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Hepatitis C Report - Department of Health (New Jersey) Mobile App

This mobile application is tailored to help healthcare professionals quickly report information regarding Hepatitis C test results. Enter specific data such as Screening, Liver Function, and Confirmatory test results. Provide physician details and submit report instantly.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Hepatitis C Report - Department of Health (New Jersey) Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico date

    Date

  • Ico textbox

    CDRSS ID No.

  • Ico textbox

    Name (last)

  • Ico textbox

    First Name

  • Ico textbox

    Middle Name

  • Ico textbox

    Sex

  • Ico date

    Date of Birth

  • Ico textbox

    Street Address

  • Ico textbox

    City

  • Ico dropdown

    Select State

  • Ico integer

    Zip

  • Ico textbox

    Telephone Number

  • Ico textbox

    County

  • Ico dropdown

    Select Race

  • Ico dropdown

    Ethnicity

  • Ico textbox

    Reporting Physician

  • Ico multiline

    Address

  • Ico textbox

    Telephone Number

  • Ico textbox

    Hospital

  • Ico multiline

    Address

  • Ico textbox

    Telephone Number

  • Ico date

    Date of Diagnosis

  • Ico date

    Onset Date of Illness

  • Ico dropdown

    Status

  • Ico dropdown

    Deceased?

  • Ico dropdown

    Is patient symptomatic?

  • Ico textbox

    If yes, what were symptoms?

  • Ico statictext

    Screening Test: Enzyme Immunoassay (EIA)*** or Enzyme

  • ...and More!

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More Information


  • Creator: Team GoCanvas
  • Language: English
  • Country: United States of America
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