  <\/div>\n\n<div class=\"field col-2 last\">\n  <label>Achternaam *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-2-achternaam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Achternaam\" value=\"\" type=\"text\" name=\"dn-2-achternaam\" \/><\/span>\n  <\/div>\n\n<div class=\"field radio horizontal\">\n  <label>Man\/Vrouw<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-2-man-vrouw\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"dn-2-man-vrouw\" value=\"Man\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Man<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"dn-2-man-vrouw\" value=\"Vrouw\" \/><span class=\"wpcf7-list-item-label\">Vrouw<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"dn-2-man-vrouw\" value=\"Neutraal\" \/><span class=\"wpcf7-list-item-label\">Neutraal<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n  <div class=\"field\">\n  <label>Functie *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-2-functie\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"dn-2-functie\"><option value=\"Analist\">Analist<\/option><option value=\"Arts\">Arts<\/option><option value=\"Kwaliteitsmedewerker\">Kwaliteitsmedewerker<\/option><option value=\"Management\">Management<\/option><option value=\"Ondersteunend\">Ondersteunend<\/option><option value=\"Paramedisch\">Paramedisch<\/option><option value=\"Verpleger\">Verpleger<\/option><option value=\"Anders\">Anders<\/option><\/select><\/span>\n  <div data-id=\"group-dn-2-functie-anders\" data-orig_data_id=\"group-dn-2-functie-anders\"  class=\"\" data-class=\"wpcf7cf_group\"><span class=\"wpcf7-form-control-wrap\" data-name=\"dn-2-functie-anders\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Functie\" value=\"\" type=\"text\" name=\"dn-2-functie-anders\" \/><\/span><\/div>\n  <\/div>\n\n  <div class=\"field col-2\">\n  <label>Telefoonnummer *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-2-telefoon\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Telefoonnummer\" value=\"\" type=\"text\" name=\"dn-2-telefoon\" \/><\/span>\n  <\/div>\n\n<div class=\"field col-2 last\">\n  <label>E-mailadres *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-2-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"E-mailadres\" value=\"\" type=\"text\" name=\"dn-2-email\" \/><\/span>\n  <\/div>\n\n<div class=\"field checkbox horizontal\">\n  <label>Account voor<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-2-type-dataentry\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-dataentry\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-2-type-dataentry[]\" value=\"DataEntry\" \/><span class=\"wpcf7-list-item-label\">DataEntry<\/span><\/label><\/span><\/span><\/span>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-2-type-batch\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-batch\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-2-type-batch[]\" value=\"Data Connect (Batch)\" \/><span class=\"wpcf7-list-item-label\">Data Connect (Batch)<\/span><\/label><\/span><\/span><\/span>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-2-type-codman\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-codman\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-2-type-codman[]\" value=\"Codman\" \/><span class=\"wpcf7-list-item-label\">Codman<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n  <div data-id=\"dn-2-codman\" data-orig_data_id=\"dn-2-codman\"  class=\"\" data-class=\"wpcf7cf_group\">\n  <div class=\"field checkbox horizontal\">\n    <label>Pati\u00ebnt inzage in Codman<\/label>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-2-codman-inzage\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-2-codman-inzage[]\" value=\"Volledige pati\u00ebnten inzage\" \/><span class=\"wpcf7-list-item-label\">Volledige pati\u00ebnten inzage<\/span><\/label><\/span><\/span><\/span>\n    <\/div>\n  <\/div>\n\n\n <div class=\"field checkbox horizontal\">\n  <label>Contactpersoon<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-2-contactpersoon\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-2-contactpersoon[]\" value=\"Aanmelden als contactpersoon\" \/><span class=\"wpcf7-list-item-label\">Aanmelden als contactpersoon<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n<\/div><!-- Deelnemer 2 end -->\n\n\n\n<!-- Deelnemer 3 start -->\n<div data-id=\"deelnemer-3\" data-orig_data_id=\"deelnemer-3\"  class=\"\" data-class=\"wpcf7cf_group\"><\/div>\n<div class=\"inner block hidden\">\n\n  <div class=\"field col-2\">\n  <label>Voornaam *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-3-naam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Voornaam\/voorletters\" value=\"\" type=\"text\" name=\"dn-3-naam\" \/><\/span>\n  <\/div>\n\n<div class=\"field col-2 last\">\n  <label>Achternaam *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-3-achternaam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Achternaam\" value=\"\" type=\"text\" name=\"dn-3-achternaam\" \/><\/span>\n  <\/div>\n\n<div class=\"field radio horizontal\">\n  <label>Man\/Vrouw<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-3-man-vrouw\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"dn-3-man-vrouw\" value=\"Man\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Man<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"dn-3-man-vrouw\" value=\"Vrouw\" \/><span class=\"wpcf7-list-item-label\">Vrouw<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"dn-3-man-vrouw\" value=\"Neutraal\" \/><span class=\"wpcf7-list-item-label\">Neutraal<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n  <div class=\"field\">\n  <label>Functie *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-3-functie\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"dn-3-functie\"><option value=\"Analist\">Analist<\/option><option value=\"Arts\">Arts<\/option><option value=\"Kwaliteitsmedewerker\">Kwaliteitsmedewerker<\/option><option