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OPHTHALMOLOGIC ASSESSMENT FORM INSTRUCTIONS 1. His form may be completed by either the prescriber or consultant ophthalmic professional. This form must be signed by T the prescriber and faxed to SHARE

How to fill out cmyk ophthalmologic assessment form

How to fill out the CMYK ophthalmologic assessment form:

1. Start by filling out the patient's personal information, including their name, contact details, and date of birth.
2. Proceed to record the patient's medical history, including any previous eye conditions, surgeries, or current medications they are taking.
3. Fill in the patient's visual acuity information, which includes testing their ability to see letters or objects at certain distances.
4. Document any visual field defects or abnormalities observed during testing.
5. Record the patient's intraocular pressure, using a tonometer to measure the pressure inside the eye.
6. Include any relevant diagnostic test results, such as fundus photography or Optical Coherence Tomography (OCT) images.
7. Finally, provide a brief summary of your assessment and any recommended treatment or follow-up plans.

Who needs the CMYK ophthalmologic assessment form?

1. Ophthalmologists: This form is primarily used by ophthalmologists to evaluate and assess patients' eye health. It helps them gather comprehensive information about the patient's visual acuity, medical history, and any existing eye conditions.
2. Optometrists: Optometrists may also require this form to conduct a thorough examination and assessment of their patients' eye health. It aids them in diagnosing and managing various eye conditions.
3. Patients: The CMYK ophthalmologic assessment form is beneficial for patients as it ensures that their eye health is comprehensively assessed. It allows them to provide accurate and detailed information about their medical history and any visual issues they may be experiencing.

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