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By . Mosby
Description This combination book and CD-ROM contains a wealth of helpful patient education handouts and front office/business documents - in both
English and Spanish. It includes office records and tracking forms for routine office procedures; letters to insurance providers, new
patients, and specialists; Information on the latest HIPAA guidelines; and many other frequently used materials. Best of all, the CD-ROM
allows users to customize many of these documents to meet their own optometric or ophthalmic practice and individual patient needs.
Contents
Part 1: Patient Handouts
1. Accommodative Disorder
2. Amblyopia
3. The Amsler Grid
4. Attention Deficit-Hyperactivity
Disorder and Vision
5. Blepharitis
6. Branch Retinal Vein Occlusion
7. Cataract
8. Lenses for Patients with Developing
Cataracts
9. Central Retinal Vein Occlusion
10. Central Serous Chorioretinopathy
11. Chalazia and Styes
12. Computer
Glasses
13. Computer Vision Syndrome
14. Computer Vision Syndrome: Treatment Sheet
15. Conjunctivitis
16. Allergic
Conjunctivitis
17. Convergence Insufficiency
18. Cool Soaks
19. Corneal Abrasion
20. Diabetic Retinopathy
21.
Drugs That Cause Problems with the Eyes
22. Drusens
23. Dry Eye
24. Eight Reasons Why You Should Purchase Your Eyewear
from Us
25. Epiretinal Membrane
26. Eye Drops and Ointment
27. Eyelid Problems
28. Eyelid Problems: Treatment Sheet
29. Eyelid Massage
30. Eyelid Scrubs
31. Floaters and Flashes
32. Glaucoma
33. Headaches, The Eyes, and Vision
34. Iritis
35. Jump Ductions
36. Keratoconus
37. Keratoconus: Treatment Sheet
38. Lattice Degeneration
39. Macular Degeneration
40. Monovision
41. No Perfect Pair
42. Ocular Hypertension
43. Orthokeratology
44.
Refractive Error
45. Reading Glasses Comparison
46. Reading and Writing
47. Retinal Detachment
48. Retinitis Pigmentosa
49. Strabismus and Amblyopia
50. Strabismus
51. Subconjunctival Hemorrhage
52. Systemic Disease and Your Eyes
53. Vision Therapy for Adults
54. Warm Soaks
55. What is Vision Therapy?
56. Family Medical History and Risk
Part
2: Letters and Forms
Appointment Schedule
Authorization for Release of Identifying Health Information
Billing Statement
Pre-Collection Statement
Collection Call Planning Form
Collection Letter
Consent to Payment
Financial Arrangements
Budget Plan Receipt
Binocular Vision
Amblyopia Treatment Flow Sheet
Binocular Vision Evaluation
Binocular Vision
Treatment Form
Binocular Vision Treatment Letter
Binocular Vision Treatment Policies
Binocular Vision Therapy Kit
Binocular Vision and Visual Skills Report
Binocular Vision Summary Sheet
Binocular Vision Report
Developmental History
Form
Binocular Vision Referral Form
Strabismus Examination Record
Visual Skills Recording Form
Visual Analysis of
Reading Strategies and Spelling Skills
Video Display Terminal Assessment
Chronological Record of Patient Care
Computer
Vision Syndrome Patient Questionnaire
Consultation Letter
Contact Lens Record
Contact Lens Policies
Contact Lens
Selection Questionnaire
Contact Lens Wearing Schedule
Contact Lens Do's and Don'ts
Contact Lens Service Agreement
Six Contact Lens Comfort Lens Plans
Fresh Lens Planned Replacement Program
Contact Lens Maximum Wearing Schedule
Dilation
of Your Pupils
Examination Form
Excusal from School (Proof of Appointment Slip)
General Eye Exam: Diabetes Study
Care Instructions for Frames and Lenses
Frame Breakage Release
Patient Prescription Laboratory and Frame Inventory Record
Informed Consent or Refusal for Dilated Fundus Exam
Glaucoma Flowsheet
Health Insurance Portability and Accountability (HIPAA)
of 1996
How HIPAA Will Affect your Eye Care Visit
Inactive Notice
Informed Consent for In-Office Procedures
Insurance
Information
Vision Insurance Coverage
Vision Insurance: Points to Consider
Determination of Insurance Benefits
Information
Request
Preauthorization of Payment
Lifestyle Questionnaire
Low Vision
Patient Information Form
Referral Information
Form
Low Vision Billing Form
Low Vision Precertification Request Form
New Resident Letter
No-Show Policy
Ocular
Emergency Report Form
Patient History
Confidential Medical History
Patient Information
Questionnaire for Children
Questionnaire for Parent
Recommendations for Additional Care
Patient Registration Form
Notice of Privacy Practices
