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Communication With Others

Referrals, sick notes, general letters, patient summaries, and more
Adverse Events Following Immunization (AEFI) - COVID 19 specific
This is a trimmed down version of the CDC AEFI form that is specifically for COVID 19 vaccinations. It was developed in a FireFox, Mac environment, running Oscar15. Comments welcome. V3 with enhanced phone contact info function. Otherwise similar to V2. V3_Jun27_2021b - has the submit animation attention seeker!
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
WCB
RCMP
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
Updated November 15th 2020. The Rich Text Letter (RTL) V2.0 has arrived with multiple improvements including easy access to labs, attachments (in some installations) and a page break. The RTLV2.0.html can be updated as a new eForm, or the contents can be copied and pasted in to your existing stand alone Rich Text Letter. There is a new Dependency - editControl2.js that must be uploaded to the images folder. If you have previously been using the Rich Text Letter, that is all you will need. However, if you have not, you should upload the images as well (outdent, indent, table, etc etc) or you could download the zip file of all the images and then unzip the file and add the images to the image folder one at a time. ------ 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.
LEAPS
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.
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.
Complex_Care_Plan_Lite_2019
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
Email to Patient eForm
Updated 2020-Sep-19 16:43 added greasemonkey script from Mike Dodd to place a button on the demographic page to jump to the eForm. You will need to edit the greasemonkey scrip with the appropriate fid. Update 2020-Sep-10 08:46 now with 6 buttons - generic email, appointments, INR, TSH, Normal Labs (reassuring patient), Hb and Fer (Anemia). Also improved the appearance (CSS tweak). 2020-Sep-09 10:38 - I have updated my eForm that clicks to open your email program and send to the patient.  It now has 3 buttons: a generic one one for appointments (includes appointment date and time and who the appointment is with) and an INR button (pulls the latest INR - you have to replace the 2 placeholders ( *** ) with their current dose and their new dose ). This is a VERY basic eform that allows you to email your patients if: 1)you have entered their email in your demographic. 2)you have a default email program set up on your computer. 3) you should get their permission first. Click where it says "email button" on the top left. It will put your default email address in the "from". It will put their email address on file in the "to". It will put "Confidential information from your Doctor" in the subject line. It will put "We wanted to make you aware of the following information: . Please call the office for further information at " along with the clinic phone number on file in the body. JohnR. Just HTML, no image file.
Strive Health and Performance Rehab: V1_Nov26_2020
Created on request by Oscar BC
VideoChat eForm ZIP package with dependencies
VideoChat eForm (Jitsi Meet Oscar Integration) Version 1.1 Please see Kevin Lai's web page for this at: https://oscaron.ca/self-host/jitsi-meet/10-jitsi-meet-install/26-videochat-jitsimeetoscar . During this COVID19, Part Deux; it is important for health providers to continue providing safe care. Although telephone calls may be part of virtual care, this technology has been around for over 150 years and is nothing new. Having more visual and salient information about a patient via a real-time video conferencing solution is crucial for making a safe diagnosis, and improving quality of care. This is important when health providers do not have the ability to conduct in-person direct patient physical exams. Here, with support from the OscarOntario community, we introduce the first version (v.1-2020-11-26) of: "VideoVisit eForm" (Jitsi Meet Oscar Integration) Commissioned by: Get Well Clinic ---------------------------------------------------------------- See patients online virtually. "The doctor will see you now." Automatically create a secure unique (per patient, per day) video meeting room to a Jitsi Meet server and email the link and instructions to the patient (must be same day) with a click. For FREE. Requirements: You need a webcamera, microphone, speakers/headphones, Firefox or Chrome, or Jitsi Meet app for your mobile phone Instructions: - Go to: Administration -> Forms/eForms -> Manage eForms -> Create an eForm in Editor - Copy and paste the contents of the TXT file in to the eForm editor window, name it "VideoVisit" and click Save. OR Upload the ZIP eForm package to eForm Library (when available on WorldOscar) - Dependencies (are included in the zip, and sourced online as well) - Once loaded in Oscar, IMPORTANT TO EDIT the beginning eForm HTML settings to configure to your local instance requirements (ie. change the video server URL, change the salt words, clinic name and add any other messages to the default email template) Notes: Jitsi Meet is a secure end-to-end open source video conferencing platform. The default eForm uses the public Jitsi Meet server for demonstration purposes. It is highly unlikely anyone will be able to video bomb your meeting as the ethereal links are more complicated and unique than a series of numbers (unfortunately, used by a leading video platform that was susceptible to brute force guessing), it changes every day, and your encounters are brief. We recommend installing your own self-hosted private Jitsi Meet server and link the eForm to your private server for enhanced security. You can enable username/password authentication with a private Jitsi server, as well as Lobby/Waiting Room function, and Room password. You can also connect to a VoIP number and make calls out from a meeting room, so instead of picking up the phone, you can do your conference calls with Jitsi Meet as well (no need to change to a phone).
Xpose Patient Support Program 2020 English et Français
These form were commissioned by Alio Health Services and have been created by OSCAR BC. There is a form in English et en Français. For patients Prescribed Riximyo (rituximab for injection) .
EMGALITY Patient Support Program
EMGALITY (GALCANEZUMAB) Eli Lilly / LillyPlus® Patient Support Program for patients with EPISODIC CLUSTER HEADACHE. Created at the request of Eli Lilly by OSCAR BC.
Initium CPM referral
Initium Centre for Pain Medicine referral eForm. Created at the request of the Chilliwack Division of Family Medicine.
My Praluent Coach
Enrolment form to enable access to Praluent (alirocumab) for the management of hyperlipidemia.

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