{"id":340,"date":"2022-08-18T17:23:52","date_gmt":"2022-08-18T15:23:52","guid":{"rendered":"https:\/\/www.orthopaedie-wilhelmstrasse.de\/news\/?page_id=340"},"modified":"2023-03-10T00:17:53","modified_gmt":"2023-03-09T23:17:53","slug":"anamnesebogen-schulter","status":"publish","type":"page","link":"https:\/\/www.orthopaedie-wilhelmstrasse.de\/news\/anamnesebogen-schulter\/","title":{"rendered":"Anamnesebogen Schulter"},"content":{"rendered":"<div class='fluentform ff-default fluentform_wrapper_6 ffs_custom_wrap'><form data-form_id=\"6\" id=\"fluentform_6\" class=\"frm-fluent-form fluent_form_6 ff-el-form-top ff_form_instance_6_1 ff-form-loading ffs_custom\" data-form_instance=\"ff_form_instance_6_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Anmnesebogen Schulter<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='340' \/><input type=\"hidden\" id=\"_fluentform_6_fluentformnonce\" name=\"_fluentform_6_fluentformnonce\" value=\"5fe39a3286\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/news\/wp-json\/wp\/v2\/pages\/340\" \/><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-6_1\" ><p><em>Sehr geehrte Patientin, sehr geehrter Patient,\u00a0<\/em><\/p>\n<p>dieses Formular ist eine M\u00f6glichkeit Ihre Schulterproblematik zu beschreiben, um unserem Schulterexperten Dr. Giesa eine zeitnahe Einsch\u00e4tzung vorab zu erm\u00f6glichen. \u00a0Um eine zeitnahe Terminvergabe werden wir uns bem\u00fchen. Diese Formular erm\u00f6glicht Ihnen im Vorfeld ggf. Zeit zu sparen.\u00a0<\/p>\n<p>Es folgt hieraus keine telefonische oder E-Mail Vorabberatung. Der \u00e4rztliche Kontakt bleibt unerl\u00e4sslich.<\/p>\n<p>Unser Praxisteam meldet sich innerhalb weniger Tage, um mit Ihnen einen Termin auszumachen, soweit dies nicht schon erfolgt ist. Auch im Falle eines schon vergebenen Erstvorstellungstermins in der Schultersprechstunde k\u00f6nnen Sie mit diesem Formular Ihre individuelle Krankheitsgeschichte uns vorab schon einreichen.\u00a0<\/p>\n<p>Sollten schriftliche Vorbefunde Ihnen vorliegen, k\u00f6nnen Sie diese hier anh\u00e4ngen. Bitte bringen Sie Ihre Befunde und Datentr\u00e4ger mit vorhanden Bildern zum Termin dennoch mit !!!<\/p>\n<p>&nbsp;<\/p><\/div><div data-type=\"name-element\" data-name=\"names\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_names_first_name_' >Vorname<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[first_name]\" id=\"ff_6_names_first_name_\" class=\"ff-el-form-control\" placeholder=\"Vorname\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_names_last_name_' >Nachname<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[last_name]\" id=\"ff_6_names_last_name_\" class=\"ff-el-form-control\" placeholder=\"Nachname\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_datetime' aria-label=\"Geburtsdatum\">Geburtsdatum<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Geburtsdatum Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime\" id=\"ff_6_datetime\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"datetime\"  aria-invalid='false' aria-required=false><\/div><\/div><div class=\"ff-name-address-wrapper fluent-address\" data-type=\"address-element\" data-name=\"address_1\" ><div class='ff-el-input--label'><label aria-label=\"Adresse\">Adresse<\/label><\/div><div