Salem Laser and Surgery Center
YAG Laser Iridotomy Flow Sheet / Orders
PRE-OPERATIVE HISTORY
Chief Complaint:
Findings:
Narrow anatomical angles
OD OS
Other:
Planned Procedure:
YAG laser Iridotomy
ODOS
Other:
Significant Medical History:
Current Medications and Dosages:
Drug Allergies:
RXN:
NAUSEA
VOMIT
RASH
SHOCK
OTHER
REASSESSMENT: H & P Current and valid. No Changes
RN Signature
Date
Physician Signature
Date
Time