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Advanced Family Eyecare, LLC – Dr. Simki Shah, OD

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Home » Contact Us » E-Prescribing Consent Form

E-Prescribing Consent Form

  • ePrescribing is defined by a Physician’s ability to electronically send an accurate, error free and understandable prescription directly to a pharmacy. Congress has determined that the ability to electronically send prescriptions is an important element in improving the quality of patient care. ePrescribing greatly reduces medication errors and enhances patient safety. The Medicare Modernization Act (MMA) 2003 listed standards that have to be included in an ePrescribe program.
    These include:
    Formulary and benefit transactions -gives the prescriber information about which drugs are covered by the drug benefit plan.

    Medication history transactions -transactions – provides the physician with information about medications the patient is already taking to minimize the number of adverse drug events.

    I authorize Advanced Family Eyecare, LLC to view my external prescription history via electronic prescribing services. I understand that prescription history from multiple other unaffiliated medical providers, insurance companies, pharmacies and pharmacy benefit managers may be viewable by my provider and staff at Advanced Family Eyecare, LLC, and it may include prescriptions back in time for several years, and may include prescriptions to treat HIV, substance abuse and psychiatric conditions, if applicable. I understand that my prescription history will become part of my Advanced Family Eyecare, LLC medical record.
    Understanding all of the above, I hereby provide informed consent to Advanced Family Eyecare, LLC to enroll me in the ePrescribe program. I have had the chance to ask questions and all of my questions have been answered to my satisfaction.
    This consent will remain enforced until revoked or changed.
  • Date Format: MM slash DD slash YYYY

At Advanced Family Eyecare, we are taking all precautions to provide a safe and efficient office environment for our patients and staff.

Some of the changes that have been implemented are:

* The ability to fill out all relevant office forms through a secure HIPPA compliant portal before your appointment.

* Check-in will be done remotely in your car via your phone- There will be no waiting in the office- We will have limited appointment booking to assure you will not be waiting long.

* Limited occupancy in office.

* No-touch temperature taking and COVID questionnaire of all persons entering office, including staff, twice a day.

* Masks required for all patients and staff and hand washing stations as well as hand sanitizer available throughout the office.

* Immediate initiating of testing when a patient enters the office.

* Shields for all appropriate equipment for additional protection.

* Disinfection of all rooms and items that may contact a patient after each encounter including all frames in the dispensary.

*Patients are not allowed to be accompanied by family members, with the exception of minors.