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History Taking

All e-Forms related to history taking goes here
Patient Intake History form-men
created by Shelter Lee based on paper forms used at Bayswater Family Practice
Mental Health Questionnaire
Joint Diagram
For recording down active joints for patients with inflammatory joint disease.
Patient Intake Form - Female.html
created by Shelter Lee based on paper forms used at Bayswater Family Practice
Sheehan Disability Scale
"A brief patient rated measure of disability and impairment" Supplied by John Yap. Dr. David V. Sheehan has formally requested that his intellectual property be removed from OCUS because it is trademarked and copyrighted.
LEAPS - Lam Employment Absence and Productivity Scale
Automated Patient Intake form Obstetics and Gynecology.
Modified from the Bayswater intake form to draw measurements in and fill out history etc.
Brief Pain Index
By John Yap
Complete Physical Exam Form
By Chris Sedergreen -- For various reasons I haven't been happy with the earlier CPX form that came with OSCAR. No doubt we all have our idiosyncratic approaches to both the performance of a CPX and the recording of our observations. Moreover, what does "Complete" really mean? And how 'Complete' is our recording of our observations? When we simply look at a patient we are making numerous observations that we don't necessarily record, perhaps because to do so would be labour intensive. Also, the recording of 'negative' or 'normal' findings is often overlooked for similar reasons. Yet it is probably becoming increasingly important to do so, especially in an increasingly litigious world. Attached is a 4 page CPX eForm - the HTML and the PNGs. Also there is a sample CPX on my long-time patient and friend, Mr. Bilbo Baggins, as well as the Word document that I created to be the template. If anybody feels like it they can play with and edit this. I certainly don't think the resulting form is ideal and if anyone has ideas for further improvement please feel free. Here are some of the advantages: It prints very nicely in the event that a printed copy was ever needed. Values for height, weight, waist, BMI, and sitting BP are pushed to the database when entered into the form, so that they should show up in other forms such as Hypertension and Diabetes management forms. A large number of items are pre-checked as "Normal" as the default, which should save quite a bit of time recording. Sides are colour coded - Red for left and Green for right (port and starboard colours if you happen to be a mariner or aviator). This should make the form a little more easy to read and use. For the majority of ranges of motion the 'normal' is listed as an aide memoire. Certain clinical tests/signs - e.g. Lachman, Lhermitte, Trendelenburg are included as an aide memoire to remind the examiner to do them if applicable. Gender-specific body parts are colour coded for easy reading and recording. Lots of "Comment" areas in case there is a need to enlarge on findings. A 'Problem List" at the beginning of the form (draws from "Ongoing Concerns" in the database) An area to record a Diagnostic Summary and another to record the Treatment Plan. Editing the HTML wouldn't be a hugely difficult task if a user wanted to change some of the default settings, e.g. from N/E ('not examined') to Nor ('Normal') in the check-box areas. The disadvantages that I see are: To cram so much information into 4 pages I had to reduce the font to 11 points. Readability is improved however by using a bold font. The CPX is still by no means "Complete", although it is a lot more so than the previous version. It lacks line drawings and the ability to draw over them, that most of us have used with paper records. I expect this CPX form to continue to evolve over time - or even to be replaced by something better. Chris.
Psychosis checklist
From: Chris Sedergreen - With psychiatrists in short supply as ever, GPs may find themselves being asked to take over the supervision of more seriously mentally disturbed patients. I've created a 'Psychosis Symptom and Side Effect Checklist' which some may find useful. It is not intended as a diagnostic instrument, although it may be helpful as a recording tool during a structured psychiatric interview. Rather it is intended as an aid to monitor progress after diagnosis. Chris.
Fagerstrom Test for Nicotine Dependence
Created Nov 2013 ---- E-form (HTML only) version of Fagerstrom clincal tool to use for smoking cessation counselling. Attached as importable zip and as uploadable HTML file. Hope people might find it useful. Tested out fine on my system. Gunther
Brief Pain Inventory Dec 2013
Update 1 the BPI full version needed further updates as per discussion at the recent PSP train-the-trainer session. Namely, labels for Lt and Rt in the drawing section. Added radio button behaviour to the rest of the X-boxes too. It uses the same background. If you import, you’ll have to delete or archive (rename) the previous version. --- Original Post --- For those who’ve been part of the MSK PSP module, or even the in-progress chronic pain PSP development, the Brief Pain inventory seems to play a prominent role. I’ve posted a full version, with drawing feature, before. But I recently found a bug in one line. I’ve corrected this, and also created BPI-lite for follow-up visits. JohnY
Unified Parkinsons Disease Rating Scale
<!-- Unified Parkinsons Disease Rating Scale --> <!-- Dec 10,13 - Earl Wertheimer --> This is a pure HTML form, there is no attached image. PDF placed in folder for identification purposes only
eForms to generate MD subjective notes
From Leo Pavone: I was checking out the initial gyne e-form and was excited to see that it can drop info into the eChart and elsewhere. I have been experimenting with a related/similar idea in using eForms to generate MD subjective notes. However, I was leaning toward generating paragraphs based on selections (radio, checkbox, drawing on chart) and free text boxes. I'm not sure I have the background to develop this totally and would like to get others to improve it. I see these forms becoming a central pillar in making our clinic more efficient. That is, eForms would be developed for various reasons why a patient would want to see their MD (i.e., chest pain, headache, bleeding etc) and be designed such that most patients would be comfortable dealing with them directly, by keeping them simple. Then their answers (choices, free text) would be incorporated (and translated) into 'medic-speak' and compiled into full english paragraphs that would be incorporated into the eChart before the MD enters the room. At our clinic I envision setting up booths, equipped with PCs and telephone, whereby patients would be asked to answer questions on an eForm designed around their main complaint. Staff would also have remote access to the screens if patients had any questions. I also see this being available via the internet so that a patient can book an appointment from home and, having chosen the reason for the appointment, an appropriate eForm is presented. Although it is far from finished, I have attached files I have been using in developing an eForm on chest pain. The original general eForm was produced.... using 'bootstrap', css, jQuery and html and I am trying to develop the "Chest Paim" eForm. In this example, I am trying out different ideas on how to use radio, checkbox, free text boxes and seeing how the choices and answers could be manipulated to produce chart notes. Having no one to guide me, the plan was to simply produce an output in basic text that the MD could cut and paste into the notes...but now you lit a fire with your intake eForm. If you wish to check this out, simply download the files into a new directory, edit the html in an appropriate editor (I use Notepad++) and then Run the html in firefox. Do you know of anyone who would be interested in developing this further? Leo Pavone 416-265-2255
Pediatric History Taking
Forms used for improving pediatric intake, history taking and letter writing
American Urological Society Prostate Symptom Score Efrom
Link to American Urological Society Prostate Symptom Score Efrom created by Chris Sedegreen.
