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The document is a vision examination report form used by the Illinois Department of Public Health. It collects personal information about a child, including their name, birth date, and contact details, as well as details regarding their vision screening results. The form includes sections for recording visual acuity tests, symptoms noted, reasons for referral, and recommendations from the examining doctor. It also requires consent from a parent or guardian to release the child's information to relevant authorities.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (175 Votes)
2015	4.8 Satisfied (126 Votes)
2014	4.8 Satisfied (160 Votes)
2014	4.1 Satisfied (31 Votes)
2011	5 Satisfied (52 Votes)
2010	4.8 Satisfied (147 Votes)
2009	4.8 Satisfied (116 Votes)
2009	4 Satisfied (20 Votes)
2008	4.8 Satisfied (109 Votes)
2008	4.4 Satisfied (318 Votes)
2002	4.3 Satisfied (231 Votes)
1999	4.5 Satisfied (62 Votes)

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How to read an eye examination report?

Key Components of Eye Exam Results Sphere (SPH): Indicates the amount of lens power needed to correct nearsightedness (-) or farsightedness (+). Cylinder (CYL): Measures the degree of astigmatism, which causes blurred or distorted vision. Axis: Specifies the orientation of astigmatism in degrees.

What is a normal eyesight report?

Results of a routine eye exam are normal when the eye doctor finds you have: 20/20 (6/6) (normal) vision. Ability to identify different colors. Full visual field.

How do you document visual acuity results?

Visual acuity is expressed as a fraction. The top number refers to the distance you stand from the chart. This is often 20 feet (6 meters). The bottom number indicates the distance at which a person with normal eyesight could read the same line you correctly read.

What does +0.25 mean on an eye test?

Commonly, this number will be different for each eye. A + in the box indicates that you are long-sighted which means you find it difficult to see things close to you. A shows that you find it hard to see things that are far away without glasses. The number might be very small, like 0.25, or a large number, like 6.00.

How do you write vision test results?

Your vision results (acuity) will be expressed as a fraction. Fractions are shown to the left of each row and identify how well you can see. The expression of results, such as 20/40 vision or 20/25 vision, will depend on how far down you were able to read the lines on a specific chart.

How do you record eye test results?

Record your visual acuity for each eye by noting the line for which you correctly identified either: a) More than half the letters on that line, but not all of them. b) All letters on that line, plus a few letters (less than half) on the next line.

What is a vision evaluation report?

The Functional Vision Evaluation (FVE) report, written by the Teacher of Students with Visual Impairments (TVI) after conducting the FVE, should be specific with details about the students performance on individual tasks in clearly described situations.

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