{"id":2937,"date":"2025-06-02T15:04:49","date_gmt":"2025-06-02T15:04:49","guid":{"rendered":"https:\/\/excent.ch\/payroll-accident-report\/"},"modified":"2025-11-28T14:18:30","modified_gmt":"2025-11-28T14:18:30","slug":"payroll-accident-report","status":"publish","type":"page","link":"https:\/\/excent.ch\/en\/payroll-accident-report\/","title":{"rendered":"Payroll | Accident report"},"content":{"rendered":"\n<p>Please complete the following form. Please note that only the fields marked with an asterisk* are mandatory. <\/p>\n\n<p>Your submissions will normally be processed within 2 business days.<\/p>\n<div id=\"quform-e236a9\" class=\"quform quform-6 quform-theme-simple quform-support-page-caching\"><form id=\"quform-form-e236a9\" class=\"quform-form quform-form-6\" action=\"\/en\/wp-json\/wp\/v2\/pages\/2937#quform-e236a9\" method=\"post\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-options=\"{&quot;id&quot;:6,&quot;uniqueId&quot;:&quot;e236a9&quot;,&quot;theme&quot;:&quot;simple&quot;,&quot;ajax&quot;:true,&quot;logic&quot;:{&quot;logic&quot;:{&quot;128&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;any&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;98&quot;,&quot;operator&quot;:&quot;not_empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;}]},&quot;130&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;124&quot;,&quot;operator&quot;:&quot;not_empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;}]},&quot;298&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;304&quot;,&quot;operator&quot;:&quot;not_empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;}]},&quot;306&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;305&quot;,&quot;operator&quot;:&quot;not_empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;}]},&quot;329&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;334&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;Ja&quot;}]},&quot;351&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;334&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;Ja&quot;}]},&quot;330&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;334&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;Ja&quot;}]},&quot;352&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;334&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;Ja&quot;}]},&quot;322&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;any&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;330&quot;,&quot;operator&quot;:&quot;not_empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;}]},&quot;328&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;346&quot;,&quot;operator&quot;:&quot;not_empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;}]},&quot;2&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;346&quot;,&quot;operator&quot;:&quot;not_empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;}]}},&quot;dependents&quot;:{&quot;98&quot;:[128],&quot;124&quot;:[130],&quot;304&quot;:[298],&quot;305&quot;:[306],&quot;334&quot;:[329,351,330,352],&quot;330&quot;:[322],&quot;346&quot;:[328,2]},&quot;elementIds&quot;:[128,130,298,306,329,351,330,352,322,328,2],&quot;dependentElementIds&quot;:[&quot;98&quot;,&quot;124&quot;,&quot;304&quot;,&quot;305&quot;,&quot;334&quot;,&quot;330&quot;,&quot;346&quot;],&quot;animate&quot;:true},&quot;currentPageId&quot;:1,&quot;errorsIcon&quot;:&quot;&quot;,&quot;updateFancybox&quot;:true,&quot;hasPages&quot;:false,&quot;pages&quot;:[1],&quot;pageProgressType&quot;:&quot;numbers&quot;,&quot;tooltipsEnabled&quot;:true,&quot;tooltipClasses&quot;:&quot;qtip-quform-dark qtip-shadow&quot;,&quot;tooltipMy&quot;:&quot;left center&quot;,&quot;tooltipAt&quot;:&quot;right center&quot;,&quot;isRtl&quot;:false,&quot;scrollOffset&quot;:-50,&quot;scrollSpeed&quot;:800}\"><button class=\"quform-default-submit\" name=\"quform_submit\" type=\"submit\" value=\"submit\" aria-hidden=\"true\" tabindex=\"-1\"><\/button><div class=\"quform-form-inner quform-form-inner-6\"><input type=\"hidden\" name=\"quform_form_id\" value=\"6\" \/><input type=\"hidden\" name=\"quform_form_uid\" value=\"e236a9\" \/><input type=\"hidden\" name=\"quform_count\" value=\"1\" \/><input type=\"hidden\" name=\"form_url\" value=\"https:\/\/excent.ch\/en\/wp-json\/wp\/v2\/pages\/2937\" \/><input type=\"hidden\" name=\"referring_url\" value=\"\" \/><input type=\"hidden\" name=\"post_id\" value=\"\" \/><input type=\"hidden\" name=\"post_title\" value=\"\" \/><input