Get Sq 214 353 2020-2025

The Sq 214 353 is an essential visual examination report form required for various evaluations. This guide provides step-by-step instructions to assist users in completing the form accurately online.

Follow the steps to fill out the Sq 214 353 effectively

1. Click ‘Get Form’ button to access the Sq 214 353 form and open it in the online editor.
2. Fill in the candidate's identification details in SECTION 1, including the candidate’s name, surname, date of birth in the format YYYY-MM-DD, and full address with postal code. Indicate whether you have undergone vision correction surgery and, if so, attach the complementary report from the ophthalmologist.
3. Sign and date the form in SECTION 1, ensuring to use the date format YYYY-MM-DD.
4. In SECTIONS 2 and 3, the ophthalmologist or optometrist must complete the visual examination details. They should include visual acuity measurements without correction and with correction for each eye. Specific vision tests and results should be clearly noted.
5. The examining eye care professional should assess and record visual fields for each eye, including any anomalies related to eye movement or binocular vision.
6. Complete the color perception tests and document the results, ensuring to provide details if any tests are failed.
7. In the comments section, detail any anomalies found during the examination and include related diagnoses if applicable.
8. Fill out the ophthalmologist or optometrist’s identification information, including their name, license number, address, specialty, and the examination date in the format YYYY-MM-DD.
9. Ensure all signatures and dates are properly completed before finalizing the form.
10. Finally, save your changes, download the completed form, print it for your records, or share it as required.

Complete your visual examination report online today.