Get the free GLAUCOMA CLINIC INITIAL REFERRAL bFORMb

GLAUCOMA CLINIC INITIAL REFERRAL FORM Optometrist to COMPLETE and FAX to (02× 8115 0799 Patient Contact Details Phone: (Title:) (Home or Work) Mobile: First Name: Email: Assistance Required Other:

How to fill out glaucoma clinic initial referral

How to fill out a glaucoma clinic initial referral:

1. Start by gathering all necessary information. This may include the patient's name, contact details, age, medical history, and any previous eye examinations or treatments.
2. Indicate the reason for the referral. Clearly state that the patient is being referred for a glaucoma evaluation and specify any concerns or symptoms that led to the referral.
3. Include pertinent medical information. Provide details about the patient's general health status, including any pre-existing medical conditions, allergies, or medication use that may be relevant to the evaluation or treatment of glaucoma.
4. Mention any relevant family history. Glaucoma can have a hereditary component, so it's important to include information about any family members who have been diagnosed with glaucoma or have had related eye conditions.
5. Specify additional tests or investigations, if any. If there are specific tests or imaging studies that are needed for the evaluation, make sure to mention them in the referral. These may include visual field tests, optic nerve imaging, or intraocular pressure measurements.
6. Provide any other relevant information. If there are additional details that may assist the glaucoma specialist in evaluating the patient, such as recent changes in vision, use of eye drops, or other relevant observations, include them in the referral.
7. Ensure clear communication. Double-check that all contact information provided is accurate and up-to-date. This includes the referring healthcare provider's contact details and any necessary authorization or insurance information.
8. Submit the referral. Once completed, send the referral through the appropriate channels as instructed by the glaucoma clinic or healthcare facility.

Who needs a glaucoma clinic initial referral?

1. Patients with suspected or confirmed glaucoma. An initial referral to a glaucoma clinic is typically necessary for individuals who have symptoms, signs, or risk factors that may indicate the presence of glaucoma. This may include individuals with high intraocular pressure, optic nerve abnormalities, or visual field defects.
2. Patients with a family history of glaucoma. As glaucoma can have a genetic component, individuals with a family history of glaucoma may require an initial referral to a glaucoma clinic for a comprehensive evaluation and close monitoring.
3. Individuals with progressive vision loss or visual disturbances. If a patient is experiencing progressive vision loss or has noticed changes in their visual field, an initial referral to a glaucoma clinic may be necessary to determine if glaucoma is the underlying cause.
4. Patients requiring specialized glaucoma care. Some patients may need the expertise of a glaucoma specialist due to complications, advanced disease, or the need for complex treatment options such as glaucoma surgeries or laser procedures.
5. Those requiring a second opinion. In cases where a patient has already been diagnosed with glaucoma or has received treatment but seeks a second opinion, an initial referral to a glaucoma clinic may be necessary to ensure a comprehensive evaluation by a different specialist.

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