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Communication With Others

Referrals, sick notes, general letters, patient summaries, and more
Department of National Defense - Consultation Report
Generic Letter
Blank letter head. Buttons on the side allows you to quickly paste in a patient label and the other patient information.
Patient Summary
Blank page with demographic at the top. Shortcut button on the side that lets you quickly insert the social history & family history/other meds/past medical history/ongoing concerns/reminders text into the page.
Sick Note
Forms for patients who are employed by the RCMP
Eforms contributed by Jel Coward
These eforms are contributed by Jel Coward. Please feel free to download and modify them. They are best edited in a text editor, eg Notepad rather than a word processor or HTML editor such as Frontpage or Dreamweaver.
A Standard Rich Text Letter
This eForm provides a method to produce multipage letters with markup attributes including bold, font size, underline, italic and database lookups that allow for pasting of attending doctor, referral doctor and patient information. All the button images (.png), the javascript (.js) the help file (editor_help.html) and the templates (blank.html, MissedAppointment.html, certificate.html, narcotic.html, custom.html and so on) need to get uploaded into your images folder. The main editor file (Editor-For-XX.html) needs to be uploaded as a form. This version is tuned for Firefox and works with FF versions 2 to 17 inclusive. IE Chrome and Opera browsers have been tested and will open and write letters, but may not have all the bells and whistles supported. For all newer browsers please use the newer version built into OSCAR 12.1.1 This version has 26 formatting functions and support to back port spelling for IE. Cut and paste are supported through keyboard shortcuts as they are variably implemented across browsers.
Sample Rich Text Letter example
Patient Assistance Program by Eli Lilly
Financial assistance application for patients requiring help with funding for medications supplied by Eli Lilly. Includes Insulin.
Lam Employment Absence and Productivity Scale
Sigvaris Prescription
Prescription for Compression Stockings. Has a link to a second image with the indications and the Disclaimers
communication with others
2012 versions of some of the forms. Supplied by JohnY
Service Canada Medical Report
Designed by Peter HC. One version with a signature image, one version with "Electronically Signed"
Merck Patient Assistance Form
For patients who cannot afford certain drugs - from Merck - financial aid
Aviation Medical eForms
Created by Chris Sedegreen: For any OSCAR user who is also a Transport Canada Civil Aviation Medical Examiner (CAMEs), I have created eForm versions of the Medical Exam Report Form: see attached. Presumably to offload their costs onto us, Transport Canada (TC) seems to have stopped sending the blank paper forms. As CAMEs know, these are printed on legal size paper; but I found that TC will accept a form that is shrunk to letter size. I've taken the PDF (see attached) and Photoshopped it without proportion constraints, so that it fits quite nicely onto a letter size page. In designing the eForm and to save time, I've also put in 'default' answers - e.g. the 'Normal' boxes are all pre-checked: since the majority of pilots that I see seem to be in excellent health. These can be un-checked if necessary where there is an abnormality. At the present time this is a two pager, but I intend to convert it to a 1 pager in the near future. Chris.
Generic Short Term Disability eForm
Attached is the new 'Generic' Short Term Disability form and images, with acknowledgement to Pat Morphy from NERD for his assistance on creating a 2 pager. Note that this is supposed to be the form that all or most insurers have agreed to use. Having completed it I'm not sure how useful it will really be in terms of reducing MD workload, but try it and see. Watch out for more to follow. Chris.
Industry Generic Long Term Disability eForm
From Chris Sedegren - Attached is the Insurance Industry generic Long Term Disability eForm html and pngs. Also attached is a sample form (in PDF) once again completed on my dear old friend and patient, Bilbo Baggins, so that you can get an idea as to what the completed form looks like. This time I was able to use 14 point font, which makes it much easier to read. The areas that the patient is required to complete are highlighted in yellow. Please feel free to adapt and modify as you see fit. Chris.
