{"id":7533,"date":"2021-02-04T17:03:33","date_gmt":"2021-02-04T16:03:33","guid":{"rendered":"https:\/\/www.corona-tracking.info\/?page_id=7533"},"modified":"2021-10-22T05:44:18","modified_gmt":"2021-10-22T03:44:18","slug":"mockup-input-speekseltest","status":"publish","type":"page","link":"https:\/\/www.corona-tracking.info\/algemene-info\/archief\/mockup-input-speekseltest\/","title":{"rendered":"Mockup input speekseltest"},"content":{"rendered":"<div class=\"forminator-ui forminator-custom-form forminator-custom-form-7532 forminator-design--flat  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-7532\" data-uid=\"64745c03ecfe5\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-7532\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-7532 forminator-design--flat  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"7532\"\n\t\t\t\t\n\t\t\t\tdata-design=\"flat\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tdata-grid=\"open\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tstyle=\"display: none;\"\n\t\t\t\t\n\t\t\t\tdata-uid=\"64745c03ecfe5\"\n\t\t\t><div class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-row forminator-no-margin\" data-multiple=\"true\"><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-first-name-1_64745c03ecfe5\" class=\"forminator-label\">Voornaam <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1-first-name\" placeholder=\"Bv. Frank\" id=\"forminator-field-first-name-1_64745c03ecfe5\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" value=\"\" \/><\/div><\/div><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-last-name-1_64745c03ecfe5\" class=\"forminator-label\">Achternaam <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1-last-name\" placeholder=\"Bv. Robben\" id=\"forminator-field-last-name-1_64745c03ecfe5\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-2\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_64745c03ecfe5\" class=\"forminator-label\">Identificatienummer Sociale Zekerheid <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"Bv. 61031617745\" id=\"forminator-field-text-2_64745c03ecfe5\" class=\"forminator-input forminator-name--field\" data-required=\"1\" maxlength=\"11\" aria-describedby=\"forminator-field-text-2_64745c03ecfe5-description\" \/><span id=\"forminator-field-text-2_64745c03ecfe5-description\" class=\"forminator-description\">Zie linksboven op de achterkant van uw elektronische identiteitskaart<span data-limit=\"11\" data-type=\"characters\">0 \/ 11<\/span><\/span><\/div><\/div><div id=\"phone-1\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_64745c03ecfe5\" class=\"forminator-label\">GSM-nummer <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"Bv. 0476879648\" id=\"forminator-field-phone-1_64745c03ecfe5\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" data-national_mode=\"enabled\" data-country=\"BE\" data-validation=\"standard\" aria-describedby=\"forminator-field-phone-1_64745c03ecfe5-description\" \/><span id=\"forminator-field-phone-1_64745c03ecfe5-description\" class=\"forminator-description\">Dit nummer dient om u te verwittigen van uw testresultaat<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-3\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_64745c03ecfe5\" class=\"forminator-label\">Naam huisarts<\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"Bv. Dani\u00eblle Grouwels\" id=\"forminator-field-text-3_64745c03ecfe5\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_64745c03ecfe5\" class=\"forminator-label\">Staalnummer <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"Bv. CV1234567890\" id=\"forminator-field-text-1_64745c03ecfe5\" class=\"forminator-input forminator-name--field\" data-required=\"1\" maxlength=\"12\" \/><span id=\"forminator-field-text-1_64745c03ecfe5-description\" class=\"forminator-description\"><span data-limit=\"12\" data-type=\"characters\">0 \/ 12<\/span><\/span><\/div><\/div><div id=\"date-1\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_64745c03ecfe5\" class=\"forminator-label\">Datum van de staalafname <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-1-picker_64745c03ecfe5\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"29-05-2023\" placeholder=\"Kies Datum\" id=\"forminator-field-date-1-picker_64745c03ecfe5\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd-mm-yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1923\" data-end-year=\"2123\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-3\" class=\"forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-64745c03ecfe5-label\"><span id=\"forminator-radiogroup-64745c03ecfe5-label\" class=\"forminator-label\">Gewest van de school <span class=\"forminator-required\">*<\/span><\/span><label for=\"forminator-field-radio-3-1-64745c03ecfe5\" class=\"forminator-radio forminator-radio-inline\" title=\"Brussels Hoofdstedelijk Gewest\"><input type=\"radio\" name=\"radio-3\" value=\"brussels-hoofdstedelijk-gewest\" id=\"forminator-field-radio-3-1-64745c03ecfe5\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-3-64745c03ecfe5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Brussels Hoofdstedelijk Gewest<\/span><\/label><label for=\"forminator-field-radio-3-2-64745c03ecfe5\" class=\"forminator-radio forminator-radio-inline\" title=\"Vlaanderen\"><input