Operation Planed : __________________________________________
Pre Surgery Medication
Pre Surgery Tropical Plus Eye Drop
(Drop Every 10 Minutes 2 Times)
Post Surgery :
Moxiroot Eye Drop
Idylon Eye Drop
Amfinac OD Eye Drop
Medication Order
Pre Surgery Tropical Plus Eye Drop
(Drop Every 10 Minutes 2 Times)
Date & Time ______________________
Date & Time ______________________
Medical History __PAC_MEDICAL_HISTORY__
O/E - General Condition - Mod / Fair / Poor
Type of Anesthesia – MAC / LA / Sedation / GA without ETT / GA with ETT
O/E - General Condition - Mod / Fair / Poor
Remark
Patient Is Fit For Discharge