miscellaneous information. These three areas arediscussed as follows:1. Patient Information: The specific informationrequired is the patient’s name, rank, SSN, dutystation, mailing address, and military status.This information is required to establisheligibility and provide the requesting activitywith an address for the patient upon receipt ofthe completed eyeglasses.2. Prescription Information: Since the spectacleprescription is the technical portion of the orderform, you should complete it with great care,ensuring that the prescription is transferred in itsentirety. The essential elements of theprescription are interpupillary distance, framesize, temple length, plus and minus designatorsfor both sphere and cylinder powers, segmentpowers and heights, prism, and prism base. It isnot necessary to calculate decentration in thesingle vision or multifocal portions of the order.It is also unnecessary to try to transpose anyprescription into plus or minus cylinder form.Leave the prescription as is, copy it onto the DDForm 771, and note in the remarks section thatthe prescription has been copied and is in theHREC.3.Miscellaneous Information:This area isreserved for any information you feel the NavyOptical Laboratory may need. Information thelaboratory may need includes specialfabrication requirements, such as multifocallenses, or proof of eligibility for specializedeyewear, such as aviator sunglasses. Standardissue items can be determined fromNAVMEDCOMINST 6810.1, OphthalmicServices.DD Forms 771 should be typewritten or computerprinted whenever possible. This practice eliminates12-23Figure 12-8.—Eyewear Prescription, DD Form 771: A. Computer-printed edition; B. Computer-generated edition.
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