Cambodia
Vision
CV Patient Site
Dashboard
Patient Registration
Refraction
GP Form
Anaesthesia
Form Builder
Anaesthesia
Patient #
*
Family Name
Given Name
Staff Name
Date
Time
:
AM
PM
Block type
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Sub-Tenon's Block
Retrobulbar Block
Peribulbar Block
Intracameral
Topical
General Anaesthesia
Other
Local anaesthetic
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Lignocaine 2%
Bupivacaine 0.5%
Bupivacaine 0.75%
Ropivacaine 1%
Levobupivacaine 0.5%
Mepivacaine 2%
Proxymetacaine
Other
Dose
ml
Units
Hyalase
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