{"id":431,"date":"2025-02-17T12:54:47","date_gmt":"2025-02-17T12:54:47","guid":{"rendered":"https:\/\/sentivopl.com\/?page_id=431"},"modified":"2025-02-17T13:20:48","modified_gmt":"2025-02-17T13:20:48","slug":"unsere-bedarfsbogen","status":"publish","type":"page","link":"https:\/\/sentivopl.com\/index.php\/unsere-bedarfsbogen\/","title":{"rendered":"Unsere Bedarfsbogen"},"content":{"rendered":"\n<div class=\"wp-block-group alignwide has-base-2-background-color has-background is-layout-flow wp-block-group-is-layout-flow\" style=\"padding-top:var(--wp--preset--spacing--10);padding-right:var(--wp--preset--spacing--60);padding-bottom:var(--wp--preset--spacing--10);padding-left:var(--wp--preset--spacing--60)\"><div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-600c4f54-3aeb-44b0-aac2-4649a412bfae wpforms-render-modern\" id=\"wpforms-462\"><form id=\"wpforms-form-462\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"462\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/431\" data-token=\"6f2094489a09b6bcb37eee57d4f6df8c\" data-token-time=\"1779778219\"><div class=\"wpforms-head-container\"><div class=\"wpforms-title\">Bedarfsbogen<\/div><\/div><noscript class=\"wpforms-error-noscript\">Aby wype\u0142ni\u0107 ten formularz, w\u0142\u0105cz obs\u0142ug\u0119 JavaScript w przegl\u0105darce.<\/noscript><div class=\"wpforms-hidden\" id=\"wpforms-error-noscript\">Aby wype\u0142ni\u0107 ten formularz, w\u0142\u0105cz obs\u0142ug\u0119 JavaScript w przegl\u0105darce.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-462-field_74-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"74\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_74\">Welche Dienstleistung m\u00f6chten Sie in Anspruch nehmen? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-462-field_74\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][74]\" required=\"required\"><option value=\"Ausw\u00e4hlen\" >Ausw\u00e4hlen<\/option><option value=\"Stundenweise Betreuung\" >Stundenweise Betreuung<\/option><option value=\"24-Stunden-Betreuung\" >24-Stunden-Betreuung<\/option><\/select><\/div><div id=\"wpforms-462-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_0\">Name Kontaktperson: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-462-field_0\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][0]\" aria-errormessage=\"wpforms-462-field_0-error\" required><\/div><div id=\"wpforms-462-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_1\">E-Mail: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-462-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" spellcheck=\"false\" aria-errormessage=\"wpforms-462-field_1-error\" required><\/div><div id=\"wpforms-462-field_3-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_3\">Telefon: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-462-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" aria-errormessage=\"wpforms-462-field_3-error\" required><\/div><div id=\"wpforms-462-field_8-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_8\">Stra\u00dfe &amp; Hausnummer <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-462-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" aria-errormessage=\"wpforms-462-field_8-error\" required><\/div><div id=\"wpforms-462-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_9\">Postleitzahl &amp; Ort <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-462-field_9\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][9]\" aria-errormessage=\"wpforms-462-field_9-error\" required><\/div><div id=\"wpforms-462-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_10\">Geburtsdatum <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-462-field_10\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][10]\" aria-errormessage=\"wpforms-462-field_10-error\" required><\/div><div id=\"wpforms-462-field_2-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_2\">Beziehung zur pflegebed\u00fcrftigen Person: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-462-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" aria-errormessage=\"wpforms-462-field_2-error\" required><\/textarea><\/div><div id=\"wpforms-462-field_11-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_11\">Name pflegebed\u00fcrftige Person: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-462-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" aria-errormessage=\"wpforms-462-field_11-error\" required><\/div><div id=\"wpforms-462-field_12-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_12\">Telefon: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-462-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" aria-errormessage=\"wpforms-462-field_12-error\" required><\/div><div id=\"wpforms-462-field_13-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_13\">Stra\u00dfe &amp; Hausnummer: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-462-field_13\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][13]\" aria-errormessage=\"wpforms-462-field_13-error\" required><\/div><div id=\"wpforms-462-field_14-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_14\">Postleitzahl &amp; Ort: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-462-field_14\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][14]\" aria-errormessage=\"wpforms-462-field_14-error\" required><\/div><div id=\"wpforms-462-field_15-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_15\">Geburtsdatum: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-462-field_15\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][15]\" aria-errormessage=\"wpforms-462-field_15-error\" required><\/div><div id=\"wpforms-462-field_131-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"131\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_131\">Gr\u00f6\u00dfe <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-462-field_131\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][131]\" aria-errormessage=\"wpforms-462-field_131-error\" required><\/div><div id=\"wpforms-462-field_132-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"132\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_132\">Gewicht <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-462-field_132\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][132]\" aria-errormessage=\"wpforms-462-field_132-error\" required><\/div><div id=\"wpforms-462-field_16-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_16\">Wer wohnt im Haushalt: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-462-field_16\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][16]\" aria-errormessage=\"wpforms-462-field_16-error\" required><\/textarea><\/div><div id=\"wpforms-462-field_76-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"76\"><fieldset><legend class=\"wpforms-field-label\">Pflegegrad <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_76\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_76_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][76][]\" value=\"1\" aria-errormessage=\"wpforms-462-field_76_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_76_1\">1<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_76_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][76][]\" value=\"2\" aria-errormessage=\"wpforms-462-field_76_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_76_2\">2<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_76_18\" data-rule-check-limit=\"true\" name=\"wpforms[fields][76][]\" value=\"3\" aria-errormessage=\"wpforms-462-field_76_18-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_76_18\">3<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_76_3\" data-rule-check-limit=\"true\" name=\"wpforms[fields][76][]\" value=\"4\" aria-errormessage=\"wpforms-462-field_76_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_76_3\">4<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_76_4\" data-rule-check-limit=\"true\" name=\"wpforms[fields][76][]\" value=\"5\" aria-errormessage=\"wpforms-462-field_76_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_76_4\">5<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_76_5\" data-rule-check-limit=\"true\" name=\"wpforms[fields][76][]\" value=\"beantragt\" aria-errormessage=\"wpforms-462-field_76_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_76_5\">beantragt<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_76_6\" data-rule-check-limit=\"true\" name=\"wpforms[fields][76][]\" value=\"ohne\" aria-errormessage=\"wpforms-462-field_76_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_76_6\">ohne<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_78-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"78\"><fieldset><legend class=\"wpforms-field-label\">Erfolgt aktuell eine Versorgung durch einen ambulanten Pflegedienst?  