value=\"Management\">Management<\/option><option value=\"Ondersteunend\">Ondersteunend<\/option><option value=\"Paramedisch\">Paramedisch<\/option><option value=\"Verpleeger\">Verpleeger<\/option><option value=\"Anders\">Anders<\/option><\/select><\/span>\n  <div data-id=\"group-dn-3-functie-anders\" data-orig_data_id=\"group-dn-3-functie-anders\"  class=\"\" data-class=\"wpcf7cf_group\"><span class=\"wpcf7-form-control-wrap\" data-name=\"dn-3-functie-anders\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Functie\" value=\"\" type=\"text\" name=\"dn-3-functie-anders\" \/><\/span><\/div>\n  <\/div>\n\n  <div class=\"field col-2\">\n  <label>Telefoonnummer *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-3-telefoon\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Telefoonnummer\" value=\"\" type=\"text\" name=\"dn-3-telefoon\" \/><\/span>\n  <\/div>\n\n<div class=\"field col-2 last\">\n  <label>E-mailadres *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-3-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"E-mailadres\" value=\"\" type=\"text\" name=\"dn-3-email\" \/><\/span>\n  <\/div>\n\n<div class=\"field checkbox horizontal\">\n  <label>Account voor<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-3-type-dataentry\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-dataentry\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-3-type-dataentry[]\" value=\"Dataentry\" \/><span class=\"wpcf7-list-item-label\">Dataentry<\/span><\/label><\/span><\/span><\/span>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-3-type-batch\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-batch\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-3-type-batch[]\" value=\"Data Connect (Batch)\" \/><span class=\"wpcf7-list-item-label\">Data Connect (Batch)<\/span><\/label><\/span><\/span><\/span>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-3-type-codman\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-codman\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-3-type-codman[]\" value=\"Codman\" \/><span class=\"wpcf7-list-item-label\">Codman<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n  <div data-id=\"dn-3-codman\" data-orig_data_id=\"dn-3-codman\"  class=\"\" data-class=\"wpcf7cf_group\">\n  <div class=\"field checkbox horizontal\">\n    <label>Pati\u00ebnt inzage in Codman<\/label>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-3-codman-inzage\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-3-codman-inzage[]\" value=\"Volledige pati\u00ebnten inzage\" \/><span class=\"wpcf7-list-item-label\">Volledige pati\u00ebnten inzage<\/span><\/label><\/span><\/span><\/span>\n    <\/div>\n  <\/div>\n\n <div class=\"field checkbox horizontal\">\n  <label>Contactpersoon<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-3-contactpersoon\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-3-contactpersoon[]\" value=\"Aanmelden als contactpersoon\" \/><span class=\"wpcf7-list-item-label\">Aanmelden als contactpersoon<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n<\/div><!-- Deelnemer 3 end -->\n\n\n\n\n<!-- Deelnemer 4 start -->\n<div data-id=\"deelnemer-4\" data-orig_data_id=\"deelnemer-4\"  class=\"\" data-class=\"wpcf7cf_group\"><\/div>\n<div class=\"inner block hidden\">\n\n  <div class=\"field col-2\">\n  <label>Voornaam *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-4-naam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Voornaam\/voorletters\" value=\"\" type=\"text\" name=\"dn-4-naam\" \/><\/span>\n  <\/div>\n\n<div class=\"field col-2 last\">\n  <label>Achternaam *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-4-achternaam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Achternaam\" value=\"\" type=\"text\" name=\"dn-4-achternaam\" \/><\/span>\n  <\/div>\n\n<div class=\"field radio horizontal\">\n  <label>Man\/Vrouw<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-4-man-vrouw\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"dn-4-man-vrouw\" value=\"Man\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Man<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"dn-4-man-vrouw\" value=\"Vrouw\" \/><span class=\"wpcf7-list-item-label\">Vrouw<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"dn-4-man-vrouw\" value=\"Neutraal\" \/><span class=\"wpcf7-list-item-label\">Neutraal<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n  <div class=\"field\">\n  <label>Functie *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-4-functie\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"dn-4-functie\"><option value=\"Analist\">Analist<\/option><option value=\"Arts\">Arts<\/option><option value=\"Kwaliteitsmedewerker\">Kwaliteitsmedewerker<\/option><option value=\"Management\">Management<\/option><option value=\"Ondersteunend\">Ondersteunend<\/option><option value=\"Paramedisch\">Paramedisch<\/option><option value=\"Verpleeger\">Verpleeger<\/option><option value=\"Anders\">Anders<\/option><\/select><\/span>\n  <div data-id=\"group-dn-4-functie-anders\" data-orig_data_id=\"group-dn-4-functie-anders\"  class=\"\" data-class=\"wpcf7cf_group\"><span class=\"wpcf7-form-control-wrap\" data-name=\"dn-4-functie-anders\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Functie\" value=\"\" type=\"text\" name=\"dn-4-functie-anders\" \/><\/span><\/div>\n  <\/div>\n\n  <div class=\"field col-2\">\n  <label>Telefoonnummer *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-4-telefoon\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Telefoonnummer\" value=\"\" type=\"text\" name=\"dn-4-telefoon\" \/><\/span>\n  <\/div>\n\n<div class=\"field col-2 last\">\n  <label>E-mailadres *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-4-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"E-mailadres\" value=\"\" type=\"text\" name=\"dn-4-email\" \/><\/span>\n  <\/div>\n\n<div class=\"field checkbox horizontal\">\n  <label>Account