Risk Management



Permanent Punctal Occlusion Consent Form

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The permanent punctal occlusion consent form was provided by OMIC Claims and Risk Management Committee member Steven I. Rosenfeld, MD, FACS. Dr. Rosenfeld is a board-certified, fellowship-trained ophthalmologist who specializes in medical and surgical treatments of corneal conditions, infectious and inflammatory eye diseases, and all forms of laser vision correction. Dr. Rosenfeld practices with Delray Eye Associates, PA in Delray Beach, Florida.

This form is intended as a sample form. It contains information OMIC recommends you as the surgeon personally discuss with the patient. Please review it and modify to fit your actual practice.

 

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OMIC is the largest insurer of ophthalmologists in the United States and we've been the only physician-owned carrier to continuously offer coverage in all states since 1987 (pending in WI). Our fully portable policy can be taken with you wherever you practice. Should you move to a new state or territory, you're covered without the cost or headache of applying for new coverage.

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