YOURmeds data- & toestemmingsformulier<\/title>\n <script src=\"https:\/\/cdnjs.cloudflare.com\/ajax\/libs\/html2canvas\/1.4.1\/html2canvas.min.js\"><\/script>\n <style>\n body {\n font-family: Arial, Helvetica, sans-serif;\n padding: 20px;\n }\n form {\n border: 1px solid #ccc;\n padding: 20px;\n border-radius: 5px;\n background-color: #f9f9f9;\n }\n h1, h3 {\n margin-bottom:1.5rem;\n text-align:center;\n font-family:'Helvetica Neue', Arial, Helvetica, sans-serif;\n }\n h4 {\n margin:1rem;\n margin-bottom:1rem;\n text-decoration:underline;\n }\n table, th, td {\n border: 1px solid black;\n border-collapse: collapse;\n text-align: left;\n padding: 7px;\n }\n \n input { \n padding: 12px; \n box-sizing: border-box; \n border: 1px solid #ccc; \n border-radius: 4px; \n font-size: 14px; \n vertical-align: middle; \n line-height: 1.6; \n }\n\n textarea {\n width: 100%;\n padding: 8px;\n margin-bottom: 10px;\n box-sizing: border-box;\n border: 1px solid #ccc;\n border-radius: 4px;\n }\n\n .signature-container { text-align: center; } \n\n .signature { \n font-family: 'Brush Script MT', cursive; \n font-size: 24px; \n margin: 10px auto; \n padding: 10px; \n border: 1px solid #ccc; \n width: fit-content; \n } \n\n button {\n padding: 10px 20px;\n background-color: #007bff;\n color: #fff;\n border: none;\n border-radius: 4px;\n cursor: pointer;\n }\n\n button:hover { background-color: #0056b3; } \n\n #timestamp { font-style: italic; }\n\n <\/style>\n<\/head>\n<body>\n <form id=\"htmlForm\">\n <h1>YOURmeds data- & toestemmingsformulier<\/h1> \n <section>\n <h3>Gegevens van de YOURmeds gebruiker<\/h3>\n <table style=\"width:70%\">\n <tr>\n <td><label for=\"title\">Aanhef (dhr\/mevr\/anders)<\/label><\/td>\n <td><input style=\"width:550px\" type=\"text\" id=\"title\" name=\"title\"><\/td>\n <\/tr>\n <tr>\n <td><label for=\"firstname\">Voornaam\/voorletter (s)<\/label><\/td>\n <td><input style=\"width:550px\" type=\"text\" id=\"firstname\" name=\"firstname\"><\/td>\n <\/tr>\n <tr>\n <td><label for=\"surname\">Achternaam<\/label><\/td>\n <td><input style=\"width:550px\" type=\"text\" id=\"surname\" name=\"surname\"><\/td>\n <\/tr>\n <tr>\n <td><label for=\"addressline1\">Adres<\/label><\/td>\n <td><input style=\"width:550px\" type=\"text\" id=\"addressline1\" name=\"addressline1\"><\/td>\n <\/tr>\n <tr>\n <td><label for=\"postcode\">Postcode<\/label><\/td>\n <td><input style=\"width:550px\" type=\"text\" id=\"postcode\" name=\"postcode\"><\/td>\n <\/tr>\n <tr>\n <td><label for=\"city\">Woonplaats<\/label><\/td>\n <td><input style=\"width:550px\" type=\"text\" id=\"city\" name=\"city\"><\/td>\n <\/tr>\n <tr>\n <td><label for=\"dob\">Geboortedatum (DD\/MM\/JJJJ)<\/label><\/td>\n <td><input type=\"date\" id=\"dob\" name=\"dob\" required><\/td>\n <\/tr>\n <tr>\n <td><label for=\"phonenumber\">Telefoonnummer<\/label><\/td>\n <td><input style=\"width:550px\" type=\"text\" id=\"phonenumber\" name=\"phonenumber\"><\/td>\n <\/tr>\n <tr>\n <td><label for=\"emailaddress\">email adres (facultatief)<\/label><\/td>\n <td><input style=\"width:550px\" type=\"text\" id=\"emailaddress\" name=\"emailaddress\"><\/td>\n <\/tr>\n <\/table>\n <br>\n <em>Telefoonnummer wordt gebruikt om supporters contact met u op te laten nemen met de YOURmeds app<\/em>\n <\/section>\n <br>\n <section>\n <h3>Uw Medicijn inname momenten<\/h3>\n <p>\n Uw YOURmeds wordt standaard ingesteld op 4 inname momenten per dag, ochtend, middag avond en nacht. \n De standaard tijdsinstellingen in ons systeem per inname moment zijn als volgt:\n <\/p>\n <ul>\n <li>ochtend 08:00-10:00<\/li>\n <li>middag 12:00-14:00<\/li>\n <li>avond 16:00-18:00<\/li>\n <li>nacht 20:00-22:00<\/li>\n <\/ul>\n <p>Steeds wanneer men het juiste vakje binnen deze 2 uur blokken opent behandelen we dat als correct.