If you are a health care provider and would like to request these credentials, please click here to register. The Initial Reporting Form can be used by emergency rooms or other health care personnel who do not have access to the patient’s medical history or do not have enough knowledge about a specific medical condition to complete the appropriate form.§ 83.3 outlines the minimum vision standards for driving a vehicle and §71.3(b)(1) outlines the minimum vision standards for school bus drivers. Plaquenil and glaucoma Is plaquenil discontinued Hydroxychloroquine and t cells Hydroxychloroquine Plaquenil Eye exam fax-back form Why do I need an eye exam? An eye exam can check for eye problems even if your vision seems fine. If you take hydroxychloroquine hahy-drok-si-KLOHR-uh-kwin Plaquenil all ophthalmology offices have the equipment to PLAK-wuh-nil, you have a higher risk of developing an eye problem Also called Plaquenil® to help manage your condition. It is a very safe and effective drug but. For this reason the NHS now offers patients taking hydroxychloroquine regular eye health checks to screen them for signs of retinopathy. A report will be sent to you, your GP and/or the Hydroxychloroquine HCQ, brand name Plaquenil is commonly used for the long-term 2 management of a variety of chronic rheumatic diseases including systemic lupus erythematosus 3 and rheumatoid arthritis. A range of potential toxicities related to HCQ use have been reported § 83.5(b)(4) states that a provider may recommend a license recall if a person has cerebral vascular insufficiency or cardiovascular disease which, within the preceding 6 months, has resulted in lack of coordination, confusion, loss of awareness, dyspnea upon mild exertion or any other sign or symptom, which impairs the ability to control and safely operate a motor vehicle.§ 83.5(b)(5) and (8) states that a provider can disqualify someone from driving if the provider feels the individual has a mental disorder manifested by the symptoms of inattentiveness to the task of driving because of, for example, preoccupation, hallucination or delusion; contemplation of suicide, as may be present in acute or chronic depression or in other disorders; excessive aggressiveness or disregard for the safety of self or others or both, presenting a clear and present danger, regardless of cause or any other condition that could impair a person's ability to drive safely.§ 83.5(a)(1) states that a person who has unstable diabetes mellitus leading to severe hypoglycemic reactions or symptomatic hyperglycemia will not be qualified to drive, unless there has been a continuous period of at least 6 months free from a disqualifying episode. Refer to the below links to Chapters 83 & 71 for a comprehensive list of the minimum vision standards.§ 83.5(a)(2) states that a person who has cerebral vascular insufficiency or cardiovascular disease which, within the preceding 6 months, has resulted in syncopal attack or loss of consciousness, vertigo, paralysis or loss of qualifying visual fields will not be qualified to drive. Plaquenil eye report form Early Plaquenil Toxicity Detected without Bull’s Eye Maculopathy, Eye screening for patients taking hydroxychloroquine. Plaquenil and essential oilsHydroxychloroquine treatment myalgiaDosage for plaquenil Taking Plaquenil long-term or at high doses may cause irreversible damage to the retina of your eye. Stop taking Plaquenil and call your doctor at once if you have trouble focusing, if you see light streaks or flashes in your vision, or if you notice any swelling or color changes in your eyes. Plaquenil Uses, Dosage & Side Effects -. AMERICAN COLLEGE OF RHEUMATOLOGY. My Take on New Ocular Screening Guidelines for Plaquenil.. Plaquenil Examination. Plaquenil is a drug routinely prescribed for rheumatoid arthritis and lupus. Plaquenil has long been associated with retinal toxicity which can lead to vision loss. In particular it affects the macular region of the retina which is responsible for central vision. Eye care professional report for Dilated Retinal Eye DRE exam Use this completed form to communicate results to your patient’s primary care provider. Patient name. ID # DOB. Health plan. PCP. Phone. FAX. Chief complaints Tonometry AOA Diabetic Eye Examination Report ©This form was developed by the Ohio Optometric Association and The Ohio State University College of Optometry through support from the NIH Healthy Vision 2010 Awards Program and an AOA Healthy Eyes Healthy People Grant.