voor<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-4-type-dataentry\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-dataentry\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-4-type-dataentry[]\" value=\"Dataentry\" \/><span class=\"wpcf7-list-item-label\">Dataentry<\/span><\/label><\/span><\/span><\/span>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-4-type-batch\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-batch\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-4-type-batch[]\" value=\"Data Connect (Batch)\" \/><span class=\"wpcf7-list-item-label\">Data Connect (Batch)<\/span><\/label><\/span><\/span><\/span>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-4-type-codman\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-codman\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-4-type-codman[]\" value=\"Codman\" \/><span class=\"wpcf7-list-item-label\">Codman<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n  <div data-id=\"dn-4-codman\" data-orig_data_id=\"dn-4-codman\"  class=\"\" data-class=\"wpcf7cf_group\">\n  <div class=\"field checkbox horizontal\">\n    <label>Pati\u00ebnt inzage in Codman<\/label>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-4-codman-inzage\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-4-codman-inzage[]\" value=\"Volledige pati\u00ebnten inzage\" \/><span class=\"wpcf7-list-item-label\">Volledige pati\u00ebnten inzage<\/span><\/label><\/span><\/span><\/span>\n    <\/div>\n  <\/div>\n\n <div class=\"field checkbox horizontal\">\n  <label>Contactpersoon<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-4-contactpersoon\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-4-contactpersoon[]\" value=\"Aanmelden als contactpersoon\" \/><span class=\"wpcf7-list-item-label\">Aanmelden als contactpersoon<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n<\/div><!-- Deelnemer 4 end -->\n\n\n\n\n<!-- Deelnemer 5 start -->\n<div data-id=\"deelnemer-5\" data-orig_data_id=\"deelnemer-5\"  class=\"\" data-class=\"wpcf7cf_group\"><\/div>\n<div class=\"inner block hidden\">\n\n  <div class=\"field col-2\">\n  <label>Voornaam *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-5-naam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Voornaam\/voorletters\" value=\"\" type=\"text\" name=\"dn-5-naam\" \/><\/span>\n  <\/div>\n\n<div class=\"field col-2 last\">\n  <label>Achternaam *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-5-achternaam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Achternaam\" value=\"\" type=\"text\" name=\"dn-5-achternaam\" \/><\/span>\n  <\/div>\n\n<div class=\"field radio horizontal\">\n  <label>Man\/Vrouw<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-5-man-vrouw\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"dn-5-man-vrouw\" value=\"Man\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Man<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"dn-5-man-vrouw\" value=\"Vrouw\" \/><span class=\"wpcf7-list-item-label\">Vrouw<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"dn-5-man-vrouw\" value=\"Neutraal\" \/><span class=\"wpcf7-list-item-label\">Neutraal<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n  <div class=\"field\">\n  <label>Functie *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-5-functie\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"dn-5-functie\"><option value=\"Analist\">Analist<\/option><option value=\"Arts\">Arts<\/option><option value=\"Kwaliteitsmedewerker\">Kwaliteitsmedewerker<\/option><option value=\"Management\">Management<\/option><option value=\"Ondersteunend\">Ondersteunend<\/option><option value=\"Paramedisch\">Paramedisch<\/option><option value=\"Verpleeger\">Verpleeger<\/option><option value=\"Anders\">Anders<\/option><\/select><\/span>\n  <div data-id=\"group-dn-5-functie-anders\" data-orig_data_id=\"group-dn-5-functie-anders\"  class=\"\" data-class=\"wpcf7cf_group\"><span class=\"wpcf7-form-control-wrap\" data-name=\"dn-5-functie-anders\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Functie\" value=\"\" type=\"text\" name=\"dn-5-functie-anders\" \/><\/span><\/div>\n  <\/div>\n\n  <div class=\"field col-2\">\n  <label>Telefoonnummer *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-5-telefoon\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Telefoonnummer\" value=\"\" type=\"text\" name=\"dn-5-telefoon\" \/><\/span>\n  <\/div>\n\n<div class=\"field col-2 last\">\n  <label>E-mailadres *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-5-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"E-mailadres\" value=\"\" type=\"text\" name=\"dn-5-email\" \/><\/span>\n  <\/div>\n\n<div class=\"field checkbox horizontal\">\n  <label>Account voor<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-5-type-dataentry\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-dataentry\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-5-type-dataentry[]\" value=\"Dataentry\" \/><span class=\"wpcf7-list-item-label\">Dataentry<\/span><\/label><\/span><\/span><\/span>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-5-type-batch\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-batch\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-5-type-batch[]\" value=\"Data Connect (Batch)\" \/><span class=\"wpcf7-list-item-label\">Data Connect (Batch)<\/span><\/label><\/span><\/span><\/span>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-5-type-codman\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-codman\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-5-type-codman[]\" value=\"Codman\" \/><span class=\"wpcf7-list-item-label\">Codman<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n  <div data-id=\"dn-5-codman\" data-orig_data_id=\"dn-5-codman\"  class=\"\" data-class=\"wpcf7cf_group\">\n  <div class=\"field checkbox horizontal\">\n    <label>Pati\u00ebnt inzage in Codman<\/label>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-5-codman-inzage\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-5-codman-inzage[]\" value=\"Volledige pati\u00ebnten inzage\" \/><span class=\"wpcf7-list-item-label\">Volledige pati\u00ebnten inzage<\/span><\/label><\/span><\/span><\/span>\n    <\/div>\n  <\/div>\n\n <div class=\"field checkbox horizontal\">\n  <label>Contactpersoon<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-5-contactpersoon\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-5-contactpersoon[]\" value=\"Aanmelden als contactpersoon\" \/><span class=\"wpcf7-list-item-label\">Aanmelden als contactpersoon<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n<\/div><!