Get the free Refractive Surgery Preoperative Form - Wilmington Eye

Revised 8/18/2015 REFRACTIVE SURGERY PREOPERATIVE FORM Legal Name Occupation Hobbies Current prescription date Contacts: VA cc None / Yes Preferred Name: Primary Eye Doctor Referred by Visual goals/expectations

How to fill out refractive surgery preoperative form

How to fill out refractive surgery preoperative form:

1. Start by carefully reading the form instructions. Make sure you understand the purpose of the form and the information it requires.
2. Begin by providing your personal information such as your full name, date of birth, address, and contact details.
3. Next, you may be asked to provide details about your medical history. This could include any previous eye surgeries, health conditions, medications you are currently taking, and any allergies.
4. You might also need to list any eye conditions or vision problems you have been diagnosed with, such as nearsightedness, farsightedness, or astigmatism.
5. Some forms may require you to disclose information about your lifestyle and habits, like whether you engage in activities that could pose a risk to your eyes, such as contact sports or exposure to hazardous materials.
6. You might be asked to provide information about your insurance coverage, so be prepared to provide your insurance company name, policy number, and any specific requirements needed for coverage.
7. Depending on the form, you may need to sign and date it to ensure that the information provided is accurate and complete.

Who needs refractive surgery preoperative form?

1. Individuals who are considering undergoing refractive surgery, such as LASIK, PRK, or lens replacement, will typically need to fill out a refractive surgery preoperative form.
2. This form is necessary for both the patient and the surgeon to assess the patient's eligibility for the procedure, and to ensure that the patient is aware of the potential risks, benefits, and alternatives.
3. The refractive surgery preoperative form helps the surgeon gather important medical and personal information to make an informed decision about the suitability of the surgery for the patient.

For pdfFiller’s FAQs

What is refractive surgery preoperative form?

Refractive surgery preoperative form is a document that contains relevant medical and personal information about a patient who is planning to undergo a refractive surgery procedure.

Who is required to file refractive surgery preoperative form?

The patient who is undergoing refractive surgery is typically required to fill out and submit the refractive surgery preoperative form.

How to fill out refractive surgery preoperative form?

The form usually includes sections for the patient to provide personal details, medical history, current medications, and any allergies. The patient must accurately fill out each section of the form.

What is the purpose of refractive surgery preoperative form?

The purpose of the form is to ensure that the patient's medical history and current health status are known to the healthcare providers performing the refractive surgery, in order to minimize risks and complications.

What information must be reported on refractive surgery preoperative form?

The form typically requires information such as the patient's name, date of birth, contact information, medical conditions, medications, allergies, and past surgeries.

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