Online Form to PDF
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Project Budget$250 - $750 USD
Project: Create a form with graphics which allows user to quickly identify which &ldquo;picture&rdquo; goes with a checkbox, and generate a written report which includes the text from the checkbox selected
The doctor performs a test utilizing a machine. Line graphs of patient muscle activity are shown, and what is required is an online form which allows them to:
1. Create an account where they can automatically have filled in their name, phone email etc. which appears as a header and on each page of the form as a footer (perhaps).
2. Fill in the patient name, and basic information like patient ID
3. Make certain the form fill out and generation is done on a secure server and emailed to them password protected with their own password (their last name and last 4 of social perhaps).
4. Answer a series of questions. They are shown for each question three or four graphics which provide examples of normal, moderate and abnormal (perhaps a few more) and they look at the picture, and &ldquo;click&rdquo; on the response below which most closely matches the sample pictures.
5. When done, they click &ldquo;Generate Report&rdquo; which produces a nicely formatted report. There is background information in this report which is &ldquo;canned&rdquo; and can be seen in the example attached.
6. Use a service where they can pay for the use of this form if needed, so this is important.
7. Make certain that the report is then emailed to them securely or set up so they have to download it form a secure https:// location. Include in the pdf filename DynaROM report the doctor last name first and patient first 4 letters of last name and first initial and date.
8. Requires two fields at the bottom for &ldquo;general impression&rdquo; and &ldquo;prognosis&rdquo; which is a text box they can simply fill out with text
9. Be able to upload their signature to this form if possible and/or a logo to go in the report.
There will be around 20 questions, so the form needs to be set up so I can alter it when required, and that this can be done by myself or my office when needed.
Look for readings at markers 1, 3, and 5: Low is normal, moderately high is moderate or chronic, and high is abnormal
Normal Moderate or Chronic Abnormal
Checkbox below for person to select on form which they see above:
o Normal: Patient appears normal and shows no indication of injury
o Moderate: Patient demonstrates moderate injury associated with chronic problem
o Severe: Patient demonstrates abnormal muscle firing indicating guarding response.
Example of report attached: See attachement for PDF of report output example.
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