-- Deelnemer 5 end -->\n\n\n\n<!-- Deelnemer 6 start -->\n<div data-id=\"deelnemer-6\" data-orig_data_id=\"deelnemer-6\"  class=\"\" data-class=\"wpcf7cf_group\"><\/div>\n<div class=\"inner block hidden\">\n\n  <div class=\"field col-2\">\n  <label>Voornaam *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-6-naam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Voornaam\/voorletters\" value=\"\" type=\"text\" name=\"dn-6-naam\" \/><\/span>\n  <\/div>\n\n<div class=\"field col-2 last\">\n  <label>Achternaam *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-6-achternaam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Achternaam\" value=\"\" type=\"text\" name=\"dn-6-achternaam\" \/><\/span>\n  <\/div>\n\n<div class=\"field radio horizontal\">\n  <label>Man\/Vrouw<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-6-man-vrouw\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"dn-6-man-vrouw\" value=\"Man\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Man<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"dn-6-man-vrouw\" value=\"Vrouw\" \/><span class=\"wpcf7-list-item-label\">Vrouw<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"dn-6-man-vrouw\" value=\"Neutraal\" \/><span class=\"wpcf7-list-item-label\">Neutraal<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n  <div class=\"field\">\n  <label>Functie *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-6-functie\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"dn-6-functie\"><option value=\"Analist\">Analist<\/option><option value=\"Arts\">Arts<\/option><option value=\"Kwaliteitsmedewerker\">Kwaliteitsmedewerker<\/option><option value=\"Management\">Management<\/option><option value=\"Ondersteunend\">Ondersteunend<\/option><option value=\"Paramedisch\">Paramedisch<\/option><option value=\"Verpleeger\">Verpleeger<\/option><option value=\"Anders\">Anders<\/option><\/select><\/span>\n  <div data-id=\"group-dn-6-functie-anders\" data-orig_data_id=\"group-dn-6-functie-anders\"  class=\"\" data-class=\"wpcf7cf_group\"><span class=\"wpcf7-form-control-wrap\" data-name=\"dn-6-functie-anders\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Functie\" value=\"\" type=\"text\" name=\"dn-6-functie-anders\" \/><\/span><\/div>\n  <\/div>\n\n  <div class=\"field col-2\">\n  <label>Telefoonnummer *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-6-telefoon\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Telefoonnummer\" value=\"\" type=\"text\" name=\"dn-6-telefoon\" \/><\/span>\n  <\/div>\n\n<div class=\"field col-2 last\">\n  <label>E-mailadres *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-6-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"E-mailadres\" value=\"\" type=\"text\" name=\"dn-6-email\" \/><\/span>\n  <\/div>\n\n<div class=\"field checkbox horizontal\">\n  <label>Account voor<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-6-type-dataentry\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-dataentry\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-6-type-dataentry[]\" value=\"Dataentry\" \/><span class=\"wpcf7-list-item-label\">Dataentry<\/span><\/label><\/span><\/span><\/span>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-6-type-batch\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-batch\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-6-type-batch[]\" value=\"Data Connect (Batch)\" \/><span class=\"wpcf7-list-item-label\">Data Connect (Batch)<\/span><\/label><\/span><\/span><\/span>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-6-type-codman\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-codman\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-6-type-codman[]\" value=\"Codman\" \/><span class=\"wpcf7-list-item-label\">Codman<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n  <div data-id=\"dn-6-codman\" data-orig_data_id=\"dn-6-codman\"  class=\"\" data-class=\"wpcf7cf_group\">\n  <div class=\"field checkbox horizontal\">\n    <label>Pati\u00ebnt inzage in Codman<\/label>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-6-codman-inzage\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-6-codman-inzage[]\" value=\"Volledige pati\u00ebnten inzage\" \/><span class=\"wpcf7-list-item-label\">Volledige pati\u00ebnten inzage<\/span><\/label><\/span><\/span><\/span>\n    <\/div>\n  <\/div>\n\n <div class=\"field checkbox horizontal\">\n  <label>Contactpersoon<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-6-contactpersoon\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-6-contactpersoon[]\" value=\"Aanmelden als contactpersoon\" \/><span class=\"wpcf7-list-item-label\">Aanmelden als contactpersoon<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n<\/div><!-- Deelnemer 6 end -->\n\n\n\n<!