Tabela man1

OD fc n,nn
(OD1)
(X)A.V.
OS fc n,nn
(OS1)

OD cc n,nn cu +/- nn,nn sfera +/- nn,nn cil./ nnn

(OD2)
(OD3)
(OD4)
(OD5)
A.V.
OS cc n,nn cu +/- nn,nn sfera +/- nn,nn cil. / nnn
(OS2)
(OS3)
(OS4)
(OS5)

Tabela man2
(X)VB prezenta/absenta
(VB1)

Stereo +/- text 2 randuri

(VB2)

Tabela man3
(X)Simt cromatic: normal text 5 r. Sc1
Tabela man4
OD +/- nn,nn DSf. +/- nn,nn Dcil., Ax nnn
Od1
od2
od3
(X)Autorefractometrie Fara picaturi / cu Cyclopentolat / cu Tropicamida
Ar1
OS +/- nn,nn DSf. +/- nn,nn Dcil., Ax nnn
Os1
os2
os3
Tabela man5
OD +/- nn,nn DSf. +/- nn,nn Dcil., Ax nnn
OD1
OD2
OD3
(X)Schiascopie Fara picaturi / cu Cyclopentolat / cu Tropicamida
SC1
OS +/- nn,nn DSf. +/- nn,nn Dcil., Ax nnn
OS1
OS2
OS3
Tabela man6
(X)TOD : nn mmHg tod1
TOD ajustata : nn mmHg tod2
Pahimetrie OD: nnn m tod3

TOS : nn mmHg
tos1
TOS ajustata: nn mmHg tos2
Pahimetrie OS: nnn m tos3

Tabela man7
(X)Biomicroscopie OD: pol anterior normal /Conjunctiva aspect normal text 5 randuri od2
Od1
Cornee aspect normal text 5 randuri od3
Cristalin aspect normal text 5 randuri od4
Iris aspect normal text 5 randuri od5
Pupila aspect normal text 5 randuri od6
Camera ant. aspect normal text 5 randuri od7
Biomicroscopie OS: pol anterior normal/ Conjunctiva aspect normal text 5 randuri os2
Os1
Cornee aspect normal text 5 randuri os3
Cristalin aspect normal text 5 randuri os4
Iris aspect normal text 5 randuri os5
Pupila aspect normal text 5 randuri os6
Camera ant. aspect normal text 5 randuri os7
Tabela man8
(X) Test Schirmer OD normal/nn mm
od1
Tabela man9
(X)Oftalmoscopie indirecta: of1
Tabela man10
(X)F.O. OD:

F.O. OS:

OS normal/nn mm
os1

Papila aspect normal text 5 randuri od1

Vase aspect normal od2
Macula aspect normal od3
Periferie aspect normal od4
Vitros aspect normal od5
Papila aspect normal os1
Vase aspect normal os2

Macula aspect normal os3

Periferie aspect normal os4
Vitros aspect normal os5
Tabela man11 ????
(X)Cover test/Krimpsky AO/OD/OS Ortoforie/Esotropie/Exotropie
Cover test cu prisme la distana +/- nn ODF/OSF/AOF cc/fc ; la aproape: +/- nn ODF/OSF/AOF cc/fc
Text 1 rand
Tabela man12
(X)Compensare prismatic OD: nn DPB Nazal/Temporal/Superior/Inferior si OS: nn DPB Nazal/Temporal/Superior/Inferior
Text 2 rand
Tabela man13
(X)Motilitate OD : Normala Text 3 rand od1
Motilitate OS : Normala Text 3 rand os1
Tabela man14 ???
(X) BIOMETRIE: OD: K1
OS: K1

K2
K2

AxAP
AxAP

D IOL
D IOL

Refr
Refr

Tabela man15
(X)Ecografie: text 30 rand tod1
Tabela man16
(X)Camp vizual computerizat atasat text 30 rand tod1
Tabela man17
(X)ERG/EOG/PEV atasat text 30 rand tod1
DIAGNOSTIC: (campurile de mai jos sunt deja definite in tabela consultations)
1 text selectabil, modificabil -2 randuri
2
3
4
5
Obs. Text 10 rand
(X)Rp/ 1 text selectabil, modificabil, salvabil -2 randuri
2
3
4

Control peste nn zile/luni/ani .

Data.....................

Dr. ..................................

(X)

OD
Sfera

OS
Cilindru

Ax

Prisma

Sfera

Cilindru

Ax

Prisma

DP(mm)

DISTAN

+/-nn,nn

+/-n,nn

nnn

APROAPE

+/-nn,nn

+/-n,nn

nnn

(X)Lentile de contact: Tip: text 50 caractere

Raza: n,n mm Diametru: nn,n
OD: sfera: +/- nn,nn
cilindru: +/- nn,nn
OS: sfera: +/- nn,nn
cilindru: +/- nn,nn

nn DPB
N/T/S/I
nn DPB
N/T/S/I

+/-nn,nn

+/-n,nn

nnn

+/-nn,nn

+/-n,nn

nnn

nn DPB
N/T/S/I
nn DPB
N/T/S/I

ax: nnn
ax: nnn

(X)Proba lentile de contact.

RECOMANDRI : text

Fiecare pagina va fi numerotata si va avea sus antet si datele de identificare pacient, iar jos data si dr.

DATA..

Dr.

nn
nn