We understand the importance of working closely
with your primary care physician and have provided
a form for your ophthalmologist or optometrist
to provide information about the health of your
eye to your doctor.
Members of NMOS have developed
a Diabetes Eye Examination Report form to help
promote communication between practitioners. Communication
from the Ophthalmologist
or Optometrist, performing
a diabetes retinal exam, to the patient’s
Primary Care Provider (PCP) helps to ensure continuity
of care in the ongoing management of the patient.
This one-page form’s “check-off”
design will save you and your staff time and energy
by reducing the task of writing out your findings
and treatment plan. Simply download and complete
the form, fax or mail a copy to the patient’s
PCP and/or the referring practitioner, and keep
the original for your records.
To download a universal diabetes
exam report click below.
You will need to download adobe acrobat below,
if you don't have it.