DocuVisit

 

 

 


Medical Forms
For
Evaluation & Treatment Documentation Of Patient Visits
In
Doctor's Offices, Clinics, and Emergency Departments

 

DocuVisit Forms contain suggestions and reminders for history, physical exam, lab tests, and treatments. They save time in documentation of the patient's visit.

DocuVisit forms are a continuing work in progress with updates as needed and as additional information is obtained. Suggestions for improvements are accepted. The purpose of DocuVisit is to aid documentation of treatment, increase good evaluation and treatment outcomes, and reduce potential liability. Items found on the forms are not treatment guidelines, but information to consider. Individual patient evaluation and treatment always depend on the physician's decisions.

 

Contact Us

 

DocuVisit Forms Color Codes
Yellow  Diagnostics
             Additional Needs

Blue     Medications
             Treatments
             Procedures

Red      Differential Diagnoses

Green
   Diagnoses
             Disposition

ADDITIONAL INFORMATION
(a) Page 2 is to be printed on the back of Page 1.
(b) Chem B/C is for B-basic or C-comprehensive chemistry panel. Also referred to as Chem 7 or chem 12 or chem 14.

 

 

 

INTRODUCTORY PRICE
$175 FOR AN INITIAL YEAR LICENSE
SUBSEQUENT YEARLY LICENSE RENEWALS REQUIRED
(Currently $75/yearly renewals)

Purchase  License
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License Fee includes all future forms added to this site during your license term.
Obtain your license now and avoid the price increases.
Future forms are planned in electronic format allowing completion on the computer.

Forms are in pdf format and can be opened and viewed on your computer
 or
printed, completed during patient visit and filed as a medical record.
(acrobat reader required).

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PayPal and Credit Cards

A license is required to use DocuVisit forms

Purchase  License
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CURRENTLY, MORE FORMS ARE BEING ADDED ! !

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NOTICE

A LICENSE IS REQUIRED FOR USE OF DOCUVISIT FORMS.  THE FORMS ARE CURRENTLY AVAILABLE FOR VIEWING AND DOWNLOADING BUT AN INDIVIDUAL LICENSE IS REQUIRED TO USE THE FORMS.  EVERY PHYSICIAN USING THESE FORMS MUST HAVE THEIR UNIQUE INDIVIDUAL LICENSE NUMBER.

View  License Agreement

CURRENT LIMITED TIME
INTRODUCTORY OFFER
$175 FOR AN INITIAL LICENSE
(Subsequent yearly license fee required)
Currently $75/yearly renewal fee

REGULAR PRICE
$275 FOR AN INITIAL YEAR LICENSE
(Subsequent yearly license fee required)
$149 yearly renewal fee


Purchase  License

PayPal and Credit Cards
 


License Renewal

PayPal and Credit Cards

 

 

 

FORMS AVAILABLE NOW
(Click filename to view samples

Chest Pain --- (CP001/V1.0/March 1, 2008) VIEW SAMPLE

Abdominal Pain --- (AP001/V1.0/March 1, 2008)

Nausea and Vomiting (Adult) --- (NV001/V1.0/March 1, 2008)

Headache --- (HA001/V1.0/March 1, 2008)

Supplemental Form - Past History / Family History / Review of Systems --- (RS001/V1.0/March 1, 2008)

Supplemental Form - Visit History --- (VV001/V1.0/March 1, 2008)

Supplemental Forms - Medication Data --- (MD001/V1.0/March 1, 2008)

EKG Interpretation Form --- (EK001/V1.0/March 1, 2008)

 

 

FORMS PENDING
(subject to change)

Dyspnea (COPD/Asthma/CHF)  --- (DY001/V1.0/March 1, 2008)

Constipation / Diarrhea

GI Bleeding

Scrotal Pain / Swelling / Mass

Jaundice

Vaginal Bleeding / Menstrual Dysfunction

Rash / Allergy

UTI / Hematuria / Urethral Discharge

Hypertension

Arrhythmia

Diabetes

Syncope / Fainting / Dizzy / Vertigo

CVA / TIA / Weakness / Altered Mental Status

Earache

Fever

Nosebleed

Sore Throat

Back Pain

Seizure

Cough

Eye (Foreign body / Pain / Visual Changes)

