BCWH eForms

Eforms specific to BCWH or for tests done at BCWH

BCWH Osteoporosis program:  Created by Kevin and Fred Meyerink
BC Womens Hospital EMMA Clinic Referral Form: The clinic's Goal is " Evaluating Maternal and fetal Markers of Adverse placental outcomes" and "Antenatal risk assessment for placentallymediated pregnancy complications" Form Created by Dina Davidson: I've attached a draft of the new BCWH EMMA Clinic Referral form. I've used the more old-fashioned checkboxes (probably JohnY will want to change them to x-boxes, but I'm rather partial to the old-school ones myself :). It is a two-pager, and I've included comments indicating which section is which. Let me know if you see anything that needs fixing. We're trialling it at 2 midwifery clinics now, and if I find errors, I'll re-export and send you a new .zip file.
BC Womens Hospital Pre Registration form
BC Women's Hospital Waterbirth Audit: Audit of Waterbirths being conducted by BC Women's Hospital - From Kat Montgomery - As you’ll see, this one has a js file that calls the names of all the current midwives in our clinic, as well as autopopulating the signature of the midwife using the eform … just one more shortcut so that each time a new midwife or locum joins our clinic, I only have to change the one file.
BCWH Consent For Rh Immunization: Provided by the Eight Avenue Clinic and NERD BC
BCWH Diabetes in Pregnancy June 2014: Provided by NERD BC and The South Community Birth Program
BCWH Heart Program for Women 2016: Created with the kind support of the Vancouver Division of Family Practice by OSCARprn
BCWH Oxytocin Induction of Labour Form and Checklist 2016: Created with the kind support of the Vancouver Division of Family Practice by OSCARprn
BCWH Medical Genetics Clinic 2016: Update March 7th: For BCWH Medical Genetics Clinic, I suggest that the address for the clinic be converted from an address line to a text box to allow a multi-line address. There is adequate "real estate" on the form for a multi-line address. For my clinic, the full address with postal code does not show up on a single line. Regards, Herb. --- Created with the kind support of the Vancouver Division of Family Practice by OSCARprn. Updated July2020 - calculates gestational age from current date. Does not require EGA measurement. Updated formatting. John Yap.
BCWH Induction of Labour Request 2014: Created by Kat Montgomery
BCWH Complex Chronic Disease Program Referral 2016: Created at the request of the Division of Family Practice of Chilliwack. There are several "extras". The date of referral comes originally as YYYY-MM-DD, however clicking on the input box, and clicking on "Today" in the calendar will give you today's date in DD-MM-YYYY format as requested on the form. The yes/no XBoxes are coded like radio buttons so that you cannot say both yes and no. Reason for referral pulls the medical history. There is a hidden link to the pdf map for BCWH. Click over Directions (entrance #77) - web instructions/map and you will jump to the pdf of the map. Page 2 was a discussion about the interpretation services, and this has been moved to a (non-printing) box beside the first page.
BCWH Registration Form - Updated August 2016: Created by Kat Montgomery.
BCWH Continence Clinic Referral Form 2016: Created by Kat Montgomery
Heartwood Referral Forms 2017: The creation of these forms was requested by The Division of Family Practice in Chilliwack. The Heartwood centre is a residential treatment program, a provincial tertiary 28 bed resource for women with substance dependence, mental health concerns (including trauma) and primary health and/or chronic disease issues. The referral form package consists of 18 pages. Pages 8-13 comprise the main referral form. This has been made in to a 6 page eform. There are several handouts that have been adapted to be opened as pdf's as per Darius Opensource's code. The links to these appear as (non printing) buttons across the first page below the client's name. There are also (non printing) buttons to the right of the first page of the form that allow you to jump to 3 other eforms - the funding information form, the early exit form, and the participation agreement form. The main form also has a link to the web page for the program. All eforms should be imported to the server. Please do not alter the names of the eforms as this will break the link to opening them from the main referral eform. JohnR.
BCWH Recurrent Pregnancy Loss Clinic 2017: Created by JohnY with Collaboration from Herb C and Khai P, Limitations: Women who have had either 2 consecutive miscarriages greater than 6 weeks gestational age, or a single miscarriage greater than 10 weeks gestational age are eligible for referral to the clinic. Physicians who see patients at 4500 Oak Street, Vancouver - Dena Bloomenthal - MSP #26460 - Obstetrics and Gynecology - Nicole Racette - MSP #07457 - Obstetrics and Gynecology - Stephanie Fisher - MSP #28132 - Obstetrics and Gynecology
