Diabetic Retinal Eye Exam Results Form

  • August 4, 2022

    Premera strives to ensure diabetic patients get the care they need. We encourage members with diabetes to have their annual diabetic retinal eye exam (DRE). However, the results of those exams are not always documented in the patient’s medical record for review and follow up by their primary care provider (PCP). While some large provider organizations have a shared electronic health record system and have access to the exam results, often the DRE exam is performed by eye care providers in clinics outside of the provider organization.

    To assist with getting this important information into a patient’s medical record, patients can take this form to their eye exam and have it completed with the results. The form can either be faxed back to the PCPs office by the eye care provider or the patient can bring the document to their PCP at their next appointment. The form is also available in Spanish.

    Suggestions for improving the form are welcome and may be directed to Premera’s Quality Program at qualityprogram-info@premera.com.

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