type=\"hidden\" name=\"quform_current_page_id\" value=\"1\" \/><input type=\"hidden\" name=\"quform_loaded\" value=\"1777198532|977b7c5e9fecc72084cff0d8f9009600\" \/><input type=\"hidden\" name=\"quform_csrf_token\" value=\"SxBdlOZBBodTwoe8bePiw8RHjXnFDuUGSccXhkeq\" \/><div class=\"quform-elements quform-elements-6 quform-cf quform-responsive-elements-phone-landscape\"><div class=\"quform-element quform-element-page quform-page-1 quform-page-6_1 quform-cf quform-group-style-plain quform-first-page quform-last-page quform-current-page\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-html quform-element-6_95 quform-cf\"><div class=\"quform-spacer\"><\/div><\/div><div class=\"quform-element quform-element-group quform-element-6_288 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">Angaben zum Arbeitgeber<\/h4><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-text quform-element-6_98 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-6_98\"><label class=\"quform-label-text\" for=\"quform_6_98_e236a9\">Name des Arbeitgebers<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-6_98\"><div class=\"quform-input quform-input-text quform-input-6_98 quform-cf\"><input type=\"text\" id=\"quform_6_98_e236a9\" name=\"quform_6_98\" class=\"quform-field quform-field-text quform-field-6_98\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-6_128 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">Angaben zum Mitarbeiter<\/h4><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-6_99 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-6_100\"><div class=\"quform-element quform-element-text quform-element-6_102 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-6_102\"><label class=\"quform-label-text\" for=\"quform_6_102_e236a9\">Vorname\/n<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-6_102\"><div class=\"quform-input quform-input-text quform-input-6_102 quform-cf\"><input type=\"text\" id=\"quform_6_102_e236a9\" name=\"quform_6_102\" class=\"quform-field quform-field-text quform-field-6_102\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-6_101\"><div class=\"quform-element quform-element-text quform-element-6_103 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-6_103\"><label class=\"quform-label-text\" for=\"quform_6_103_e236a9\">Nachname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-6_103\"><div class=\"quform-input quform-input-text quform-input-6_103 quform-cf\"><input type=\"text\" id=\"quform_6_103_e236a9\" name=\"quform_6_103\" class=\"quform-field quform-field-text quform-field-6_103\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-6_313 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-6_314\"><div class=\"quform-element quform-element-date quform-element-6_124 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-6_124\"><label class=\"quform-label-text\" for=\"quform_6_124_e236a9\">Geburtsdatum<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-6_124\"><div class=\"quform-input quform-input-date quform-input-6_124 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_6_124_e236a9\" name=\"quform_6_124\" class=\"quform-field quform-field-date quform-field-6_124\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;&quot;,&quot;start&quot;:&quot;month&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;de-CH&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;6_124&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-6_315\"><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-6_130 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">Angaben zum Unfall<\/h4><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-6_290 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-6_291\"><div class=\"quform-element quform-element-date quform-element-6_289 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-6_289\"><label class=\"quform-label-text\" for=\"quform_6_289_e236a9\">Datum des Unfalles<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-6_289\"><div class=\"quform-input quform-input-date quform-input-6_289 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_6_289_e236a9\" name=\"quform_6_289\" class=\"quform-field quform-field-date quform-field-6_289\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;&quot;,&quot;start&quot;:&quot;month&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;de-CH&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;6_289&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-6_292\"><div class=\"quform-element