{"content":"<form name=\"booking_form\" id=\"booking_form\" action=\"\" method=\"post\" enctype=\"multipart\/form-data\" accept-charset=\"UTF-8\">\r\n    \t<input type=\"hidden\" name=\"captcha_id\" value=\"6713400\">\r\n    <h2>Additional information<\/h2>\r\n    <fieldset class=\"booking\">\r\n        <div id=\"booking_doc_content\">\r\n            <div class=\"flexgrid\">\r\n                <div class=\"box box-50\">\r\n                    <div class=\"content\">\r\n                        <h3>Insurance type<span>*<\/span><\/h3>\r\n                        <div class=\"formItem formRadio\">\r\n                            <input class=\"chk01 outtaHere\" type=\"radio\" value=\"1\" name=\"insurance_type\" id=\"insurance_type_1\">\r\n                            <label for=\"insurance_type_1\">\r\n                                <i><\/i> <span>State insurance<\/span>\r\n                            <\/label>\r\n                        <\/div>\r\n                        <div class=\"formItem formRadio\">\r\n                            <input class=\"chk01 outtaHere\" type=\"radio\" value=\"2\" name=\"insurance_type\" id=\"insurance_type_2\">\r\n                            <label for=\"insurance_type_2\">\r\n                                <i><\/i> <span>Private health insurance<\/span>\r\n                            <\/label>\r\n                        <\/div>\r\n                        <div class=\"formItem formRadio\">\r\n                            <input class=\"chk01 outtaHere\" type=\"radio\" value=\"3\" name=\"insurance_type\" id=\"insurance_type_3\">\r\n                            <label for=\"insurance_type_3\">\r\n                                <i><\/i> <span>Self-pay patient<\/span>\r\n                            <\/label>\r\n                        <\/div>\r\n                    <\/div>                        \r\n                <\/div>\r\n                <div class=\"box box-50\">\r\n                    <div class=\"content\">\r\n                        <h3>Your specialist<\/h3>\r\n                                                <div class=\"formItem formRadio\">\r\n    <input type=\"radio\" value=\"5172\" id=\"booking_form_id_5172\" name=\"booking_form_id\" data-private=\"1\" class=\"formRadio\" checked=\"checked\"\/>\r\n    <label for=\"booking_form_id_5172\"><i><!-- --><\/i> <span>Prof. Dr. med. Harms <small>Specialist in Orthopedics and Trauma Surgery<\/small><\/span><\/label>\r\n    <div class=\"clearfloat\"><\/div>\r\n<\/div>                    <\/div>\r\n                <\/div>\r\n                <div class=\"box\">\r\n                    <div class=\"content\">\r\n                        <p class=\"hint\" style=\"display:none;\">Unfortunately, this appointment is only available to self-payers or privately insured patients.<\/p>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n            <a href=\"javascript:;\" id=\"booking_doc_button\" class=\"formSubmit disabled\">next<i><\/i><\/a>\r\n        <\/div>\r\n        <div id=\"booking_patient_content\" style=\"display:none;\">\r\n            <div class=\"flexgrid\">\r\n                <div class=\"box box-50\">\r\n                    <div class=\"content\">\r\n                        <div class=\"formItem\">\r\n                            <label>Last name<\/label>\r\n                            <input class=\"formText\" style=\"\" type=\"text\" maxlength=\"255\" name=\"vorname\" value=\"\" placeholder=\"Last name *\">\r\n                        <\/div>\r\n                        <div class=\"formItem\">\r\n                            <label>First name<\/label>\r\n                            <input class=\"formText\" style=\"\" type=\"text\" maxlength=\"255\" name=\"nachname\" value=\"\" placeholder=\"First name *\">\r\n                        <\/div>\r\n                        <div class=\"formItem\">\r\n                            <label>e-mail<span>*<\/span><\/label>\r\n                            <input class=\"formText\" style=\"\" type=\"text\" maxlength=\"255\" name=\"email\" value=\"\" placeholder=\"e-mail *\">\r\n                        <\/div>\r\n                        <div class=\"formItem\">\r\n                            <label>Phone number<\/label>\r\n                            <input class=\"formText\" style=\"\" type=\"text\" maxlength=\"255\" name=\"telefon\" value=\"\" placeholder=\"Phone number\">\r\n                        <\/div>\r\n                        <div class=\"formItem\">\r\n                            <label>Message to the doctor<\/label>\r\n                            <textarea class=\"tfield\" style=\"\" wrap=\"virtual\" rows=\"6\" name=\"message\"  placeholder=\"Message to the doctor *\"><\/textarea>\r\n                        <\/div>\r\n                    <\/div>\r\n                <\/div>\r\n                <div class=\"box box-50\">\r\n                    <div class=\"content\">\r\n\t\t\t\t\t\t<p style=\"margin-bottom: 10px;\">Please insert the character string.<\/p>\r\n\t\t\t\t\t\t<img src=\"data:image\/png;base64,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\">\r\n                        <div class=\"formItem\" style=\"margin-bottom: 50px;\">\r\n                            <label>en[Klinikkontaktform, Captcha Label\t]<\/label>\r\n                            <input class=\"formText\" type=\"text\" maxlength=\"255\" name=\"captcha\" value=\"\" placeholder=\"Security question *\">\r\n\t\t\t\t\t\t<\/div>\r\n                        <div class=\"formItem\">\r\n                            <h3>Data Protection Statement<\/h3>\r\n                            <p><p>Please refer to the <a href=\"\/en\/datenschutzerklaerung\">Data Protection Statements<\/a> available here for the information required for the management of your personal data.<\/p><\/p>\r\n                        <\/div>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n            <div class=\"content\">\r\n                <div class=\"formItem\">\r\n                    <div class=\"formRadio\">\r\n                        <input id=\"booking-datennutzung\" value=\"1\" type=\"checkbox\" name=\"booking-datennutzung\">\r\n                        <label for=\"booking-datennutzung\">\r\n                            <i><\/i> \r\n                            <span>I am over 16 years of age. I give my consent for Deutscher Verlag fuer Gesundheitsinformation GmbH to collect, process and make use of my personal data, in particular, my health data, in connection with the Leading Medicine Guide and to forward this data to the physician selected by me for the purposes of advice or treatment. <span>*<\/span><\/span>\r\n                        <\/label>\r\n                    <\/div>\r\n                <\/div>\r\n                                <div class=\"formItem formRadio\">\r\n                    <input id=\"booking-agb\" value=\"1\" type=\"checkbox\" name=\"booking-agb\">\r\n                    <label for=\"booking-agb\">\r\n                        <i><\/i> \r\n                        <span>I accept the <a href=\"https:\/\/www.leading-medicine-guide.de\/AGB\">General Terms and Conditions<\/a> available here. <span>*<\/span><\/span>\r\n                    <\/label>\r\n                <\/div>\r\n            <\/div>\r\n            <a href=\"javascript:;\" id=\"booking_patient_button\" class=\"formSubmit disabled\">next<i><\/i><\/a>\r\n        <\/div>\r\n    <\/fieldset>\r\n    <div id=\"booking_confirm_content\" style=\"display:none;\">\r\n        <div class=\"content\">\r\n            <div class=\"flexgrid\">\r\n                <div class=\"box box-40\">\r\n                    <div class=\"check-data data-date\">\r\n                    <\/div>\r\n                <\/div>\r\n                <div class=\"box box-60\">\r\n                    <div class=\"check-data data-personals\">\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n        <\/div>\r\n        <button type=\"submit\" class=\"formSubmit\">Request firm appointment<\/button>\r\n    <\/div>\r\n<\/form>\r\n\r\n\r\n<script>\r\n\tfunction booking_confirm_content (){\r\n\t\t$('.data-date').html('<h3>Termin<\/h3>');\r\n\t\t$('.data-date').append('<div><strong>Datum:<\/strong> '+'03.05.2021'+'<\/div>');\r\n\t\t$('.data-date').append('<div><strong>Uhrzeit:<\/strong> '+'13:00'+'<\/div>');\r\n\t\t$('.data-date').append('<div><strong>Arzt:<\/strong> '+$($('input[name=\"booking_form_id\"]:checked').closest('.formItem').find('span').contents().get(0)).text()+'<\/div>');\r\n\t\t\r\n\t\t$('.data-personals').html('<h3>Ihre Daten<\/h3>');\r\n\t\t$('.data-personals').append('<div><strong>Versicherungsart:<\/strong> '+$('input[name=\"insurance_type\"]:checked').closest('.formItem').find('span').text()+'<\/div>');\r\n\t\r\n\t\t$('.data-personals').append('<div><strong>Vorname:<\/strong> '+$('#booking_patient_content input[name=\"vorname\"]').val()+'<\/div>');\r\n\t\t$('.data-personals').append('<div><strong>Name:<\/strong> '+$('#booking_patient_content input[name=\"nachname\"]').val()+'<\/div>');\r\n\t\t$('.data-personals').append('<div><strong>Email:<\/strong> '+$('#booking_patient_content input[name=\"email\"]').val()+'<\/div>');\r\n\t\t$('.data-personals').append('<div><strong>Telefon:<\/strong> '+$('#booking_patient_content input[name=\"telefon\"]').val()+'<\/div>');\r\n\t\t$('.data-personals').append('<div><strong>Text:<\/strong><br \/>'+$('#booking_patient_content textarea[name=\"message\"]').val().replace(\/\\r?\\n\/g, '<br \/>')+'<\/div>');\r\n\t}\r\n\t\r\n\t$(document).ready(function() {\r\n\t\t$('#booking_doc_button').click(function(e){\r\n\t\t\te.preventDefault();\r\n\t\t\t$('#booking_doc_content').hide();\r\n\t\t\t$('#booking_patient_content').show();\r\n\t\t});\r\n\t\t$('#booking_patient_button').click(function(e){\r\n\t\t\te.preventDefault();\r\n\t\t\tbooking_confirm_content();\r\n\t\t\t$('#booking_patient_content').hide();\r\n\t\t\t$('#booking_confirm_content').show();\r\n\t\t});\r\n\t\t$('#booking_doc_content input').change(function(){\r\n\t\t\tvar priv = $('input[name=\"booking_form_id\"]:checked').data('private');\r\n\t\t\tvar insurance = 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input[name=\"email\"]').closest('.formItem').removeClass('formError');\r\n\t\t\t}\r\n\t\t\tvar datenschutz = $('#booking_patient_content input[name=\"booking-datennutzung\"]').prop(\"checked\");\r\n\t\t\tif (!datenschutz){\r\n\t\t\t\t$('#booking_patient_content input[name=\"booking-datennutzung\"]').closest('.formItem').addClass('formError');\r\n\t\t\t}else{\r\n\t\t\t\t$('#booking_patient_content input[name=\"booking-datennutzung\"]').closest('.formItem').removeClass('formError');\r\n\t\t\t}\r\n\t\t\tvar agb = $('#booking_patient_content input[name=\"booking-agb\"]').prop(\"checked\");\t\t\t\r\n\t\t\tif (!agb){\r\n\t\t\t\t$('#booking_patient_content input[name=\"booking-agb\"]').closest('.formItem').addClass('formError');\r\n\t\t\t}else{\r\n\t\t\t\t$('#booking_patient_content input[name=\"booking-agb\"]').closest('.formItem').removeClass('formError');\r\n\t\t\t}\r\n\t\t\tif(datenschutz && agb && email){\r\n\t\t\t\t$('#booking_patient_button').removeClass('disabled');\r\n\t\t\t}else{\r\n\t\t\t\t$('#booking_patient_button').addClass('disabled');\r\n\t\t\t}\r\n\t\t});\r\n\t\t\r\n\t\t$('#booking_form').submit(function(e){\r\n\t\t\tconsole.log('submited');\r\n\t\t\te.preventDefault();\r\n\t\t\t$.ajax({\r\n\t\t\t\ttype: \"POST\",\r\n\t\t\t\turl: \"https:\/\/www.leading-medicine-guide.com\/en\/?p=292&s=prj_terminbuchung&kid=1084&\",\r\n\t\t\t\tdata: new FormData(this),\r\n\t\t\t\tcache: false,\r\n\t\t\t\tcontentType: false,\r\n\t\t\t\tprocessData: false\r\n\t\t\t}).done(function( response ) {\r\n\t\t\t\t$(\".formError\").removeClass(\"formError\");\r\n\t\t\t\tvar oResponse = jQuery.parseJSON(response);\r\n\t\t\t\tif( oResponse.status == 'OK' ){\r\n\t\t\t\t\t$('#bookingPopupContent').html(oResponse.content);\r\n\t\t\t\t}else{\r\n\t\t\t\t\tif(typeof oResponse.errors != \"undefined\" ){\r\n\t                    for (var prop in oResponse.errors) {\r\n\t\t\t\t\t\t\t$(\"select[name=\"+prop+\"],input[name=\"+prop+\"],textarea[name=\"+prop+\"]\").closest(\".formItem\").addClass(\"formError\");\r\n\t\t\t\t\t\t}\r\n\t\t\t\t\t\t$('#booking_patient_content').show();\r\n\t\t\t\t\t\t$('#booking_confirm_content').hide();\r\n\t\t\t\t\t}\r\n\t\t\t\t}\r\n\t\t\t});\r\n\t\t});\r\n\t});\r\n<\/script>","status":"OK"}