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  • Clinical Telephone Review Form

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    Andrew Coates
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    This document summarizes a telephone or video consultation with an optometry patient. It includes the patient's name and contact details, reason for contacting the practice, existing prescription information if relevant, questions asked about symptoms and medical history, the patient's self-reported vision in each eye compared to previous, and the optometrist's recommendations which may include referring to casualty, booking an urgent or routine appointment, or advising self-management. The optometrist signs and dates the document.

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    Clinical-telephone-review-form

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    This document summarizes a telephone or video consultation with an optometry patient. It includes the patient's name and contact details, reason for contacting the practice, existing prescription information if relevant, questions asked about symptoms and medical history, the patient's self-reported vision in each eye compared to previous, and the optometrist's recommendations which may include referring to casualty, booking an urgent or routine appointment, or advising self-management. The optometrist signs and dates the document.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    6 views1 page

    Clinical Telephone Review Form

    Uploaded by

    Andrew Coates
    This document summarizes a telephone or video consultation with an optometry patient. It includes the patient's name and contact details, reason for contacting the practice, existing prescription information if relevant, questions asked about symptoms and medical history, the patient's self-reported vision in each eye compared to previous, and the optometrist's recommendations which may include referring to casualty, booking an urgent or routine appointment, or advising self-management. The optometrist signs and dates the document.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Clinical telephone/video review

    Patient name: Patient


    identifier:
    Contact details: Date of birth:
    Relevant OH: Date of last
    sight test:

    Reason for contacting the practice

    Existing spectacle prescription (if relevant)


    Right: Previous VA

    Left: Previous VA

    Telephone/ video consultation (delete as approriate)


    History and symptoms Have you experienced any of the
    following? N/R/L
    Eye pain:
    Photophobia:
    Haloes around
    lights:
    Recent trauma:
    Distortion in vision:
    Recent onset
    floaters:
    Red eye
    Sudden change in
    VA:
    Patient self-estimated VA Right Left GH/Medications:
    (Same/ little worse/ much worse
    than previous)
    Recommendations (tick)
    Sight/life threatening?: Refer to eye casualty Minor eye condition: Advise to self-manage

    Potentially sight/life threatening?: Book urgent Non urgent condition: Book appt in 6/12
    optom review

    Advice given:

    Signature: Date:
    GOC:

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