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HEALTH PARTNERS PLANS PRIOR AUTHORIZATION REQUEST FORMOphthalmic Antibiotics Phone: 2159914300Fax back to: 8662403712Health Partners Plans manages the pharmacy drug benefit for your patient. Certain
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How to fill out ophthalmic antibiotics

How to fill out ophthalmic antibiotics
01
Wash your hands thoroughly before handling the ophthalmic antibiotics.
02
Check the expiry date on the antibiotic bottle to ensure it is still safe to use.
03
Tilt your head back slightly and pull down your lower eyelid to create a small pocket.
04
Hold the antibiotic bottle with the dropper tip pointing downwards and gently squeeze to release a drop into the pocket created by your lower eyelid.
05
Avoid touching the dropper tip to your eye or any other surface to prevent contamination.
06
Close your eyes gently and blink a few times to allow the antibiotic to spread evenly across the surface of the eye.
07
If you need to use the antibiotic in both eyes, repeat steps 3 to 6 for the other eye.
08
Wipe off any excess antibiotic from the eyelids or surrounding area using a clean tissue.
09
Recap the antibiotic bottle tightly and store it according to the instructions provided.
10
Wash your hands again to remove any remaining antibiotic residue.
Who needs ophthalmic antibiotics?
01
Individuals with bacterial eye infections, such as conjunctivitis or keratitis, may require ophthalmic antibiotics to help treat the infection.
02
People who have undergone certain eye surgeries, like cataract surgery or corneal transplants, may also be prescribed ophthalmic antibiotics to prevent infection.
03
Individuals at high risk of eye infections, such as contact lens wearers, may need ophthalmic antibiotics as a preventive measure.
04
Patients with systemic infections that have spread to the eyes, like ocular tuberculosis or endophthalmitis, may require ophthalmic antibiotics in conjunction with other treatments.
05
It is important to consult with an ophthalmologist or healthcare provider to determine if ophthalmic antibiotics are necessary for your specific condition.
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What is ophthalmic antibiotics?
Ophthalmic antibiotics are medications designed to treat bacterial infections of the eye or surrounding tissues. They can be in the form of eye drops or ointments.
Who is required to file ophthalmic antibiotics?
Healthcare providers who prescribe ophthalmic antibiotics, such as ophthalmologists and optometrists, are typically required to file prescriptions for these medications.
How to fill out ophthalmic antibiotics?
To fill out a prescription for ophthalmic antibiotics, include the patient's name, the specific medication and dosage, directions for use, the quantity to be dispensed, and the prescriber's information and signature.
What is the purpose of ophthalmic antibiotics?
The purpose of ophthalmic antibiotics is to eliminate bacterial infections in the eye or to prevent infections following eye surgery or injury.
What information must be reported on ophthalmic antibiotics?
The information that must be reported includes the name of the medication, dosage, route of administration, frequency of use, duration of treatment, and any patient allergies or contraindications.
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