BC Specific

BCCA Referral

Referral form to the BC Cancer Agency

BCWH - Osteoporosis Program Referral

 

Complex Care Plan

 

Driver Reporting

Reporting unsafe driver to BC's superintentent of motor vehicles

Fraser Health Authority (FHA) specific forms

 

GF Strong Rehab Center Referral From

 

Hereditary Cancer Program Referral Form

 

Medication Coverage

Collection of Special Authority forms/drug coverage forms/etc

Patient Conference

 

Rapid Access Spine Clinic - Lions Gate Hospital

 

West Care Medical - Pre-screening for Sleep Disordered Breathing

Req for Epworth Sleepiness Scale and Overnight Oximetry

Thorson Pain Clinic

 

UBC Fertility Clinic

 

Campbell River, BC and Comox, BC specific forms

Specific E-forms used locally at the Campbell River Hospital, the St Joseph's Hospital in Comox, and in the communities of these two cities on Vancouver Island. For sharing by the local cluster of OSCAR users

FHA Stroke Prevention Clinic

This is a totally re-GIMP'd version of FHA's referral form. It incorporates ABCD-2 scoring algorithm. Upload the HTML file to your e-form library, and the png file to your image library.

Personal Health Risk Assessment-Screening

For use with fee item 14066 in BC

Allergy testing BC Children's Hospital

Mandatory req for allergen specific IgE antibody testing performed centrally at BC Women's and Childrens' Hospital Lab

VIHA specific forms

This folder will contain e-forms specific for VIHA, as requested by Oscar users in this area. More to follow. Stay tuned.

BC NeuroPsychaitry Referral

Referral to UBC NeuroPsychiatry Clinic

Personal Health Risk Assessment 2011

 

Canadian Blood Services Prenatal Form BC and Yukon.

Prenatal Requisition for testing with Canadian Blood Services

Link to 2011 Pap smear Requsitions for BC

 

Canadian Cancer Society Support Referral

 

VCH specific forms

Vancouver Coastal Health specific e-Forms.

Palliative Care Benefits Updated Nov 2011

BC Palliative Care Benefits Referral Updated Nov 2011

Walk in Spirometry Centre Vancouver Costal Health

Provided By John Yap - NB Drop Down lists on this form reset.

PCRM Referral Form

Infertility Referral for Pacific Centre for Reproductive Medicine

BC Centre For Sexual Medicine Referral Form

Three page form - all HTML, but requires "blank pages" to allow for proper page breaks. This page has been used in other forms, so you may have it already in your image library

Bounce Back Referral Form

Referral for Community Coaching for mild to moderate depression

BC Centre for Disease Control Serology Form

As Requested By Jel. Uses X boxes, has a time stamp, and a counter so the time stamp does not update the next time the form is opened.

BC CDC PHSA Lab Requisition for Bacteriology and Mycology Page 1

This is a double sided form, but as the second page is completely separate and used for Isolates Submitted for Identification, I have elected to do the pages separately.

St Pauls Reproductive Mental Health Program

For Mental Health Problems relating to: Pregnancy, the postpartum period, breastfeeding, pregnancy loss, infertility, perimenopause, menopause, pre pregnancy medication assessement, or pms. 2 pages.

BC CDC PHSA Lab Requisition for Bacteriology and Mycology Page 2

This is to send to the Provincial Lab for further testing - it appears it would most commonly be used by smaller Labs.

BC CDC PHSA Lab Requisition for Virology

Has some radio buttons, and a link to the guidelines for ordering stool specimens.

BC CDC PHSA Lab Requisition for Parasitology

 

Prenatal Library

 

Palliative Care Project - David Page

As presented at the May 2012 BC Oscar Meeting

Residential Care Project

As presented by David Page at the 2012 BC Oscar Meeting

BCWH Reproductive Mental Health Program Referral

2 page referral for pregnancy/postpartum/infertility/pms/perimenopausal mental health issues.