<\/p>\n <br>\n <p>Het schema is dagelijks terugkerend en geldt dan voor de gehele ingestelde periode<\/p>\n <p>\n In het geval u uw YOURmeds voor anders dan 4 inname momenten per dag wilt gebruiken, gelieve dit aan \n te geven in onderstaande schema door JA of NEE bij elk inname moment hier aan te kruisen.\n <\/p>\n <br>\n <table>\n <tr>\n <td style=\"text-align: center;\">ochtend<\/td>\n <td style=\"text-align: center;\">middag<\/td>\n <td style=\"text-align: center;\">avond<\/td>\n <td style=\"text-align: center;\">nacht<\/td>\n <\/tr>\n <tr>\n <td style=\"text-align: center;\">\n <label><input type=\"checkbox\" id=\"y\" name=\"yes\" onclick=\"yesOrNo(this)\"> JA<\/label>\n <label><input type=\"checkbox\" id=\"n\" name=\"no\" onclick=\"yesOrNo(this)\"> NEE<\/label>\n <\/td>\n <td style=\"text-align: center;\">\n <label><input type=\"checkbox\" id=\"yes\" name=\"yes\" onclick=\"yesOrNo2(this)\"> JA<\/label>\n <label><input type=\"checkbox\" id=\"no\" name=\"no\" onclick=\"yesOrNo2(this)\"> NEE<\/label>\n <\/td>\n <td style=\"text-align: center;\">\n <label><input type=\"checkbox\" id=\"oui\" name=\"yes\" onclick=\"yesOrNo3(this)\"> JA<\/label>\n <label><input type=\"checkbox\" id=\"non\" name=\"no\" onclick=\"yesOrNo3(this)\"> NEE<\/label>\n <\/td>\n <td style=\"text-align: center;\">\n <label><input type=\"checkbox\" id=\"ja\" name=\"yes\" onclick=\"yesOrNo4(this)\"> JA<\/label>\n <label><input type=\"checkbox\" id=\"nein\" name=\"no\" onclick=\"yesOrNo4(this)\"> NEE<\/label>\n <\/td>\n <\/tr>\n <\/table>\n <p><em>Met deze tabel laat u ons weten welke inname momenten u hanteerd en gebruiken wij voor ons systeem.<\/em><\/p>\n <\/section>\n <br>\n <section>\n <h3>Supporters – familie, vrienden en anderen<\/h3>\n <p>\n Geef minimaal 1 supporter op die een melding ontvangt wanneer een medicijn inname moment wordt vergeten, zij worden dan gevraagd contact \n met u op te nemen om u eraan te herinneren.\n <\/p>\n <p>\n Als genomineerde hulpverlener gaan de onderstaande perso(o)n(en) akkoord met het ontvangen van medicatiewaarschuwingen via de YOURmeds-smartphone-app. \n Supporters krijgen per mail een uitnodiging om de YOURmeds supporters-app te downloaden. Ze hebben een Android- of Apple-smartphone met \n gegevenstoegang nodig om de app te installeren en meldingen te ontvangen. Als hulpverlener stemmen ze ermee in om tijdig contact op te nemen \n met de verzorgde persoon en indien nodig passende maatregelen te nemen\n <\/p>\n <br>\n <table>\n <tr>\n <td>Naam Supporter 1<\/td>\n <td><input style=\"width:500px\" type=\"text\" id=\"respondername\" required><\/td>\n <\/tr>\n <tr>\n <td>Email Adres<\/td>\n <td><input style=\"width:500px\" type=\"text\" id=\"responderemail\" required><\/td>\n <\/tr>\n <tr>\n <td>Telefoon number<\/td>\n <td><input style=\"width:500px\" type=\"text\" id=\"responderphone\"><\/td>\n <\/tr>\n <\/table>\n <br>\n <table>\n <tr>\n <td>Naam Supporter 2<\/td>\n <td><input style=\"width:500px\" type=\"text\"><\/td>\n <\/tr>\n <tr>\n <td>Email Adres<\/td>\n <td><input style=\"width:500px\" type=\"text\"><\/td>\n <\/tr>\n <tr>\n <td>Telefoon number<\/td>\n <td><input style=\"width:500px\" type=\"text\"><\/td>\n <\/tr>\n <\/table>\n <p><em>Naam en e-mail zijn verplichte Velden om de app te kunnen downloaden, telefoonnummer is nuttig<\/em><\/p>\n <br>\n <p>\n U kunt zelf ook de YOURmeds app gebruiken en tevens op deze manier zelf de herinneringen ontvangen. \n Wanneer u hier voor kiest dient u onderstaande tabel ook in te vullen.