-- Deelnemer 7 start -->\n<div data-id=\"deelnemer-7\" data-orig_data_id=\"deelnemer-7\"  class=\"\" data-class=\"wpcf7cf_group\"><\/div>\n<div class=\"inner block hidden\">\n\n  <div class=\"field col-2\">\n  <label>Voornaam *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-7-naam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Voornaam\/voorletters\" value=\"\" type=\"text\" name=\"dn-7-naam\" \/><\/span>\n  <\/div>\n\n<div class=\"field col-2 last\">\n  <label>Achternaam *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-7-achternaam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Achternaam\" value=\"\" type=\"text\" name=\"dn-7-achternaam\" \/><\/span>\n  <\/div>\n\n<div class=\"field radio horizontal\">\n  <label>Man\/Vrouw<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-7-man-vrouw\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"dn-7-man-vrouw\" value=\"Man\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Man<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"dn-7-man-vrouw\" value=\"Vrouw\" \/><span class=\"wpcf7-list-item-label\">Vrouw<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"dn-7-man-vrouw\" value=\"Neutraal\" \/><span class=\"wpcf7-list-item-label\">Neutraal<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n  <div class=\"field\">\n  <label>Functie *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-7-functie\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"dn-7-functie\"><option value=\"Analist\">Analist<\/option><option value=\"Arts\">Arts<\/option><option value=\"Kwaliteitsmedewerker\">Kwaliteitsmedewerker<\/option><option value=\"Management\">Management<\/option><option value=\"Ondersteunend\">Ondersteunend<\/option><option value=\"Paramedisch\">Paramedisch<\/option><option value=\"Verpleeger\">Verpleeger<\/option><option value=\"Anders\">Anders<\/option><\/select><\/span>\n  <div data-id=\"group-dn-7-functie-anders\" data-orig_data_id=\"group-dn-7-functie-anders\"  class=\"\" data-class=\"wpcf7cf_group\"><span class=\"wpcf7-form-control-wrap\" data-name=\"dn-7-functie-anders\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Functie\" value=\"\" type=\"text\" name=\"dn-7-functie-anders\" \/><\/span><\/div>\n  <\/div>\n\n  <div class=\"field col-2\">\n  <label>Telefoonnummer *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-7-telefoon\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Telefoonnummer\" value=\"\" type=\"text\" name=\"dn-7-telefoon\" \/><\/span>\n  <\/div>\n\n<div class=\"field col-2 last\">\n  <label>E-mailadres *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-7-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"E-mailadres\" value=\"\" type=\"text\" name=\"dn-7-email\" \/><\/span>\n  <\/div>\n\n<div class=\"field checkbox horizontal\">\n  <label>Account voor<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-7-type-dataentry\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-dataentry\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-7-type-dataentry[]\" value=\"Dataentry\" \/><span class=\"wpcf7-list-item-label\">Dataentry<\/span><\/label><\/span><\/span><\/span>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-7-type-batch\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-batch\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-7-type-batch[]\" value=\"Data Connect (Batch)\" \/><span class=\"wpcf7-list-item-label\">Data Connect (Batch)<\/span><\/label><\/span><\/span><\/span>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-7-type-codman\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-codman\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-7-type-codman[]\" value=\"Codman\" \/><span class=\"wpcf7-list-item-label\">Codman<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n  <div data-id=\"dn-7-codman\" data-orig_data_id=\"dn-7-codman\"  class=\"\" data-class=\"wpcf7cf_group\">\n  <div class=\"field checkbox horizontal\">\n    <label>Pati\u00ebnt inzage in Codman<\/label>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-7-codman-inzage\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-7-codman-inzage[]\" value=\"Volledige pati\u00ebnten inzage\" \/><span class=\"wpcf7-list-item-label\">Volledige pati\u00ebnten inzage<\/span><\/label><\/span><\/span><\/span>\n    <\/div>\n  <\/div>\n\n <div class=\"field checkbox horizontal\">\n  <label>Contactpersoon<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-7-contactpersoon\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-7-contactpersoon[]\" value=\"Aanmelden als contactpersoon\" \/><span class=\"wpcf7-list-item-label\">Aanmelden als contactpersoon<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n<\/div><!-- Deelnemer 7 end -->\n\n\n\n<!-- Deelnemer 8 start -->\n<div data-id=\"deelnemer-8\" data-orig_data_id=\"deelnemer-8\"  class=\"\" data-class=\"wpcf7cf_group\"><\/div>\n<div class=\"inner block hidden\">\n\n  <div class=\"field col-2\">\n  <label>Voornaam *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-8-naam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Voornaam\/voorletters\" value=\"\" type=\"text\" name=\"dn-8-naam\" \/><\/span>\n  <\/div>\n\n<div class=\"field col-2 last\">\n  <label>Achternaam *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-8-achternaam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Achternaam\" value=\"\" type=\"text\" name=\"dn-8-achternaam\" \/><\/span>\n  <\/div>\n\n<div class=\"field radio horizontal\">\n  <label>Man\/Vrouw<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-8-man-vrouw\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"dn-8-man-vrouw\" value=\"Man\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Man<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"dn-8-man-vrouw\" value=\"Vrouw\" \/><span class=\"wpcf7-list-item-label\">Vrouw<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"dn-8-man-vrouw\" value=\"Neutraal\" \/><span class=\"wpcf7-list-item-label\">Neutraal<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n  <div class=\"field\">\n  <label>Functie *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-8-functie\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"dn-8-functie\"><option value=\"Analist\">Analist<\/option><option value=\"Arts\">Arts<\/option><option value=\"Kwaliteitsmedewerker\">Kwaliteitsmedewerker<\/option><option value=\"Management\">Management<\/option><option value=\"Ondersteunend\">Ondersteunend<\/option><option