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JotForm is a free online form builder which helps you create online forms without writing a single line of code. No sign-up required.

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    Is it possible to use this for designing and maintaining a patient medical record?

    Asked by jason@steppinuppt.com on February 09, 2014 at 09:23 AM

    I would like to create forms that we use to:

    1.  email the initial intake form to patient to fill out and return

    2.  this initial intake would be filled out by the patient, but the exam portion would then be finished by the clinician. 

    3.  completed form would be faxed to referring MD for signature and then we would need to scan this signed doc back into the patient's file

    4.  daily intervention notes would need to be added to the file. Hopefully, there is a method for the demographics to self-populate at the top of each intervention note: Name, DOB, Diagnosis, Visit #, Referring MD...

    5.  ideally, each document, once complete, would need to be saved to an uneditable pdf

     

    I'm envisioning a folder for each patient that houses their medical record. We have two offices (physical therapy) that would be using this as an Electronic Medical Record (we are not happy with our current EMR).  There would be 16 users total at this point.  I would like to be able to fully design our forms and make changes as necessary. 

     

    Is this possible?  I realize we would need to be using your Professional package.

     

    Thank you,

     

    Jason

    and create forms email name professional
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    JotForm Support

    Answered by NeilVicente on February 09, 2014 at 11:36 AM

    Jason,

    Thank you for your interest in our product. First and foremost, JotForm is a web form creation tool, but with extended functionalities that prove to be useful to our users.

    After reading your message over and over again, I still am not quite sure if you're asking whether the things that you have listed can be accomplished with JotForm alone.

    1.  email the initial intake form to patient to fill out and return

    Check. Easily doable with JotForm.

    2.  this initial intake would be filled out by the patient, but the exam portion would then be finished by the clinician.

    Check. The clinician can edit the completed form using an edit link, and fill out the exam portion which can be  shown only to the patient via conditional logic.

    3.  completed form would be faxed to referring MD for signature and then we would need to scan this signed doc back into the patient's file

    This is out of the question. JotForm cannot do fax.

    4.  daily intervention notes would need to be added to the file. Hopefully, there is a method for the demographics to self-populate at the top of each intervention note: Name, DOB, Diagnosis, Visit #, Referring MD...

    I am not sure how exactly this can be achieved with our product. Are you perhaps looking for a patient database system?

    5.  ideally, each document, once complete, would need to be saved to an uneditable pdf

    Check. Form submissions can be exported to PDF files.

    We sure hope we can get your business, but we need to make sure that the expectations are set correctly.

    Hope to hear from you soon.