quform-element-time quform-element-6_293 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-6_293\"><label class=\"quform-label-text\" for=\"quform_6_293_e236a9\">Uhrzeit des Unfalles<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-time quform-inner-6_293\"><div class=\"quform-input quform-input-time quform-input-6_293 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_6_293_e236a9\" name=\"quform_6_293\" class=\"quform-field quform-field-time quform-field-6_293\" placeholder=\"HH:MM\" data-options=\"{&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;&quot;,&quot;interval&quot;:&quot;30&quot;,&quot;locale&quot;:&quot;de-CH&quot;,&quot;format&quot;:&quot;&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;6_293&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-schedule\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-date quform-element-6_347 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-6_347\"><label class=\"quform-label-text\" for=\"quform_6_347_e236a9\">Letzer Arbeitstag vor Unfall<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-6_347\"><div class=\"quform-input quform-input-date quform-input-6_347 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_6_347_e236a9\" name=\"quform_6_347\" class=\"quform-field quform-field-date quform-field-6_347\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;&quot;,&quot;start&quot;:&quot;month&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;de-CH&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;6_347&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-6_316 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-6_317\"><div class=\"quform-element quform-element-text quform-element-6_294 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-6_294\"><label class=\"quform-label-text\" for=\"quform_6_294_e236a9\">Ort des Unfalles<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-6_294\"><div class=\"quform-input quform-input-text quform-input-6_294 quform-cf\"><input type=\"text\" id=\"quform_6_294_e236a9\" name=\"quform_6_294\" class=\"quform-field quform-field-text quform-field-6_294\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-6_318\"><div class=\"quform-element quform-element-select quform-element-6_295 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-6_295\"><label class=\"quform-label-text\" for=\"quform_6_295_e236a9\">NBU\/BU<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-6_295\"><div class=\"quform-input quform-input-select quform-input-6_295 quform-cf\"><select id=\"quform_6_295_e236a9\" name=\"quform_6_295\" class=\"quform-field quform-field-select quform-field-6_295\"><option value=\"\" selected=\"selected\">Please select<\/option><option value=\"Unfall w\u00e4hrend der Arbeitszeit\">Unfall w\u00e4hrend der Arbeitszeit<\/option><option value=\"Unfall w\u00e4hrend der Freizeit\">Unfall w\u00e4hrend der Freizeit<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-6_319 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-6_320\"><div class=\"quform-element quform-element-select quform-element-6_296 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-6_296\"><label class=\"quform-label-text\" for=\"quform_6_296_e236a9\">Hat eine Drittperson den Unfall verursacht?<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-6_296\"><div class=\"quform-input quform-input-select quform-input-6_296 quform-cf\"><select id=\"quform_6_296_e236a9\" name=\"quform_6_296\" class=\"quform-field quform-field-select quform-field-6_296\"><option value=\"\" selected=\"selected\">Please select<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-6_321\"><div class=\"quform-element quform-element-select quform-element-6_297 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-6_297\"><label class=\"quform-label-text\" for=\"quform_6_297_e236a9\">Wurde ein Polizeiraport erstellt?