Clinical Record
Location
LG - UoS
Western Road
Appt Date
-
Day
-
Month
Year
Date
Name
First Name
Last Name
DOB
-
Day
-
Month
Year
Date Picker Icon
Appointment Type
NHS Eye Test
Eye Test
CL Fit
CL check
MECS
Re-Check
Other
LEE
Last eye exam
Driver
VDU
CL wearer
Occupation/Hobbies
History & Symptoms
RFV
Distance Vision
Near Vision
Flashes
Floaters
Diplopia
HA
HES
Other issue
Injury
Infection
GH
Medication List
Hx & Sx: additional info
Use FLOADS. Freq, Location, Onset, Association, Duration, Severity
FH: Glauc
FH: Diab
Refraction
Rows
Unaided
Pin Hole
Current Rx
VA
Objective
VA
PD
Notes
R
L
Subjective
Rows
Sph
Cyl
Axis
D VA
Prism
Near add
N VA
Int Add
Notes
R
L
Final Prescription
Rows
Sph
Cyl
Axis
D VA
Prism
Near add
N VA
Int Add
Notes
R
L
R RX
L RX
NHS Specs
Binocular Vision tests
Distance CT
Near CT
Motility
OM drawing
NPC (cm)
Ocular Health
Anterior RE
Anterior Shortcuts
Anterior LE
Optic Disc RE
Disc Shortcuts
Optic Disc LE
Blood Vessels RE
Vessels Shortcuts
Blood Vessels LE
Retina RE
Retina Shortcuts
Retina LE
Pupils RE
Pupil shortcut
Pupils LE
IOP & Fields
Rows
IOP 1
IOP 2
IOP 3
IOP 4
IOP 5
Time
Visual Fields
R
L
Additional / Drops
Additional / Drops shortcut
CL Checks
Modality
CL Hx/Sx
any probs with CLs, vision, comfort, infections, redness, dryness, etc.
Wear Time: Avg to Max
Redness
Discharge
Discomfort
Swimming
Days per week
Compliance
Solutions
case Condition
Current CL Spec
Rows
CL Name
BOZR
TD
Sph
Cyl
Axis
D VA
Add
N VA
R
L
Over Refraction
Rows
OR
VA
Notes
R
L
CL in situ RE
CL in situ buttons
CL in situ LE
CL Health RE
CL Health buttons
CL Health LE
New CL Spec
Rows
CL Name
BOZR
TD
Sph
Cyl
Axis
D VA
Add
N VA
R
L
CL Recall
-
Day
-
Month
Year
Date Picker Icon
Advice
Referral
Dispense
Advice
Lens Recommendation
ST Recall
-
Day
-
Month
Year
Date
Referral Letter
GP
GP Name
Address
City
County
Post Code
GP action required
For information only
Patient asked to visit GP
Patient sent to Eye casualty
Urgent referral to Eye dept
Routine Referral to Eye Dept
Clinic Type
Strabismus & Amblyopia
Paediatric non-strab
Orthoptic
Cataract
Cornea
Diabetic medical retina
External Eye disease
Glaucoma
Laser (YAG capsulotomy)
Low Vision
Oculoplastics
Medical Retina (e.g. ARMD)
Squint/Ocular Motility
Vitreoretinal
Other
Referral text
Optician writes whatever extra info he wants here
Referral Complete
yes
Other Appointment - Optometrist notes
Other RFV
e.g. px came in with CL stuck in eye
Other Action and Checks performed by Optom
e.g. removed CLs and checked cornea for any staining.
Other Advice given by Optom
e.g. advised px to stop wearing CLs and book in for another CL teach.
Optom Name and Submit button
Optom name
GOC number
Submit
Should be Empty: