MCN’s customizable template, Supplemental Eye History and Physical Exam - Sample Form, is taken from our Outpatient Surgery and Ambulatory Services Policy and Procedure Manual. MCN Healthcare’s proven policy and procedure templates, competencies and compliance tools have assisted more than 20,000 health care organizations worldwide meet their regulatory compliance goals.

MCN’s templates save you time, money and resources, rather than developing healthcare policy and procedure manuals from scratch.

Here is some sample content from Supplemental Eye History and Physical Exam - Sample Form:

	SUPPLEMENTAL EYE HISTORY AND PHYSICAL EXAM SAMPLE Patient Name: Chief Complaint:? Poor vision For the past weeks, months, yearsPresent Illness:This patient has had decreasing vision in the since . He/she now desires surgery for this eye because it interferes with the patient's ability to: ? Drive a car ? Move about his/her place of resident with confidence ? All of the above ? Other reasons: If yes, explain: Previous eye disease: Allergies to eye medications: Explain: Slit Lamp Exam: Cornea Lens Tension: Fundus Exam: External Eye Exam: Diagnosis: Treatment Plan:...
Second excerpt:
	... Previous eye disease: Allergies to eye medications: Explain: Slit Lamp Exam: Cornea Lens Tension: Fundus Exam: External Eye Exam: Diagnosis: Treatment Plan: Signature: 1 Reference #2011 Outpatient...