POST PROCEDURE CARE - LASIK

POST PROCEDURE CARE - LASIK

POST PROCEDURE CARE - LASIK
SightMD POST PROCEDURE LASIK

SightMD POST PROCEDURE LASIK
Patient Name

First NameLast Name
Co-Managing Doctor

First NameLast Name
Co-Managing Doctor Email
example@example.com
Co-Managing Doctor Phone
Please enter a valid phone number.
Co-Managing Doctor Fax
Please enter a valid phone number.
SightMD Surgeon*

Rows	Procedure Date	Procedure Type	Original RX	Original BCVA: 20/	Age	Aim
Right Eye
Original RX

Exam Information*

Rows	Exam Date	Post Op Type
Right Eye
Left Eye

Rows	PT Remarks
Right Eye
Left Eye

Meds*

Rows	Meds	Meds (Cont)
Right Eye
Left Eye

UCVA*

Rows	20/	Fluctuating Vision
Right Eye
Left Eye

Refraction*

Rows	Auto Refraction	(Wet / Dry )	20/
Right Eye
Left Eye

LASIK Corneal Flap*

Rows	Position	Clarity	Interface	Edges
Right Eye
Left Eye

IOP ( after 1 week/applanation): *

Rows	mmHg
Right Eye
Left Eye

Rows	Doctor Comments	Enhancement	Follow Up
Right Eye
Left Eye

Rows	Treatment
Right Eye
Left Eye

Follow up*

Rows	Follow Up	Next Visit in
Right Eye
Left Eye

Comments
Doctor Signature*

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Date*

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Date
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