Get the free Eye Donor Referral Form - cera org

Contact phone 0408 370 148. Donor Details: Donor Name Date of Birth Age Sex Hospital No. (if applicable) Coroner s Case? Case Number.

How to fill out eye donor referral form

How to Fill Out Eye Donor Referral Form:

1. Obtain the eye donor referral form: Contact your local eye bank or healthcare provider to request the eye donor referral form. They will provide you with the necessary paperwork to fill out.
2. Gather the required information: Before filling out the form, make sure you have all the necessary information readily available. This may include the donor's full name, contact information, date of birth, and any relevant medical history.
3. Provide donor consent: The eye donor referral form usually includes a consent section. Ensure that the donor has given their permission to donate their eyes after their passing. If the donor is unable to provide consent, consult with their immediate family members for authorization.
4. Complete the donor's personal details: Fill in the form with the donor's accurate personal information, such as full name, date of birth, gender, and contact details. It is crucial to ensure accuracy, as any errors might hinder the donation process.
5. Provide relevant medical details: The eye bank needs to be aware of any medical conditions or relevant medications the donor may have been taking. Fill out this section carefully, including any recent surgeries or treatments.
6. Indicate any known exclusions: Certain conditions or circumstances may exclude someone from being an eye donor. If the donor has any of these exclusions, such as HIV/AIDS, active cancer, or certain infections, indicate them on the form.
7. Complete the family history section (if applicable): Some eye banks request information on the donor's family medical history. Fill in any relevant information concerning eye diseases or hereditary conditions.
8. Submit the completed form: Once you have filled out the eye donor referral form, review it for accuracy and completeness. Then, follow the instructions provided by the eye bank or healthcare provider to submit the form. It may be through mailing, faxing, or an electronic submission.

Who Needs Eye Donor Referral Form:

1. Individuals considering eye donation: If someone wishes to donate their eyes after their passing, they would need to fill out an eye donor referral form. This form provides crucial information to eye banks and helps facilitate the donation process.
2. Family members or authorized representatives: In certain cases, if the potential donor is unable to provide consent themselves, their immediate family members or authorized representatives may need to fill out the eye donor referral form on their behalf.
3. Healthcare professionals: Ophthalmologists, optometrists, and other healthcare professionals involved in the care of potential eye donors may also be responsible for filling out the eye donor referral form. They would have access to the necessary medical information required on the form.

For pdfFiller’s FAQs

What is eye donor referral form?

The eye donor referral form is a document used to officially refer an individual as a potential eye donor after their passing.

Who is required to file eye donor referral form?

Medical professionals, such as doctors or eye care specialists, are required to file the eye donor referral form.

How to fill out eye donor referral form?

The eye donor referral form must be completed with accurate personal information of the deceased individual and signed by a medical professional before submission.

What is the purpose of eye donor referral form?

The purpose of the eye donor referral form is to express the deceased individual's wish to donate their eyes for transplant or research purposes.

What information must be reported on eye donor referral form?

The eye donor referral form must include the deceased individual's name, date of birth, date of passing, and consent for eye donation.

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