| Document Date: 2007-10-11 23:05:55
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MedicalCondition glaucoma / light-headedness / needlestick/sharps injury / HIV / further retinal detachments / retinal detachments / infection / FOR RETINAL DETACHMENT DOB / MR CONSENT FORM FOR SURGERY FOR RETINAL DETACHMENT Retinal detachment / retinal detachment / high blood pressure / sympathetic ophthalmia / constipation / nausea / skin rash / heart disease / cataract / blindness / disorders / / MedicalTreatment surgery / / Position specialist surgeon / surgeon / ophthalmic surgeon / NORMAL EYE lens The surgeon / INTERPRETER / / Technology laser / /
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Med Rec. No……………………………………………………… CONSENT FORM Surname:……………………………………………………………