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DIABETIC RETINAL EXAM
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Diabetic Retinopathy
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Diabetic Retinal Exam done today
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Update this section when results come in.
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Right Eye - Diabetic Retinopathy Result
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Left Eye - Diabetic Retinopathy Result
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Diabetic Retinopathy Present?
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Macular Edema
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Right Eye - Macular Edema Result
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Left Eye - Macular Edema Result
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Other Findings
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Other (suspect) findings:
• • •
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Other:
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REFERRAL NEEDED
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Referral needed to:
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IRIS Results
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