MVA

Extremity Injury / Pain

Psychiatric / Overdose

Trauma

Lacerations

Animal Bite

Toothache

Cellulitis

Vomiting (Pediatric)

Burns

Falls

Head Injury

Chest Injury

Disease Follow Up Guidelines Forms

Instructions / Treatment Plans Form

Order Sheet

Radiology Interpretation

Telephone Message / Report

Laboratory Report

Follow Up / Call Backs

Medical Notes

Not Available Yet
Download Zip File of all Forms
Not Available Yet

Creation Date:  September 1, 2008

 

 

THE INCREDIBLE MEDICAL SCHOOL

HYPERTENSION MEDICATIONS

DOCUVISIT

HEALTHCARE POLICIES, PROCEDURES, AND FORMS

PEDIATRIC CRITICAL CARE

ANATOMICAL MODELS

ANATOMICAL CHARTS

ONLINE MEDICAL VIDEOS

MEDICAL EDUCATIONAL VIDEOS

 

Starr Vision Productions, Inc., 2142 Riverside Drive, West Columbia, TX 77486

 

 


Users of DocuVisit
Forms Agree to the following

License Agreement

This License Agreement (this "Agreement") is made effective as of first date of use by the User of DocuVisit Forms (the "Effective Date") between Starr Vision Productions, 2142 Riverside Drive, West Columbia, Texas, USA 77486 ("Licensor") and User of DocuVisit Forms ("Licensee").

In consideration of the mutual promises contained herein and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows:

I. Content of Licensed Materials; Grant of License

The materials that are the subject of this Agreement shall consist of printed and electronic information published or otherwise made available by Licensor (hereinafter referred to as the "Licensed Materials").

Licensee and its Authorized Users acknowledge that the copyright and title to the Licensed Materials and any trademarks or service marks relating thereto remain with Licensor and/or its suppliers. Neither Licensee nor its Authorized Users shall have right, title or interest in the Licensed Materials except as expressly set forth in this Agreement.

Licensor hereby grants to Licensee non-exclusive use of the Licensed Materials and the right to provide the Licensed Materials to Authorized Users in accordance with this Agreement.

II. Delivery/Access of Licensed Materials to Licensee

Licensor will provide the Licensed Materials to the Licensee in some of the following manners:

Network Access. The Licensed Materials will be stored at one or more Licensor locations in digital form accessible by telecommunications links between such locations and authorized networks of Licensee.

Physical Media. Copies of the Licensed Materials will be provided to the Licensee on physical media (e.g., Digital Video Disk, CD-ROM, digital tape) for use on Licensee's network and workstations.

File Transfer. Copies of the Licensed Materials will be provided to the Licensee through electronic transfer (by means of File Transfer Protocol or otherwise).

III. Fees

Licensee shall make payment to Licensor for use of the Licensed Materials pursuant to the following terms:
Payment to Licensor shall be the current price provided by Licensor and for the length of time provided by Licensor.
Payment shall be made prior to use of the Licensed Materials.
Licensor shall provide the Licensee a License ID which must be entered by Licensee on all Licensed Materials used by Licensee.

Users of DocuVisit Forms without a valid License ID agree to pay Licensor a sum of not less than $10,000 per form used and to cease use of any DocuVisit Forms.

 

IV. Authorized Use of Licensed Materials

Authorized Users. "Authorized Users" are:

Licensee. Only those individuals licensed to use DocuVisit are authorized to use DocuVisit.

Authorized Uses. Licensee and Authorized Users may make all use of the Licensed Materials as is consistent with the Fair Use Provisions of United States and international law. Nothing in this Agreement is intended to limit in any way whatsoever Licensee's or any Authorized User's rights under the Fair Use provisions of United States or international law to use the Licensed Materials.

The Licensed Materials may be used for purposes of research, education or other non-commercial use as follows:

Display. Licensee and Authorized Users shall have the right to electronically display the Licensed Materials.

Digitally Copy. Licensee and Authorized Users may download and digitally copy a reasonable portion of the Licensed Materials.

Print Copy. Licensee and Authorized Users may print a reasonable portion of the Licensed Materials.

