{"id":43,"date":"2022-03-30T21:18:48","date_gmt":"2022-03-30T19:18:48","guid":{"rendered":"http:\/\/interreg24.de\/?page_id=43"},"modified":"2022-03-30T22:05:38","modified_gmt":"2022-03-30T20:05:38","slug":"kontakt-erfassungsbogen","status":"publish","type":"page","link":"https:\/\/interreg24.de\/index.php\/kontakt-erfassungsbogen\/","title":{"rendered":"Kontakt &#8211; Erfassungsbogen"},"content":{"rendered":"\n<p class=\"has-text-color wp-block-paragraph\" style=\"color:#000000\"><\/p>\n\n\n\n<p class=\"has-text-color wp-block-paragraph\" style=\"color:#000000;font-size:19px\">Der folgende Fragebogen erleichtert uns die Auswahl einer geeigneten Betreuungskraft f\u00fcr Sie. Daher bitten wir Sie, ihn sorgf\u00e4ltig und m\u00f6glichst genau auszuf\u00fcllen.&nbsp;<\/p>\n\n\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f85-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"85\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/43#wpcf7-f85-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"85\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.7\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f85-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<p style=\"font-size:32px\"> 1. Information zum Auftraggeber\n<\/p>\n<p><label> Anrede*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"anrede\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"anrede\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Herr\">Herr<\/option><option value=\"Frau\">Frau<\/option><\/select><\/span> <\/label><label> Titel<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-Titel\"><input size=\"32\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Titel\" \/><\/span> <\/label><label> Nachname*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-Nachname\"><input size=\"32\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Nachname\" \/><\/span> <\/label><label> Vorname*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-Vorname\"><input size=\"32\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Vorname\" \/><\/span> <\/label><label> PLZ*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-PLZ\"><input size=\"26\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-PLZ\" \/><\/span> <\/label><label> Ort*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-Ort\"><input size=\"26\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Ort\" \/><\/span> <\/label><label> Stra\u00dfe und Haus-Nr.*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"26\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span> <\/label><label> Wie wurden Sie auf<br \/>\nuns aufmerksam?*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Wie\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Wie\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Internet\">Internet<\/option><option value=\"Arzt\">Arzt<\/option><option value=\"Krankenhaus\">Krankenhaus<\/option><option value=\"Pflegedienst\">Pflegedienst<\/option><option value=\"Freunde\">Freunde<\/option><option value=\"Durch Empfehlung\">Durch Empfehlung<\/option><option value=\"Sonstiges\">Sonstiges<\/option><\/select><\/span> <\/label><label> E-Mail-Adresse f\u00fcr Kontaktaufnahme*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"30\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span> <\/label><label> Handy-Nummer*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-Handy\"><input size=\"30\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Handy\" \/><\/span> <\/label><label> Telefon (Privat)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Telefon\"><input size=\"30\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"Telefon\" \/><\/span> <\/label><label>Skype-Adresse<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-skype\"><input size=\"30\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-skype\" \/><\/span> <\/label>\n<\/p>\n<p><label> Erg\u00e4nzungen zu den Antworten<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-message1\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"your-message1\"><\/textarea><\/span> <\/label>\n<\/p>\n<p style=\"font-size:32px\"> 2. Information zur betreuten Person\n<\/p>\n<p><label> Anrede*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"anrede2\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"anrede2\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Herr\">Herr<\/option><option value=\"Frau\">Frau<\/option><\/select><\/span> <\/label><label> Titel<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-Titel2\"><input size=\"20\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Titel2\" \/><\/span> <\/label><label> Nachname*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-Nachname2\"><input size=\"20\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Nachname2\" \/><\/span> <\/label><label> Vorname*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-Vorname2\"><input size=\"20\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Vorname2\" \/><\/span> <\/label><label> Geburtstag*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-835\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" min=\"1901-01-01\" max=\"2019-11-30\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-835\" \/><\/span> <\/label><label> PLZ*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-PLZ2\"><input size=\"32\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-PLZ2\" \/><\/span> <\/label><label> Ort*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-Ort2\"><input size=\"32\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Ort2\" \/><\/span> <\/label><label> Stra\u00dfe und Haus-Nr.*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name2\"><input size=\"32\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name2\" \/><\/span> <\/label><br \/>\n<label> Wie wurden Sie auf<br \/>\nuns aufmerksam?