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Medical Form Template Library

12 results found

Featured Forms

Comp Exam

Dentist
View detailed
Published 06/11/2014
Rating: 11

Other Forms

onpatient Additional Info

Dentist
View detailed
Published 03/12/2016
Rating: 0

Message

Dentist
View detailed
Published 10/23/2015
Rating: 0

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

Dentist
View detailed
Published 09/13/2016
Rating: 0

Head & Neck Evaluation

Dentist
View detailed
Published 07/16/2016
Rating: 0

INITIAL PSYCHOTHERAPY ASSESSMENT

Dentist
View detailed
Published 08/04/2016
Rating: 0

INITIAL PSYCHOTHERAPY ASSESSMENT

Dentist
View detailed
Published 08/04/2016
Rating: 0

Pediatric Airway Questionnaire

Dentist
View detailed
Published 06/02/2020
Rating: 0

ROF- Adult

Dentist
View detailed
Published 02/14/2023
Rating: 0

H&P Review of Systems

Dentist
View detailed
Published 09/16/2024
Rating: 0

test form1

Dentist
View detailed
Published 04/10/2017
Rating: 0
"}, {"row": 3, "type": "short-text-field", "col": 1, "label": "New Field"}], "1375068": [{"row": 0, "type": "single-select", "col": 0, "label": "Where did you find us?"}, {"row": 1, "type": "multiple-select", "col": 0, "label": "Which specialists do you see?"}, {"row": 2, "type": "short-text-field", "col": 0, "label": "Who referred you? "}, {"row": 3, "type": "switch", "col": 0, "label": "Do you use online scheduling?"}, {"row": 4, "type": "switch", "col": 0, "label": "Want access to online portal?"}, {"row": 5, "type": "short-text-field", "col": 0, "label": "Anything special we need to know"}], "1527962": [{"row": 0, "type": "switch", "col": 0, "label": "Chief Complaint"}, {"row": 0, "type": "switch", "col": 1, "label": "Referred by"}, {"row": 1, "type": "switch", "col": 0, "label": "Currently undergoing ortho"}, {"row": 1, "type": "multiple-select", "col": 1, "label": "Prior ortho/tmj tx?"}, {"row": 2, "type": "multiple-select", "col": 0, "label": "Habits"}, {"row": 2, "type": "yes-no", "col": 1, "label": "Sleep study ever done?"}, {"row": 3, "type": "short-text-field", "col": 0, "label": "S.S. notes (where,when,results?)"}, {"row": 3, "type": "multiple-select", "col": 1, "label": "Sleep related symptoms:"}, {"row": 4, "type": "short-text-field", "col": 0, "label": "Epworth Score:"}, {"row": 4, "type": "short-text-field", "col": 1, "label": "Review of symptoms"}, {"row": 6, "type": "switch", "col": 0, "label": "Stomatognathic Exam"}, {"row": 7, "type": "switch", "col": 0, "label": "Range of Motion"}, {"row": 7, "type": "switch", "col": 1, "label": "ROM WNL"}, {"row": 8, "type": "fraction-fields", "col": 0, "label": "Comfort Open/Active (w/pain) Open mm"}, {"row": 8, "type": "short-text-field", "col": 1, "label": "Passive Open (assisted in mm)"}, {"row": 9, "type": "fraction-fields", "col": 0, "label": "Laterotrusive (Rt/Lt) (mm)."}, {"row": 9, "type": "fraction-fields", "col": 1, "label": "Max Protrusion/Retrusion (mm)."}, {"row": 10, "type": "short-text-field", "col": 0, "label": "Deflection (doesn't return) mm"}, {"row": 10, "type": "short-text-field", "col": 1, "label": "Deviation (pops back) mm"}, {"row": 11, "type": "single-select", "col": 0, "label": "Midline aligned?"}, {"row": 11, "type": "short-text-field", "col": 1, "label": "Notes:"}, {"row": 13, "type": "switch", "col": 0, "label": "TMJ eval done?"}, {"row": 14, "type": "multiple-select", "col": 0, "label": "Noise heard at:"}, {"row": 14, "type": "yes-no", "col": 1, "label": "TMJ evaluation any pain?"}, {"row": 15, "type": "multiple-select", "col": 0, "label": "Other symptoms present"}, {"row": 15, "type": "multiple-select", "col": 1, "label": "Muscle palpation pain on"}, {"row": 16, "type": "short-text-field", "col": 0, "label": "Palpation notes."}, {"row": 17, "type": "switch", "col": 0, "label": "Bite Maneuvers"}, {"row": 18, "type": "single-select", "col": 0, "label": "Right separator (ipsi-muscle;contra-tmj)"}, {"row": 18, "type": "single-select", "col": 1, "label": "Left separator (ipsi-muscle;contra-tmj)"}, {"row": 19, "type": "short-text-field", "col": 0, "label": "TMJ/Bite Notes:"}, {"row": 21, "type": "switch", "col": 0, "label": "Intraoral Exam:"}, {"row": 21, "type": "short-text-field", "col": 1, "label": "Last dental visit on:"}, {"row": 22, "type": "switch", "col": 0, "label": "No dental tx needed."