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Ophthalmic Medication Table
Patient Name:
Date:
Please separate all drops by at least 5 minutes.
Medication:
Top Color:
Eye:
Right
Left
Both
to right eyelid
to left eyelid
to both eyelids
to incision
Oral
Nasal Spray
Times per day:
Suggest common frequencies
A suggested frequency was filled in. You can edit it.
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Print
Cap Color
Medication
Eye
Times per day
Action
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Patient Handouts
This tool is for convenience only and does not provide medical advice. Verify all instructions with a licensed eye care professional. Medication names are for identification only.
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