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Fraser Health Authority (FHA) specific forms

Chilliwack Area Specific eForms
Fraser Health Assessment Network (FHAN)
Referral form for Complex Developmental Behavioural Conditions (Austistic Spectrum Disorder, Complex Developmental Concerns, Fetal Alcohol Syndrome)
FHA - Home Oxygen Program Application
FHA - Longterm Care Application Package
FHA-Vancouver Coastal Spirometry Requisition
This new spirometry from was released recently by the Health Authority, without much consultation with the respiratory labs, apparently. I've added the office fax #, which was requested by the staff at RCH. You need to download two png files for the library, as well as the html.
Consent Forms/Forms for the OR
Hospital Forms for consent for procedures, consent for blood products, OR booking, etc.
Speech and Language Services for Adults - For Abbotsford and East
Speech and Language Services Referral to Abbotsford Regional Hospital and Cancer Centre (ARHCC)
Swallowing Interevention Services - For Abbotsford and East
Created by Giana Tanner. For referral to ARHCC Outpatient Clinic.
Lung Health Clinic Referral Form Jim Pattison Outpatient Care and Surgery Centre
Surrey Centre Referral Form - 2 pages with x boxes
Early Psychosis Intervention Form - Fraser North
Quoting Herb Chang: New referral form for the Early Psychosis Intervention Program-for Fraser North: Burnaby, New West, Tri-Cities, Pitt Meadows and Maple Ridge.
Diabetes In Pregnancy Jim Pattison Outpatient Clinic and Surgery Centre
Referral for Assessment and treatment of diabetes in pregnancy
TIA Rapid Assessment Clinic
Made by John Yap. Calculator at the bottom is for interest only, it does not populate the form as per the clinic's request. There are 3 images, the referral form and 2 information sheets. Load all of them into the image section.
Anticoagulation Bridging Therapy
FH Pharmacy Pre-printed orders. Now calculates dates based on day of procedure (thanks DavidP!). Preset for stopping ASA 10 days prior to procedure - change day number and date for a different choice.
NEUROLOGY CLINIC REFERRAL JIM PATTISON OUTPATIENT CARE AND SURGERY CENTRE
For Neurology Consult, EEG, EMG, and Evoked Potential
FHA Falls Prevention Mobile Clinic
Produced By Giana Tanner
Fraser Health Specialized Seniors Clinic
Created by John Yap
FHA Concussion Clinic
Updated April 21 2018 - contact information has been updated. You may need to delete the previous form in order to be able to upload this form depending on your version. JohnR. As Per JohnY: My original concussion form .... printed off all 3 pages, though displaying only the 1st page. The X-Box features allows you to reference png files in your library, for optional print out. These can be accessed by hypertext links, which I've used extensively in recent forms. So I've redone the form....a bit. OK - a whole lot. Unfortunately, I am still unhappy with the main background. Fraser Health needs to release more of their original pdf for their referral forms! I have attached the new html, the new background page for the e-form, but pages 2 and 3 remain the same, and there is now a GCS reference.Comments welcome. JohnY
FH Outpatient Anticoagulation Orders
This is a 2 page form, but both pages can be used separately. Therefore I have made each form separately and then combined them into a 2 page form. On the second page there are calendars to pick the days and timestamps.
Colposcopy Referral for the Jim Pattison Outpatient Care and Surgery Clinic
Referral for colposcopy. Has calendars for picking dates. Will push and pull the Cytology number as a measurement if you add CYTO to your measurements.
Colposcopy Referral Form for Abbotsford
The original image was "not pretty". So this is mostly an HTML form. The background image has a bar code, a logo, and a couple of lines.
Advanced Care Planning
Created by Kevin Meyerink. Goes with MOST form. If you have created a MOST measurement, will import that measurement in to the form. The back of this form had instructions. That is the second png form. There is a hyperlink on the first page so you can view the instructions if you need them, but I decided not to set it up as the second page of an eform as there is no information to enter in to it. It comes up as a new tab in the main browser not as a separate window. If you choose to print it, you still can, as you would print any web page.
Actively Dying
A colleague had to fill this form today and was less than completely thrilled with finding out there was yet another Fraser Health form to fill out. I have made it into an eform. It has a link to an image which is the back side of the form, it has a time stamp, and I made the date fill out in the d/m/y format the form requested. The image is horrid, but I could not get an electronic original. JohnR.
