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CONTACT LENS CONSENT FORM VIA HANDBOOK 1173.12 (paragraphs 810) Patient Name Last 4 Contact lenses may be provided to eligible beneficiaries with monocular aphasia, binocular aphasia, severe astigmatism,
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How to fill out contact lens consent

01
Step 1: Start by reading the consent form carefully. Make sure you understand all the information provided.
02
Step 2: Provide your personal details such as name, address, date of birth, and contact information.
03
Step 3: Answer the medical history questions truthfully. It is important to disclose any existing eye conditions or health issues.
04
Step 4: Understand the risks and benefits of wearing contact lenses. Take your time to go through this section and ask any questions you may have.
05
Step 5: If you have any concerns or doubts, consult with your eye care professional before signing the consent form.
06
Step 6: Once you are confident and have understood everything, sign the consent form and date it.
07
Step 7: Keep a copy of the completed consent form for your records.

Who needs contact lens consent?

01
Anyone who wants to wear contact lenses needs to fill out a contact lens consent form.
02
This includes individuals who are new to wearing contacts or those who wish to switch to a different type or brand of contact lenses.
03
Minors or individuals under the age of 18 may require parental or guardian consent.
04
It is important to have a contact lens consent form on file to ensure that the wearer is aware of the risks and responsibilities associated with wearing contacts.
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Contact lens consent is a form that must be signed by a patient before receiving contact lenses.
Eye care professionals are required to file contact lens consent.
Contact lens consent should be filled out by the patient, providing necessary personal and medical information.
The purpose of contact lens consent is to ensure that patients understand the risks and responsibilities associated with wearing contact lenses.
Contact lens consent must include patient's personal information, prescription details, and any relevant medical history.
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Relevant keywords

beneficiarys aphakia pathologic hypoesthesia VHA conjunctiva aphakic lacrimal monocular aniseikonia subacute keratoconus binocular contraindicated insufficiency myopia corneal REDNESS astigmatism systemic secretion ophthalmologist optometrist paragraphs c

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