Termination of Pregnancy Request Form

Merge Document for Vision

The template document for a Termination of Pregnancy Request Form TOPFORM.doc can be downloaded from the Vision website, and should be copied to p:\wordproc\template. It is in Word 97 format.

It is based on the standard termination request form, and features fill fields, merge fields, check boxes and drop down selection fields.

The information required to complete the form is as follows

Name and qualifications of two referring practitioners

Addresses of the practitioners

Address where patient seen

Date patient seen

Patient name and address (this is merged automatically from referral screen)

To use the template

1. Complete the Referral Maintenance screen, then click the letter icon.
2. Select the document TOPFORM.doc from the list displayed.
3. On first use, you may encounter a dialogue box headed Open Data Source. See Open Data Source error when opening Word templates on how to deal with this before proceeding.
4. After a few seconds the word document displays on screen and you will be prompted for the details of the first practitioner. Type the details into this box. Do not press Enter. Click OK when complete.
5. You will now be prompted for the address of the first practitioner. Again, type in the details all on one line. Do not press Enter. Click OK when complete.
6. Continue in this way until all the "fill fields" have been completed. The screen will now display as illustrated below.
7. You may need to display the Forms Toolbar: From the main menu, select View, Toolbars and ensure Forms has a tick beside it.
8. Before you can select from the drop down fields, you need to press the Protect Form icon . Click in the Click to Select field for a drop down list from you can select:
9. The patient’s name and address details have been merged from their record.
10. Scroll down the screen, to the next section and click in the box next to the appropriate paragraph.
11. Click Protect Form again to switch the form protection off again.
12. Check the document for accuracy, amend if required then print as usual - the document has to be printed for signature.
13. Save and exit.