Ozurdex

This sample consent form for Ozurdex is written in plain language to make it easier for patients to understand.

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Perform a time out before each intravitreal injection.

OMIC has received reports of “wrong” events associated with intravitreal injections. These include wrong patient, wrong eye, wrong condition, wrong drug, and wrong dose.

To ensure that the correct drug and dose are injected into the correct eye every time, the ophthalmologist needs to lead a time out. Time out before intravitreal injections provides the opportunity to confirm that the patient, medical record, and ophthalmologist are in agreement.

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OMIC was founded by members of the American Academy of Ophthalmology nearly a quarter century ago and is the only carrier sponsored and endorsed by AAO. OMIC is also endorsed by 54 other ophthalmic societies. The OMIC partnerships with state and subspecialty societies qualifies their members for an exclusive 10% premium credit. Contact your state society for details.