Consent Forms
Welcome to OMIC’s Consent Form library, a collection of procedure-specific consent forms that you can modify to suit your practice and patient population. Contact riskmanagement@omic.com with questions.
Found
18
resources.
Oct 9, 2014
| Consent Form
...you have obtained informed consent. 1. Keep the original in the patient’s medical record. Version 10/09/2014 [bookmark: _GoBack] Consent for LASIK (Laser In Situ Keratomileusis) Retreatment INTRODUCTION It is our hope to fully inform you about the indications, side effects, limitations, and complications of repeat LASIK surgery, or retreatment. This...
Oct 9, 2014
| Consent Form
...benefits to determine whether to proceed with further surgery. INDICATIONS AND ALTERNATIVES As you were informed before your first LASIK procedure, retreatments are at times indicated to correct remaining or induced myopia (nearsightedness), hyperopia (farsightedness), and astigmatism. There is no guarantee that repeat LASIK will correct these problems. Alternative forms...
Oct 9, 2014
| Consent Form
...combined with the use of a device known as an excimer laser, to perform LASIK. LASIK is one of a number of alternatives for correcting nearsightedness, farsightedness and astigmatism. In LASIK, the microkeratome is used to shave the cornea to create a flap. The flap then is opened like the...
Apr 7, 2007
| Consent Form
...information is being provided to you so that you can make an informed decision about IntraLASIK, or “all-laser” LASIK. Traditional LASIK surgery involves two procedures: first, a microkeratome blade is used to create a flap on the cornea to expose the underlying tissue. After the flap is created, an excimer...
Oct 9, 2014
| Consent Form
...you have obtained informed consent. · Keep the original in the patient’s medical record. Version 10/09/2014 Addendum: Consent for Bilateral Simultaneous LASIK LASIK has become a common procedure for many refractive surgery patients. While many patients choose to have both eyes treated at the same surgical setting, there may be...
Oct 8, 2014
| Consent Form
...that you have obtained informed consent. · Keep the original in the patient’s medical record. Version 10/08/2014 Informed Consent for Therapeutic Use Of Intacs® for Post-LASIK Ectasia This information is to help you make an informed decision about having Intacs® inserted in your eye to reduce the myopia (nearsightedness) and...
Oct 9, 2014
| Consent Form
...excimer laser, and the flap is returned to its original position. LASIK has been found to be quite successful and relatively safe for the correction of moderate and high myopia up to -12 D. Above 12 diopters, LASIK is known to have a high incidence of complications involving the quality...
Apr 16, 2012
| Consent Form
...2. The excimer laser can be used to correct low to moderate amounts of hyperopia (generally +1 to +5 D or diopters) and low to higher amounts of myopia (generally -1 D to –12D) through either PRK (photorefractive keratectomy) or LASIK (laser in situ keratomileusis). LASIK is an operation which...
May 10, 2023
| Consent Form
...of being round like a basketball, the cornea is shaped like a football. This can make your vision blurry. Astigmatism can be reduced by a toric IOL, glasses, contact lenses, and refractive surgery (LASIK or PRK). There is also a procedure called a limbal relaxing incision (LRI) that can be...
Aug 27, 2024
| Consent Form
...With astigmatism, the eye is long (like a football). Many people with cataracts have astigmatism. If you have astigmatism, wearing glasses or contact lenses can help you see more clearly. Or you could have surgery (called LASIK or PRK) to change the shape of your eye to correct astigmatism. There...
Nov 23, 2016
| Consent Form
...not be able to read printed words more clearly just because you had blepharoplasty. Talk with your ophthalmologist about other ways to improve vision such as with eyeglasses, contact lenses, cataract surgery, or LASIK surgery. It is your choice whether to have blepharoplasty. Here are some other options: · You...
Feb 13, 2020
| Consent Form
...because you had blepharoplasty. Talk with your ophthalmologist about other ways to improve vision such as with eyeglasses, contact lenses, cataract surgery, or LASIK surgery. It is your choice whether to have blepharoplasty. Here are some other options: · You may decide to do nothing. Excess skin, muscle, and fat...
Aug 25, 2024
| Consent Form
...irregularly shaped cornea; instead of being round like a basketball, the cornea is shaped like an American style football. This can make your vision blurry. In addition to toric IOLs, astigmatism can be reduced by glasses, contact lenses, and refractive surgery (Laser assisted in situ keratomileusis [LASIK] or Photorefractive keratectomy...
Sep 24, 2014
| Consent Form
...being round like a basketball, the cornea is shaped like a football. This can make your vision blurry. In addition to toric IOLs, astigmatism can be reduced by glasses, contact lenses, and refractive surgery (LASIK or PRK). There is also a procedure called a limbal relaxing incision (LRI), which can...
Aug 15, 2016
| Consent Form
...after eye surgery such as LASIK (post-refractive ectasia). Corneal cross-linking (CXL) can help make the middle layer stronger. CXL is an eye treatment that may be done in your ophthalmologist’s (eye surgeon’s) office. There are 3 steps. 1) Your ophthalmologist will numb your eye with drops and then gently remove...
Oct 3, 2014
| Consent Form
...are several reasons why you may need a new cornea: · Complications from LASIK or PRK surgery · Degenerative eye conditions called corneal dystrophies which affect the clarity of the cornea. · Scarring from previous infections, such bacterial, fungal, and viral (e.g. Herpes simplex) infections. · Excessive swelling (edema) of...
Oct 9, 2014
| Consent Form
...an elective procedure. · The alternatives to KeraVision Intacs for correcting nearsightedness include eyeglasses, contact lenses, and other kinds of refractive surgery procedures such as Radial Keratotomy (RK), Photorefractive Keratectomy (PRK) and Laser in situ keratomileusis (LASIK). · KeraVision Intacs will not prevent the development of naturally occurring eye problems...
Jul 1, 2015
| Consent Form
...refraction) by changing the shape of the cornea, the clear front of the eye. The FS laser uses suction. If you have had a type of refractive surgery called LASIK, the suction could open up or move the flap. If you have had other refractive surgeries called AK or RK,...
These are sample forms—download, review and revise as needed.