french version of the Service Canada Form for Disability
Hi there, this is the french version of the Service Canada Form for Disability. Great to have some french forms on here :) If you have any tweaks, don't be shy and just let me know! Thanks Luc Frenette NB
RBC Insurance Form
Provided February 2014 by Chris Sedergreen - Attached herewith a an eForm version of the Royal Bank of Canada Insurance Attending Physician Supplementary Statement - a two pager. For those who may wish to modify the 'Degree' - e.g. a specialist or those with a non-north American degree, this can be done fairly easily as follows: After uploading the two images and html file to the appropriate places, go to the eForm list and click the Edit button (towards the right of the screen). This brings up the html. Scroll down to near the bottom, where the line begins with the words input name 'Degrees' , then scroll across that line to the end and find " value="MD" Substitute or add any letters you wish, for example "value="FRCS(C)" if you are a surgeon. In the same way you can alter any of the pre-formatted statements in the response boxes of the various questions, such as my "What does this question mean?" about 3/4 of the way down. Chris.
Great West Life Attending Physician's Statement
Attached is an eForm for the Great West Life Attending Physician's Statement (APS) for Short Term Disability (STD). The original PDF booklet is also attached. Chris.
Coast Mountain Bus Short Term Disability eForm
From Chris Sedergreen - For those of us in the Lower Mainland of BC who have bus drivers in our practices, attached is the Coast Mountain Bus Short Term Disability eForm. Chris.
Canada Life - Confirmation of Ongoing Disability
Yet another variation on the disability insurance form. This one from Canada Life calls itself "Confirmation of Ongoing Disability". Chris.
Link to Canadian Diabetes Association insulin presciption template
4 page Service Canada CPP application form
From Peter HC ====== March 2014 ====== made with the new eForm Generator with some additional tweaks
Insurance Form Industrial Alliance
From Chris Sedergreen: I've created a new eForm for the Industrial Alliance physician's statement. The files are attached herewith.
Insurance Form Fenchurch Supplemental Information
From Chris Sedergreen: Another insurance form! This one goes under the name "Fenchurch Supplemental Information" and is a 3 pager. HTML and Images attached. Chris.
Exercise is Medicine Canada
From Patti Rodger Kirkpatrick - Commisioned by Drs. Keeler, Young and McClurg of Victoria BC Exercise Rx and referral from from Exercise is Medicine Canada.
Physiotherapy Referral Form - generic template
This is a generic template for a background-less, HTML-only type, physiotherapy referral form. You would edit the HTML to insert contact details for local physiotherapy clinics
Midwives Protection Program
Incident reporting form provided by Kat Montgomery
Request for access to personal information
Form for patients who are requesting access to their records. Pure HTML. Uses tables and border-collapse: collapse; PDF included for identification purposes
Doctor's note
Provided by Eileen Cochien - This is a stand alone html eform for a doctors note. It has multiple choices including surgery, illness, illness in the family, can return to work etc. It uses the calendar feature to pick dates.
Rich Text Letter 2015
Selwyn Wan has modified a version of the Rich Text letter for use in Firefox past version 17, From Selwyn - - More recent firefox will not execute the old eform's javascript properly. New versions will now work for most browsers up to IE11 and Firefox 31. repackaged the Letter Eform with a renamed editControl.js as to not require any Eform Image manipulation in order to install.
