| PROFORMA |
| • Name Age Sex • Address • Occupation • Type of substance abuse • Family History of substance abuse • Age at first substance abuse • Frequency of substance abuse • Quantity of substance abuse • Total duration of substance abuse • Time of last use • History of any medical problem-i.e. any - Post traumatic coma - Visual defects - Other Psychiatric Disorders - Neuro logical diseases (Multiple Sclerosis, Optic neuritis, Optic neuropathy) • History of any medication |
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