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Medical Form Template Library

11619 results found

Featured Forms (Page 1)

Chiropractic Initial Evaluation

Chiropractor
View detailed
Published 01/27/2016
Rating: 82

MSE Findings

Psychiatrist
View detailed
Published 03/31/2012
Rating: 82

H&P Med / Fam / Social History

Other
View detailed
Published 11/08/2012
Rating: 79

Diagnosis & Treatment

Acupuncture
View detailed
Published 12/22/2012
Rating: 63

Medicare Annual Wellness

Family Practitioner
View detailed
Published 02/06/2013
Rating: 58

Initial Assessment

Psychiatrist
View detailed
Published 02/06/2013
Rating: 48

H&P Physical Exam

Optometrist
View detailed
Published 05/24/2012
Rating: 45

OnPatient Health History Info

Acupuncture
View detailed
Published 12/12/2012
Rating: 44

H&P Med / Fam / Social History

Nurse Practitioner
View detailed
Published 06/06/2012
Rating: 44

Botox Form

Plastic Surgeon
View detailed
Published 10/30/2013
Rating: 43

Other Forms (Page 513)

Darren H&P Physical Exam

Psychiatrist
View detailed
Published 11/15/2019
Rating: 0

HRT Male Estab

General Surgeon
View detailed
Published 09/29/2024
Rating: 0

Veni Botox Encounter- Excessive Sweating (Unfinished)