class='ff-el-input--content'><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_address_1_address_line_1_' aria-label=\"Stra\u00dfe\">Stra\u00dfe<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[address_line_1]\" id=\"ff_6_address_1_address_line_1_\" class=\"ff-el-form-control\" placeholder=\"Stra\u00dfe\" data-key_name=\"address_line_1\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_address_1_address_line_2_' aria-label=\"Hausnummer\">Hausnummer<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[address_line_2]\" id=\"ff_6_address_1_address_line_2_\" class=\"ff-el-form-control\" placeholder=\"Hausnummer\" data-key_name=\"address_line_2\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_address_1_zip_' aria-label=\"Postleitzahl\">Postleitzahl<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[zip]\" id=\"ff_6_address_1_zip_\" class=\"ff-el-form-control\" placeholder=\"Postleitzahl\" data-key_name=\"zip\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_address_1_city_' aria-label=\"Stadt\">Stadt<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[city]\" id=\"ff_6_address_1_city_\" class=\"ff-el-form-control\" placeholder=\"Stadt\" data-key_name=\"city\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_phone' aria-label=\"Telefon\">Telefon<\/label><\/div><div class='ff-el-input--content'><input name=\"phone\" class=\"ff-el-form-control ff-el-phone\" type=\"tel\" placeholder=\"Telefonnummer\" data-name=\"phone\" id=\"ff_6_phone\" inputmode=\"tel\"  aria-invalid='false' aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_email' aria-label=\"E-Mail\">E-Mail<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" id=\"ff_6_email\" class=\"ff-el-form-control\" placeholder=\"Email Address\" data-name=\"email\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_dropdown' aria-label=\"Krankenversicherung\">Krankenversicherung<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown\" id=\"ff_6_dropdown\" class=\"ff-el-form-control\" data-name=\"dropdown\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=false><option value=\"\">- Bitte ausw\u00e4hlen -<\/option><option  selected><\/option><option value=\"Gesetzlich\"  >Gesetzlich<\/option><option value=\"Privat\"  >Privat<\/option><option value=\"Selbstzahler\"  >Selbstzahler<\/option><\/select><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-6_2\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_dropdown_1' aria-label=\"H\u00e4ndig\">H\u00e4ndig<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_1\" id=\"ff_6_dropdown_1\" class=\"ff-el-form-control\" data-name=\"dropdown_1\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=false><option value=\"\">- Bitte ausw\u00e4hlen -<\/option><option  ><\/option><option value=\"Rechtsh\u00e4nder\"  >Rechtsh\u00e4nder<\/option><option value=\"Linksh\u00e4nder\"  >Linksh\u00e4nder<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_multi_select' aria-label=\"Vorerkrankungen\">Vorerkrankungen<\/label><\/div><div class='ff-el-input--content'><select name=\"multi_select[]\" id=\"ff_6_multi_select\" class=\"ff-el-form-control  ff_has_multi_select\" multiple=\"1\" data-name=\"multi_select\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=false><option value=\"Diabetes\"  >Diabetes<\/option><option value=\"gesichtertes Rheuma\"  >gesichtertes Rheuma<\/option><option value=\"chronische Schmerzerkrankung\"  >chronische Schmerzerkrankung<\/option><option value=\"Zustand nach Schulter OP (betroffene Seite)\"  >Zustand nach Schulter OP (betroffene Seite)<\/option><option value=\"Zustand nach Herzinfarkt\"  >Zustand nach Herzinfarkt<\/option><option value=\"Zustand nach Apoplex\"  >Zustand nach Apoplex<\/option><option value=\"Zustand nach Stent\/KHK\"  >Zustand nach Stent\/KHK<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_dropdown_2' aria-label=\"Blutverd\u00fcnnung\">Blutverd\u00fcnnung<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_2\" id=\"ff_6_dropdown_2\" class=\"ff-el-form-control\" data-name=\"dropdown_2\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=false><option value=\"keine\"  >keine<\/option><option value=\"ASS\"  >ASS<\/option><option value=\"Clopidogrel\"  >Clopidogrel<\/option><option value=\"Markumar\"  >Markumar<\/option><option value=\"NOAK (Xarelto, Eliquis)\"  >NOAK (Xarelto, Eliquis)<\/option><option value=\"Andere Blutverd\u00fcnner\"  >Andere