Get Missouri Eye Exam Form - Moeyecare

The Missouri Eye Examination Form for School is an essential document for assessing students’ eye health. This guide provides a step-by-step approach to completing the form online, ensuring that users can effectively navigate each section with ease and confidence.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the identifying information section. Enter the student’s name, the provider's last name (only the first four digits), date of birth of the student, and the last four digits of the student’s social security number. Additionally, include the parent or guardian's name in the designated field.
3. Proceed to the case history section. Here, indicate the date of the eye exam. Choose 'Normal' or 'Positive' for ocular and medical histories, and specify any drug allergies the student may have or note 'NKDA' if there are none.
4. Move on to the family ocular and medical history section. Add any relevant information and list other pertinent details as necessary.
5. In the exam section, assess and mark each evaluation as 'Normal,' 'Abnormal,' or 'Not Able to Assess' for the following components: amblyopia, strabismus, internal eye health, external eye health, visual acuity, and binocular vision.
6. Complete the visual acuity tests by filling in the distance unaided acuity and distance best-corrected acuity for both eyes (OD and OS) at 20 feet, and near unaided and near best-corrected acuity at 14 inches.
7. Fill out the refraction section for both eyes (OD and OS) where applicable.
8. In the diagnosis section, indicate if the findings are 'Normal' or identify any conditions such as myopia, hyperopia, astigmatism, strabismus, or amblyopia, along with any other diagnosis as needed.
9. For treatment recommendations, detail any prescribed glasses, the specifications for wearing them (such as constant wear or only for distance vision), and whether they may be removed during recess or physical education.
10. Finally, indicate the payer type, whether it is insurance, MO HealthNet, complimentary, or another form of payment. Fill in the examiner’s name and the date of the exam before completing the form.
11. Once you've filled out all sections, ensure that all information is accurate and complete. You can then save changes, download, print, or share the form as needed.

Complete your Missouri Eye Examination Form online today to ensure a smooth process for your eye health assessment.