GP Obstetrics Invoice Fraser Health
For those of you invoicing Fraser Health for unattached Obstetrical Patients
Mother to Child post partum HIV orders
fraser health orders. 1 HTML but 2 images (back page is instructions). Created by Kevin Meyerink.
Fraser Health Mother to Child ante partum HIV orders
Developed By Kevin Meyerink
Fraser Health Mother to Child intrapartum HIV orders
Neurology Referral Abbotsford for Migraines (botox injection)
pure HTML see notes in header <!--- Pure HTML, no background, has tables with outlines for boxes, check marks (as text), and line segments --->
Fraser Valley Child Development Centre Referral
Sleep Clinic Surrey Referral Form
Here is the comment from the header <!--- Created December 2012, Written for version 12.0, Has x boxes, Has checkgender, has fax code, has calendar select --> Created By Fred & Kevin Meyerink.
Outpatient Nausea and Vomiting in Pregnancy
Community Respiratory Services Referral Fraser Health
from the header <!--- Created December 2012, Written for version 12.0, Has x boxes, fills in subject line, uses calendar code---> Created by Kevin and Fred Meyerink.
Community Birth Program JPOCSC
Created by John Yap Update: For BC/Lower Mainland/Fraser North users primarily - several referral forms were developed to our local clinics in the past year. I guess I haven't used them much, but recently tried - and failed - as some of the inputs didn't save. So I looked at them again, and yes - there were some missing quotes, etc. I think I've exterminated the bugs, and standardized most of them to X-box format, with the ability to pull and push LMP as per the Pap smear form. Interesting thing learned from this experience is that FF ESR is very forgiving when there is "bad html", so will render an e-form nicely even with errors. Oscar V12 is not so kind, and won't save (e.g. the GTPAL info), or worse, with the same errors. Please review if you've been using these forms and consider these updates. They are designed to zip right into the e-form library. JohnY
Community Maternity Centre Port Moody
Update April 2013 For BC/Lower Mainland/Fraser North users primarily - several referral forms were developed to our local clinics in the past year. I guess I haven't used them much, but recently tried - and failed - as some of the inputs didn't save. So I looked at them again, and yes - there were some missing quotes, etc. I think I've exterminated the bugs, and standardized most of them to X-box format, with the ability to pull and push LMP as per the Pap smear form. Interesting thing learned from this experience is that FF ESR is very forgiving when there is "bad html", so will render an e-form nicely even with errors. Oscar V12 is not so kind, and won't save (e.g. the GTPAL info), or worse, with the same errors. Please review if you've been using these forms and consider these updates. They are designed to zip right into the e-form library. JohnYPure HTML form created by John Yap. I have tweaked it to push and pull measurements (Look at adding measurements and add G, PRET, LIVE, TERM) Also has button for primigravida - here is the note in the header. <!--- Updated January 2013, Written for version 12.0, No Image, pushes and pulls measurements for use in other areas, has a Primigravida button for setting all pregnancy values except G to 0 (G=1) with code in header to put initial values in to form --->
New Westminister Primary Care Obstetrical Clinic (PCOC)
Update : For BC/Lower Mainland/Fraser North users primarily - several referral forms were developed to our local clinics in the past year. I guess I haven't used them much, but recently tried - and failed - as some of the inputs didn't save. So I looked at them again, and yes - there were some missing quotes, etc. I think I've exterminated the bugs, and standardized most of them to X-box format, with the ability to pull and push LMP as per the Pap smear form. Interesting thing learned from this experience is that FF ESR is very forgiving when there is "bad html", so will render an e-form nicely even with errors. Oscar V12 is not so kind, and won't save (e.g. the GTPAL info), or worse, with the same errors. Please review if you've been using these forms and consider these updates. They are designed to zip right into the e-form library. JohnYOriginal Code by John Yap. Minor modifications by John Robertson. Here is the header - <!--- Updated January 2013, Written for version 12.0, No Image, pushes and pulls measurements for use in other areas, has a Primigravida button for setting all pregnancy values except G to 0 (G=1) with code in header to put initial values in to form --->
Fraser Health Ophthalmology Referral