Blutverd\u00fcnner<\/option><\/select><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-6_3\" ><h3 class='ff-el-section-title'>Beschwerden<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_multi_select_1' aria-label=\"Beschwerden in\">Beschwerden in<\/label><\/div><div class='ff-el-input--content'><select name=\"multi_select_1[]\" id=\"ff_6_multi_select_1\" class=\"ff-el-form-control  ff_has_multi_select\" multiple=\"1\" data-name=\"multi_select_1\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=false><option value=\"nur rechter Schulter\"  >nur rechter Schulter<\/option><option value=\"nur linker Schulter\"  >nur linker Schulter<\/option><option value=\"rechte mehr als linke Schulter\"  >rechte mehr als linke Schulter<\/option><option value=\"linke mehr als rechte Schulter\"  >linke mehr als rechte Schulter<\/option><option value=\"beiden Schultern gleich\"  >beiden Schultern gleich<\/option><option value=\"Halswirbels\u00e4ule \"  >Halswirbels\u00e4ule<\/option><option value=\"Brustwirbels\u00e4ule \"  >Brustwirbels\u00e4ule<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_dropdown_3' aria-label=\"Schulter links\">Schulter links<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_3\" id=\"ff_6_dropdown_3\" class=\"ff-el-form-control\" data-name=\"dropdown_3\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=false><option value=\"keine\"  >keine<\/option><option value=\"Vorne \"  >Vorne<\/option><option value=\"Oberarm  bzw. Schulter seitlich\"  >Oberarm  bzw. Schulter seitlich<\/option><option value=\"Schulterblatt\"  >Schulterblatt<\/option><option value=\"zum Nackenziehend \/HWS\"  >zum Nackenziehend \/HWS<\/option><option value=\"Auf der Schulter oben \"  >Auf der Schulter oben<\/option><option value=\"Brustwirbels\u00e4ule\"  >Brustwirbels\u00e4ule<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_dropdown_4' aria-label=\"Schulter rechts\">Schulter rechts<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_4\" id=\"ff_6_dropdown_4\" class=\"ff-el-form-control\" data-name=\"dropdown_4\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=false><option value=\"keine\"  >keine<\/option><option value=\"Vorne \"  >Vorne<\/option><option value=\"Oberarm \/Schulter seitlich\"  >Oberarm \/Schulter seitlich<\/option><option value=\"Schulterblatt\"  >Schulterblatt<\/option><option value=\"zum Nackenziehend \/ HWS\"  >zum Nackenziehend \/ HWS<\/option><option value=\"Auf der Schulter oben \"  >Auf der Schulter oben<\/option><option value=\"Brustwirbels\u00e4ule\"  >Brustwirbels\u00e4ule<\/option><\/select><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-6_4\" ><h3 class='ff-el-section-title'>Aktuelle Schmerzen<\/h3><div class='ff-section_break_desk'><p>Schmerzangaben (0 = keine Schmerzen 10 = maximale Schmerzen)<\/p><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_rangeslider' aria-label=\"Ruheschmerz rechts:\">Ruheschmerz rechts: <\/label><\/div><div class='ff-el-input--content'><div class='ff_slider_wrapper'><input name=\"rangeslider\" class=\"ff-el-form-control\" value=\"0\" min=\"0\" max=\"10\" type=\"range\" data-name=\"rangeslider\" id=\"ff_6_rangeslider\" data-calc_value=\"0\"  aria-invalid='false' aria-required=false><div class='ff_range_value'>0<\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_rangeslider_1' aria-label=\"Bewegungschmerz rechts:\">Bewegungschmerz rechts:<\/label><\/div><div class='ff-el-input--content'><div class='ff_slider_wrapper'><input name=\"rangeslider_1\" class=\"ff-el-form-control\" value=\"0\" min=\"0\" max=\"10\" type=\"range\" data-name=\"rangeslider_1\" id=\"ff_6_rangeslider_1\" data-calc_value=\"0\"  aria-invalid='false' aria-required=false><div class='ff_range_value'>0<\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_rangeslider_3' aria-label=\"Nachtschmerz rechts:\">Nachtschmerz