| Source | csiro.fhir.au.smartforms#current:Smart Forms (v4.0.1) |
| resourceType | Questionnaire |
| id | EyeHealth |
| canonical | http://www.health.gov.au/assessments/mbs/715/EyeHealth |
| version | 0.1.0 |
| status | draft |
| publisher | AEHRC CSIRO |
| name | EyeHealth |
| title | Aboriginal and Torres Strait Islander Health Check - Eye Health |
| date | 2022-05-24 |
| experimental | false |
| description | Eye Health sub-questionnaire for Aboriginal and Torres Strait Islander Health Check. |
| copyright | CSIRO © 2022+; Licensed under Apache License, Version 2.0 |
| jurisdictions | au |
| Usages | (none) |
Eye health
In progress
Complete
Vision concerns
Is there anything that you are worried about with your child's vision?
Is there anything that you are worried about with your vision?
Details
Eye examination
Red reflex (up to six months)
Right eye
Left eye
Evidence of squint or other abnormality
Right eye
Left eye
Visual acuity
Right eye
Left eye
Trachoma Check (endemic areas)
Right eye
Left eye
Health priorities, actions and follow-up
Mark section as complete
Produced 08 Sep 2023