task: #49462 check data by health_insurance_name - not GLN!
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1 changed files with 39 additions and 19 deletions
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@ -91,25 +91,45 @@ kommentar = 'age und hobbies sind honeypots'
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<input type="text" id="servername" name="servername" placeholder="name" required >
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</div>
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<div>
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<h5>In welchen Kantonen haben Sie eine Bewilligung oder haben eine Bewilligung beantragt?</h5><br>
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<div id="checkbox-group">
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<input type="checkbox" id="AG" name="AG" value="AG: Aargau">
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<label for="AG">AG: Aargau</label>
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<input type="checkbox" id="AI" name="AI" value="AI: Appenzell Innerrhoden">
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<label for="AI">AI: Appenzell Innerrhoden</label>
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<input type="checkbox" id="AR" name="AR" value="AR: Appenzell Ausserrhoden">
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<label for="AR">AR: Appenzell Ausserrhoden</label>
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<input type="checkbox" id="BE" name="BE" value="BE: Bern">
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<label for="BE">BE: Bern</label>
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<br/>
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<input type="checkbox" id="BL" name="BL" value="BL: Basel-Landschaft">
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<label for="BL">BL: Basel-Landschaft</label>
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<input type="checkbox" id="BS" name="BS" value="BS: Basel-Stadt">
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<label for="BS">BS: Basel-Stadt</label>
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<br/>
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</div>
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<h5>In welchen Kantonen haben Sie eine Bewilligung oder haben eine Bewilligung beantragt?</h5><br>
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<table>
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<tr>
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<td>
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<input type="checkbox" id="AG" name="AG" value="AG: Aargau">
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<label for="AG">AG: Aargau</label>
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</td>
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<td>
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<input type="checkbox" id="AI" name="AI" value="AI: Appenzell Innerrhoden">
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<label for="AI">AI: Appenzell Innerrhoden</label>
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</td>
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<td>
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<input type="checkbox" id="AR" name="AR" value="AR: Appenzell Ausserrhoden">
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<label for="AR">AR: Appenzell Ausserrhoden</label>
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</td>
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<td>
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<input type="checkbox" id="BE" name="BE" value="BE: Bern">
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<label for="BE">BE: Bern</label>
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</td>
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</tr>
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<tr>
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<td>
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<input type="checkbox" id="BL" name="BL" value="BL: Basel-Landschaft">
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<label for="BL">BL: Basel-Landschaft</label>
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</td>
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<td>
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<input type="checkbox" id="BS" name="BS" value="BS: Basel-Stadt">
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<label for="BS">BS: Basel-Stadt</label>
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</td>
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<td>
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<input type="checkbox" id="AR" name="AR" value="AR: Appenzell Ausserrhoden">
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<label for="AR">AR: Appenzell Ausserrhoden</label>
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</td>
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<td>
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<input type="checkbox" id="BE" name="BE" value="BE: Bern">
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<label for="BE">BE: Bern</label>
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</td>
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</tr>
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</table>
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<div>
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<label for="modulpop2">Wünschen Sie die Erweiterung um das Modul POP2?</label>
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<select id="modulpop2" name="modulpop2" required >
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