Laser Consent
|
|
Topical Anesthetic
|
Retrobulbar block
|
Grid Laser OD
|
Grid Laser OS
|
PRP Laser OD
|
PRP Laser OS
|
Laser Retinopexy OD
|
Laser Retinopexy OS
|
Cryopexy OD
|
Cryopexy OS
|
Spot Size
|
Laser Lens
|
Laser Power
|
Duration
|
Number of Spots
|
Tolerated?
|
Right Eye Diagram
|
Left Eye Diagram
|
|
|
PDT Consent
|
ABN PDT
|
Treatment Size
|
Visudyne Volume
|
PDT OD
|
PDT OS
|
Tolerated?
|
|