Get Dilated Eye Form (pdf) - Tn.gov - State Tn

The Dilated Eye Form is a crucial document required by the Tennessee Athletic Commission for individuals seeking licensure in combative sports. This guide provides clear instructions on how to fill out this form online, ensuring that users can complete it with ease and accuracy.

Follow the steps to successfully complete the Dilated Eye Form online.

1. Press the ‘Get Form’ button to access the Dilated Eye Form. This will allow you to open the document in your preferred editor.
2. Begin by providing the participant’s full name in the designated fields: last name, first name, and middle name.
3. In the history section, answer the questions regarding any previous eye conditions or surgeries. Mark 'Yes' or 'No' for each condition and provide additional details where requested.
4. Proceed to the examination section where you will need to document vision acuity. Record the measurements for each eye without glasses and with glasses, including any necessary refraction data.
5. Fill out the slit lamp exam results for the conjunctiva, cornea, iris/pupil, lens, and eyelids, marking normal or abnormal for each.
6. Complete the indirect ophthalmoscopy section by specifying whether the findings were normal or abnormal for the right and left sides, listing any abnormalities noted.
7. In the final section, the examining physician must provide their opinion on the applicant's fitness for licensure, including their name, medical license number, and signatures for both the applicant and physician.
8. Once all the information is filled in, ensure to save the changes, and download the completed form. You may also print or share it as needed.

Start filling out your Dilated Eye Form online to ensure a smooth application process.