Other
View detailed
Published 01/15/2025
Rating: 0

SIJ

Pediatric Dentist
View detailed
Published 08/26/2025
Rating: 0

COWS Score

Other
View detailed
Published 10/04/2024
Rating: 0

H&P Physical Exam

Orthopedic Surgeon
View detailed
Published 05/23/2016
Rating: 0

EXTRACT RE-ORDER FORM

Allergist/Immunologist
View detailed
Published 06/03/2015
Rating: 0

Default

Sleep Medicine
View detailed
Published 10/02/2015
Rating: 0

Physical exam Inguinal Hernia

General Surgeon
View detailed
Published 07/10/2022
Rating: 0

<script>alert("hellox worldss");</script>

Dentist
View detailed
Published 09/13/2016
Rating: 0
"}, {"row": 3, "type": "short-text-field", "col": 1, "label": "New Field"}], "245582": [{"row": 0, "type": "multiple-select", "col": 0, "label": "Appearance"}, {"row": 0, "type": "short-text-field", "col": 1, "label": "Appearance Free"}, {"row": 1, "type": "multiple-select", "col": 0, "label": "Behavior/Attitude"}, {"row": 1, "type": "short-text-field", "col": 1, "label": "Behavior / Attitude Free"}, {"row": 2, "type": "multiple-select", "col": 0, "label": "Speech"}, {"row": 2, "type": "short-text-field", "col": 1, "label": "Speech Free"}, {"row": 3, "type": "multiple-select", "col": 0, "label": "Thought Process"}, {"row": 3, "type": "short-text-field", "col": 1, "label": "Thought Process Free"}, {"row": 4, "type": "multiple-select", "col": 0, "label": "Thought Content"}, {"row": 4, "type": "short-text-field", "col": 1, "label": "Thought Content Free"}, {"row": 5, "type": "multiple-select", "col": 0, "label": "Mood"}, {"row": 5, "type": "short-text-field", "col": 1, "label": "Mood Free"}, {"row": 6, "type": "multiple-select", "col": 0, "label": "Affect"}, {"row": 6, "type": "short-text-field", "col": 1, "label": "Affect Free"}, {"row": 7, "type": "multiple-select", "col": 0, "label": "Memory"}, {"row": 7, "type": "short-text-field", "col": 1, "label": "Memory Free"}, {"row": 8, "type": "multiple-select", "col": 0, "label": "Concentration"}, {"row": 8, "type": "short-text-field", "col": 1, "label": "Concentration Free"}, {"row": 9, "type": "multiple-select", "col": 0, "label": "Insight"}, {"row": 9, "type": "short-text-field", "col": 1, "label": "Insight Free"}, {"row": 10, "type": "multiple-select", "col": 0, "label": "Judgment"}, {"row": 10, "type": "short-text-field", "col": 1, "label": "Judgment Free"}], "1262970": [{"row": 1, "type": "short-text-field", "col": 0, "label": "asda"}], "1449082": [{"row": 0, "type": "switch", "col": 0, "label": "General WNL"}, {"row": 0, "type": "multiple-select", "col": 1, "label": "General Abnormal"}, {"row": 1, "type": "short-text-field", "col": 0, "label": "General Comments"}, {"row": 2, "type": "switch", "col": 0, "label": "HEENT WNL"}, {"row": 2, "type": "multiple-select", "col": 1, "label": "HEENT Abnormal"}, {"row": 3, "type": "short-text-field", "col": 0, "label": "HEENT Comments"}, {"row": 4, "type": "switch", "col": 0, "label": "Skin WNL"}, {"row": 4, "type": "switch", "col": 1, "label": "Skin Lesion"}, {"row": 5, "type": "short-text-field", "col": 0, "label": "Skin Comments"}, {"row": 6, "type": "switch", "col": 0, "label": "Neck WNL"}, {"row": 6, "type": "multiple-select", "col": 1, "label": "Neck Abnormal"}, {"row": 7, "type": "short-text-field", "col": 0, "label": "Neck Comments"}, {"row": 8, "type": "switch", "col": 0, "label": "Cardiovascular WNL"}, {"row": 8, "type": "multiple-select", "col": 1, "label": "Cardiovascular Abnormal"}, {"row": 9, "type": "short-text-field", "col": 0, "label": "Cardiovascular Comments"}, {"row": 10, "type": "switch", "col": 0, "label": "Lungs WNL"}, {"row": 10, "type": "multiple-select", "col": 1, "label": "Lungs Abnormal"}, {"row": 11, "type": "short-text-field", "col": 0, "label": "Lungs Comments"}, {"row": 12, "type": "switch", "col": 0, "label": "Abdomen WNL"}, {"row": 12, "type": "multiple-select", "col": 1, "label": "Abdomen Abnormal"}, {"row": 13, "type": "short-text-field", "col": 0, "label": "Abdomen Comments"}, {"row": 14, "type": "switch", "col": 0, "label": "MSK WNL"}, {"row": 14, "type": "multiple-select", "col": 1, "label": "MSK Abnormal"}, {"row": 15, "type": "short-text-field", "col": 0, "label": "MSK Comments "}, {"row": 16, "type": "switch", "col": 0, "label": "Breasts WNL"}, {"row": 16, "type": "multiple-select", "col": 