Certificate of visual performance - dove posso ottenerlo ?

caro giovanotto
qualsiasi medico specialista in oculistica può fare questo tipo di certificazione.

LUIGI MARINO CHIRURGO OCULISTA
CASA di CURA “ LA MADONNINA “ via Quadronno n. 29 MILANO prenota 02 50030013 urgenze 3356028808

Il certificato consiste in quanto segue:

CERTIFICATE OF VISUAL PERFORMANCE EUROCONTROL
Medical Service

To be completed by a medical doctor, specialist in ophthalmology, and to be returned with a completed application form.
No more than one pair of spectacles shall be used to meet the requirements

FOR
Surname: _____________________________ Forename: _____________________
Date of birth: ___________________________ Place of birth: __________________
Address: _________________________________________________________¬¬_________
Are there abnormalities of the function of the eyes or their adnexae: yes / / no
Is there an active pathological condition, acute or chronic: yes / no Has there been eye surgery (e.g. refractive surgery) or an eye trauma: yes / no
(if yes to any of these 3 questions: indicate date and type) ……………………………………..

In case of refractive surgery: indicate refraction before surgery: right : …… left : ……

• VISUAL ACUITY: right eye left eye binocular vision
- distant visual acuity: …. / 10 .… / 10 …. / 10
(on 5 m) cc: …. / 10 cc: …. / 10 cc: …. / 10
- intermediate vision: ...… nr. chart ………………
(on 100 cm) cc: …… nr. chart ………………
- near visual capacity: ..… nr. chart …………….
(30 to 50 cm) cc: ..… nr. chart …………….
Indicate type of used chart: NChart/Parinaud/orthotypes at correct distance
• REFRACTION: right eye: …… left eye: ……
• CORRECTION: right eye left eye
type: spectacles/lenses spheric cyl axis spheric cyl axis
distant: ….. …. ….. ….. …. ….
near add: ….. …. ….. ….. …. ….
• CONVERGENCE: ….. cm
• ACCOMMODATION: ….. diopters
• BINOCULAR VISION, stereopsis: - abnormal/normal - diplopia: yes/no
• MUSCULAR BALANCE (Heterophorias): at 6 meters at 33 cm
prism diopters esophoria: …..… ….…
prism diopters exophoria: ……. ….…
prism diopters hyperphoria: ……. …….
In case of dysphoria indicate FUSIONAL RESERVE: at 6 meters at 33 cm
ESO: ……. …….
EXO: ….… …….
Vertical: ……. …….

• FIELDS OF VISION (central and peripheral perimetry): right eye: ……….. left eye: ……..
• COLOUR VISION: number of mistakes on the Ishihara 24 plates test: ……….
(or) Nagel’s anomaloscope result: ……….
• BIOMICROSCOPY (eyes exterior): …………………………….
• OPTIC FUNDI: …………………………………………………….
• TONOMETRY (intra-ocular pressure): right eye: ……. left eye: …..…

I hereby certify that I have personally examined this applicant and that this report with any attachments are my complete and correct findings,


Place/Date: Stamp and Signature



Spero lei mi possa confermare quanto scritto sopra.

Grazie ancora per la disponibilità.

certo
ripeto e' una certificazione che qualsiasi specialista puo' rilasciare...
se vuole faccia un salto a milano o a pisa da duilio siravo, ma ripeto e' una certificazione che attesta le sue complete capacita' visive

Grazie mille Professore, spero di poterla passare a trovare, oltre che per il certificato, per conoscere la sua Eccelsa Persona :)!

allora a prestp

ps mio nonno era palermitano