<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-6_297\"><div class=\"quform-input quform-input-select quform-input-6_297 quform-cf\"><select id=\"quform_6_297_e236a9\" name=\"quform_6_297\" class=\"quform-field quform-field-select quform-field-6_297\"><option value=\"\" selected=\"selected\">Please select<\/option><option value=\"Ja\">Ja<\/option><option value=\"Nein\">Nein<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-textarea quform-element-6_304 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-6_304\"><label class=\"quform-label-text\" for=\"quform_6_304_e236a9\">Beschreibung des Unfalles<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-textarea quform-inner-6_304\"><div class=\"quform-input quform-input-textarea quform-input-6_304 quform-cf\"><textarea id=\"quform_6_304_e236a9\" name=\"quform_6_304\" class=\"quform-field quform-field-textarea quform-field-6_304\"><\/textarea><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-6_298 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">Angaben zur Verletzung<\/h4><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-6_299 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-6_300\"><div class=\"quform-element quform-element-multiselect quform-element-6_353 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-6_353\"><label class=\"quform-label-text\" for=\"quform_6_353_e236a9\">Betroffener K\u00f6rperteil<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-multiselect quform-inner-6_353\"><div class=\"quform-input quform-input-multiselect quform-input-6_353 quform-cf\"><select id=\"quform_6_353_e236a9\" name=\"quform_6_353[]\" class=\"quform-field quform-field-multiselect quform-field-6_353\" multiple><option value=\"Auge\">Auge<\/option><option value=\"Bauch\">Bauch<\/option><option value=\"Becken\">Becken<\/option><option value=\"Blase\">Blase<\/option><option value=\"Brustwirbels\u00e4ule\">Brustwirbels\u00e4ule<\/option><option value=\"Ellbogen\">Ellbogen<\/option><option value=\"Finger\">Finger<\/option><option value=\"Fussgelenk\">Fussgelenk<\/option><option value=\"Ganzer K\u00f6rper (systemische Wirkung\">Ganzer K\u00f6rper (systemische Wirkung<\/option><option value=\"Genitalien\">Genitalien<\/option><option value=\"Gesicht\">Gesicht<\/option><option value=\"Hals\">Hals<\/option><option value=\"Halswirbels\u00e4ule\">Halswirbels\u00e4ule<\/option><option value=\"Handgelenk\">Handgelenk<\/option><option value=\"Herz\">Herz<\/option><option value=\"H\u00fcftgelenk\">H\u00fcftgelenk<\/option><option value=\"Kiefer\">Kiefer<\/option><option value=\"Knie\">Knie<\/option><option value=\"Leber\">Leber<\/option><option value=\"Leiste\">Leiste<\/option><option value=\"Lendenwirbels\u00e4ule\">Lendenwirbels\u00e4ule<\/option><option value=\"Lunge (inkl. Atemwege)\">Lunge (inkl. Atemwege)<\/option><option value=\"mehrere Bereiche der oberen Extremit\u00e4ten\">mehrere Bereiche der oberen Extremit\u00e4ten<\/option><option value=\"mehrere Bereiche der unteren Extremit\u00e4ten\">mehrere Bereiche der unteren Extremit\u00e4ten<\/option><option value=\"Mehrfachverletzung (Polyblesse)\">Mehrfachverletzung (Polyblesse)<\/option><option value=\"Milz\">Milz<\/option><option value=\"Mittelfuss (ohne Zehen)\">Mittelfuss (ohne Zehen)<\/option><option value=\"Mittelhand (ohne Finger)\">Mittelhand (ohne Finger)<\/option><option value=\"Nase\">Nase<\/option><option value=\"Niere\">Niere<\/option><option value=\"Oberarm\">Oberarm<\/option><option value=\"Oberschenkel\">Oberschenkel<\/option><option value=\"Ohr (Geh\u00f6r)\">Ohr (Geh\u00f6r)<\/option><option value=\"R\u00fccken\">R\u00fccken<\/option><option value=\"Sch\u00e4del\/Hirn\">Sch\u00e4del\/Hirn<\/option><option value=\"Schock (Psyche)\">Schock (Psyche)<\/option><option value=\"Schulter\">Schulter<\/option><option value=\"Steissbein (Ges\u00e4ss), \">Steissbein (Ges\u00e4ss), <\/option><option value=\"Thorax (Rippen, Brustkorb)\">Thorax (Rippen, Brustkorb)<\/option><option value=\"Unterarm\">Unterarm<\/option><option value=\"Unterschenkel\">Unterschenkel<\/option><option value=\"Z\u00e4hne\">Z\u00e4hne<\/option><option value=\"Zehen\">Zehen<\/option><\/select><\/div><p class=\"quform-description quform-description-below\">Mehrfachauswahl m\u00f6glich<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-6_301\"><div class=\"quform-element quform-element-radio quform-element-6_354 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-6_354\"><label class=\"quform-label-text\" id=\"quform_6_354_e236a9_label\">K\u00f6rperseite<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-6_354\"><div class=\"quform-input quform-input-radio quform-input-6_354 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_6_354_e236a9_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_6_354\" id=\"quform_6_354_e236a9_1\" class=\"quform-field quform-field-radio quform-field-6_354 quform-field-6_354_1\" value=\"Links\" \/><label for=\"quform_6_354_e236a9_1\" class=\"quform-option-label quform-option-label-6_354_1\"><span