Get the free Pre-Op OD Refractive Form - Chu Vision Institute

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PRE-OPERATIVE REFRACTIVE SUMMARY Patient Name: DOB: Date: Patient Address: Patient s Home Phone #: Work #: Cell Phone #: Referring Doctor: Office #: Please include a copy of your exam with this summary.

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How to fill out pre-op od refractive form

How to fill out a pre-op OD refractive form:

01

Start by carefully reading the instructions at the top of the form.

02

Fill in your personal information such as your full name, date of birth, and contact information.

03

Provide details about your medical history, including any past surgeries or eye conditions.

04

Answer questions about your current medications, allergies, and any eye-related symptoms or concerns you may have.

05

Indicate your preferred method of correcting your vision, such as glasses, contact lenses, or refractive surgery.

06

If you wear contact lenses, make sure to mention the type and brand as well as the duration of use.

07

If you have any other eye-related measurements or information, such as your current prescription or corneal thickness, include those details in the appropriate sections.

08

Review the form to ensure all sections are filled out correctly and legibly before submitting it to your healthcare provider.

Who needs a pre-op OD refractive form:

01

Individuals who are considering or have been recommended for refractive surgery, such as LASIK or PRK, need to fill out a pre-op OD refractive form. This form helps capture important information about their eye health and medical history before undergoing the procedure.

02

Patients who are experiencing vision problems and are seeking professional advice from an optometrist may also be asked to complete a pre-op OD refractive form. This helps the optometrist assess their condition and determine the best course of action, which may include referrals or recommendations for further tests.

03

Additionally, individuals who have previously undergone refractive surgery and are seeking follow-up care may also be required to fill out this form. It assists in monitoring their progress and ensuring proper eye care management.

Overall, the pre-op OD refractive form is relevant for those pursuing or seeking guidance related to refractive surgery or general eye care.

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What is pre-op od refractive form?

Pre-op OD refractive form is a document that collects information about a patient's eyes before a refractive surgery.

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

The patient undergoing a refractive surgery is required to file the pre-op OD refractive form.

How to fill out pre-op od refractive form?

The pre-op OD refractive form can be filled out by providing accurate information about the patient's eye condition, medical history, and any medications being taken.

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

The purpose of pre-op OD refractive form is to assess the patient's suitability for a refractive surgery and to ensure that the procedure can be performed safely.

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

The pre-op OD refractive form typically requires information such as visual acuity, corneal thickness, ocular health, and any past eye surgeries.

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