Mostly HTML Form - here is the header <!--- Created January 2013, Written for version 12.0, Has x boxes, fills in subject line, uses js script to click through a list of choices for input box, uses onclick to fill second box with same information as first box, click address box and it will be filled depending on surgeon name box, need to edit surgeon names and addresses for local surgeons, imports History, uses JSMPC.css --->
Fraser Health Community Mental Health Referral Form
Created By Herb Chang
EMG Nerve Conduction Studies-Dr. Julian Lee
Created by Herb Chang and John Yap header <!----- Created February 2013 for Version 12.1. Has X-boxes and gender check. No Background JohnY----------------------->
Langley Maternity Clinic
For BC/Lower Mainland/Fraser North users primarily - several referral forms were developed to our local clinics in the past year. I guess I haven't used them much, but recently tried - and failed - as some of the inputs didn't save. So I looked at them again, and yes - there were some missing quotes, etc. I think I've exterminated the bugs, and standardized most of them to X-box format, with the ability to pull and push LMP as per the Pap smear form. Interesting thing learned from this experience is that FF ESR is very forgiving when there is "bad html", so will render an e-form nicely even with errors. Oscar V12 is not so kind, and won't save (e.g. the GTPAL info), or worse, with the same errors. Please review if you've been using these forms and consider these updates. They are designed to zip right into the e-form library. JohnY
FHA Heart Function Clinic Referral 2017
Updated Sep2017 for Pathways. John Yap.
JPOCSC Outpatient Fetal Monitoring Referral
Created by John Yap (please not the original was actually made by Jan Nusche) - JohnR, Just tried your version. Background much better than mine. But I have discovered the same "bug" as in mine. When viewed in Oscar, none of the input window borders show, except for the message phone, where the "noborder" class is not stated - possibly an oversight? Anyway - this makes it difficult for users to know if a non-populated window needs an input. All the older e-forms seem to behave properly, and the style areas seem OK. Other than there are redundant entries in the style for media print. Would removing a second "background: transparent;" entry make a difference? I'm not sure how to resolve this - the e-form does not behave as older e-forms have. Maybe the real programmers out there could chime in. In my version, I've referenced the NST protocol in my e-doc folder, where it resides as a pdf. However, I find the upload much slower than if that feature was excluded. This feature uses new script from the wonderful Darius Opensource, and I wonder if that bit of js creates a bit too much work for the server? Here are the files. For now, I may reference the NST protocol as a png in the image library, as I had done prior to openOscarEdoc.js. JohnY
NeuroPsychology referral for Fraser East
For referring to Dr. Lyster <!--- Created August 2013 by John Robertson, Written for version 12, Has x boxes, Uses measurements for MMSE, _3MS, and MOCA --->
NeuroPsychology referral for New Westminister
<!--- Created August 2013, Written for version 12.0, Uses JSMPC.css to show the image while editing, uses X Box for check boxes, uses span for electronically signed, uses provider_name_first_init, Uses a button to give you todays date in dd-mm-yyyy format, Uses onmousedown to change interpreter answer from N to Y to blank again, same for outpatient referral, uses onblur to fill subject line with diagnosis--->
FHA TIA rapid access clinic form
A relatively new Oscar user had asked me about the Fraser Health TIA Rapid Access Clinic form on OCUS. I must admit, I haven't needed it for a while, but it prompted me to look at it again, and I found a few bugs, and annoying apostrophes, that needed fixing. It is not (yet) X-boxed, but I've manage to hide the CHADS2 calculator that required extra work. Something we all enjoy doing, right? NOT! It uses the same backgrounds, so you'll get errors for png files if you've used the old version of the html. Please let me know if it imports properly. Thanks. JohnY
Updated Fraser Health (BC) Diabetes Health Center listing
<!-- Updated March 2013, X-box, pop-ups, page 2 reference; new background Nov2/12 Updated Newport Village phone number Sept 2013 -->Enclosed is the updated code for the Diabetes Education Center (now called the Diabetes Health Center) for changes in the locations for Maple Ridge (at Health unit), Eagle Ridge/Tri-Cities (at Health Unit with new phone numbers) and New Westminster (at Ross Drive). Same image as before. Just need to upload the code and replace previous file. The link at the top still shows the previous image file however with the older addresses. I updated the new locations (and checked all of the old ones) from the Fraser Health website, so I assume that they are the most current. Herb.
