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Member Name: Member ID#:DILATED FUNDS EXAMINATION (for the diabetic patient) Patient:DOB:HP ID#:Primary Physician:Gender:Exam Date:Date of Diabetes Diagnosis:Date of Last Ophthalmology/Optometry Exam:Visual
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How to fill out dilated fundus examination

How to fill out dilated fundus examination
01
To fill out a dilated fundus examination, follow these steps:
02
Prepare the necessary materials, which include a retinal camera, a dilating agent (such as eye drops containing tropicamide or phenylephrine), disposable gloves, and an examination form.
03
Explain the procedure to the patient and obtain their consent.
04
Wash your hands thoroughly and put on disposable gloves.
05
Prepare the dilating agent according to the instructions and administer it to the patient as per the recommended dosage.
06
Allow sufficient time for the pupil to dilate, usually around 20-30 minutes.
07
Position the patient comfortably in front of the retinal camera.
08
Adjust the camera settings for optimal image quality and ensure proper focus.
09
Instruct the patient to look straight ahead and keep their eye wide open.
10
Carefully align the camera with the patient's dilated pupil and capture the fundus images.
11
Review the captured images on the camera or transfer them to a computer for further analysis.
12
Fill out the examination form with relevant details, including patient demographics and findings from the fundus examination.
13
Clearly document any abnormalities or significant observations.
14
Provide the patient with post-examination instructions, such as wearing protective eyewear if their vision is still blurry due to the dilating agent.
15
Clean and disinfect the retinal camera and dispose of used gloves properly.
16
Store the examination form and images securely for future reference and sharing with other healthcare professionals if needed.
Who needs dilated fundus examination?
01
Dilated fundus examination is recommended for the following individuals:
02
- Patients with known or suspected eye diseases or conditions, such as diabetic retinopathy, macular degeneration, glaucoma, or retinal detachment.
03
- Individuals with a family history of eye diseases or conditions.
04
- Patients experiencing visual disturbances, such as blurred or distorted vision, floaters, or flashes of light.
05
- Individuals with certain systemic conditions that may impact eye health, such as hypertension, diabetes, or autoimmune diseases.
06
- People above a certain age, as some eye diseases, like age-related macular degeneration, are more prevalent in older individuals.
07
- Individuals who require baseline or routine eye examinations as part of preventive care or monitoring their eye health.
08
- Patients undergoing specific therapies that may have ocular side effects, such as certain medications or radiation treatments.
09
- Individuals involved in occupational tasks or hobbies with potential eye hazards, such as welders, construction workers, or contact sports athletes.
10
- Pregnant women, as certain eye conditions may develop or worsen during pregnancy due to hormonal changes.
11
- Anyone seeking a comprehensive and detailed evaluation of their eye health and early detection of potential abnormalities or diseases.
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What is dilated fundus examination?
Dilated fundus examination is a procedure where drops are placed in the eyes to dilate the pupils in order to examine the back of the eye, including the retina and optic nerve.
Who is required to file dilated fundus examination?
Patients with certain eye conditions or at risk for eye diseases may be required to undergo dilated fundus examination as advised by their healthcare provider.
How to fill out dilated fundus examination?
To fill out dilated fundus examination, a healthcare provider usually administers the eye drops to dilate the pupils and then performs a thorough examination of the back of the eye using specialized equipment.
What is the purpose of dilated fundus examination?
The purpose of dilated fundus examination is to evaluate the health of the retina and optic nerve, detect any abnormalities or signs of eye diseases, and monitor the progression of certain conditions.
What information must be reported on dilated fundus examination?
The information reported on dilated fundus examination typically includes findings related to the condition of the retina, optic nerve, blood vessels, and any abnormalities observed during the examination.
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