*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Wie2\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Wie2\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Internet\">Internet<\/option><option value=\"Arzt\">Arzt<\/option><option value=\"Krankenhaus\">Krankenhaus<\/option><option value=\"Pflegedienst\">Pflegedienst<\/option><option value=\"Freunde\">Freunde<\/option><option value=\"Durch Empfehlung\">Durch Empfehlung<\/option><option value=\"Sonstiges\">Sonstiges<\/option><\/select><\/span> <\/label><label> E-Mail-Adresse f\u00fcr Kontaktaufnahme*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email2\"><input size=\"32\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email2\" \/><\/span> <\/label><label> Handy-Nummer*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-Handy2\"><input size=\"32\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Handy2\" \/><\/span> <\/label><label> Telefon (Privat)*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Telefon2\"><input size=\"32\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"Telefon2\" \/><\/span> <\/label>\n<\/p>\n<p><label> Erg\u00e4nzungen zu den Antworten<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-message2\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"your-message2\"><\/textarea><\/span> <\/label>\n<\/p>\n<p style=\"font-size:32px\"> 3. Anforderungen an die Betreuungskraft\n<\/p>\n<p><label> Alter in Jahren*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Alter\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Alter\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"20-30\">20-30<\/option><option value=\"30-40\">30-40<\/option><option value=\"40-50\">40-50<\/option><option value=\"Alter als 50\">Alter als 50<\/option><option value=\"Unwichtig\">Unwichtig<\/option><\/select><\/span> <\/label><label> Geschlecht*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Geschlecht\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Geschlecht\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Weiblich\">Weiblich<\/option><option value=\"M\u00e4nnlich\">M\u00e4nnlich<\/option><option value=\"Egal\">Egal<\/option><\/select><\/span> <\/label><label> Rauchen*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Rauchen\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Rauchen\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><option value=\"Drau\u00dfen\">Drau\u00dfen<\/option><\/select><\/span> <\/label><label> Deutschkenntnisse*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Deutschkenntnisse\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Deutschkenntnisse\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Sehr gut\">Sehr gut<\/option><option value=\"Gut\">Gut<\/option><option value=\"Grundkenntnisse\">Grundkenntnisse<\/option><\/select><\/span> <\/label>\n<\/p>\n<p><label> Erg\u00e4nzungen zu den Antworten<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-message3\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"your-message3\"><\/textarea><\/span> <\/label>\n<\/p>\n<p style=\"font-size:32px\"> 4. Gegebenheiten am Betreuungsort\n<\/p>\n<p><label> Art der Wohnung*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Art\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Art\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Wohnung\">Wohnung<\/option><option value=\"Einfamilienhaus\">Einfamilienhaus<\/option><option value=\"Mehrfamilienhaus\">Mehrfamilienhaus<\/option><\/select><\/span> <\/label><label> Lage der Wohnung*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Lage\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Lage\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Stadtzentrum\">Stadtzentrum<\/option><option value=\"Stadtrand\">Stadtrand<\/option><option value=\"Vorort\">Vorort<\/option><option value=\"Dorf\">Dorf<\/option><option value=\"Alleinlage\">Alleinlage<\/option><\/select><\/span> <\/label><label> Stockwerk<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-Stockwerk\"><input size=\"20\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Stockwerk\" \/><\/span> <\/label><label> Lift*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Lift\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Lift\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><\/select><\/span> <\/label><br \/>\n<label> Anzahl der Zimmer*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-Anzahl\"><input size=\"32\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Anzahl\" \/><\/span> <\/label><label> Gr\u00f6\u00dfe der Wohnung (qm)*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-GreBe\"><input size=\"32\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-GreBe\" \/><\/span> <\/label><label> Personen im Haushalt*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-Personen\"><input size=\"32\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Personen\" \/><\/span> <\/label><label> Haustiere<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-Haustiere\"><input size=\"32\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Haustiere\" \/><\/span> <\/label><label>Eigenes Zimmer f\u00fcr die<br \/>\nBetreuungskraft?*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"EigenesZimmer\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"EigenesZimmer\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><\/select><\/span> <\/label><label> Eigenes Bad\/Dusche<br \/>\nf\u00fcr Betreuungskraft?*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Eigenes\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Eigenes\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><\/select><\/span> <\/label><label> Einkaufsm\u00f6glichkeit zu Fu\u00df*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Einkaufsmoglichkeit\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Einkaufsmoglichkeit\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Ca. 10 min\">Ca. 10 min<\/option><option value=\"Ca. 20 min\">Ca. 20 min<\/option><option value=\"Ca. 30 min\">Ca. 30 min<\/option><\/select><\/span> <\/label><label> Internet vorhanden?