Medical History
A copy of the medical history form for our office can be downloaded and printed here.
A lot of information is required for this form. It is a bit annoying to fill out, but all of the information does serve a purpose. Your name, address, phone number and identification numbers are required for your insurance company to pay for the eye exam. Also, this information is used to communicate with your primary care Doctor or other specialist (such as a retinal specialist) in the event of an emergency.
Medical History is a comprehensive listing of any medical conditions a patient or their family may have. Proper function of the eye is significantly affected by the health of the rest of the body. Also, certain signs identified in a patient's eye can indicate various systemic conditions. Many health conditions can be linked to genetics. For genetic conditions, when one family member has a condition, this represents increased risk of this condition for other family members.
Symptoms are also used to identify problems. Common problems such as blurred vision are mentioned to help the Eye Doctor quickly identify which problems are present. With a complete medical history of the patient, the Eye Doctor can narrow down the likely causes of the patient's problems.
Allergies are listed to identify which medications and/or eye drops that should be avoided for the patient. Medications are listed to identify any medical conditions the patient may have forgotten, or to identify medications, such as Plaquenil that can have side effects affecting the eye.
Expecting Moms that breastfeed can experience changes in their prescription. We also closely watch Moms at risk for gestational diabetes, as diabetes can lead retinal damage and permanent vision loss. The birthing process itself can cause a retinal detachment and vision loss.
Hobbies, sports, work and driving are mentioned to assess the distances the patient focuses at the most and to identify which types of correction will help the patient most in their day to day activities. Examples would be a computer prescription with an anti-reflective coating for a patient spending over 8 hours a day working at a computer. Another example, could be polarized sunglasses for a patient who enjoys fishing.
Smoking is listed not only as a threat to general health, but also a threat to the eyes. Smokers are more likely to lose vision due to cataracts and macular degeneration. Alcohol consumption relates more to severe alcoholism. Alcohol decreases the body's ability to absorb vitamin A and can cause night blindness. Also, alcohol can cause optic atrophy or death of nerve fibers forming the optic nerve.
Illegal drugs can leave waste products in the eye and can result in vision loss. For example, a cocaine abuser could develop talc retinopathy or deposits of talcum powder in the retinal blood vessels. Cocaine abuse is also associated with an increased risk of glaucoma.
Some of the questions may seem odd, but they all do help the Eye Doctor get the answer to your eye-related problems faster and more precisely.
A lot of information is required for this form. It is a bit annoying to fill out, but all of the information does serve a purpose. Your name, address, phone number and identification numbers are required for your insurance company to pay for the eye exam. Also, this information is used to communicate with your primary care Doctor or other specialist (such as a retinal specialist) in the event of an emergency.
Medical History is a comprehensive listing of any medical conditions a patient or their family may have. Proper function of the eye is significantly affected by the health of the rest of the body. Also, certain signs identified in a patient's eye can indicate various systemic conditions. Many health conditions can be linked to genetics. For genetic conditions, when one family member has a condition, this represents increased risk of this condition for other family members.
Symptoms are also used to identify problems. Common problems such as blurred vision are mentioned to help the Eye Doctor quickly identify which problems are present. With a complete medical history of the patient, the Eye Doctor can narrow down the likely causes of the patient's problems.
Allergies are listed to identify which medications and/or eye drops that should be avoided for the patient. Medications are listed to identify any medical conditions the patient may have forgotten, or to identify medications, such as Plaquenil that can have side effects affecting the eye.
Expecting Moms that breastfeed can experience changes in their prescription. We also closely watch Moms at risk for gestational diabetes, as diabetes can lead retinal damage and permanent vision loss. The birthing process itself can cause a retinal detachment and vision loss.
Hobbies, sports, work and driving are mentioned to assess the distances the patient focuses at the most and to identify which types of correction will help the patient most in their day to day activities. Examples would be a computer prescription with an anti-reflective coating for a patient spending over 8 hours a day working at a computer. Another example, could be polarized sunglasses for a patient who enjoys fishing.
Smoking is listed not only as a threat to general health, but also a threat to the eyes. Smokers are more likely to lose vision due to cataracts and macular degeneration. Alcohol consumption relates more to severe alcoholism. Alcohol decreases the body's ability to absorb vitamin A and can cause night blindness. Also, alcohol can cause optic atrophy or death of nerve fibers forming the optic nerve.
Illegal drugs can leave waste products in the eye and can result in vision loss. For example, a cocaine abuser could develop talc retinopathy or deposits of talcum powder in the retinal blood vessels. Cocaine abuse is also associated with an increased risk of glaucoma.
Some of the questions may seem odd, but they all do help the Eye Doctor get the answer to your eye-related problems faster and more precisely.
Thanks for the advice, very helpful and appreciated!Medical History Template
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