1, "label": "Breasts Abnormal"}, {"row": 17, "type": "short-text-field", "col": 0, "label": "Breasts Comments"}, {"row": 18, "type": "switch", "col": 0, "label": "Neuro WNL"}, {"row": 18, "type": "multiple-select", "col": 1, "label": "Neuro Abnormal"}, {"row": 19, "type": "short-text-field", "col": 0, "label": "Neuro Comments"}, {"row": 20, "type": "switch", "col": 0, "label": "Extremities WNL"}, {"row": 20, "type": "multiple-select", "col": 1, "label": "Extrem Abnormal"}, {"row": 21, "type": "short-text-field", "col": 0, "label": "Extrem Comments"}], "471587": [{"row": 0, "type": "short-text-field", "col": 0, "label": "How did you hear about us?"}, {"row": 1, "type": "yes-no", "col": 0, "label": "Have you had acupuncture before?"}, {"row": 1, "type": "yes-no", "col": 1, "label": "Chinese herbal medicine before?"}, {"row": 2, "type": "short-text-field", "col": 0, "label": "Reason for\t today\u2019s visit"}, {"row": 2, "type": "short-text-field", "col": 1, "label": "Any diagnosis given?"}, {"row": 3, "type": "yes-no", "col": 0, "label": "Have you had it in past?"}, {"row": 3, "type": "short-text-field", "col": 1, "label": "How long have you had this"}, {"row": 4, "type": "single-select", "col": 0, "label": "Is your condition getting"}, {"row": 4, "type": "single-select", "col": 1, "label": "Level of pain"}, {"row": 5, "type": "multiple-select", "col": 0, "label": "Is the problem aggravated by"}, {"row": 5, "type": "short-text-field", "col": 1, "label": "If yes,describe when"}, {"row": 6, "type": "multiple-select", "col": 0, "label": "Is the problem helped by"}, {"row": 6, "type": "short-text-field", "col": 1, "label": "Diagnosing physician"}, {"row": 7, "type": "yes-no", "col": 0, "label": "Other Physicians treating you?"}, {"row": 7, "type": "short-text-field", "col": 1, "label": "Date of last physical exam"}, {"row": 8, "type": "short-text-field", "col": 0, "label": "Being treated for other problems"}, {"row": 8, "type": "short-text-field", "col": 1, "label": "If yes,List problem"}, {"row": 9, "type": "yes-no", "col": 0, "label": "Are you treated by other practit"}, {"row": 9, "type": "short-text-field", "col": 1, "label": "PreviousTreatments"}, {"row": 10, "type": "short-text-field", "col": 0, "label": "LIst your medications"}, {"row": 10, "type": "short-text-field", "col": 1, "label": "Reason for medication"}, {"row": 11, "type": "short-text-field", "col": 0, "label": "List any herbs you are taking"}, {"row": 11, "type": "short-text-field", "col": 1, "label": "List supplements you are taking"}, {"row": 12, "type": "multiple-select", "col": 0, "label": "Family medical history"}, {"row": 12, "type": "short-text-field", "col": 1, "label": "List surgeries and date"}, {"row": 13, "type": "multiple-select", "col": 0, "label": "Did you ever have/had"}, {"row": 13, "type": "short-text-field", "col": 1, "label": "Accident/traumas with date"}, {"row": 14, "type": "multiple-select", "col": 0, "label": "Inoculations you had"}, {"row": 14, "type": "short-text-field", "col": 1, "label": "Inoculation had last year"}, {"row": 15, "type": "yes-no", "col": 0, "label": "Taken adrenal corticosteroids"}, {"row": 15, "type": "yes-no", "col": 1, "label": "More than 2 Course of antibiotic"}, {"row": 16, "type": "yes-no", "col": 0, "label": "Travelled outside country"}, {"row": 16, "type": "short-text-field", "col": 1, "label": "Which countries?"}, {"row": 17, "type": "yes-no", "col": 0, "label": "Unusual birth history\t"}, {"row": 18, "type": "switch", "col": 0, "label": "Medical History"}, {"row": 19, "type": "multiple-select", "col": 0, "label": "General Symptoms"}, {"row": 19, "type": "multiple-select", "col": 1, "label": "Musculoskeletal"}, {"row": 20, "type": "multiple-select", "col": 0, "label": "Eyes"}, {"row": 20, "type": "multiple-select", "col": 1, "label": "Head, Ears, Nose, Mouth ,Throat"}, {"row": 21, "type": "multiple-select", "col": 0, "label": "Cardiovascular"}, {"row": 21, "type": "multiple-select", "col": 1, "label": "Cardiovascular Continued"}, {"row": 22, "type": "multiple-select", "col": 0, "label": "Respiratory"}, {"row": 22, "type": "multiple-select", "col": 1, "label": "Skin\tand Hair"}, {"row": 23, "type": "multiple-select", "col": 0, "label": "Gastrointestinal"}, {"row": 23, "type": "short-text-field", "col": 1, "label": "Frequency of