pain – The Oscar Galaxy

FH Regional Pain Self Management

John Robertson — Thu, 07 May 2026 16:03:20 +0000

Referral to the Regional Community Pain Self Management Program. Created by the Chilliwack Division of Family Practice.

JPOCSC Chronic Pain Clinic

John Robertson — Sun, 21 Jul 2024 17:59:24 +0000

This eForm was created at the request of Sardis Family Practice and the Chilliwack Division of Family Practice. It is a referral form to The Jimmy Pattison Outpatient Care and Surgery Centre – Chronic Pain Clinic. The first two pages are for the Physician to fill. The last 2 pages are for the patient to fill. Because of peculiarities about the drawing code, the order of the first 2 pages is reversed (if anyone knows how to modify the drawing code to draw on subsequent pages in a multi page eForm I would be interested to learn). In the patient forms there are questions about the GAD7, PHQ9, TSK, and PCS questionnaires. All but the PCS are linked in the form.

This eForm is protected by the GNU General Public License version 2 (GPLv2)

Fraser Valley Pain Management Clinic Referral 2024

John Robertson — Sat, 06 Jul 2024 20:23:55 +0000

Referral to Dr. Breden at the Fraser Valley Pain Management Clinic. Created at the request of the Kipp Health Clinic and the Chilliwack Division of Family Practice.

This eForm is protected by the GNU General Public License version 2 (GPLv2)

Kipp Pain Clinic Chilliwack 2023

John Robertson — Sun, 22 Jan 2023 15:55:37 +0000

This eForm was created at the request of the Chilliwack Division of Family Practice. For referral to the Kipp Pain clinic. This eForm is protected by a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) Licence.
Under the following terms:

Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.

NonCommercial — You may not use the material for commercial purposes.

NoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.

No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.