rechts:<\/label><\/div><div class='ff-el-input--content'><div class='ff_slider_wrapper'><input name=\"rangeslider_3\" class=\"ff-el-form-control\" value=\"0\" min=\"0\" max=\"10\" type=\"range\" data-name=\"rangeslider_3\" id=\"ff_6_rangeslider_3\" data-calc_value=\"0\"  aria-invalid='false' aria-required=false><div class='ff_range_value'>0<\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_rangeslider_5' aria-label=\"Ruheschmerz links:\">Ruheschmerz links:<\/label><\/div><div class='ff-el-input--content'><div class='ff_slider_wrapper'><input name=\"rangeslider_5\" class=\"ff-el-form-control\" value=\"0\" min=\"0\" max=\"10\" type=\"range\" data-name=\"rangeslider_5\" id=\"ff_6_rangeslider_5\" data-calc_value=\"0\"  aria-invalid='false' aria-required=false><div class='ff_range_value'>0<\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_rangeslider_6' aria-label=\"Bewegungsschmerz links:\">Bewegungsschmerz links:<\/label><\/div><div class='ff-el-input--content'><div class='ff_slider_wrapper'><input name=\"rangeslider_6\" class=\"ff-el-form-control\" value=\"0\" min=\"0\" max=\"10\" type=\"range\" data-name=\"rangeslider_6\" id=\"ff_6_rangeslider_6\" data-calc_value=\"0\"  aria-invalid='false' aria-required=false><div class='ff_range_value'>0<\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_rangeslider_4' aria-label=\"Nachtschmerz links:\">Nachtschmerz links:<\/label><\/div><div class='ff-el-input--content'><div class='ff_slider_wrapper'><input name=\"rangeslider_4\" class=\"ff-el-form-control\" value=\"0\" min=\"0\" max=\"10\" type=\"range\" data-name=\"rangeslider_4\" id=\"ff_6_rangeslider_4\" data-calc_value=\"0\"  aria-invalid='false' aria-required=false><div class='ff_range_value'>0<\/div><\/div><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-6_5\" ><h3 class='ff-el-section-title'>Ursache und Provokation<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_multi_select_2' aria-label=\"Provokation durch\">Provokation durch<\/label><\/div><div class='ff-el-input--content'><select name=\"multi_select_2[]\" id=\"ff_6_multi_select_2\" class=\"ff-el-form-control  ff_has_multi_select\" multiple=\"1\" data-name=\"multi_select_2\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=false><option value=\"Bewegung \u00fcber Schulterh\u00f6he\"  >Bewegung \u00fcber Schulterh\u00f6he<\/option><option value=\"Innenrotation (Griff zum Ges\u00e4\u00df)\"  >Innenrotation (Griff zum Ges\u00e4\u00df)<\/option><option value=\"Au\u00dfenrotation (Griff in Nacken)  \"  >Au\u00dfenrotation (Griff in Nacken)<\/option><option value=\"Wurfbewegung \/ Position\"  >Wurfbewegung \/ Position<\/option><option value=\"darauf liegen\"  >darauf liegen<\/option><option value=\"tragen von Einkaufst\u00fcte\"  >tragen von Einkaufst\u00fcte<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_multi_select_3' aria-label=\"m\u00f6gliche Ursache\">m\u00f6gliche Ursache<\/label><\/div><div class='ff-el-input--content'><select name=\"multi_select_3[]\" id=\"ff_6_multi_select_3\" class=\"ff-el-form-control  ff_has_multi_select\" multiple=\"1\" data-name=\"multi_select_3\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=false><option value=\"Beschwerden ohne Ursache \"  >Beschwerden ohne Ursache<\/option><option value=\"\u00dcberlastung durch k\u00f6rperliche Arbeit\"  >\u00dcberlastung durch k\u00f6rperliche Arbeit<\/option><option value=\"\u00dcberlastung durch Sport  \"  >\u00dcberlastung durch Sport<\/option><option value=\"Unfallereignis\"  >Unfallereignis<\/option><option value=\"Sportverletzung\"  >Sportverletzung<\/option><option value=\"alte Verletzung\"  >alte Verletzung<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_input_text' aria-label=\"Freitext (Unfalldatum, Ergeignis, o.\u00e4.)\">Freitext (Unfalldatum, Ergeignis, o.\u00e4.)