Diagnosis:___________________________________________________________________
Surgery: _____________________________________________________________________
Pre-Surgery Medication/ drops given Frequency/ Intervals Date & Time Signature
Pre-Surgery ¯ TROPICACYL PLUS EYE DROP 1 Drop Every 10 minutes 4 times

Betadine painted around the eye

Name of Nurse: _____________________Sign Of Nurse & Date ___________________
Sr. No. Medication Order Frequency/ Intervals
1 Pre-Surgery ¯ TROPICACYL PLUS EYE DROP 1 Drop Every 10 minutes 4 times
2 Post Surgery ¯ TAB ZOXON,
TAB NAPARA-D(SOS),
MOXIROOT EYE DROP,
IDYLON EYE DROP,
AMFINAC EYE DROP		 AS PER DISCHARGE CARD
Post surgery medicines are also mentioned in Discharge summary given to the patient.
Signature of the Doctor : _______________________________