Bowel Movements"}, {"row": 24, "type": "multiple-select", "col": 0, "label": "Urinary and Genital"}, {"row": 24, "type": "short-text-field", "col": 1, "label": "How often you urinate at night"}, {"row": 25, "type": "short-text-field", "col": 0, "label": "Urinate in 24 hours"}, {"row": 26, "type": "multiple-select", "col": 0, "label": "Sleep"}, {"row": 26, "type": "short-text-field", "col": 1, "label": "Hours you sleep"}, {"row": 27, "type": "multiple-select", "col": 0, "label": "Emotional"}, {"row": 27, "type": "yes-no", "col": 1, "label": "Treated for emotional Problems"}, {"row": 28, "type": "yes-no", "col": 0, "label": "Emotionally abused"}, {"row": 28, "type": "yes-no", "col": 1, "label": "Sexually abused"}, {"row": 29, "type": "yes-no", "col": 0, "label": "Unusual Stressful Experience"}, {"row": 29, "type": "yes-no", "col": 1, "label": "Physically abused"}, {"row": 30, "type": "short-text-field", "col": 0, "label": "Other emotional problems"}, {"row": 31, "type": "short-text-field", "col": 1, "label": "Any numb areas?"}, {"row": 32, "type": "multiple-select", "col": 0, "label": "Pregnancy and Gynecology"}, {"row": 33, "type": "short-text-field", "col": 0, "label": "Pregnancy/Gynecological Problem"}, {"row": 33, "type": "short-text-field", "col": 1, "label": "Date of last menses"}, {"row": 34, "type": "short-text-field", "col": 0, "label": "Date of last pap test"}, {"row": 34, "type": "short-text-field", "col": 1, "label": "Method of birth control"}, {"row": 35, "type": "short-text-field", "col": 0, "label": "Other"}, {"row": 35, "type": "short-text-field", "col": 1, "label": "Other"}], "294110": [{"row": 0, "type": "yes-no", "col": 0, "label": "MHx/FHx/Meds/Allergies REVIEWED"}, {"row": 1, "type": "yes-no", "col": 0, "label": "Prescreen?"}, {"row": 2, "type": "single-select", "col": 0, "label": "VAsc @ Distance OD"}, {"row": 2, "type": "single-select", "col": 1, "label": "VAsc @ Distance OS"}, {"row": 3, "type": "single-select", "col": 0, "label": "VAsc @ Near OD "}, {"row": 3, "type": "single-select", "col": 1, "label": "VAsc @ Near OS"}, {"row": 4, "type": "single-select", "col": 0, "label": "VAcc @ Distance OD"}, {"row": 4, "type": "single-select", "col": 1, "label": "VAcc @ Distance OS"}, {"row": 5, "type": "single-select", "col": 0, "label": "Type of Correction for VAcc"}, {"row": 5, "type": "short-text-field", "col": 1, "label": "LENSOMETRY OD / OS"}, {"row": 6, "type": "short-text-field", "col": 0, "label": "AUTOREFRACTION OD / OS"}, {"row": 6, "type": "short-text-field", "col": 1, "label": "AUTOKERATOMETRY OD / OS"}, {"row": 7, "type": "single-select", "col": 0, "label": "COLOR VISION (Ishihara)"}, {"row": 7, "type": "multiple-select", "col": 1, "label": "STEREOVISION"}, {"row": 8, "type": "multiple-select", "col": 0, "label": "WELLNESS VF SCREENING"}, {"row": 9, "type": "multiple-select", "col": 0, "label": "PUPILS"}, {"row": 9, "type": "multiple-select", "col": 1, "label": "EOM"}, {"row": 10, "type": "multiple-select", "col": 0, "label": "COVER TEST"}, {"row": 10, "type": "multiple-select", "col": 1, "label": "CVF"}, {"row": 11, "type": "yes-no", "col": 0, "label": "SUBJECTIVE REFRACT"}, {"row": 12, "type": "short-text-field", "col": 0, "label": "SUBJECTIVE REFRACTION OD"}, {"row": 12, "type": "single-select", "col": 1, "label": "VA OD"}, {"row": 13, "type": "short-text-field", "col": 0, "label": "SUBJECTIVE REFRACTION OS"}, {"row": 13, "type": "single-select", "col": 1, "label": "VA OS"}, {"row": 14, "type": "single-select", "col": 0, "label": "ADD (+)"}, {"row": 14, "type": "single-select", "col": 1, "label": "NEAR VA OU"}, {"row": 15, "type": "short-text-field", "col": 0, "label": "NRA(+)/PRA(-)"}, {"row": 15, "type": "yes-no", "col": 1, "label": "BINOCULAR BALANCED FINAL SRX"}, {"row": 16, "type": "short-text-field", "col": 0, "label": "PHORIA DIST"}, {"row": 16, "type": "short-text-field", "col": 1, "label": "PHORIA NEAR"}, {"row": 17, "type": "short-text-field", "col": 0, "label": "WET/CYCLO"}, {"row": 17, "type": "short-text-field", "col": 1, "label": "CYCLO VA"}, {"row": 18, "type": "single-select", "col": 0, "label": "NPC"}, {"row": 20, "type": "yes-no", "col": 0, "label": "ANT SEG?"