type=\"radio\" name=\"radio-3\" value=\"vlaanderen\" id=\"forminator-field-radio-3-2-64745c03ecfe5\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-3-64745c03ecfe5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Vlaanderen<\/span><\/label><label for=\"forminator-field-radio-3-3-64745c03ecfe5\" class=\"forminator-radio forminator-radio-inline\" title=\"Walloni\u00eb\"><input type=\"radio\" name=\"radio-3\" value=\"walloni\" id=\"forminator-field-radio-3-3-64745c03ecfe5\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-3-64745c03ecfe5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Walloni\u00eb<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-64745c03ecfe5-label\"><span id=\"forminator-radiogroup-64745c03ecfe5-label\" class=\"forminator-label\">Welke school <span class=\"forminator-required\">*<\/span><\/span><label for=\"forminator-field-radio-1-1-64745c03ecfe5\" class=\"forminator-radio forminator-radio-inline\" title=\"School 1\"><input type=\"radio\" name=\"radio-1\" value=\"school-1\" id=\"forminator-field-radio-1-1-64745c03ecfe5\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-1-64745c03ecfe5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">School 1<\/span><\/label><label for=\"forminator-field-radio-1-2-64745c03ecfe5\" class=\"forminator-radio forminator-radio-inline\" title=\"School 2\"><input type=\"radio\" name=\"radio-1\" value=\"school-2\" id=\"forminator-field-radio-1-2-64745c03ecfe5\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-1-64745c03ecfe5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">School 2<\/span><\/label><label for=\"forminator-field-radio-1-3-64745c03ecfe5\" class=\"forminator-radio forminator-radio-inline\" title=\"School 3\"><input type=\"radio\" name=\"radio-1\" value=\"school-3\" id=\"forminator-field-radio-1-3-64745c03ecfe5\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-1-64745c03ecfe5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">School 3<\/span><\/label><label for=\"forminator-field-radio-1-4-64745c03ecfe5\" class=\"forminator-radio forminator-radio-inline\" title=\"School 4\"><input type=\"radio\" name=\"radio-1\" value=\"school-4\" id=\"forminator-field-radio-1-4-64745c03ecfe5\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-1-64745c03ecfe5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">School 4<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-64745c03ecfe5-label\"><span id=\"forminator-radiogroup-64745c03ecfe5-label\" class=\"forminator-label\">Welke school <span class=\"forminator-required\">*<\/span><\/span><label for=\"forminator-field-radio-2-1-64745c03ecfe5\" class=\"forminator-radio forminator-radio-inline\" title=\"Ecole 1\"><input type=\"radio\" name=\"radio-2\" value=\"ecole-1\" id=\"forminator-field-radio-2-1-64745c03ecfe5\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-2-64745c03ecfe5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Ecole 1<\/span><\/label><label for=\"forminator-field-radio-2-2-64745c03ecfe5\" class=\"forminator-radio forminator-radio-inline\" title=\"Ecole 2\"><input type=\"radio\" name=\"radio-2\" value=\"ecole-2\" id=\"forminator-field-radio-2-2-64745c03ecfe5\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-2-64745c03ecfe5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Ecole 2<\/span><\/label><label for=\"forminator-field-radio-2-3-64745c03ecfe5\" class=\"forminator-radio forminator-radio-inline\" title=\"Ecole 3\"><input type=\"radio\" name=\"radio-2\" value=\"ecole-3\" id=\"forminator-field-radio-2-3-64745c03ecfe5\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-2-64745c03ecfe5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Ecole 3<\/span><\/label><label for=\"forminator-field-radio-2-4-64745c03ecfe5\" class=\"forminator-radio forminator-radio-inline\" title=\"Ecole 4\"><input type=\"radio\" name=\"radio-2\" value=\"ecole-4\" id=\"forminator-field-radio-2-4-64745c03ecfe5\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-2-64745c03ecfe5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Ecole 4<\/span><\/label><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Bericht Verzenden<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"b8a49e1694\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/7533\" \/><input type=\"hidden\" name=\"form_id\" value=\"7532\"><input type=\"hidden\" name=\"page_id\" value=\"7533\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/www.corona-tracking.info\/algemene-info\/archief\/mockup-input-speekseltest\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":3,"featured_media":0,"parent":4376,"menu_order":4,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/www.corona-tracking.info\/wp-json\/wp\/v2\/pages\/7533"}],"collection":[{"href":"https:\/\/www.corona-tracking.info\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.corona-tracking.info\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.corona-tracking.info\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.corona-tracking.info\/wp-json\/wp\/v2\/comments?post=7533"}],"version-history":[{"count":2,"href":"https:\/\/www.corona-tracking.info\/wp-json\/wp\/v2\/pages\/7533\/revisions"}],"predecessor-version":[{"id":11093,"href":"https:\/\/www.corona-tracking.info\/wp-json\/wp\/v2\/pages\/7533\/revisions\/11093"}],"up":[{"embeddable":true,"href":"https:\/\/www.corona-tracking.info\/wp-json\/wp\/v2\/pages\/4376"}],"wp:attachment":[{"href":"https:\/\/www.corona-tracking.info\/wp-json\/wp\/v2\/media?parent=7533"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}