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["Name, Vorname",{"$nulls":3},"Geburtsdat."]
["Straße, Hausnr., Etage",{"$nulls":3},"Telefon"]
["PLZ, Ort",{"$nulls":3},"Mobil"]
[{"$nulls":4},"E-Mail"]
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[]
["Kontaktperson","bitte auswählen",null,null,"Name"]
["Straße, Hausnr., Etage",{"$nulls":3},"Telefon/Mobil"]
["PLZ, Ort",{"$nulls":3},"E-Mail"]
[]
[]
["2. Kontaktperson","bitte auswählen"]
["Straße, Hausnr., Etage",{"$nulls":3},"Telefon/Mobil"]
["PLZ, Ort",{"$nulls":3},"E-Mail"]
[]
[]
["Schwerbehindertenausweis","       JA                             NEIN",null,null,"GdB"]
[{"$nulls":4},"Merkzeichen"]
[]
[]
["Bankverbindung IBAN"]
[]
[]
[]
["Gesetzl. Betreuung",{"$nulls":3},"Telefon/Mobil"]
["Straße, Hausnr.",{"$nulls":3},"Fax"]
["PLZ, Ort",{"$nulls":3},"E-Mail"]
["Wirkungskreise"]
[]
["Einwilligungsvorbehalt"]
[]
[]
[]
["Bewilligte Stunden",{"$nulls":3},"Betreut seit…"]
["Betreuungsart"]
[]
[]
[]
["Einkommensarten"]
[]
[]
[]
[]
["SDZ Grundsicherung",{"$nulls":3},"Sachbearbeit."]
["Straße, Hausnr.",{"$nulls":3},"Telefon"]
["PLZ, Ort",{"$nulls":3},"Akt-Z."]
[]
[]
["Bezirksamt Wandsbek / Fachamt EH",{"$nulls":3},"Sachbearbeit."]
["Kurt-Schumacher-Allee 4",{"$nulls":3},"Telefon"]
["20097 Hamburg",{"$nulls":3},"Akt-Z."]
[]
[]
["SPD"]
["Straße, Hausnr.",{"$nulls":3},"Sachbearbeit."]
["PLZ, Ort",{"$nulls":3},"Telefon"]
[]
[]
["Jobcenter (Leistung)","BG-Nr.: ",null,null,"Sachbearbeit."]
["Straße, Hausnr.",{"$nulls":3},"Telefon"]
["PLZ, Ort",{"$nulls":3},"Fax"]
[]
[]
["Jobcenter (Jobvermittlung)","Akt-Z.: ",null,null,"Sachbearbeit."]
["Straße, Hausnr.",{"$nulls":3},"Telefon"]
["PLZ, Ort",{"$nulls":3},"Fax"]
[]
[]
["Arbeitgeber"]
["Straße, Hausnr.",{"$nulls":3},"Ansprechpart."]
["PLZ, Ort",{"$nulls":3},"Telefon"]
[]
[]
[]
["Schule / Kita"]
["Straße, Hausnr.",{"$nulls":3},"Ansprechpart."]
["PLZ, Ort",{"$nulls":3},"Telefon"]
[]
[]
["Vermieter",{"$nulls":3},"Sachbearbeit."]
["Straße, Hausnr.",{"$nulls":3},"Telefon"]
["PLZ, Ort",{"$nulls":3},"Hausmeister"]
[{"$nulls":4},"Telefon"]
[]
[]
[]
["Krankenkasse",{"$nulls":3},"Sachbearbeit."]
["Straße, Hausnr.",{"$nulls":3},"Telefon"]
["PLZ, Ort",{"$nulls":3},"Versicher.-Nr."]
["Befreiung bis…"]
[]
[]
[]
["Diagnose"]
[]
["Uns bekannte Medikamente"]
[]
["Besonderheiten"]
[]
[]
[]
["Arzt   Name / Zuständigkeit ",null,"  Anschrift",{"$nulls":3},"  Telefon"]
["1."]
["2."]
["3."]
["4."]
[]
[]
["Therapeut   Name / Zuständigkeit ",null,"  Anschrift",{"$nulls":3},"  Telefon"]
["1."]
["2."]
["3."]
["4."]
[]
[]
[]
["Ausgefüllt von (insel-Mitarbeiter_in)"]
["Datum"]

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[]
[]
[{"$nulls":3},"bitte auswählen"]
[null,"QPA (PBW)",null,"Eltern"]
[null,"EA (WA)",null,"Angehörige_r"]
[null,"WmA (AWG)",null,"Partner_in"]
[null,"ASP",null,"Ehepartner_in"]
[null,"FA (HFbK)"]
[null,"Erz. Beist."]
[null,"SpFh"]
[null,"§ 35"]