Braverman Eye Center Ophthalmology LASIK Cataract Laser Vision Correction Hallandale Beach South Florida Eye Surgery Bascom Palmer Eye Cataract Implant Surgery Corneal and Refractive Surgery and Glaucoma

Cataract/Lensectomy Post-Op Form

Use the following form to submit reports on Cataract/Lensectomy procedures. The submitted form will be automatically sent to the Braverman Eye Center. You will also be able to print a copy for your records after submitting your form.

Co-managing OD/MD:

Patient Name:(last name first)

Age:

Procedure:

Procedure Date OD:

Procedure Date OS:

Select if patient did not show up for scheduled appointment
Left message for patient to reschedule
Unable to contact patient

PRE-OP Rx:

OD:

VA: 20/

OS:

VA: 20/

Post-Op Information:

Assessment Date

Binocular UCVA          20 /
OD UCVA                   20 /
OS UCVA                   20 /

OD Manifest * (if no cyl, select 0)
x ==> 20/

OS Manifest * (if no cyl, select 0)
x ==> 20/

OD SL Exam:

Wound
Cornea
Ant. Chamber
Lens Implant
Posterior Capsule

OS SL Exam:

Wound
Cornea
Ant. Chamber
Lens Implant
Posterior Capsule

TaG:

OD mm. Hg. OS mm. Hg.

Retina:

OD OS

Alert Issues - (If present, must include in alert issue comments below)

	Dissatisfaction Issues
	Nighttime Halos/Glare
	Glare/Light Sensitivity

Learn about LASIK in Ft Lauderdale, Miami & South Florida

Learn about LASIK in Ft
Lauderdale, Miami & South Florida