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Health Savings Plan Medical, Vision and Prescription Drug Benefits Effective January 1, 2019 www.fchn.comIn the event there is a discrepancy between information provided during annual enrollment and

How to fill out medical vision and prescription

How to fill out medical vision and prescription

1. Start by filling out your personal information, including your full name, date of birth, contact information, and address.
2. Provide your insurance information, including your insurance company name, policy number, and any other relevant details.
3. Indicate your current symptoms or issues that you are experiencing with your vision. Be as detailed as possible to help the healthcare provider understand your situation.
4. Include any relevant medical history or pre-existing conditions that may affect your vision.
5. If you have had previous eye exams or vision tests, provide the dates and results if available.
6. Specify any medications or eye drops that you are currently using.
7. If you wear glasses or contact lenses, provide the prescription details or bring your current eyewear for reference.
8. Mention any concerns or questions you have regarding your vision or specific vision-related requirements.
9. Review the form for accuracy and completeness before submitting it to the healthcare provider or clinic.

Who needs medical vision and prescription?

1. Individuals who are experiencing vision problems such as blurry vision, difficulty seeing objects clearly, or changes in their visual acuity.
2. People who have been advised by a healthcare professional to undergo a vision examination or update their prescription.
3. Those who are interested in obtaining corrective eyewear, such as glasses or contact lenses.
4. Individuals who are planning to undergo a vision correction procedure, such as LASIK or cataract surgery.
5. People who have a family history of eye diseases or conditions and want to monitor their eye health.
6. Those who require a medical vision and prescription for occupational purposes, such as pilots, drivers, or certain job roles with specific vision requirements.
7. Individuals seeking routine eye care and preventive measures for maintaining good vision and eye health.

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