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Surgical Consent
General Anesthesia Consent
Surgical Header
Preoperative Diagnosis OD
• • •
Preoperative Diagnosis OS
• • •
Postoperative Diagnosis
• • •
Procedure
• • •
Retrobulbar Anesthesia
Subtenon’s block
Anesthesiologist
Complications
• • •
Specimens
• • •
Report Header
Eye
Retrobulbar Anesthesia
Prep
Subtenon’s block
Scleral Loops
Corneal Epi Debridement
Vitrectomy Phakic
Vitrectomy Pseudophakic
Vitrectomy Phakic 25g
Vitrectomy Pseudophakic 25g
Chandelier
PVD
Prior Vitrectomy
Kenalog
TRD Repair
Hemostasis
Silicone Oil Removal
BBG
ICG
Membrane Peel
PVR Peel
Retinectomy
Degrees of Retinectomy
Subretinal Bands
Retinotomy
Perfluoron
AFE
SRF Drainage
Peritomy for Scleral Fixation
Trocars for Scleral Fixation
Lens Power
Lens Type
Fixation/Closure
Scleral Fixation of Old Lens
Free Text
Focal Retinopexy
PRP
Laser Retinopexy
360 Laser
Endophotocoagulation
Cryopexy
• • •
Scleral Band
Buckle Suturing
External Drainage
Vitreous Substitute
Buckle Closure
Sutures-less
Comments
IOP/Optic Nerve
Close
Retinal Diagram OD
Retinal Diagram OS
Eye Diagram

Surgery Note v7 2021 Medical Form

Ophthalmologist

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Published: Feb. 23, 2021, 6:33 p.m.
Doctor: Dr. History Physical
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Sunnyvale, CA 94089

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