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Total # of Questions: 15

PhenX - retinal digital photography protocol 111501 [62709-1]

Date Done

Time Done

Where Done

Comment

Name

Value

Units

Agency patient number [46496-6]

Photographer ID [65884-9]

Retinal digital photography instrument model [65883-1]

Right Eye Fields photographed in the Retinal Digital Photography [65898-9]

Oth eye field R eye Ret dig photog [65899-7]

Right Eye Flash Setting in the Retinal Digital Photography [65900-3]

Right Eye Number of images captured in the Retinal Digital Photography [65901-1]

Right Eye Estimated Diameter of Pupil at 1st Photograph [65902-9]

Right Eye Describe any problems or unusual findings [65903-7]

Left Eye Flash Setting in the Retinal Digital Photography [65904-5]

Left Eye Number of images captured in the Retinal Digital Photography [65905-2]

Right Eye Flash Setting in the Retinal Digital Photography [65900-3]

Right Eye Number of images captured in the Retinal Digital Photography [65901-1]

Left Eye Estimated Diameter of Pupil at 1st Photograph [65906-0]

Left Eye Describe any problems or unusual findings [65907-8]

PLEASE WAIT