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_78\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_78_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][78][]\" value=\"Ja\" aria-errormessage=\"wpforms-462-field_78_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_78_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_78_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][78][]\" value=\"Nein\" aria-errormessage=\"wpforms-462-field_78_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_78_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_120-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"120\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_120\">Welche T\u00e4tigkeiten \u00fcbt der Pflegedienst aus<\/label><textarea id=\"wpforms-462-field_120\" class=\"wpforms-field-medium\" name=\"wpforms[fields][120]\" aria-errormessage=\"wpforms-462-field_120-error\" ><\/textarea><\/div><div id=\"wpforms-462-field_20-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-3-columns\" data-field-id=\"20\"><fieldset><legend class=\"wpforms-field-label\">Medizinische Angaben <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_20\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_20_1\" name=\"wpforms[fields][20][]\" value=\"Depression\" aria-errormessage=\"wpforms-462-field_20_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_20_1\">Depression<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_20_2\" name=\"wpforms[fields][20][]\" value=\"Tumor\" aria-errormessage=\"wpforms-462-field_20_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_20_2\">Tumor<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_20_18\" name=\"wpforms[fields][20][]\" value=\"Diabetes\" aria-errormessage=\"wpforms-462-field_20_18-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_20_18\">Diabetes<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_20_3\" name=\"wpforms[fields][20][]\" value=\"Schlaganfall\" aria-errormessage=\"wpforms-462-field_20_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_20_3\">Schlaganfall<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_20_4\" name=\"wpforms[fields][20][]\" value=\"Hypertonie (Bluthochdruck)\" aria-errormessage=\"wpforms-462-field_20_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_20_4\">Hypertonie (Bluthochdruck)<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_20_5\" name=\"wpforms[fields][20][]\" value=\"Dekubitus\" aria-errormessage=\"wpforms-462-field_20_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_20_5\">Dekubitus<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_20_6\" name=\"wpforms[fields][20][]\" value=\"Stoma\" aria-errormessage=\"wpforms-462-field_20_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_20_6\">Stoma<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_20_7\" name=\"wpforms[fields][20][]\" value=\"Alzheimer\" aria-errormessage=\"wpforms-462-field_20_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_20_7\">Alzheimer<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_20_8\" name=\"wpforms[fields][20][]\" value=\"altersbedingte Gehschw\u00e4che\" aria-errormessage=\"wpforms-462-field_20_8-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_20_8\">altersbedingte Gehschw\u00e4che<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_20_10\" name=\"wpforms[fields][20][]\" value=\"Multiple Sklerose\" aria-errormessage=\"wpforms-462-field_20_10-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_20_10\">Multiple Sklerose<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_20_11\" name=\"wpforms[fields][20][]\" value=\"Allgerien\" aria-errormessage=\"wpforms-462-field_20_11-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_20_11\">Allgerien<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_20_12\" name=\"wpforms[fields][20][]\" value=\"Herzrythmusst\u00f6rungen\" aria-errormessage=\"wpforms-462-field_20_12-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_20_12\">Herzrythmusst\u00f6rungen<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_20_13\" name=\"wpforms[fields][20][]\" value=\"Herzinfakt\" aria-errormessage=\"wpforms-462-field_20_13-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_20_13\">Herzinfakt<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_20_14\" name=\"wpforms[fields][20][]\" value=\"Osteoporose\" aria-errormessage=\"wpforms-462-field_20_14-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_20_14\">Osteoporose<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_20_15\" name=\"wpforms[fields][20][]\" value=\"Demenz\" aria-errormessage=\"wpforms-462-field_20_15-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_20_15\">Demenz<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_20_16\" name=\"wpforms[fields][20][]\" value=\"Parkinson\" aria-errormessage=\"wpforms-462-field_20_16-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_20_16\">Parkinson<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_20_17\" name=\"wpforms[fields][20][]\" value=\"chronische Durchf\u00e4lle\" aria-errormessage=\"wpforms-462-field_20_17-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_20_17\">chronische Durchf\u00e4lle<\/label><\/li><li class=\"choice-19 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_20_19\" name=\"wpforms[fields][20][]\" value=\"Herzinsuffizienz\" aria-errormessage=\"wpforms-462-field_20_19-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_20_19\">Herzinsuffizienz<\/label><\/li><li class=\"choice-20 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_20_20\" name=\"wpforms[fields][20][]\" value=\"Asthma\" aria-errormessage=\"wpforms-462-field_20_20-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_20_20\">Asthma<\/label><\/li><li class=\"choice-21 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_20_21\" name=\"wpforms[fields][20][]\" value=\"Rheuma\" aria-errormessage=\"wpforms-462-field_20_21-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_20_21\">Rheuma<\/label><\/li><li class=\"choice-23 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_20_23\" name=\"wpforms[fields][20][]\" value=\"Krebserkrankung\" aria-errormessage=\"wpforms-462-field_20_23-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_20_23\">Krebserkrankung<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_20_22\" name=\"wpforms[fields][20][]\" value=\"Bettl\u00e4gerig\" aria-errormessage=\"wpforms-462-field_20_22-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_20_22\">Bettl\u00e4gerig<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_80-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"80\"><fieldset><legend class=\"wpforms-field-label\">Wollen Sie k\u00fcnftig einen ambulanten Pflegedienst in Anspruch nehmen? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_80\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_80_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][80][]\" value=\"Ja\" aria-errormessage=\"wpforms-462-field_80_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_80_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_80_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][80][]\" value=\"Nein\" aria-errormessage=\"wpforms-462-field_80_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_80_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_81-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"81\"><fieldset><legend class=\"wpforms-field-label\">Sind ansteckende Krankheiten vorhanden (z.B. MRSA): <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_81\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_81_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][81][]\" value=\"Ja\" aria-errormessage=\"wpforms-462-field_81_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_81_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_81_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][81][]\" value=\"Nein\" aria-errormessage=\"wpforms-462-field_81_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_81_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_23-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_23\">Falls ja, welche:<\/label><textarea id=\"wpforms-462-field_23\" class=\"wpforms-field-medium\" name=\"wpforms[fields][23]\" aria-errormessage=\"wpforms-462-field_23-error\" ><\/textarea><\/div><div id=\"wpforms-462-field_82-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"82\"><fieldset><legend class=\"wpforms-field-label\">H\u00f6rverm\u00f6gen: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_82\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_82_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][82][]\" value=\"keine Probleme\" aria-errormessage=\"wpforms-462-field_82_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_82_1\">keine Probleme<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_82_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][82][]\" value=\"m\u00e4\u00dfige Probleme\" aria-errormessage=\"wpforms-462-field_82_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_82_2\">m\u00e4\u00dfige Probleme<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_82_22\" data-rule-check-limit=\"true\" name=\"wpforms[fields][82][]\" value=\"erhebliche Probleme\" aria-errormessage=\"wpforms-462-field_82_22-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_82_22\">erhebliche Probleme<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_83-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"83\"><fieldset><legend