Get Urgent Care Work Release Form

Filling out the Urgent Care Work Release Form online can streamline the process of obtaining necessary medical documentation for your employer. This guide will walk you through each section and field of the form to ensure you complete it accurately and efficiently.

Follow the steps to fill out the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the patient's name in the designated field for identification. Ensure the name is spelled correctly to avoid any confusion.
3. Provide an emergency contact number to ensure you can be reached if necessary. This information is critical for urgent situations.
4. Fill out the 'Rx Refill' section, including your Illinois Eye Institute (IEI) number and the date of the request, along with any other relevant details.
5. Complete the home and work contact information fields, providing both phone numbers as needed.
6. Indicate the time that you are available for contact to ensure prompt communication.
7. Note who the call was taken by in the 'Taken By' section, ensuring that this field reflects the individual's name accurately.
8. Detail the reason for your call. Be as specific and concise as possible to facilitate effective communication with healthcare providers.
9. After the receptionist's disposition, indicate whether you spoke to someone, left a message, or if a page was sent, and note the physician's name and time.
10. Complete the symptoms checklist by selecting any relevant symptoms you are experiencing, such as pain, redness, and blurred vision.
11. Provide the date when your symptoms began and answer any follow-up questions regarding your vision changes and eye injuries.
12. Fill in any additional details regarding changes in your vision, potential flashes or spots, and whether your condition is worsening.
13. In the 'Advice to patient' section, note any instructions you received and schedule your next appointment if required. Specify if it is for urgent care, a general exam, none, or other.
14. Call or fax your pharmacy if instructed, ensuring you have all necessary medication refills processed.
15. Finally, sign and date the form. Ensure all information is accurate before saving your changes, downloading, printing, or sharing the completed form as necessary.

Complete your Urgent Care Work Release Form online today for a smooth and efficient process.