This is what the electronic patient record will look like! In this tutorial lab, we explore how to use forms on the web to mimic the EPR. This example by Rich Frash is a fine one to learn from. We use PageSpinner to build them.

The Electronic Doc

"Committed to bringing you the finest in web-based medical assessment..."

Patient Information:

Enter your full name: Age: Insurance Provider:

Street Address: Smoker: Primary-care physician:

City: State: Zip:

Complaint: Medical Injury

**Attention: if you are experiencing chest pain, trouble breathing, a serious injury, or anything that may be life threatening or an emergency: call 9-1-1 immediately**

Male Female

Weight:

Pulse:

Temp:

Resp:

Pain (1-10)

Symptoms:

Check all that apply:
Nausea
Headache
Discoloration
Swelling
Dizziness
Abdominal Pain

Vomitting
Diabetic
Fever/Cold
Loose stools
Muscular pain
Joint discomfort

This page wasbuilt by Richard M. Frasch and was last revised: 1/22/99

If you have any other questions about building a form like this in ID-251 or questions about the course, please feel free to send an email to Prof. Walters.

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