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eForms in development/beta testing

These eForms are not intended for general download and use. This area is for the uploading of test/development versions. When developers are happy with an eForm it will be moved to the general 'eForms for download' area.
Useful Code
Code that enhances the OSCAR user's experience. This started out as a collection of various types of files with code that could be inserted into new eforms to improve/enhance their performance. It has now expanded to include code that can be added to enhance the way OSCAR works in Firefox (Greasemonkey scripts), and other code/pdfs/forms that can be added on to OSCAR, or used by the office to improve work flow.
Two Page Letter with buttons.
A two page letter with buttons to fill some of the basic measurements etc. Possibly useful for consults or Medical Legal Letters.
Fifteen Page letter with Buttons
I was asked to make a 15 page letter with buttons for someone who does long Medical Legal letters. The first five pages have buttons to draw many of the parts of the demographic and measurements. There are also some buttons with canned text and a button to print out a CV. Uses the blank page as the image. JohnR
Ontario eforms for sorting
For review and potential posting by interested Ontario users.
Diagnostic Tools
From David Chan: (this) attachment is a tool to create diagnostic pathway for a number of conditions based on likelihood ratios (mostly from the JAMA Rational Clinical Examination series). You can unzip the file and run the file called conditionIndex.html. I am hoping to turn this into another App for MyDrugRef (soon to be renamed to Know2Act or K2A). Send me your feedback, or better still, add to the list of conditions!! Have fun with it. It's a great teaching tool for my EBM seminars. David David H Chan, MD, CCFP, MSc, FCFP Professor and Director of Information Technology Department of Family Medicine
MoCA 2014
Update September 2014 --- Not sure how the Oscar community will accept this info - but the “powers that be” at Center for Dx and Research on Alzheimer’s disease (CEDRA) who own the copyright to the MoCA dementia assessment tool, do not want any publication of an “autocalculating” version of that test - which basically means we cannot use an EMR-version, and are forced to use a paper version. As such, it becomes basically useless for us. Apparently they are developing their own “electronic” version of the tool, which is not likely to integrate with any EMR. I tried to point this out to the contact person, but I don’t think she understands that what I’ve developed is for “all” to share, even them! I would like to communicate directly with the physician lead, and he has been cc’d, but nothing so far. So - I think we’ll have to remove it from OCUS, and put in the statement from CEDRA, dated Aug27/14. Hello John, Unfortunately we do not authorize the development of programs that auto-calculate the MoCA© as we are developing such a tool. Kind regards, Kathleen Gallant, MSOT Occupational Therapist/Psychometrician On behalf of Dr Ziad Nasreddine, Neurologist, MoCA© Copyright Owner CEDRA: Center for Diagnosis and Research on Alzheimer's disease 4896 Taschereau Blvd, suite 250, Greenfield Park, J4V 2J2, Québec, Canada Tel: 450-672-1931 ext: 285 Fax: 450-672-1443 MoCA form updated by John Yap --- adapted the push/pull/non-measurement features from EOL into the MoCA.
MedSleepBC referral form 2017
Updated February 6th - removed unnecessary box. OSCARWest has updated the MedSleep referral form with new addresses.
Chilliwack Primary Care Clinic Referral Form 2017
Updated March 11th - Fax number corrected. *** Updated February 10th 2017 - both html and image corrected for spelling errors. Delete January 2017 versions of both html and image and replace with February 2017 version (zip).
Heartwood Referral Forms 2017
The creation of these forms was requested by The Division of Family Practice in Chilliwack. The Heartwood centre is a residential treatment program, a provincial tertiary 28 bed resource for women with substance dependence, mental health concerns (including trauma) and primary health and/or chronic disease issues. The referral form package consists of 18 pages. Pages 8-13 comprise the main referral form. This has been made in to a 6 page eform. There are several handouts that have been adapted to be opened as pdf's as per Darius Opensource's code. The links to these appear as (non printing) buttons across the first page below the client's name. There are also (non printing) buttons to the right of the first page of the form that allow you to jump to 3 other eforms - the funding information form, the early exit form, and the participation agreement form. The main form also has a link to the web page for the program. All eforms should be imported to the server. Please do not alter the names of the eforms as this will break the link to opening them from the main referral eform. JohnR.
