SIERRA EYE MEDICAL GROUP, INC.
ANNUAL GLAUCOMA TREATMENT PLAN REPORT
Consultant: Steven M. Cantrell, M.D. Byron W. Riegel, M.D.
Treating Doctor:
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Patient's Name:
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The following information is the annual update on this patient.
Confirmed Diagnosis: OD Open angle glaucoma Narrow angle glaucoma Low tension glaucoma Normal OS Open angle glaucoma Narrow angle glaucoma Low tension glaucoma Normal
Approved Treatment Plan:
OD Xalatan i qhs Travatan i qhs Timolol 0.5% i qd Timolol 0.5% i bid Alphagan P 0.1% i bid Trusopt i tid OS Xalatan i qhs Travatan i qhs Timolol 0.5% i qd Timolol 0.5% i bid Alphagan P 0.1% i bid Trusopt i tid (Use Cntrl key to make multiple selections)
Goals of Treatment Plan:
OD OS
Visual Field Plot Available Yes No Copy of Visual Field Plot Mailed Faxed e-transfer
Intraocular Presures: OD mm Hg OS mm Hg Instrument Goldmann AO NCT Schiotz Tonopen
Target Intaocular Pressures: OD mm Hg OD mm Hg
Optic Nerve Head OD C/D: H 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 V 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 Comment OS C/D: H 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 V 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 Comment
Additional Testing:
Allergies to Medications:
Current Medications OD Xalatan i qhs Travatan i qhs Timolol 0.5% i qd Timolol 0.5% i bid Alphagan P 0.1% i bid Trusopt i tid OS Xalatan i qhs Travatan i qhs Timolol 0.5% i qd Timolol 0.5% i bid Alphagan P 0.1% i bid Trusopt i tid (Use Cntrl key to make multiple selections)
Have treatment plan goals been achieved?
Proposed Changes in Treatment Plan:
Additional Commnets:
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