<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" maxlength=\"70\" data-name=\"input_text\" id=\"ff_6_input_text\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-6_6\" ><h3 class='ff-el-section-title'>Dauer der Beschwerden<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_input_text_1' aria-label=\"Beschwerden erstmalig seit\">Beschwerden erstmalig seit<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_1\" class=\"ff-el-form-control\" maxlength=\"10\" data-name=\"input_text_1\" id=\"ff_6_input_text_1\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_input_text_5' aria-label=\"Beschwerdeverschlechterung seit\">Beschwerdeverschlechterung seit<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_5\" class=\"ff-el-form-control\" maxlength=\"10\" data-name=\"input_text_5\" id=\"ff_6_input_text_5\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-6_7\" ><h3 class='ff-el-section-title'>Beruf<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"K\u00f6rperliche berufliche Beanspruchung\">K\u00f6rperliche berufliche Beanspruchung <\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=input_radio_09ce875fa0079dd48a5aaa12e647855f><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"besteht\"  id='input_radio_09ce875fa0079dd48a5aaa12e647855f' aria-label='besteht' aria-invalid='false' aria-required=false> <span>besteht<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=input_radio_f7fc232788aa954d451dd93aa5e28395><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"besteht nicht\"  id='input_radio_f7fc232788aa954d451dd93aa5e28395' aria-label='besteht nicht' aria-invalid='false' aria-required=false> <span>besteht nicht<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_input_text_2' aria-label=\"aktuelle T\u00e4tigkeit\/Beruf\">aktuelle T\u00e4tigkeit\/Beruf<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_2\" class=\"ff-el-form-control\" maxlength=\"15\" data-name=\"input_text_2\" id=\"ff_6_input_text_2\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-6_8\" ><h3 class='ff-el-section-title'>Sport<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group ff-el-form-hide_label'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"Sport\">Sport<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=input_radio_1_17dc842935a320f0c458727bc6e27ec7><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"ja\"  id='input_radio_1_17dc842935a320f0c458727bc6e27ec7' aria-label='ja' aria-invalid='false' aria-required=false> <span>ja<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=input_radio_1_07db5db2c5822cd9936105069f5c1a97><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"nein\"  id='input_radio_1_07db5db2c5822cd9936105069f5c1a97' aria-label='nein' aria-invalid='false' aria-required=false> <span>nein<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_input_text_4' aria-label=\"Hauptsportart\">Hauptsportart<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_4\" class=\"ff-el-form-control\" maxlength=\"15\" data-name=\"input_text_4\" id=\"ff_6_input_text_4\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-6_9\" ><h3 class='ff-el-section-title'>Vorbehandlung<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group ff-el-form-hide_label'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"Checkbox Field\">Checkbox Field<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_91795e264d93ae12b720ee2625c8a5d2><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"keine\"  id='checkbox_91795e264d93ae12b720ee2625c8a5d2' aria-label='keine' aria-invalid='false' aria-required=false> <span>keine<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_multi_select_5' aria-label=\"vorbehandelt durch:\">vorbehandelt durch:<\/label><\/div><div class='ff-el-input--content'><select name=\"multi_select_5[]\" id=\"ff_6_multi_select_5\" class=\"ff-el-form-control  