Get the free Pre-Op Refractive Examination form for ODs

Frank R. Orchard, M.D. Paul C. Mitchell, O.D. Refractive Vision Correction Preoperative Examination Name: Date: Telephone: Referring Doctor: Address: DOB: HISTORY Expectations Ocular He Hobbies Medical

How to fill out pre-op refractive examination form

How to fill out pre-op refractive examination form:

1. Begin by carefully reading the instructions on the form. Make sure you understand what information is being asked for and how to provide it.
2. Start by filling out your personal information accurately. This typically includes your name, date of birth, contact information, and any relevant medical or insurance identification numbers.
3. Provide a brief medical history, including any past or current eye conditions, surgeries, or medications you are taking. Be honest and thorough to help the healthcare provider assess your candidacy for refractive surgery.
4. In the section for medications, list all prescription and over-the-counter drugs, eye drops, vitamins, or herbal supplements you are currently using. Mention any allergies or adverse reactions you may have had to any medications.
5. If you wear contact lenses or eyeglasses, state the type and prescription strength. Include details about the brand, wearing schedule, and any issues you may have experienced while wearing them.
6. The form may also request information about your lifestyle, hobbies, and occupation. Answer these questions truthfully as they can help determine the most suitable refractive surgery approach for you.
7. Provide information about any other medical conditions you have, even if they are not directly related to your eyes. Certain systemic conditions or medications may have an impact on your eligibility for refractive surgery.
8. Review the completed form for accuracy and completeness before submitting it. If any section is unclear or you have questions, don't hesitate to seek clarification from the healthcare provider or staff.

Who needs pre-op refractive examination form:

1. Individuals considering or planning to undergo refractive surgery, such as LASIK, PRK, or lens replacement.
2. Patients with refractive errors, including nearsightedness, farsightedness, astigmatism, or presbyopia, who are exploring surgical treatment options.
3. Anyone seeking to improve their vision without the need for eyeglasses or contact lenses, and who has been advised by their eye care professional to consider refractive surgery.

For pdfFiller’s FAQs

What is pre-op refractive examination form?

The pre-op refractive examination form is a document used to assess a patient's eye health and vision before undergoing refractive surgery.

Who is required to file pre-op refractive examination form?

Patients who are planning to undergo refractive surgery are required to file the pre-op refractive examination form.

How to fill out pre-op refractive examination form?

The form should be filled out by a qualified eye care professional during a comprehensive eye exam, which includes measuring visual acuity, checking for eye diseases, and determining the suitability for refractive surgery.

What is the purpose of pre-op refractive examination form?

The purpose of the form is to ensure that the patient is a suitable candidate for refractive surgery and to minimize the risk of complications.

What information must be reported on pre-op refractive examination form?

The form should include the patient's medical history, current medications, eye health status, visual acuity measurements, and the eye care professional's recommendation for refractive surgery.

How can I edit pre-op refractive examination form from Google Drive?

pdfFiller and Google Docs can be used together to make your documents easier to work with and to make fillable forms right in your Google Drive. The integration will let you make, change, and sign documents, like pre-op refractive examination form, without leaving Google Drive. Add pdfFiller's features to Google Drive, and you'll be able to do more with your paperwork on any internet-connected device.

How can I get pre-op refractive examination form?

The premium subscription for pdfFiller provides you with access to an extensive library of fillable forms (over 25M fillable templates) that you can download, fill out, print, and sign. You won’t have any trouble finding state-specific pre-op refractive examination form and other forms in the library. Find the template you need and customize it using advanced editing functionalities.

How do I edit pre-op refractive examination form on an iOS device?

Use the pdfFiller mobile app to create, edit, and share pre-op refractive examination form from your iOS device. Install it from the Apple Store in seconds. You can benefit from a free trial and choose a subscription that suits your needs.