|
You will need Adobe Acrobat Reader to view the files below.
QUICK LIST FOR REFERRING PATIENTS
1. Patient Eligibility
- One year's continuous residency in the communities served by the
LEF
- Income (this is based on NET INCOME)
Single Person/Married Couple $22,800
Single Parent/Parents with One Child $25,200
Single Parent/Parents with Two Children $27,600
Single Parent/Parents with Three Children $30,000
Add $2,400 for each additional child
- Patient has no insurance/coverage for eye surgical care.
2. Doctor Referral
- It must first be determined that the patient does indeed have an eye problem that requires
treatment and care (excluding eye glasses and contact lenses). A referral from a doctor stating
the patient's diagnosis is required.
3. Club's Responsibility
- Completion of patient financial statement and patient referral form (must be signed by doctor, patient and club representative).
- Provide money for transportation to and from appointment in San Francisco.
- Provide glasses after patient has completed treatment/surgery.
4. Questions:
- Call/contact Mark Paskvan tel (415) 600-3950; fax (415) 600-3949;
e-mail paskvam@sutterhealth.org.
- Emergency cases (retina detachments and foreign object in eye), call Mark rather than
completing the forms. It can be done by phone!
5. Forms:
|
