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)
OD Date
OS Date
How is the patient doing?
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

Other
Slit Lamp Exam
Cornea OD (Use other to grade striae when present)

Other
Cornea OS (Use other to grade striae when present)

Other
Conjunctiva OD
Conjunctiva OS
Wound Appearance

Other
Wound Appearance

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

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

Other
IOL OD

Other
IOL OS

Other
Posterior Capsule OD (Use Other to grade PCO)

Other
Posterior Capsule OS (Use Other to grade PCO)

Other
Anterior Vitreous OD
Anterior Vitreous OS
Retina OD

Other
Retina OD

Other
Post Op Assessment OD

Other
Post Op Assessment OS

Other
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:

Information