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Click ‘Get Form’ to open the PRESCRIPTION FORM - ZZ medical in the editor.
Begin by entering the CUSTOMER NAME and ORDER NUMBER in the designated fields at the top of the form.
Select the type of prescription you are submitting by checking one of the three boxes: SINGLE VISION, BIFOCAL, or PROGRESSIVE.
For SINGLE VISION prescriptions, fill in the SPHERE, CYLINDER, AXIS, and PRISM BASE for both OD (Right Eye) and OS (Left Eye). Ensure to include PUPILARY DISTANCE as well.
If applicable, for BIFOCAL or PROGRESSIVE prescriptions, provide additional details such as ADD BIFOCAL POWER along with other required information.
Verify that all Rx information is current for the year before finalizing your submission.
Once completed, fax the form to 319-277-3998 or email it to orders@zzmedical.com directly from our platform.
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Commonly, this number will be different for each eye. A + in the box indicates that you are long-sighted which means you find it difficult to see things close to you. A shows that you find it hard to see things that are far away without glasses. The number might be very small, like 0.25, or a large number, like 6.00.
What is an eye prescription?
Parts of a prescription Prescriber information: The doctors name, address and phone number should be clearly written (or preprinted) on the top of the prescription form. Patient information: This portion of the prescription should include at least the first and last name of the patient and the age of the patient.
What does a +0.25 eye prescription mean?
Positive numbers on an eye prescription indicate they are correcting farsightedness, while negative numbers correct shortsightedness. A larger number suggests a stronger prescription.
What is on a prescription form?
It contains all the details of the medication prescribed by the physician (or prescriber), such as the prescribers information, patient information, medication prescribed including the name, dose, and dosage form, dispensing instructions, and number of refills.
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A separate form must be completed for each patient and for each pharmacy patronized. For compounded medications, please use the Compounded. Medication Claim
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