|
Op Note?
|
|
|
Conj Cautery
|
|
|
LPI?
|
|
|
SLT?
|
|
|
SK?
|
|
|
|
|
|
OD
|
OS
|
|
Date of Procedure
|
|
|
Diagnosis for Procedure (OD)
|
Diagnosis for Procedure (OS)
|
|
Diagnosis Freewrite
|
|
|
Conj Cautery indication
|
Conj Cautery Procedure Description
|
|
LPI Indication
|
LPI Procedure Descrption
|
|
SLT Indication
|
SLT Procedure Descrption
|
|
epithelial debridement indication
|
Epithelial Debridement Procedure Description
|
|
Energy (mJ)
|
|
|
Total pulses
|
|
|
Total Energy (mJ)
|
|
|
|
|
|
LPI Postop Drops
|
SLT Postop Drops
|
|
Comments
|
|
|
Signature
|
|
