Eye Examination Report builder
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Clinic & Report
Clinic/Brand
Tagline
Report Title
Exam Date
Report ID / Ref
Examiner
Contact
Owner & Patient
Owner name
Owner phone
Owner email
Patient name
Species
Breed
Sex
Select
Male
Female
Neutered male
Spayed female
Age
Color
Weight (kg)
Microchip/ID
History
Eye affected
Select
Right (OD)
Left (OS)
Both (OU)
Duration
Previous treatment
Presenting complaint
Relevant medical history
Vision & Reflexes
Menace response
Dazzle reflex
PLR (direct/consensual)
Palpebral reflex
Basic Tests
Schirmer tear test (mm/min)
IOP Tonometry (mmHg)
Tonometry method
Fluorescein stain
Jones test (NL patency)
TBUT / Tear film (s)
Biomicroscopy (Slit-lamp)
Eyelids/Adnexa
Conjunctiva/Third eyelid
Cornea
Anterior Chamber
Iris/Pupil
Lens
Posterior Segment
Vitreous
Fundus/Retina
Optic nerve
Eye Ultrasound
Performed?
N/A
Yes
No
Findings
Diagnosis
Primary diagnosis
Differentials
Plan & Recommendations
Treatment / Medications
Owner recommendations
Recheck / Follow-up
Owner Summary
Photos (optional)
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Signatures
Examiner name/signature
Owner signature
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