Archival/Backup Copy. Upon request of Licensee, Licensee may receive from Licensor and/or create one (1) copy of the entire set of Licensed Materials to be maintained as a backup or archival copy during the term of this Agreement or as required to exercise Licensee's rights under Section XIII, "Perpetual License", of this Agreement.

Course Packs. Licensee and Authorized Users may use a reasonable portion of the Licensed Materials in the preparation of Course Packs or other educational materials.

Electronic Reserve. Licensee and Authorized Users may use a reasonable portion of the Licensed Materials for use in connection with specific courses of instruction offered by Licensee and/or its parent institution.

Databases. If the Licensed Materials are a database, compilation, or collection of information, Authorized Users shall be permitted to extract or use information contained in the database for educational, scientific, or research purposes, including extraction and manipulation of information for the purpose of illustration, explanation, example, comment, criticism, teaching, research, or analysis.

Electronic Links. Licensee may provide electronic links to the Licensed Materials from Licensee's web page(s), and is encouraged to do so in ways that will increase the usefulness of the Licensed Materials to Authorized Users. Licensor staff will assist Licensee upon request in creating such links effectively. Licensee may make changes in the appearance of such links and/or in statements accompanying such links as reasonably requested by Licensor.

Caching. Licensee and Authorized Users may make such local digital copies of the Licensed Materials as are necessary to ensure efficient use by Authorized Users by appropriate browser or other software.

Indices. Licensee may use the Licensed Materials in connection with the preparation of or access to integrated indices to the Licensed Materials, including author, article, abstract and keyword indices.

  Scholarly Sharing. Authorized Users may transmit to a third party colleague in hard copy or electronically, minimal, insubstantial amounts of the Licensed Materials for personal use or scholarly, educational, or scientific research or professional use but in no case for re-sale. In addition, Authorized Users have the right to use, with appropriate credit, figures, tables and brief excerpts from the Licensed Materials in the Authorized User's own scientific, scholarly and educational works.

Interlibrary Loan. Licensee may fulfill requests from other institutions, a practice commonly called Interlibrary Loan. Licensee agrees to fulfill such requests in compliance with Section 108 of the United States Copyright Law (17 USC 108, "Limitations on exclusive rights: Reproduction by libraries and archives") and clause 3 of the Guidelines for the Proviso of Subsection 108(g)(2) prepared by the National Commission on New Technological Uses of Copyrighted Works.

V. Access by and Authentication of Authorized Users

Licensee and its Authorized Users may be granted access to the Licensed Materials pursuant to the following:

IP Addresses. Authorized Users shall be identified and authenticated by the use of Internet Protocol ("IP") addresses provided by Licensee to Licensor.

Passwords. Authorized Users shall be identified and authenticated by the use of usernames and passwords assigned by Licensee. Licensee shall be responsible for issuing and terminating passwords, verifying the status of Authorized Users, providing lists of valid passwords to Licensor and updating such lists on a regular basis.

Public keys/Certificates. Authorized Users shall be identified and authenticated by means of public-key and X.509 certificates.

Developing Protocols. Authorized Users shall be identified and authenticated by such means and protocols as may be developed during the term of this Agreement.

VI. Specific Restrictions on Use of Licensed Materials

Unauthorized Use. Except as specifically provided elsewhere in this agreement, Licensee shall not knowingly permit anyone other than Authorized Users to use the Licensed Materials.

Modification of Licensed Materials. Licensee shall not modify or create a derivative work of the Licensed Materials without the prior written permission of Licensor.

Removal of Copyright Notice. Licensee may not remove, obscure or modify any copyright or other notices included in the Licensed Materials.

Commercial Purposes. Other than as specifically permitted in this Agreement, Licensee may not use the Licensed Materials for commercial purposes, including but not limited to the sale of the Licensed Materials or bulk reproduction or distribution of the Licensed Materials in any form.

VII. Licensor Performance Obligations

Availability of Licensed Materials. Within 7 days, Licensor shall make the Licensed Materials available to Licensee and Authorized Users.

Documentation. Licensor will provide and maintain help files and other appropriate user documentation.

Quality of Service. Licensor shall use reasonable efforts to ensure that the Licensor's server or servers have sufficient capacity and rate of connectivity to provide the Licensee and its Authorized Users with a quality of service comparable to current standards in the on-line information provision industry in the Licensee's locale.