RCH Psych referral
<!--created by Dr. Chris Sedergreen. Modified 2013-09 for X-boxes, push-pull EDC and LMP.------------> Also used for Reproductive Mental Health Referrals
Fraser Health Outpatient Fetal Assessment Referral
<!--Created by Dina Ryan Davidson Modified 2013-09 for X-boxes, push-pull EDC and LMP.------------> Hi all, Just dashed this off, as the new form was released today. If you don't have clean copies and/or want to see the rest of the new documentation re: kick counting, etc, e-mail me off-list and I'll forward them as sent to me by the FHA Midwifery Dept Head. Please feel free to critique/tweak as necessary! best, -- Dina Ryan Davidson, RM http://birthingway.ca Hi Dina, Thanks for the form. Couldn't resist the tweaks. Your original form has the Print line at the top of the form. I moved it down to the bottom. I converted the form to X-box and tweaked it to push/pull the EDC. Note that this is EDC, not EDD. My understanding is that future versions of Oscar will use EDC as the measurement. Herb ---- Herb, Great minds think alike. I couldn't resist either. I didn't put defaults in (language, e.g.) but I did tweak the background - the form designers obviously have no concept of EMR. Here's my contribution. JohnY ----- I have added the eform disclaimer, the "copy left" a check for locums filling out forms, Peter HC's code for EDC - EDD checks and the default no interpreter needed. JohnR.
Developmental Disabilities Mental Health (Adult) Referral Form Fraser Health
5 page Referral Form
Internal Medicine For Obstetrics JPOPSC Referral Form
Created November 2013. Parses EDD and EDC so that either saved value will end up in form.
Updated referral for Burnaby Maternity Clinic
This one has a pop-up for the recommended labs for late referrals. I’d be interested if there are other labs considered useful. JohnY
Positive Health Services - BC eForm
Updated Oct2017 with new background - released in 2014 apparently. JohnY Created December 2013 by John Yap - A relatively new Oscar user in Surrey found this requisition for new program at Jimmy Pattison centre. The form will push/pull certain measurements that seem to be preloaded into my system. I suspect they relate to an existing flowsheet for HIV management, etc. However, some of the conventions seem a bit odd, though they may reflect the way labs values are sent. For example - HpCA (hepatitis C antibody) answer is yes/no/NA, to the question “positive”. And HPCP (Hep C PCR) answer is the same Yes/No/NA - to the question “Yes/No”. I suppose it makes sense depending on how the lab values come back. Sadly the only value I could find in a live patient was "Sent to BCCDC.” - as the result came back on paper rather than as HL-7. The paper result came back as “non-reactive No evidence of HCV infection”, which would probably wreck the eForm as it does not conform to the validation parameters for HpCA. None of these problems are insurmountable. Just need to have a consensus as to how the validation for these measurements would be done, and an idea of what the labs are spitting out in terms of results. For comments/feedback, as always. JohnY
Subcutaneous Immune Globulin Home infusion program
Created by Fred Meyerink for the Chilliwack COP January 2014. This is a Fraser Health referral form for the Subcutaneous Immune Globulin Home infusion program. There is a second page for instructions which is viewed in the eform but does not print. JohnR.
Best Beginnings Referral form
Update - this form does not appear to zip properly, so I have posted the HTML and png files separately. --- Recently the public health nurses presented a new initiative to us for pregnant women at risk. It is called "The Nurse Family Partnership" . Here is an Exerpt: The Children’s Health Policy Centre at Simon Fraser University (SFU) is leading a scientific evaluation of the Nurse-Family Partnership (NFP), a nurse home-visitation program. The NFP program is new to BC and is designed to help young, pregnant first-time mothers and their children. --- Registration occurs through screening the best beginnings forms. I have therefore made an eform for the best beginnigs referral.