value=\"Paramedisch\">Paramedisch<\/option><option value=\"Verpleeger\">Verpleeger<\/option><option value=\"Anders\">Anders<\/option><\/select><\/span>\n  <div data-id=\"group-dn-8-functie-anders\" data-orig_data_id=\"group-dn-8-functie-anders\"  class=\"\" data-class=\"wpcf7cf_group\"><span class=\"wpcf7-form-control-wrap\" data-name=\"dn-8-functie-anders\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Functie\" value=\"\" type=\"text\" name=\"dn-8-functie-anders\" \/><\/span><\/div>\n  <\/div>\n\n  <div class=\"field col-2\">\n  <label>Telefoonnummer *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-8-telefoon\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Telefoonnummer\" value=\"\" type=\"text\" name=\"dn-8-telefoon\" \/><\/span>\n  <\/div>\n\n<div class=\"field col-2 last\">\n  <label>E-mailadres *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-8-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"E-mailadres\" value=\"\" type=\"text\" name=\"dn-8-email\" \/><\/span>\n  <\/div>\n\n<div class=\"field checkbox horizontal\">\n  <label>Account voor<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-8-type-dataentry\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-dataentry\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-8-type-dataentry[]\" value=\"Dataentry\" \/><span class=\"wpcf7-list-item-label\">Dataentry<\/span><\/label><\/span><\/span><\/span>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-8-type-batch\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-batch\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-8-type-batch[]\" value=\"Data Connect (Batch)\" \/><span class=\"wpcf7-list-item-label\">Data Connect (Batch)<\/span><\/label><\/span><\/span><\/span>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-8-type-codman\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-codman\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-8-type-codman[]\" value=\"Codman\" \/><span class=\"wpcf7-list-item-label\">Codman<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n  <div data-id=\"dn-8-codman\" data-orig_data_id=\"dn-8-codman\"  class=\"\" data-class=\"wpcf7cf_group\">\n  <div class=\"field checkbox horizontal\">\n    <label>Pati\u00ebnt inzage in Codman<\/label>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-8-codman-inzage\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-8-codman-inzage[]\" value=\"Volledige pati\u00ebnten inzage\" \/><span class=\"wpcf7-list-item-label\">Volledige pati\u00ebnten inzage<\/span><\/label><\/span><\/span><\/span>\n    <\/div>\n  <\/div>\n\n <div class=\"field checkbox horizontal\">\n  <label>Contactpersoon<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-8-contactpersoon\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-8-contactpersoon[]\" value=\"Aanmelden als contactpersoon\" \/><span class=\"wpcf7-list-item-label\">Aanmelden als contactpersoon<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n<\/div><!-- Deelnemer 8 end -->\n\n\n\n<!-- Deelnemer 9 start -->\n<div data-id=\"deelnemer-9\" data-orig_data_id=\"deelnemer-9\"  class=\"\" data-class=\"wpcf7cf_group\"><\/div>\n<div class=\"inner block hidden\">\n\n  <div class=\"field col-2\">\n  <label>Voornaam *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-9-naam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Voornaam\/voorletters\" value=\"\" type=\"text\" name=\"dn-9-naam\" \/><\/span>\n  <\/div>\n\n<div class=\"field col-2 last\">\n  <label>Achternaam *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-9-achternaam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Achternaam\" value=\"\" type=\"text\" name=\"dn-9-achternaam\" \/><\/span>\n  <\/div>\n\n<div class=\"field radio horizontal\">\n  <label>Man\/Vrouw<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-9-man-vrouw\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"dn-9-man-vrouw\" value=\"Man\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Man<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"dn-9-man-vrouw\" value=\"Vrouw\" \/><span class=\"wpcf7-list-item-label\">Vrouw<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"dn-9-man-vrouw\" value=\"Neutraal\" \/><span class=\"wpcf7-list-item-label\">Neutraal<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n  <div class=\"field\">\n  <label>Functie *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-9-functie\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"dn-9-functie\"><option value=\"Analist\">Analist<\/option><option value=\"Arts\">Arts<\/option><option value=\"Kwaliteitsmedewerker\">Kwaliteitsmedewerker<\/option><option value=\"Management\">Management<\/option><option value=\"Ondersteunend\">Ondersteunend<\/option><option value=\"Paramedisch\">Paramedisch<\/option><option value=\"Verpleeger\">Verpleeger<\/option><option value=\"Anders\">Anders<\/option><\/select><\/span>\n  <div data-id=\"group-dn-9-functie-anders\" data-orig_data_id=\"group-dn-9-functie-anders\"  class=\"\" data-class=\"wpcf7cf_group\"><span class=\"wpcf7-form-control-wrap\" data-name=\"dn-9-functie-anders\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Functie\" value=\"\" type=\"text\" name=\"dn-9-functie-anders\" \/><\/span><\/div>\n  <\/div>\n\n  <div class=\"field col-2\">\n  <label>Telefoonnummer *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-9-telefoon\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Telefoonnummer\" value=\"\" type=\"text\" name=\"dn-9-telefoon\" \/><\/span>\n  <\/div>\n\n<div class=\"field col-2 last\">\n  <label>E-mailadres *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-9-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"E-mailadres\" value=\"\" type=\"text\" name=\"dn-9-email\" \/><\/span>\n  <\/div>\n\n<div class=\"field checkbox horizontal\">\n  <label>Account