class=\"quform-option-text\">Links<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_6_354\" id=\"quform_6_354_e236a9_2\" class=\"quform-field quform-field-radio quform-field-6_354 quform-field-6_354_2\" value=\"Rechts\" \/><label for=\"quform_6_354_e236a9_2\" class=\"quform-option-label quform-option-label-6_354_2\"><span class=\"quform-option-text\">Rechts<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-textarea quform-element-6_305 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-6_305\"><label class=\"quform-label-text\" for=\"quform_6_305_e236a9\">Beschreibung der Verletzung<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-textarea quform-inner-6_305\"><div class=\"quform-input quform-input-textarea quform-input-6_305 quform-cf\"><textarea id=\"quform_6_305_e236a9\" name=\"quform_6_305\" class=\"quform-field quform-field-textarea quform-field-6_305\"><\/textarea><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-6_306 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">\u00c4rztliche Behandlung<\/h4><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-6_331 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-6_332\"><div class=\"quform-element quform-element-radio quform-element-6_334 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-6_334\"><label class=\"quform-label-text\" id=\"quform_6_334_e236a9_label\">Waren Sie beim Arzt?<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-6_334\"><div class=\"quform-input quform-input-radio quform-input-6_334 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_6_334_e236a9_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_6_334\" id=\"quform_6_334_e236a9_1\" class=\"quform-field quform-field-radio quform-field-6_334 quform-field-6_334_1\" value=\"Ja\" \/><label for=\"quform_6_334_e236a9_1\" class=\"quform-option-label quform-option-label-6_334_1\"><span class=\"quform-option-text\">Ja<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-6_333\"><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-6_308 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-6_309\"><div class=\"quform-element quform-element-text quform-element-6_329 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-6_329\"><label class=\"quform-label-text\" for=\"quform_6_329_e236a9\">Erstbehandelnder Arzt<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-6_329\"><div class=\"quform-input quform-input-text quform-input-6_329 quform-cf\"><input type=\"text\" id=\"quform_6_329_e236a9\" name=\"quform_6_329\" class=\"quform-field quform-field-text quform-field-6_329\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-6_351 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-6_351\"><label class=\"quform-label-text\" for=\"quform_6_351_e236a9\">Adresse Arzt<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-6_351\"><div class=\"quform-input quform-input-text quform-input-6_351 quform-cf\"><input type=\"text\" id=\"quform_6_351_e236a9\" name=\"quform_6_351\" class=\"quform-field quform-field-text quform-field-6_351\" placeholder=\"Strasse, Plz., Ort\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-6_310\"><div class=\"quform-element quform-element-date quform-element-6_330 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-6_330\"><label class=\"quform-label-text\" for=\"quform_6_330_e236a9\">Datum der ersten Behandlung<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-6_330\"><div class=\"quform-input quform-input-date quform-input-6_330 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_6_330_e236a9\" name=\"quform_6_330\" class=\"quform-field quform-field-date quform-field-6_330\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;&quot;,&quot;start&quot;:&quot;month&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;de-CH&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;6_330&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-file quform-element-6_352 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-6_352\"><label class=\"quform-label-text\" for=\"quform_6_352_e236a9\">Arztzeugnis<\/label><\/div><div class=\"quform-inner quform-inner-file quform-inner-6_352\"><div class=\"quform-input quform-input-file quform-input-6_352 quform-cf quform-button-style-theme\"><input type=\"file\" id=\"quform_6_352_e236a9\" name=\"quform_6_352[]\" class=\"quform-field quform-field-file quform-field-6_352 quform-field-file-enhanced\" data-config=\"{&quot;id&quot;:352,&quot;identifier&quot;:&quot;6_352&quot;,&quot;name&quot;:&quot;quform_6_352&quot;,&quot;max&quot;:1,&quot;size&quot;:10485760,&quot;allowedExtensions&quot;:[&quot;jpg&quot;,&quot;jpeg&quot;,&quot;png&quot;,&quot;gif&quot;,&quot;pdf&quot;],&quot;notAllowedTypeWithFilename&quot;:&quot;File type of &#039;%filename%&#039; is not allowed&quot;,&quot;tooBigWithFilename&quot;:&quot;File &#039;%filename%&#039; exceeds the maximum allowed file size&quot;,&quot;tooMany&quot;:&quot;You cannot upload more than %max% file(s)&quot;,&quot;buttonType&quot;:&quot;button&quot;,&quot;buttonText&quot;:&quot;Browse...