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 2|Pfizer x 2|J&J x 1|not provided|plus bivalent booster|declination received, in processing|plus monovalent booster|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="comments"]

___________________________________________________________
OHS Cleared: [textarea name="variable_11" default=" "]
Needs: 
[textarea name="variable_18" default=" "]
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 0.67, 12 form elements, 18 boilerplate words, 1 text boxes, 3 text areas, 8 checkboxes, 57 total clicks
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