class=\"wpforms-field-label\">Sehverm\u00f6gen: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_83\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_83_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][83][]\" value=\"keine Probleme\" aria-errormessage=\"wpforms-462-field_83_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_83_1\">keine Probleme<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_83_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][83][]\" value=\"m\u00e4\u00dfige Probleme\" aria-errormessage=\"wpforms-462-field_83_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_83_2\">m\u00e4\u00dfige Probleme<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_83_22\" data-rule-check-limit=\"true\" name=\"wpforms[fields][83][]\" value=\"erhebliche Probleme\" aria-errormessage=\"wpforms-462-field_83_22-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_83_22\">erhebliche Probleme<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_84-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"84\"><fieldset><legend class=\"wpforms-field-label\">Spracheverm\u00f6gen: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_84\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_84_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][84][]\" value=\"keine Probleme\" aria-errormessage=\"wpforms-462-field_84_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_84_1\">keine Probleme<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_84_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][84][]\" value=\"m\u00e4\u00dfige Probleme\" aria-errormessage=\"wpforms-462-field_84_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_84_2\">m\u00e4\u00dfige Probleme<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_84_22\" data-rule-check-limit=\"true\" name=\"wpforms[fields][84][]\" value=\"erhebliche Probleme\" aria-errormessage=\"wpforms-462-field_84_22-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_84_22\">erhebliche Probleme<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_27-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_27\">Hilfsmittel f\u00fcr H\u00f6r-, Seh- &amp; sprachliche Einschr\u00e4nkungen:<\/label><input type=\"text\" id=\"wpforms-462-field_27\" class=\"wpforms-field-medium\" name=\"wpforms[fields][27]\" aria-errormessage=\"wpforms-462-field_27-error\" ><\/div><div id=\"wpforms-462-field_117-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"117\"><fieldset><legend class=\"wpforms-field-label\">Orientierung &#8211; zeitlich <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_117\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_117_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][117][]\" value=\"uneingeschr\u00e4nkt\" aria-errormessage=\"wpforms-462-field_117_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_117_1\">uneingeschr\u00e4nkt<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_117_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][117][]\" value=\"teilweise eingeschr\u00e4nkt\" aria-errormessage=\"wpforms-462-field_117_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_117_2\">teilweise eingeschr\u00e4nkt<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_117_22\" data-rule-check-limit=\"true\" name=\"wpforms[fields][117][]\" value=\"eingeschr\u00e4nkt\" aria-errormessage=\"wpforms-462-field_117_22-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_117_22\">eingeschr\u00e4nkt<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_118-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"118\"><fieldset><legend class=\"wpforms-field-label\">Orientierung &#8211; \u00f6rtlich <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_118\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_118_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][118][]\" value=\"uneingeschr\u00e4nkt\" aria-errormessage=\"wpforms-462-field_118_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_118_1\">uneingeschr\u00e4nkt<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_118_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][118][]\" value=\"teilweise eingeschr\u00e4nkt\" aria-errormessage=\"wpforms-462-field_118_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_118_2\">teilweise eingeschr\u00e4nkt<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_118_22\" data-rule-check-limit=\"true\" name=\"wpforms[fields][118][]\" value=\"eingeschr\u00e4nkt\" aria-errormessage=\"wpforms-462-field_118_22-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_118_22\">eingeschr\u00e4nkt<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_119-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"119\"><fieldset><legend class=\"wpforms-field-label\">Orientierung &#8211; pers\u00f6nlich <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_119\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_119_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][119][]\" value=\"uneingeschr\u00e4nkt\" aria-errormessage=\"wpforms-462-field_119_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_119_1\">uneingeschr\u00e4nkt<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_119_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][119][]\" value=\"teilweise eingeschr\u00e4nkt\" aria-errormessage=\"wpforms-462-field_119_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_119_2\">teilweise eingeschr\u00e4nkt<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_119_22\" data-rule-check-limit=\"true\" name=\"wpforms[fields][119][]\" value=\"eingeschr\u00e4nkt\" aria-errormessage=\"wpforms-462-field_119_22-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_119_22\">eingeschr\u00e4nkt<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_85-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"85\"><fieldset><legend class=\"wpforms-field-label\">Gesichtspflege: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_85\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_85_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][85][]\" value=\"Selbstst\u00e4ndig\" aria-errormessage=\"wpforms-462-field_85_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_85_1\">Selbstst\u00e4ndig<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_85_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][85][]\" value=\"teilweise selbstst\u00e4ndig\" aria-errormessage=\"wpforms-462-field_85_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_85_2\">teilweise selbstst\u00e4ndig<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_85_22\" data-rule-check-limit=\"true\" name=\"wpforms[fields][85][]\" value=\"nur mit Unterst\u00fctzung\" aria-errormessage=\"wpforms-462-field_85_22-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_85_22\">nur mit Unterst\u00fctzung<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_86-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"86\"><fieldset><legend class=\"wpforms-field-label\">Mundpflege: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_86\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_86_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][86][]\" value=\"Selbstst\u00e4ndig\" aria-errormessage=\"wpforms-462-field_86_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_86_1\">Selbstst\u00e4ndig<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_86_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][86][]\" value=\"teilweise selbstst\u00e4ndig\" aria-errormessage=\"wpforms-462-field_86_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_86_2\">teilweise selbstst\u00e4ndig<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_86_22\" data-rule-check-limit=\"true\" name=\"wpforms[fields][86][]\" value=\"nur mit Unterst\u00fctzung\" aria-errormessage=\"wpforms-462-field_86_22-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_86_22\">nur mit Unterst\u00fctzung<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_87-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"87\"><fieldset><legend class=\"wpforms-field-label\">Oberk\u00f6rperpflege: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_87\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_87_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][87][]\" value=\"Selbstst\u00e4ndig\" aria-errormessage=\"wpforms-462-field_87_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_87_1\">Selbstst\u00e4ndig<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_87_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][87][]\" value=\"teilweise selbstst\u00e4ndig\" aria-errormessage=\"wpforms-462-field_87_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_87_2\">teilweise selbstst\u00e4ndig<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_87_22\" data-rule-check-limit=\"true\" name=\"wpforms[fields][87][]\" value=\"nur mit Unterst\u00fctzung\" aria-errormessage=\"wpforms-462-field_87_22-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_87_22\">nur mit Unterst\u00fctzung<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_88-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"88\"><fieldset><legend