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PHC Geriatric Clinic Referral eForm

Created by Dr. Patyal. An eForm for referral to the Providence Health Care - Elder Care Geriatric Outpatient Clinic. -- Updated 2019-Nov-23 Moved second page to the side - do not print - to save ink and paper Updated Code for X boxes Added Radio X boxes Converted 2 "other" inputs to 1 text area Photoshopped out boxes and some lines on image added span /span with text to clarify some inputs corrected DOB to conform with requested format Parsed Referring Physician Name Pre-Checked some boxes on initial opening Added some cosmetics

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