AP- Chart Review
AP/Chart Review [textarea name="variable_1" default="notes:"] ___________________________________________________________ Immunizations: MMR: [checkbox name="variable_1" value="vaccine x 2|hx of pos titer|not required|not provided|negative titer|vaccine x1|cleared by badge or peer institution"] Varicella: [checkbox name="variable_2" value="vaccine x 2|vaccine x1| negative titer|hx of pos titer|not required|not provided|cleared by badge or peer institution"] Hep B: [checkbox name="variable_3" value="vaccine x 3|vaccine x1| vaccine x2| hx of negative titer| declination received|hx of pos titer|not required|not provided|cleared by badge or peer institution"] Tdap: [checkbox name="variable_4" value="UTD|last immunization >10 years|not provided|cleared by badge or peer institution"] Flu: [checkbox name="variable_5" value="UTD|declination received; in processing|not provided|not required with start date after 4/30|cleared by badge or peer institution"] COVID: [checkbox name="variable_6" value="Moderna x '24-'25|Pfizer x '24-'24|International '24-'25|not provided|declination received, in processing|declination received, approved|other"] TB: [checkbox name="variable_7" value="Neg IGRA w/i 90 doh|not provided|hx of pos TST or IGRA|Neg CXR provided|PPD X1, recent with negative result|not required|TST x 2, most current w/i 90 doh|cleared by badge or peer institution"] ___________________________________________________________ Respiratory Baseline Questionnaire: [checkbox name="variable_10" value="clear|not clear|not required|not provided|other"] [text name="variable_1" default=""] ___________________________________________________________ OHS Cleared:[select name="variable_1" value="YES|NO"] Needs: [checkbox name="variable_11" value="POS measles or proof of vaccination|POS mumps or proof of vaccination|POS rubella or proof of vaccination|POS varicella or proof of vaccination|Hep B vaccination or POS titer OR Hep B declination| Tdap or exemption request|flu vaccine or exemption requestion|COVID vaccine or exemption request|Negative IGRA or 2 step PPD|CXR|Symptom Analysis"]
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Sandbox Metrics: Structured Data Index 0.83, 12 form elements, 18 boilerplate words, 1 text boxes, 1 text areas, 9 checkboxes, 1 drop downs, 66 total clicks
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