class=\"wpforms-field-label\">Ges\u00e4\u00df\/Beinpflege: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_88\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_88_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][88][]\" value=\"Selbstst\u00e4ndig\" aria-errormessage=\"wpforms-462-field_88_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_88_1\">Selbstst\u00e4ndig<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_88_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][88][]\" value=\"teilweise selbstst\u00e4ndig\" aria-errormessage=\"wpforms-462-field_88_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_88_2\">teilweise selbstst\u00e4ndig<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_88_22\" data-rule-check-limit=\"true\" name=\"wpforms[fields][88][]\" value=\"nur mit Unterst\u00fctzung\" aria-errormessage=\"wpforms-462-field_88_22-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_88_22\">nur mit Unterst\u00fctzung<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_89-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"89\"><fieldset><legend class=\"wpforms-field-label\">Intimpflege: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_89\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_89_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][89][]\" value=\"Selbstst\u00e4ndig\" aria-errormessage=\"wpforms-462-field_89_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_89_1\">Selbstst\u00e4ndig<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_89_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][89][]\" value=\"teilweise selbstst\u00e4ndig\" aria-errormessage=\"wpforms-462-field_89_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_89_2\">teilweise selbstst\u00e4ndig<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_89_22\" data-rule-check-limit=\"true\" name=\"wpforms[fields][89][]\" value=\"nur mit Unterst\u00fctzung\" aria-errormessage=\"wpforms-462-field_89_22-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_89_22\">nur mit Unterst\u00fctzung<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_90-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"90\"><fieldset><legend class=\"wpforms-field-label\">Haarpflege: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_90\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_90_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][90][]\" value=\"Selbstst\u00e4ndig\" aria-errormessage=\"wpforms-462-field_90_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_90_1\">Selbstst\u00e4ndig<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_90_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][90][]\" value=\"teilweise selbstst\u00e4ndig\" aria-errormessage=\"wpforms-462-field_90_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_90_2\">teilweise selbstst\u00e4ndig<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_90_22\" data-rule-check-limit=\"true\" name=\"wpforms[fields][90][]\" value=\"nur mit Unterst\u00fctzung\" aria-errormessage=\"wpforms-462-field_90_22-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_90_22\">nur mit Unterst\u00fctzung<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_91-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"91\"><fieldset><legend class=\"wpforms-field-label\">Rasieren: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_91\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_91_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][91][]\" value=\"Selbstst\u00e4ndig\" aria-errormessage=\"wpforms-462-field_91_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_91_1\">Selbstst\u00e4ndig<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_91_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][91][]\" value=\"teilweise selbstst\u00e4ndig\" aria-errormessage=\"wpforms-462-field_91_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_91_2\">teilweise selbstst\u00e4ndig<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_91_22\" data-rule-check-limit=\"true\" name=\"wpforms[fields][91][]\" value=\"nur mit Unterst\u00fctzung\" aria-errormessage=\"wpforms-462-field_91_22-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_91_22\">nur mit Unterst\u00fctzung<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_92-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"92\"><fieldset><legend class=\"wpforms-field-label\">Handpflege: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_92\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_92_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][92][]\" value=\"Selbstst\u00e4ndig\" aria-errormessage=\"wpforms-462-field_92_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_92_1\">Selbstst\u00e4ndig<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_92_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][92][]\" value=\"teilweise selbstst\u00e4ndig\" aria-errormessage=\"wpforms-462-field_92_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_92_2\">teilweise selbstst\u00e4ndig<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_92_22\" data-rule-check-limit=\"true\" name=\"wpforms[fields][92][]\" value=\"nur mit Unterst\u00fctzung\" aria-errormessage=\"wpforms-462-field_92_22-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_92_22\">nur mit Unterst\u00fctzung<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_93-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"93\"><fieldset><legend class=\"wpforms-field-label\">Fu\u00dfpflege: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_93\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_93_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][93][]\" value=\"Selbstst\u00e4ndig\" aria-errormessage=\"wpforms-462-field_93_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_93_1\">Selbstst\u00e4ndig<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_93_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][93][]\" value=\"teilweise selbstst\u00e4ndig\" aria-errormessage=\"wpforms-462-field_93_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_93_2\">teilweise selbstst\u00e4ndig<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_93_22\" data-rule-check-limit=\"true\" name=\"wpforms[fields][93][]\" value=\"nur mit Unterst\u00fctzung\" aria-errormessage=\"wpforms-462-field_93_22-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_93_22\">nur mit Unterst\u00fctzung<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_94-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"94\"><fieldset><legend class=\"wpforms-field-label\">Motorische Einschr\u00e4nkungen in der Bewegung: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_94\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_94_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][94][]\" value=\"Selbstst\u00e4ndig\" aria-errormessage=\"wpforms-462-field_94_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_94_1\">Selbstst\u00e4ndig<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_94_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][94][]\" value=\"mit Unterst\u00fctzung\" aria-errormessage=\"wpforms-462-field_94_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_94_2\">mit Unterst\u00fctzung<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_94_22\" data-rule-check-limit=\"true\" name=\"wpforms[fields][94][]\" value=\"Rollstuhl\" aria-errormessage=\"wpforms-462-field_94_22-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_94_22\">Rollstuhl<\/label><\/li><li class=\"choice-23 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_94_23\" data-rule-check-limit=\"true\" name=\"wpforms[fields][94][]\" value=\"bettl\u00e4gerig\" aria-errormessage=\"wpforms-462-field_94_23-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_94_23\">bettl\u00e4gerig<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_95-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"95\"><fieldset><legend class=\"wpforms-field-label\">Motorische Einschr\u00e4nkungen beim Treppensteigen <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_95\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_95_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][95][]\" value=\"Selbstst\u00e4ndig\" aria-errormessage=\"wpforms-462-field_95_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_95_1\">Selbstst\u00e4ndig<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_95_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][95][]\" value=\"mit Unterst\u00fctzung\" aria-errormessage=\"wpforms-462-field_95_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_95_2\">mit Unterst\u00fctzung<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_95_22\" data-rule-check-limit=\"true\" name=\"wpforms[fields][95][]\" value=\"nicht m\u00f6glich\" aria-errormessage=\"wpforms-462-field_95_22-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_95_22\">nicht m\u00f6glich<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_96-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"96\"><fieldset><legend class=\"wpforms-field-label\">Motorische Einschr\u00e4nkungen beim