\n <\/p>\n <br>\n <table>\n <tr>\n <td>Zels Support naam<\/td>\n <td><input style=\"width:500px\" type=\"text\" required><\/td>\n <\/tr>\n <tr>\n <td>Email Adres<\/td>\n <td><input style=\"width:500px\" type=\"text\" required><\/td>\n <\/tr>\n <tr>\n <td>Telefoon number<\/td>\n <td><input style=\"width:500px\" type=\"text\"><\/td>\n <\/tr>\n <\/table>\n <p><em>Naam en e-mail zijn verplichte Velden om de app te kunnen downloaden, telefoonnummer is nuttig<\/em><\/p>\n <br>\n <table style=\"width:40%\">\n <tr>\n <td>\n Handtekening<br><br><br>\n <div class=\"signature-container\"> \n <textarea id=\"signature-input\" placeholder=\"Typ hier uw naam\"><\/textarea> \n <div id=\"signature-preview\" class=\"signature\"><\/div> \n <input \n type=\"button\" \n style=\" \n padding: 20px 10px; \n background-color: #007bff; \n color: #fff; \n border: none; \n border-radius: 4px; \n cursor: pointer; \n width: 50%; \n \" \n onclick=\"addSignature()\" \n value=\"Voeg Handtekening Toe\"> \n <\/input>\n <p id=\"timestamp\"><\/p> \n <\/div> \n <\/td>\n <\/tr>\n <\/table>\n <br>\n <p><em>Om te lezen hoe we met uw data omgang kunt u hierop klikken <a href=\"https:\/\/yourmeds.net\/privacy-policy\/\" target=\"_blank\">privacy policy<\/a><\/em><\/p>\n <\/section>\n <br>\n <button type=\"button\" onclick=\"captureForm()\">Formulierafbeelding Downloaden<\/button>\n <\/form>\n\n <script>\n function yesOrNo(clickedCheckbox) {\n var yesCheckbox = document.getElementById('y'); var noCheckbox = document.getElementById('n'); \n if (clickedCheckbox === yesCheckbox && yesCheckbox.checked) { noCheckbox.checked = false; } \n else if (clickedCheckbox === noCheckbox && noCheckbox.checked) { yesCheckbox.checked = false; } \n }\n function yesOrNo2(clickedCheckbox) {\n var yesCheckbox = document.getElementById('yes'); var noCheckbox = document.getElementById('no'); \n if (clickedCheckbox === yesCheckbox && yesCheckbox.checked) { noCheckbox.checked = false; } \n else if (clickedCheckbox === noCheckbox && noCheckbox.checked) { yesCheckbox.checked = false; } \n }\n function yesOrNo3(clickedCheckbox) {\n var yesCheckbox = document.getElementById('oui'); var noCheckbox = document.getElementById('non'); \n if (clickedCheckbox === yesCheckbox && yesCheckbox.checked) { noCheckbox.checked = false; } \n else if (clickedCheckbox === noCheckbox && noCheckbox.checked) { yesCheckbox.checked = false; } \n }\n function yesOrNo4(clickedCheckbox) {\n var yesCheckbox = document.getElementById('ja'); var noCheckbox = document.getElementById('nein'); \n if (clickedCheckbox === yesCheckbox && yesCheckbox.checked) { noCheckbox.checked = false; } \n else if (clickedCheckbox === noCheckbox && noCheckbox.checked) { yesCheckbox.checked = false; } \n }\n \n function addSignature() { \n const signatureInput = document.getElementById('signature-input').value; \n const signaturePreview = document.getElementById('signature-preview'); \n const timestampElement = document.getElementById('timestamp');\n signaturePreview.textContent = signatureInput;\n const timestamp = new Date().toLocaleString(); \n