DT's IP Logbook

IP LogBook

Drew Thompson MCOptom DipTp(IP) FBCLA
Date

Month Day Year
Date
Is this patient from?

T&H Optometrists Blackpool Victoria Hospital
Optix ID / Hospital Number *
Diagnosis *
Known Allergies (If yes detail below)

Yes No
Other Information
Drug Prescribed? *
Dose? *
Which eye? *
Frequency? *
Amount prescribed? *
Referred onward?

Yes No

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Which eye?
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Drug Prescribed?
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Which eye?
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Drug Prescribed?
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