Get the free Specialty Contact Lens Referral Form - med emory

Please download this form, have your referring provider fill it out, and then ask them to fax it to 404-778-3479 before your scheduled visit at the Emory Eye Center. Incomplete referral forms will

How to fill out specialty contact lens referral

How to fill out specialty contact lens referral

1. Gather patient information: Name, age, medical history, and current vision prescription.
2. Include reason for referral: Specify the visual problems or conditions the patient is experiencing.
3. Select appropriate specialty lenses: Determine the type of specialty contact lenses needed (e.g., scleral, ortho-k, toric).
4. Fill in the required measurements: Include corneal curvature, diameter, and other relevant fitting measurements.
5. Provide any previous treatment history: List any previous contact lenses used and the outcomes.
6. Sign and date the referral: Ensure the referral is signed off by the referring practitioner.
7. Send the referral to the specialist: Submit the completed referral through the preferred method (email, fax, or physical delivery).

Who needs specialty contact lens referral?

1. Patients with irregular corneas (e.g., keratoconus or after corneal transplant).
2. Individuals with severe dry eye or other ocular surface disorders.
3. Patients requiring vision correction due to high levels of astigmatism.
4. Those with specific needs for myopia control or presbyopia management.
5. Patients who have not had success with conventional contact lenses.

For pdfFiller’s FAQs

How can I edit specialty contact lens referral from Google Drive?

It is possible to significantly enhance your document management and form preparation by combining pdfFiller with Google Docs. This will allow you to generate papers, amend them, and sign them straight from your Google Drive. Use the add-on to convert your specialty contact lens referral into a dynamic fillable form that can be managed and signed using any internet-connected device.

How can I send specialty contact lens referral for eSignature?

Once your specialty contact lens referral is ready, you can securely share it with recipients and collect eSignatures in a few clicks with pdfFiller. You can send a PDF by email, text message, fax, USPS mail, or notarize it online - right from your account. Create an account now and try it yourself.

Can I create an eSignature for the specialty contact lens referral in Gmail?

You may quickly make your eSignature using pdfFiller and then eSign your specialty contact lens referral right from your mailbox using pdfFiller's Gmail add-on. Please keep in mind that in order to preserve your signatures and signed papers, you must first create an account.

What is specialty contact lens referral?

A specialty contact lens referral is a recommendation or request made by an eye care professional to refer a patient to another practitioner who specializes in fitting specialty contact lenses, such as scleral or toric lenses.

Who is required to file specialty contact lens referral?

Typically, the referring eye care professional (such as an optometrist or ophthalmologist) is required to file a specialty contact lens referral when they believe the patient requires advanced contact lens fitting not provided in their practice.

How to fill out specialty contact lens referral?

To fill out a specialty contact lens referral, the eye care professional should gather patient information, details of the visual condition, specific lens requirements, and any relevant medical history, then record these details in the referral form.

What is the purpose of specialty contact lens referral?

The purpose of a specialty contact lens referral is to ensure that patients receive the best possible care for their specific visual needs by connecting them with practitioners who have specialized expertise in custom contact lens fittings.

What information must be reported on specialty contact lens referral?

The information that must be reported includes the patient's personal details, the reason for referral, any diagnosed conditions affecting lens choice, preferred lens type, and relevant diagnostic test results.