Get the free PRE-OPERATIVE CO-MANAGEMENT FORM -

PREOPERATIVE COMANAGEMENT FORM NAME OF COMANAGING DOCTOR: DATE: NAME OF PATIENT: PHONE NUMBER: (H) (W) (C) EMAIL ADDRESS: D.O.B (MAY) MAILING ADDRESS: UCLA ACVA Refraction Manifest/Cycle. OD 20/ 20/

How to fill out pre-operative co-management form

How to fill out pre-operative co-management form:

1. Start by entering your personal information, including your full name, address, phone number, and date of birth. This information is important for identification purposes and ensures accurate record-keeping.
2. Provide your medical history. This includes any known medical conditions, allergies, previous surgeries, or current medications you are taking. It is crucial to disclose this information to your healthcare provider to avoid any potential complications during the operation.
3. Indicate your surgical procedure. Specify the type of surgery you are scheduled to undergo, such as cataract surgery, LASIK, or any other ophthalmic procedure. This information helps the eye care team to prepare and coordinate the necessary pre and post-operative care accordingly.
4. State your preferred co-managing doctor. If you have a specific eye care provider whom you would like to manage your post-operative care, provide their name and contact information in this section. Co-management involves multiple healthcare professionals collaborating to ensure the best possible outcome for the patient.
5. Include your insurance details. If you have medical or vision insurance coverage, make sure to provide the necessary information, such as policy numbers or any specific requirements related to your coverage. This helps in streamlining the billing and reimbursement process.
6. Sign and date the form. By affixing your signature and date, you acknowledge that the information provided is accurate to the best of your knowledge and that you understand the terms and conditions of the co-management process.

Who needs pre-operative co-management form?

1. Patients undergoing certain ophthalmic surgeries often require pre-operative co-management forms. This includes procedures such as cataract surgery, refractive surgeries like LASIK or PRK, corneal transplants, and other ocular surgeries.
2. The purpose of the pre-operative co-management form is to ensure a smooth transition of care between different eye care professionals involved in the surgical process. It allows for effective communication and collaboration, enhancing the overall patient experience and outcome.
3. Patients who prefer to have a specific eye care provider manage their post-operative care may use the pre-operative co-management form to communicate their preferences. This allows for continuity of care with a trusted doctor who is knowledgeable about the patient's medical history and previous treatment plans.

It is essential to understand that the need for a pre-operative co-management form may vary depending on the specific surgical procedure and the protocols followed by the healthcare facility or surgeon. It is recommended to consult with your eye care provider or surgeon to determine if such a form is required for your particular case.

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What is pre-operative co-management form?

The pre-operative co-management form is a document that outlines the responsibilities and agreements between different healthcare providers involved in a patient's surgery.

Who is required to file pre-operative co-management form?

The pre-operative co-management form is required to be filed by both the operating surgeon and the co-managing physician.

How to fill out pre-operative co-management form?

The pre-operative co-management form can be filled out by providing the required information about the patient, the surgery, and the responsibilities of each healthcare provider.

What is the purpose of pre-operative co-management form?

The purpose of the pre-operative co-management form is to ensure clear communication and collaboration between all healthcare providers involved in a patient's surgery.

What information must be reported on pre-operative co-management form?

The pre-operative co-management form must include information about the patient's medical history, the planned surgery, the roles and responsibilities of each healthcare provider, and any agreements regarding post-operative care.