• CATARACT POST-OPERATIVE ASSESSMENT

  • Patient DOB*
     - -
    2 digit month, 2 digit day, 4 digit year
  • OD Procedure Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • OS Procedure Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Procedure Information
    Rows
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Post Op Dates*
    Rows

  • Visual Acuity (Uncorrected) : OD - 20/OS - 20/     
    Intraocular Pressure (mmHg) : OD - OS -      

  • Manifest Refraction : (1 Month post op appt*)
    OD - (SPH) (CYL)     X (AXIS)      (Acuity) 20/
    OS - (SPH) (CYL)     X (AXIS)      (Acuity) 20/    

  • Slit Lamp - Wound*
    Rows
  • Cornea*
    Rows
  • Anterior Chamber*
    Rows
  • IOL*
    Rows
  • Posterior Capsule*
    Rows
  • Retina*
    Rows
  • Medications/Dosages - OD:*
    Rows
  • Medications/Dosages - OS:*
    Rows

  • Appointment made for patient with Dr.         on   Pick a Date   at      

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year

  • PATIENTS MAY BE REFERRED BACK TO THEIR SURGEON AT ANY TIME AND FOR ANY REASON. IF THE PATIENT FAILS TO KEEP THEIR APPOINTMENT, PLEASE CALL US AT 855.295.4144 WITHIN 24 HOURS OF A MISSED EXAM. PLEASE RETAIN A COPY FOR YOUR RECORDS

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