Referral Form for Patient and Physician
When you refer your patient to another healthcare provider (particularly for urgent or emergent situations or lab work), we suggest that you send a referral request to the provider and give the patient (family member, caregiver etc.) a written document with details regarding the referral. This recommendation is based on several major lawsuits OMIC has litigated where the patient has denied being referred for a consultation, even when there was a clear note in the patient’s chart that such a referral was made. We have been able to successfully defend some of these cases, others we have had to settle. However, regardless of the outcome, it was clear the cases were more difficult to defend because of the lack of evidence the patient received written documentation of their condition and the urgency of the referral.
Download a copy of the referral form to send to the other physician by clicking here: Referral Note to MD.
Download a copy of the referral form by clicking here: Referral Note for Patient
The sample referral note is an example of what OMIC considers important information to provide to the patient. This is simply a recommendation and does not constitute a standard of care. You will want to modify the referral note to best meet your patient’s specific needs.
HIPAA/HITECH Resources
OMIC Business Associate Agreement
OMIC has completed its revision of the HIPAA Business Associate (BA) Agreement it maintains between itself and each of its insureds. You can download a copy here: Business Associate Agreement-OMIC-9.1.2013. A hard copy is also being sent to OMIC insureds by mail. Please understand that because OMIC has 4,500 physician insureds, it would be administratively burdensome for OMIC to review and sign individual BA Agreements provided by each of its insureds. OMIC’s BA Agreement meets the latest HIPAA and HITECH standards as promulgated in the Omnibus HIPAA/HITECH Final Rule and is the only BA Agreement that OMIC will maintain between itself and its insureds. Please retain your copy of the OMIC BA Agreement with your HIPAA compliance materials.
Sample Documents for Your Practice
OMIC has drafted several sample documents that you may download and use in your practice. These samples are a starting point for ophthalmology practices. They should be customized, as necessary, to meet your practice’s specific needs and circumstances. These materials do not constitute the provision of legal advice by OMIC and are not a substitute for legal or professional advice.
- Sample Notice of Privacy Practices
- Sample Notice of Privacy Practices Acknowledgment
- Sample Authorization for Use and Disclosure of Health Information
- Sample Business Associate Agreement
- Sample Breach Notification Letter to Patients
- Sample Breach Notification Policy
The Department of Health and Human Services (HHS) has also created several sample documents for use in your practice. The can be found by following these links:
Guidance Tools
The American Medical Association has prepared a booklet explaining the changes to the HIPAA regulations: AMA HIPAA Privacy and Security Toolkit.
See also the following free resources, which include webinars and guidance documents to train yourself and your staff. The webinar series was presented by the Workgroup for Electronic Data Interchange (WEDI) and the Office of the Inspector General (OIG). The Office of Civil Rights (OCR) has useful guidance documents for physician offices.
- WEDI Webinar Series > HIPAA Privacy and Security Training and Resources
- HIPAA Privacy Page
- Omnibus Rule
- OCR’s Protecting Patient Rights Resource Center (Registration Required)
- Are You a Covered Entity?
- For Small Providers, Small Health Plans, and Other Small Businesses
- Summary/Guidance on Significant Aspects of the Privacy and Security Rules
- Fast Facts for Covered Entities
- Business Associates FAQs
- Security Rule Guidance Material
- Guidance on Risk Analysis
- Mobile Device Security
- Communicating with a Patient’s Family, Friends, or Others Involved in The Patient’s Care
- FAQs About the Disposal of Protected Health Information
- Training Materials on the HIPAA Privacy Rule
- Resources for Consumer
Patient Education Check-Up Project
The Academy and OMIC are jointly sponsoring the fourth annual Patient Education Check-Up Project. This campaign encourages MDs and office administrators to audit all of their Academy patient education materials and informed consent documents to ensure they are current. While the connection between patient education and patient compliance is widely known, the connection between accurate, timely patient education and informed consent materials in reducing malpractice risk may not be. The primary message of this campaign is risk mitigation through up-to-date patient education materials and informed consent documents.
Download the checklist to help you review your existing patient education materials.
Visit OMIC’s library of informed consent forms to make sure you have the most current version.
For more information on the Academy’s patient education products e-mail patientinfo@aao.org.
For information on OMIC’s informed consent documents, contact the OMIC Risk Management Hotline at 800.562-6642, extension 641.
Want to have the most up-to-date patient education at a click of a button?
Subscribe to the Academy’s Downloadable Patient Education Handouts
Have peace of mind that you are reducing your malpractice risk by giving your patients the most up-to-date information about their eye condition and treatment options. The Downloadable Patient Education Handout Subscription – gives you unlimited, print on demand, access to a comprehensive collection of nearly 100 titles in downloadable PDF format. The handouts are updated regularly, eliminating the time-consuming task of having to audit your own materials.
