{"id":12,"date":"2011-11-20T13:44:00","date_gmt":"2011-11-20T12:44:00","guid":{"rendered":"http:\/\/retinaok.wordpress.com\/?page_id=12"},"modified":"2023-06-22T12:02:43","modified_gmt":"2023-06-22T12:02:43","slug":"verwijsbrief","status":"publish","type":"page","link":"https:\/\/retinaok.com\/utrecht\/verwijsbrief\/","title":{"rendered":"Verwijzing"},"content":{"rendered":"<section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock  '   itemprop=\"text\" ><div style=\"margin-right: 5%; margin-left: 10%;\">\n<p style=\"text-align: left;\"><span style=\"color: #000000;\">1.<b>\u00a0<\/b><\/span>U downloadt en print hier de instructies voor de pati\u00ebnt voor het maken van een afspraak en een routebeschrijving :\u00a0\u00a0<span style=\"color: #0000ff;\"><span style=\"color: #0000ff;\"><a href=\"http:\/\/retinaok.com\/utrecht\/wp-content\/uploads\/2022\/06\/Patienteninstructie-utrecht.pdf\">Pati\u00ebnteninstructie<\/a><\/span><\/span><\/p>\n<p style=\"text-align: left;\"><strong>Wij nemen zelf contact op met de pati\u00ebnt.<\/strong><\/p>\n<p style=\"text-align: left;\">2. U kunt de rechter muisknop gebruiken om tekst van elders te kopi\u00ebren en hier te plakken. U krijgt de mogelijkheid een afdruk te\u00a0maken voor uw eigen documentatie voordat het bericht verzonden wordt.<\/p>\n<p>We doen er alles aan om de toegangstijden zo laag mogelijk te houden. Vanwege toenemende drukte vragen we daarom aan u als verwijzer of u er bezwaar tegen heeft wanneer uw pati\u00ebnt(e) op \u00e9\u00e9n van onze andere locatie wordt gezien en eventueel behandeld. Op het verwijsformulier kunt u dit met \u00e9\u00e9n druk op de knop aangeven.<\/p>\n<p>WILT U AUB in het belang van de pati\u00ebnt goed het formulier invullen?<\/p>\n<p>LET OP: correcte AGB code arts, BSN en TELEFOONNUMMER van pati\u00ebnt.<\/p>\n<p style=\"text-align: left;\"><strong>Het formulier wordt beveiligd verstuurd via ZIVVER. U heeft geen account hiervoor nodig.<\/strong><\/p>\n<\/div>\n<\/div><\/section>\n<section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock  '   itemprop=\"text\" ><div style=\"margin-left: 10%; margin-right: 5%;\">\n<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-3715\"><form id=\"wpforms-form-3715\" class=\"wpforms-validate wpforms-form\" data-formid=\"3715\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/utrecht\/wp-json\/wp\/v2\/pages\/12\" data-token=\"c1924b765a17c703ff15f44396a37087\" data-token-time=\"1776237927\"><noscript class=\"wpforms-error-noscript\">Schakel JavaScript in je browser in om dit formulier in te vullen.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-3715-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><label class=\"wpforms-field-label\" for=\"wpforms-3715-field_0\">Naam verwijzer <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3715-field_0\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][0]\" required><\/div><div id=\"wpforms-3715-field_18-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-3715-field_18\">Functie verwijzer<\/label><input type=\"text\" id=\"wpforms-3715-field_18\" class=\"wpforms-field-medium\" name=\"wpforms[fields][18]\" value=\"Oogarts\" placeholder=\"Oogarts\" ><\/div><div id=\"wpforms-3715-field_3-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-3715-field_3\">AGB code verwijzer <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3715-field_3\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][3]\" required><div class=\"wpforms-field-description\">Vermelding van de AGB code is een verplichting van de NZa<\/div><\/div><div id=\"wpforms-3715-field_19-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-3715-field_19\">Welke behandeling<\/label><input