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

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.
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Starting from June 11 to September 3, our office will be closed every SATURDAY.

At Advanced Family Eyecare, we are taking all precautions to provide a safe and efficient office environment for our patients and staff.
* Masks required for all patients and staff and hand washing stations as well as hand sanitizer available throughout the office.