Created by Dr. Ian Bekker. Referral form for the VIHA Urgent Medical Assessment Clinic run by Vancouver Island Health Authority. I have made some modifications: radio X-boxes, increase or decrease font size in textareas, auto-fill reason from check boxes, added placeholders, added Calendar, added links to other parts of the chart, added email link (look at the bottom of the page).
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VIHA_Urgent_Medical_Assessment_Clinic_Referral_2020.zip | Download |