Get Ophthalmology Referral Form

Completing the Ophthalmology Referral Form online is a straightforward process that ensures accurate communication of patient needs. This guide outlines each section of the form and provides step-by-step instructions for efficient completion.

Follow the steps to successfully complete the form

1. Click the ‘Get Form’ button to access the Ophthalmology Referral Form and open it in your preferred editor.
2. Begin by filling out the 'Patient details' section. Provide the patient's surname, first name, date of birth, and contact information, including their mobile number and address.
3. Next, complete the 'Referring clinician’s details' section. Include your surname, first name, telephone number, GOC number, practice name, and address.
4. In the 'Reason for referral' section, select the appropriate options such as cataract, glaucoma, or other specified conditions. Indicate the priority level of the referral, including emergency, urgent, or routine.
5. Proceed to the 'Tonometry' section. Enter the relevant readings for both right eye (RE) and left eye (LE), including any averages obtained.
6. Fill out the 'Prescription details' section with the patient's vision metrics, including sphere (Sph), cylinder (Cyl), axis, and any other relevant clinical details such as the CD ratio of the optic nerve head (ONH).
7. In the 'Patient preferences' section, detail the patient's near visual acuity (VA), prism details, and any observations or ocular history that may be pertinent to the treatment.
8. Verify that the patient has consented to the exchange of information. Ensure you have noted any attachments that should accompany the referral.
9. Finally, review all entered information for accuracy. Once satisfied, you can save the changes, download the referral for your records, print a hard copy, or share the form as needed.

Complete your Ophthalmology Referral Form online today for efficient patient referrals.