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F2F Editable
URC
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F2FVF
Post Cataract
VGC
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Inj Test
URC
Diagnosis
Eye(s):
Right Eye
Left Eye
Both Eyes
Systemic
Diagnosis:
Select Diagnosis
FB
Dry Eye
Dry AMD
Wet AMD
Diabetic Macular Oedema
PDR
BRVO
CRVO
Papilloedema
No Papilloedema
PVD
PCMO
AAU
Retinal Tear
NVG
Steroid Response
POAG
OHT
PACG
Trabeculectomy
Cyclodiode Laser
SLT
Failed Trabeculectomy
MicroPulse Diode Laser
YAG PI
DM 2
Diabetes 1
HTN
Stroke
Ankylosing Spondylitis
HLA B27
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Treatment
Eye(s):
Right Eye
Left Eye
Both Eyes
Oral
Treatment Option:
Select Treatment Option
G CPL
OC CPL
Hyloforte
Thealoz duo
Cationorm
VisuXL
Evolve Revive
VisuXL Gel
Hylo Night
Acular
DEXA 2 hourly
DEXA PF 2 hourly
DEXA QDS
DEXA PF QDS
Monopost
Cosopt
Fixapost
Trusopt BD
Trusopt TDS
Alphagan BD
Alphagan TDS
Acetazolamide BD
Acetazolamide 250mg TDS
Acetazolamide QDS
Add Treatment
Findings
Vision
Right Eye: 6/
Left Eye: 6/
Intraocular Pressure
Right Eye:
Left Eye:
Impression
FB
Wet AMD
Dry AMD
Ischaemic CRVO
CRVO
BRVO
BRVO Observe
No Papilloedema
Papilloedema
Vitreous Bleed
Vitreous Bleed
Vitreous Bleed
Vitreous Bleed
Plan
FB
WetAMD BRVO CRVO
Dry AMD
Dry Eye
No Papilloedema
Papilloedema
Papilloedema
Papilloedema
Papilloedema
Papilloedema
Title:
Mr
Mrs
Ms
Miss
Gender:
Gentleman
Lady
Normal Eye:
BE
RE
LE
Affected Eye:
BE
RE
LE
Treat/Plan:
Vabysmo
Eylea
Lucentis
Ongavia
Ozurdex
IVTA
PRP
Focal
Retinopexy
LE
LE
Referral:
GP
Optician
Ward
A/E
Self Referral
Reason:
Reduced Vision
Sore Painful
Scattered Hg
Distortion
Blurr Disc
Patient's Name:
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Letter:
