Medium

Available on

Apple Android Windows

Allergy and Immunology Patient Questionnaire Mobile App

The Allergy and Immunology Patient Questionnaire mobile app covers Primary Care Physician, Preferred Pharmacy, Birth and Developmental History, Allergy Immunology Related, General, Hospitalization, Surgeries, Vaccination, Social and Emotional History and Exposure, Diet History, Allergies, Family Medical History and Systems Review. This app is easy to use on a mobile device. A GoCanvas account can be specified as being HIPAA compliant. By turning on HIPAA compliance, a number of features that most of users find desirable will be disabled to meet HIPAA Standards. Individual apps in the GoCanvas Application Store can easily be made HIPAA Compliant. If you have any questions or need assistance you can contact our Sales team to help you at Sales@GoCanvas.com. If you would like to enable HIPAA on your GoCanvas account please follow the instructions below: 1. Log onto your Account 2. Click “My Account” in the top right corner of the screen 3. Click “Customize” on the left 4. The third option is for HIPAA Compliance, click “Edit” on the right 5. Check the “Enable HIPAA Compliance” box and select “Save”

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

Want to learn more about GoCanvas?

Request a Demo

Take a peek inside the Allergy and Immunology Patient Questionnaire 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.'}}

  • {{data.title}}

Included Fields

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

  • Ico textbox

    Patient Name

  • Ico date

    Today’s Date

  • Ico date

    Date of Birth

  • Ico integer

    Age

  • Ico dropdown

    Sex

  • Ico multiline

    What is the most important thing that we can help you with today?

  • Ico statictext

    Primary Care Physician: (this physician will receive a copy of your visit notes)

  • Ico textbox

    Name:

  • Ico multiline

    Address:

  • Ico textbox

    Phone Number:

  • Ico textbox

    Fax Number:

  • Ico statictext

    Preferred Pharmacy:

  • Ico textbox

    Name:

  • Ico multiline

    Address:

  • Ico textbox

    Phone Number:

  • Ico statictext

    Birth and Developmental History:

  • Ico dropdown

    Born on Time?

  • Ico textbox

    If no, how early?

  • Ico dropdown

    Severe breathing problems at birth?

  • Ico statictext

    Pediatric patients, please complete remaining birth history.

  • Ico dropdown

    Cradle cap at birth?

  • Ico dropdown

    History of eczema?

  • Ico integer

    If yes, at what age?

  • Ico decimal

    Birth Weight

  • Ico dropdown

    Breast fed?

  • Ico textbox

    If yes, for how long?

  • Ico dropdown

    Bottle Fed?

  • Ico textbox

    If yes, which formula(s)?

  • ...and More!

Related Health Care & Social Services Apps... and they're all free for GoCanvas subscribers!

App Name

New Customer Form

This new customer form mobile app provides simple new customer forms for service based companies such as dry cleaning, law...

App Name

School Injury Report - Simple Version

If you're a staff member at a school the School Injury Report Mobile App is perfect for collecting key accident/injury inf...

App Name

OSHA - Notice of Alleged Safety Viola...

"OSHA inspections for occupational safety can reveal health hazards and even imminent danger. This mobile app for the comp...

App Name

Parking Citation

The Parking Citation mobile app for police departments and parking services professionals makes it possible to generate ne...

App Name

Natural Gas - Pipeline Survey

The Natural Gas Pipeline Survey mobile app was designed specifically for the natural gas industry. Instead of using paper ...

App Name

VA Dem House Race - Political Canvass...

This VA Dem House Race Political Canvassing Form was developed to be an electronic form of a survey sent out by the Virgin...

App Name

Road Construction and Equipment Tracking

The Road Construction and Equipment Tracking mobile app for construction managers and road crews tracks employee time shee...

App Name

Apparel Retail Form

This handy apparel retail form mobile app was built for a mobile retail sales associate or sales assistant. Great for depa...

More Information