}, {"row": 20, "type": "multiple-select", "col": 1, "label": "NEUROLOGIC"}, {"row": 21, "type": "multiple-select", "col": 0, "label": "OCULAR ADNEXA"}, {"row": 21, "type": "short-text-field", "col": 1, "label": "OA Comments: "}, {"row": 22, "type": "yes-no", "col": 0, "label": "PRE-AURICULAR NODE; Palpable?"}, {"row": 22, "type": "short-text-field", "col": 1, "label": "PA Comments: "}, {"row": 23, "type": "multiple-select", "col": 0, "label": "EYELIDS/LASHES"}, {"row": 23, "type": "short-text-field", "col": 1, "label": "Lids/Lashes Comments"}, {"row": 24, "type": "multiple-select", "col": 0, "label": "SCLERA/EPISCLERA"}, {"row": 24, "type": "short-text-field", "col": 1, "label": "S/E Comments"}, {"row": 25, "type": "multiple-select", "col": 0, "label": "CONJUNCTIVA"}, {"row": 25, "type": "short-text-field", "col": 1, "label": "Conj Comments"}, {"row": 26, "type": "multiple-select", "col": 0, "label": "CORNEA"}, {"row": 26, "type": "short-text-field", "col": 1, "label": "Cornea Comments"}, {"row": 27, "type": "multiple-select", "col": 0, "label": "IRIS"}, {"row": 27, "type": "short-text-field", "col": 1, "label": "Iris Comments"}, {"row": 28, "type": "multiple-select", "col": 0, "label": "ANTERIOR CHAMBER"}, {"row": 28, "type": "short-text-field", "col": 1, "label": "AC Comments"}, {"row": 29, "type": "multiple-select", "col": 0, "label": "ANGLE ESTIMATE"}, {"row": 30, "type": "fraction-fields", "col": 0, "label": "IOP (Icare) OD/OS"}, {"row": 30, "type": "fraction-fields", "col": 1, "label": "IOP (Goldmann) OD/OS"}, {"row": 31, "type": "diagram", "col": 0, "label": "Anterior Segment OD"}, {"row": 31, "type": "diagram", "col": 1, "label": "Anterior Segment OS"}, {"row": 33, "type": "yes-no", "col": 0, "label": "Post Seg?"}, {"row": 33, "type": "diagram", "col": 1, "label": "Dilation Refusal SIG"}, {"row": 34, "type": "multiple-select", "col": 0, "label": "LENS"}, {"row": 34, "type": "single-select", "col": 1, "label": "DILATION"}, {"row": 35, "type": "multiple-select", "col": 0, "label": "OPTIC NERVE"}, {"row": 35, "type": "short-text-field", "col": 1, "label": "ONH Comments"}, {"row": 36, "type": "short-text-field", "col": 0, "label": "C/D RATIO OD, OS"}, {"row": 37, "type": "multiple-select", "col": 0, "label": "MACULA"}, {"row": 37, "type": "short-text-field", "col": 1, "label": "Macula Comments: "}, {"row": 38, "type": "yes-no", "col": 0, "label": "FOVEAL REFLEX OU?"}, {"row": 39, "type": "multiple-select", "col": 0, "label": "VITREOUS"}, {"row": 39, "type": "short-text-field", "col": 1, "label": "Vitreous Comments"}, {"row": 40, "type": "multiple-select", "col": 0, "label": "POSTERIOR POLE"}, {"row": 40, "type": "short-text-field", "col": 1, "label": "Post Pole Comments"}, {"row": 41, "type": "multiple-select", "col": 0, "label": "VASCULATURE"}, {"row": 41, "type": "short-text-field", "col": 1, "label": "Vasculature Comments"}, {"row": 42, "type": "multiple-select", "col": 0, "label": "PERIPHERY"}, {"row": 42, "type": "short-text-field", "col": 1, "label": "Periphery Comments"}, {"row": 43, "type": "diagram", "col": 0, "label": "Retina OD"}, {"row": 43, "type": "diagram", "col": 1, "label": "Retina OS"}], "7213434": [{"row": 0, "type": "short-text-field", "col": 0, "label": "Time test perfomed"}, {"row": 1, "type": "single-select", "col": 0, "label": "Resting Pulse Rate"}, {"row": 2, "type": "single-select", "col": 0, "label": "Sweating (over past 1/2 hour not accounted for by room temp or patient activity"}, {"row": 3, "type": "single-select", "col": 0, "label": "Restlessness (observation during assessment)"}, {"row": 4, "type": "single-select", "col": 0, "label": "Pupil Size"}, {"row": 5, "type": "single-select", "col": 0, "label": "Bone or Joint Aches (only component 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Myotomes "}, {"row": 120, "type": "single-select", "col": 0, "label": "L2/3"}, {"row": 120, "type": "single-select", "col": 1, "label": "Rt."}, {"row": 121, "type": "single-select", "col": 0, "label": "Left L3/4"}, {"row": 121, "type": "single-select", "col": 1, "label": "Rt."}, {"row": 122, "type": "single-select", "col": 0, "label": "Left L4/L5"}, {"row": 122, "type": "single-select", "col": 1, "label": "Rt."}, {"row": 123, "type": "single-select", "col": 0, "label": "L5"}, {"row": 123, "type": "single-select", "col": 1, "label": "Rt. "}, {"row": 124, "type": "single-select", "col": 0, "label": "S1 Lt"}, {"row": 124, "type": "single-select", "col": 1, "label": "Rt."