OCFS-1119. Low Vision Evaluation Report

Form Low Vision Evaluation Report is a form used by doctors to assess the level of vision impairment in patients. It is used by the New York State Office of Children and Family Services (OCFS) to evaluate the vision of children in need of special services.

The form consists of three main sections. The first section is the patient information section, which includes identifying information such as the patient’s name, date of birth, gender, and address. The second section is the vision assessment section, which contains questions about the patient’s vision, including their visual acuity, contrast sensitivity, depth perception, and color vision. The third section is the physician’s report section, which contains the doctor’s assessment of the patient’s vision, including their diagnosis and recommendations for further testing or treatment.

Important fields in this form include the patient’s name, date of birth, and the doctor’s diagnosis and recommendations. It is important to ensure that all of the information provided in the form is accurate and complete in order to accurately assess the patient’s vision. In addition, the doctor should provide detailed explanations for any diagnosis or recommendations made in the form.

An example scenario where the form would be used is a doctor who is assessing the vision of a child who is in need of special services. By completing the form, the doctor can accurately assess the level of vision impairment and provide recommendations for further testing or treatment. The benefits of using the form include providing an accurate assessment of the patient’s vision and providing a record of the assessment for future reference.

Additional documents that may need to be completed in order to fill out the form include any test results or medical records that the doctor has for the patient. Related forms or alternatives that may exist for similar purposes include the Low Vision Evaluation Summary and the Low Vision Mobility Assessment.