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"]
AP/Chart Review


___________________________________________________________
Immunizations:
MMR:
Varicella:
Hep B:
Tdap:
Flu:
COVID:
TB:
___________________________________________________________
Respiratory Baseline Questionnaire:


___________________________________________________________
OHS Cleared:
Needs:

Result - Copy and paste this output:

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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