UBC Sports Medicine Clinic referral form Feb 2012

From Herb Chang: Updated UBC Sports Medicine Clinic referral form using the "new" 2012 referral form. Apologies in advance for the poor quality of the PNG as I was using a faxed document. Note that the legal,ICBC, WCB checkboxes are "pre-checked" to No, as they will not see these cases. Also note that the png image name is similar to but different from the previous image name (UBCSportsMed.png)

Perinatal Services of BC Levels of Service Document

Ranking of complexity of obstetrical patients

Lung Health Centre Referral Form

VGH: The Lung Centre (Respiratory Clinic) Referral Form.

Mobile Lab

BC Bio Mobile lab form for shut ins etc

End Of Life Planning

Forms for End of life planning

Generic Imaging

Several Versions Of Generic Imaging Created By John Yap

Hereditary Cancer Program Referral Form

Created By John Yap

Handy Dart Application Form

Created by John Yap

OASIS

 

Wound Clinic VGH

Managed to get an original pdf for the wound clinic at Vancouver General Hospital. It had to be modified to be useful, and grammatically correct! JohnY

Non Pap Cytology for BC

Two versions developed simultaneously from Chris Sedergreen's original.

Quit Now BC

New form from BC lung association. subitted to me from Gianna Tanner.

Ultrasound/Fetal Monitoring Requisition for BCWH

By Kevin Meyerink

Heart Function Referral for St. Pauls

similar to Jim Pattison Referral. Created by Kevin Meyerink

EMG Requisition Vancouver Coastal Health

From the Header <!--- Created December 2012, Written for version 12.0, Has x boxes, Has checkgender, fills in subject line---> Created by Kevin and Fred Meyerink

BCWH Osteoporosis program

<!--- Created December 2012, Written for version 12.0, Has x boxes, ---> Created by Kevin and Fred Meyerink

Complex Care December 2012

This is an HTML only (no image) - Updated form from John Yap: From the header <!-------Updated Dec 2012: includes diagnostic R, CLD, and CND codes; additional Resp/CND conditions suggested; CLD criteria-----------> - primarily for BC users. I have tried to update the complex care form developed by the Chilliwack group. But with the introduction of 2 new categories, one of which has a variety of different conditions with no well-defined guidelines, it's not so easy following the same format as the great work already done. If anyone has good references for some of these other conditions, please let me know and I will add the links. For now, I have just mentioned them in the CLD and CND group. Feedback welcome, as always.

Olive Infertility Clinic Referral form

referral to Olive clinic. Header says the following. <!--- Created February 2013, Written for version 12.0, Has x boxes, fills in subject line, uses JSMPC.css --->

Providence Health Care Pulmonary Diagnostics Requisition

Created by John Yap

BCCA Request for Pathology Review

OSCAR Zipped file

EMG Nerve Conduction VCH

OK - most of the original background has been wiped clean, and the remaining (top) bit has been edited to fit our e-form! There rest is html. And the patient instructions are still there for the printing, if you so wish. Requires new background, of course. Hope no one used the original too much. JohnY Feedback welcome.

BCWH Pelvic Pain and Endometriosis Clinic

<!--- Created February 2013, Written for version 12.1, Has x boxes, fills in subject line, uses JSMPC.css,--->

BC Special Authority Request Generic

BC Pap Smear 2013 zip file

<!----- Created March 2013 for Version 12.1. Updated background. Has X-boxes, BCCA reference; JohnY, HerbC, GuntherK-----------------------> Updated to add checkbox in the floating menu for hpv immunization

BC Standard Outpatient Bone Densiometry Requisition

<!----- Created March 2013 for Version 12.1. Has X-boxes, Checks Gender by Herb Chang----------------------->

Frailty Scale

This will be of interest to BC users as a result of the new fee codes introduced April 1 - which allows for a single entity - "frailty" - to qualify for complex care billing. This will be a significant item for those looking after frail elderly patients. First introduced by JohnR as a non-background e-form, I've just added the reference background. Requires some measurement set up for tracking purposes. JohnY