VISION CARE OKLAHOMA

Through Vision Care Direct, provider offices can offer an individual vision plan to their patients and receive a 5% Referral Fee as long as that patient remains on Vision Care Direct. If the patient enrolls via our on-line enrollment system, they can receive a 10% discount off the internet rates simply by entering a promo code assigned to your office. We ask for your assistance in naming this promo code. Think of a word, numbers or combination thereof you would like to use (i.e. FAMILY VISION, VISION123, DRSMITH) and enter it below.

Each office where care is provided must have the below listed equipment in good working order on site to perform patient examinations and for Quality Management Provider Review.

• Biomicroscope (Slit Lamp)
• Blood Pressure Measuring Device
• Contact Lens Magnifier with Reticule
• Contact Lens Thickness Gauge for Rigid Lens (or lens clock)
• Lensometer
• Ophthalmoscope
• Phoropter
• Radiuscope and/or Keratometer Attachment
• Tonometer
• Visual Field Screening Device
• Binocular Indirect Ophthalmoscope and Condensing Lens
• Foreign Body Removal Instruments
• Gonioprism
• Irrigators
• Lacrimal Dilators
• Punctal Plugs
• Threshold Visual Fields Device
• Volk or Hruby Type Lens

List the hours this doctor routinely works in this office

By applying for membership to the New Vision Care Oklahoma and Vision Care Direct I hereby;

• signify my willingness to appear for interviews in regard to my application;
• authorize the staff and appropriate representatives to consult with my previous and current associates and others who may have information bearing on my professional competence, character, health status, ethical qualifications, ability to work cooperatively, and other qualifications;
• consent to the inspection by the staff, its Medical or Optometric Director, and their representatives of all documents that may be material to an evaluation of my qualifications and competence;
• consent to release from any liability, to the fullest extent permitted by law, New Vision Care Oklahoma and Vision Care Direct its staff, and all its employees, agents, and representatives, for acts performed in connection with evaluating me, including recommendations made in connection with this application;
• consent to release from liability anyone who provides information to New Vision Care Oklahoma and Vision Care Direct, in good faith and without malice concerning my professional competence, ethics, character, and other qualifications for membership;
• pledge to maintain the ethical practice, to provide for continuous care for my patients, and to refrain from delegating the responsibility for any aspect of the care of my patients to any practitioner not qualified to undertake that responsibility;
• agree to keep New Vision Care Oklahoma and its representatives up to date on any change made or proposed in the status of my professional license to practice, DEA or other controlled substances registration, professional liability insurance coverage, status of claims, initiation of new malpractice claims and appointment or clinical privileges at other institutions;
• acknowledge that I, as an applicant have the responsibility of producing adequate information for proper evaluation of my professional, ethical, and other qualifications for appointment and for resolving any doubts about such qualifications; and
• acknowledge that any misstatements or omissions in this application constitute cause for denial of appointment or cause for summary dismissal.

To assist Vision Care Direct in evaluating my application as a participating provider in the Vision Care Direct managed care network, I authorize the Federation of State Medical Boards, National Practitioner Data Bank, malpractice insurance carriers, references and/or any hospital(s) (“Agency”) to release to Vision Care Direct information regarding my professional credentials, qualifications and hospital records related to privileges, qualifications, type of clinical practice, and competence, including my moral and ethical qualifications.