timestampElement.textContent = `Ondertekend op: ${timestamp.slice(0,17)}`; \n }\n \n function captureForm() {\n const formElement = document.querySelector(\"#htmlForm\");\n const fileName = document.getElementById('surname').value ? document.getElementById('surname').value : 'anoniem';\n\n html2canvas(formElement).then(canvas => {\n const imageData = canvas.toDataURL(\"image\/png\");\n const downloadLink = document.createElement(\"a\");\n downloadLink.href = imageData;\n downloadLink.download = `${fileName}.png`; \/\/ Set custom file name\n downloadLink.click();\n });\n }\n <\/script>\n<\/body>\n<\/html>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-560f648 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"560f648\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-17dfe08\" data-id=\"17dfe08\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-54c621f elementor-widget elementor-widget-formidable\" data-id=\"54c621f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"formidable.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"frm_forms with_frm_style frm_style_yourmeds\" id=\"frm_form_34_container\" data-token=\"fbe2111aca726e1642352b13bfce7590\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form \" id=\"form_referral-form-upload\" data-token=\"fbe2111aca726e1642352b13bfce7590\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Referral Form Upload<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"34\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_34\" id=\"frm_hide_fields_34\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"referral-form-upload\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_34\" name=\"frm_submit_entry_34\" value=\"e169b2a7e3\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/de\/wp-json\/wp\/v2\/pages\/8505\" \/><div id=\"frm_field_591_container\" class=\"frm_form_field form-field frm_required_field frm_top_container\">\r\n <label for=\"field_rdwlx\" id=\"field_rdwlx_label\" class=\"frm_primary_label\">Referral Form Upload\r\n <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n <\/label>\r\n <input type=\"text\" id=\"field_rdwlx\" name=\"item_meta[591]\" value=\"\" data-reqmsg=\"Referral Form Upload cannot be blank.\" data-invmsg=\"Referral Form Upload is invalid\" aria-invalid=\"false\" \/>\r\n \r\n \r\n<\/div>\n<div id=\"frm_field_603_container\" class=\"frm_form_field form-field \">\r\n\t<div class=\"frm_submit frm_flex\">\r\n<button class=\"frm_button_submit\" type=\"submit\" >Submit Referral Form to YOURmeds<\/button>\r\n\r\n\r\n\r\n<\/div>\r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_650_container\">\n\t\t\t<label for=\"field_ervya\" >\n\t\t\t\tFalls Du menschlich bist, lasse dieses Feld leer.\t\t\t<\/label>\n\t\t\t<input id=\"field_ervya\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[650]\" value=\"\" \/>\n\t\t<\/div>\n\t\t<\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p> YOURmeds data- & toestemmingsformulier YOURmeds data- & toestemmingsformulier Gegevens van de YOURmeds gebruiker Aanhef (dhr\/mevr\/anders) Voornaam\/voorletter (s) […]<\/p>\n","protected":false},"author":40,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"content-type":"","site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"full-width-container","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"default","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center 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<\/p>\n\n \n \n YOURmeds data- & toestemmingsformulier<\/title>\n <script src=\"https:\/\/cdnjs.cloudflare.com\/ajax\/libs\/html2canvas\/1.4.1\/html2canvas.min.js\"><\/script>\n <style>\n body {\n font-family: Arial, Helvetica, sans-serif;\n padding: 20px;\n }\n form {\n border: 1px solid #ccc;\n padding: 20px;\n border-radius: 5px;\n background-color: #f9f9f9;\n }\n h1, h3 {\n margin-bottom:1.5rem;\n text-align:center;\n font-family:'Helvetica Neue', Arial, Helvetica, sans-serif;\n }\n h4 {\n margin:1rem;\n margin-bottom:1rem;\n text-decoration:underline;\n }\n table, th, td {\n border: 1px solid black;\n border-collapse: collapse;\n text-align: left;\n padding: 7px;\n }\n \n input { \n padding: 12px; \n box-sizing: border-box; \n border: 1px solid #ccc; \n border-radius: 4px; \n font-size: 14px; \n vertical-align: middle; \n line-height: 1.6; \n }\n\n textarea {\n width: 100%;\n padding: 8px;\n margin-bottom: 10px;\n box-sizing: border-box;\n border: 1px solid #ccc;\n border-radius: 4px;\n }\n\n .signature-container { text-align: center; } \n\n .signature { \n font-family: 'Brush Script MT', cursive; \n font-size: 24px; \n margin: 10px auto; \n padding: 10px; \n border: 1px solid #ccc; \n width: fit-content; \n } \n\n button {\n padding: 10px 20px;\n background-color: #007bff;\n color: #fff;\n border: none;\n border-radius: 4px;\n cursor: pointer;\n }\n\n button:hover { background-color: #0056b3; } \n\n #timestamp { font-style: italic; }\n\n <\/style>\n<\/head>\n<body>\n <form id=\"htmlForm\">\n <h1>YOURmeds data- & toestemmingsformulier<\/h1> \n <section>\n <h3>Gegevens van de YOURmeds gebruiker<\/h3>\n <table style=\"width:70%\">\n <tr>\n <td><label for=\"title\">Aanhef (dhr\/mevr\/anders)<\/label><\/td>\n <td><input style=\"width:550px\" type=\"text\" id=\"title\" name=\"title\"><\/td>\n <\/tr>\n <tr>\n <td><label for=\"firstname\">Voornaam\/voorletter (s)<\/label><\/td>\n <td><input style=\"width:550px\" type=\"text\" id=\"firstname\" name=\"firstname\"><\/td>\n <\/tr>\n <tr>\n <td><label for=\"surname\">Achternaam<\/label><\/td>\n <td><input style=\"width:550px\" type=\"text\" id=\"surname\" name=\"surname\"><\/td>\n <\/tr>\n <tr>\n <td><label for=\"addressline1\">Adres<\/label><\/td>\n <td><input style=\"width:550px\" type=\"text\" id=\"addressline1\" name=\"addressline1\"><\/td>\n <\/tr>\n <tr>\n <td><label for=\"postcode\">Postcode<\/label><\/td>\n <td><input style=\"width:550px\" type=\"text\" id=\"postcode\" name=\"postcode\"><\/td>\n <\/tr>\n <tr>\n <td><label for=\"city\">Woonplaats<\/label><\/td>\n <td><input style=\"width:550px\" type=\"text\" id=\"city\" name=\"city\"><\/td>\n <\/tr>\n <tr>\n <td><label for=\"dob\">Geboortedatum (DD\/MM\/JJJJ)<\/label><\/td>\n <td><input type=\"date\" id=\"dob\" name=\"dob\" required><\/td>\n <\/tr>\n <tr>\n <td><label for=\"phonenumber\">Telefoonnummer<\/label><\/td>\n <td><input style=\"width:550px\" type=\"text\" id=\"phonenumber\" name=\"phonenumber\"><\/td>\n <\/tr>\n <tr>\n <td><label for=\"emailaddress\">email adres (facultatief)<\/label><\/td>\n <td><input style=\"width:550px\" type=\"text\" id=\"emailaddress\" name=\"emailaddress\"><\/td>\n <\/tr>\n <\/table>\n <br>\n <em>Telefoonnummer wordt gebruikt om supporters contact met u op te laten nemen met de YOURmeds app<\/em>\n <\/section>\n <br>\n <section>\n <h3>Uw Medicijn inname momenten<\/h3>\n <p>\n Uw YOURmeds wordt standaard ingesteld op 4 inname momenten per dag, ochtend, middag avond en nacht. \n De standaard tijdsinstellingen in ons systeem per inname moment zijn als volgt:\n <\/p>\n <ul>\n <li>ochtend 08:00-10:00<\/li>\n <li>middag 12:00-14:00<\/li>\n <li>avond 16:00-18:00<\/li>\n <li>nacht 20:00-22:00<\/li>\n <\/ul>\n <p>Steeds wanneer men het juiste vakje binnen deze 2 uur blokken opent behandelen we dat als correct.