Get Cln-22 Referral Form - Cincinnati Eye Institute

The CLN-22 Referral Form is essential for facilitating seamless communication between referring doctors and the Cincinnati Eye Institute. This guide will provide you with clear, step-by-step instructions on how to fill out the form accurately and efficiently online.

Follow the steps to complete the CLN-22 Referral Form online.

1. Click ‘Get Form’ button to retrieve the CLN-22 Referral Form and open it in the online editor.
2. Begin by entering the requestor's information, including your name, phone number, and address. Ensure this information is accurate to facilitate communication.
3. Next, provide the patient's information by entering their name, date of birth, appointment date, appointment time, and phone number. This is crucial for identifying the patient and scheduling their appointment.
4. Indicate the specific consultation requested for further evaluation. Options include cataract, refractive, cornea, retina, glaucoma, neuro-ophthalmology, uveitis, and oculoplastic. If other ocular diagnoses are being treated by the referring doctor, please specify.
5. Include detailed medical information about the patient, such as best visual acuity, refraction, intraocular pressure, cup-to-disc ratio, ocular medications, and pertinent findings in both the anterior and posterior segments.
6. Add any additional remarks or information that may help the eye care professionals at the Cincinnati Eye Institute. If applicable, note if co-management was discussed with the patient.
7. Finally, requestor must sign and date the form to validate the referral. Review all entries for accuracy before submission.
8. Once all sections are completed, save the changes and choose to download or print the form for submission. Alternatively, you can share it as needed.

Start filling out the CLN-22 Referral Form online today for efficient processing.