MEDICAL HISTORY QUESTIONNAIRE OPHTHALMOLOGY
Strabismus Surgery (eye muscle surgery) Trabeculectomy (glaucoma surgery) Vitrectomy Please continue on the back side of this page Date:_____ Reviewed by:_____ Family History: Blindness Prostate Cancer Ovarian/Uterine CA BPH Other:_____ Musculoskeletal ... Document Retrieval
Welcome To Carbon Valley Eye Care. Thank You For Choosing Us ...
Have you had any eye surgery? Are you interested in finding out if you are a candidate for LASER refractive surgery (LASIK, PRK)? Rheumatoid Arthritis! ! Nystagmus! ! ! Macular Degeneration! Dry Eye Sjogren’s Syndrome! ! Retinal Detachment! ! Glaucoma! ! ... Fetch Here
Registration Form (Please Print Legibly & Fill In All Fields)
• Have you ever had any surgery, injuries or laser treatments to the eye? (lazy eye) Retinal disease Cornea transplant Blindness Prostate Disease HIV ... Read Full Source
Informed Consent - Siskiyou Eye Center
Surgical trauma to various parts of the eye, retinal detachment, especially in patients with nearsightedness, surgery with laser, lens removal and exchange, surgery, eye drops, glasses, contact lenses, medical consultations, travel, time off ... Document Viewer
Urologist Advocates For prostate Screening
With laser surgery. This procedure is called scatter laser treatment. hundred small laser burns in the areas of retinal leakage - You feel pressure in your eye - You can't see things at the side - You have trouble reading ... Get Content Here
Routine Care Of Healthy Patient, 'common Symptoms', Msk Pain ...
She states that last year she had a painful rash on the right side of her back that can try photodynamic tx or laser photocoagulation. Intraperitoneal, intrathoracic, endovascular aortic aneurysm, CEA, head/neck, orthopedic, prostate. Vascular Surgery. Peripheral vascular, major ... Access Document
Cataract surgery - Frank's Hospital Workshop
For mechanical pupillary dilatation may be needed during the surgery. • The patients with retinal detachment may be scheduled for a combined vitreo-retinal procedure, • Eye surgery • Africa Cataract Project References Surgery Encyclopedia - Laser posterior capsulotomy (http:/ / www ... Document Viewer
State-of-the-art cataract surgery, all-laser LASIK, intacs for keratoconus, and Prostate Cancer DSAEK Right Eye LTP Right Eye Retinal Laser Right Eye Other _____ DSAEK ... Read Full Source
Eye Neoplasm - Wikipedia, The Free Encyclopedia
Other less common sites of origin include the prostate, kidney, thyroid, skin, colon and blood or Tumors in the eye and orbit can be benign like vision, double vision, eventual vision loss and if they continue to grow the tumor can break past the retina causing retinal detachment. ... Read Article
Patient Please Bring Completed Form Day Of History ...
Hemorrhoids Hernia repair Kidney stones Tonsils Prostate surgery Neck/Back: Skin cancer Other, Please describe: Have you been (Crossed Eye) Yes No Retinal Detachment or Hole Yes No Injury Yes No Surgery or Laser Comments. Family History of Disease . ... Access Content
Retinal surgery or laser right eye left eye date(s) please turn paper over and complete the back side. prostate yes no explain_____date_____ radiation yes no explain ... Retrieve Content
Patient Please Bring Completed Form Day Of History ...
Yes No Peripheral Neuropathy Yes No Pulmonary Hypertension Prostate Surgery Yes No (Crossed Eye) Yes No Retinal Detachment or Hole Yes No Injury Yes No Surgery or Laser Comments. C A R O L I N A E Y E A S S O C I A T E S © 1998 Carolina Eye Associates, P.A ... Get Document
Volume 2, Issue 4 December 2009 Proudly Owned By Employees ...
Omni Eye Specialists • Madison Street Surgery Center Spivack Vision Center include retinal vascular thrombosis, dry eye and pseudotumor cerebri has been reported. (prostate cancer medication) has ocular side ... Read Full Source
Trucs Glauques 2 - YouTube
Intraocular tumor Surgery, Other less common sites of origin include the prostate, kidney double vision, eventual vision loss and if they continue to grow the tumor can break past the retina causing retinal detachment. Treatment: Laser therapy Plaque therapy Radiotherapy Enucleation ... View Video
Patient Information Pharmacy Referral Source Insurance ...
Prostate Cancer Arthritis Colon Cataract Surgery Left Eye LASIK Left Eye Punctal Plugs Right Eye Yag Capsulotomy Right Eye . Initials _____ DOB _____ Corneal DSAEK Right Eye LTP Right Eye Retinal Laser Right Eye Other _____ DSAEK ... Retrieve Here
MEDICAL HISTORY QUESTIONNAIRE
_____ Do you want laser eye surgery instead of glasses or contacts? drooping eyelid, glaucoma, retinal disease, cataracts, eye infections, or eye injury, seeing double, or any other eye problems, including any eye surgeries: Prostate Kidney Other: Bladder ... Document Viewer
Med X Change HD Eye Surgery Video Sample 1 - YouTube
High Definition Eye Surgery Captured by Med X Change For optimum results, view in 720p HD www.medxchange.com ... View Video
Medical History Questionnaire
(lazy eye) Retinal Hole Surgery PatchingRetinal Degeneration Inflammatory Disorder Please complete reverse side. __ Chronic Obstruction __ Acid Reflux __ Prostate disease/cancer __ Muscular Dystrophy __ Rosacea ... Fetch Full Source
Medical History Questionnaire - North Georgia Eye Clinic
Have you ever had any eye surgery (including laser) Loss of Side Vision Other Double Vision Diabetes Type I Prostate Diabetes Type II Other Other BONES/JOINT/MUSCLES EARS, NOSE, MOUTH, THROAT Rheumatoid or ... Fetch This Document
Confidential Education Law 6527 - Medical Care And Services ...
Eye Surgery Please list any . eye laser(s) or surgeries, Prostate Disease Yes No. Eye surgery Yes No. Crossed eyes Yes No. Problems after laser vision correction surgery ... Read More
MEDICAL HISTORY QUESTIONNAIRE - Merrimack Eye Clinic
Eye surgery/laser, catarac. t, tonsillectomy, heart, appendectomy, Loss of side vision . Tired eyes - Eye Strain. Seeing Flashes - Fluctuating vision . Distorted vision BLADDER, PROSTATE PROBLEMS? Stones? Infection? Frequency, VD? MUSCLES, BONES, JOINTS . Arthritis? Joint swelling, low ... Content Retrieval
Vitamin A - Wikipedia, The Free Encyclopedia
As light enters the eye, the 11-cis-retinal is isomerized to the all-"trans" form. Isotretinoin is a teratogen with a number of potential side-effects. Consequently, its use requires medical supervision. Retinal/retinol versus retinoic acid Edit. ... Read Article
Health Talk
Surgery is the removal of the prostate.The a hospital stay to ensure proper recover. For some men, however, surgery may mean undesirable side effects, like impotence and scientists have made great progress in managing and treating diabetic eye disease. Laser surgery, ... Read More
The Eye Center Of Southern Indiana Medical History / Interval ...
Glaucoma borderline __ retinal tearing __cataracts __ eye trauma __ glaucoma __ retinal detachment __ other (specify) Have you had any of the following eye surgeries? Put a “+” sign if so. Please include month & year of surgery. ___ retinal laser ___ after cataract SEE OTHER SIDE ... Fetch This Document
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