|
Contact Lens Followup
|
Glasses Check
|
|
Contact Lens
|
Glasses
|
|
OD VA
|
OD Type of Correction
|
|
OS VA
|
OS Type of Correction
|
|
OD CL BRAND
|
OS CL BRAND
|
|
CL CHANGES
|
|
|
New CL Brand
|
|
|
Contact Lens Power OD
|
Add OD
|
|
Contact Lens Power OS
|
Add OS
|
|
GLASS RX
|
|
|
Lensometer Reading:
|
|
|
OLD Glasses RX OD
|
OLD Glass RX OS
|
|
OD New Subjective Refraction:
|
OD VA
|
|
OS New Subjective Refraction:
|
OS VA
|
|
Assessment
|
|
|
Plan
|
|