voor<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-9-type-dataentry\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-dataentry\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-9-type-dataentry[]\" value=\"Dataentry\" \/><span class=\"wpcf7-list-item-label\">Dataentry<\/span><\/label><\/span><\/span><\/span>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-9-type-batch\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-batch\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-9-type-batch[]\" value=\"Data Connect (Batch)\" \/><span class=\"wpcf7-list-item-label\">Data Connect (Batch)<\/span><\/label><\/span><\/span><\/span>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-9-type-codman\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-codman\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-9-type-codman[]\" value=\"Codman\" \/><span class=\"wpcf7-list-item-label\">Codman<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n  <div data-id=\"dn-9-codman\" data-orig_data_id=\"dn-9-codman\"  class=\"\" data-class=\"wpcf7cf_group\">\n  <div class=\"field checkbox horizontal\">\n    <label>Pati\u00ebnt inzage in Codman<\/label>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-9-codman-inzage\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-9-codman-inzage[]\" value=\"Volledige pati\u00ebnten inzage\" \/><span class=\"wpcf7-list-item-label\">Volledige pati\u00ebnten inzage<\/span><\/label><\/span><\/span><\/span>\n    <\/div>\n  <\/div>\n\n <div class=\"field checkbox horizontal\">\n  <label>Contactpersoon<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-9-contactpersoon\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-9-contactpersoon[]\" value=\"Aanmelden als contactpersoon\" \/><span class=\"wpcf7-list-item-label\">Aanmelden als contactpersoon<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n<\/div><!-- Deelnemer 9 end -->\n\n\n\n<!-- Deelnemer 10 start -->\n<div data-id=\"deelnemer-10\" data-orig_data_id=\"deelnemer-10\"  class=\"\" data-class=\"wpcf7cf_group\"><\/div>\n<div class=\"inner block hidden\">\n\n  <div class=\"field col-2\">\n  <label>Voornaam *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-10-naam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Voornaam\/voorletters\" value=\"\" type=\"text\" name=\"dn-10-naam\" \/><\/span>\n  <\/div>\n\n<div class=\"field col-2 last\">\n  <label>Achternaam *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-10-achternaam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Achternaam\" value=\"\" type=\"text\" name=\"dn-10-achternaam\" \/><\/span>\n  <\/div>\n\n<div class=\"field radio horizontal\">\n  <label>Man\/Vrouw<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-10-man-vrouw\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"dn-10-man-vrouw\" value=\"Man\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Man<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"dn-10-man-vrouw\" value=\"Vrouw\" \/><span class=\"wpcf7-list-item-label\">Vrouw<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"dn-10-man-vrouw\" value=\"Neutraal\" \/><span class=\"wpcf7-list-item-label\">Neutraal<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n  <div class=\"field\">\n  <label>Functie *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-10-functie\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"dn-10-functie\"><option value=\"Analist\">Analist<\/option><option value=\"Arts\">Arts<\/option><option value=\"Kwaliteitsmedewerker\">Kwaliteitsmedewerker<\/option><option value=\"Management\">Management<\/option><option value=\"Ondersteunend\">Ondersteunend<\/option><option value=\"Paramedisch\">Paramedisch<\/option><option value=\"Verpleeger\">Verpleeger<\/option><option value=\"Anders\">Anders<\/option><\/select><\/span>\n  <div data-id=\"group-dn-10-functie-anders\" data-orig_data_id=\"group-dn-10-functie-anders\"  class=\"\" data-class=\"wpcf7cf_group\"><span class=\"wpcf7-form-control-wrap\" data-name=\"dn-10-functie-anders\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Functie\" value=\"\" type=\"text\" name=\"dn-10-functie-anders\" \/><\/span><\/div>\n  <\/div>\n\n  <div class=\"field col-2\">\n  <label>Telefoonnummer *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-10-telefoon\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Telefoonnummer\" value=\"\" type=\"text\" name=\"dn-10-telefoon\" \/><\/span>\n  <\/div>\n\n<div class=\"field col-2 last\">\n  <label>E-mailadres *<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-10-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"E-mailadres\" value=\"\" type=\"text\" name=\"dn-10-email\" \/><\/span>\n  <\/div>\n\n<div class=\"field checkbox horizontal\">\n  <label>Account voor<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-10-type-dataentry\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-dataentry\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-10-type-dataentry[]\" value=\"Dataentry\" \/><span class=\"wpcf7-list-item-label\">Dataentry<\/span><\/label><\/span><\/span><\/span>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-10-type-batch\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-batch\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-10-type-batch[]\" value=\"Data Connect (Batch)\" \/><span class=\"wpcf7-list-item-label\">Data Connect (Batch)<\/span><\/label><\/span><\/span><\/span>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-10-type-codman\"><span class=\"wpcf7-form-control wpcf7-checkbox conditional set-has-codman\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-10-type-codman[]\" value=\"Codman\" \/><span class=\"wpcf7-list-item-label\">Codman<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n  <div data-id=\"dn-10-codman\" data-orig_data_id=\"dn-10-codman\"  class=\"\" data-class=\"wpcf7cf_group\">\n  <div class=\"field checkbox horizontal\">\n    <label>Pati\u00ebnt inzage in Codman<\/label>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-10-codman-inzage\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-10-codman-inzage[]\" value=\"Volledige pati\u00ebnten inzage\" \/><span class=\"wpcf7-list-item-label\">Volledige pati\u00ebnten inzage<\/span><\/label><\/span><\/span><\/span>\n    <\/div>\n  <\/div>\n\n <div class=\"field checkbox horizontal\">\n  <label>Contactpersoon<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"dn-10-contactpersoon\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"dn-10-contactpersoon[]\" value=\"Aanmelden als contactpersoon\" \/><span class=\"wpcf7-list-item-label\">Aanmelden als contactpersoon<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n<\/div><!