<\/p>\n <br>\n <p>Het schema is dagelijks terugkerend en geldt dan voor de gehele ingestelde periode<\/p>\n <p>\n In het geval u uw YOURmeds voor anders dan 4 inname momenten per dag wilt gebruiken, gelieve dit aan \n te geven in onderstaande schema door JA of NEE bij elk inname moment hier aan te kruisen.\n <\/p>\n <br>\n <table>\n <tr>\n <td style=\"text-align: center;\">ochtend<\/td>\n <td style=\"text-align: center;\">middag<\/td>\n <td style=\"text-align: center;\">avond<\/td>\n <td style=\"text-align: center;\">nacht<\/td>\n <\/tr>\n <tr>\n <td style=\"text-align: center;\">\n <label><input type=\"checkbox\" id=\"y\" name=\"yes\" onclick=\"yesOrNo(this)\"> JA<\/label>\n <label><input type=\"checkbox\" id=\"n\" name=\"no\" onclick=\"yesOrNo(this)\"> NEE<\/label>\n <\/td>\n <td style=\"text-align: center;\">\n <label><input type=\"checkbox\" id=\"yes\" name=\"yes\" onclick=\"yesOrNo2(this)\"> JA<\/label>\n <label><input type=\"checkbox\" id=\"no\" name=\"no\" onclick=\"yesOrNo2(this)\"> NEE<\/label>\n <\/td>\n <td style=\"text-align: center;\">\n <label><input type=\"checkbox\" id=\"oui\" name=\"yes\" onclick=\"yesOrNo3(this)\"> JA<\/label>\n <label><input type=\"checkbox\" id=\"non\" name=\"no\" onclick=\"yesOrNo3(this)\"> NEE<\/label>\n <\/td>\n <td style=\"text-align: center;\">\n <label><input type=\"checkbox\" id=\"ja\" name=\"yes\" onclick=\"yesOrNo4(this)\"> JA<\/label>\n <label><input type=\"checkbox\" id=\"nein\" name=\"no\" onclick=\"yesOrNo4(this)\"> NEE<\/label>\n <\/td>\n <\/tr>\n <\/table>\n <p><em>Met deze tabel laat u ons weten welke inname momenten u hanteerd en gebruiken wij voor ons systeem.<\/em><\/p>\n <\/section>\n <br>\n <section>\n <h3>Supporters – familie, vrienden en anderen<\/h3>\n <p>\n Geef minimaal 1 supporter op die een melding ontvangt wanneer een medicijn inname moment wordt vergeten, zij worden dan gevraagd contact \n met u op te nemen om u eraan te herinneren.\n <\/p>\n <p>\n Als genomineerde hulpverlener gaan de onderstaande perso(o)n(en) akkoord met het ontvangen van medicatiewaarschuwingen via de YOURmeds-smartphone-app. \n Supporters krijgen per mail een uitnodiging om de YOURmeds supporters-app te downloaden. Ze hebben een Android- of Apple-smartphone met \n gegevenstoegang nodig om de app te installeren en meldingen te ontvangen. Als hulpverlener stemmen ze ermee in om tijdig contact op te nemen \n met de verzorgde persoon en indien nodig passende maatregelen te nemen\n <\/p>\n <br>\n <table>\n <tr>\n <td>Naam Supporter 1<\/td>\n <td><input style=\"width:500px\" type=\"text\" id=\"respondername\" required><\/td>\n <\/tr>\n <tr>\n <td>Email Adres<\/td>\n <td><input style=\"width:500px\" type=\"text\" id=\"responderemail\" required><\/td>\n <\/tr>\n <tr>\n <td>Telefoon number<\/td>\n <td><input style=\"width:500px\" type=\"text\" id=\"responderphone\"><\/td>\n <\/tr>\n <\/table>\n <br>\n <table>\n <tr>\n <td>Naam Supporter 2<\/td>\n <td><input style=\"width:500px\" type=\"text\"><\/td>\n <\/tr>\n <tr>\n <td>Email Adres<\/td>\n <td><input style=\"width:500px\" type=\"text\"><\/td>\n <\/tr>\n <tr>\n <td>Telefoon number<\/td>\n <td><input style=\"width:500px\" type=\"text\"><\/td>\n <\/tr>\n <\/table>\n <p><em>Naam en e-mail zijn verplichte Velden om de app te kunnen downloaden, telefoonnummer is nuttig<\/em><\/p>\n <br>\n <p>\n U kunt zelf ook de YOURmeds app gebruiken en tevens op deze manier zelf de herinneringen ontvangen. \n Wanneer u hier voor kiest dient u onderstaande tabel ook in te vullen.