Get Suny Optometry Referral

Filling out the Suny Optometry Referral form online is an important step in facilitating patient care. This comprehensive guide will walk you through each section and provide clear, step-by-step instructions to ensure that you complete the form accurately.

Follow the steps to complete the Suny Optometry Referral form online.

1. Click ‘Get Form’ button to access the Suny Optometry Referral form and open it in the editor.
2. Enter the date of referral in the first field.
3. Input the patient's name in the section labeled 'Patient Name (First & Last Name)'.
4. Fill in the patient's date of birth in the adjacent field marked 'DOB'.
5. Provide the patient's address in the 'Patient Address' section. Ensure this information is accurate as it is required.
6. Complete the patient's city, state, and zip code in the respective fields.
7. Enter the patient's phone number in the 'Patient Phone #' field.
8. Input the referring provider's name in the 'Referred By (First & Last Name)' section.
9. Fill out the 'Name of Practice/Facility' field for the referring provider.
10. Provide the address for the referring provider, including city, state, and zip.
11. Enter the phone number for the referring provider.
12. If applicable, enter the fax number for the referring provider.
13. Provide the referring provider's email address in the corresponding field.
14. If applicable, enter the NPI number of the new referring provider.
15. Fill in the member insurance company name and member ID number.
16. Attach a copy of the patient’s insurance card (front & back) as instructed.
17. Indicate whether you dispense eyeglasses at your location by selecting ‘Yes’ or ‘No’.
18. If the referral is urgent, check 'Yes' for handling within 24-48 hours.
19. Choose how you would like the patient to proceed with future care by checking the appropriate box.
20. Select the nature of the referral by checking one of the options provided (imaging center, consultation, etc.).
21. Complete the special testing and specialty care sections as applicable by checking relevant options.
22. Input any diagnoses and diagnosis codes where indicated.
23. Choose your preferred method of correspondence by checking the box for call, mail, or fax report.
24. Document the patient's latest refraction figures for both eyes.
25. Provide reasons for the referral and any pertinent patient information in the designated space.
26. Record the date of the last dilated fundus exam along with any findings.
27. Once all information is filled out, save changes, download, print, or share the completed form as needed.

Complete your forms online to streamline the referral process today.