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Forms for the Greater Toronto Area

GTA forms - Read More…

Scarborough Health Network

2020-Feb-28 08:09 Created at the suggestion of Leo Pavone for the Merged Hospital

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OHIP Patient enrolment and consent form

From Ian Pun: I also wrote an eForm that prints the patient info for the PATIENT ENROLMENT AND CONSENT TO RELEASE PERSONAL INFORMATION FORM for rostering patients . Saves time in having the patient fill it out themselves. They just need to sign. Email me if you want it. ---- Ian Pun----- and---- Here's the Patient Enrolment and Consent eForm html - just copy it into the eform code editor There is no background to this. OHIP wants original forms so you have to print on the original forms provided by them. Tear the original triplicate carbon copy Patient Enrolment form into the three separate sheets - white , yellow and pink. Put them in your manual feed of your laser printer. Print three copies. (no borders, no URL's etc), One for OHIP , one for your patient and one for your paper chart (or scanner). My Brother Laser HL5250 (I have 7) can take all sorts of this abuse. Other printers may rip the thin paper to shreds. Not perfect. I could not get the laser printer to print right at the bottom of the page where the phone numbers are. I didn't work on the child part one yet.

OHIP Patient enrolment and consent form - Read More…

Accessible Parking Permit

A two page form to fill to allow access to designated "handicapped" parking spots in Ontario

Accessible Parking Permit - Read More…

Do Not Ressusitate

Ontario DNR form. Caveat, you need to supply an unique serial number to the form (eg take one from a paper one and destroy the paper)

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Smoking Cessation Flowsheet

Helpful to document smoking cessation management and eligiblity to charge Ontario smoking cessation fee codes Q041A and Q042A Draws smoking status from the echart

Smoking Cessation Flowsheet - Read More…

4406 Nonformulary Exceptional Access Program (Section 8) 2009

Application for coverage under Ontario Drug Benefit for a "Section 8" type coverage for a non formulary drug,

4406 Nonformulary Exceptional Access Program (Section 8) 2009 - Read More…

Prenatal Public Health Labs

VDRL HIV Rubella and Hepatitis testing through Public Health in Ontario

Prenatal Public Health Labs - Read More…

Ontario Lab eForm

By Peter HC - Spurned by a change at the ministry of their lab forms last November. Comes with decision support ORDER SETS that gently alerts you to both overdue indicated investigations as well as those that have been done recently.

Ontario Lab eForm - Read More…

OBSP High Risk

Ontario Breast Screening Program Request for High Risk Screening 2011

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4768 CCAC Health Assessment Report 2010

5 page eForm required to bill K038 for application to nursing homes and long term care. Turns a tedious task into one which fills itself from the chart.

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Methadone Maintenance Ontario

From: Ron Phillipson ---I am including our add ons for Methadone maintenance. We have have added measurements for the urine drug screens and for the dosing and carry schedules. I have included the CPSO Methadone template for those who would like to use it. It is based on the gynecological intake form but may be interesting for other people to see what can be accomplished with scripting. I have included the Methadone Auto Hot Key script to insert HTML code into the prescription instructions. It will print correctly however it gets inserted into the toilet roll in pure html text It needs a file of pharmacies with the | pipe symbol between each line. This can be generated using the following query and using the first column. Cut and paste into Notepad and save as pharmacies.txt. --- Addendum --- Query for Pharmacies select Concat ("|",name,", ", address,", ", city,", ", province,", ", postalCode,", tel ", phone1,", fax ", fax) from pharmacyInfo group by ID order by name; I also forgot to let people know that to use the AutoHotKey script you type !met in the directions field. Ron

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KingMar Imaging Centre Requisition

Front and back pages were made on separate forms. Back is intructions and a map. No input required.

KingMar Imaging Centre Requisition - Read More…

Home Oxygen Ontario application

From Peter HC ======= - 4 page form - Over 128 Inputs - also works stand alone ( jquery-1.7.1.min.js required) - uses gender checkboxes - black box technique - free hand signature - auto stamp signature the auto stamp signatures are not included, please supply your own! ================ Peter Hutten-Czapski Haileybury Ontario

Home Oxygen Ontario application - Read More…

OCF-18 Feb 2014

An Ontario 5 pager for Automobile Accident Insurance Claim that has been massaged to keep under 64kb. Blackbox, date pickers, fax, pdf, signature stamp for the doctor and classic signature for capturing the patients signature.

OCF-18 Feb 2014 - Read More…

Fibroscan Referral Eform

From Ian Pun: --- I made a Eform to order fibroscan for you. . It's a useful test to check liver fibrosis and fatty liver, usually for patients with liver disease like hepatitis B , where we can institute intemediate anti-viral treatment if we find stage 2 fibrosis or greater. Examination with Fibroscan®, also called transient elastography, is a technique used to assess liver stiffness (measured in kPa correlated to fibrosis) without human body intrusion. The result is immediate, it shows the evolution of the liver health and allows physicians to diagnose and monitor disease evolution regardless of treatment or collateral factors. Exam result helps to anticipate various complications, as well as to monitor and assess the damages caused by diseases such as cirrhosis. Disclosure: I rent my office space out to Dr. Rob Myers , hepatologist, fibroscan machine and technician. Ian PUN MD

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Sleep Study Requisition for Sleep Disorders GTA 2015

Provided by Ian Pun: Sleep Study Req for Toronto area sleep labs for patients with sleep apnea investigation.