\n <\/p>\n <br>\n <table>\n <tr>\n <td>Zels Support naam<\/td>\n <td><input style=\"width:500px\" type=\"text\" required><\/td>\n <\/tr>\n <tr>\n <td>Email Adres<\/td>\n <td><input style=\"width:500px\" type=\"text\" required><\/td>\n <\/tr>\n <tr>\n <td>Telefoon number<\/td>\n <td><input style=\"width:500px\" type=\"text\"><\/td>\n <\/tr>\n <\/table>\n <p><em>Naam en e-mail zijn verplichte Velden om de app te kunnen downloaden, telefoonnummer is nuttig<\/em><\/p>\n <br>\n <table style=\"width:40%\">\n <tr>\n <td>\n Handtekening<br><br><br>\n <div class=\"signature-container\"> \n <textarea id=\"signature-input\" placeholder=\"Typ hier uw naam\"><\/textarea> \n <div id=\"signature-preview\" class=\"signature\"><\/div> \n <input \n type=\"button\" \n style=\" \n padding: 20px 10px; \n background-color: #007bff; \n color: #fff; \n border: none; \n border-radius: 4px; \n cursor: pointer; \n width: 50%; \n \" \n onclick=\"addSignature()\" \n value=\"Voeg Handtekening Toe\"> \n <\/input>\n <p id=\"timestamp\"><\/p> \n <\/div> \n <\/td>\n <\/tr>\n <\/table>\n <br>\n <p><em>Om te lezen hoe we met uw data omgang kunt u hierop klikken <a href=\"https:\/\/yourmeds.net\/privacy-policy\/\" target=\"_blank\">privacy policy<\/a><\/em><\/p>\n <\/section>\n <br>\n <button type=\"button\" onclick=\"captureForm()\">Formulierafbeelding Downloaden<\/button>\n <\/form>\n\n <script>\n function yesOrNo(clickedCheckbox) {\n var yesCheckbox = document.getElementById('y'); var noCheckbox = document.getElementById('n'); \n if (clickedCheckbox === yesCheckbox && yesCheckbox.checked) { noCheckbox.checked = false; } \n else if (clickedCheckbox === noCheckbox && noCheckbox.checked) { yesCheckbox.checked = false; } \n }\n function yesOrNo2(clickedCheckbox) {\n var yesCheckbox = document.getElementById('yes'); var noCheckbox = document.getElementById('no'); \n if (clickedCheckbox === yesCheckbox && yesCheckbox.checked) { noCheckbox.checked = false; } \n else if (clickedCheckbox === noCheckbox && noCheckbox.checked) { yesCheckbox.checked = false; } \n }\n function yesOrNo3(clickedCheckbox) {\n var yesCheckbox = document.getElementById('oui'); var noCheckbox = document.getElementById('non'); \n if (clickedCheckbox === yesCheckbox && yesCheckbox.checked) { noCheckbox.checked = false; } \n else if (clickedCheckbox === noCheckbox && noCheckbox.checked) { yesCheckbox.checked = false; } \n }\n function yesOrNo4(clickedCheckbox) {\n var yesCheckbox = document.getElementById('ja'); var noCheckbox = document.getElementById('nein'); \n if (clickedCheckbox === yesCheckbox && yesCheckbox.checked) { noCheckbox.checked = false; } \n else if (clickedCheckbox === noCheckbox && noCheckbox.checked) { yesCheckbox.checked = false; } \n }\n \n function addSignature() { \n const signatureInput = document.getElementById('signature-input').value; \n const signaturePreview = document.getElementById('signature-preview'); \n const timestampElement = document.getElementById('timestamp');\n signaturePreview.textContent = signatureInput;\n const timestamp = new Date().toLocaleString(); \n