|
Contact Lens Exam
|
Chief Complaint
• • •
|
|
CL Comments
|
|
|
Brand
|
Power OD
|
|
Visual Acuity OD
|
Over Refraction OD
|
|
CL Fit Evaluation / Comments OD
• • •
|
CL Comments
|
|
Brand
|
Power OS
|
|
Visual Acuity OS
|
Over Refraction OS
|
|
Contact Lens Fit Evaluation OS
• • •
|
Cleaning/Storage Solution
|
|
Rewetting Drops (if needed)
|
Replacement Frequency
|
|
Assessment/Plan
• • •
|
Comments
|
|
Contact Lens Warning/Expiration
• • •
|
Misc. Documents
|