Duschen\/Baden: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_96\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_96_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][96][]\" value=\"Selbstst\u00e4ndig\" aria-errormessage=\"wpforms-462-field_96_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_96_1\">Selbstst\u00e4ndig<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_96_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][96][]\" value=\"mit Unterst\u00fctzung\" aria-errormessage=\"wpforms-462-field_96_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_96_2\">mit Unterst\u00fctzung<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_96_22\" data-rule-check-limit=\"true\" name=\"wpforms[fields][96][]\" value=\"komplett hilfsbed\u00fcrftig\" aria-errormessage=\"wpforms-462-field_96_22-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_96_22\">komplett hilfsbed\u00fcrftig<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_97-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"97\"><fieldset><legend class=\"wpforms-field-label\">Motorische Einschr\u00e4nkungen beim An- &amp; Ausziehen: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_97\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_97_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][97][]\" value=\"Selbstst\u00e4ndig\" aria-errormessage=\"wpforms-462-field_97_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_97_1\">Selbstst\u00e4ndig<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_97_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][97][]\" value=\"mit Unterst\u00fctzung\" aria-errormessage=\"wpforms-462-field_97_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_97_2\">mit Unterst\u00fctzung<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_97_22\" data-rule-check-limit=\"true\" name=\"wpforms[fields][97][]\" value=\"komplett hilfsbed\u00fcrftig\" aria-errormessage=\"wpforms-462-field_97_22-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_97_22\">komplett hilfsbed\u00fcrftig<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_41-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"41\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_41\">Hilfsmittel f\u00fcr motorische Einschr\u00e4nkungen:<\/label><textarea id=\"wpforms-462-field_41\" class=\"wpforms-field-medium\" name=\"wpforms[fields][41]\" aria-errormessage=\"wpforms-462-field_41-error\" ><\/textarea><\/div><div id=\"wpforms-462-field_135-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"135\"><fieldset><legend class=\"wpforms-field-label\">Transfer <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_135\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_135_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][135][]\" value=\"Ja\" aria-errormessage=\"wpforms-462-field_135_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_135_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_135_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][135][]\" value=\"Nein\" aria-errormessage=\"wpforms-462-field_135_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_135_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_136-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"136\"><fieldset><legend class=\"wpforms-field-label\">Hilft die Person beim Transfer mit? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_136\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_136_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][136][]\" value=\"Ja\" aria-errormessage=\"wpforms-462-field_136_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_136_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_136_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][136][]\" value=\"Nein\" aria-errormessage=\"wpforms-462-field_136_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_136_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_137-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"137\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_137\">Wenn ja, wie?<\/label><input type=\"text\" id=\"wpforms-462-field_137\" class=\"wpforms-field-medium\" name=\"wpforms[fields][137]\" aria-errormessage=\"wpforms-462-field_137-error\" ><\/div><div id=\"wpforms-462-field_98-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"98\"><fieldset><legend class=\"wpforms-field-label\">Nahrungsaufnahme: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_98\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_98_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][98][]\" value=\"Selbstst\u00e4ndig\" aria-errormessage=\"wpforms-462-field_98_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_98_1\">Selbstst\u00e4ndig<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_98_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][98][]\" value=\"mit Unterst\u00fctzung\" aria-errormessage=\"wpforms-462-field_98_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_98_2\">mit Unterst\u00fctzung<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_98_22\" data-rule-check-limit=\"true\" name=\"wpforms[fields][98][]\" value=\"komplett hilfsbed\u00fcrftig\" aria-errormessage=\"wpforms-462-field_98_22-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_98_22\">komplett hilfsbed\u00fcrftig<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_99-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"99\"><fieldset><legend class=\"wpforms-field-label\">Kau-\/Schluckst\u00f6rungen: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_99\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_99_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][99][]\" value=\"Ja\" aria-errormessage=\"wpforms-462-field_99_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_99_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_99_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][99][]\" value=\"Nein\" aria-errormessage=\"wpforms-462-field_99_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_99_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_44-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"44\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_44\">Wenn ja, welche:<\/label><input type=\"text\" id=\"wpforms-462-field_44\" class=\"wpforms-field-medium\" name=\"wpforms[fields][44]\" aria-errormessage=\"wpforms-462-field_44-error\" ><\/div><div id=\"wpforms-462-field_100-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"100\"><fieldset><legend class=\"wpforms-field-label\">Nimmt der\/die pflegebed\u00fcrftige Schlafmittel? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_100\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_100_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][100][]\" value=\"Ja\" aria-errormessage=\"wpforms-462-field_100_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_100_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_100_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][100][]\" value=\"Nein\" aria-errormessage=\"wpforms-462-field_100_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_100_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_101-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"101\"><fieldset><legend class=\"wpforms-field-label\">Hat der\/die pflegebed\u00fcrftige Einschlafprobleme? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_101\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_101_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][101][]\" value=\"Ja\" aria-errormessage=\"wpforms-462-field_101_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_101_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_101_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][101][]\" value=\"Nein\" aria-errormessage=\"wpforms-462-field_101_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_101_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_102-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"102\"><fieldset><legend class=\"wpforms-field-label\">Hat der\/die pflegebed\u00fcrftige Durchschlafprobleme? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_102\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_102_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][102][]\" value=\"Ja-braucht Nachts Hilfe\" aria-errormessage=\"wpforms-462-field_102_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_102_1\">Ja-braucht Nachts Hilfe<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_102_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][102][]\" value=\"Nein\" aria-errormessage=\"wpforms-462-field_102_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_102_2\">Nein<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_102_3\" data-rule-check-limit=\"true\" name=\"wpforms[fields][102][]\" value=\"Schlaf-Wach-Rythmuns gest\u00f6rt\" aria-errormessage=\"wpforms-462-field_102_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_102_3\">Schlaf-Wach-Rythmuns gest\u00f6rt<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_134-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"134\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_134\">Wie oft\/ zu welchen Zeiten?