Clinic & doctor
Patient
Optional. Leave these blank if you are printing a pad to fill by hand.
Spectacle powers
Leave these empty for a blank pad. On an eye prescription, OD means right eye, not once daily. Prescription abbreviations explains the medicine codes separately.
| Eye | SPH | CYL | AXIS | ADD | PD |
|---|---|---|---|---|---|
| RE / OD | |||||
| LE / OS |
| Eye | Distance VA | Near VA |
|---|---|---|
| RE / OD | ||
| LE / OS |
Print-ready A4. In the print dialog, choose Save as PDF for a file, or a printer for paper. Sign only after a real examination. This file is a blank format, not a prescription.
Preview
Spectacle prescription
Blank format. Not a signed prescription.
| Eye | SPH | CYL | AXIS | ADD | PD |
|---|---|---|---|---|---|
| RE / OD | |||||
| LE / OS |
| Eye | Distance VA | Near VA |
|---|---|---|
| RE / OD | ||
| LE / OS |
Blank format from Medabha. Not a signed prescription.
How to use this spectacle prescription format
The sheet on this page is a format, not a prescription. Leave the power cells empty if you want a pad for the desk. Fill clinic and doctor lines only when you want them pre-printed.
- Enter the doctor’s details if you want them on the pad: name, qualifications, registration number and the council that issued it, then the clinic name, address and phone.
- Leave the power cells empty for a blank format. SPH, CYL, AXIS, ADD and PD are there for each eye (RE/OD and LE/OS). Distance and near visual acuity are optional rows. Write PD only when it has been measured.
- Print or save a PDF. The page is laid out for A4. In the print dialog, choose Save as PDF for a file, or a printer for paper.
- Sign only after a real examination. A file from this page is a blank format, not a prescription. The medicine prescription template is a separate pad for drug lines, not spectacle powers. The spectacle prescription format guide explains how to read SPH, CYL, AXIS, ADD and PD.
Sources
- Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, which the National Medical Commission adopted. These include the expectation that a physician’s registration particulars appear on prescriptions.
This page is general information about a blank format. It is not a clinical review of any prescription, and it is not legal advice.
Frequently asked questions
Is this a valid spectacle prescription?
No. This page is a blank format only. A spectacle prescription has to be completed and signed after the appropriate eye examination, by the practitioner who is allowed to issue it. This tool does not examine anyone, and it does not check the powers you type.
Does it store or upload what I type?
No. The entries stay in your browser. They are not sent to Medabha and are not stored. A visit to this page is counted, the same way as other public pages. Closing the tab clears what you typed, unless you printed it or saved a PDF on your device.
Is this the same as the medicine prescription template?
No. This sheet is for spectacle powers: SPH, CYL, AXIS, ADD and PD for each eye. The medicine prescription template is a separate pad for drug lines. On an eye prescription, OD means right eye, which is not the same as OD for once daily on a medicine slip.
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Book a demoThis is a blank format, not a signed prescription. What you type stays in your browser and is not sent to or stored on our servers. Complete and sign a spectacle prescription only after the appropriate eye examination. This page does not check those powers, and it is not legal advice.