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INTACT RESEARCH STUDY HCQ Retinopathy Screening Referral Request Form PLEASE SEND COMPLETE FORM TO RETINOLOGIST & INTACT STUDY TEAMintact.study@arthritisresearch.ca | P: (604) 2074038 | F: (604) 2074059

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How to fill out risk of retinal toxicity

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Make sure to thoroughly read the instructions provided by your healthcare provider

02

Use a steady hand to carefully administer the medication into the eye

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Avoid touching the tip of the dropper to prevent contamination

04

If you experience any unusual symptoms, contact your healthcare provider immediately

Who needs risk of retinal toxicity?

01

Patients who are prescribed medications known to have potential retinal toxicity

02

Individuals with pre-existing eye conditions that may be exacerbated by certain medications

03

Those who have a history of retinal toxicity or eye problems

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What is risk of retinal toxicity?

Risk of retinal toxicity refers to the potential harm that certain medications or substances can cause to the retina, which may lead to vision impairment or loss.

Who is required to file risk of retinal toxicity?

Manufacturers and healthcare providers who prescribe or distribute medications known to have retinal toxicity risks are typically required to file reports on this issue.

How to fill out risk of retinal toxicity?

Filing a report involves gathering patient data, documenting instances of retinal toxicity, and completing a standardized form which requires detailed information about the cases.

What is the purpose of risk of retinal toxicity?

The purpose of documenting risks of retinal toxicity is to monitor and manage the safety of medications, ensure proper patient care, and prevent vision loss related to treatments.

What information must be reported on risk of retinal toxicity?

Reports must include details such as patient demographics, the medication involved, observed symptoms, diagnosis, and any interventions made to address the toxicity.

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