Get the free VTV-Referral901-Glaucoma Surgery Referral Form 2016-09-06.indd

Glaucoma Surgical Referral Form Vance Thompson Vision 3101 W. 57th St. Sioux Falls, SD 57108 (877) 5223937 (605) 3613937 FAX: (605) 3717035 4776 28th Ave S ×201 Fargo, ND 58104 (866) 9073937 (701)

How to fill out vtv-referral901-glaucoma surgery referral form

How to fill out vtv-referral901-glaucoma surgery referral form

1. First, download the vtv-referral901-glaucoma surgery referral form from the official website.
2. Fill out the patient information section accurately, including full name, date of birth, and contact details.
3. Provide the referring physician's information, including name, address, and contact number.
4. Indicate the date of the original glaucoma diagnosis.
5. Specify the type of glaucoma and its severity.
6. Include relevant medical history, such as previous surgeries or treatments related to glaucoma.
7. Attach copies of any relevant medical reports, test results, or imaging studies.
8. If applicable, mention any ongoing medications or allergies the patient may have.
9. Sign and date the referral form.
10. Submit the completed form to the appropriate recipient or healthcare facility.

Who needs vtv-referral901-glaucoma surgery referral form?

1. Patients who have been diagnosed with glaucoma and require referral for surgery.
2. Individuals with advanced stages of glaucoma that necessitate surgical intervention.
3. Patients with uncontrolled intraocular pressure despite medical treatment for glaucoma.
4. Individuals experiencing vision loss or impairment due to glaucoma that may be improved through surgery.
5. Those who have been recommended by their ophthalmologist or treating physician to undergo glaucoma surgery.

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What is vtv-referral901-glaucoma surgery referral form?

The vtv-referral901-glaucoma surgery referral form is a document used for referring patients for glaucoma surgery.

Who is required to file vtv-referral901-glaucoma surgery referral form?

Ophthalmologists and healthcare providers who are recommending glaucoma surgery for their patients are required to file the vtv-referral901-glaucoma surgery referral form.

How to fill out vtv-referral901-glaucoma surgery referral form?

The vtv-referral901-glaucoma surgery referral form needs to be filled out with the patient's information, medical history, reason for referral, and any other relevant details related to the need for glaucoma surgery.

What is the purpose of vtv-referral901-glaucoma surgery referral form?

The purpose of the vtv-referral901-glaucoma surgery referral form is to provide a formal request and documentation for a patient to be considered for glaucoma surgery.

What information must be reported on vtv-referral901-glaucoma surgery referral form?

The vtv-referral901-glaucoma surgery referral form must include the patient's name, contact information, medical history, diagnosis of glaucoma, reason for referral, and any relevant test results.