Postoperative report —
brintonvision.com/PostopReport
"
*
" indicates required fields
Patient name
*
Date of birth
*
MM slash DD slash YYYY
Hidden
Age
Date of visit
*
MM slash DD slash YYYY
SBK
EVO ICL
CLR
PRK
SMILE
LRI
KAMRA
Reason for visit / HPI
UDVA OD 20/
*
UDVA OS 20/
*
UDVA OU 20/
*
UNVA OD
UNVA OS
UNVA OU
Refraction OD=CDVA
Refraction OS=CDVA
IOP OD
IOP OS
Slit lamp exam – change as applicable
LIDS & LASHES
CONJUNCTIVA
ANTERIOR CHAMBER
IRIS
CORNEA
LENS
IRIS
CORNEA
LENS
IRIS
CORNEA
LENS
IRIS
CORNEA
LENS
IRIS
CORNEA
LENS
IRIS
CORNEA
LENS
Additional comments
Would you like for one of our doctors to call/text you or the patient regarding any concerns?
please call/text the patient
please call/text me
Doctor full name and degree
Doctor/practice email, to get a copy for your EMR