}, {"row": 22, "type": "short-text-field", "col": 1, "label": "Dental tx underway:"}, {"row": 23, "type": "short-text-field", "col": 0, "label": "Estimated tx completion date:"}, {"row": 23, "type": "fraction-fields", "col": 1, "label": "Dental relationship [left/right]"}, {"row": 24, "type": "fraction-fields", "col": 0, "label": "Overjet/overbite (mm)"}, {"row": 24, "type": "multiple-select", "col": 1, "label": "Occlusion eval: no contact on"}, {"row": 25, "type": "short-text-field", "col": 0, "label": "Other notes..."}, {"row": 27, "type": "single-select", "col": 0, "label": "Mallampati class"}, {"row": 27, "type": "single-select", "col": 1, "label": "Soft palate"}, {"row": 28, "type": "single-select", "col": 0, "label": "Uvula"}, {"row": 28, "type": "single-select", "col": 1, "label": "Tonsils"}, {"row": 29, "type": "multiple-select", "col": 0, "label": "Tongue"}, {"row": 29, "type": "single-select", "col": 1, "label": "Gag reflex"}, {"row": 30, "type": "multiple-select", "col": 0, "label": "Maxilla presents"}, {"row": 30, "type": "multiple-select", "col": 1, "label": "Mandible presents"}, {"row": 31, "type": "single-select", "col": 0, "label": "Bruxism"}, {"row": 31, "type": "single-select", "col": 1, "label": "Inflammation/Calculus"}, {"row": 32, "type": "multiple-select", "col": 0, "label": "Caries/fractures/failing restor"}, {"row": 32, "type": "short-text-field", "col": 1, "label": "Pt reports pain on tth #'s:"}, {"row": 33, "type": "multiple-select", "col": 0, "label": "Airway tests completed"}, {"row": 34, "type": "short-text-field", "col": 0, "label": "Impression:"}, {"row": 36, "type": "header-field", "col": 0, "label": "Assessment"}, {"row": 37, "type": "short-text-field", "col": 0, "label": "Notes"}, {"row": 39, "type": "switch", "col": 0, "label": "Treatment Plan:"}, {"row": 40, "type": "short-text-field", "col": 0, "label": "Step 1"}, {"row": 40, "type": "short-text-field", "col": 1, "label": "Step 2"}, {"row": 41, "type": "short-text-field", "col": 0, "label": "Step 3"}, {"row": 41, "type": "short-text-field", "col": 1, "label": "Step 4"}, {"row": 42, "type": "switch", "col": 0, "label": "Stretching exercises given"}, {"row": 42, "type": "switch", "col": 1, "label": "Diagnostic sleep study needed"}, {"row": 43, "type": "single-select", "col": 0, "label": "HST selected"}, {"row": 43, "type": "short-text-field", "col": 1, "label": "Referral to [Dr./sleep clinic]"}, {"row": 44, "type": "switch", "col": 0, "label": "Pt will think about it"}, {"row": 44, "type": "single-select", "col": 1, "label": "Referred back in..."}, {"row": 45, "type": "short-text-field", "col": 0, "label": "Any tx/ins notes:"}], "5043423": [{"row": 0, "type": "single-select", "col": 0, "label": "Type of Appt"}, {"row": 1, "type": "short-text-field", "col": 0, "label": "Health History findings"}, {"row": 2, "type": "short-text-field", "col": 0, "label": "Medications:"}, {"row": 2, "type": "short-text-field", "col": 1, "label": "Allergies"}, {"row": 3, "type": "multiple-select", "col": 0, "label": "Findings that prompted recommendation for sleep screening/sleep study:"}, {"row": 3, "type": "short-text-field", "col": 1, "label": "Additional notes on reason for sleep screening:"}, {"row": 4, "type": "multiple-select", "col": 0, "label": "Clinical Findings:"}, {"row": 5, "type": "short-text-field", "col": 0, "label": "Findings of sleep SCREENING."}, {"row": 5, "type": "single-select", "col": 1, "label": "Findings of Sleep STUDY"}, {"row": 6, "type": "multiple-select", "col": 0, "label": "CBCT findings."}, {"row": 6, "type": "short-text-field", "col": 1, "label": "Additional notes on CBCT findings"}, {"row": 7, "type": "short-text-field", "col": 0, "label": "Additional notes on CBCT TMJ assessment:"}, {"row": 7, "type": "short-text-field", "col": 1, "label": "MRI findings:"}, {"row": 8, "type": "multiple-select", "col": 0, "label": "Treatment options:"}, {"row": 9, "type": "short-text-field", "col": 0, "label": "Referrals given:"}, {"row": 9, "type": "short-text-field", "col": 1, "label": "Additional notes:"}, {"row": 10, "type": "diagram", "col": 0, "label": "New Free Draw"}]}; 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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