*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Internet\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Internet\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><\/select><\/span> <\/label><label> Wohnung der Angeh\u00f6rigen*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Wohnung\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Wohnung\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Im gleichen Haus\">Im gleichen Haus<\/option><option value=\"In der N\u00e4he\">In der N\u00e4he<\/option><option value=\"Weiter entfernt\">Weiter entfernt<\/option><\/select><\/span><\/label>\n<\/p>\n<p><label> Erg\u00e4nzungen zu den Antworten<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-message4\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"your-message4\"><\/textarea><\/span> <\/label>\n<\/p>\n<p style=\"font-size:32px\"> 5. Angaben zur betreuten Person\n<\/p>\n<p><label> Pflegesgrad*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Pflegesgrad\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"Pflegesgrad\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Keine\">Keine<\/option><option value=\"Beantragt\">Beantragt<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><\/select><\/span> <\/label><label> Versorgung durch Pflegedienst?*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Versorgung\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"Versorgung\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><\/select><\/span> <\/label><label> Wenn ja: Soll der Pflegedienst weiterhin<br \/>\nin Anspruch genommen<br \/>\nwerden?*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Soll\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Soll\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><\/select><\/span> <\/label><label> H\u00e4ufigkeit des Pflegedienstes<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-Haufigkeit\"><input size=\"20\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Haufigkeit\" \/><\/span> <\/label><label> T\u00e4tigkeiten des Pflegedienstes<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-Tatigkeiten\"><input size=\"20\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Tatigkeiten\" \/><\/span> <\/label>\n<\/p>\n<p><label> Erg\u00e4nzungen zu den Antworten<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-message5\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"your-message5\"><\/textarea><\/span> <\/label>\n<\/p>\n<p style=\"font-size:32px\"> 6. Zustand der betreuten Person\n<\/p>\n<p><label> K\u00f6rpergr\u00f6\u00dfe (cm)*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-KorpergroBe\"><input size=\"15\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-KorpergroBe\" \/><\/span> <\/label><label> Gewicht (kg)*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-Gewicht\"><input size=\"15\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Gewicht\" \/><\/span> <\/label><label> Liegen ansteckende<br \/>\nKrankheiten vor?*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Liegen\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Liegen\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><\/select><\/span><\/label><label> Falls ja, welche?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-Falls\"><input size=\"20\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Falls\" \/><\/span> <\/label><label> Diagnosen*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-Diagnosen\"><input size=\"20\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Diagnosen\" \/><\/span> <\/label><label> Allergien<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-Allergien\"><input size=\"20\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Allergien\" \/><\/span> <\/label><label> Sonstige Einschr\u00e4nkungen<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-Sonstige\"><input size=\"20\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Sonstige\" \/><\/span> <\/label><label> Welche Hilfsmittel sind vorhanden?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-WelcheHilfsmittel\"><input size=\"20\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-WelcheHilfsmittel\" \/><\/span> <\/label><label> Umfang n\u00e4chtlicher Hilfe*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Umfang\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Umfang\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Keine\">Keine<\/option><option value=\"Gelegentlich\">Gelegentlich<\/option><option value=\"Ein-zweimal pro Nacht\">Ein-zweimal pro Nacht<\/option><\/select><\/span> <\/label><label> Welche Hilfe ist nachts n\u00f6tig?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-Welche\"><input size=\"32\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Welche\" \/><\/span> <\/label><label> Beliebte Besch\u00e4ftigungen und Hobbys<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-Beliebte\"><input size=\"32\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Beliebte\" \/><\/span> <\/label><label> Raucher*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Raucher\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Raucher\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><\/select><\/span><\/label><label> Kommunikation*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Kommunikation\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Kommunikation\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Gut\">Gut<\/option><option value=\"Eingeschr\u00e4nkt\">Eingeschr\u00e4nkt<\/option><option value=\"Nicht m\u00f6glich\">Nicht m\u00f6glich<\/option><\/select><\/span> <\/label><label> Besonderheiten im Umgang<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-Besonderheiten\"><input size=\"32\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Besonderheiten\" \/><\/span> <\/label>\n<\/p>\n<p><label> Erg\u00e4nzungen zu den Antworten<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-message6\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"your-message6\"><\/textarea><\/span> <\/label>\n<\/p>\n<p