The Registered Optician's Association of Texas (ROATx) is currently conducting a survey of Eye Care Providers across to country tracking wrongly made eyewear.
Please print the attached form and use it to document any glasses that come back to your office made incorrectly.
The first page is self-explanatory. Just fill in the information requested. Give a copy of the form to your patient to take back to the place they purchased their glasses and keep a copy for your records. Just cut off or block out the top portion of the form and fax to ROATx at (512) 420-0262 or email to info@roatx.org with the subject 'Prescription Analysis Form'.
The second page of the form explains the role of a Registered Optician in the State of Texas.
Per Sam Johnson, President of ROATx, you may alter these forms as needed to identify your state or area. We just ask that you utilize this tool and send it back to us in whatever form you choose.
I have included a .pdf, Word, and Rich Text Format of the forms. If you have any questions, please let me know.
The Word and Rich Text Format versions have been changed to reflect HIPAA instead of HIPPA. I don't have access to change the .pdf file and will update as soon as it is changed.
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