type=\"text\" id=\"wpforms-3715-field_19\" class=\"wpforms-field-medium\" name=\"wpforms[fields][19]\" value=\"vitreoretinale zorg\" placeholder=\"vitreoretinale zorg\" ><\/div><div id=\"wpforms-3715-field_21-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-3715-field_21\">Burgerservicenummer (BSN) patient: <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-3715-field_21\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][21]\" step=\"any\" required><\/div><div id=\"wpforms-3715-field_20-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-3715-field_20\">Naam van de patient(e)<\/label><input type=\"text\" id=\"wpforms-3715-field_20\" class=\"wpforms-field-medium\" name=\"wpforms[fields][20]\" ><\/div><div id=\"wpforms-3715-field_14-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-3715-field_14\">Geboortedatum patient: dd-mm-jjjj <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3715-field_14\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][14]\" required><\/div><div id=\"wpforms-3715-field_22-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-3715-field_22\">Telefoonnummer patient: <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-3715-field_22\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][22]\" step=\"any\" required><\/div><div id=\"wpforms-3715-field_23-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-3715-field_23\">Pati\u00ebntennummer Eyescan (EMMA nummer voor interne verwijzingen)<\/label><input type=\"number\" id=\"wpforms-3715-field_23\" class=\"wpforms-field-medium\" name=\"wpforms[fields][23]\" step=\"any\" ><\/div><div id=\"wpforms-3715-field_7-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"7\"><label class=\"wpforms-field-label\">Geslacht <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3715-field_7\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3715-field_7_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][7][]\" value=\"Man\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3715-field_7_1\">Man<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-3715-field_7_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][7][]\" value=\"Vrouw\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3715-field_7_2\">Vrouw<\/label><\/li><\/ul><\/div><div id=\"wpforms-3715-field_4-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-3715-field_4\">Naam kliniek <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3715-field_4\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][4]\" required><\/div><div id=\"wpforms-3715-field_8-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-3715-field_8\">Visus OD<\/label><select id=\"wpforms-3715-field_8\" class=\"wpforms-field-large\" name=\"wpforms[fields][8]\"><option value=\"1.0\"  class=\"choice-1 depth-1\"  >1.0<\/option><option value=\"0.8\"  class=\"choice-2 depth-1\"  >0.8<\/option><option value=\"0.6\"  class=\"choice-3 depth-1\"  >0.6<\/option><option value=\"0.5\"  class=\"choice-4 depth-1\"  >0.5<\/option><option value=\"0.4\"  class=\"choice-5 depth-1\"  >0.4<\/option><option value=\"0.3\"  class=\"choice-6 depth-1\"  >0.3<\/option><option value=\"0.2\"  class=\"choice-7 depth-1\"  >0.2<\/option><option value=\"0.1\"  class=\"choice-8 depth-1\"  >0.1<\/option><option value=\"vingerstellen\"  class=\"choice-9 depth-1\"  >vingerstellen<\/option><option value=\"handbewegingen\"  class=\"choice-10 depth-1\"  >handbewegingen<\/option><option value=\"lichtperceptie positief\"  class=\"choice-11 depth-1\"  >lichtperceptie positief<\/option><option value=\"lichtperceptie negatief\"  class=\"choice-12 depth-1\"  >lichtperceptie negatief<\/option><\/select><\/div><div id=\"wpforms-3715-field_10-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-3715-field_10\">Visus OS<\/label><select