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VISUAL FIELD/OCT REQUISITION FORM BRAMPTON EYES Dr. Mohammad Salem Khan Unit 44, 80 Maritime Ontario Blvd Brampton ON L6S 0E7 Intersection: Airport Road/Queens Street E Tel: 9057993937 / Fax: 9057997337

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How to fill out visual fieldoct requisition form

01

To fill out a visual fieldoct requisition form, follow these steps:

02

Start by providing your personal information such as your name, contact number, and address.

03

Include the name of the healthcare provider or clinic requesting the visual fieldoct test.

04

Indicate the reason for the test and any specific instructions provided by the healthcare provider.

05

Fill in the date and time of the appointment for the visual fieldoct test.

06

If applicable, provide any relevant medical history or details that may help the healthcare provider interpret the test results.

07

Review the completed form for accuracy and ensure all required fields are filled.

08

Finally, sign and date the form to acknowledge your consent and understanding of the test.

Who needs visual fieldoct requisition form?

01

The visual fieldoct requisition form is needed by individuals who have been recommended or prescribed a visual fieldoct test by their healthcare provider or eye specialist.

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What is visual fieldoct requisition form?

The visual fieldoct requisition form is a document used to request visual field testing and optical coherence tomography (OCT) scans.

Who is required to file visual fieldoct requisition form?

Eye specialists or healthcare providers who want to assess a patient's visual field and retina health may be required to file a visual fieldoct requisition form.

How to fill out visual fieldoct requisition form?

To fill out the visual fieldoct requisition form, the healthcare provider must provide patient information, reason for testing, and any relevant medical history.

What is the purpose of visual fieldoct requisition form?

The purpose of the visual fieldoct requisition form is to request and authorize visual field testing and OCT scans for diagnostic or monitoring purposes.

What information must be reported on visual fieldoct requisition form?

The visual fieldoct requisition form must include patient demographics, referring provider information, reason for testing, and any relevant clinical notes.

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