Nutrition Counseling in Fraser Health
Update October 2015 - Fax number has changed from a 1-800 number to a 1-855 number. <!-- Created Mar 2014, Written by Dr. John Yap, for version 12.1. New background created. No original PDF available. Push/Pull for Ht, Wt, BMI, meds; Pop-Up cues -->A relatively new Oscar user in Surrey asked about this eForm. Apparently, referral to hospital-based dieticians changed in 2012. I rarely use the hospital system, now that the health hotline (811) is available. Getting a background proved frustrating. I received the Jan22/14 faxed version from the GP, and the Mar7/14 directly from a Fraser Health representative - contact info retrieved from FHA website. No amount of searching their site could produce any reference to this program! So I gave in and created Oscar?s version of the referral form. Judge for yourself, but I think it?s a bit better than the original. It will push/pull height, weight, BMI and med list from the Oscar database. Comments welcome. May create a BlackBox version of this later. JohnY
PCOC_Referral_V6_Jul_25_2016.zip
Updated with back page reference for GP/MOA
Seamless Perinatal Care Referral
Created March 2014 By John Robertson. Made using eform generator 5.1. This form is Very busy. I have done my best to make things legible. JohnR. Updated Jul9_2017 by Dr. John Yap. Still a very busy form! Now with font-size change function, colour X-boxes, JohnR's radio_Box function, signature script. If you have the old eForm, you need to rename or delete/archive that one first before importing the new zip file.
FHA South Asian Referral Nurse Practitioner
Provided by The Colebrook Family Practice and NERD BC - Update by JohnY - This one has the X-box gender boxes, and the proper way of setting defaults using the Xbox architecture. Prior to Xbox, preset checkboxes, if unchecked so that another box could be selected, would save and print with the alteration. But when opened again, the default and the altered checkboxes would be checked, even if the default was unchecked. This could lead to confusion. Someone came out with the “checkit” function - which may be found in older eForms. This as rather cumbersome to work with. The Xbox version is way easier. Comments welcome. JohnY
FHA South Asian Health Centre Diabetes Service
Provided by The Colebrook Family Practice clinic and NERD BC
MOST form April 2014
From JohnY: Here is another eForm that has been updated. It’s essentially Dr. Page’s MOST form, which is increasingly used as BC docs adopted the End of Life Care protocols. It is used in all FHA hospitals, as well as residential care facilities - which are apparently labeled as “assisted living” by FHA management now! What I’ve done is added the section 7 and 9 links, forced the subject line to include the MOST choice, and changed the logic for the combinations slightly. The X-boxes behave like radio buttons where appropriate now. Could not get Do CPR with C2 to turn on and off together. Comments welcome. It’s zipped, and I’ve recently had problems with getting files to unzip properly into Oscar (as have others). So if that does not work, then unzip it outside of Oscar and load up the usual way. JohnY
Fraser Health Home Health Referral Form
Updated May 11 - From JohnY --- figured out what was odd about the Home Health form - onFocus creates the desired behaviour. I’ve added links to to additional eForms. Update May 10th 2014 -- Herb Chang -- Hi JohnY, I could not resist. I merged some of the features from the form created by Kevin Meyerink onto your form. It will save now some of the information checked into the Subject box. H. Update May 7th 2014: -- Minor tweaks and major proofreading and trimming to this eForm. Now 22% “lighter”!! Thanks to Herb for noticing, and JohnR for the wound care tweak. JohnY------Update March 20 2014 - A request was made to import the history in to the Details/Problem list box. Two versions have been created - the first inputs the latest history in to the text box. V2 is for those who have multiple bullets in their history box, but has the characters and dates that divide the inputs. JohnR. <!--- Created July 2013, Written by Kevin Meyerink for version 12.0, Has x boxes, and gender boxes, Updated March 2014---> They have changed 1 line in the form and sent out a new form - HTML code has compensated for this - HTML, Zip, and png all supplied, but those with the previous version from a few months ago will only need the html. JohnR.
Abbotsford Urodynamics Clinic 2014
(For those who do not wish to edit the eform consider the 2 page form at the bottom) Update Dec 2015 - the clinic is now asking all patients to fill out a voiding diary. They said they did not have an electronic version to email me, so I recreated their voiding diary on excel and converted it to a pdf to be placed in eDocs. I then added a button to link from the referral form to the voiding diary. The button needs to be edited in the form for the link to work. The eform will still work without the linkage, you will just need to manually find and print the voiding diary. I have also updated the code for the Xboxes and the calendars. To link the voiding diary to the eform; Once you have placed the voiding diary PDF in your eDocs Go in to eDocs and select (open up) the voiding diary. When it opens up look on the address line of your browser and find the document number. It should look something like --- https://000.000.0.000:00000/oscar_doctor/dms/ManageDocument.do?method=display&doc_no=57276&providerNo=1000 -- the part that says doc_no=57276 is what you are looking for. Copy that number and put that in place of 57276 in the eform. The line in the eform you are looking to change is: function dLink1() { window.open("../dms/ManageDocument.do?method=display&doc_no=57276"); } JohnR.
