DILATED OPHTHALMOLOGICAL EXAM - Florida Department 2026

1. Click ‘Get Form’ to open the DILATED OPHTHALMOLOGICAL EXAM in the editor.
2. Begin by entering your name in the designated fields for LAST, FIRST, and MIDDLE names. Ensure accuracy as this information is crucial.
3. Fill in your age and birth date in the specified format. This helps verify your identity and eligibility.
4. Provide your Social Security Number (SS#) in the appropriate field. This is necessary for identification purposes.
5. Indicate whether you have ever had any eye diseases or injuries by selecting YES or NO. If applicable, list the nature of these conditions in the provided space.
6. Complete the examination section by entering details such as the date of examination and vision metrics for both eyes, including naked eye and corrective lenses vision.
7. For each eye condition listed (e.g., glaucoma, cataract), provide specific remarks based on your ophthalmologist's findings.
8. Finally, ensure that your ophthalmologist completes their section, including signature and license number before submitting the form.

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