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Endocrinology and Diabetes Patient Questionnaire Mobile App

The Endocrinology and Diabetes Patient Questionnaire mobile app should be completed to the best of the patient’s ability. The app covers: general health, chief complaint, physical notes, past medical history, surgeries, immunizations, allergies, habits, medications, social history, family history, illnesses and review of systems. 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
  • Red Bull
  • Mirvac

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Take a peek inside the Endocrinology and Diabetes 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.'}}

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Included Fields

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

  • Ico textbox

    NAME

  • Ico multiline

    ADDRESS

  • Ico textbox

    PRIMARY M.

  • Ico textbox

    REFERRING M.

  • Ico multiline

    M.

  • Ico statictext

    Please answer all questions to the best of your ability.

  • Ico dropdown

    GENERAL HEALTH

  • Ico multiline

    Please state briefly the main problem which prompted you to come and the length of time you have ...

  • Ico multiline

    PHYSICAL NOTES:

  • Ico dropdown

    (Illnesses you have been diagnosed with.

  • Ico checkbox

    YES

  • Ico checkbox

    NO

  • Ico integer

    YEAR

  • Ico integer

    YEAR

  • Ico textbox

    SURGERY

  • Ico checkbox

    FLU

  • Ico checkbox

    HEPATITIS B

  • Ico checkbox

    PNEUMOVAX

  • Ico checkbox

    TETANUS

  • Ico textbox

    ALLERGY

  • Ico textbox

    REACTION

  • Ico statictext

    ALLERGIES: (LIST DRUGS OR SUBSTANCES TO WHICH YOU ARE ALLERGIC AND SPECIFY TYPE OF REACTION i.

  • Ico dropdown

    HABIT

  • Ico checkbox

    YES

  • Ico checkbox

    NO

  • Ico textbox

    HOW MUCH (PER DAY/ WEEK)

  • Ico textbox

    PAST USE

  • Ico textbox

    MEDICATION

  • ...and More!

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