&quot;,&quot;buttonIcon&quot;:&quot;qicon-file_upload&quot;,&quot;buttonIconPosition&quot;:&quot;right&quot;}\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-6_322 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">Sonstige Angaben<\/h4><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-6_343 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-6_344\"><div class=\"quform-element quform-element-radio quform-element-6_346 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-6_346\"><label class=\"quform-label-text\" id=\"quform_6_346_e236a9_label\">Besteht ein Arbeitsausfall?<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-6_346\"><div class=\"quform-input quform-input-radio quform-input-6_346 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_6_346_e236a9_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_6_346\" id=\"quform_6_346_e236a9_1\" class=\"quform-field quform-field-radio quform-field-6_346 quform-field-6_346_1\" value=\"Nein\" \/><label for=\"quform_6_346_e236a9_1\" class=\"quform-option-label quform-option-label-6_346_1\"><span class=\"quform-option-text\">Nein<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_6_346\" id=\"quform_6_346_e236a9_2\" class=\"quform-field quform-field-radio quform-field-6_346 quform-field-6_346_2\" value=\"Ja\" \/><label for=\"quform_6_346_e236a9_2\" class=\"quform-option-label quform-option-label-6_346_2\"><span class=\"quform-option-text\">Ja<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-6_345\"><div class=\"quform-element quform-element-textarea quform-element-6_328 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-6_328\"><label class=\"quform-label-text\" for=\"quform_6_328_e236a9\">Sonstige Bemerkungen<\/label><\/div><div class=\"quform-inner quform-inner-textarea quform-inner-6_328\"><div class=\"quform-input quform-input-textarea quform-input-6_328 quform-cf\"><textarea id=\"quform_6_328_e236a9\" name=\"quform_6_328\" class=\"quform-field quform-field-textarea quform-field-6_328\"><\/textarea><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-submit quform-element-6_2 quform-cf quform-button-style-theme\"><div class=\"quform-button-submit quform-button-submit-default quform-button-submit-6_2\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-submit\" value=\"submit\"><span class=\"quform-button-text quform-button-submit-text\">Send<\/span><\/button><\/div><div class=\"quform-loading quform-loading-position-left quform-loading-type-spinner-1\"><div class=\"quform-loading-inner\"><div class=\"quform-loading-spinner\"><div class=\"quform-loading-spinner-inner\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-upload-progress-wrap\"><div class=\"quform-upload-progress-bar-wrap\"><div class=\"quform-upload-progress-bar\"><\/div><\/div><div class=\"quform-upload-info quform-cf\"><div class=\"quform-upload-filename\"><\/div><\/div><\/div><\/div><\/form><\/div>\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Please complete the following form. 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Your submissions will normally be processed within 2 business days.<\/p>\n","protected":false},"author":4,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-2937","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/excent.ch\/en\/wp-json\/wp\/v2\/pages\/2937","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/excent.ch\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/excent.ch\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/excent.ch\/en\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/excent.ch\/en\/wp-json\/wp\/v2\/comments?post=2937"}],"version-history":[{"count":1,"href":"https:\/\/excent.ch\/en\/wp-json\/wp\/v2\/pages\/2937\/revisions"}],"predecessor-version":[{"id":2938,"href":"https:\/\/excent.ch\/en\/wp-json\/wp\/v2\/pages\/2937\/revisions\/2938"}],"wp:attachment":[{"href":"https:\/\/excent.ch\/en\/wp-json\/wp\/v2\/media?parent=2937"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}