Get the free Refractive Surgery Referral

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) ILL preference

How to fill out refractive surgery referral

How to fill out a refractive surgery referral:

1. Start by gathering the necessary information. This typically includes the patient's name, date of birth, contact information, and insurance details.
2. Next, specify the reason for the referral, which is refractive surgery in this case. Provide any relevant details or medical history that may be important for the surgeon to know.
3. Ensure that the referring physician's name, clinic or hospital address, and contact information are accurately provided.
4. Include any relevant tests or diagnostic reports that support the need for refractive surgery referral. This may include visual acuity measurements, corneal topography, or evaluation of previous glasses or contact lens prescriptions.
5. Attach any relevant medical records, including a summary of the patient's ocular and general health history.
6. If the patient has specific preferences for the type of refractive surgery, such as LASIK or PRK, make sure to include that information.
7. Double-check all the information provided on the referral form for accuracy and completeness before submitting it to the surgeon or specialist.

Who needs a refractive surgery referral:

1. Patients who have been diagnosed with refractive errors, such as nearsightedness, farsightedness, astigmatism, or presbyopia, may require a refractive surgery referral.
2. Individuals experiencing significant visual impairment or dissatisfaction with their current visual correction methods, such as glasses or contact lenses, may benefit from a referral for refractive surgery.
3. It is essential to consult with an eye care professional, such as an optometrist or ophthalmologist, to determine the suitability and necessity of refractive surgery for each particular patient. They will then provide the proper referral if deemed appropriate.

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What is refractive surgery referral?

Referral for refractive surgery involves recommending a patient to a specialist for vision correction procedures such as LASIK or PRK.

Who is required to file refractive surgery referral?

The referring healthcare provider, such as an optometrist or ophthalmologist, is responsible for filing the refractive surgery referral.

How to fill out refractive surgery referral?

The referral form should include the patient's personal information, medical history, reason for referral, and any supporting documentation.

What is the purpose of refractive surgery referral?

The purpose of the referral is to guide the patient to a specialist who can perform the necessary refractive surgery to correct their vision.

What information must be reported on refractive surgery referral?

The referral form should include the patient's name, date of birth, contact information, insurance details, reason for referral, and any relevant medical history.