<\/label><textarea id=\"wpforms-462-field_134\" class=\"wpforms-field-medium\" name=\"wpforms[fields][134]\" aria-errormessage=\"wpforms-462-field_134-error\" ><\/textarea><\/div><div id=\"wpforms-462-field_138-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"138\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_138\">Wie lange dauert der Nachteinsatz?<\/label><input type=\"text\" id=\"wpforms-462-field_138\" class=\"wpforms-field-medium\" name=\"wpforms[fields][138]\" aria-errormessage=\"wpforms-462-field_138-error\" ><\/div><div id=\"wpforms-462-field_121-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"121\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_121\">Um wie viel Uhr wacht der Klient auf? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-462-field_121\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][121]\" aria-errormessage=\"wpforms-462-field_121-error\" required><\/textarea><\/div><div id=\"wpforms-462-field_122-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"122\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_122\">Um wie viel Uhr geht der Klient zu Bett? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-462-field_122\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][122]\" aria-errormessage=\"wpforms-462-field_122-error\" required><\/textarea><\/div><div id=\"wpforms-462-field_103-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"103\"><fieldset><legend class=\"wpforms-field-label\">Leidet der\/die pflegebed\u00fcrftige unter Inkontinenz? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_103\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_103_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][103][]\" value=\"Ja\" aria-errormessage=\"wpforms-462-field_103_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_103_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_103_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][103][]\" value=\"Nein\" aria-errormessage=\"wpforms-462-field_103_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_103_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_139-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"139\"><fieldset><legend class=\"wpforms-field-label\">Meldet sich die Person, wenn sie zur Toilette muss? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_139\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_139_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][139][]\" value=\"Ja\" aria-errormessage=\"wpforms-462-field_139_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_139_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_139_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][139][]\" value=\"Nein\" aria-errormessage=\"wpforms-462-field_139_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_139_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_49-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"49\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_49\">Hilfsmittel f\u00fcr die Inkontinenz:<\/label><input type=\"text\" id=\"wpforms-462-field_49\" class=\"wpforms-field-medium\" name=\"wpforms[fields][49]\" aria-errormessage=\"wpforms-462-field_49-error\" ><\/div><div id=\"wpforms-462-field_104-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"104\"><fieldset><legend class=\"wpforms-field-label\">Ist der\/die pflegebed\u00fcrftige aktuell in einer Therapie? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_104\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_104_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][104][]\" value=\"Nein\" aria-errormessage=\"wpforms-462-field_104_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_104_1\">Nein<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_104_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][104][]\" value=\"Krankengymnastik\" aria-errormessage=\"wpforms-462-field_104_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_104_2\">Krankengymnastik<\/label><\/li><li class=\"choice-24 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_104_24\" data-rule-check-limit=\"true\" name=\"wpforms[fields][104][]\" value=\"Logop\u00e4die\" aria-errormessage=\"wpforms-462-field_104_24-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_104_24\">Logop\u00e4die<\/label><\/li><li class=\"choice-25 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_104_25\" data-rule-check-limit=\"true\" name=\"wpforms[fields][104][]\" value=\"psychologische Betreuung\" aria-errormessage=\"wpforms-462-field_104_25-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_104_25\">psychologische Betreuung<\/label><\/li><li class=\"choice-26 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_104_26\" data-rule-check-limit=\"true\" name=\"wpforms[fields][104][]\" value=\"andere\" aria-errormessage=\"wpforms-462-field_104_26-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_104_26\">andere<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_51-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"51\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_51\">Charakter &amp; Wesen der\/des pflegebed\u00fcrftigen: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-462-field_51\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][51]\" aria-errormessage=\"wpforms-462-field_51-error\" required><\/textarea><\/div><div id=\"wpforms-462-field_123-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"123\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_123\">Kurze Beschreibung des Tagesablaufs der\/des Betreuten <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-462-field_123\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][123]\" aria-errormessage=\"wpforms-462-field_123-error\" required><\/textarea><\/div><div id=\"wpforms-462-field_105-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"105\"><fieldset><legend class=\"wpforms-field-label\">Wo wohnt der\/die pflegebed\u00fcrftige? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_105\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_105_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][105][]\" value=\"st\u00e4dtisch (zentral)\" aria-errormessage=\"wpforms-462-field_105_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_105_1\">st\u00e4dtisch (zentral)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_105_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][105][]\" value=\"st\u00e4dtisch (au\u00dferhalb)\" aria-errormessage=\"wpforms-462-field_105_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_105_2\">st\u00e4dtisch (au\u00dferhalb)<\/label><\/li><li class=\"choice-24 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_105_24\" data-rule-check-limit=\"true\" name=\"wpforms[fields][105][]\" value=\"l\u00e4ndlich\" aria-errormessage=\"wpforms-462-field_105_24-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_105_24\">l\u00e4ndlich<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_106-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"106\"><fieldset><legend class=\"wpforms-field-label\">Wohnung: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_106\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_106_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][106][]\" value=\"Wohnung\" aria-errormessage=\"wpforms-462-field_106_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_106_1\">Wohnung<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_106_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][106][]\" value=\"Einfamilienhaus\" aria-errormessage=\"wpforms-462-field_106_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_106_2\">Einfamilienhaus<\/label><\/li><li class=\"choice-24 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_106_24\" data-rule-check-limit=\"true\" name=\"wpforms[fields][106][]\" value=\"Mehrfamilienhaus\" aria-errormessage=\"wpforms-462-field_106_24-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_106_24\">Mehrfamilienhaus<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_107-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"107\"><fieldset><legend class=\"wpforms-field-label\">Einkaufsm\u00f6glichkeiten (zu Fu\u00df erreichbar in ca.): <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_107\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_107_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][107][]\" value=\"0 - 15 Minuten\" aria-errormessage=\"wpforms-462-field_107_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_107_1\">0 &#8211; 15 Minuten<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_107_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][107][]\" value=\"15 - 30 Minuten\" aria-errormessage=\"wpforms-462-field_107_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_107_2\">15 &#8211; 30 Minuten<\/label><\/li><li class=\"choice-24 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_107_24\" data-rule-check-limit=\"true\" name=\"wpforms[fields][107][]\" value=\"\u00fcber 30 Minuten\" aria-errormessage=\"wpforms-462-field_107_24-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_107_24\">\u00fcber 30 Minuten<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_55-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"55\"><fieldset><legend class=\"wpforms-field-label\">Ausstattung des Zimmers der