ff_has_multi_select\" multiple=\"1\" data-name=\"multi_select_5\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=false><option value=\"Hausarzt\"  >Hausarzt<\/option><option value=\"Orthop\u00e4de\"  >Orthop\u00e4de<\/option><option value=\"Chirurg\"  >Chirurg<\/option><option value=\"Heilpraktiker\"  >Heilpraktiker<\/option><option value=\"Osteopath\"  >Osteopath<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_input_text_3' aria-label=\"Vorbehandlungsdauer:\">Vorbehandlungsdauer:  <\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_3\" class=\"ff-el-form-control\" placeholder=\"? Tage, Wochen, Monate, Jahre \" data-name=\"input_text_3\" id=\"ff_6_input_text_3\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-6_10\" ><h3 class='ff-el-section-title'>Bisherige Therapie<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_multi_select_6' aria-label=\"bisherige Ma\u00dfnahmen:\">bisherige Ma\u00dfnahmen:<\/label><\/div><div class='ff-el-input--content'><select name=\"multi_select_6[]\" id=\"ff_6_multi_select_6\" class=\"ff-el-form-control  ff_has_multi_select\" multiple=\"1\" data-name=\"multi_select_6\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=false><option value=\"Einnahme NSAR (zB. Ibuprofen, Diclo etc:)\"  >Einnahme NSAR (zB. Ibuprofen, Diclo etc:)<\/option><option value=\"Einnahme Schmerzmedikamente (Novamin, Opioide, etc.)\"  >Einnahme Schmerzmedikamente (Novamin, Opioide, etc.)<\/option><option value=\"passive Physiotherapie (Massage, Manuelle Therapie)\"  >passive Physiotherapie (Massage, Manuelle Therapie)<\/option><option value=\"aktive Physiotherapie (KG, \u00dcbungen)\"  >aktive Physiotherapie (KG, \u00dcbungen)<\/option><option value=\"Eigen\u00fcbungen\"  >Eigen\u00fcbungen<\/option><option value=\"Elektrotherapie (zB. Tens)\"  >Elektrotherapie (zB. Tens)<\/option><option value=\"Osteopathie\"  >Osteopathie<\/option><option value=\"Akupunktur\"  >Akupunktur<\/option><option value=\"Injektion in Schulter \"  >Injektion in Schulter<\/option><option value=\"Injektion in HWS\"  >Injektion in HWS<\/option><option value=\"Schulter OP (Arthroskopie)\"  >Schulter OP (Arthroskopie)<\/option><option value=\"Ruhigstellung\"  >Ruhigstellung<\/option><\/select><\/div><\/div><div class='ff-el-group ff-el-form-hide_label'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_description' aria-label=\"erfolgreiche Ma\u00dfnahmen:\">erfolgreiche Ma\u00dfnahmen: <\/label><\/div><div class='ff-el-input--content'><textarea aria-invalid=\"false\" aria-required=false name=\"description\" id=\"ff_6_description\" class=\"ff-el-form-control\" placeholder=\"kurzer Freitext \" rows=\"3\" cols=\"2\" maxlength=\"30\" data-name=\"description\" ><\/textarea><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-6_11\" ><h3 class='ff-el-section-title'>Vorberfunde<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group ff-el-form-hide_label'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"Vorbefunde\">Vorbefunde<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_2_72de23e1178cb83e912633361cf1f053><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"R\u00f6ntgen Schulter\"  id='checkbox_2_72de23e1178cb83e912633361cf1f053' aria-label='R\u00f6ntgen Schulter' aria-invalid='false' aria-required=false> <span>R\u00f6ntgen Schulter<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_2_a458ba904a4a2aaa4a20ad0864eac4f2><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"R\u00f6ntgen HWS\"  id='checkbox_2_a458ba904a4a2aaa4a20ad0864eac4f2' aria-label='R\u00f6ntgen HWS' aria-invalid='false' aria-required=false> <span>R\u00f6ntgen HWS<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_2_d41c189b92d2705607b5fff180097d88><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Sonographie\"  