---
FieldType: Text
FieldName: Name des Beraters
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Name
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Geburtsort
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Vorname
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Geburtsname
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Geschlecht
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Staatsangehörigkeit
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Wohnort
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Straße und Hausnummer
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Postleitzahl
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Kundennummer
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Zimmernummer
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: DKZ
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Zeichen
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Namenszeichen
FieldFlags: 0
FieldJustification: Left
---
FieldType: Button
FieldName: Aufforderung von der Krankenkasse? Nein
FieldFlags: 0
FieldJustification: Left
FieldStateOption: Ja
FieldStateOption: Off
---
FieldType: Text
FieldName: Tel. Nr des Beraters
FieldFlags: 0
FieldJustification: Left
---
FieldType: Button
FieldName: Aufforderung von der Krankenkasse? Ja
FieldFlags: 0
FieldJustification: Left
FieldStateOption: Ja
FieldStateOption: Off
---
FieldType: Button
FieldName: ledig
FieldFlags: 0
FieldJustification: Left
FieldStateOption: Ja
FieldStateOption: Off
---
FieldType: Button
FieldName: verheiratet
FieldFlags: 0
FieldJustification: Left
FieldStateOption: Ja
FieldStateOption: Off
---
FieldType: Button
FieldName: geschieden
FieldFlags: 0
FieldJustification: Left
FieldStateOption: Ja
FieldStateOption: Off
---
FieldType: Button
FieldName: verwitwet
FieldFlags: 0
FieldJustification: Left
FieldStateOption: Ja
FieldStateOption: Off
---
FieldType: Button
FieldName: eingetragene Lebenspartnerschafft
FieldFlags: 0
FieldJustification: Left
FieldStateOption: Ja
FieldStateOption: Off
---
FieldType: Text
FieldName: Ziffer_1 (Versicherungsnummer)
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Ziffer_2 (Versicherungsnummer)
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Ziffer_3 (Versicherungsnummer)
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Ziffer_4 (Versicherungsnummer)
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Ziffer_5 (Versicherungsnummer)
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Ziffer_6 (Versicherungsnummer)
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Ziffer_7 (Versicherungsnummer)
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Ziffer_8 (Versicherungsnummer)
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Ziffer_9 (Versicherungsnummer)
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Ziffer_10 (Versicherungsnummer)
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Ziffer_11 (Versicherungsnummer)
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Ziffer_12 (Versicherungsnummer)
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Geburtsdatum
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: Antrag ausgehändigt
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: telefonisch zu erreichen unter
FieldFlags: 0
FieldJustification: Left