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1. To begin with, when filling in the 850014, start out with the section containing next fields:
2. The subsequent stage is usually to submit these particular blank fields: SURGERY, A IF SURGERY HAS BEEN PERFORMED, B IS SURGERY ANTICIPATED WITHIN, YES PROBABLE, NO NOT LIKELY, INITIAL RESPONSE TO THERAPY, PRESENT TREATMENT Indicate exact, ADEQUACY OF CONTROL, A DESCRIBE PRIOR CONTROL INCLUDING, B MAXIMUM INTRAOCULAR PRESSURES IN, C INTRACOCULAR PRESSURE, TEST METHOD USED, TIME SINCE LAST MEDICATION, and NOTE Pressures should NOT be.
3. In this step, examine A DID EXAMINEE WEAR GLASSES OR, B SIZE OF TEST OBJECT USED WITH, TEST Specify which, SCREEN, VISUAL ACUITY Record Use Snellen, A DISTANT, B NEAR, C INTERMEDIATE, INCHES, TEST METHOD USED, UNCORRECTED, CORRECTED, O D, O U, and O D. These will need to be completed with highest accuracy.
4. To move forward, this next section will require completing a couple of blanks. These include GLASSES, CONTACT LENSES, PUPILS Statement of relative, process healed or active, OPHTHALMOSCOPIC D escribe any, disease process healed or active, SLIT LAMP Record results of slit, FUSION Estimate fusion ability, A TYPED NAME AND ADDRESS OF EYE, B SIGNATURE OF EYE SPECIALIST, FAA FORM Supersedes Previous, NSN, and Page, which you'll find key to carrying on with this particular document.
Those who use this form frequently make some mistakes when filling in SLIT LAMP Record results of slit in this area. Ensure that you double-check whatever you enter here.
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