Get the free OD Refractive Referral Contact Request - Hunkeler Eye Institute, P.A.

7950 College Blvd. Ste B Overland Park, KS 66210 Phone: 9133384733 Fax: 9139066551 Name Of Referring Practice: Name Of Physician Referring: Contact Phone Number: Please contact the following patients

How to fill out od refractive referral contact

How to fill out od refractive referral contact:

1. Obtain the necessary paperwork: Start by obtaining the od refractive referral contact form from your eye care provider. This form is typically provided when you are referred for refractive surgery.
2. Fill in personal information: Begin by providing your full name, date of birth, contact information, and any other requested personal details. This will ensure that the form is properly identified and processed.
3. Provide referral information: Fill in the referral information, including the name of the referring eye care provider, their contact information, and the reason for the referral. This will help communicate the purpose of the referral to the receiving specialist.
4. Complete medical history: Provide a detailed medical history, including any preexisting eye conditions, past surgeries, current medications, and allergies. This information is crucial for the receiving specialist to assess your suitability for refractive surgery.
5. Include visual acuity measurements: Record your current visual acuity measurements, such as your uncorrected and corrected vision with glasses or contact lenses. These measurements will help the specialist evaluate your visual needs and customize the refractive surgery accordingly.
6. Indicate desired outcomes: Clearly state your desired outcomes for the refractive surgery. This may include reducing dependence on glasses or contact lenses, improving overall vision, or addressing specific visual issues. Being specific will help the specialist understand your expectations.
7. Sign and date the form: Once you have completed all the necessary sections, sign and date the od refractive referral contact form. Your signature indicates that the information provided is accurate to the best of your knowledge and that you consent to the referral process.

Who needs od refractive referral contact?

1. Individuals considering refractive surgery: People who are considering refractive surgery, such as LASIK or PRK, typically require an od refractive referral contact. This form serves as a means for their primary eye care provider to communicate their referral to a refractive surgeon.
2. Patients with specific visual needs: Individuals with specific visual needs, such as those with high prescriptions or certain eye conditions, may require an od refractive referral contact. This form ensures that their unique needs are communicated effectively to the receiving specialist.
3. Those seeking expert evaluation: When individuals want an expert evaluation of their eligibility for refractive surgery, an od refractive referral contact can be necessary. This form helps connect them with experienced refractive surgeons who can assess their suitability for the procedure.

For pdfFiller’s FAQs

What is od refractive referral contact?

OD refractive referral contact is a form used to refer patients to an optometrist or ophthalmologist for further evaluation of their refractive errors.

Who is required to file od refractive referral contact?

Optometrists or eye care professionals are required to file OD refractive referral contact when they identify a patient in need of further evaluation.

How to fill out od refractive referral contact?

OD refractive referral contact should be filled out with the patient's information, reason for referral, and any relevant medical history.

What is the purpose of od refractive referral contact?

The purpose of OD refractive referral contact is to ensure that patients receive the appropriate follow-up care for their refractive errors.

What information must be reported on od refractive referral contact?

Information such as patient's name, contact information, reason for referral, and any relevant medical history must be reported on OD refractive referral contact.

Can I sign the od refractive referral contact electronically in Chrome?

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