}, {"row": 126, "type": "switch", "col": 0, "label": "DTRs "}, {"row": 127, "type": "single-select", "col": 0, "label": "Lt C5"}, {"row": 127, "type": "single-select", "col": 1, "label": "Rt"}, {"row": 128, "type": "single-select", "col": 0, "label": "Lt. C6"}, {"row": 128, "type": "single-select", "col": 1, "label": "Rt."}, {"row": 129, "type": "single-select", "col": 0, "label": "Lt. C7"}, {"row": 129, "type": "single-select", "col": 1, "label": "Rt."}, {"row": 130, "type": "single-select", "col": 0, "label": "L4 Lt."}, {"row": 130, "type": "single-select", "col": 1, "label": "Rt."}, {"row": 131, "type": "single-select", "col": 0, "label": "S1 Lt."}, {"row": 131, "type": "single-select", "col": 1, "label": "Rt."}, {"row": 133, "type": "switch", "col": 0, "label": "Elbow/Wrist/Hand"}, {"row": 134, "type": "multiple-select", "col": 0, "label": "Observation:"}, {"row": 135, "type": "multiple-select", "col": 0, "label": "Palpation (Spasm)"}, {"row": 135, "type": "multiple-select", "col": 1, "label": "Palpation (Trigger Points)"}, {"row": 137, "type": "switch", "col": 0, "label": "Elbow/Wrist/Hand AROM"}, {"row": 138, "type": "single-select", "col": 0, "label": "Right Elbow Extension"}, {"row": 138, "type": "single-select", "col": 1, "label": "Right Elbow Flexion"}, {"row": 139, "type": "single-select", "col": 0, "label": "Left Elbow Extension"}, {"row": 139, "type": "single-select", "col": 1, "label": "Left Elbow Flexion"}, {"row": 140, "type": "single-select", "col": 0, "label": "Right Forearm Pronation"}, {"row": 140, "type": "single-select", "col": 1, "label": "Right Forearm Supination"}, {"row": 141, "type": "single-select", "col": 0, "label": "Left Forearm Pronation"}, {"row": 141, "type": "single-select", "col": 1, "label": "Right Forearm Supination"}, {"row": 142, "type": "single-select", "col": 0, "label": "Right Wrist Extension"}, {"row": 142, "type": "single-select", "col": 1, "label": "Right Wrist Flexion"}, {"row": 143, "type": "single-select", "col": 0, "label": "Left Wrist Extension"}, {"row": 143, "type": "single-select", "col": 1, "label": "Left Wrist Flexion"}, {"row": 145, "type": "switch", "col": 0, "label": "Knee/Ankle/Foot"}, {"row": 146, "type": "multiple-select", "col": 0, "label": "Observation:"}, {"row": 147, "type": "multiple-select", "col": 0, "label": "Palpation (Spasm)"}, {"row": 147, "type": "multiple-select", "col": 1, "label": "Palpation (Trigger Points)"}, {"row": 148, "type": "switch", "col": 0, "label": "Knee/Ankle/Foot AROM"}, {"row": 149, "type": "single-select", "col": 0, "label": "Right Knee Extension"}, {"row": 149, "type": "single-select", "col": 1, "label": "Right Knee Flexion"}, {"row": 150, "type": "single-select", "col": 0, "label": "Left Knee Extension"}, {"row": 150, "type": "single-select", "col": 1, "label": "Left Knee Flexion"}, {"row": 151, "type": "single-select", "col": 0, "label": "Right Ankle Dorsiflexion"}, {"row": 151, "type": "single-select", "col": 1, "label": "Right Ankle Plantarflexion"}, {"row": 152, "type": "single-select", "col": 0, "label": "Left Ankle Dorsiflexion"}, {"row": 152, "type": "single-select", "col": 1, "label": "Left Ankle PlantarFlexion"}, {"row": 154, "type": "switch", "col": 0, "label": "Assessment"}, {"row": 155, "type": "multiple-select", "col": 0, "label": "Diagnosis"}, {"row": 156, "type": "short-text-field", "col": 0, "label": "Comments on DX"}, {"row": 157, "type": "multiple-select", "col": 0, "label": "Prognosis"}, {"row": 158, "type": "short-text-field", "col": 0, "label": "Comments"}, {"row": 159, "type": "switch", "col": 0, "label": "Plan:"}, {"row": 160, "type": "multiple-select", "col": 0, "label": "Treatment Frequency month:"}, {"row": 160, "type": "single-select", "col": 1, "label": "Treatment Duration Month"}, {"row": 161, "type": "multiple-select", "col": 0, "label": "Treatment Frequency Weeks:"}, {"row": 161, "type": "single-select", "col": 1, "label": "Treatment Duration week"}, {"row": 162, "type": "single-select", "col": 0, "label": "Re-examination:"}, {"row": 163, "type": "multiple-select", "col": 0, "label": "Chiropractic Adjustments 98940"}, {"row": 164, "type": "multiple-select", "col": 0, "label": "Extraspinal Adjustments 98943"}, {"row": 165, "type": "multiple-select", "col": 0, "label": "Therapeutic