Licensor shall use reasonable efforts to provide continuous service with an average of seventy-five percentage up-time per month. The twenty-five percentage down-time includes periodic unavailability due to maintenance of the server(s), the installation or testing of software, the loading of additional Licensed Materials as they become available, and downtime related to the failure of equipment or services outside the control of Licensor, including but not limited to public or private telecommunications services or internet nodes or facilities. Scheduled down-time will be performed at a time to minimize inconvenience to Licensee and its Authorized Users.

If the Licensed Materials fail to operate in conformance with the terms of this Agreement, Licensee shall immediately notify Licensor, and Licensor shall promptly use reasonable efforts to restore access to the Licensed Materials as soon as possible. In the event that Licensor fails to repair the nonconformity in a reasonable time, Licensor shall reimburse Licensee in an amount that the nonconformity is proportional to the total Fees owed by Licensee under this Agreement.

Notification of Modifications of Licensed Materials. Licensee understands that from time to time the Licensed Materials may be added to, modified, or deleted from by Licensor and/or that portions of the Licensed Materials may migrate to other formats.

Completeness of Content. Where applicable, Licensor will inform Licensee of instances where online content differs from the print versions of the Licensed Materials.

Where applicable, Licensor shall use reasonable efforts to ensure that the online content is at least as complete as print versions of the Licensed Materials, represents complete, accurate and timely replications of the corresponding content contained within the print versions of such Materials, and will cooperate with Licensee to identify and correct errors or omissions.

Notice of "Click-Through" License Terms or Other Means of Passive Assent. In the event that Licensor requires Authorized Users to agree to terms relating to the use of the Licensed Materials before permitting Authorized Users to gain access to the Licensed Materials (commonly referred to as "click-through" licenses), or otherwise attempts to impose such terms on Authorized Users through mere use or viewing of the Authorized Materials, Licensor shall provide Licensee with notice of and an opportunity to comment on such terms prior to their implementation. In no event shall such terms materially differ from the provisions of this Agreement. In the event of any conflict between such terms and this Agreement, the terms of this Agreement shall prevail.

Withdrawal of Licensed Materials. Licensor reserves the right to withdraw from the Licensed Materials any item or part of an item for which it no longer retains the right to publish, or which it has reasonable grounds to believe infringes copyright or is defamatory, obscene, unlawful or otherwise objectionable. Licensor shall post online notice of such withdrawal no later than 14 days following the removal of any item pursuant to this section.

VIII. Licensee Performance Obligations

Provision of Notice of License Terms to Authorized Users. Licensee shall make reasonable efforts to provide Authorized Users with appropriate notice of the terms and conditions under which access to the Licensed Materials is granted under this Agreement including, in particular, any limitations on access or use of the Licensed Materials as set forth in this Agreement.

 Protection from Unauthorized Use. Licensee shall be aware of the restrictions on use of the Licensed Materials. In the event of any unauthorized use of the Licensed Materials by an Authorized User, (a) Licensor may terminate such Authorized User's access to the Licensed Materials, (b) Licensor may terminate the access of the Internet Protocol ("IP") address(es) from which such unauthorized use occurred, and/or (c) Licensee may terminate such Authorized User's access to the Licensed Materials upon Licensor's request. Licensor shall take none of the steps described in this paragraph without first providing reasonable notice to Licensee (in no event less than 7 days).

Maintaining Confidentiality of Access Passwords. Where access to the Licensed Materials is to be controlled by use of passwords, Licensee shall issue log-on identification numbers and passwords to each Authorized User and use reasonable efforts to ensure that Authorized Users do not divulge their numbers and passwords to any third party. Licensee shall also maintain the confidentiality of any institutional passwords provided by Licensor.

IX. Mutual Performance Obligations

Confidentiality of User Data. Licensor and Licensee agree to maintain the confidentiality of any data relating to the usage of the Licensed Materials by Licensee and its Authorized Users. Such data may be used solely for purposes directly related to the Licensed Materials and may only be provided to third parties in aggregate form. Raw usage data, including but not limited to information relating to the identity of specific users and/or uses, shall not be provided to any third party.

Implementation of Developing Security Protocols. Licensee and Licensor shall cooperate in the implementation of security and control protocols and procedures as they are developed during the term of this Agreement.

