Get the free Low Vision Assessment REFERRAL FORM

JUNIC Specialist Centre Molonglo Health Hub 110 Woodberry Avenue Coombs ACT 2611 Phone: 02 6152 8585 Fax: 02 6113 0743 Email: info@junicimaging.com.au Web: www.junieyecare.com.auJUNIC EYECARE PLUS

How to fill out low vision assessment referral

How to fill out low vision assessment referral

1. Gather patient information such as name, age, and medical history.
2. Document the patient's visual impairments and any relevant symptoms.
3. Include any previous eye examinations or treatments the patient has received.
4. Fill out specific sections regarding the patient's functional abilities and limitations.
5. Provide the reason for referral, emphasizing the need for specialized assessment.
6. Check if consent has been obtained from the patient for the referral.
7. Review the referral for completeness and accuracy before submission.

Who needs low vision assessment referral?

1. Individuals with significant vision impairment that cannot be fully corrected with regular glasses or surgery.
2. Patients experiencing difficulties in daily activities due to low vision.
3. Those with medical conditions affecting their eyesight, such as diabetic retinopathy or macular degeneration.
4. People who have undergone treatment for eye diseases and still have residual low vision.

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What is low vision assessment referral?

A low vision assessment referral is a process in which individuals with visual impairments are referred for specialized assessment to determine the extent of their low vision and to explore options for rehabilitation and support.

Who is required to file low vision assessment referral?

Typically, healthcare providers such as optometrists, ophthalmologists, and specialists in vision rehabilitation are required to file low vision assessment referrals for patients who may benefit from additional evaluation and support.

How to fill out low vision assessment referral?

To fill out a low vision assessment referral, the healthcare provider must complete the referral form with patient information, medical history, details of the visual impairment, and any previous treatments or assessments that have been conducted.

What is the purpose of low vision assessment referral?

The purpose of a low vision assessment referral is to facilitate access to specialized services that can help individuals optimize their remaining vision, improve their quality of life, and gain skills to better manage their visual impairment.

What information must be reported on low vision assessment referral?

The information that must be reported includes patient demographics, specific visual impairments, duration of the condition, any previous medical or therapeutic interventions, and the reason for the referral.