Reschedule of Missed Appointment
Teen's or Child's Vision Examination Recall
Refractive Surgery
Laser Vision Correction
Screening Form
Laser Vision Correction Preoperative Exam form
Laser Vision Correction Postoperative Exam Form
Laser Vision
Correction Preoperative Patient Questionnaire
Laser Vision Correction Postoperative Patient Questionnaire
Professional Request
for Patient Information
Authorization for Release of Health Information
Reminder of Scheduled Exam
Report to Physician
for Routine Eye Examination
Missed Contact Lens Appointment
Confirming Appointment for New Patient
Super Bill
Supplemental
Services Record of Visit
Patient Survey
Telephone Inquiry
Thank You to Current Patient
Thank You to New Patient
Thank You for Your Referral
Transfer of Spectacle Information
Triage Sheet
Visual Field Examination
Welcome to Our
Office
Patients Who Need to Be Rescheduled
Priority Rescheduling
Part 3: Practice Administration and Sample Contracts
Introduction to Using These Samples (Disclaimer and Recommendation for Legal Consult)
Application for Employment
Telephone
Reference Check and Offer of Employment
Employee Evaluation Report
Employee Self-Evaluation
Personnel Performance Evaluation
Employee Performance Review
Progress Evaluation
Employment Agreement
Agreement Between Independent Contractor and
Client
Letter of Intent
Agreement of partnership of Eye Center Optometry
1. Exhibit A
Agreement for Purchase and
Sale of Assets
2. Exhibit A
3. Exhibit B-Security Agreement
4. Exhibit C-Promissory Note
Optometric Group partnership
Agreement
Part 4: Office Manual
Introduction
1. Example #1
2. Example #2
3. Example #3
Mission Statement
(Orientation)
4. Example #1
5. Example #2
6. Example #3
Profile of Doctors
Personnel Policies and Guidelines
At-Will Statement
1. Example 1
2. Example 2
Equal Opportunity Employment
Discrimination
Sexual Harassment
3. Example 1
4. Example 2
Resignation/Dismissal
5. Example 1
Exit Interview
Resignations
Reduction
to Staff
Termination
Dismissal
Overtime
Calculation of Overtime
Overtime
6. Example 1
7. Example 2
8. Example 3
Performance Review
9. Example 1
10. Example 2
Pay Period
11. Example 1
12. Example 2
Holidays
13. Example 1
14. Example 2
15. Example 3
Disability/Medical leave of Absence
16. Example 1
17. Example 2
Lunch and Rest Periods
Jury Duty/Witness Leave
18. Example 1
19. Example 2
20. Example 3
21. Example 4
Bereavement Leave
22. Example 1
23. Example 2
Personal Leaves of Absence
24. Example 1
25.
Example 2
Profit Sharing
26. Example 1
27. Example 2
Leave for Domestic Violence
Military Leave
Expense
Reimbursement
Continuing Education
Keys
Profit Sharing
28. Example 1
29. Example 2
30. Example 3
Office
Decorum
Discipline
Amendments
31. Example 1
32. Example 2
Staff Meetings
Conditions of Employment
CLASSIFICATION OF EMPLOYEES
33. Example 1
34. Example 2
35. Example 3
Meal and Rest Periods
36. Example 1
37. Example 2
Compensation
Hours of Operation
38. Example 1
39. Example 2
Work Hours and Wages
Timecards/Records
40. Example 1
41. Example 2
REDUCTIONS TO STAFF
Benefits
401(k)
Profit Sharing
Health Insurance
Childcare Benefits
Flexible Spending accounts
Life Insurance
Sick Leave
Vacations
Personal Leaves of Absence
Uniform Allowance
Professional Courtesy for Staff
Credit Union
Costco Membership
Job Descriptions
By Area
Worked
42. When Working at the Front Desk
43. When Working in the Style Center
44. When Working in the Data Collection
Room
45. When Working in the Contact Lens Area
46. When Working in the Laboratory
By Title
47. Office Manager
48. Ophthalmic Technician
49. Optometric Assistant
Office Procedures
Office Policies
Fires and Emergencies
Injury
and Illness
Ergonomics
Safety Committee
Part 5: Office Polices and Procedures for Handling Managed Care Patients
How to Use this Manual
List of Plans Accepted by the Office
List of Plans Not Accepted by the Office
Brief Summary of
Accepted Managed Care Plans
Expanded Information Devoted to Each Plan
Telephone Call Summary Form
Patient Price List
Scripts for Use by the Receptionist
Patient Sign-in Sheet
Eligibility Guarantee
Doctor's Plan Coverage Summary
Managed
Care Referral Request
Scripts for the Optician
Scripts for Recall
Monitoring Payment
Staff Training Exercise:
Capitation Plans
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