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Get Il Health Alliance Jak Optical Laboratories Eyeglass Order Form 2019-2025
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How to fill out the IL Health Alliance JAK Optical Laboratories Eyeglass Order Form online
Completing the IL Health Alliance JAK Optical Laboratories Eyeglass Order Form online can streamline the process of ordering eyeglasses. This guide provides clear, step-by-step instructions to help users navigate each section of the form effectively.
Follow the steps to complete your eyeglass order form.
- Press the ‘Get Form’ button to acquire the form and open it for completion.
- Begin by entering your JAK account number in the designated field at the top of the form.
- Fill in the provider's contact information, including the provider name, phone number, and address in the appropriate sections.
- Enter the member identification number related to your health plan under the 'IL Member Identification Number' section.
- Complete the patient information area by providing the first name, last name, gender, and date of birth.
- Specify the lens type by selecting options in the 'Lens Base' section, including plastic or polycarbonate, which is available for specific age groups and prescriptions.
- Provide details for the prescription by filling out the fields for sphere, cylinder, axis, decentration, and prism specifications.
- Complete the pupillary distance (PD) measurements for both right and left eye, including far and near positions.
- If applicable, note the date of order and any special instructions related to the eyeglass order.
- Upon completing all fields, you can save your changes, download the completed form, or print it directly.
Get started on filling out your eyeglass order form online today!
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