Referral From Community to the ER Fraser Health
From JohnY - for transfer of community patients to ER. This has a “bar code” which means the info is actually uploaded to the patient’s hospital chart for future reference. Comments welcome.
Transfer from Residential care to ER Fraser North 2017
From JohnY - for transfer of residential care patients to ER. Please note which sections are for GP and which are for ER doc.
Eform Generator V 6
Updated March 30th - jquery fixes. Updated March 27th - correction to allow for transparent underline in signature script. Updated March 21st - correction of Radio X boxes code. Updated to 6h - which is g plus some elementary validation so that you are prevented from putting in names that have blanks in them --- Updated to 6g March 12th - changes include - Xbox child parent support - a serious attempt to prevent extra pages on print - including fixing the location of the subject line - and making the background setting sticky only within a given input - and setting the default background for Xboxes to white - which solves a lot of formatting issues with pdfs and faxes ----- And cleaned up the generator output to only conditionally load boilerplate - (and we have a lot of it) - removing empty attributes for items - and tidy ed the generated formatting so its a bit easier to follow - and removing ancient CSS that really doesn't work in Firefox ---- all in - shrinking a minimal two page eform to about 100 lines and 4k while increasing the eform generator by a similar amount to 134k in this version ------ Updated to 6e March 11th. Now has less "boiler plate" - From Peter - Here is e - I have dropped the lot of the scrollbar CSS for both the eform generator and generated eforms we don't support IE anymore as its not supported in Firefox anyway and its support in Chrome requires a -webkit- pseudoproperty prefix (The generated bit is commented out at this point in the eform generator so its easy to revert if necessary) ----- The boilerplate has been adapted, The .sig CSS is now conditional on having a jSignature sig class , The checkbox radio and parent child jquery doesn't get put in unless - 1. The date calendar option is checked - AND - 2. There is a "date" or "day" in the name of the text box (today_rx and dob_day excepted) --- That's all I have done yet which gets an "empty form" to 114 lines - I still need to add logic to take out the jquery reference if you are not Xboxing jSignature pdf or faxing --- Updated to 6b March 5th. Now has Radio X boxes and a transparent underline for the signature script. Updated Feb 22nd pm - 5.5d (not sure what happened to c) - more bug fixes AND this has the fax number prefiled for OSCAR fax (if enabled) --- Updated Feb 22nd am - 5.5b which fixes a bug that prevented adjusting textbox locations (introduced in a) --- Updated Feb 21st 2017 - 5.5a Its 5.4 with some of that series bugs ironed out (stamps, divisions a few other niggles) AND it has radio checkboxes and parent child checkboxes both front and back ends lightly debugged --- From Peter HC - Feb 20th 2017 - New in 5.5 automatically sets the default Xbox to a white background (transparent is still available) Checkboxes gain Optional radio button functionality (including yes no) and also for parent child functionality where the parent needs checking to allow for parent checkboxes to be available Its hard to explain easier to try the attached test.html just check each of the check boxes in turn to test it should be self explanatory and if anyone has some eforms that they are willing to test it on, bugs reports are welcome
Kelowna Cardiology Associates Holter Monitor Requisition 2017
Created by Mukaila (muki) Olundegun - This e-form is from Kelowna Cardiology Associates. They want to make it available to all oscar users.
Special Authority Cholinesterase Inhibitor (CI) DONEPEZIL, GALANTAMINE AND RIVASTIGMINE February 2017
Replaces 2015 version - From JohnY - The new Cholinesterase inhibitor Special Authority form replaces the initial, switching, and renewal eForms! All 3 of the CI eForms were referenced in the general Special Authority eForm. So that one had to be updated too
Special Authority Generic Form February 2017
Updated because of Changes to the Cholinesterase Inhibitor forms.
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
Nanaimo Disability Resource Centre Parking permit application 2017
Form Updated by NERD BC - commissioned by the Sayward Primary Health Clinic.
Pacific Sleep Care 2017
NERD BC has provided the following forms: Pacific Sleep Care eForms for the Courtenay, Duncan and Nanaimo locations to share with the OSCAR community. They have been commissioned by Simone at Pacific Sleep Care.
Western Health Interventional Radiology Abdominal Aortic Aneurysm eForm
Created By NERD BC - WH IR Abdominal Aortic Aneurysm eForm, which was commissioned by Dr. Birender Wadhwa.