Falls Prevention Mobile Clinic FHA
Created by Kevin and Fred Meyerink June 2014
FHA_Fraser_South_Eating_Disorder_Program
Donated by Nerd BC and the Colebrook Family Practice
RCH Genetic Amniocentesis Referral form
Created by Dina Ryan Davidson and Herb Chang July 2014
New Westminster Healthy Heart Referral eForm
From Chris Sedergreen: Attached herewith is the New Westminster Healthy Heart Physician's Referral eForm and related image file. I've also attached a completed form for interest as well as the original MS Word doc used to create it, in case anyone wants to play with it. Chris.
FHA MRI
Supplied by John Yap - link to form which is stored with imaging forms.
Pediatric Asthma Clinic Abbotsford
Original image was of dubious quality, so most of this form is HTML. JohnR.
RCH Psych Referrral updated 2014 V3
This version updated to include check boxes that behave like radio buttons, and newer code for x boxes.
Fraser Health Imaging form Apr 9 2017
Updated by JohnY
Specialized Seniors Clinic Fraser Health
Updated by Herb Chang November 2014
Fraser Valley Child Development Centre Referral Form
Replaces the 2012 form. Has X boxes that work as radio boxes.
Psychosis Treatment Optimization Program Referral form Royal Columbian Hospital
Update - JohnY's version posted as well. From Chris Sedergreen: Attached are the necessary html and png files for the Fraser Health Psychosis Treatment Optimization Program referral form. The forms pretty much speak for themselves, but for those unfamiliar, the program is for psychotic patients whose outcomes have been less than ideal. This may be because of persistence of psychotic symptoms in spite of treatment; or else for unacceptable side effects from treatment that is otherwise effective at controlling symptoms. Chris.
Fraser Health Transfusion Request form
Fraser East Eating Disorder Services Referral Form December 2014
Form for referral to Chilliwack And Abbotsford Eating Disorder services. Backgrounds are 1) a blank page with the Fraser Health Logo on it, and 2) a blank page. This is done as the page break does not seem to work without these backgrounds. The rest of the form is all html created with the help of tables. JohnR.
Geriatric Mental Health Referrral eform
Update - I have added 3 buttons (light blue near the bottom of the form) - Code is borrowed from David Page. First button gives allows you to jump to the lab grid display so you can included it with your referral, the second button allows you to jump to the edocs for that patient and selects the type "consult" so you can select which ones you wish to combine in to a pdf to send with the patient. The third button is similar to the second but selects for the type "radiology". It is a 3 page eform. Background is Fraser health Logo on a blank page for all 3 pages. Form is primarily composed of html tables.
FHA Diagnostic Cardiology eform
Commissioned by Dr. Bess Leung, created by NERD BC. Referral to Cardiology Diagnostic Services at Surrey Memorial Hospital
Cardiology Services Jimmie Pattison Pavilion
Created by John Yap for Dr. Verma
Acquired Brain Injury Referral Form Fraser Health
10 page referral form for Acquired Brain Injury program in Fraser Health
Falls Prevention Mobile Clinic 2015
Updated as of March 2015.
FHA Movement Disorders Clinic Referral Eform 2015
This form was commissioned by the Colebrook Clinic and created by NERD BC - with thanks to both.
Admission History - Progress Note for Fraser Health updated 2015
October 18 2015 - update - have added a check box for stating the MOST form has been filled out and a button to jump to the MOST form. The MOST form must be installed in the eform folder and named MOST . using an image of the Admission History/Progress Note page from Fraser Health, I have created a form for those who wish to type these up using oscar. It has a menu to help with the typing, and will import such things as sex, allergies, medications, history etc. JohnR.
Most Form Fraser Health March 2015
From John Yap ---- This is for Fraser Health users. We have advanced directives noted in the MOST form. David Page and I have worked on this at different times. I’ve added links to the representation agreements - section 7 and 9. If someone can tell me in plain English what the difference is, I’d greatly appreciate it! Plus, if one creates a MOST measurement, the status can be tracked. There is some “logic” programmed into the form. Hopefully it works! Comments welcome.
