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F2F Editable
URC
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MOCT rev
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F2FVF
Post Cataract
VGC
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TEST
Diagnosis
Eye(s):
Both Eyes
Right Eye
Left Eye
Systemic
Diagnosis:
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Primary Open Angle Glaucoma
Ocular Hypertension
Normal Pressure Glaucoma
Glaucoma Suspect
Primary Angle Closure Suspect
Primary Angle Closure
Primary Angle Closure Glaucoma
Chronic Angle Closure Glaucoma
Pseudoexfoliation Glaucoma
Secondary Glaucoma
Neovascular Glaucoma
Steroid Response
Mixed Glaucoma
Trabeculectomy
Cyclodiode Laser
Selective Laser Trabeculoplasty
Failed Trabeculectomy
MicroPulse Diode Laser
YAG Peripheral Iridotomy
Phaco + MIGS
Dry Age Related Macular Degeneration
Wet Age Related Macular Degeneration
Diabetic Macular Oedema
Branch Retinal Vein Occlusion
Central Retinal Vein Occlusion
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Treatment
Eye(s):
Both Eyes
Right Eye
Left Eye
Oral
Treatment Option:
Select Treatment Option
Monopost
Cosopt
Fixapost
Trusopt BD
Trusopt TDS
Alphagan BD
Alphagan TDS
Acetazolamide BD
Acetazolamide 250mg TDS
Acetazolamide QDS
G CPL
DEXA 2 hourly
DEXA PF 2 hourly
DEXA QDS
DEXA PF QDS
OC CPL
Hyloforte
Thealoz duo
Cationorm
VisuXL
Evolve Revive
VisuXL Gel
Hylo Night
Acular
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Visual Fields
Eye(s):
Both Eyes
Right Eye
Left Eye
Assessment:
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Normal Full
Unreliable
Superior Arcuate
Inferior Arcuate
Double Arcuate
Central
Centrocecal
Temporal Wedge
Nasal Step
Bjerrum's
Sup Altitudinal
Inf Altitudinal
R Hemianopia
L Hemianopia
R Heteronymous
L Heteronymous
R Sup Quad
R Inf Quad
L Sup Quad
L Inf Quad
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Disc OCT
Eye(s):
Both Eyes
Right Eye
Left Eye
Evaluation:
Select Option
Healthy NFL
Cosopt
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Findings
Vision
Right Eye: 6/
Left Eye: 6/
Intraocular Pressure
Right Eye:
Left Eye:
Central Corneal Thickness
Right Eye:
Left Eye:
Impression
NTG Suspect-PACS
OHT
Stable NTG-POAG-PACG-Periperimetric
PAC-OHT-NTG suspect--> On Treatment
Normal IOP but progression RE
Normal IOP but progression LE
Creeping up IOP but Stable field
Patent PI
Progression
SLT Effective
SLT failure
Pre-Perimetric
Advancing Damage + High Pressure
Plan
FB
Wet AMD
BRVO
CRVO
No Papilloedema
Papilloedema
Papilloedema
Papilloedema
Papilloedema
Papilloedema
Title:
Mr
Mrs
Ms
Miss
Gender:
Gentleman
Lady
Referral:
FU POAG
FU NTG
FU OHT
Post Trabe
Post SLT
GP
Optician
Ward
A/E
Self Referral
Patient's Name:
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Letter: