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  • History & PE Blank Chart

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    hellokrisjaejoong
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    This document contains a template for recording patient information and examination findings for an ophthalmology patient chart. It includes sections for the patient's chief complaint, history of present illness, past medical history, previous eye history, family history, physical examination findings, clinical impression, and treatment plan. The physical exam section focuses on visual acuity, external eye exam, extraocular muscles, fundoscopy, tonometry, and visual fields.

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    History & PE blank chart

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    This document contains a template for recording patient information and examination findings for an ophthalmology patient chart. It includes sections for the patient's chief complaint, history of present illness, past medical history, previous eye history, family history, physical examination findings, clinical impression, and treatment plan. The physical exam section focuses on visual acuity, external eye exam, extraocular muscles, fundoscopy, tonometry, and visual fields.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    Download as docx, pdf, or txt
    8 views3 pages

    History & PE Blank Chart

    Uploaded by

    hellokrisjaejoong
    This document contains a template for recording patient information and examination findings for an ophthalmology patient chart. It includes sections for the patient's chief complaint, history of present illness, past medical history, previous eye history, family history, physical examination findings, clinical impression, and treatment plan. The physical exam section focuses on visual acuity, external eye exam, extraocular muscles, fundoscopy, tonometry, and visual fields.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 3

    PAMANTASAN NG LUNGSOD NG MAYNILA COLLEGE OF MEDICINE

    DEPARTMENT OF OPHTHALMOLOGY

    JUNIOR INTERNSHIP PERFORMANCE TASK

    GENERAL OPHTHALMOLOGY PATIENT CHART

    Patient’s Initials: ___________________________________________ Age/Sex: _________ Date: _________________


    Address: _____________________________________________________________________________________

    Chief Complaint:

    History of Present Illness:

    Past Medical History: ____________________________________________________________________________


    [ ]Hypertension [ ] Diabetes mellitus [ ] asthma [ ] allergies [ ] TB Others: ______________________

    Previous Eye History: _____________________________________________________________________________

    Family History: __________________________________________________________________________________

    Personal/Social History: ___________________________________________________________________________

    Review of Systems:_______________________________________________________________________________
    PHYSICAL EXAMINATION
    Distance sc ph cc Near Visual Acuity Patient’s Refractive
    Visual Acuity Power (if uses
    spectacles/contact
    lenses)
    sc cc
    OD
    OS

    External Eye Exam:

    Extraocular Muscles:

    Fundoscopy:
    OD: _______________________________________________________________________________________
    OS: _______________________________________________________________________________________

    Digital Tonometry/Palpation:
    OD: _________________
    OS:__________________
    Confrontation visual field:

    OS OD

    CLINICAL IMPRESSION/ASSESSMENT: ____________________________________________________________

    PLAN: ______________________________________________________________________________________

    EXAMINED BY:

    _____________________
    Junior Intern

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