Custom Forms

PS Suite format

Several of our primary care clinics use TELUS PS Suites (PSS). FLA Ontario Health Team partners and the Digital Technology Working Group have collaborated in this effort to share existing PSS Custom Forms (.cfm files).

  • Click on the cfm file or zip folder below to download the desired cfm file(s), which can then be imported to PSS Custom Forms. If zip folder contains more than one cfm file, files are listed below folder name.
  • Click on view PDF to see PDF version on source website, if available.

Do you have a PSS Custom Form (.cfm file) to share or update?

Brockville General Hospital (Brockville GH)

Brockville GH Diagnostic Imaging zip folder includes:

  • Bone Density Requisition/Questionnaire  (view PDF)

  • General Radiology-Fluoro Requisition  (view PDF)
  • Mammography Requisition  (view PDF)
  • Ultrasound-Echocardiography Requisition  (view PDF)

Cancer Care Ontario (CCO)

High Risk Ontario Breast Screening Program (OBSP) Requisition cfm file (view PDF)

Kingston Cardiology Associates

Kingston Health Sciences Centre (KHSC) 

Hotel Dieu Hospital site (HDH)

Audiology Referral zip folder  (view PDF)

Breast Imaging Requisition zip folder  (View PDF)

Chronic Pain Clinic Referral zip folder  (view PDF)

Dysphagia Referral zip folder

GI Function Testing Requisition  (view PDF)

Kingston General Hospital site (KGH)

KHSC CT Requisition  (view PDF)

Gastroenterology zip folder includes:

  • KHSC Gastroenterology Direct to Procedure Upper Endoscopy - Dyspepsia May2022.cfm
  • KHSC Gastroenterology Direct to Procedure Upper Endoscopy - GERD May2022.cfm

  • KHSC Gastroenterology Liver Clinic Referral NAFLD Feb2022.cfm

KHSC General Internal Medicine Referral zip folder   (view PDF)

General Surgery Referral zip folder (view PDF)

Kingston MRI

Limestone City Sleep Lab

Lennox & Addington County General Hospital (LACGH) 

Diagnostic Imaging zip folder includes:

Cardiac Diagnostic Services Requisition zip folder  (view PDF)

Perth & Smith Falls District Hospital

Diagnostic Imaging zip folder includes:

  • Ultrasound Request 

  • X-ray Request

Providence Care Hospital (PCH) 

Public Health Ontario

Quinte Health Care  (QHC)

Diagnostic Imaging Requisitions zip folder includes:

RFLA Health Collective

AI Scribe Materials zip folder includes:

  • AI Scribe Stamp (txt file)
  • AI Scribe Email Consent Toolbar (cfm file) - adapted from the current Ocean Email Consent Toolbar
  • AI Scribe reminder to trigger toolbar (srx file)
  • ScribeBerry’s Notice of Privacy Practices (View pdf)
  • Ocean eForm: ScribeBerry – Patient Informed Consent – RFLA Healthcare - search your eForms under View Shared Forms

South East Ontario Addictions & Mental Health Service (AMHS)