X. Term

This Agreement shall continue in effect for 10 years - commencing on the Effective Date.

XI. Renewal

This Agreement shall be renewable at the end of the current term for a successive 10 year term unless either party gives written notice of its intention not to renew 30 days before expiration of the current term.

XII. Early Termination

In the event that either party believes that the other materially has breached any obligations under this Agreement, or if Licensor believes that Licensee has exceeded the scope of the License, such party shall so notify the breaching party in writing. The breaching party shall have 30 days from the receipt of notice to cure the alleged breach and to notify the non-breaching party in writing that cure has been effected. If the breach is not cured within the 30 days, the non-breaching party shall have the right to terminate the Agreement without further notice.

Upon Termination of this Agreement for cause online access to the Licensed Materials by Licensee and Authorized Users shall be terminated. Authorized copies of Licensed Materials may NOT be retained by Licensee or Authorized Users and may NOT be used subject to the terms of this Agreement.

In the event of early termination permitted by this Agreement, Licensee shall NOT be entitled to a refund of any fees or pro-rata portion thereof paid by Licensee for any remaining period of the Agreement from the date of termination.

 

XIII. Perpetual License

There is no perpetual license to use Licensed Materials. Except for termination for cause, Licensor hereby grants to Licensee a nonexclusive, royalty-free license to use any Licensed Materials during the term of this Agreement. Such use shall be in accordance with the provisions of this Agreement.

XIV. Warranties

Subject to the Limitations set forth elsewhere in this Agreement:

Licensor warrants that it has the right to license the rights granted under this Agreement to use Licensed Materials, that it has obtained any and all necessary permissions from third parties to license the Licensed Materials, and that use of the Licensed Materials by Authorized Users in accordance with the terms of this Agreement shall not infringe the copyright of any third party. The Licensor shall indemnify and hold Licensee and Authorized Users harmless for any losses, claims, damages, awards, penalties, or injuries incurred, including reasonable attorney's fees, which arise from any claim by any third party of an alleged infringement of copyright or any other property right arising out of the use of the Licensed Materials by the Licensee or any Authorized User in accordance with the terms of this Agreement. This indemnity shall survive the termination of this agreement. NO LIMITATION OF LIABILITY SET FORTH ELSEWHERE IN THIS AGREEMENT IS APPLICABLE TO THIS INDEMNIFICATION.

Licensor warrants that the physical medium, if any, on which the Licensed Materials is provided to Licensee will be free from defects for a period of 1 year from delivery.

XV. Limitations on Warranties

Notwithstanding anything else in this Agreement:

Neither party shall be liable for any indirect, special, incidental, punitive or consequential damages, including but not limited to loss of data, business interruption, or loss of profits, arising out of the use of or the inability to use the Licensed Materials.

Licensor makes no representation or warranty, and expressly disclaims any liability with respect to the content of any Licensed Materials, including but not limited to errors or omissions contained therein, libel, infringement of rights of publicity, privacy, trademark rights, moral rights, or the disclosure of confidential information.

Except for the express warranties stated herein, the Licensed Materials are provided on an "as is" basis, and Licensor disclaims any and all other warranties, conditions, or representations (express, implied, oral or written), relating to the Licensed Materials or any part thereof, including, without limitation, any and all implied warranties of quality, performance, merchantability or fitness for a particular purpose. Licensor makes no warranties respecting any harm that may be caused by the transmission of a computer virus, worm, time bomb, logic bomb or other such computer program. Licensor further expressly disclaims any warranty or representation to Authorized Users, or to any third party.

XVI. Indemnities

Each party shall indemnify and hold the other harmless for any losses, claims, damages, awards, penalties, or injuries incurred by any third party, including reasonable attorney's fees, which arise from any alleged breach of such indemnifying party's representations and warranties made under this Agreement, provided that the indemnifying party is promptly notified of any such claims. The indemnifying party shall have the sole right to defend such claims at its own expense. The other party shall provide, at the indemnifying party's expense, such assistance in investigating and defending such claims as the indemnifying party may reasonably request. This indemnity shall survive the termination of this Agreement.

XVII. Assignment and Transfer

Neither party may assign, directly or indirectly, all or part of its rights or obligations under this Agreement without the prior written consent of the other party, which consent shall not be unreasonably withheld or delayed.

