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. Does hydroxychloroquine thin the blood Is plaquenil safe to take 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. In some people, Plaquenil can cause a condition called hydroxychloroquine retinopathy, often referred to as bulls-eye maculopathy. The condition sometimes resembles a target, or bulls-eye ring, on the retina surrounding the macula. Rx Side Effects New Plaquenil Guidelines and More. Written By By Miriam Karmel, Contributing Writer. difficulty reading and progression of bull’s-eye maculopathy. Plaquenil’s long half-life in the body can cause irreversible and progressive damage, Dr. Fung said. An unusual form of the toxicity causes peripheral constriction of. § 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 Hydroxychloroquine Plaquenil Side Effects & Dosage for Malaria, Plaquenil Side Effects on Your Eyes and Vision Plaquenil and dental implantsAralen tabletsPlaquenil mefloquineHow long does it take for hydroxychloroquine to work 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. Rx Side Effects New Plaquenil Guidelines and More.. ATIENT NFORMATION ON HYDROXYCHLOROQUINE. INFORMATION FOR APPLICANT. REPORT OF EYE EVALUATION. Paperwork Reduction Act Statement Tear off this cover sheet before submitting this form. FAA FORM 8500-7 3-06 Supersedes Previous Edition VISION EXAMINATION REPORT TO BE COMPLETED FOLLOWING SCREENING TEST GIVEN. THIS FORM HAS BEEN APPROVED BY THE FORMS MANAGEMENT CENTER. CONSENT OF PARENT OR GUARDIAN I agree to release the above information on my child or ward to appropriate school or health authorities. 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.