Ophthalmology Patient Encounter Elective Logbook

Name:

Elective

Individually Designed      Extramural

 

Course number/name:

Elective End Week:

Date Patient Seen:

  

Patient's Age:

   Years   Months

Patient's Gender:

Male          Female

Location: 

Eye

Right          Left          Both

Chief Complaint:
(to select more than one item, click on each item while holding down the <control> key)

If "other", describe:

Physical Exam:

Primary Diagnosis: (check all that apply)

*None

Disorder of the Eye - Unspecified

ocular histoplasmosis

Age-related Macular Degeneration (ARMD)

drooping eyelids

ocular hypertension

AIDS-related eye disorders

dry eye

onchocerciasis

allergies of the eye

epiphora

open globe repair

amblyopia

epiretinal membrane (ERM)

open-angle glaucoma

angioma

esotropia optic atrophy
aniridia

exam under anesthesia

optic ischemic syndrome

anisocoria

exotropia

optic neuritis

aphakia

exposure keratopathy

optic neuroma

asthenopia

fuch's dystrophy

optic neuropathy

astigmatism

fungal keratitis

orbital fracture

Bardet-Beidl Syndrome

glasses prescription

orbital tumor

basal cell nevus syndrome

glaucoma

Other Ill-Defined Disorder of Eyes 

Batten Disease

Graves disease ophthalmopathy

Pain in/or Around Eyes

Bellís palsey

heterophobia

photophobia

blepharitis

HIV retinopathy

post-op check

blepharospasm

HSV keratitis

presbyopia

blindness

HTN

pseudoesotropia

branch retinal vein occlusion / central retinal vein occlusion

hyperopia

pterygium

cancer: eye

hypertensive retinopathy

retinal detachment

cancer: eyelid skin

hypertropia

retinitis pigmentosa

cataract

hyphema

retinoblastoma

cataract removal

hypopyon

retinopathy of prematurity / myopia

chalazion

immature cataract

ruptured globe

choroidal hemangioma

intraocular lens repositioning

sarcoidosis

choroidal melanoma

intropion

Sjogren's syndrome

choroidal metastasis

IOL lens OS

strabismus

choroidal nevus

IOL placement

sty

choroidal osteoma

iritis

subconjunctival hemorrhages

closed-angle glaucoma

keratitis

suspected child abuse

CN V palsy

keratoconus

sympathetic ophthalmia

CN IV palsy

lid laceration

temporal arteritis

computer vision syndrome

macular degeneration

trachoma

conjunctival tumor

macular pucker

trauma

conjunctivitis

multiple sclerosis

traumatic cataract

corneal abrasion

myopia

traumatic iritis

corneal dystrophy

narrow-angle glaucoma

uveitis

corneal transplant

neurofibromatosis

vertebral artery tear

corneal ulcers

NFT

vitreous detachment

cystoid macular edema (CME)

NLDO

vitreous hemorrhage

CVA 

Normal Eye Exam

Von Hippelís angioma

dacryocystitis

nystagmus

*Other:

diabetic check

   

diabetic retinopathy

   
       

Procedure:
(to select more than one item, click on each item while holding down the <control> key)

Procedure Role:

Surgeries:

Problem List:

Notes/Comments:

Problems with any entries?  Contact Jean Afflerbach

Revised: September 02, 2014