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Myopia Management Patient Tracking Sheet<<Insert Month>> Goals Goal for the month<<Month> Actual<<Month>> RESULTSCurrent Practice Data
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Number of Consultations Booked/Month >>0How many kids exams (<18 yrs) did you complete last year during this month?
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% of Consultations Closed/Month >>60%Percentage expected to come back
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Approximate maximum number of myopic kids you'll see (base on 25% being myopic)
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Percentage goal of myopic kids who will book a consultation
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Available Consult Dates & TimesUnique IdentifierLead SourceExamining ODConsultation Booked?Consultation ODMyopia CounselorConsultation Complete?Parents?
1, 2 or Both
Treated?Treatment type
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1Facebook AdDr. JohnYesDr. JohnSamYesMomYesCSMFCL
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2YesNo
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3No
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4Yes
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5
12
6
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7
14
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21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
Totals00212
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
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70
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80
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82
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84
85
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88
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90
91
92
93
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95
96
97
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100