If you are a health care provider and would like to request these credentials, please click here to register. The Initial Reporting Form can be used by emergency rooms or other health care personnel who do not have access to the patient’s medical history or do not have enough knowledge about a specific medical condition to complete the appropriate form.§ 83.3 outlines the minimum vision standards for driving a vehicle and §71.3(b)(1) outlines the minimum vision standards for school bus drivers. Plaquenil method of action Does hydroxychloroquine cause demyleination Difference between hydroxychloroquine and hydroxychloroquine sulfate Macular Society Eye screening for patients taking hydroxychloroquine Hydroxychloroquine is a medication used to treat several conditions including rheumatoid arthritis, systemic lupus erythematosus, some skin conditions especially photosensitive ones and others that involve inflammation. It was previously used in the treatment and REPORT OF VISION EXAMINATION SECTION 1 — APPLICANT COMPLETES THIS SECTION INSTRUCTIONS Please complete the driver license number, date of birth, telephone number, name, and address areas of this form. You must sign and date the authorization line. All medical information received by the Department of Motor Vehicles DMV is confidential under Also called Plaquenil® to help manage your condition. It is a very safe and effective drug but. For this reason the NHS now offers patients taking hydroxychloroquine regular eye health checks to screen them for signs of retinopathy. A report will be sent to you, your GP and/or the § 83.5(b)(4) states that a provider may recommend a license recall if a person has cerebral vascular insufficiency or cardiovascular disease which, within the preceding 6 months, has resulted in lack of coordination, confusion, loss of awareness, dyspnea upon mild exertion or any other sign or symptom, which impairs the ability to control and safely operate a motor vehicle.§ 83.5(b)(5) and (8) states that a provider can disqualify someone from driving if the provider feels the individual has a mental disorder manifested by the symptoms of inattentiveness to the task of driving because of, for example, preoccupation, hallucination or delusion; contemplation of suicide, as may be present in acute or chronic depression or in other disorders; excessive aggressiveness or disregard for the safety of self or others or both, presenting a clear and present danger, regardless of cause or any other condition that could impair a person's ability to drive safely.§ 83.5(a)(1) states that a person who has unstable diabetes mellitus leading to severe hypoglycemic reactions or symptomatic hyperglycemia will not be qualified to drive, unless there has been a continuous period of at least 6 months free from a disqualifying episode. Refer to the below links to Chapters 83 & 71 for a comprehensive list of the minimum vision standards.§ 83.5(a)(2) states that a person who has cerebral vascular insufficiency or cardiovascular disease which, within the preceding 6 months, has resulted in syncopal attack or loss of consciousness, vertigo, paralysis or loss of qualifying visual fields will not be qualified to drive. Plaquenil eye report form New Plaquenil Guidelines -, Report of Vision Examination DL 62 Hydroxychloroquine plaquenil direct sunlightHydroxychloroquine lupus treatment Detected without Bull’s Eye Maculopathy. in the case report, the left VF is clearly abnormal, but the right. Plaquenil is manufactured in only a 200 mg tablet Early Plaquenil Toxicity Detected without Bull’s Eye Maculopathy. Eye screening for patients taking hydroxychloroquine.. ATIENT NFORMATION ON HYDROXYCHLOROQUINE. As optometrists, it is important that we are aware of the possible ocular complications that can occur from the use of high risk medications. Patients starting chloroquine CQ or hydroxychloroquine HCQ; i.e. Plaquenil should have a baseline examination that serves as a reference point, as well as to rule out any preexisting maculopathies. Hydroxychloroquine Plaquenil - see mandatory eye evaluation requirement below, NSAIDS. Complete blood count CBC and complete metabolic panel Within 90 days Normal CBC, Liver Function Test, and Creatinine FAA Report of Eye Evaluation Form 8500-7 is required if hydroxychloroquine Plaquenil is used. Plaquenil official prescribing information for healthcare professionals. Includes indications, dosage, adverse reactions, pharmacology and more. who acquired malaria in a geographic area where chloroquine resistance is known to occur should be treated with another form of antimalarial therapy. Eye disorders Irreversible retinopathy.