{"id":11193,"date":"2025-08-21T16:14:11","date_gmt":"2025-08-21T14:14:11","guid":{"rendered":"https:\/\/support.mrdm.com\/?post_type=codman&#038;p=11193"},"modified":"2025-10-15T08:38:08","modified_gmt":"2025-10-15T06:38:08","slug":"aanmeldformulier","status":"publish","type":"codman","link":"https:\/\/support.mrdm.com\/nl\/codman\/codman-connect\/aanmeldprocedure\/aanmeldformulier\/","title":{"rendered":"Aanmeldformulier"},"content":{"rendered":"\n<p>Middels dit aanvraagformulier vraagt u Codman Connect aan voor uzelf en samenwerkende zorginstellingen.\u00a0<\/p>\n\n\n\n<p>Zodra MRDM dit ingevulde aanvraagformulier ontvangen heeft, stelt MRDM een contract op voor de participerende zorginstellingen. Nadat alle participerende zorginstellingen dit contract hebben ondertekend, wordt Codman Connect geactiveerd.<\/p>\n\n\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f11190-o1\" lang=\"nl-NL\" dir=\"ltr\" data-wpcf7-id=\"11190\">\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\/codman\/11193#wpcf7-f11190-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=\"11190\" \/><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-f11190-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;:11190,&quot;conditions&quot;:[{&quot;then_field&quot;:&quot;anders&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;tijdsperiode&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Anders&quot;}]},{&quot;then_field&quot;:&quot;indicatoren&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dashboard&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Codman Indicatoren&quot;}]},{&quot;then_field&quot;:&quot;exploratief&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;dashboard&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Codman Exploratief&quot;}]},{&quot;then_field&quot;:&quot;-1&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;-1&quot;,&quot;operator&quot;:&quot;not empty&quot;,&quot;if_value&quot;:&quot;show-afwijkingen&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<!-- 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=\"aanvrager-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=\"aanvrager-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 class=\"field\">\n    <label>Wat is de naam van de samenwerking? *<\/label>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"samenwerking\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Samenwerking\" value=\"\" type=\"text\" name=\"samenwerking\" \/><\/span>\n  <\/div>\n\n<\/div>\n<\/div>\n<!-- Aanvrager -->\n\n\n<!-- Registratie -->\n<div class=\"block\">\n<div class=\"inner\">\n\n  <h4>Connect aanvragen voor<\/h4>\n\n  <div class=\"field checkbox horizontal\">\n    <label>Kies voor welk dashboard u Codman Connect wilt aanvragen. U kunt beide selecteren.<\/label>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"dashboard\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"dashboard[]\" value=\"Codman Indicatoren\" \/><span class=\"wpcf7-list-item-label\">Codman Indicatoren<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"dashboard[]\" value=\"Codman Exploratief\" \/><span class=\"wpcf7-list-item-label\">Codman Exploratief<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n<\/div>\n\n<div data-id=\"indicatoren\" data-orig_data_id=\"indicatoren\"  class=\"\" data-class=\"wpcf7cf_group\">\n<div class=\"inner block\">\n\n  <h4>Codman Indicatoren<\/h4>\n\n  <div class=\"field checkbox dropdown horizontal\">\n    <label>Registratie(s) waarvoor u Codman Connect wilt 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=\"indicatoren-registratie\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"indicatoren-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=\"indicatoren-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=\"indicatoren-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=\"indicatoren-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=\"indicatoren-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=\"indicatoren-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=\"indicatoren-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=\"indicatoren-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=\"indicatoren-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=\"indicatoren-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=\"indicatoren-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=\"indicatoren-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=\"indicatoren-registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,transparency,integrations,codman,data-verification,dlca-r,dica\" \/><span