style=\"font-size:32px\"> 7. Gew\u00fcnschte Betreuungsleistungen\n<\/p>\n<p><label> An- und Auskleiden*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"An-\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"An-\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><\/select><\/span> <\/label><label> Toilettengang*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Toilettengang\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Toilettengang\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><\/select><\/span> <\/label><label> K\u00f6rperhygiene*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Korperhygiene\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Korperhygiene\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><\/select><\/span> <\/label><label> Nahrungsaufnahme*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Nahrungsaufnahme\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Nahrungsaufnahme\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><\/select><\/span> <\/label><br \/>\n<label> Gespr\u00e4che f\u00fchren*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Gesprache\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Gesprache\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><\/select><\/span> <\/label><label> Bewegungs\u00fcbungen*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Bewegungsubungen\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Bewegungsubungen\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><\/select><\/span> <\/label><label> Hilfe beim Gehen und<br \/>\nStehen*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Hilfe\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Hilfe\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><\/select><\/span> <\/label><label> Spazieren gehen*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Spazieren\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Spazieren\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><\/select><\/span> <\/label>\n<\/p>\n<p><label> Erg\u00e4nzungen zu den Antworten<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-message7\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"your-message7\"><\/textarea><\/span> <\/label>\n<\/p>\n<p style=\"font-size:32px\"> 8. Gew\u00fcnschte hauswirtschaftliche Leistungen\n<\/p>\n<p><label> Raumpflege*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Raumpflege\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Raumpflege\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><\/select><\/span> <\/label><label> Waschen und B\u00fcgeln*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Waschen\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Waschen\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><\/select><\/span> <\/label><label> Balkon- und Gartenpflege*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Balkon\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Balkon\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><\/select><\/span> <\/label><label> Einkaufen*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Einkaufen\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Einkaufen\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><\/select><\/span> <\/label><label> Versorgung von Haustieren*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Versorgung\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Versorgung\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><\/select><\/span> <\/label><label> Kochen und Backen*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Kochen\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Kochen\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><\/select><\/span> <\/label>\n<\/p>\n<p><label> Erg\u00e4nzungen zu den Antworten<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-message8\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"your-message8\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"quiz-305\"><label><span class=\"wpcf7-quiz-label\">7+1=<\/span> <input size=\"5\" maxlength=\"10\" class=\"wpcf7-form-control wpcf7-quiz\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" type=\"text\" name=\"quiz-305\" \/><\/label><input type=\"hidden\" name=\"_wpcf7_quiz_answer_quiz-305\" value=\"92f140d75c2cd87e5ce63a6c59cbd8e9\" \/><\/span><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n<\/p>\n<p>Mit * gekennzeichnete Felder bitten wir Sie unbedingt auszuf\u00fcllen.<br \/>\nNach Senden erhalten Sie automatisch eine Kopie Ihrer Mail auf die angegebene eigene Mailadresse.\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n\n\n\n<h3 class=\"wp-block-heading\"><a href=\"https:\/\/interreg24.de\/index.php\/fragen-und-antworten\/\" data-type=\"page\" data-id=\"47\">Fragen und Antworten<\/a><\/h3>\n","protected":false},"excerpt":{"rendered":"<p>Der folgende Fragebogen erleichtert uns die Auswahl einer geeigneten Betreuungskraft f\u00fcr Sie. Daher bitten wir Sie, ihn sorgf\u00e4ltig und m\u00f6glichst genau auszuf\u00fcllen.&nbsp; Fragen und Antworten<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-43","page","type-page","status-publish"],"_links":{"self":[{"href":"https:\/\/interreg24.de\/index.php\/wp-json\/wp\/v2\/pages\/43","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/interreg24.de\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/interreg24.de\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/interreg24.de\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/interreg24.de\/index.php\/wp-json\/wp\/v2\/comments?post=43"}],"version-history":[{"count":5,"href":"https:\/\/interreg24.de\/index.php\/wp-json\/wp\/v2\/pages\/43\/revisions"}],"predecessor-version":[{"id":104,"href":"https:\/\/interreg24.de\/index.php\/wp-json\/wp\/v2\/pages\/43\/revisions\/104"}],"wp:attachment":[{"href":"https:\/\/interreg24.de\/index.php\/wp-json\/wp\/v2\/media?parent=43"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}