Kipp Eye Clinic Referral eForm

Created for Dr. A Dhillon OD. Referral to the Eye clinic on Kipp in Chilliwack (BC).
Open Source Clinical Applications and Resources
Open Source Clinical Applications and Resources
Created for Dr. A Dhillon OD. Referral to the Eye clinic on Kipp in Chilliwack (BC).
For referrals to the Emergency Department at Chilliwack General Hospital. Created at the request of Cheam Medical Centre.
2021-Jan-30 12:08 “Updated” back to version 3 as per the official version from CGH. Now uses the Fraser health background.Updated 2020-Dec-17 08:04 Referral date added to the top of the form. Updated 2020-Nov-28 07:32 created an input for days as…
Created 2020-Jul-16 15:27
Created for the Chilliwack Obstetrics group for general communications. This form is mostly HTML with a basic header and a Logo. JohnR.
Created for the Chilliwack Obstetrics group when they are returning their post partum patients back to their regular primary care providers. Has a drop down list that accepts freehand inputs. This form is mostly HTML with a basic header and…
Updated 2020-Jul-02 22:06 corrected mistake that did not allow retention of the “circles” around inputs when form was re-opened. Changed class=”noborder” to class=circle_box” for those inputs. Made for the Chilliwack Midwifery group – to record post partum visits – Baby’s…
Updated 2020-Jul-02 22:05 corrected mistake that did not allow retention of the “circles” around inputs when form was re-opened. Changed class=”noborder” to class=circle_box” for those inputs. Made for the Chilliwack Midwifery group – to record post partum visits – Mom’s…
updated 2022 – increase/decrease font size for History. Updated some of the code. 2020-Sep-17 11:21 Updated with new Fax number . 2019-Nov-29 14:25 Added LNMP as a REQUIRED field. 2019-Oct-31 08:37 – Updated – there are now 4 buttons –…
For referral to the Canadian Back Institute in Chilliwack for Male and Female complaints related to pelvic health.