Get the free Vision Screening Referral Form - Burrell School District

Vision Screening Results Educational Materials for Parents and Guardians Date: ___School: ___Dear Parent/Guardian of: ___ Your student was given a vision screening in school. The results of the screening

How to fill out vision screening referral form

How to fill out vision screening referral form

1. Obtain the vision screening referral form from the appropriate source (e.g. school nurse, eye doctor)
2. Fill out the patient's personal information including name, date of birth, and contact information.
3. Provide information on the reason for referral and relevant medical history.
4. Include any recommendations or notes from the administering vision screening test.
5. Sign and date the form to confirm completion.

Who needs vision screening referral form?

1. Children in school settings who have failed a routine vision screening test.
2. Individuals who are experiencing vision problems or symptoms that require further evaluation by an eye care professional.

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What is vision screening referral form?

The vision screening referral form is a document used to refer individuals for further vision testing after an initial screening.

Who is required to file vision screening referral form?

Healthcare providers or organizations conducting vision screenings are required to file vision screening referral forms.

How to fill out vision screening referral form?

The form should be filled out with the individual's information, screening results, and any other relevant details before being submitted.

What is the purpose of vision screening referral form?

The purpose of the vision screening referral form is to ensure that individuals with potential vision issues receive the necessary follow-up testing or treatment.

What information must be reported on vision screening referral form?

Information such as the individual's name, screening results, screening date, and any recommendations for follow-up care must be reported on the form.