|
General WNL
|
General Abnormal
• • •
|
|
General Comments
|
|
|
Visual Acuity OD sc
|
Visual Acuity OD cc
|
|
Visual Acuity OS sc
|
Visual Acuity OS cc
|
|
Reading Acuity OD
|
Reading Acuity OS
|
|
Pupils
|
Pupils Comment
|
|
EOM
|
EOM Comment
|
|
Visual Fields
|
Visual Field Comment
|
|
Color vision Normal
|
Color vision abnormal
|
|
Color vision comment
|
IOP OD/OS
/
|
|
Adnexa
• • •
|
Adnexa comment
|
|
Anterior Segment OD WNL
|
|
|
Anterior segment OD Abnormal
|
|
|
Lids, lashes, lacrimal OD
• • •
|
Lids, lashes, lacrimal OD commen
|
|
Sclera/conj OD
• • •
|
Sclera/conj OD comment
|
|
Cornea OD
• • •
|
Cornea OD comment
|
|
Anterior chamber OD
• • •
|
Anterior chamber OD comment
|
|
Iris OD
• • •
|
Iris OD comment
|
|
Lens OD
• • •
|
Lens OD comment
|
|
Anterior vitreous OD
• • •
|
Anterior vitreous OD comment
|
|
Anterior Segment OS WNL
|
|
|
Anterior Segment OS abnormal
|
|
|
Lids,lashes,lacrimal OS
• • •
|
Lids,lashes,lacrimal OS comment
|
|
Sclera/conj OS
• • •
|
Sclera/conj OS comment
|
|
Cornea OS
• • •
|
Cornea OS comment
|
|
Anterior Chamber OS
• • •
|
Anterior Chamber OS comment
|
|
Iris OS
• • •
|
Iris OS comment
|
|
Lens OS
• • •
|
Lens OS comment
|
|
Anterior Vitreous OS
• • •
|
Anterior Vitreous OS comment
|
|
Dilation
• • •
|
|
|
C:D ratio OD
|
C:D ratio OS
|
|
Fundus Exam OD WNL
|
|
|
Fundus OD Abnormal
|
|
|
Optic Disc OD
• • •
|
Optic Disc OD comment
|
|
Macula OD
• • •
|
Macula OD comment
|
|
Peripheral Retina OD
• • •
|
Peripheral Retina OD comment
|
|
Vitreous OD
• • •
|
Vitreous OD comment
|
|
Retinal Vessels OD
• • •
|
Retinal Vessels OD comment
|
|
Fundus Exam OS WNL
|
|
|
Fundus Exam OS abnormal
|
|
|
Optic Disc OS
• • •
|
Optic Disc OS comments
|
|
Macula OS
• • •
|
Macula OS comments
|
|
Peripheral Retina OS
• • •
|
Peripheral Retina OS comments
|
|
Vitreous OS
• • •
|
Vitreous OS comment
|
|
Retinal Vessels OS
• • •
|
Retinal Vessels OS comment
|
|
Keratometry OD
|
Axis OD
|
|
Keratometry OS
|
Axis OS
|
|
Keratometry comment
|
Stereopsis
• • •
|
|
Schirmer's Test
/
|
|
|
HEENT WNL
|
|
|
HEENT Comments
|
HEENT Abnormal
• • •
|
|
Skin WNL
|
|
|
Skin Comments
|
Skin Lesion
|
|
Neck WNL
|
|
|
Neck Comments
|
Neck Abnormal
• • •
|
|
Cardiovascular WNL
|
|
|
Cardiovascular Comments
|
Cardiovascular Abnormal
• • •
|
|
Lungs WNL
|
|
|
Lungs Comments
|
Lungs Abnormal
• • •
|
|
Abdomen WNL
|
|
|
Abdomen Comments
|
Abdomen Abnormal
• • •
|
|
MSK WNL
|
|
|
MSK Comments
|
MSK Abnormal
• • •
|
|
Breasts WNL
|
|
|
Breasts Comments
|
Breasts Abnormal
• • •
|
|
Neuro WNL
|
|
|
Neuro Comments
|
Neuro Abnormal
• • •
|
|
Extremities WNL
|
|
|
Extrem Comments
|
Extrem Abnormal
• • •
|
