Post Op Report
Idaho Eye and Laser Center
Co Managing Doctor
Patient Name
*
First Name
Last Name
Patient Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Surgery
Cataract
LASIK
YAG
Other
Operative eye
OD
OS
OU
Other
Post Op Visit
One week
One month
Three month
Six month
Other
Exam Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Visual Acuity
Rows
OD
OS
UCVA
MRx
BCVA
Exam Findings, Notes, Plan
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