PPHI SINDH

SUMMARY REPORT FOR OPHTHALMIC AND VISUAL SERVICES (SROVS)

Section 01: Basic Health Facility Data
01 Name of Health Facility 03 HF Code
Sign of HF
02 Reporting Month 04
Incharge/Optometrist

15-49 > 50
Section 02-A: Special EYE OPD Cases < 1 Year 1-4 Year 5-14 Year
Year Year
Total

01 Male New Case

02 Female New Cases
03 Grand Total

Section 02-B: OPD Cases Description

01 Follow-up Cases 04 Cases Referred for Refraction from OPD
02 Referred in Cases from other HFs 05
03 Referred out cases

Section 02-C: Refraction Done (Refraction Register)

01 Total Refraction Cases (new) 04 Myopia
02 Refractive errors (follow-up - All) 05 Astigmatism
03 Hypermetropia 06 Presbyopia

Section 03: Ophthalmic Diseases / Diagnosed (New Cases)

S.No Syndrome / Condition Number S.No Syndrome / Condition Number
01 Blepharitis 11 Corneal ulcers
02 Dacryocystitis 12 Foreign body
03 Trachoma 13 Trauma
04 Chalazion 14 Glaucoma
05 Stye (hordeolum) 15 Cataract (ALL)
06 Conjunctivitis 16 Strabismus
07 Pterygium 17 Cyst
08 Pingeculum 18 Retinopathy
09 Keratitis (Corneal Inflammation) 19 Cancer
10 Keratoconjunctivitis 20 Others

Section 04: Ophthalmic Procedures done

S.No Condition Number S.No Syndrome / Condition Number
01 Phacoemulsification 09 Trabeculectomy
02 Extracapsular Cataract Extraction (ECCE) 10 Iridectomy
03 Intracapsular Cataract Extraction (ICCE) 11 Keratotomy
04 Probing and syringing 12 Yag laser
05 Blepharoplasty 13 Pediatric retinoscopy
06 Intra vitreal Injection 14 Resection
07 Foreign body Removal 15 Excision
08 Incision and Curettage 16 Others