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Surgical Consent
General Anesthesia Consent
Surgical Header
Preoperative Diagnosis OD
• • •
Preoperative Diagnosis OS
• • •
Postoperative Diagnosis
• • •
Procedure
• • •
Subtenon’s block
Retrobulbar Anesthesia
General Anesthesia
Anesthesiologist
Complications
• • •
Specimens
• • •
Report Header
Eye
Retrobulbar Anesthesia
General Anesthesia
Prep
Subtenon’s block
Scleral Loops
Scleral Buckle Revision
Corneal Epi Debridement
Susvimo
Vitrectomy Phakic
Vitrectomy Pseudophakic
Vitrectomy Phakic 25g
Vitrectomy Pseudophakic 25g
Posterior capsulotomy
Chandelier
PVD
Prior Vitrectomy
Kenalog
Vitrector Lensectomy
Phacofragmatome
TRD Repair
Hemostasis
Silicone Oil Removal
BBG
ICG
Membrane Peel
PVR Peel
Retinectomy
Degrees of Retinectomy
Subretinal Bands
Retinotomy
Perfluoron
AFE
SRF Drainage
Old IOL removed - SFIOL
Corneal Incision in Aphakic
Old IOL removed - ACIOL
Peritomy for Scleral Fixation
Trocars for Scleral Fixation
Lens Power
Lens Type
Fixation/Closure
Scleral Fixation of Old Lens
ACIOL
Free Text
Focal
PRP
Laser Retinopexy
360 Laser
Endophotocoagulation
Cryopexy
• • •
Scleral Band
Buckle Suturing
External Drainage
Additional buckle components
Vitreous Substitute
Trocar removal with suture
Trocar removal without suture
Buckle Closure
Peritomy Closure
Sutures-less
Comments
IOP/Optic Nerve
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Retinal Diagram OD
Retinal Diagram OS
Eye Diagram

Surgery Note 11/2/2022 Medical Form

Ophthalmologist

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Published: Nov. 2, 2022, 1:03 p.m.
Doctor: Dr. History Physical
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Sunnyvale, CA 94089

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