Jim Pattison Outpatient Care and Surgery Centre – The Oscar Galaxy

JPOSC Endometriosis and Pelvic Pain Clinic 2025

John Robertson — Thu, 17 Jul 2025 15:11:03 +0000

Created at the request of the Chilliwack Division of Family Practice and Cedar Family Practice. Referral form for the JPOSC Endometriosis and Pelvic Pain Clinic in Surrey. There is a link to a Patient Questionnaire that is required with the referral. This link points to a PDF on Pathways BC.

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

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 Health Authority Reproductive Mental Health Referral

John Yap — Thu, 11 Apr 2024 06:53:56 +0000

How to import an eform that is in a zip file

This original form was created by Jan Nusche with some additions by John Robertson – found here.

The fax number has changed. I have written a line to overwrite the old number with the new one. 2020-Sep-08 15:54.

The latest version has cosmetic improvements and signatures stamp, with fax copy.

FHA Colposcopy

John Yap — Sat, 03 Jun 2023 15:24:05 +0000

This eFORM has Jim Pattison and Langley Memorial Hospital sites referenced. Royal Columbian Hospital site decided to have their own unique eFORM.

JPOCSC Medical DayCare referral for iron infusion or Phlebotomy

John Yap — Mon, 22 May 2023 15:41:47 +0000

This is an updated version of the coversheet and MDC request specific to the Jim Pattison site. The changes are VERY minor compared to the 2015 background. In addition, there is no place to add details for your iron infusion instructions. That requires another eFORM, called “FHA Parenteral Iron PPO”.

FHA Jim Pattison Breast Health Clinic eFORM

John Yap — Sat, 28 Jan 2023 14:46:08 +0000

This clinic, in Surrey, fast-tracks the work-up of patients with suspected breast cancer. This eFORM is NOT for routine or screening mammography.

FH Cardiac Rehabilitation Referral 2021

John Robertson — Tue, 27 Dec 2022 00:15:23 +0000

Created at the request of the Chilliwack Division of Family Practice. Referral to one of 4 Centres for Cardiac Rehabilitation in Fraser Health. The second page is available as a printout, but is also in the side menu in accordion format. The Fax numbers in the side menu can be copied if clicked on.

V2_Nov23_2023 has formatting upgrades. Thanks JohnR for the great side menu.

MFM Referral Fraser Health, Provincial Health, Jim Pattison, Royal Columbian

John Robertson — Sat, 17 Jul 2021 21:53:43 +0000

Updated 2021-Jul-17 14:50. Still based on the image from 2012 – However, the following updated have been added: Fixed signature running on to second page, updated signature code, removed print and submit as per recommendations, rounded the circling function, added links to other parts of the chart, and updated required fields.

POST-COVID-19 INTERDISCIPLINARY CLINICAL CARE NETWORK REFERRAL 2022

John Robertson — Fri, 29 Jan 2021 20:56:41 +0000

Updated 2021-Feb-10 06:30 Now only pops up if you are less than 3 months out from symptoms, AND automatically sets a postdated tickler for 3 months from onset of symptoms. Updated 2021-Feb-04 13:06. Now calculates the 3 months required after symptoms before a referral can be made. This is labelled as a Fraser Health form, but also has information for St. Paul’s Hospital and VGH. I debated creating a 2 page form, but went with a 1 page form and a link to the second page. Also contains links to the race app and an email link. JohnR.

Version 4b is the manual option where a button appears after filling in the first symptoms date, and you can click on it if you wish to create a tickler for 3 months after first symptoms. Updated 2021-Feb-15 12:58 with a red border around the tickler button.

V5_Aug5_2022 has the new update and criteria for 2022. The clinic is now called the Post-COVID 19 Interdisciplinary Clinical Care Network (PC-ICCN). The associated eFORMS are Lower Mainland-centric. Adjust accordingly for your Health Authority.

Note that referrals are not accepted until 90 days post-onset of symptoms. The first day of symptom is day zero.

Neurology Outpatient Referral Form for JPOCSC June 2020

John Robertson — Fri, 25 Dec 2020 02:48:40 +0000

2025/04/22/ 15:07 The “Surrey Headache Tool” website appears to have been pirated. The link has been removed.

2020-Dec-24 18:41 Created for Sardis Family Practice when they found out the form they were using was no longer accepted. 2 versions – a version with “Electronically Signed” in the signature area, and a version that will pull a signature image if you have one stored. You will need to tweak the code for the stored signature.