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Page last modified 04:48, 4 Jan 2008 by Graham
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Synapse Developer > Documentation Index > PDF Forms - Shared > PDF Forms - New Zealand > Humira Declaration

Humira Declaration

From $1

Table of contents
  1. 1. Native Offsets
  2. 2. PNG Image
  3. 3. EPS Image
  4. 4. Layout

Prescriber and Patient declaration form which needs to be witnessed.

Native Offsets

TopLeft 11x27    BottomRight 223x340

PNG Image

TopLeft 44x108  BottomRight 892x1360

EPS Image

TopLeft 26x768  Bottomright 552x36 

Layout

pagesize A4
at 48x177 field 40 (surnamefld/text)
at 140x177 field (40) (fnamesfld/text)
at 49x190 field 8 (cms1500-3-2/text) 
at 60x190 field 8 (cms1500-3-1/text)
at 72x190 field 15 (cms1500-3-3/text)
at 100x190 check data (1 = cms1500-3-4/picked)
at 126x190 check data (2 = cms1500-3-4/picked)
at 161x190 field 40 (ssnfld/text)
at 180x200 field 20 (form now/date )
at 56x259 field 40 (config/doctor)
at 180x255 field 20 (form now/date)
at 180x293 field 20 (form now/date)




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Attach file or image
Files (2)
FileSizeDateAttached by 
 SA0812-declaration.pdf
PDF version of declaration form (original)
4.41 kB04:45, 4 Jan 2008GrahamActions
 sa0812-declaration.eps
EPS version of declaration form
133.21 kB04:45, 4 Jan 2008GrahamActions
Images (1)
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Viewing 1 - 1 of 1 images | View All
PNG version of declaration form
PNG version of declaration form
sa0812-de...  Actions
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