timestampElement.textContent = `Ondertekend op: ${timestamp.slice(0,17)}`; \n }\n \n function captureForm() {\n const formElement = document.querySelector(\"#htmlForm\");\n const fileName = document.getElementById('surname').value ? document.getElementById('surname').value : 'anoniem';\n\n html2canvas(formElement).then(canvas => {\n const imageData = canvas.toDataURL(\"image\/png\");\n const downloadLink = document.createElement(\"a\");\n downloadLink.href = imageData;\n downloadLink.download = `${fileName}.png`; \/\/ Set custom file name\n downloadLink.click();\n });\n }\n <\/script>\n<\/body>\n<\/html>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-560f648 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"560f648\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-17dfe08\" data-id=\"17dfe08\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-54c621f elementor-widget elementor-widget-formidable\" data-id=\"54c621f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"formidable.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"frm_forms with_frm_style frm_style_yourmeds\" id=\"frm_form_34_container\" data-token=\"fbe2111aca726e1642352b13bfce7590\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form \" id=\"form_referral-form-upload\" data-token=\"fbe2111aca726e1642352b13bfce7590\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Referral Form Upload<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"34\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_34\" id=\"frm_hide_fields_34\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"referral-form-upload\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_34\" name=\"frm_submit_entry_34\" value=\"e169b2a7e3\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/de\/wp-json\/wp\/v2\/pages\/8505\" \/><div id=\"frm_field_591_container\" class=\"frm_form_field form-field frm_required_field frm_top_container\">\r\n <label for=\"field_rdwlx\" id=\"field_rdwlx_label\" class=\"frm_primary_label\">Referral Form Upload\r\n <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n <\/label>\r\n <input type=\"text\" id=\"field_rdwlx\" name=\"item_meta[591]\" value=\"\" data-reqmsg=\"Referral Form Upload cannot be blank.\" data-invmsg=\"Referral Form Upload is invalid\" aria-invalid=\"false\" \/>\r\n \r\n \r\n<\/div>\n<div id=\"frm_field_603_container\" class=\"frm_form_field form-field \">\r\n\t<div class=\"frm_submit frm_flex\">\r\n<button class=\"frm_button_submit\" type=\"submit\" >Submit Referral Form to YOURmeds<\/button>\r\n\r\n\r\n\r\n<\/div>\r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_650_container\">\n\t\t\t<label for=\"field_ervya\" >\n\t\t\t\tFalls Du menschlich bist, lasse dieses Feld leer.\t\t\t<\/label>\n\t\t\t<input id=\"field_ervya\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[650]\" value=\"\" \/>\n\t\t<\/div>\n\t\t<\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p> YOURmeds data- & toestemmingsformulier YOURmeds data- & toestemmingsformulier Gegevens van de YOURmeds gebruiker Aanhef (dhr\/mevr\/anders) Voornaam\/voorletter (s) […]<\/p>\n","protected":false},"author":40,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"content-type":"","site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"full-width-container","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"default","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center 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