Chronic Pain Clinic Referral Form JPOCSC 2015
They have updated their form from 2 years ago. The drawing was on the second page. The drawing code I am employing does not appear to work past the first page, so I have brought up the second page first. JohnR.
Outpatient Diabetes Referral eform Fraser Health 2015
Updated June 2016 - The form has been updated for May 2015. The new form will pull the patient's FBS and HbA1c if they are in measurements. Also pulls EDC and medications. Medications are duplicated and will need to be edited to separate diabetes meds from other meds. Link to image of back of page for centre locations and contact information. Web link to FH web page. Two versions, one for primary care and one for specialists to allow proper information to be completed for physicians. GP version has been updated for Pathways, JohnY.
Pathology requisition for Abbotsford Regional Hospital 2015
New form for ARHCC as of 2015
Perinatal Loss Investigations 2015 Fraser Health
Investigations for losses beyond 14 weeks
JPOCSC Neurology Neuromuscular and EMG Clinic 2015
Updated referral form for 2015. Has signature script.
JPOCSC General Neurology Clinic Referral Form 2015
JPOCSC Neurology Diagnostic Clinic Referral Form 2015
Referral form for Dr. Manbir Sandhu Surrey BC
This is a pure html eform - there is no image. To upload to OSCAR, save the html file somewhere you will remember, then: In Administration under upload eform enter an eform name (such as the one above) and click on browse. Find the eform and select it, then select open. back on the upload page select upload - this is all that is required. JohnR.
Continence Clinic Referral eForm Fraser Health New West and Whiterock
Created By John Yap. For the continence clinic in New West and South Surrey.
FHA Imaging Requisition August 21 2015
Updated to correct problems with the MRP and MRP number not being added to the form
Reproductive Mental Health referral eForm for Royal Columbian Hospital
From John Yap: Here is the new “reproductive mental health” referral form. It’s actually a rebadged, slightly toned down generic RCH referral form. I’ve heavily modified the background to suit the needs of our EMR. I'm reasonably happy with this version. Take it for a spin. There was an accompanying letter that came with the original form. It outlined the eligibility requirements, hours of operation, etc. I?ve asked the psych group if this is still accurate. For now, I have not referenced it. Interesting idea adding a 2nd page though. Would certainly allow more options for autopopulating fields - e.g. PMHx and meds. I did find a medication database tag that seems reasonable. I see this eForm accompanying a regular consult letter. The consult module still serves a purpose - it allows for tracking and checks/balances of consults made. If we simply used ever-changing one-off eForms for all referrals, it would be a nightmare tracking such things as lag time between consult request and reply, etc. Comments welcome. >>> >>> JohnY
Health Evaluation Assessment and Liaison Clinic (HEAL) Referral Form 2014
Referral form for the Health Evaluation Assessment and Liaison Clinic (HEAL) for possible Child abuse.
Requisition-Cardiology Service For Dr. Kapil Bhagirath
Created by Muki Olundegun for Dr. Kapil Bhagirath - Cardiology .
Fraser Health Orders and Directives 2015
Inpatient orders for Fraser health. Includes 2 menus - 1 for OBGYN related orders and 1 for Outpatient Parenteral Antibiotic Therapy. Also include links that pop up like page alerts with information about preferred antibiotics and dosing.
RCH Psychiatry Referral eForm
Created by JohnY September 2015. Updated Oct2017 for Pathways and new Fraser Northwest Division initiative
Rapid Access Clinic (RAC) for Psychiatry
Updated by JohnY, October 2016
Pathology Request Form Surrey Memorial Hospital
SMH_Pathology_Requisition eForm was commissioned by Peninsula Medical Clinic in Surrey, and created by NERD BC.
FHA Burnaby Hospital Pathology Requisition eForm 2015
The FHA Burnaby Hospital Pathology Requisition eForm was commissioned by Dawson Medical in Burnaby, and created by NERD BC.
Modified Barium Swallow Fraser Health BC
From John Yap November 25th 2015: Was asked to create this for a new attachment project in Fraser Northwest Division. Generally ordered in acute care setting, by ward staff, but our community NP wanted it.

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