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Your Partner in Health Care QualityDiabetic Dilated Eye Exam Fax Back ReportPatient Name: ___ Birth Date:___Primary Care Physician:___Findings/Impressions: Right LeftLenticular Changes Diabetes without
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How to fill out diabetic dilated eye exam

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How to fill out diabetic dilated eye exam

01
Schedule an appointment with an eye care specialist or an ophthalmologist who is experienced in diabetic eye exams.
02
Make sure to inform the doctor that you have diabetes.
03
Bring a list of your current medications, including any eye drops you are using.
04
During the exam, your eyes will be dilated using eye drops to allow the doctor to get a better view of the retina and other structures at the back of the eye.
05
The doctor will then examine your eyes using specialized tools and may take photographs of your retina for future reference.
06
After the exam, your eyes may remain dilated for a few hours, so make sure to bring sunglasses to protect your eyes from bright light.

Who needs diabetic dilated eye exam?

01
Individuals with diabetes, especially those who have had diabetes for many years or who have poorly controlled blood sugar levels, are at a higher risk for diabetic retinopathy.
02
People with diabetes should have a dilated eye exam at least once a year to check for signs of diabetic eye disease, such as diabetic retinopathy.

What is Diabetic Dilated Eye Exam Fax-Back Report Form?

The Diabetic Dilated Eye Exam Fax-Back Report is a document needed to be submitted to the specific address to provide specific info. It must be completed and signed, which may be done in hard copy, or using a particular software e. g. PDFfiller. This tool allows to complete any PDF or Word document right in the web, customize it according to your needs and put a legally-binding e-signature. Right away after completion, the user can send the Diabetic Dilated Eye Exam Fax-Back Report to the relevant person, or multiple individuals via email or fax. The template is printable as well from PDFfiller feature and options proposed for printing out adjustment. Both in digital and physical appearance, your form will have a organized and professional appearance. You may also turn it into a template to use it later, without creating a new blank form over and over. All that needed is to customize the ready document.

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A diabetic dilated eye exam is a comprehensive eye examination for individuals with diabetes that involves the use of eye drops to widen (dilate) the pupils, allowing an eye care professional to thoroughly examine the retina and other structures at the back of the eye to check for any signs of diabetic retinopathy or other complications.
Individuals diagnosed with diabetes are generally required to undergo a diabetic dilated eye exam regularly, as recommended by their healthcare provider, to monitor for potential eye health issues.
To fill out a diabetic dilated eye exam form, you typically need to provide personal information such as your name, date of birth, medical history, details of your diabetes management, and the results from previous eye exams. It is important to follow the specific instructions on the form and include any relevant information requested by the eye care professional.
The purpose of a diabetic dilated eye exam is to detect early signs of diabetic retinopathy and other potential eye problems that can arise from diabetes, allowing for timely intervention to prevent vision loss.
The information that must be reported typically includes findings related to the retina, the presence of any damage or changes due to diabetes, current visual acuity, and any recommendations for further treatment or follow-up care.
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