class=\"wpcf7-list-item-label\">DLCA-R<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"indicatoren-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=\"indicatoren-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=\"indicatoren-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=\"indicatoren-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=\"indicatoren-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=\"indicatoren-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=\"indicatoren-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=\"indicatoren-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=\"indicatoren-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=\"indicatoren-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=\"indicatoren-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 last\"><label><input type=\"checkbox\" name=\"indicatoren-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 class=\"field checkbox\">\n    <label>Welke indicatoren wilt u delen? <\/label>\n    <p>(deze keuze geldt voor alle eerder geselecteerde registraties)<\/p>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"delen\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"delen[]\" value=\"Verplicht transparante indicatoren\" \/><span class=\"wpcf7-list-item-label\">Verplicht transparante indicatoren<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"delen[]\" value=\"Vrijwillig transparante indicatoren\" \/><span class=\"wpcf7-list-item-label\">Vrijwillig transparante indicatoren<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"delen[]\" value=\"Interne indicatoren\" \/><span class=\"wpcf7-list-item-label\">Interne indicatoren<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n<\/div>\n<\/div>\n<div data-id=\"exploratief\" data-orig_data_id=\"exploratief\"  class=\"\" data-class=\"wpcf7cf_group\">\n<div class=\"inner block\">\n\n  <h4>Codman Exploratief<\/h4>\n\n  <div class=\"field checkbox dropdown horizontal\">\n    <label>Registratie(s) waarvoor u Codman Connect wilt 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=\"exploratief-registratie\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"exploratief-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=\"exploratief-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=\"exploratief-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=\"exploratief-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=\"exploratief-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=\"exploratief-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=\"exploratief-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=\"exploratief-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=\"exploratief-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=\"exploratief-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=\"exploratief-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=\"exploratief-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=\"exploratief-registratie[]\" value=\"sign-up,account,self-service-portal,downloads,dataentry,batch,transparency,integrations,codman,data-verification,dlca-r,dica\" \/><span class=\"wpcf7-list-item-label\">DLCA-R<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"exploratief-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=\"exploratief-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=\"exploratief-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=\"exploratief-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=\"exploratief-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=\"exploratief-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=\"exploratief-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=\"exploratief-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=\"exploratief-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=\"exploratief-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=\"exploratief-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=\"exploratief-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=\"exploratief-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=\"exploratief-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 last\"><label><input type=\"checkbox\" name=\"exploratief-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<p>Wanneer u Connect voor Exploratief aanvraagt worden alle uitkomsten uit Codman Exploratief gedeeld. Dit omvat zowel de transparante als niet-transparante data. Daarnaast zijn alle filters (m.u.v. behandelaarsfilters) beschikbaar voor zowel de eigen als gedeelde data. Wanneer er 10 pati\u00ebnten of minder overblijven voor een samenwerkende zorginstelling wordt de uitkomst niet getoond.<\/p>\n\n<\/div>\n<\/div>\n<\/div>\n<!-- Registratie -->\n\n\n<!