Bounce Back Referral 2017
March 8th 2017 - updated by John Yap - I tweaked the form a bit. Found the fields were a bit too high when running on Mac. Is it the same when displaying on PC? Plus - decided to add link to PHQ-9 eForm. This eform (and many others for adult mental health) requires creation of measurements such as PHQ9, GAD7, etc. JohnY *** Created at the request of Sophy Zhang MPH - Program Administrative Coordinator - CMHA BC - Canadian Mental Health Association, BC Division. This form has been updated for the inclusion of youth 15 years and older. I have incorporated the recent jquery to create radio buttons from X boxes. JohnR.
Preoperative Medication Prescription
Designed By Petrus Retief at Chilliwack General Hospital as a guide for surgeons to use when deciding how to deal with patient's medications prior to surgery. Converted to an eform by me (JohnR). First form posted that uses *** $("#CanvasSignature1").jSignature({'decor-color':'rgba(255, 255, 255, 0)'}) *** The 0 is what makes the signature line transparent.
Rheumatoid Assessment Tool update 2017
From David Page - I have made some updates to the rheumatoid assessment tool- cleaner interface, labs come in through lab engine, links to rheuminfo, better handling of non numeric results (eg ‘<10’) *** If you have a previous version delete it first. *** I have not included the methotrexate link as it is still a WIP. Instructions for updating measurements included.
CRA form T2201 Tax credit for Disabilities
Created by Peter Hutten-Czapski with help from Chris Sedergreen. This is a 5 page form for application for tax credits for persons with disabilities.
Richmond Cardiology Referral Form
Created by NERD BC for the SWF Medical Clinic (Dr M Frankel Medical Corporation)
Vancouver Coastal Health / Providence Nutritional Counselling Clinic Referral
Created by NERD BC for the SWF Medical Clinic (Dr M Frankel Medical Corporation)
Richmond Diabetes Education Centre Referral 2017
Created by NERD BC for the SWF Medical Clinic (Dr M Frankel Medical Corporation)
Richmond Early Childhood Mental Health Program
Created by NERD BC for the SWF Medical Clinic (Dr M Frankel Medical Corporation)
Richmond Childhood Public Health Services Referral
Created by NERD BC for the SWF Medical Clinic (Dr M Frankel Medical Corporation)
Trillium Prenatal Screening Requisition 2017
Created by Peter Hutten-Czapski (EFTS) Credit Valley Hospital Mississauga Ontario
Panorama MoH funded (Ontario) form 2016
Created by Peter Hutten-Czapski - Panorama MoH funded (Ontario) form - "Aug 2016 two pager kazillion signatures"
Adult Community Mental Health and Substance Use Referral Form 2017
Created by OSCARWest For the Vancouver Coastal Health central intake ( HOPE program )
BC Inherited Arrhythmia Program referral form 2017
Created using the eForm generator version 6d
South Fraser Cardiology form
Created 08 Mar 2017 by Dr. K Phan using E-From Generator v5.5 by Dr P Hutten-Czapski/S Lee
BC Palliative Care Benefits Registration March 2017
The form has been updated to conform with the latest requisition. It has the SPICT tool to help with filling out the form. It has links to the various government web sites. Built on the 2015 version - Updated November 17th 2015 - signatures improved, button for MD Decision Maker. --- Created using the latest eform generator. Has signature fields, x boxes, links to outside web pages, and a side menu that allows for insertion of the necessary diagnoses. There is a link to the original 3 page fillable pdf so that the instructions can be reviewed. JohnR.
Surrey Memorial Hospital Anesthesia Consult 2017
Created by Jan Nusche with some additions by myself (JohnR).