MVA First Visit
Provided by Chris Sedegreen February 2016
Diabetic Foot Exam
Created By John Yap January 30th 2016
Persistent Pain Assessment eForm
Provided by NERD BC - commissioned by Foothills Medical Clinic - Persistent Pain Assessment eForm - Adapted from Squire. P Documentation tool for persistent pain
Periodic Screening 2016 (Health Screening and Prevention)
This form is the result of a suggestion by Jel Coward: Hi all We serve some remote communities who have difficulty accessing health care. We want to try to improve empowerment and engagement by using a patient held record of preventive/screening health measures. We have put together the attached document that we feel is appropriate to our communities (open to suggestions/corrections :) What I would like is to OSCAR-ise this process somewhat - probably using an eForm - and using the Measurements where possible. So.....two questions/requests if I may please? Is there an existing equivalent resource? Would someone be able to write an eform that would print (readily) as a 1 pager, and that would populate measurements.
From Chris Sedegreen: The World Health Organization Disability Assessment Schedule second edition (WHODAS 2.0) is a useful tool to evaluate the extent of disability in persons over the age of 18, whose disability is arising from a mental health disorder. It can be found in section 3 of DSM V. To quote, > This approach is practical to use as a hand-scoring approach, and may be the method of choice in busy clinical settings or in paper–pencil interview situations. As a result, the simple sum of the scores of the items across all domains constitutes a statistic that is sufficient to describe the degree of functional limitations. The WHODAS 2.0 consists of a 36-item measure that is completed by the patient or, if severely disabled with severely impaired insight and communication challenges, may be completed by a proxy, such as a close relative who knows the patient well.
HINTS test for acute vertigo syndrome 2018
From Stanley Hurwitz: I was recently introduced to the HINTS test at the Family Medicine Update: The evidence -> 100% sensitivity and 96% specificity for central cause of AVS. More sensitive than early MRI for stroke. Watch the Video Demonstration I've added in an interpretive table to facilitate use in Oscar. This test is new to me, so for those of you familiar with test, please let me know if I've made any errors in the interpretation. Stan NB - this is a pure HTML form, so I have printed to pdf for a visual. JohnR.
SCAT-5 Concussion eForm
Symptom questionnaire validated for head-injured athletes over 18 html only. --- Created by Peter Hutten-Czapski
Annual History and Physical based on the Formedic form.
Created by Dr. Reza Montazeri
Modified Centor Score
Pharyngitis Risk Score - Modified Centor Score Updated for 2021
ECOG Performance Scale 2021
From Günther Klein: I've built another simple HTML-only E-form for the ECOG performance scale for cancer patients under treatment. The ECOG score seems to be favored by oncologists and palliative care docs over the old Palliative Performance Scale (PPS) these days. ECOG v2.1 (with measurements - click on measurement setup for guidance) and ECOG v3.1 (no measurements)
Lower Extremity Functional Score (LEFS) eForm
Created by Günther Klein. Used fairly regularly for referral to Joint Replacement Programs --- From Günther: I tweaked the CSS print media script to render a one page paper questionnaire for patients to fill out on a clipboard. Rearranged the questionnaire to make it less confusing for patients to understand (we are asking about "difficulty" but points are allocated per "level of function") --- v2 push-pulls "LEFS" from measurements, and has embedded measurement setup instructions. --- v3 has measurements disabled (commented out) for those that don't use measurements
eForm for Home Checks on CDM patients
2021-Apr-23 10:33 This eForm was created to be filled out when home checks are done on CDM patients that are not receiving homecare. It is meant to be used as a site risk assessment.
MTOQ-5 Migraine Treatment Optimization Questionnaire (acute therapy)
Created for Cam Ross: This is a validated tool to use patient-reported outcomes to identify: • Identify patients with an inadequate treatment response • Identify patients who require a change of their current acute treatment --- Suggested treatment optimization strategies:
Migraine Disability Assessment eForm
Updated 2021-May-15 16:25 - newer version retains the numbers when the eForm is re-opened. --- Created for Cam Ross: The MIDAS (Migraine Disability Assessment) questionnaire was put together to help measure the impact headaches have on a patient's life. The information is also helpful for primary care providers to determine the level of pain and disability caused by the headaches and to find the best treatment. The eForm calculates with a button and highlights the appropriate Grade, Definition, and Score. © Innovative Medical Research, 1997 © 2007, AstraZeneca Pharmaceuticals, LP. All Rights reserved.

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