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Vision Format For Bgas Exams

(1) The vision certificate requires an initial eye exam to test near vision acuity, far vision acuity, and color perception. (2) For annual recertification, only near vision acuity needs to be retested. (3) The certificate is valid for 6 months from the eye exam date and must be signed by an optometrist, medical doctor, registered nurse, or certified examiner.

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junaid Shah
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206 views1 page

Vision Format For Bgas Exams

(1) The vision certificate requires an initial eye exam to test near vision acuity, far vision acuity, and color perception. (2) For annual recertification, only near vision acuity needs to be retested. (3) The certificate is valid for 6 months from the eye exam date and must be signed by an optometrist, medical doctor, registered nurse, or certified examiner.

Uploaded by

junaid Shah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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VISION CERTIFICATE

GENERAL
Initial examination is required, with or without corrective lenses, to prove (1) near vision acuity of Snellen English or
equivalent Jaeger J-1 at 12 inches; (2) far vision acuity of 20/40 or better and (3) color perception test for red/green and
blue/yellow differentiation.
For annual re-certification, the examination is required to prove near vision acuity or Snellen English or equivalent
Jaeger J-1 at 12 inches. This certificate is valid for 6 months only from the date of eye test.
This certification will be valid only if signed by one of the following:
„ Optometrist „ Medical doctor „ Registered nurse „ Certified Physician's Assistant
„ ASNT/SNT-TC-1a Level III „ ANSI N45.2.6 Level III

APPLICANT INFORMATION (To be completed by Candidate)


Candidate Date of Candidate
Name: eye test Signature:

TEST/EXAMINATION RESULTS (To be completed by Doctor / Examiner)


Meets Without Eye Correction Meets With Eye Correction

(1) Far Vision – 20/40 Minimum

(2) Near Vision --Jaeger J-1 letters at 12 inches


(3) Color Perception Pseudoisochromatic Plates

(a) Red/Green Differentiation

(b) Blue/Yellow Differentiation


Comments:

DOCTOR / EXAMINER INFORMATION (To be completed by Doctor / Examiner)

I administered the vision examination(s) to the applicant/candidate


The examiner's professional title is:
Optometrist Medical Doctor Registered Nurse
Certified Physician's Assistant ASNT/SNT-TC-1a Level III ANSI N45.2.6 Level III

Name of the Docto r/ Examiner with stamp :

Signature of Doctor / Examiner:

Professional Address:

Telephone Number: State License Number:

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