Exercise 97110 59"}, {"row": 166, "type": "multiple-select", "col": 0, "label": "Electrical Stim Attended 97032"}, {"row": 167, "type": "multiple-select", "col": 0, "label": "Manual Therapy Techniques 97140"}, {"row": 168, "type": "multiple-select", "col": 0, "label": "Cold/Hot Pack 97010"}, {"row": 169, "type": "multiple-select", "col": 0, "label": "Neuromuscular Re-Ed 97112 59"}, {"row": 170, "type": "multiple-select", "col": 0, "label": "Ultrasound Therapy 97035"}, {"row": 171, "type": "multiple-select", "col": 0, "label": "Mechanical Traction 97012"}, {"row": 172, "type": "multiple-select", "col": 0, "label": "Supplies"}, {"row": 173, "type": "multiple-select", "col": 0, "label": "Radiology"}, {"row": 174, "type": "multiple-select", "col": 0, "label": "Laboratory"}, {"row": 175, "type": "multiple-select", "col": 0, "label": "Records reviewed"}, {"row": 176, "type": "short-text-field", "col": 0, "label": "Comments"}]}; Handlebars.registerHelper('isCurrentPage', function(page, options) { if (page === currentPage) { return options.fn(this); } return options.inverse(this); }); Handlebars.registerHelper('specialty', function() { return specialties = $('#specialty').val(); }); Handlebars.registerHelper('urlencode', function(name) { return encodeURIComponent(name); }); Handlebars.registerHelper('ifCond', function(v1, v2, options) { if(v1 === v2) { return options.fn(this); } return options.inverse(this); }); $(window).load(function() { try { $.getJSON('/ipdetector/', {}, function(data) { $('.state').val(data.state); $('.country').val(data.country); }); } catch (err) {} }); (function() { var params = window.location.search.substring(1).split('&'); var specialties = []; for (var i = 0; i < params.length; i++) { var pair = params[i].split('='); if (pair[0] === 'query') { $('#full-text-search').val(pair[1]); } else if (pair[0] === 'specialty') { specialties.push(decodeURIComponent(pair[1]).replace(/\+/g, ' ')); } } $('#specialty').val(specialties).change().trigger('chosen:updated'); })(); var displayError = function(message) { $('#errors').html('
' + message + '
'); }; var renderTableTemplates = function(data, specialties, searchText) { if (!data) { displayError('We couldn\'t process the receieved data. Try again in a few seconds.'); } else { for (var i = 0; i < categories.length; i++) { var category = categories[i]; var categoryPagination = data[category + '_pagination']; var categoryPaginationData = { category: category, current_page: categoryPagination.current_page, prev_page: Math.max(categoryPagination.current_page - 1, 1), last_page: categoryPagination.total_pages, next_page: Math.min(categoryPagination.current_page+1, categoryPagination.total_pages), } var categoryPaginationScript = $('#' + category + '-pagination'); categoryPaginationScript.html(''); 
 categoryPaginationScript.append(template_pagination(categoryPaginationData)); var selectorForm = $('#' + category + '-forms'); if (data[category + '_match']) { selectorForm.html(''); $.each(data[category + '_templates'], function(i, match) { selectorForm.append(template_table_row(match)); }); } else if (!specialties && !searchText) { selectorForm.html(template_table_no_results({ message: "There aren't any " + category + " medical forms right now." })); } else { selectorForm.html(template_table_no_results({ message: "We couldn't find any " + category + " forms that match the given filter/search criteria." })); } } } }; var display_preview_modal = function(template_id, form_title, sharing_url, has_copy, elem, event) { if (template_id in templatePreviews) { var data = templatePreviews[template_id]; var num_columns = 2; var table_row_parts = []; data.map(function(field) { if (table_row_parts[field.row] === undefined) { table_row_parts[field.row] = []; } var field_cell = $("", {"class": "field-icon " + field.type}); field_cell.text(field.label); table_row_parts[field.row].push(field_cell[0].outerHTML); }); var table_rows = table_row_parts.map(function(row) { while (row.length < num_columns) { row.push(''); } return row.join(''); }); var rendered_fields = '' + table_rows.join('') + ''; var preview_data = { name: form_title, template_id: template_id, rendered_fields: rendered_fields, sharing_url: sharing_url, has_copy: has_copy }; $('.form-row').trigger('mouseout'); elem.popover({ template: '

