Inspection by the board a patients name address phone 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's name in the designated field. Ensure accuracy for proper identification.
3. Next, input the patient's phone number. This is crucial for appointment confirmations and follow-ups.
4. Fill in the date of birth to help verify the patient's identity and medical history.
5. Select the referring diagnosis from the provided options, marking any relevant conditions such as Wet AMD or Diabetic Retinopathy.
6. Indicate which eye(s) are affected by checking OD (right), OS (left), or OU (both) as applicable.
7. Complete the referring physician information section, including their name and office number for coordination.
8. Finally, specify the appointment date and time, ensuring all details are correct before submission.

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