BCWH Transfusion Medicine Laboratory Post Natal Maternal Fetal Investigation Request 2017: This form was created by Kat Montgomery for Rh testing of cord blood after deliver (presumably for home births).
Early Pregancy Assessment Clinic - BCWH 2018: This form has been updated by Kat Montgomery - Some of the boxes had incorrect checkmarks, e.g. “Interpreter required NO” alongside “Interpreter booked YES”.
BCWH Maternal Fetal Medicine Referral 2018: 2018-Sep-22 16:38 - Updated so that EGA can be calculated regardless of whether EDC has previously been stored in measurements. Referral to BCWH for MFM. There are 2 versions of the form. The first version is plain and does not have any added measurements for "term" "preterm" etc. The second one includes all of these measurements for those that wish to add them to their server. Both versions contain code to change dates from the format 2018-09-19 --- to --- 19/Sep/2018. Both versions can calculate the EGA if the EDC has previously been stored in measurements.
BCWH Ambulatory Clinic Referral 2019: 2019-Aug-24 21:15 Updated to include buttons to open labs and documents. For referral to the Ambulatory Clinics at BC Women's Hospital - Internal Medicine, Infectious Diseases, Hematology and Anesthesia.
BCWH Fetal Diagnostics referral eForm 2020: updated 2021-Dec-30 16:10 - DateParse function was giving incorrect date. New Javascript used. Updated 2021-Dec-27 18:42 - New background requires 1 new field - patient's email. Otherwise the form is identical. Code updated. **** Updated referral form for the BC Women's Hospital Fetal Diagnostics Services. It does a few extra things like remind you to fill required fields and it has a button to calculate the estimated gestational age.
BCWH Pelvic Pain Endometriosis Referral 2020: 2021-Sep-19 13:19 This form has been updated to reflect the new requirement for a email address. **** 2 forms, one for specialists and one for primary care providers.
British Columbia Women's Hospital Referral Form for Recurrent Pregnancy Loss circa September 2020: This is the new form for referral to BCWH RPL. It has some required fields and some colour changes when "sub Xboxes" are required. JohnR
BCWH_Ultrasound_Fetal_Monitoring_Referral_2019: Referral to BC Women's Hospital for Ultrasound and/or Fetal monitoring. This form parses the dates in to the requested format. It also parses the names to Firstname Lastname. It has a side bar with the patient instructions from the second page. It also has a link to the second page that can be printed. There are links to the labs, to the documents, to the Antenatal Record, and to the map of BC Women's Hospital. It pulls EDC and LMP. It pushes and pulls Gravida, Term, Preterm, Ectopic, SA, TOP, and Live.
BCWH Prenatal Procedures referral eForm May2019: For referral to the BCWH Procedural unit including CVS and Amniocentesis
BCWH Medical Genetics Prenatal Referral 2021: BC Women's Hospital Medical Genetics Prenatal Referral form. 2021-Sep-02 12:31 Updated from 2019 to 2020 version - added email address, added some required fields.
BCWH Access Clinic Referral 2021: The Access Clinic offers cervical cancer screening (pap tests) to adolescents and women with disabilities, or who have had difficulties with routine screening at their health care provider's clinic. We aim to help any woman who has experienced barriers to cervical cancer screening, menstrual management, or who require specialized contraception counselling.
Referral to Reproductive ID +/- Oak Tree Clinic BCWH 2021: Referral to Reproductive Infections disease clinic and the Oak Tree clinic. The Oak Tree Clinic at BC Women's is a leader in providing specialized clinical care to women, children and their families living with HIV. We are a provincial resource for providers seeking information on best practice and evidence-informed care.
BCWH Ambulatory Clinic Referral 2021: Created at the request of Westside Midwives. 2021-Dec-18 15:38. Updated for 2021. For referral to the Ambulatory Clinics at BC Women's Hospital - Internal Medicine, Hematology and Anesthesia. Includes a calculator for Gestational age and links to other portions of the Chart.
BCWH Early Pregnancy Assessment Clinic: 2021-Dec-24 07:47 Patient's name was missing - corrected. 2021-Dec-23 15:20. New version with the October 2020 background. Has calculators for EGA based either on LMP results or US results. Click the By LMP or By Ultrasound button to calculate.
BCWH Reproductive Mental Health Referral Form 2021: Created at the request of the Westside Midwives, this is the updated BCWH Reproductive Mental Health ( RMH ) eForm. There are required fields, links to other parts of the chart, and an EGA calculator. JohnR.

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