id='checkbox_2_d41c189b92d2705607b5fff180097d88' aria-label='Sonographie' aria-invalid='false' aria-required=false> <span>Sonographie<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_2_b241dad07233d23094ce2891b965f8b6><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"MRT Schulter\"  id='checkbox_2_b241dad07233d23094ce2891b965f8b6' aria-label='MRT Schulter' aria-invalid='false' aria-required=false> <span>MRT Schulter<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_2_0da13e9025cbb1654020ddc93f9d8c1a><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"MRT HWS\"  id='checkbox_2_0da13e9025cbb1654020ddc93f9d8c1a' aria-label='MRT HWS' aria-invalid='false' aria-required=false> <span>MRT HWS<\/span><\/label><\/div><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-6_12\" ><h3 class='ff-el-section-title'>Dateianhang<\/h3><div class='ff-section_break_desk'><p>Foto oder PDF-Befund: (MRT, R\u00f6ntgen, Unfallbericht oder OP Bericht)<\/p>\n<p>nur 2 Dateien m\u00f6glich.\u00a0<\/p>\n<p>&nbsp;<\/p><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_file-upload_1' aria-label=\"Datei hochladen\">Datei hochladen<\/label><\/div><div class='ff-el-input--content'><label for='ff_6_file-upload_1' class='ff_file_upload_holder'><span class='ff_upload_btn ff-btn' tabindex='0'>Datei ausw\u00e4hlen<\/span> <input type=\"file\" name=\"file-upload\" id=\"ff_6_file-upload_1\" class=\"ff-el-form-control  ff-screen-reader-element\" data-name=\"file-upload\" multiple=\"1\"  aria-invalid='false' aria-required=false><\/label><\/div><\/div><div class='ff-el-group    ff-el-input--content'><div class='ff-el-form-check ff-el-tc'><label aria-label='Ich erkl\u00e4re mich mit der Verarbeitung der Verarbeitung meiner eingegebenen personenbezogenen Daten einverstanden und habe die Datenschutzerkl\u00e4rung zur Kenntnis genommen.' class='ff-el-form-check-label ff_tc_label' for=gdpr-agreement_d5f64c927db63cd9763107c71d6fdd1f><span class='ff_tc_checkbox'><input type=\"checkbox\" name=\"gdpr-agreement\" 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Ihre Schulterproblematik zu beschreiben, um unserem Schulterexperten Dr. Giesa eine zeitnahe Einsch\u00e4tzung vorab zu erm\u00f6glichen. \u00a0Um eine zeitnahe Terminvergabe werden wir uns bem\u00fchen. Diese Formular erm\u00f6glicht Ihnen im Vorfeld ggf. Zeit zu sparen.\u00a0 Es folgt hieraus keine telefonische oder E-Mail Vorabberatung. Der \u00e4rztliche Kontakt bleibt unerl\u00e4sslich. Unser Praxisteam meldet sich innerhalb weniger Tage, um mit Ihnen einen Termin auszumachen, soweit dies nicht schon erfolgt ist. Auch im Falle eines schon vergebenen Erstvorstellungstermins in der Schultersprechstunde k\u00f6nnen Sie mit diesem Formular Ihre individuelle Krankheitsgeschichte uns vorab schon einreichen.\u00a0 Sollten&hellip;<\/p>\n","category_list_v2":"","author_info_v2":{"name":"Arne Strohbach","url":"https:\/\/www.orthopaedie-wilhelmstrasse.de\/news\/author\/arne-strohbach\/"},"comments_num_v2":"0 comments","_links":{"self":[{"href":"https:\/\/www.orthopaedie-wilhelmstrasse.de\/news\/wp-json\/wp\/v2\/pages\/340","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.orthopaedie-wilhelmstrasse.de\/news\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.orthopaedie-wilhelmstrasse.de\/news\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.orthopaedie-wilhelmstrasse.de\/news\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.orthopaedie-wilhelmstrasse.de\/news\/wp-json\/wp\/v2\/comments?post=340"}],"version-history":[{"count":3,"href":"https:\/\/www.orthopaedie-wilhelmstrasse.de\/news\/wp-json\/wp\/v2\/pages\/340\/revisions"}],"predecessor-version":[{"id":374,"href":"https:\/\/www.orthopaedie-wilhelmstrasse.de\/news\/wp-json\/wp\/v2\/pages\/340\/revisions\/374"}],"wp:attachment":[{"href":"https:\/\/www.orthopaedie-wilhelmstrasse.de\/news\/wp-json\/wp\/v2\/media?parent=340"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}