Get the free LOW VISION REHAB REFERRAL FORM
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FAX for Client Referral and Clinical Records (616) 8409528 or (616) 4587113 VISION REHABILITATION/LOW VISION CLINIC REFERRAL Please fax this completed form along with your most recent chart notes
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How to fill out low vision rehab referral
How to fill out low vision rehab referral
01
Consult with an eye care professional to determine if the patient is a good candidate for low vision rehab
02
Obtain the necessary forms or paperwork from the eye care professional
03
Fill out the patient's personal information, medical history, and reason for referral
04
Include any relevant test results or documentation to support the referral
05
Submit the completed referral form to the appropriate low vision rehab center or specialist
Who needs low vision rehab referral?
01
Individuals with visual impairments such as macular degeneration, diabetic retinopathy, glaucoma, or other eye conditions that cannot be fully corrected with glasses, contact lenses, or surgery
02
Patients who are struggling with daily tasks such as reading, writing, driving, or navigating their environment due to their vision loss
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What is low vision rehab referral?
Low vision rehab referral is a referral to a rehabilitation program designed to help individuals with visual impairments improve their quality of life and function independently.
Who is required to file low vision rehab referral?
Low vision rehab referral can be filed by healthcare professionals, including ophthalmologists, optometrists, or other medical providers.
How to fill out low vision rehab referral?
To fill out a low vision rehab referral, the healthcare professional must provide detailed information about the patient's visual impairment, medical history, and any specific goals for rehabilitation.
What is the purpose of low vision rehab referral?
The purpose of a low vision rehab referral is to connect individuals with visual impairments to specialized programs and services that can help them improve their visual function and daily living skills.
What information must be reported on low vision rehab referral?
Information such as the patient's visual acuity, field of vision, diagnosis, and any current treatments or interventions must be reported on a low vision rehab referral.
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