Medical Office and Patient Safety/Commnunications Documents

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	Medical Office and Patient Safety/Communication Documents
	Ophthalmic Risk Management Forms & Documents is published by the Ophthalmic Mutual Insurance Company (OMIC), a risk retention group, for educational purposes only. It is intended solely to provide general information on a number of medical and legal issues. It is not intended to constitute legal counsel and should not be relied on as a source for legal advice. If legal advice is desired or needed, an attorney should be consulted.
	The following forms are in Rich-Text Format (RTF). If you are on a PC, your browser will use a word-processing application such as MS Word to open the document within your browser window. If you are on an Apple computer, the file will be downloaded to a designated folder or your desktop. Information for Patients Authorization For Use or Disclosure of Health Care Information Letter of Termination of Care. A sample termination letter is also available in Spanish. Information Regarding General Anesthesia Noncompliance Letter to Patient. Sample missed appointment and noncompliant letters are also available in Spanish. Parents: Read This About Your Premature Baby's Eyes! Parents: Read This About Your Premature Baby's Eyes! (Spanish version) Refusal of Recommended Medical or Surgical Procedure/Intervention Information and Letters Regarding Release of Contact Lens Information Letter to a Patient Examined and/or Fitted for Contact Lenses But Who Has Not Had Medically Necessary Follow-up Examination Letter to a Patient Examined and Fitted for Contact Lenses Who Has Requested a Copy of the Prescription Letter to a Patient Requesting Medical Record Which Contains Expired Contact Lens Prescription eRisk Documents eRisk Guidelines Online Communications Informed Consent Back To Top Managed Care Forms and Letters Referral Form for Managed Care Patients Appeal Letter to MCO When Treatment Has Been Denied on Grounds That It Is Not "Medically Necessary" Appeal Letter to MCO When Treatment Has Been Denied on Grounds That It Is Not a "Covered Service" Letter to Patient Regarding Informed Choice Not To Undergo a Recommended Treatment/Procedure "Not Medically Necessary" Letter to Patient Regarding Informed Choice Not To Undergo A Recommended Treatment/Procedure "Not Covered Benefit" Back To Top Medical Office Forms Glaucoma Flow Chart History and Physical Forms (Courtesy of Daniel A. Long, MD, a practicing ophthalmologist in Gretna, LA.) Medical Record Audit Uveitis-Specific History Form Surgery Face Sheet Special Testing Documentation Aids Forms To Use When Seeing A Patient For Refraction/Screening Eye Exam Refraction/Screening Eye Exam Protocol Your Examination Today Was Not a Complete Eye Examination (Recommended follow-up) Eye History Brief Vision Examination Back to Top\|Home\|Copyright, Disclaimer & Privacy Statement © 2006 - 2011 Ophthalmic Mutual Insurance Company, A Risk Retention Group