-- Tijdsperiode -->\n<div class=\"block\">\n<div class=\"inner\">\n\n  <h4>Tijdsperiode<\/h4>\n  <p>Hoe lang wilt u Codman Connect blijven gebruiken? Na afloop van deze periode wordt de functionaliteit automatisch stopgezet. Uw reguliere Codman dashboards blijven uiteraard actief. Indien u niets invult wordt er uitgegaan van 3 maanden. Codman Connect wordt binnen 2 weken na ontvangst van alle getekende DocuSign contracten geactiveerd.<\/p>\n\n  <div class=\"field radio\">\n    <label>Voor welke periode wilt u Codman Connect gebruiken?<\/label>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"tijdsperiode\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"tijdsperiode\" value=\"Onbepaalde tijd\" \/><span class=\"wpcf7-list-item-label\">Onbepaalde tijd<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"tijdsperiode\" value=\"12 maanden\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">12 maanden<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"tijdsperiode\" value=\"3 maanden\" \/><span class=\"wpcf7-list-item-label\">3 maanden<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"tijdsperiode\" value=\"1 maand\" \/><span class=\"wpcf7-list-item-label\">1 maand<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"tijdsperiode\" value=\"Anders\" \/><span class=\"wpcf7-list-item-label\">Anders<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n<div data-id=\"anders\" data-orig_data_id=\"anders\"  class=\"\" data-class=\"wpcf7cf_group\">\n  <div class=\"field\">\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"andere-periode\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Anders\" value=\"\" type=\"text\" name=\"andere-periode\" \/><\/span>\n  <\/div>\n<\/div>\n<\/div>\n<\/div>\n<!-- Tijdsperiode -->\n\n\n<!-- Aanvrager -->\n<div class=\"block\">\n<div class=\"inner\">\n\n  <h4>Deelnemende instellingen<\/h4>\n  <p>Voor welke zorginstellingen wenst u Codman Connect te activeren? Alle zorginstellingen krijgen identieke functionaliteit overeenkomstig met de wensen uit dit formulier.<\/p>\n\n<h6>Benodigde informatie:<\/h6>\n\n<ol>\n<li>Namen van de zorginstellingen die deelnemen in Codman Connect samenwerking (inclusief uw eigen instellingen)<\/li>\n<li>Namen en emailadressen van de contactpersonen die binnen de zorginstellingen zorgen dat het Codman Connect contract ondertekend wordt door een geautoriseerd persoon<\/li>\n<\/ol>\n\n<p>Let op: alle zorginstellingen met wie u data wilt delen dienen hieronder expliciet vermeld te worden inclusief contactpersoon. Zonder deze informatie kan de aanvraag niet worden verwerkt.<\/p>\n\n  <div class=\"field\">\n    <label>Deelnemende instellingen<\/label>\n    <p>Voorbeeld: DICA ziekenhuis, Frank de Jong, fdejong@dica.nl; Medisch Centrum MRDM, Ronald Jansen, rjansen@mrdm.nl<\/p>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"instellingen\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Deelnemende instellingen\" name=\"instellingen\"><\/textarea><\/span>\n  <\/div>\n\n   <div class=\"field\">\n    <label>Zijn er instellingen die afwijken van de ingevulde functionaliteiten in dit formulier?<\/label>\n    <p>Hierbij kunt u denken aan een instelling die niet wilt deelnemen aan een bepaalde registratie of voor een kortere tijdsperiode<\/p>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"afwijkingen\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Afwijkingen\" name=\"afwijkingen\"><\/textarea><\/span>\n  <\/div>\n<\/div>\n<\/div>\n<!-- Aanvrager -->\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=\"eyJzb3VyY2UiOlsiY29udGFjdC1mb3JtLTdcL3dwLWNvbnRhY3QtZm9ybS03LnBocCJdLCJmb3JtX2lkIjowfQ==-d7cc6e466e8426f5e62e270f1090fe89\">\n\t\t\t\t<span id=\"hcap_cf7-69d077d27e2e83.62539340\" 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=\"9f36e59814\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/nl\/wp-json\/wp\/v2\/codman\/11193\" \/><\/span><input class=\"wpcf7-form-control wpcf7-submit has-spinner bg-color-primary bg-hover txt-color-white\" type=\"submit\" value=\"Verzenden\" \/><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"parent":3106,"menu_order":0,"template":"","class_list":["post-11193","codman","type-codman","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/support.mrdm.com\/nl\/wp-json\/wp\/v2\/codman\/11193","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/support.mrdm.com\/nl\/wp-json\/wp\/v2\/codman"}],"about":[{"href":"https:\/\/support.mrdm.com\/nl\/wp-json\/wp\/v2\/types\/codman"}],"version-history":[{"count":1,"href":"https:\/\/support.mrdm.com\/nl\/wp-json\/wp\/v2\/codman\/11193\/revisions"}],"predecessor-version":[{"id":11194,"href":"https:\/\/support.mrdm.com\/nl\/wp-json\/wp\/v2\/codman\/11193\/revisions\/11194"}],"up":[{"embeddable":true,"href":"https:\/\/support.mrdm.com\/nl\/wp-json\/wp\/v2\/codman\/3106"}],"wp:attachment":[{"href":"https:\/\/support.mrdm.com\/nl\/wp-json\/wp\/v2\/media?parent=11193"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}