-- Deelnemer 10 end -->\n\n\n\n<div class=\"inner block add-block\">\n<span class=\"icon\">add_circle<\/span>\nDeelnemer toevoegen\n <\/div>\n<\/div>\n\n\n<!-- Chirurg -->\n<div data-id=\"chirurg\" data-orig_data_id=\"chirurg\"  class=\"\" data-class=\"wpcf7cf_group\">\n<div class=\"block\">\n<div class=\"inner\">\n\n  <h4>Chirurgenlijst <\/h4>\n  <p>Voor de DBIR registratie is er een chirurgenlijst beschikbaar. Deze chirurgenlijst is gekoppeld aan de DBIR registratie en vormt een optieset voor het invullen van de behandelaar in de registratie. Wanneer u in deze lijst toegevoegd wenst te worden, zouden wij graag de onderstaande gegevens willen ontvangen:<\/p>\n\n<div class=\"field radio horizontal\">\n  <label>Chirurg toevoegen<\/label>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"chirurg-toevoegen\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"chirurg-toevoegen\" value=\"Ja\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"chirurg-toevoegen\" value=\"Nee\" \/><span class=\"wpcf7-list-item-label\">Nee<\/span><\/label><\/span><\/span><\/span>\n<\/div>\n\n<div data-id=\"chirurg-gegevens\" data-orig_data_id=\"chirurg-gegevens\"  class=\"\" data-class=\"wpcf7cf_group\">\n  <div class=\"field\">\n    <label>Titel<\/label>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"chirurg-titel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Titel\" value=\"\" type=\"text\" name=\"chirurg-titel\" \/><\/span>\n  <\/div>\n\n  <div class=\"field col-2\">\n    <label>Initialen<\/label>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"chirurg-initialen\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Initialen\" value=\"\" type=\"text\" name=\"chirurg-initialen\" \/><\/span>\n  <\/div>\n\n  <div class=\"field col-2 last\">\n    <label>Achternaam<\/label>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"chirurg-achternaam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Achternaam\" value=\"\" type=\"text\" name=\"chirurg-achternaam\" \/><\/span>\n  <\/div>\n\n  <div class=\"field\">\n    <label>Organisatie<\/label>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"chirurg-organisatie\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Organisatie\" value=\"\" type=\"text\" name=\"chirurg-organisatie\" \/><\/span>\n  <\/div>\n<\/div>\n\n<\/div>\n<\/div>\n<\/div>\n<!-- Chirurg -->\n\n<!-- Info -->\n<div class=\"block\">\n<div class=\"inner\">\n<ul>\n<li>Door het invullen van dit formulier geeft u toestemming voor het gebruik van deze gegevens door MRDM<span class=\"conditional set-has-dica\"> en DICA<\/span>.<\/li>\n<li>De doeleinde voor het gebruik van deze gegevens beperken zich tot communicatie rondom de deelname aan de registratie(s) waarvoor er een samenwerkingsverband is tussen uw organisatie en MRDM<span class=\"conditional set-has-dica\"> en DICA<\/span>.<\/li> \n<li>De via dit document bekende personen kunnen te allen tijde een verzoek indienen bij de Servicedesk voor rectificatie, verwijdering en opvraag van de bij ons bekende gegevens.<\/li>\n<li>De gegevens worden niet verder verspreid naar derden en worden opgeslagen bij MRDM voor zover er een samenwerkingsverband bestaat tussen uw organisatie en MRDM<span class=\"conditional set-has-dica\"> en DICA<\/span>.<\/li>\n<li>MRDM is ISO 27001:2013 en NEN 7510:2011 gecertificeerd en waarborgt daarmee de veilige verwerking van persoonsgegevens.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n<span class=\"wpcf7-form-control-wrap\" data-name=\"hcap-cf7\">\t\t<input\n\t\t\t\ttype=\"hidden\"\n\t\t\t\tclass=\"hcaptcha-widget-id\"\n\t\t\t\tname=\"hcaptcha-widget-id\"\n\t\t\t\tvalue=\"eyJzb3VyY2UiOlsiY29udGFjdC1mb3JtLTdcL3dwLWNvbnRhY3QtZm9ybS03LnBocCJdLCJmb3JtX2lkIjoyNzk5fQ==-dad60bd3196084f1859e2ac6a75d0194\">\n\t\t\t\t<span id=\"hcap_cf7-69de09b7760f98.17577569\" class=\"wpcf7-form-control h-captcha \"\n\t\t\tdata-sitekey=\"16310c4e-78ea-428a-97c4-0237baf70ce2\"\n\t\t\tdata-theme=\"light\"\n\t\t\tdata-size=\"normal\"\n\t\t\tdata-auto=\"false\"\n\t\t\tdata-ajax=\"false\"\n\t\t\tdata-force=\"false\">\n\t\t<\/span>\n\t\t<input type=\"hidden\" id=\"_wpnonce\" name=\"_wpnonce\" value=\"d2e6b25db6\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/nl\/wp-json\/wp\/v2\/account\/2800\" \/><\/span><input class=\"wpcf7-form-control wpcf7-submit has-spinner bg-color-primary bg-hover txt-color-white\" type=\"submit\" value=\"Verzenden\" \/>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"parent":8233,"menu_order":0,"template":"","class_list":["post-2800","account","type-account","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/support.mrdm.com\/nl\/wp-json\/wp\/v2\/account\/2800","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/support.mrdm.com\/nl\/wp-json\/wp\/v2\/account"}],"about":[{"href":"https:\/\/support.mrdm.com\/nl\/wp-json\/wp\/v2\/types\/account"}],"version-history":[{"count":16,"href":"https:\/\/support.mrdm.com\/nl\/wp-json\/wp\/v2\/account\/2800\/revisions"}],"predecessor-version":[{"id":10968,"href":"https:\/\/support.mrdm.com\/nl\/wp-json\/wp\/v2\/account\/2800\/revisions\/10968"}],"up":[{"embeddable":true,"href":"https:\/\/support.mrdm.com\/nl\/wp-json\/wp\/v2\/account\/8233"}],"wp:attachment":[{"href":"https:\/\/support.mrdm.com\/nl\/wp-json\/wp\/v2\/media?parent=2800"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}