Get Wet Amd Rapid Access Referral Form - Primary Health Net

Filling out the WET AMD RAPID ACCESS REFERRAL FORM online is essential for ensuring timely access to needed eye care services. This guide will walk you through each section of the form, providing necessary details to help you complete it accurately.

Follow the steps to fill out the WET AMD RAPID ACCESS REFERRAL FORM online.

1. Press the ‘Get Form’ button to access the referral form and open it in your preferred online editor.
2. Begin by entering the patient details. Fill in the ‘Date of referral’, ‘Name’, ‘Date of birth’, and, if available, ‘Hospital number’. Provide the patient's complete ‘Address’ and ‘Contact telephone numbers’.
3. Next, you will input the optometrist details. Please print clearly, avoid using a stamp. Include the ‘Name’, ‘Company’, ‘GOC number’, ‘Address’, ‘Telephone number’, and ‘Fax number’ of the referring optometrist.
4. Indicate which eye is suspected to have wet age-related macular degeneration (wet AMD) by selecting either ‘Right’ or ‘Left’.
5. In the presenting symptoms section, answer the questions regarding recent symptoms in the affected eye. At least one answer must be ‘Yes’ for either visual loss, distortion, or onset of missing patch/blurring in central vision. Choose accordingly.
6. For findings, provide the corrected near and distance acuity for both the right and left eye. Include any additional necessary details about the affected eye, such as the presence of macular haemorrhage, sub-retinal fluid, exudate, or choroidal neovascular membrane.
7. Review all sections to ensure all fields are filled out correctly. Once you have confirmed the accuracy of the information, you can save any changes, download, print, or share the completed form as needed.

Complete your documents online now for efficient processing and timely referrals.