The work-up a department records before the doctor sees the patient — and, in detail, what the ophthalmology sheet accepts.
A pre-consultation sheet is the work-up a department records before the doctor sees the patient: the readings its technicians take in the room, written down on one screen instead of on paper. It is opened from the appointment — either on its own Pre-Consultation screen, or as a tab of the consultation page, titled with the name of the form that department uses.
Which sheet a department gets, if any, is a setting on the department rather than something built into the screen. On the department master, the Pre-consultation form field picks the sheet that department's doctors get: they gain a Pre-Consult button on their appointments, opening that form before the consultation starts. A department left at None has no pre-consultation step at all, and its visits carry straight on to the consultation — which is how every department starts, and how most of them stay. A specialty added to the system appears in the same picker with its own sheet and its own fields, so the list there is the list of sheets that exist.
Ophthalmology is the sheet configured today, and everything specific to it is under the Ophthalmology heading below. What follows on this page before that heading is true of any sheet.
Every field on a sheet has a limit, and the sheet shows you what it will accept rather than letting a typo travel onto the patient's record and the printed copy. The same limits are enforced twice: on the screen, so you see the problem while you are typing, and on the server, so nothing that slipped past the screen is ever stored.
Nothing on a sheet is required. A blank sheet saves, and so does a half-filled one — the sheet is filled in over the course of a visit, and an untouched field is blank, not wrong. The limits only refuse a reading; they never demand one.
The ophthalmology sheet is the work-up the optometrist or technician captures before the doctor sees the patient. It holds the readings taken in the room — visual acuity, refraction, intra-ocular pressure, the slit lamp findings and the fundus — and it is the sheet a department gets by picking Ophthalmology eye examination as its pre-consultation form.
Two kinds of reading on it are also finished off for you. The part of a distance acuity that never changes is its test distance, and the part of a lens power that never changes is its sign and its places — so in those fields you type only what varies and the sheet writes the rest when you leave the field. Both show what they are about to write while you are still typing, and both are described below.
The acuity fields take whatever the chart says, written the way your clinic writes it. They are free text: no format is imposed, and the only limit is length (12 characters). All of the following are accepted exactly as typed:
| Notation | Reads as |
|---|---|
6/6, 6/9, 6/12, 6/18, 6/24, 6/36, 6/60 | A line on the six metre Snellen chart |
3/60 | Counts fingers at three metres |
CF | Counts fingers |
HM | Hand movements |
PL | Perception of light |
N5, N6, N8 | A near vision card, at the reading distance |
6/6 PH | A reading improved by the pinhole |
This is deliberate. Acuity is a notation rather than a number, and a rule
that only accepted a fraction would refuse CF on the very
patient who most needs it written down.
Distance acuity is always tested at six metres — that part is the same for every patient in the room, and only the line the patient reached varies. So in the distance acuity fields you can type just the line and the sheet writes the test distance in front of it when you leave the field.
| You type | The field holds |
|---|---|
6 | 6/6 |
9 | 6/9 |
12 | 6/12 |
18 | 6/18 |
24 | 6/24 |
36 | 6/36 |
60 | 6/60 |
While you are typing, the reading the field is about to hold is shown in grey at the right-hand end of the box. Press Tab or Enter and it becomes the reading; carry on typing and it follows you.
The completion is deliberately cautious. It does nothing at all unless the field holds a bare line of the chart:
| You type | What happens |
|---|---|
6/6, CF, PL, 6/6 PH | Left exactly as you wrote it — already a complete reading |
7, 10, 20, 100 | Left as typed — not a line of the chart, so nothing is assumed. A completed 6/7 would sit on the sheet looking like a line the patient read |
This applies to Visual acuity, Pinhole, Vision with PG and the DV acuity column of the Refraction table. It does not apply to near vision — the NV acuity column and Glass NV are N-notation, where a test distance means nothing.
A lens power is always written with its sign and to two places, because that is how it is prescribed and how the column is read down. So in the sphere and cylinder fields you can type the number alone and the sheet writes the rest of it when you leave the field.
| You type | The field holds |
|---|---|
5 | +5.00 |
-5 | -5.00 |
+2.5 | +2.50 |
-0.75 | -0.75 — already written in full |
5., -, abc | Left as typed — not a number, so nothing is assumed |
1.234 | +1.234 — never rounded, so the sheet can refuse it instead |
A sphere typed without a sign is read as positive. A
prescription carries its own sign, so a bare 5 in a sphere box
is taken to be the +5.00 you did not bother to sign — not a
-5.00. If you mean a minus power, type the minus. The grey hint
beside the box shows you the reading this produces before you leave the
field, so you will see it.
This applies to every sphere and cylinder on the ophthalmology sheet: glass power, auto-refraction, and both the distance and near columns of the Refraction table. Axis, IOP and IPD are left alone — a whole number read off the instrument or the chart is already written in full, and neither a sign nor a place means anything on one.
Four kinds of reading are checked against a clinical range as well as a length. A reading outside the range is refused, and the field turns red with the reason on it.
| Reading | Accepted | Message when refused |
|---|---|---|
| Axis (glass, auto-refraction, DV and NV) | A whole number from 0 to 180 | Enter a whole number between 0 and 180 |
| Sphere and cylinder (all four blocks, both eyes) | A number from −30 to +30, at most two decimals — +2.50, -1.25, +30.00 |
Enter a number between -30 and 30 |
| Intra-ocular pressure (AT and NCT, both eyes) | 0 to 80 | Enter a number between 0 and 80 |
| IPD | 30 to 90 mm | Enter a number between 30 and 90 |
Both bounds are inclusive, so 0, 180,
+30 and 80 are all accepted.
Sphere and cylinder take a plain number only. The clinical
shorthand PL and +1.25 DS is refused in these two
fields, and so is anything else that is not a number — abc, a
lone -, or three decimals such as 1.234. A box
that accepts anything cannot catch a typo, which is the whole reason these
two are checked. Write the shorthand in Diagnosis,
Procedure / follow-up or Notes instead.
Every field stops accepting characters at its own limit, so an over-long entry is not possible to type in the first place. The same limit is checked again when the sheet is saved.
| Field | Limit |
|---|---|
| Visual acuity, Pinhole, Vision with PG, DV and NV acuity, Glass NV | 12 characters |
| Sphere and cylinder (all four blocks, both eyes) | 10 characters |
| Axis (all four blocks, both eyes) | 3 characters |
| IOP — AT and NCT, and IPD | 5 characters |
| CTC horizontal and vertical | 20 characters |
| Each anterior segment cell (nine structures, both eyes) | 120 characters |
| Fundus | 200 characters |
| Past illness, Past eye treatment, Drug allergy | 500 characters |
| Procedure / follow-up | 500 characters |
| Diagnosis | 1,000 characters |
| Present complaints, Notes | 2,000 characters |
A reading that is too long is refused with Cannot be longer than 12 characters, naming its own limit.
Not everything is bounded, and the exceptions are deliberate:
Nothing is written when a save is refused — not the readings, and not the attachments or the diagram saved alongside them.
A reading is not marked while you are still typing it. The
fields stay neutral until you first press Save, and clear individually as
you correct them. Half a reading — the - on the way to
-1.25 — is a normal moment on the sheet, not an error.