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<\/head>\n<body>\n\n<div id=\"pdf-wrapper\" style=\"background-color: #fff; color: #000; padding: 20px; margin: 0 auto; max-width: 800px; min-height: 100vh; box-sizing: border-box;\">\n <h2 class=\"mb-4\">Formulaire de sortie du patient – Summit Health<\/h2>\n\n <div class=\"mb-3\">\n <label for=\"patientName\" class=\"form-label\"><strong>Nom complet du patient<\/strong><\/label>\n <input type=\"text\" class=\"form-control\" id=\"patientName\" placeholder=\"Entrez le nom complet\">\n <\/div>\n\n <div class=\"mb-3\">\n <label for=\"dischargeDate\" class=\"form-label\"><strong>Date<\/strong><\/label>\n <input type=\"date\" class=\"form-control\" id=\"dischargeDate\">\n <\/div>\n\n <div id=\"dischargeSection\" style=\"display: block;\">\n <p><strong>Reconnaissance de la sortie<\/strong><\/p>\n <ul>\n <li>Je reconnais avoir choisi de quitter la clinique avant la fin de la p\u00e9riode de surveillance post-infusion recommand\u00e9e. 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 relatedObjectId from URL\n const urlParams = new URLSearchParams(window.location.search);\n const relatedObjectId = urlParams.get(\"relatedObjectId\");\n\n \/\/ Validate relatedObjectId\n if (!relatedObjectId) {\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 relatedObjectId 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\"; });\n\n document.getElementById(\"clearSignature\").addEventListener(\"click\", () => {\n signaturePad.clear();\n });\n\n document.getElementById(\"submitForm\").addEventListener(\"click\", () => {\n const name = document.getElementById(\"patientName\").value.trim();\n const date = document.getElementById(\"dischargeDate\").value;\n\n if (!name || !date || signaturePad.isEmpty()) {\n alert(\"Veuillez remplir tous les champs et signer avant de soumettre.\");\n return;\n }\n\n const consentCheckbox = document.getElementById(\"consentCheckbox\");\n if (!consentCheckbox.checked) {\n alert(\"Veuillez confirmer que vous avez lu et acceptez les termes avant de soumettre.\");\n return;\n }\n\n const estDate = new Date().toLocaleString(\"en-CA\", { timeZone: \"America\/Toronto\" });\n const browserInfo = navigator.userAgent;\n\n const metaDiv = document.getElementById(\"signatureMetadata\");\n metaDiv.innerText = `Sign\u00e9 le ${estDate} (HNE)\\nNavigateur : ${browserInfo}\\nIP : ${userIP}`;\n\n const signature = signaturePad.toDataURL();\n\n \/\/ Convert canvas to image\n const signatureImg = new Image();\n signatureImg.src = signature;\n signatureImg.style.width = '100%';\n signatureImg.style.maxWidth = '600px';\n\n \/\/ Replace canvas with static image before PDF\n const canvasEl = document.getElementById(\"signature-pad\");\n canvasEl.parentNode.replaceChild(signatureImg, canvasEl);\n\n document.getElementById(\"submitForm\").style.display = \"none\";\n document.getElementById(\"clearSignature\").style.display = \"none\";\n document.getElementById(\"successMessage\").style.display = \"none\";\n document.getElementById(\"errorMessage\").style.display = \"none\";\n\n const wrapper = document.getElementById(\"pdf-wrapper\");\n wrapper.style.display = \"block\";\n wrapper.style.visibility = \"visible\";\n wrapper.style.position = \"relative\";\n\n function generatePdfAndUpload() {\n requestAnimationFrame(() => {\n html2pdf()\n .set({\n margin: 10,\n filename: `Discharge - ${name}.pdf`,\n image: { type: 'jpeg', quality: 0.98 },\n html2canvas: {\n scale: 1.5,\n useCORS: true,\n logging: true,\n scrollY: 0\n },\n jsPDF: { unit: 'mm', format: 'a4', orientation: 'portrait' }\n })\n .from(wrapper)\n .toPdf()\n .get('pdf')\n .then((pdf) => {\n const total = pdf.internal.getNumberOfPages();\n if (total > 1) {\n for (let i = 1; i <= total; i++) {\n pdf.setPage(i);\n pdf.setFontSize(10);\n const pageSize = pdf.internal.pageSize;\n const x = pageSize.getWidth() - 5;\n const y = pageSize.getHeight() - 5;\n pdf.text(`Page ${i} de ${total}`, x, y, { align: 'right' });\n }\n }\n return pdf.output('blob');\n })\n .then((pdfBlob) => {\n \/\/ Upload first, then download\n const reader = new FileReader();\n reader.onloadend = function () {\n const base64PDF = reader.result.split(',')[1];\n const payload = {\n formType: \"discharge\",\n base64PDF,\n fileName: `Discharge - ${name}.pdf`,\n relatedId: relatedObjectId\n };\n\n fetch(\"https:\/\/api.summittravelhealthdev.com\/v1\/pdf\/uploadPatientAgreementForm\", {\n method: \"POST\",\n headers: { \"Content-Type\": \"application\/json\" },\n body: JSON.stringify(payload),\n })\n .then(response => {\n if (!response.ok) throw new Error(\"Upload failed\");\n return response.json();\n })\n .then(data => {\n console.log(\"Uploaded to backend:\", data);\n document.getElementById(\"successMessage\").style.display = \"block\";\n\n \/\/ Save locally AFTER successful upload\n if (typeof saveAs !