EYE HISTORY AND PHYSICAL 572264 Hartford Hospital Admission Forms - harthosp 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's name and date of surgery at the top of the form. This information is crucial for identifying the patient and scheduling.
3. Indicate whether the admission is for right or left eye surgery by checking the appropriate box next to 'Admission for'.
4. In the section regarding blurred vision, check all applicable activities that are affected, such as driving or reading. This helps in assessing the urgency of the procedure.
5. Document any previous ocular surgeries in the designated area to provide a complete medical history.
6. Fill out findings from the most recent exam, including best corrected distance and near vision, as well as other relevant measurements.
7. Complete details about IOL type and power, along with incision location, ensuring accuracy for surgical planning.
8. Review co-existent conditions like glaucoma or diabetes and add any additional comments that may be pertinent to the surgery.

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