XVIII. Governing Law

This Agreement shall be interpreted and construed according to, and governed by, the laws of County of Brazoria, State of Texas, excluding any such laws that might direct the application of the laws of another jurisdiction. The federal or state courts located in Houston, Texas shall have jurisdiction to hear any dispute under this Agreement.

XIX. Dispute Resolution

In the event any dispute or controversy arising out of or relating to this Agreement, the parties agree to exercise their best efforts to resolve the dispute as soon as possible. The parties shall, without delay, continue to perform their respective obligations under this Agreement which are not affected by the dispute.

Mediation. In the event that the parties can not by exercise of their best efforts resolve the dispute, they shall submit the dispute to Mediation. The parties shall, without delay, continue to perform their respective obligations under this Agreement which are not affected by the dispute. The invoking party shall give to the other party written notice of its decision to do so, including a description of the issues subject to the dispute and a proposed resolution thereof. Designated representatives of both parties shall attempt to resolve the dispute within [time period] after such notice. If those designated representatives cannot resolve the dispute, the parties shall meet at a mutually agreeable location and describe the dispute and their respective proposals for resolution to responsible executives of the disputing parties, who shall act in good faith to resolve the dispute. If the dispute is not resolved within 30 days after such meeting, the dispute shall be submitted to binding arbitration in accordance with the Arbitration provision of this Agreement.

Arbitration. Any controversies or disputes arising out of or relating to this Agreement shall be resolved by binding arbitration in accordance with the then current Commercial Arbitration Rules of the American Arbitration Association. The parties shall endeavor to select a mutually acceptable arbitrator knowledgeable about issues relating to the subject matter of this Agreement. In the event the parties are unable to agree to such a selection, each party will select an arbitrator and the arbitrators in turn shall select a third arbitrator. The arbitration shall take place at a location that is reasonably centrally located between the parties, or otherwise mutually agreed upon by the parties.

All documents, materials, and information in the possession of each party that are in any way relevant to the claim(s) or dispute(s) shall be made available to the other party for review and copying no later than 14 days after the notice of arbitration is served.

The arbitrator(s) shall not have the authority, power, or right to alter, change, amend, modify, add, or subtract from any provision of this Agreement or to award punitive damages. The arbitrator shall have the power to issue mandatory orders and restraining orders in connection with the arbitration. The award rendered by the arbitrator shall be final and binding on the parties, and judgment may be entered thereon in any court having jurisdiction. The agreement to arbitration shall be specifically enforceable under prevailing arbitration law. During the continuance of any arbitration proceeding, the parties shall continue to perform their respective obligations under this Agreement.

XX. Force Majeure

Neither party shall be liable in damages or have the right to terminate this Agreement for any delay or default in performing hereunder if such delay or default is caused by conditions beyond its control including, but not limited to Acts of God, Government restrictions (including the denial or cancellation of any export or other necessary license), wars, insurrections and/or any other cause beyond the reasonable control of the party whose performance is affected.

XXI. Entire Agreement

This Agreement constitutes the entire agreement of the parties and supersedes all prior communications, understandings and agreements relating to the subject matter hereof, whether oral or written.

XXII. Amendment

No modification or claimed waiver of any provision of this Agreement shall be valid except by written amendment signed by authorized representatives of Licensor and Licensee.

XXIII. Severability

If any provision or provisions of this Agreement shall be held to be invalid, illegal, unenforceable or in conflict with the law of any jurisdiction, the validity, legality and enforceability of the remaining provisions shall not in any way be affected or impaired thereby.

XXIV. Waiver of Contractual Right

Waiver of any provision herein shall not be deemed a waiver of any other provision herein, nor shall waiver of any breach of this Agreement be construed as a continuing waiver of other breaches of the same or other provisions of this Agreement.

XXV. Notices

All notices given pursuant to this Agreement shall be in writing and may be hand delivered, or shall be deemed received within 14 days after mailing if sent by registered or certified mail, return receipt requested. If any notice is sent by facsimile, confirmation copies must be sent by mail or hand delivery to the specified address. Either party may from time to time change its Notice Address by written notice to the other party.

Version 1.0 (November 28, 2007)