Eye Examination PDF Details

The intricacy and detail encompassed within the Eye Examination form, as prescribed by the Department of Defence and revised in March 2005, underline its critical role in maintaining the ocular health and operational readiness of Defence Force personnel. Composed meticulously to cover an array of visual assessments, the document serves multiple functions; it begins with basic identification details, including the patient's Defence Force information—a testament to its tailored design. Crucial visual acuity tests for both distance and near vision provide foundational data, pivotal especially for Special Forces applicants, ensuring that those who protect are themselves protected against the impairments that could hinder their formidable tasks. The form delves deeper into ocular health with examinations for refractive errors and heterophoria, thereby encompassing a wide spectrum of potential visual disorders with the aim of identifying even the subtlest anomaly that might compromise a service member's efficiency. Further sections on general physical examination, diseases of the eyelid, and intraocular pressure, alongside a comprehensive fundus examination, illustrate the form's thorough approach. It even includes provisions for individuals who have undergone refractive surgery or those who wear contact lenses, requiring a second appointment to fully assess the delicate balance between corrected vision and its potential impact on natural sight. This conscientious document closes with a section for comments and recommendations from the examining ophthalmologist or optometrist, emphasizing the personalized care behind each filled form. With its detailed approach, the Eye Examination form exemplifies the Department of Defence's commitment to the health and operational capacity of its service members, ensuring through meticulous ocular scrutiny that those who serve are as visually equipped as they are physically and mentally prepared for the demands of their duties.

QuestionAnswer
Form NameEye Examination
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameseye exam form for school, eye exam templates, optometry exam forms, eye exam blank form

Form Preview Example

MEDICAL-IN-CONFIDENCE (After first entry)

PM 529

Department of Defence

 

Revised Mar 2005

 

 

 

 

 

 

Eye Examination

 

 

 

 

 

 

 

 

 

PFID number (Recruiting use only)

 

Use only black pen and/or stamps

 

 

 

 

 

 

 

 

 

Health facility or Defence Force Recruiting Centre

 

 

Employee ID

Rank

 

 

 

 

 

Service

 

 

Family name

 

 

 

 

 

 

Unit, ship or section

 

 

Given name(s)

 

 

 

 

 

 

Corps, category or mustering

 

 

Date of birth

Gender

 

 

 

 

 

Visual acuity

 

 

 

 

Encl/Folio

Distance vision

 

 

 

 

 

 

 

 

 

 

 

 

Right

 

 

Left

Corrected

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Uncorrected

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Near vision (Corrected) (Special Forces applicants only)

 

 

 

 

 

 

 

 

Right

 

 

Left

N5 at 30-50cm

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N14 at 100cm

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Refractive limits with effective cycloplegia (Cyclopentolate HCL 1% is to be used)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Right

 

 

Left

Hypermetropia

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hypermetropic astigmatism

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Myopia

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Myopic astigmatism

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Heterophoria

 

 

 

 

 

 

 

 

 

 

 

 

Right

 

 

Left

 

 

 

 

 

 

 

 

 

Exophoria

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Esophoria

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hyperphoria

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hypophoria

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

General physical examination

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Normal or abnormal

 

 

Comments

 

 

Fields of vision

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Diseases of the eyelid

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fundus examination

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

External and anterior segment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Right

 

 

Left

Intraocular pressure (mmHg)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

History of refractive surgery

 

 

 

 

 

 

 

 

 

 

 

 

 

Second appointment (Required if contact lenses worn)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Right

 

 

Left

Visual acuity wearing lenses

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Spectacle blur

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comments

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Recommended MVR

 

 

 

 

 

 

 

 

MVR 1

MVR 2

MVR 3

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature

 

 

Printed name

Ophthalmologist or optometrist

 

Date

 

 

 

 

 

 

 

 

 

MEDICAL-IN-CONFIDENCE (After first entry)

PM 529 - Page 1 of 1

How to Edit Eye Examination Online for Free

Our leading developers worked hard to implement the PDF editor we're content to deliver to you. Our application will let you shortly fill out optometry exam form pdf and will save you precious time. You simply need to keep up with the following procedure.

Step 1: Choose the orange button "Get Form Here" on the following website page.

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You need to provide the next data so you can fill out the document:

portion of empty spaces in eye test report format

Provide the expected details in the section Right, Normal or abnormal, Comments, Exophoria, Esophoria, Hyperphoria, Hypophoria, General physical examination, Fields of vision, Diseases of the eyelid, Fundus examination, External and anterior segment, Intraocular pressure mmHg, History of refractive surgery, and Right.

eye test report format Right, Normal or abnormal, Comments, Exophoria, Esophoria, Hyperphoria, Hypophoria, General physical examination, Fields of vision, Diseases of the eyelid, Fundus examination, External and anterior segment, Intraocular pressure mmHg, History of refractive surgery, and Right blanks to fill out

You'll be required particular key particulars if you would like fill in the Recommended MVR, MVR, MVR, MVR, Signature, Printed name, Ophthalmologist or optometrist, Date, MEDICALINCONFIDENCE After first, and PM Page of field.

stage 3 to completing eye test report format

Step 3: As soon as you've selected the Done button, your form is going to be ready for transfer to any electronic device or email address you identify.

Step 4: Make sure to remain away from possible future difficulties by making minimally a pair of copies of your form.

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