id=\"wpforms-3715-field_10\" class=\"wpforms-field-large\" name=\"wpforms[fields][10]\"><option value=\"1.0\"  class=\"choice-1 depth-1\"  >1.0<\/option><option value=\"0.8\"  class=\"choice-2 depth-1\"  >0.8<\/option><option value=\"0.6\"  class=\"choice-3 depth-1\"  >0.6<\/option><option value=\"0.5\"  class=\"choice-4 depth-1\"  >0.5<\/option><option value=\"0.4\"  class=\"choice-5 depth-1\"  >0.4<\/option><option value=\"0.3\"  class=\"choice-6 depth-1\"  >0.3<\/option><option value=\"0.2\"  class=\"choice-7 depth-1\"  >0.2<\/option><option value=\"0.1\"  class=\"choice-8 depth-1\"  >0.1<\/option><option value=\"vingerstellen\"  class=\"choice-9 depth-1\"  >vingerstellen<\/option><option value=\"handbewegingen\"  class=\"choice-10 depth-1\"  >handbewegingen<\/option><option value=\"lichtperceptie positief\"  class=\"choice-11 depth-1\"  >lichtperceptie positief<\/option><option value=\"lichtperceptie negatief\"  class=\"choice-12 depth-1\"  >lichtperceptie negatief<\/option><\/select><\/div><div id=\"wpforms-3715-field_9-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-3715-field_9\">Pathologie OD<\/label><select id=\"wpforms-3715-field_9\" class=\"wpforms-field-large\" name=\"wpforms[fields][9]\"><option value=\"geen afwijkingen\"  class=\"choice-1 depth-1\"  >geen afwijkingen<\/option><option value=\"zie aanvullende informatie\"  class=\"choice-2 depth-1\"  >zie aanvullende informatie<\/option><option value=\"endophthalmitis\"  class=\"choice-3 depth-1\"  >endophthalmitis<\/option><option value=\"ablatio binnen vaatboog met aanliggende fovea\"  class=\"choice-4 depth-1\"  >ablatio binnen vaatboog met aanliggende fovea<\/option><option value=\"ablatio buiten vaatboog\"  class=\"choice-5 depth-1\"  >ablatio buiten vaatboog<\/option><option value=\"ablatio met macula af\"  class=\"choice-6 depth-1\"  >ablatio met macula af<\/option><option value=\"submaculaire bloeding\"  class=\"choice-7 depth-1\"  >submaculaire bloeding<\/option><option value=\"glasvochtbloeding\"  class=\"choice-8 depth-1\"  >glasvochtbloeding<\/option><option value=\"dropped nucleus\"  class=\"choice-9 depth-1\"  >dropped nucleus<\/option><option value=\"maculagat\"  class=\"choice-11 depth-1\"  >maculagat<\/option><option value=\"lamellair maculagat\"  class=\"choice-16 depth-1\"  >lamellair maculagat<\/option><option value=\"diabetische retinopathie\"  class=\"choice-12 depth-1\"  >diabetische retinopathie<\/option><option value=\"floaters\"  class=\"choice-13 depth-1\"  >floaters<\/option><option value=\"pucker\"  class=\"choice-14 depth-1\"  >pucker<\/option><option value=\"vitreo-maculaire tractie\"  class=\"choice-15 depth-1\"  >vitreo-maculaire tractie<\/option><\/select><\/div><div id=\"wpforms-3715-field_11-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-3715-field_11\">Pathologie OS<\/label><select id=\"wpforms-3715-field_11\" class=\"wpforms-field-large\" name=\"wpforms[fields][11]\"><option value=\"geen afwijkingen\"  class=\"choice-1 depth-1\"  >geen afwijkingen<\/option><option value=\"zie aanvullende informatie\"  class=\"choice-2 depth-1\"  >zie aanvullende informatie<\/option><option value=\"endophthalmitis\"  class=\"choice-3 depth-1\"  >endophthalmitis<\/option><option value=\"ablatio binnen vaatboog met aanliggende fovea\"  class=\"choice-4 depth-1\"  >ablatio binnen vaatboog met aanliggende fovea<\/option><option value=\"ablatio buiten vaatboog\"  class=\"choice-5 depth-1\"  >ablatio buiten vaatboog<\/option><option value=\"ablatio met macula af\"  class=\"choice-6 depth-1\"  >ablatio met macula af<\/option><option value=\"submaculaire bloeding\"  class=\"choice-7 depth-1\"  >submaculaire bloeding<\/option><option value=\"glasvochtbloeding\"  class=\"choice-8 depth-1\"  >glasvochtbloeding<\/option><option value=\"dropped nucleus\"  class=\"choice-9 depth-1\"  >dropped nucleus<\/option><option value=\"maculagat\"  class=\"choice-11 depth-1\"  >maculagat<\/option><option value=\"lamellair maculagat\"  class=\"choice-16 depth-1\"  >lamellair maculagat<\/option><option value=\"diabetische retinopathie\"  class=\"choice-12 depth-1\"  >diabetische retinopathie<\/option><option value=\"floaters\"  class=\"choice-13 depth-1\"  >floaters<\/option><option value=\"pucker\"  class=\"choice-14 depth-1\"  >pucker<\/option><option value=\"vitreo-maculaire tractie\"  class=\"choice-15 depth-1\"  >vitreo-maculaire tractie<\/option><\/select><\/div><div id=\"wpforms-3715-field_12-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-3715-field_12\">OCT en andere bijlagen<\/label><select id=\"wpforms-3715-field_12\" class=\"wpforms-field-large\" name=\"wpforms[fields][12]\"><option value=\"geen bijlagen\"  class=\"choice-1 depth-1\"  >geen bijlagen<\/option><option value=\"zijn meegegeven aan de patient\"  class=\"choice-2 depth-1\"  >zijn meegegeven aan de patient<\/option><option value=\"per mail verzonden\"  class=\"choice-3 depth-1\"  >per mail verzonden<\/option><option value=\"per post verzonden\"  class=\"choice-4 depth-1\"  >per post verzonden<\/option><option value=\"als fax verzonden\"  class=\"choice-5 depth-1\"  >als fax verzonden<\/option><\/select><\/div><div id=\"wpforms-3715-field_25-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-3715-field_25\">Hebt u bezwaar als pati\u00ebnt(e) eventueel in in \u00e9\u00e9n van onze andere centra behandeld wordt?(verplicht)<\/label><select id=\"wpforms-3715-field_25\" class=\"wpforms-field-large\" name=\"wpforms[fields][25]\"><option value=\"Ja\"  class=\"choice-1 depth-1\"  >Ja<\/option><option value=\"Nee\"  class=\"choice-2 depth-1\"  >Nee<\/option><\/select><\/div><div id=\"wpforms-3715-field_2-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-3715-field_2\">Aanvullende informatie en vraagstelling <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-3715-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" required><\/textarea><div class=\"wpforms-field-description\">U kunt de rechter muisknop gebruiken om tekst van elders te kopi\u00ebren en hier te plakken.\r\n\r\nU kunt een afdruk maken voor uw eigen documentatie. Wacht even met printen tot bericht verzonden is.<\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-field wpforms-field-hp\"><label for=\"wpforms-3715-field-hp\" class=\"wpforms-field-label\">Message<\/label><input type=\"text\" name=\"wpforms[hp]\" id=\"wpforms-3715-field-hp\" class=\"wpforms-field-medium\"><\/div><div class=\"wpforms-recaptcha-container wpforms-is-recaptcha wpforms-is-recaptcha-type-v2\" ><div class=\"g-recaptcha\" data-sitekey=\"6LfNIwoaAAAAAFSjAmWSzvqG21FT-Ke2_NFF_qdo\"><\/div><input type=\"text\" name=\"g-recaptcha-hidden\" class=\"wpforms-recaptcha-hidden\" style=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\" data-rule-recaptcha=\"1\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"3715\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/retinaok.com\/utrecht\/wp-json\/wp\/v2\/pages\/12\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-3715\" class=\"wpforms-submit\" data-alt-text=\"Verzenden...\" data-submit-text=\"Verstuur\" aria-live=\"assertive\" value=\"wpforms-submit\">Verstuur<\/button><\/div><\/form><\/div>  <!-- .wpforms-container -->\n<\/div>\n<div style=\"margin-left: 10%;\"><\/div>\n<\/div><\/section>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":4,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-12","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - 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