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
YAG Laser Flow Sheet / Orders
PRE-OPERATIVE HISTORY
Patient complains of poor vision in
right -
left
eye(s), and activities of daily living are adversely affected, particularly in the areas of:
reading newsprint-
books-
computer-
distant objects-
street/road signs-
knitting-
sewing-
crocheting:
driving;
recognizing faces;
watching TV;
worsened in bright light;
complains of glare disability:
other:
Findings: Opacified posterior lens capsule OD OS
VA:
BAT:
Other:
Pre-op Diagnosis:Opacified posterior lens capsule
OD
OS
Other:
Planned Procedure:YAG laser posterior capsulotony,
OD
OS
Other:
Drug Allergies:
RXN:
NAUSEA
VOMIT
RASH
SHOCK
OTHER
REASSESSMENT: H & P Current and valid. No
Changes
RN Signature
Date
Physician Signature
Date
Time