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Click ‘Get Form’ to open the diabetic eye exam form in our platform's editor.
Begin by entering the clinic or office name and address at the top of the form. This ensures that all relevant information is clearly documented.
Fill in the patient’s name, ID number, and contact details. Accurate patient identification is crucial for effective follow-up.
Record visual acuity for both eyes (R for right, L for left) and intraocular pressure readings. These measurements are essential for assessing eye health.
In the retinal examination findings section, check the appropriate boxes based on your assessment. This includes options for retinopathy status and any necessary treatments.
Complete the plan of treatment by circling the recommended procedures and indicating which eye(s) they apply to.
Finally, have the eye care provider print their name, sign, and date the form before submission.
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Is a diabetic eye exam different from a regular eye exam?
That is why a visual acuity test is essential in a diabetic eye exam. A reduced eye acuity may lead to refraction. This tests aim is to see if the patients eyeglasses prescription has changed. The eye check will give way to the testing of new lenses.
What is included in a diabetic eye exam?
People with diabetes should see an optometrist at least once a year for a complete dilated eye exam to detect the earliest stages of any diabetes-related eye complications and prevent them from worsening.
Diabetes: Eye Exam | eCQI Resource Center - HealthIT.gov
Aug 27, 2025 - Patients with type 2 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist at the
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