Teleopto Services Form
Reference ID
Date of Images
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Month
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Day
Year
Date
Gender
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Male
Female
Date of Birth
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Month
-
Day
Year
Date
Camera Type
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Canon-CR-DGi
Carl Zeiss-VISUCAM 500-VISUCAM Pro NM
Crystalvue-FundusVue
Topcon-NW8-TRC 50DX
Others
Disease
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Diabetic Retinopathy
Glaucoma Suspect
Age-Related Macular Degeneration
Image For Left Eye
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Image For Right Eye
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Documentation Description
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