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Ocular History
Ocular History
Goals
Goals
Current Low Vision Devices
Current LV Devices
Current Glasses
Current Glasses
Distance VA s Rx:
Distance VA s Rx
Near VA s Rx:
Near VA s Rx
Distance VA c Current Rx:
Distance VA c Current Rx
Near VA c Current Rx:
Near VA c Current Rx
Distance VA c Current LV Device:
Distance VA c Current LV Device
Near VA c Current LV Device:
Near VA c Current LV Device
Manifest Refraction:
Manifest Refraction
Contrast Sensitivity
Contrast Sensitivity
PRL:
PRL
Reading Cognition:
Reading Cognition
Assessment
Assessment
Plan
Plan
Minutes
John Stuart, Jr., OD

Low Vision Assessment Medical Form

Optometrist

Stuart Low Vision Center

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Published: April 4, 2023, 5:22 p.m.
Doctor: Dr. History Physical
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