', placement: 'right', html: true, trigger: 'hover', delay: {show: 300, hide: 0}, content: template_preview_modal(preview_data) }); var e = new jQuery.Event('mouseover'); e.pageX = event.pageX; elem.trigger(e); elem.data('has-popover', 'true'); } else { displayError('Unfortunately, we couldn\'t create a preview for that medical form.'); } }; var reloadTables = function(page_index) { var specialties = $('#specialty').val(), searchText = $('#full-text-search').val(), data = {'specialty': specialties} if (searchText) { data['query'] = searchText } if (page_index) { data['featured_page'] = page_index; data['other_page'] = page_index; } $.ajax({ url: "/form_library_ajax/", type: "GET", data: data, traditional: true, dataType: 'json', success: function(data, textStatus) { renderTableTemplates(data, specialties, searchText); lastPage = Math.max(data.featured_pagination.total_pages, data.other_pagination.total_pages); if (data.featured_pagination.current_page !== data.other_pagination.current_page) { $('.featured-page').html('(Page ' + data.featured_pagination.current_page + ')'); $('.other-page').html('(Page ' + data.other_pagination.current_page + ')'); } else { $('.featured-page').html(''); $('.other-page').html(''); } templatePreviews = data.template_previews; updateUrl(); updateNumTemplate(data, specialties, searchText); }, error: function(data, textStatus) { displayError('Sorry, there was an error getting the list of forms. Wait a few seconds and try again.'); } }); return false; }; var updateUrl = function() { var data = {}; if (currentPage > 1) { data['featured_page'] = currentPage; data['other_page'] = currentPage; } var specialty = $('#specialty').val(); var searchText = $('#full-text-search').val(); if (specialty) { data['specialty'] = specialty; } if (searchText) { data['query'] = searchText; } window.history.replaceState(null, null, '/ehr-emr/medical-form-templates/?' + $.param(data, true)); }; var updateNumTemplate = function(data, specialties, searchText) { if (data) { var numTemplates = (data.featured_paginator_count || 0) + (data.other_paginator_count || 0); if (numTemplates == 0) { $('#num-templates').html('No results found'); } else { var textToFill = numTemplates + ' results found'; $('#num-templates').html(textToFill); } } }; var changePage = function(toThis, change) { return function(event) { event.preventDefault(); var nextPage = toThis ? parseInt($(this).text()) : currentPage + change; if (nextPage < 1 || nextPage > lastPage) { return; } currentPage = nextPage; reloadTables(nextPage); }; }; $('.pagination').on('click', '.page-link', changePage(true, null)); $('.pagination').on('click', '.prev-page-link', changePage(false, -1)); $('.pagination').on('click', '.next-page-link', changePage(false, 1)); var goToPage = function(page) { return function(event) { changePage(false, -currentPage + page)(event); }; }; $('#specialty').chosen().bind('change', function(event){ $('#specialty').trigger('chosen:updated'); goToPage(1)(event); }); $('#performSearch').click('change', goToPage(1)); $('#resetSearch').click('change', function(event) { $('#full-text-search').val(''); $('#specialty').val('').trigger('chosen:updated'); goToPage(1)(event); }); $('#full-text-search').keypress(function(event) { if (event.which == 13) { goToPage(1)(event); } }); $(document).on('click', '.disabled', function(event) { event.preventDefault(); }); $(document).on('click', '.filter-specialty', function(event) { event.preventDefault(); $('#specialty').val($(this).text()).change().trigger('chosen:updated'); goToPage(1)(event); }); var showUseFormModal = function(elem) { var temp_anchor = $('', {href: elem.data('pickup-url')})[0]; var data = { id: elem.data('pickup-id'), pickupUrl: temp_anchor.pathname, name: elem.data('title'), firstName: '', lastName: '', email: '', state: $('.state').val(), country: $('.country').val(), errors: {} }; return template_use_form_modal(data); }; $(document).on('click', '.use-form-from-modal', function(event) { event.preventDefault(); var elem = $(this); $('#templatePreview').html(showUseFormModal(elem)); }); $(document).on('click', '.use-form-modal', function(event) { event.preventDefault(); var elem = $(this); $('#useFormModal').html(showUseFormModal(elem)); $('#useFormModal').modal(); }); $('.form-table').on('mouseenter', '.form-row', function(event) { var elem = $(this); if (recentlyHovered.indexOf(this) === -1 && elem.data('has-popover') === undefined) { recentlyHovered.push(this); setTimeout(function() { recentlyHovered.splice(recentlyHovered.indexOf(this), 1); }, 1000); var template_id = elem.data('id'); var link_to_use = $('a[data-id="' + template_id + '"]'); display_preview_modal(template_id, elem.data('title'), link_to_use.data('pickup-url'), link_to_use.hasClass('disabled'), elem, event); } }); $(document).on('click', '.btn-switch-view', function(event) { event.preventDefault(); $('.' + $(this).data('show')).removeClass('hide'); $('.' + $(this).data('hide')).addClass('hide'); if ($(this).data('show') === 'log-in') { $('.use-form-register').attr('action', '/accounts/login/'); $('.modal-submit-button').val('Login'); } else { $('.use-form-register').attr('action', '?'); $('.modal-submit-button').val('Create Your Free Account'); } });
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