VHS-OPHTHO
THE VOLUNTARY HEALTH SERVICES
OPHTHALMOLOGY DEPARTMENT
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VHS OPHTHO
User :
Last Login :
29/09/2019
30/09/2019
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Diagnosis - History
Patient ID Patient Name Visit Date Token No.
Diagnosis - History Report
Visual Assessment
Parameter Name Right Eye Reading Right Eye Reading UOM
Refraction
Paramter Name Right / Left SPH CYL Axis V/A
Investigation
Paramter Name Right Eye Left Eye
Vision & Non-Vision Related Complaints
Complaint Name Left / Right / Both Since When Frequency
Standard Clinical Data
Clinical Data Since When Value Range
Lab Readings
Lab Test Name Value Range
Prescribed Medicine
Medicine Left / Right / Both Dosage When Time Duration
Current Medication
Medicine Dosage Since When
Allergies
Medicine Allergy
Current Medication - Self Prescribed
Medicine Dosage Since When
Habits
Habit Frequency Since When
Patient Report
Status : Completed
Doctor : JOHN Dezouza
IE done by : Doctor
Visual Assessment
Parameter Name Right Eye Reading Right Eye Reading UOM
Refraction
Paramter Name Right / Left SPH CYL Axis V/A
LV-Assessment
Complaint Name Vision Problem Since When
eye both 2008
LV-Refraction
Paramter Name Right / Left SPH CYL Axis V/A
Doctor Examination
Examination Right - Abnormality Reason Left - Abnormality Reason
Plan of Management
Treatment Advice - Medication
Medicine Left / Right / Both Dosage When Time Duration
Treatment Advice - Glasses
Parameter Right Left
SPH CYL AXIS V/A SPH CYL AXIS V/A
Distant Vision
Near Vision
Treatment Advice - Surgery
Surgery Name Eye Position Suggested Surgery Date
Treatment Advice - Referred Elsewhere
Referred To Comments
FollowUp Review
Followup Not Required
Followup For Review
Clinical Diagnosis (ICD - Code)
ICD - Code Clinical Diagnosis
Diagnosis
Diagnosis Problem Eye
Vision & Non-Vision Related Complaints
Complaint Name Left / Right / Both Since When Frequency
Past History
Standard Clinical Data
Clinical Data Since When Value Range
Investigation
Paramter Name Right Eye Left Eye
ReAssign
Reassign To
Review MetaData
Parameter Name
Non Normal Reasons for
Reason
Prescribe Medicine Type
Reason
Prescribe Medicine Type
Reason
Morning
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Diagnosis - Comparison Report
Standard Clinical Data
Parameter Name
Visual Assessment
Parameter Name
Right Eye Left Eye Right Eye Left Eye
Refraction
Parameter Name
SPH CYL Axis V/A SPH CYL Axis V/A
Investigation
Parameter Name
Right Eye Left Eye Right Eye Left Eye
Information
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