Optometrist Practice | Optometrist Name | Date Referral Received by Practice | Date Patient Contacted | CAS reference ID | Date of visit | Assessment / Follow-Up / DNA | Primary Diagnosis | Assessment Outcome | Onward referral for same condition as original referral | Glaucoma Referral to Secondary Care or Community Care | Postcode | Gender | Age | Ethnicity | Comments |
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Optometrist Practice | Optometrist Name | Date Referral Received by Practice | Date Patient Contacted | CAS reference ID | Date of visit | Assessment / Follow-Up / DNA | Primary Diagnosis | Assessment Outcome | Onward referral for same condition as original referral | Glaucoma Referral to Secondary Care or Community Care | Postcode | Gender | Age | Ethnicity | Comments |
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