Generic Allied Health Referral eForm
From JohnY - I created a "generic" allied health referral eForm, based on the original eForm from JelC and the Pemberton Clinic many, many years ago! Then I realized I wanted to include specific people and places based on referral patterns. This eForm is all HTML, and allows you to customize with as many/few specific agents you choose. There are additional pop-up boxes to remind you what scope of practice may be included. There is no background, and it should not be shared via zip due to "escape characters". JohnY
Record Request - 2017
Updated October 23rd - to include a few missing FHA sites (Abbotsford, Hope), and tagged on a PDF viewer made possible by Darius Opensource. I found it does not work if both online (inside Oscar) and off-line (outside Oscar) references are made in the eForm html. So I’ve set up the zip to work inside Oscar. Developers can uncomment the relevant line and use it elsewhere if they wish. --- Updated September 17th - Here’s the updated general record request. With the VCH list linked. It should be zipped in, or add the bmp file to the image library. I did change the location js file name - adding revision date. - Updated September 14th - to add most of the FHA and the major VCH sites in the drop down list. - Updated Sept 13th - added a link to ALL the FHA medical records sites! Hopefully their fax #’s are up to date. - JohnY - Update Sept 5th - Once the eForm is saved, on reload it goes back to default setting for the Health Record request - which means the usual stuff for former GP is added back. It’s easy enough to over-ride by just clicking on the source again, but that’s a hassle, and another click! So, in order to save the MOA that extra click, here’s version 5. - Update September 4th - This eForm requires even less customization - mainly if you wish to have multiple doctors names available. Default name is the current user - in proper order, full name! The city and Province are on the same line. Minor cosmetic tweaks for alignment. The clinic name in the Footer autopopulates, and if you want to shrink or expand the field to align with the comma, you may do so!! If you want to set it to custom width, you may do that too - but that involves customizing. - Created By John Yap - Here is a non-background record request eForm - initially created simply to get records sent from patient’s previous GP. It is zip-importable, and should be loaded up initially as a zip, as there is a location js file that goes into the image file. BUT - you’ll have to customize it as per the html instructions. Because of formatting limits, the clinic name, address, phone, physician’s names, and a few other bits, need to be hard coded. If you cannot figure out how to do this, ask your OSP. It’s not that difficult. Updated Jun2017 - updated zip file and js for locations. JY.
Doctors Note 2017
The original version of this eForm was, I believe, from GuntherK, and was a huge improvement over the previous “sick note” eForm I was using. It is a great platform for using boiler plate - those standard letters for orthotics, CPAP authorization, RTW, etc, etc. The novice “programmer” can add more menu items by using the pattern set out in the js file stored in the image library (Doctors_Note_V8.js). If you’re not sure how to do so, ask your OSP. The original may have had “hard coding” for a specific clinic. I believe the current (attached) one is more “generic” and will reflect whoever is the user at the time. Which means - if your MOA is creating the note, it will be her/his name on the form! The latest upgrade has the fontSizechanger added - because my presbyopia challenges me every day! If there is other boilerplate you would like added, I’d be pleased to help out. If you already have an older version of the Doctor’s Note - you can keep that by renaming it. And you can add this one as a new eForm - with a different name, of course. Then decide which you prefer. JohnY
Consent to use electronic communications
Posted at the request of (and created for OSCAR by) John Yap. Be advised - prior to using this form the physician should be well versed in the CMPA and college guidelines surrounding electronic communications with patients. This form is based on a CMPA template and is to be used as a guideline when obtaining consent for electronic communications with patients.
Maviret Patient Enrollment Form 2019
For patients Prescribed Maviret for the treatment of Chronic Hepatitis C
Primary Care Provider Patient Summary - 2019
Presented at OSCAR Con 2019 - For communication between providers - such as communication between family physicians in the community and hospitalists. Or communication between primary care providers and long term care facilities.
For the evaluation of Complex Care patients in the office. Please read all the instructions at the bottom before deciding which button to click.
Harvest Medicine Referral Form -Canada 2019
Description:Harvest Medicine's digital referral form for patients inquiring about medical cannabis. This is specialty clinic for assessments, patient education, & patient support.
Red Cross Loan Program 2019
These eForms were created by Rachel, the MOA from Dogwood Medical Clinic in Campbell River. It is for the Red Cross Equipment Loan program (They were built using the Juno E-form generator so they may require further testing) These should be usable Canada wide. Dr. Klein has added a button to link to the local Red Cross branch lookup page.
Medical Report for a Canada Pension Plan Disability Benefit 2018
14 page eform for CPP Disability Benefits
Emgality Patient support program Lilly 2020
Lilly Support program for the prescription drug Emgality (Galcanezumab) for the treatment of migraines. Tags: Emgality, Galcanezumab, LillyPlus, Eli Lilly, Lilly, Migraine, Patient Support Program, PSP

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