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Vision: Examination Report

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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 do you write an eye report?

Basic items needed in an eye report include: Visual acuity with and without glasses. The prescription being worn. The etiology (Cause of a disease or abnormal condition.) The diagnosis. The prognosis (The prospect of recovery from disease and if it is expected to deteriorate.) Restriction in activities.

How to read vision test results?

Normal 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 is a normal visual field test result?

A normal visual field is an island of vision measuring 90 degrees temporally to central Fixation, 50 degrees superiorly and nasally, and 60 degrees inferiorly. Visual acuity increases from movement discrimination in the extreme peripheral vision to better than 20/20 in the center of vision.

How do you describe your eyes on a physical exam?

In a physical exam, eyes are described based on visual acuity, pupil size and reactivity, eye movement coordination, and the absence of abnormalities in the external structures. Descriptions may include terms like 20/20 vision, equal and reactive pupils, and smooth eye movements.

What line is 20-40 on an eye chart?

Line 3: This line is ~ 20/40. You need to be able to read letters this size to pass the vision test for your drivers licence in California. Line 4, 5 6: These lines are 20/30, 20/20 and 20/10 respectively. Visual acuity in this range is considered to be normal.

How do you describe a normal eye exam?

Standard eye exam You will be asked to read random letters that become smaller line by line as your eyes move down the chart. To see if you need glasses, the doctor will place several lenses in front of your eye, one at a time, and ask you when the letters on the Snellen chart become easier to see.

How do you document normal eyes?

Normal: Eyeballs are symmetrical in size and position. The eyeballs are in the same plane as eyebrow and maxilla. The upper lid covers upper portion of cornea , when the patient is looking straight. Eye lashes span outwards. The edge of the lids are in apposition to eyeballs. Small lachrymal gland is recognizable.

How do you write normal eyesight?

20/20 vision is normal vision acuity (the clarity or sharpness of vision) measured at a distance of 20 feet.