VIHA specific forms
This folder will contain e-forms specific for VIHA, as requested by Oscar users in this area. More to follow. Stay tuned.
- LifeLab Requisition
- This e-form requires jsgraphics.js in the image library in order to create the darker check marks. It is matched with LifeLabReq.png image file.
- LifeLabReq.png
- Click to view full-size image before saving with exact title, as above, in image library.
- jsgraphics.js
- Load into image library to enable printing of darker checkmarks.
- CML MRI Victoria requisition
- Requires MRIVic.png in image library.
- MRIVic.png
- Click to view full-size image before saving with exact title, as above, in image library.
- VIHA Pulmonary Function Test requisition
- Requires vihapulmonaryfunctiontesting.png.
- vihapulmonaryfunctiontesting.gif
- Click to view full-size image before saving with exact title, as above, in image library.
- VIHA Bone Density (rev.Aug 2007)
- Bone Density Requisition eForm. Revised Aug 30, 2007.
- VIHA Caesarean Section Pre-Op (v.1)
- A two page eForm for pre-operative Caesarian section check-list. Version 1. Upload the HTML file to your e-form library, and BOTH image files to your image library.
- VIHA Cardiac Cath/EP/Pacemaker Referral (rev.Dec 2005)
- A two page eForm for cardiac catheterization, EP study and Pacemaker inpatient urgent referral. Revised December 2005. Upload the HTML file to your e-form library, and BOTH image files to your image library.
- VIHA Cardiac Risk Reduction (rev.Jan 2010)
- Cardiac Risk Reduction Program referral form. Revised Jan 2010.
- VIHA Central N. Isl. Diabetes Education Centre (rev.Aug 2008)
- Central North Island Diabetes Education Centre referral form. Revised Aug 2009.
- VIHA CFAU Booking Request (rev.Nov 2002)
- CFAU Booking Request. Revised November 2002.
- VIHA Heart Function Clinic Referral (v.1)
- Heart Function Clinic referral form for Victoria, Nanaimo and Campbell River clinics. Version 1.
- VIHA Echocardiography (v.1)
- VIHA Heart Health Program Echocardiography Lab request for exam.
- VIHA Cystology Histology Specimen (v.1)
- Cystology and Histology Specimen eForm for the Royal Jubilee Hospital Diagnostic Treatment Centre.
- VIHA Home Oxygen Program Application (rev.Nov 11)
- VIHA Home Oxygen Program application form, revised November 26, 2011
- VIHA Kidney Clinic Referral (rev.Jan 2006)
- VIHA Kidney Care Clinic Referral. Revised Jan 2006.
- VIHA Island Lab Services Requisition (v.1)
- Lab requisition for Island Lab Services. Version 1.
- VIHA Major Pre-Op Gyne Physicians Orders (v.1)
- South Island Region physicians prepared orders for pre-operative major gynecological procedures. Version 1.
- VIHA Medical Imaging Requisition (rev. Oct 2007)
- VIHA Medical Imaging Requisition. Revised Oct 2007.
- VIHA Mental Health Intake Referral (v.1)
- Mental Health intake referral form for patients 19 years of age and older. Version 1.
- VIHA Minor Pre-Op Gyne Physicians Orders (v.1)
- South Island Region physicians prepared orders for pre-operative minor gynecological procedures. Version 1.
- VIHA OR Booking Form (v.1)
- Regional surgical booking request form. Version 1.
- VIHA Outpatient Adult Diabetes Services (v.1)
- Outpatient adult diabetes services referral form. Version 1.
- VIHA Pre-Op History and Physical with ASA Classification, 2 pages (rev. May 2006)
- A two page eForm for pre-operative patient history and physical. Second page includes ASA Classification. Revised May 2006. Upload the HTML file to your e-form library, and BOTH image files to your image library.
- VIHA Pulmonary Function Testing (rev. Sept 2007)
- Royal Jubilee Hospital requisition for outpatient pulmonary function testing. Revised Sept 2007.
- VIHA Stroke Rapid Assessment Referral (v.1)
- Victoria General Hospital Stroke Rapid Assessment Unit referral form. Version 1.
- VIHA Ultrasound and Vascular Lab (v.1)
- See updated Version 2 (below). Original ultrasound and vascular lab request form (version 1).
- VIHA VGH Maternity Admission Form (rev. March 2011)
- Victoria General Hospital maternity admission information form. Revised March 2011.
- VIHA Ultrasound and Vascular Lab (v.3)
- Replaces Version 1 & 2. Ultrasound and vascular lab request form (version 3).
- VIHA MRI Requisition (rev. Oct 2007)
- VIHA MRI Requisition. Revised October 2007.
- VIHA Colposcopy Clinic (v.1)
- RJH Colposcopy Clinic referral form for Victoria. Version 1.
- VIHA Consent for Blood Products (v.1)
- VIHA consent form for blood products. Version 1.
- VIHA Induction of Labour (v.1)
- Induction of Labour Booking Form. Version 1.
- VIHA Bone Density v.2
- This eForm replaces VIHA Bone Density (rev. Aug 2007) with a clearer image.
- VIHA Echocardiography Lab (2012)
- Updated VIHA Echocardiography Lab.
