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Je comprends les risques potentiels et d\u00e9charge Summit Health de toute responsabilit\u00e9 en cas de r\u00e9action retard\u00e9e ou de complication apr\u00e8s mon d\u00e9part.<\/li>\n <\/ul>\n <\/div>\n\n <div class=\"form-check mb-3\">\n <input class=\"form-check-input\" type=\"checkbox\" value=\"\" id=\"consentCheckbox\">\n <label class=\"form-check-label\" for=\"consentCheckbox\">\n Je confirme avoir lu et compris les informations ci-dessus et j\u2019accepte les termes et conditions.\n <\/label>\n <\/div>\n\n <div class=\"mb-3\">\n <label class=\"form-label\"><strong>Signature<\/strong><\/label><br>\n <canvas id=\"signature-pad\"><\/canvas><br>\n <button class=\"btn btn-secondary mt-2\" id=\"clearSignature\">Effacer la signature<\/button>\n <\/div>\n\n <div id=\"signatureMetadata\" class=\"mb-3\" style=\"font-size: 12px; color: #555;\"><\/div>\n\n <button class=\"btn btn-primary\" id=\"submitForm\">Soumettre le formulaire<\/button>\n\n <div class=\"alert alert-success mt-3\" style=\"display: none;\" id=\"successMessage\">\n Le formulaire de consentement a \u00e9t\u00e9 soumis avec succ\u00e8s.\n <\/div>\n <div class=\"alert alert-danger mt-3\" style=\"display: none;\" id=\"errorMessage\">\n Une erreur s’est produite lors de la soumission du formulaire. 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{"id":2087,"date":"2025-06-26T20:15:13","date_gmt":"2025-06-26T20:15:13","guid":{"rendered":"https:\/\/summithealth.ca\/?page_id=2087"},"modified":"2026-07-09T14:18:32","modified_gmt":"2026-07-09T14:18:32","slug":"formulaire-de-consentement-de-sortie-pour-perfusion","status":"publish","type":"page","link":"https:\/\/summithealth.ca\/fr\/formulaire-de-consentement-de-sortie-pour-perfusion\/","title":{"rendered":"Formulaire de consentement de sortie pour perfusion"},"content":{"rendered":"\n\n\n\n \n Formulaire de sortie du patient – Summit Health<\/title>\n <meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0\">\n <link href=\"https:\/\/cdn.jsdelivr.net\/npm\/bootstrap@5.0.1\/dist\/css\/bootstrap.min.css\" rel=\"stylesheet\">\n <script src=\"https:\/\/cdn.jsdelivr.net\/npm\/signature_pad@4.1.5\/dist\/signature_pad.umd.min.js\"><\/script>\n <script src=\"https:\/\/ajax.googleapis.com\/ajax\/libs\/jquery\/3.6.0\/jquery.min.js\"><\/script>\n <script src=\"https:\/\/cdnjs.cloudflare.com\/ajax\/libs\/html2pdf.js\/0.10.1\/html2pdf.bundle.min.js\"><\/script>\n <style>\n html, body {\n margin: 0;\n padding: 0;\n background: #fff;\n }\n\n * {\n box-sizing: border-box;\n }\n\n body {\n padding: 20px;\n font-family: sans-serif;\n font-size: 14px;\n }\n #signature-pad {\n border: 1px solid #ccc;\n width: 100%;\n max-width: 600px;\n height: 200px;\n }\n canvas {\n touch-action: none;\n display: block;\n }\n <\/style>\n<script>\n(function (root, factory) {\n var api = factory(root);\n\n if (typeof module === \"object\" && module.exports) {\n module.exports = api;\n }\n\n root.SummitQuestionnaireV2 = api;\n\n \/\/ Expose helper functions as globals so legacy HTML call sites that reference them\n \/\/ by bare name (e.g. `resolvePublicApiBase(...)`) keep working after the helper is\n \/\/ inlined into the page. 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Je comprends les risques potentiels et d\u00e9charge Summit Health de toute responsabilit\u00e9 en cas de r\u00e9action retard\u00e9e ou de complication apr\u00e8s mon d\u00e9part.<\/li>\n <\/ul>\n <\/div>\n\n <div class=\"form-check mb-3\">\n <input class=\"form-check-input\" type=\"checkbox\" value=\"\" id=\"consentCheckbox\">\n <label class=\"form-check-label\" for=\"consentCheckbox\">\n Je confirme avoir lu et compris les informations ci-dessus et j\u2019accepte les termes et conditions.\n <\/label>\n <\/div>\n\n <div class=\"mb-3\">\n <label class=\"form-label\"><strong>Signature<\/strong><\/label><br>\n <canvas id=\"signature-pad\"><\/canvas><br>\n <button class=\"btn btn-secondary mt-2\" id=\"clearSignature\">Effacer la signature<\/button>\n <\/div>\n\n <div id=\"signatureMetadata\" class=\"mb-3\" style=\"font-size: 12px; color: #555;\"><\/div>\n\n <button class=\"btn btn-primary\" id=\"submitForm\">Soumettre le formulaire<\/button>\n\n <div class=\"alert alert-success mt-3\" style=\"display: none;\" id=\"successMessage\">\n Le formulaire de consentement a \u00e9t\u00e9 soumis avec succ\u00e8s.\n <\/div>\n <div class=\"alert alert-danger mt-3\" style=\"display: none;\" id=\"errorMessage\">\n Une erreur s’est produite lors de la soumission du formulaire. Veuillez en informer votre infirmier(\u00e8re).\n <\/div>\n<\/div>\n\n<script>\n \/\/ Retrieve secure discharge token from URL\n const urlParams = new URLSearchParams(window.location.search);\n const accessToken = urlParams.get(\"accessToken\");\n\n \/\/ Validate secure token\n if (!accessToken) {\n document.getElementById(\"pdf-wrapper\").innerHTML = `\n <div class=\"alert alert-danger\">\n Ce formulaire contient une erreur technique. Veuillez parler \u00e0 votre infirmier(\u00e8re) pour compl\u00e9ter le processus de sortie.\n <\/div>\n `;\n throw new Error(\"Missing accessToken in URL\");\n }\n\n const canvas = document.getElementById(\"signature-pad\");\n const signaturePad = new SignaturePad(canvas);\n\n \/\/ Set today's date as default for dischargeDate\n document.getElementById(\"dischargeDate\").valueAsDate = new Date();\n\n function resizeCanvas() {\n const ratio = Math.max(window.devicePixelRatio || 1, 1);\n canvas.width = canvas.offsetWidth * ratio;\n canvas.height = canvas.offsetHeight * ratio;\n canvas.getContext(\"2d\").scale(ratio, ratio);\n const data = signaturePad.toDataURL();\n signaturePad.clear();\n try { signaturePad.fromDataURL(data); } catch (_) {}\n }\n\n window.addEventListener(\"resize\", resizeCanvas);\n resizeCanvas();\n\n let userIP = \"Fetching...\";\n fetch(\"https:\/\/api.ipify.org?format=json\")\n .then(response => response.json())\n .then(data => { userIP = data.ip; })\n .catch(() => { userIP = \"Unavailable\"; 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