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  2. 2017
  3. April
  4. R
  5. RD QUESTIONNARE
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Exit Survey
 
 
PATIENT NUMBER
   
 
 
 
DIGNOSIS
 
EXUDATIVE RD
 
RHEGMATOGENOUS RD
 
TRACTIONAL RD

 
 
 
OPERATION TYPE
 
PPV
 
BUCKLE
 
BAND

 
 
 
EYE
 
RIGHT
 
LEFT

 
 
 
BCVA1
   
BCVA2
   
BCVA3
   
BCVA IMPROVEMENT %
   
 
 
 
FUNDUS EXAM
   
 
 
 
COMPLICATIONS
   
 
 
 
REDO
 
YES
 
NO