Get the free Refractive Surgery Referral - PCLI: For Doctors of Optometry

Refractive Surgery Referral Referring Doctor Patient information Name Address Phone () Date of exam Date of birth Phone: Hm (Surgery desired: LAST PARK Implantable Contact Lens (ICL) Undetermined

How to fill out refractive surgery referral

How to fill out refractive surgery referral:

1. Gather the necessary patient information, such as their name, date of birth, contact information, and medical history.
2. Obtain the patient's visual acuity results, including their current prescription and any recent eye exams or tests.
3. Include information about the specific refractive surgery being recommended, such as LASIK, PRK, or lens replacement surgery.
4. Clearly indicate the reason for the referral, whether it is for the correction of nearsightedness, farsightedness, astigmatism, or presbyopia.
5. Include any relevant medical conditions or medications that may impact the patient's eligibility for refractive surgery.
6. Provide any additional comments or notes that may be helpful for the receiving surgeon, such as the patient's expectations or concerns.

Who needs refractive surgery referral:

1. Patients who are interested in undergoing refractive surgery, such as LASIK or PRK, to correct their vision.
2. Individuals with refractive errors, such as nearsightedness, farsightedness, astigmatism, or presbyopia, that are affecting their daily lives or overall visual function.
3. Patients who have undergone thorough evaluations, including comprehensive eye exams, to determine their suitability for refractive surgery.

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What is refractive surgery referral?

Refractive surgery referral is a recommendation from a healthcare provider for a patient to consult with an ophthalmologist or refractive surgeon for procedures that correct vision issues, such as LASIK or PRK.

Who is required to file refractive surgery referral?

Typically, a primary care physician, optometrist, or eye care specialist is required to file a refractive surgery referral on behalf of the patient.

How to fill out refractive surgery referral?

To fill out a refractive surgery referral, the healthcare provider must complete a referral form by including the patient's basic information, the reason for referral, medical history, and any prior eye examination results.

What is the purpose of refractive surgery referral?

The purpose of a refractive surgery referral is to ensure that patients receive appropriate evaluation and care for their vision problems and to provide necessary documentation for the surgery process.

What information must be reported on refractive surgery referral?

Information that must be reported on a refractive surgery referral includes the patient's name, contact information, relevant medical history, specific vision issues, and any prior treatments or surgeries related to vision.