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Treatment Form

I run a LASIK surgery center. We have a treatment form that we require referring doctors to complete and send to us for every patient that we treat. I'm having trouble getting doctors to complete the entire form, so what I would like to do is have someone build our EXACT form electronically and make it so doctors cannot submit the form to us without every data field required being completed. it would be great if they could also electronically sign the form stating that the data is accurate and complete.

Kỹ năng: Lập trình C, Electronic Forms, Y khoa

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Về Bên Thuê:
( 0 nhận xét ) United States

Mã Dự Án: #1657357

12 freelancer đang chào giá trung bình $195 cho công việc này

scribblerspk

I am interested doing your project, for more details kindly see your mail box. Thanks, Faisal.

$250 USD trong 20 ngày
(3 Đánh Giá)
4.6
travelerbd

Want to delivery a quality work with reduced [url removed, login to view] PM for sample form. Thanks.

$50 USD trong 4 ngày
(4 Đánh Giá)
3.3
HardWorker1989

Hello Dear Sir / Ma'am. I am a highly qualified & certified Adobe Acrobat , Adobe LiveCycle Form Designer and MS OFFICE professional with more than 4 years of teaching experience for these softwares in an institute. Thêm

$60 USD trong 0 ngày
(9 Đánh Giá)
3.2
vkbansallx

hi this is a long form. it is not clear whether doctors have to fill all the fields or their are some alternate fields , i.e., doctors must fill either of them , e.g. LEFT EYE Sphere Cylinder Axis Date will a d Thêm

$250 USD trong 30 ngày
(0 Đánh Giá)
0.0
techfreelancer1

Please check PMB

$250 USD trong 5 ngày
(0 Đánh Giá)
0.0
bpreeya22

plz check you PM.

$250 USD trong 10 ngày
(0 Đánh Giá)
0.0
teamvalid

Hi there! I can get the job done for you in a matter of day. The only thing I need to is if you want the form electronically on the web(online) or you need it as an application that's executable on a click on any Windo Thêm

$200 USD trong 1 ngày
(0 Đánh Giá)
3.6
X7K0I8juF

Custom software development - <b><i>Removed by Admin</i></b>

$250 USD trong 1 ngày
(0 Đánh Giá)
0.0
alexanderonline

Greetings, I assume that you have a web-site with database. I have done a lot of similar tasks using various technologies (PHP, .NET, ColdFusion) so I think I can easily do the job for you. If you'd prefer a l Thêm

$500 USD trong 7 ngày
(0 Đánh Giá)
0.0
chetanparekh19

Expert in software development. Hope have a great business together.

$175 USD trong 2 ngày
(0 Đánh Giá)
0.0
socialGaurav

I have created a demo of your form. Please check your PMB for details

$150 USD trong 5 ngày
(0 Đánh Giá)
0.0
adaschevici

Hello. I can have this built electronically and validation of the form when the doctor tries to submit it. Check pmb for questions. Regards, -Arthur

$150 USD trong 4 ngày
(0 Đánh Giá)
0.0
sanjaygarai

I can do [url removed, login to view] check pm for details.

$60 USD trong 1 ngày
(0 Đánh Giá)
0.0