| |
| Complaints |
|
| Ocular History |
|
| Medical & Other History |
|
|
| Visual Acuity |
RE |
LE |
| |
|
|
| Old Glasses |
|
|
| |
| +1.00 |
+1.00 |
180 |
+2.00 |
| 6/6 |
N6 |
|
| +1.00 |
+1.00 |
180 |
+2.00 |
| 6/6 |
N6 |
|
| Ref. & Glasses |
|
|
| |
| +1.00 |
+1.00 |
180 |
+2.00 |
| 6/6 |
N6 |
|
| +1.00 |
+1.00 |
180 |
+2.00 |
| 6/6 |
N6 |
|
|
| Ocular Examination |
| |
RE |
LE |
| Oc. Movement |
|
|
| Lids |
|
|
| Conjuntiva |
|
|
| Cornea |
|
|
| Ant Chamber |
|
|
| Iris |
|
|
| Pupil |
|
|
| IOP |
|
|
| Lens |
|
|
| NLP |
|
|
|
| |
|
|
| Fundus Drawing |
| Media |
| Optic Disc |
| Macula |
| B.V |
| Periphery |
|
|
|
|
| |
| Investigation |
|
| Diagnosis |
|
| Advice |
|
| Treatment |
|
| Cost Quote |
|
|
| |
|
