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  • Diabetic Eye Exam Referral Form - The Humboldt Ipa

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Humboldt IPA Diabetes Eye Exam Referral and Report REFERRAL INFORMATION Referred By: Fax #: Referred To: Fax #: Reason for Referral: Patients Name: Date of Birth: Home Phone: Gender: M F Insurance:.

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CPT codes 92002 through 92004, and CPT codes 92012 and 92014 When billing for an ophthalmological evaluation and dilated eye exam for patients with diabetes, consider using ophthalmological service codes. These codes describe the evaluation of new or existing conditions of the eye only.

Diabetes can cause several changes inside your eyes that can affect the clarity of your vision. So a visual acuity test is almost always included in a diabetic eye exam. If your visual acuity has decreased since your last exam, your eye doctor may also perform a refraction.

Before the exam, an eye care professional will dilate your pupils with eye drops. Once your pupils widen about 20 minutes later, the eye care professional will check your visual acuity (sharpness), depth perception and eye movement. They will also examine the back of the eye for signs of diabetic retinopathy.

How is a diabetic eye exam different from a regular eye exam? Diabetic eye exams are similar to regular eye exams in many ways. However, during a diabetic eye exam, your eye doctor will specifically focus on the health of your retina and integrity of the blood vessels in your eye.

Diabetic retinopathy is best diagnosed with a comprehensive dilated eye exam. For this exam, drops placed in your eyes widen (dilate) your pupils to allow your doctor a better view inside your eyes. The drops can cause your close vision to blur until they wear off, several hours later.

You go for diabetic eye screening in your GP practice, at a hospital or at a clinic. They use a camera to take photographs of your eyes. The test takes about 15 minutes. If you're aged over 50, you might need eye drops to dilate your pupils.

Documentation can be in the form of a note or letter prepared by an ophthalmologist, optometrist, PCP or other health care professional. Include: date of service, the test (indicate a dilated or retinal exam) or result, and the care provider's credentials.

Dilating eye drops are often present in a diabetic eye exam. This helps enlarge the diabetic patient's pupils for a short while. This removes the eye's natural reaction to light. The pupil dilation allows the eye doctor to see into the back of the eye to check the fundus of the retina.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232