BCWH Recurrent Pregnancy Loss Clinic 2017
Created by JohnY with Collaboration from Herb C and Khai P, Limitations: Women who have had either 2 consecutive miscarriages greater than 6 weeks gestational age, or a single miscarriage greater than 10 weeks gestational age are eligible for referral to the clinic. Physicians who see patients at 4500 Oak Street, Vancouver - Dena Bloomenthal - MSP #26460 - Obstetrics and Gynecology - Nicole Racette - MSP #07457 - Obstetrics and Gynecology - Stephanie Fisher - MSP #28132 - Obstetrics and Gynecology
BCWH Early Pregnancy Assessment Clinic
Created by JohnY with collaboration from Herb C and Khai P - For Threatened abortions, known SA etc
Jim Pattison Lipid Clinic 2017
Created by John Yap
KARP Active Rehab Referral Form
Created by NERD BC - “Referral form for Karp Active Rehabilitation Programs. Attached you will find HTML and PNG files of the referral form for an easy paperless system. There are check box options for reason of referral and easy to fill boxes for doctor and patient information. This is the 2017 Update of the Karp Rehab Referral Form”
KARP Active Rehab and Physio Referral Form
Created by NERD BC - “Referral form for Karp Active Rehab, Physiotherapy and Occupational Therapy services. Attached you will find HTML and PNG files of the referral form for an easy paperless system. There are check box options for reason of referral and easy to fill boxes for doctor and patient information. This is the 2017 Update of the Karp Rehab Referral Form”
Richmond Child and Youth Mental Health Referral Form
created by NERD BC and commissioned by SWF Medical Clinic (Dr M Frankel Medical Corporation.)
Richmond Home and Community Care referral form 2017
created by NERD BC and commissioned by SWF Medical Clinic (Dr M Frankel Medical Corporation.)
Vancouver Coastal Health Mental Health Intake Form 2017
Update March 17th - added David Page's code to increase and decrease font size. Created at the request of Khai Phan
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.
Mt St. Josephs Breast Imaging Request for Consultation March 2017
As Requested by Herb Chang. This form has drawing code and signature code. PLEASE NOTE: If you do not sign this form (even if you decide to use "Electronically Signed") then it will not re-load properly. I have therefore made a warning that shows up on load. This form is based mostly on the code from JohnY's Standard Outpatient Breast Imaging Form. JohnR.
VIHA_Atrial Fibrillation Clinic
Created by NERD BC, Commissioned by Urgent Medical Assessment Clinic Victoria.
VIHA_Bone Marrow Biopsy
Created by NERD BC, Commissioned by Urgent Medical Assessment Clinic Victoria.
VIHA_Adult IV Iron therapy 2017
Edited by John Yap - I think VIHA users may find the tidbits from the FHA Iron infusion form helpful - i.e. autopopulation of Hgb, Ferritin, and TSAT. You may need to ensure these results are properly mapped to your measurements to be fully functional. Created by Nerd BC, commissioned by Urgent Medical Assessment Clinic Victoria.
Child and Youth Mental Health Supporting documents for Intake
Created by NERD BC
MedPro Respiratory - Thompson / Okanagan 2017
Created by NERD BC and Commissioned by George Louvros, MedPro Respiratory Care.
MedPro Respiratory - Vancouver / Lower Mainland 2017
Created by NERD BC and Commissioned by George Louvros, MedPro Respiratory Care.
MedPro Respiratory - Vancouver Island 2017
Created by NERD BC and Commissioned by George Louvros, MedPro Respiratory Care.
FHA Imaging Requisition March 28 2017
Created by John Yap: FHA has decided the old imaging req needed to be updated. The latest (2016) background has only 1 obvious change: the priority levels are listed as P1, P2, P3, and P4 now. The old one only had 1, 2, 3 and 4. There is a 2nd page pt info eForm which provides pt instructions. JohnY
Fraser Health Diabetes and Pregnancy Clinic Referral 2017
New Referral form March 2017 Created by Dina Ryan Davidson with modifications by John Yap and John Robertson.
Salt Spring Island Community Services Confidential Child and Youth Referral 2016
This form was created by NERD BC and commissioned by Kings Lane Medical Clinic on Salt Spring Island
KARP Foot Care Referral Form 2017
Karp Foot Care Referral: Referral form for Karp Foot Care, in home service for seniors. This is the 2017 Update of the Karp Foot Care Referral Form - Created by NERD BC and commissioned by Karp Home Care
KARP Home Care Referral 2017
Karp Home Care Services Referral: Referral form for Karp Homecare and nursing services. There are check box options for reason of referral and easy to fill boxes for doctor and patient information. This is the 2017 Update of the Karp Homecare Referral Form - Created by NERD BC and commissioned by Karp Home Care.
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
FHA Parenteral Antibiotics PPO 2017
Updated Version of FHA Parenteral Antibiotics with improved background created by JohnY now with link to restricted antibiotic PPO.

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