Sleep Study Requisition for Sleep Disorders GTA 2015 - Read More…

Toronto Sleep Study Requisition 2015

Provided by Ian Pun: Sleep Study Req for Toronto area sleep labs for patients with sleep apnea investigation.

Toronto Sleep Study Requisition 2015 - Read More…

Digestive Health Referral eform

Digestive Health Referral eform provided by Sara Bond and KAI Innovations. Commissioned by the Digestive Health Clinic (Gastroenterology and hepatology). I have tweaked it slightly (added x-boxes, an html link, and compressed the image file size further without loss of resolution). JohnR.

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Health Link Coordinated Care Plan

May 14th update - there is a menu beside page 2 at the bottom to fill in the responses for "suggested by". This will replace the drop down lists that did not word wrap. For use in Ontario - Originally Requested by Paul Brookbanks. As of May 14th it is ready for use with a caveat : I am still looking for the right code for a drop down list that has to word wrap over several lines. As such, there are 3 inputs (bottom of page 2, top of page 3) that need some work. Apart from this it should be fully functional. I have placed it on the beta testing side, and would appreciate feedback - especially as it relates to whether the drop down list selection is retained on your server (after you submit it, when you open it up again, are the selections retained). I am also interested in help to hammer out the details for the "word wrap in select" issue that I have identified. JohnR.

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Ontario Oxygen Application

From Peter Hutten-Czapski - With all the bells and whistles including the new radio checkboxes Xboxes Stamp signatures Free form signatures date calendars etc Made with Generator 5.5d

Ontario Oxygen Application - Read More…

Trillium Prenatal Screening Requisition 2017

Created by Peter Hutten-Czapski (EFTS) Credit Valley Hospital Mississauga Ontario

Trillium Prenatal Screening Requisition 2017 - Read More…

Dynecare Hystology

July 30th 2017 - Form provided by Leo Pavone

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The Prenatal/Postnatal resources sourced from the Ontario Prenatal Forms 2017

Calculators for PHQ2 GAD2 T-ACE and the Edinburgh and norms and recommendations for weight gain taken from the 4th page of the Ontario Prenatal form released this July

The Prenatal/Postnatal resources sourced from the Ontario Prenatal Forms 2017 - Read More…

AIM Centre for pain management 2017

Provided by Leo Pavone - Central intake form for Toronto, Mississauga, Brampton, Scarborough, Oakville, Oshawa, London, Ottawa, Hamilton.

AIM Centre for pain management 2017 - Read More…

LifeLabs Cytology and HPV Testing Ontario

This eform was commissioned by LifeLabs for Ontario OSCAR installations only: Description:**For OSCAR Ontario only. Key words :Cytology and HPV Testing, Requistion, LifeLabs

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VitalAire ON Respiratory Care 2019

A referral form to refer an Ontario patient to VitalAire for home oxygen therapy. Key words:VitalAire, Air Liquide, Respiratory, Home oxygen, Oxygen, O2 therapy, O2

VitalAire ON Respiratory Care 2019 - Read More…

MOT medical condition reporting form (2018)

Created by Peter Hutten-Czapski - For Ontario Ministry of Transport reporting of Medical conditions.

MOT medical condition reporting form (2018) - Read More…

QHC Imaging Requisition

Update January 20th 2014 - Many further tweaks made to this form. X-box architecture added. Background heavily photoshopped. It’s still not great, but will have to do. I struggled with the finger/toes field. The form is enlarged slightly - stretched out to 850px width, and it’s still too crammed. It does not have a quick-pick menu as many of the BC imaging forms do. I’ve added the patient info (back) page as a linked eForm, with some colour to brighten your day! JohnY --- Imaging requisition for Belleville, Picton, Trenton, and Bancroft. Originally supplied by Donato Gugliotta, subsequently modified by Gunther Klein. From Gunther: I've attached the tweaked version of the eForm (Attached as zip file, and the fixed markup also as html and txt). It prints and submits properly for me now. Please check if it also works on your system. I couldn't resist tweaking your form a little more: - Made the weight and height fields auto-populate from your Measurements database - Cursor defaults into the history field on loading - Nudged the fields and textboxes around a little to straighten and make the text fit nicely.

QHC Imaging Requisition - Read More…

Colonoscopy (FIT +) referral Oakville Ontario 2019

Provided by Gyula Voros. Referral eForm for FIT positive patients to receive a Colonoscopy through Halton Healthcare in Oakville Ontario.

Colonoscopy (FIT +) referral Oakville Ontario 2019 - Read More…

Wharton Medical Clinic Weight and Diabetes Management

provided by Dr. Gyula Voros, referral eForm to the Wharton Medical Clinic for Weight and Diabetes Management .

Wharton Medical Clinic Weight and Diabetes Management - Read More…

Oakville Cardiologists Referral eForm

Referral eForm for the Oakville Cardiologists provided by Dr. Gyula Voros

Oakville Cardiologists Referral eForm - Read More…

Humber Valley Imaging

Created by S Nakawala at Humber Valley Imaging and posted as her request. Zip file upgraded only to allow for Oscar Import. Direct any concerns to Ms. Nakawala.

Humber Valley Imaging - Read More…

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