Post Op Report

POST-OP REPORT
Information
Patient Name*

First NameLast Name
Date of Post-op Exam

MonthDayYear
Date
Referring Doctor
Ocular Meds
Surgery Info
Surgery type performed(e.g cataract surgery)
Which eye(s)

ODOS
OD Date
OS Date
How is the patient doing?

doing well, no complaintsdiscomfort / photophobiablurred visionflashes / floaters
How many days Post-op is the patient? (OD/OS)
Visual Acuity
Uncorrected VA OD (20/XX)
Uncorrected VA OS (20/XX)
Pinhole VA OD
Pinhole VA OS
Auto-Keratometry
OD
OS
OD Manifest Refraction
OS Manifest Refraction
BCVA OD (20/XX)
BCVA OS (20/XX)
PH OD
PH OS
IOP OD
IOP OS
Pupils

OD Round, ReactiveOS Round ReactiveOther
Slit Lamp Exam
Cornea OD (Use other to grade striae when present)

ClearNormal POStriaeEdemaOther
Cornea OS (Use other to grade striae when present)

ClearNormal POStriaeEdemaOther
Conjunctiva OD

Normal POIncreased InjectionChemosisSubconj Heme
Conjunctiva OS

Normal POIncreased InjectionChemosisSubconj Heme
Wound Appearance

NormalOther
Wound Appearance

NormalOther
Anterior Chamber OD (Use Other to grade cells when present)

QuietCells PresentHypopyonOther
Anterior Chamber OS (Use Other to grade cells when present)

QuietCells PresentHypopyonOther
IOL OD

Well CenteredOther
IOL OS

Well CenteredOther
Posterior Capsule OD (Use Other to grade PCO)

Clear/OpenOther
Posterior Capsule OS (Use Other to grade PCO)

Clear/OpenOther
Anterior Vitreous OD

ClearCellsPVD
Anterior Vitreous OS

ClearCellsPVD
Retina OD

NormalMacular EdemaARMDPeripheral ChangesOther
Retina OD

NormalMacular EdemaARMDPeripheral ChangesOther
Post Op Assessment OD

Normal HealingOther
Post Op Assessment OS

Normal HealingOther
Other comment/concerns
If pain and/or decrease in vision or field develops, an immediate consultation is indicated to speak with an ECC doctor. (812) 426-2020.
Should be Empty:

POST-OP REPORT

Information

Surgery Info

Visual Acuity

Auto-Keratometry

Slit Lamp Exam