Ariz. Admin. Code § R4-21-306 - Optometric Prescription Standards; Release to Patients
A. When a licensee completes an eye
examination and generates an optometric prescription, the licensee shall
provide the patient with a copy of the optometric prescription without charging
a fee other than the examination fee.
B. A licensee shall ensure that an optometric
prescription written by the licensee includes:
1. For ophthalmic lenses other than contact
lenses:d.c.
Printed name, office address, telephone number, and signature of the licensee;
and
e.d. Date of the
examination and expiration date of the prescription;
a. Name of the patient;
b. Refractive power of the lenses;
c.
Interpupillary distance;
2. For contact lenses, including plano
lenses:
a. Name of the patient;
b. For a patient who has not completed a
trial period appropriate under the circumstances and desires to have a
prescription, the information required for the patient to purchase trial lenses
at another optical establishment or location;
c. For a patient who has completed a trial
period appropriate under the circumstances for the lenses prescribed, all
information necessary to reproduce the contact lenses accurately;
d. Printed name, office address, telephone
number, license number, and signature of the licensee;
e. Date of the examination and the issue and
expiration date of the prescription; and
f. Information regarding the prescribed
contact lenses:
i. Refractive
power;
ii. Base curve or other
appropriate designation;
iii.
Diameter, if appropriate;
iv. Tint,
if applicable;
v. Material,
manufacturer, or both; and
vi. In
the case of private-label contact lenses, manufacturer, trade name, and, if
applicable, trade name of equivalent brand name; and
3. For pharmaceutical agents:
a. Name and address of the patient;
b. Date the prescription is issued;
c. Name, strength, and quantity of the
pharmaceutical agent prescribed;
d.
Directions for use of the pharmaceutical agent prescribed;
e. Name, office address, and telephone number
of the prescribing licensee;
f.
When prescribing controlled substances, the DEA number of the prescribing
licensee;
g. Two adjacent signature
lines with the following printed words:
i.
"Dispense as written" under the left signature line, and
ii. "Substitution permissible" under the
right signature line; and
h. Original signature of the prescribing
licensee on one of the signature lines; and
4. Additional information that the licensee
considers necessary.
C.
A licensee who dispenses or directs the dispensing of ophthalmic materials
shall ensure that a prescription is filled accurately.
D. A licensee shall be available to verify
that a prescription written by the licensee but filled by another provider of
ophthalmic goods is accurately filled. The licensee may charge a fee for
verifying the accuracy or quality of ophthalmic goods dispensed by another
provider.
E. A licensee shall not:
1. Require purchase of contact lenses from
the prescriber or from another person as a condition of providing a copy of the
prescription;
2. Require a payment
in addition to, or as part of, the fee for an eye examination, fitting, and
evaluation as a condition of providing a copy of a prescription or verification
of a prescription;
3. Require the
patient to sign a waiver or release as a condition of verifying or releasing a
prescription.
Notes
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