OPHTHAMOLOGY PRE -- SURGERY ASSESSMENT
Patient’s Name: {[__________FullName__________]} MRD : {[PatientCode]} Age:{[Age]} Sex: {[Sex]}
Address : {[______________________________Address______________________________]}
Tel/ Mob no. {[MobileNumber]} Under Dr. {[____Consultant____]}
Date of Operation : {[Dateofoperation]}
Operation Eye : {[EyeTobeOperated]}: Bed No.: ………………
Procedure: {[_______________Procedure_______________]}
Types Of Anaesthesia : {[_Anesthesia_]}I.V Manitol (IfRequired ):…………
Allergies (If any): .………….. History (If any): …………………………….
Pulse :............/minute Drugs Used :T.Plus/Paracane/moxicip/Gatiquin p(Eye drop start on admission)
SPO2 : % Before Discharges:
Blood Pressure : mmhg SPO2 %
Time: Pulse : /
Biometry: Blood Pressure : mmhg
Vision: Blood Sugar : mg/dl
IOP:
Papillary Reaction
Preocular Region
Anterior segment
Posterior Segment Counsultant's Signature