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Orientation
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Routine eye examination
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EOM OD
• • •
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EOM OS
• • •
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Cover Tests
• • •
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Color Vision / Amsler Grid
• • •
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CVF OD
• • •
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CVF OS
• • •
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Pupils: PERRL, APD (-) OD
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Pupils: PERRL, APD (-) OS
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Afferent Pupillary Defect OD
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Afferent Pupillary Defect OS
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Snellen Chart
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Tumbling E's chart
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Visual Acuity SC: OD
• • •
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Visual Acuity (SC): OS
• • •
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VA (CC) OD
• • •
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VA (CC) OS
• • •
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Near vision OD
• • •
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Near Vision OS
• • •
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Refraction OD
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Refraction OS
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Eye Glasses OD/CL
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Eye Glasses/CL OS
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CCT: OD
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CCT: OS
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TMax: OD
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TMax: OS
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Eye Drops
• • •
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Eye drops comments
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IOP Method
• • •
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IOP after DFE
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IOP OD
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IOP OS
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Normal Slit Lamp exam
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SLE title
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SLE Normal
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SLE comment
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Lids/Lashes OD Normal
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Lids/Lashes OS Normal
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Lid and Lashes OD
• • •
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Lid location OD
• • •
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Lids and Lashes OS
• • •
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Lid location OS
• • •
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Conjunctiva/Sclera Normal OD
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Conjunctiva/Sclera Normal OS
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Conjunctiva/Sclera OD
• • •
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Conjunctiva/Sclera OS
• • •
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Cornea Normal OD
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Cornea Normal OS
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Cornea OD
• • •
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Cornea OS
• • •
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Iris Normal OD
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Iris Normal OS
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Iris OD
• • •
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Iris OS
• • •
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AC OD Normal
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AC OS Normal
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Anterior Chamber OD
• • •
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Anterior Chamber OS
• • •
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Lens Normal OD
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Lens Normal OS
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Lens OD
• • •
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Lens OS
• • •
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Gonioscopy OD
• • •
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Gonioscopy comment OD
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Gonioscopy OS
• • •
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Gonioscopy comment OS
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FUNDUSCOPY title and date
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Dilated
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Fundus Normal
• • •
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DFE comment
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Vitreous Normal OD
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Vitreous Normal OS
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Vitreous OD
• • •
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Vitreous OS
• • •
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Cup to Disc Ratio OD
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Cup to Disc Ratio OS
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Optic Nerve Normal OD
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Optic Nerve Normal OS
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Optic Nerve OD
• • •
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Optic Nerve OS
• • •
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Macula Normal OD
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Macula Normal OS
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Macula OD
• • •
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Macula OS
• • •
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Vessels Normal OD
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Vessels Normal OS
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Vessels OD
• • •
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Vessels OS
• • •
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Periphery Normal OD
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Periphery Normal OS
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Periphery OD
• • •
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Periphery OS
• • •
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Last HVF
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Last OCT
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Last DFE
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Last Gonio
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Addendums
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