== \"undefined\") {\n saveAs(pdfBlob, `Discharge - ${name}.pdf`);\n } else {\n const url = URL.createObjectURL(pdfBlob);\n const a = document.createElement(\"a\");\n a.href = url;\n a.download = `Discharge - ${name}.pdf`;\n document.body.appendChild(a);\n a.click();\n document.body.removeChild(a);\n URL.revokeObjectURL(url);\n }\n })\n .catch(err => {\n console.error(err);\n document.getElementById(\"errorMessage\").style.display = \"block\";\n });\n };\n reader.readAsDataURL(pdfBlob);\n })\n .catch(error => {\n console.error(\"PDF generation failed:\", error);\n document.getElementById(\"errorMessage\").style.display = \"block\";\n });\n });\n }\n\n if (signatureImg.complete) {\n generatePdfAndUpload();\n } else {\n signatureImg.onload = generatePdfAndUpload;\n }\n });\n\/\/ FileSaver.js for saveAs\n<\/script>\n<script src=\"https:\/\/cdnjs.cloudflare.com\/ajax\/libs\/FileSaver.js\/2.0.5\/FileSaver.min.js\"><\/script>\n\n<\/body>\n<\/html>\n","protected":false},"excerpt":{"rendered":"<p>Formulaire de sortie du patient – Summit Health Formulaire de sortie du patient – Summit Health Nom complet du patient Date Reconnaissance de la sortie … <a title=\"Formulaire de consentement de sortie pour perfusion\" class=\"read-more\" href=\"https:\/\/summithealth.ca\/fr\/formulaire-de-consentement-de-sortie-pour-perfusion\/\" aria-label=\"En savoir plus sur Formulaire de consentement de sortie pour perfusion\">Lire plus<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-2087","page","type-page","status-publish"],"yoast_head":"\n<title>Formulaire de consentement de sortie pour perfusion - Summit Health<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/summithealth.ca\/fr\/formulaire-de-consentement-de-sortie-pour-perfusion\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Formulaire de consentement de sortie pour perfusion - Summit Health\" \/>\n<meta property=\"og:description\" content=\"Formulaire de sortie du patient – Summit Health Formulaire de sortie du patient – Summit Health Nom complet du patient Date Reconnaissance de la sortie ... 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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":"2025-08-11T12:29:03","modified_gmt":"2025-08-11T12:29:03","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<\/head>\n<body>\n\n<div id=\"pdf-wrapper\" style=\"background-color: #fff; color: #000; padding: 20px; margin: 0 auto; max-width: 800px; min-height: 100vh; box-sizing: border-box;\">\n <h2 class=\"mb-4\">Formulaire de sortie du patient – Summit Health<\/h2>\n\n <div class=\"mb-3\">\n <label for=\"patientName\" class=\"form-label\"><strong>Nom complet du patient<\/strong><\/label>\n <input type=\"text\" class=\"form-control\" id=\"patientName\" placeholder=\"Entrez le nom complet\">\n <\/div>\n\n <div class=\"mb-3\">\n <label for=\"dischargeDate\" class=\"form-label\"><strong>Date<\/strong><\/label>\n <input type=\"date\" class=\"form-control\" id=\"dischargeDate\">\n <\/div>\n\n <div id=\"dischargeSection\" style=\"display: block;\">\n <p><strong>Reconnaissance de la sortie<\/strong><\/p>\n <ul>\n <li>Je reconnais avoir choisi de quitter la clinique avant la fin de la p\u00e9riode de surveillance post-infusion recommand\u00e9e. 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 relatedObjectId from URL\n const urlParams = new URLSearchParams(window.location.search);\n const relatedObjectId = urlParams.get(\"relatedObjectId\");\n\n \/\/ Validate relatedObjectId\n if (!relatedObjectId) {\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 relatedObjectId 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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