Risk Management

Brief Vision Exam


Name:                                                              Age:                 Date:                                               

Va       cc                                 Vnear  cc          W                           x               Add               


sc                                             sc                                          x                                    

M                                                         x                                             Add                             




Impression:      Refractive error

Normal exam


Plan:                Rx = M

No Rx

Follow-up for additional ophthalmology evaluation


                                                            , M.D.

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