Get the free Vision rescreening worksheet - Illinois Department of Public Health

VISION PRESCREENING WORKSHEET State of Illinois Department of Public Health LOCATION GRADE ROOM SCREENING TECHNICIAN IS NAME DATE GRADE OR PASS AGE NAME 1. TEST SCORES PEORIA N F V.A. R +LENS L R

How to fill out vision rescreening worksheet

How to fill out a vision rescreening worksheet:

1. Start by filling in the basic information section of the worksheet. This typically includes the patient's name, date of birth, and contact information.
2. Next, record any pertinent medical history that may be relevant to the vision rescreening. This can include any previous eye conditions or surgeries, current medications, or any family history of eye problems.
3. Move on to the visual acuity section, where you will document the patient's ability to see at different distances. This often involves using an eye chart and recording the measurements for each eye separately.
4. Then, proceed to the visual field assessment. This is where you evaluate the patient's peripheral vision by utilizing various testing methods, such as confrontation testing or visual field machines. Record any abnormalities or limitations observed.
5. The color vision section is next, where you assess the patient's ability to perceive different colors accurately. This can be done through color plates or specialized tests, and the results should be noted on the worksheet.
6. If applicable, add any additional tests or evaluations that are specific to the purpose of the vision rescreening. This can include assessing depth perception, eye coordination, or focusing ability.

Who needs a vision rescreening worksheet?

1. Individuals who have previously undergone a comprehensive eye examination but are experiencing new vision problems or changes may require a vision rescreening worksheet.
2. Students or children who are recommended for further examination by their teachers or school nurses may be candidates for a vision rescreening worksheet.
3. Certain occupations or activities that demand clear vision, such as pilots, drivers, or athletes, may need regular vision rescreening and thus utilize the worksheet to track their eye health.

It's important to note that the decision to use a vision rescreening worksheet should be made in consultation with an eye care professional who can determine the appropriate course of action based on individual circumstances and needs.

For pdfFiller’s FAQs

What is vision rescreening worksheet?

Vision rescreening worksheet is a form used to record the results of vision screenings for individuals.

Who is required to file vision rescreening worksheet?

Schools and healthcare providers are required to file vision rescreening worksheet for their students or patients.

How to fill out vision rescreening worksheet?

Vision rescreening worksheet can be filled out by recording the individual's vision screening results including visual acuity and any corrective measures taken.

What is the purpose of vision rescreening worksheet?

The purpose of vision rescreening worksheet is to ensure that individuals receive necessary vision screenings and follow-up care.

What information must be reported on vision rescreening worksheet?

Information such as individual's name, date of birth, screening date, visual acuity results, and any corrective measures taken must be reported on vision rescreening worksheet.

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