Ese hari kimwe muri ibi bikurikira uhura nacyo? (Hitamo byose bihuye n'ibyo uhura na byo) / Are you experiencing any of the following? (Select all that apply)

Blurred vision

Double Vision

Sudden Vision Loss

has_eye_redness

has_eye_swelling

has_eye_pain

has_photophobia

has_excess_tearing

has_eye_discharge

has_dry_eye

has_flashes_of_light

has_floaters_or_spots

How often do you experience these symptoms?

Occasionally

Frequently

Always

Have you ever been diagnosed with any eye condition?

Yego / Yes

Oya / No

Ku kibazo cyavuzwe haruguru, ndakwinginze usobanure uburyo bwo gusuzuma no kuvura / Please specify the diagnosis and treatment to the above question.

Prior Condition

Prior Treatment

Does he/she need medication?

Yego / Yes

Oya / No

Ku kibazo cyavuzwe haruguru, ndakwinginze usobanure uburyo bwo gusuzuma no kuvura / Please specify the diagnosis and treatment to the above question.

Diagnosis

Treatment

Ese akeneye koherezwa kugira ngo akurikirane izindi nzego? / Does he/she need a referral for further management?

Yego / Yes

Oya / No

Submit