| 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 ... |
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