Betreuungskraft: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_55\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_55_1\" name=\"wpforms[fields][55][]\" value=\"eigenes Bad\" aria-errormessage=\"wpforms-462-field_55_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_55_1\">eigenes Bad<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_55_2\" name=\"wpforms[fields][55][]\" value=\"TV\" aria-errormessage=\"wpforms-462-field_55_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_55_2\">TV<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_55_3\" name=\"wpforms[fields][55][]\" value=\"WLAN\/Internet\" aria-errormessage=\"wpforms-462-field_55_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_55_3\">WLAN\/Internet<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_55_4\" name=\"wpforms[fields][55][]\" value=\"Fahrrad\" aria-errormessage=\"wpforms-462-field_55_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_55_4\">Fahrrad<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_55_5\" name=\"wpforms[fields][55][]\" value=\"Auto - Automatikgetriebe\" aria-errormessage=\"wpforms-462-field_55_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_55_5\">Auto &#8211; Automatikgetriebe<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_55_6\" name=\"wpforms[fields][55][]\" value=\"Auto - Schaltgetriebe\" aria-errormessage=\"wpforms-462-field_55_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_55_6\">Auto &#8211; Schaltgetriebe<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_142-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"142\"><fieldset><legend class=\"wpforms-field-label\">Freie Zeit f\u00fcr den Betreuer (jeder Betreuer hat Anspruch auf 2 Stunden Pause pro Tag und 2 x halbe Tage oder 1 ganzen Tag frei) Fur welche Option enscheiden Sie sich? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_142\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_142_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][142][]\" value=\"2 x halbe Tage\" aria-errormessage=\"wpforms-462-field_142_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_142_1\">2 x halbe Tage<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_142_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][142][]\" value=\"1 ganzer freier Tag\" aria-errormessage=\"wpforms-462-field_142_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_142_2\">1 ganzer freier Tag<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_129-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"129\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_129\">Wer \u00fcbernimmt ist dieser Zeit die Betreuung <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-462-field_129\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][129]\" aria-errormessage=\"wpforms-462-field_129-error\" required><\/div><div id=\"wpforms-462-field_108-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"108\"><fieldset><legend class=\"wpforms-field-label\">Soll die Betreuungskraft weiblich oder m\u00e4nnlich sein? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_108\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_108_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][108][]\" value=\"weiblich\" aria-errormessage=\"wpforms-462-field_108_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_108_1\">weiblich<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_108_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][108][]\" value=\"m\u00e4nnlich\" aria-errormessage=\"wpforms-462-field_108_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_108_2\">m\u00e4nnlich<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_108_3\" data-rule-check-limit=\"true\" name=\"wpforms[fields][108][]\" value=\"egal\" aria-errormessage=\"wpforms-462-field_108_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_108_3\">egal<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_112-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"112\"><fieldset><legend class=\"wpforms-field-label\">Ben\u00f6tigt die Betreuungskraft einen F\u00fchrerschein? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_112\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_112_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][112][]\" value=\"Egal\" aria-errormessage=\"wpforms-462-field_112_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_112_1\">Egal<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_112_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][112][]\" value=\"Ja\" aria-errormessage=\"wpforms-462-field_112_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_112_2\">Ja<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_112_3\" data-rule-check-limit=\"true\" name=\"wpforms[fields][112][]\" value=\"Nein\" aria-errormessage=\"wpforms-462-field_112_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_112_3\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_116-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"116\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_116\">Wof\u00fcr wird der F\u00fchrerschein ben\u00f6tigt <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-462-field_116\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][116]\" aria-errormessage=\"wpforms-462-field_116-error\" required><\/textarea><\/div><div id=\"wpforms-462-field_64-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"64\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_64\">Welche Vorstellungen &amp; Erwartungen soll die Betreuungskraft erf\u00fcllen? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-462-field_64\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][64]\" aria-errormessage=\"wpforms-462-field_64-error\" required><\/textarea><\/div><div id=\"wpforms-462-field_65-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"65\"><fieldset><legend class=\"wpforms-field-label\">Welche Aufgaben soll die Betreuungskraft \u00fcbernehmen? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_65\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_65_1\" name=\"wpforms[fields][65][]\" value=\"Einkaufen\" aria-errormessage=\"wpforms-462-field_65_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_65_1\">Einkaufen<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_65_2\" name=\"wpforms[fields][65][]\" value=\"Kochen\" aria-errormessage=\"wpforms-462-field_65_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_65_2\">Kochen<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_65_3\" name=\"wpforms[fields][65][]\" value=\"W\u00e4sche waschen\" aria-errormessage=\"wpforms-462-field_65_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_65_3\">W\u00e4sche waschen<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_65_4\" name=\"wpforms[fields][65][]\" value=\"B\u00fcgeln\" aria-errormessage=\"wpforms-462-field_65_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_65_4\">B\u00fcgeln<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_65_6\" name=\"wpforms[fields][65][]\" value=\"Putzen\" aria-errormessage=\"wpforms-462-field_65_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_65_6\">Putzen<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_65_7\" name=\"wpforms[fields][65][]\" value=\"Begleitung bei Arztbesuchen\" aria-errormessage=\"wpforms-462-field_65_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_65_7\">Begleitung bei Arztbesuchen<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_127-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"127\"><fieldset><legend class=\"wpforms-field-label\">Ben\u00f6tigt der Ehepartner Unterst\u00fctzung? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_127\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_127_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][127][]\" value=\"ja\" aria-errormessage=\"wpforms-462-field_127_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_127_1\">ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_127_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][127][]\" value=\"nein\" aria-errormessage=\"wpforms-462-field_127_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_127_2\">nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_124-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"124\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_124\">Wie hoch ist das w\u00f6chentliche Einkaufsbudget der Familie? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-462-field_124\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][124]\" aria-errormessage=\"wpforms-462-field_124-error\" required><\/textarea><\/div><div id=\"wpforms-462-field_125-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"125\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_125\">Wie unterst\u00fctzt der Ehepartner den Pflegebed\u00fcrftigen bei den tatichen Aktivit\u00e4ten? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-462-field_125\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][125]\" aria-errormessage=\"wpforms-462-field_125-error\" required><\/textarea><\/div><div id=\"wpforms-462-field_126-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"126\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_126\">Welche T\u00e4tigkeiten soll die Betreuungsperson vom Ehepartner des Pflegebed\u00fcrftigen \u00fcbernehmen? