Co-management transfer of care form - North Cascade Eye Associates 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's name and date of birth in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Fill in the home phone number, Medicare number, and any other insurance details. This section helps streamline billing and insurance processes.
4. Specify the date of surgery and select the procedure/lens used. Include diagnosis and CPT codes to provide comprehensive medical information.
5. Indicate the co-managing optometrist or ophthalmologist's name along with the dates for post-operative care. This ensures clear communication between healthcare providers.
6. Document post-operative uncorrected visual acuity (VA) for both eyes, followed by findings from the post-op exam.
7. List any medications prescribed and schedule future post-op visits according to patient needs.
8. Finally, ensure that both surgeon and PECP signatures are obtained before faxing back to the Surgery Center using the provided numbers.

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