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-462-field_126\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][126]\" aria-errormessage=\"wpforms-462-field_126-error\" required><\/textarea><\/div><div id=\"wpforms-462-field_113-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"113\"><fieldset><legend class=\"wpforms-field-label\">Ist eine Haushaltshilfe im Einsatz? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_113\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_113_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][113][]\" value=\"Ja\" aria-errormessage=\"wpforms-462-field_113_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_113_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_113_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][113][]\" value=\"Nein\" aria-errormessage=\"wpforms-462-field_113_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_113_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_67-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"67\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_67\">Wen ja, wie oft?<\/label><input type=\"text\" id=\"wpforms-462-field_67\" class=\"wpforms-field-medium\" name=\"wpforms[fields][67]\" aria-errormessage=\"wpforms-462-field_67-error\" ><\/div><div id=\"wpforms-462-field_114-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"114\"><fieldset><legend class=\"wpforms-field-label\">Haben Sie Haustiere? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_114\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_114_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][114][]\" value=\"Ja\" aria-errormessage=\"wpforms-462-field_114_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_114_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_114_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][114][]\" value=\"Nein\" aria-errormessage=\"wpforms-462-field_114_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_114_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_69-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"69\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_69\">Wen ja, welche?<\/label><input type=\"text\" id=\"wpforms-462-field_69\" class=\"wpforms-field-medium\" name=\"wpforms[fields][69]\" aria-errormessage=\"wpforms-462-field_69-error\" ><\/div><div id=\"wpforms-462-field_70-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"70\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_70\">Wird im Haushalt an weiteren Stellen Hilfe ben\u00f6tigt? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-462-field_70\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][70]\" aria-errormessage=\"wpforms-462-field_70-error\" required><\/textarea><\/div><div id=\"wpforms-462-field_71-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"71\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_71\">Wann soll Ihre Pflegekraft den Einsatz beginnen? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-462-field_71\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][71]\" aria-errormessage=\"wpforms-462-field_71-error\" required><\/div><div id=\"wpforms-462-field_115-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"115\"><fieldset><legend class=\"wpforms-field-label\">Wie lange soll die Betreuung dauern? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_115\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_115_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][115][]\" value=\"bis zu 3 Monate\" aria-errormessage=\"wpforms-462-field_115_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_115_1\">bis zu 3 Monate<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_115_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][115][]\" value=\"3 - 12 Monate\" aria-errormessage=\"wpforms-462-field_115_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_115_2\">3 &#8211; 12 Monate<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_115_8\" data-rule-check-limit=\"true\" name=\"wpforms[fields][115][]\" value=\"auf unbestimmte Zeit\" aria-errormessage=\"wpforms-462-field_115_8-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_115_8\">auf unbestimmte Zeit<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_140-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"140\"><fieldset><legend class=\"wpforms-field-label\">Wie haben Sie von uns erfahren? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_140\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_140_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][140][]\" value=\"Fleyer\" aria-errormessage=\"wpforms-462-field_140_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_140_1\">Fleyer<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_140_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][140][]\" value=\"Webseite\" aria-errormessage=\"wpforms-462-field_140_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_140_2\">Webseite<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_140_8\" data-rule-check-limit=\"true\" name=\"wpforms[fields][140][]\" value=\"Zeitung\" aria-errormessage=\"wpforms-462-field_140_8-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_140_8\">Zeitung<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_140_10\" data-rule-check-limit=\"true\" name=\"wpforms[fields][140][]\" value=\"Sonstiges\" aria-errormessage=\"wpforms-462-field_140_10-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_140_10\">Sonstiges<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_141-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"141\"><label class=\"wpforms-field-label\" for=\"wpforms-462-field_141\">Wenn Sonstiges, bitte angeben:<\/label><input type=\"text\" id=\"wpforms-462-field_141\" class=\"wpforms-field-medium\" name=\"wpforms[fields][141]\" aria-errormessage=\"wpforms-462-field_141-error\" ><\/div><div id=\"wpforms-462-field_6-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"6\"><fieldset><legend class=\"wpforms-field-label\">DSGVO-Einverst\u00e4ndnis: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_6\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_6_1\" name=\"wpforms[fields][6][]\" value=\"Ich willige ein, dass diese Website meine \u00fcbermittelten Informationen speichert und verarbeitet, sodass meine Anfrage beantwortet werden kann. Ihre Einwilligung dazu k\u00f6nnen Sie jederzeit f\u00fcr die Zukunft per E-Mail an info@lichtblickpflege.de widerrufen.\" aria-errormessage=\"wpforms-462-field_6_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_6_1\">Ich willige ein, dass diese Website meine \u00fcbermittelten Informationen speichert und verarbeitet, sodass meine Anfrage beantwortet werden kann. Ihre Einwilligung dazu k\u00f6nnen Sie jederzeit f\u00fcr die Zukunft per E-Mail an info@lichtblickpflege.de widerrufen.<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-462-field_73-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"73\"><fieldset><legend class=\"wpforms-field-label\">Best\u00e4tigung <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-462-field_73\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-462-field_73_1\" name=\"wpforms[fields][73][]\" value=\"Ich best\u00e4tige, dass die zuvor genannten Informationen nach meinem besten Wissen  wahrheitsgem\u00e4\u00df und vollst\u00e4ndig sind.\" aria-errormessage=\"wpforms-462-field_73_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-462-field_73_1\">Ich best\u00e4tige, dass die zuvor genannten Informationen nach meinem besten Wissen  wahrheitsgem\u00e4\u00df und vollst\u00e4ndig sind.<\/label><\/li><\/ul><\/fieldset><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"462\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/sentivopl.com\/index.php\/wp-json\/wp\/v2\/pages\/431\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-462\" class=\"wpforms-submit\" data-alt-text=\"Senden\u2026\" data-submit-text=\"Absenden\" aria-live=\"assertive\" value=\"wpforms-submit\">Absenden<\/button><img decoding=\"async\" src=\"https:\/\/sentivopl.com\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Wczytywanie\"><\/div><\/form><\/div>  <!-- .wpforms-container --><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-431","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/sentivopl.com\/index.php\/wp-json\/wp\/v2\/pages\/431","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sentivopl.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/sentivopl.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/sentivopl.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/sentivopl.com\/index.php\/wp-json\/wp\/v2\/comments?post=431"}],"version-history":[{"count":8,"href":"https:\/\/sentivopl.com\/index.php\/wp-json\/wp\/v2\/pages\/431\/revisions"}],"predecessor-version":[{"id":494,"href":"https:\/\/sentivopl.com\/index.php\/wp-json\/wp\/v2\/pages\/431\/revisions\/494"}],"wp:attachment":[{"href":"https:\/\/sentivopl.com\/index.php\/wp-json\/wp\/v2\/media?parent=431"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}