Wis. Admin. Code Optometry Examining Board Opt 6.025 - Adverse drug reaction referral plan
(1) An optometrist
who wants to use diagnostic pharmaceutical agents authorized under s.
SPS 10.02 or therapeutic pharmaceutical agents authorized
under s.
SPS 10.03 shall submit an adverse drug reaction referral
plan prior to providing pharmaceutical agents. The plan shall be submitted to
the department on an approved form in which the optometrist agrees to do all of
the following:
(a) Refer any patient who
notifies the optometrist of an adverse drug reaction to appropriate medical
specialists or facilities.
(b)
Routinely advise all patients to immediately contact the optometrist if the
patient experiences adverse reactions.
(c) Place in a patient's permanent record
information describing any adverse drug reactions experienced by the patient
and the date and time that any referral was made.
(2) The plan shall include the names of at
least 3 physicians, physician clinics, or hospitals to whom the optometrist
agrees to refer patients who experience an adverse drug reaction. At least one
of these physicians shall be skilled in the diagnosis and treatment of diseases
of the eye.
(3) An optometrist
authorized to use diagnostic or therapeutic pharmaceutical agents shall file a
revised adverse drug reaction referral plan with the department within 10
working days after the optometrist designates a new physician, physician
clinic, or hospital to which the optometrist agrees to refer patients who
experience adverse drug reactions.
(4) An optometrist authorized to use
therapeutic pharmaceutical agents shall file with the department within 10
working days of its occurrence a report on any adverse drug reaction resulting
from the optometrist's administration of the agents. This report shall include
all of the following:
(a) The optometrist's
name, address, and license number.
(b) The patient's name, address, and
age.
(c) The patient's presenting
problem, the diagnosis, the agent administered and the method of
administration, the reaction, and the subsequent action taken.
Notes
The TPA Adverse Reaction Report (Form #1728) and DPA/TPA Certification Application are available on the department's website at dsps.wi.gov, or by request from the Department of Safety and Professional Services, P.O. Box 8935, Madison, Wisconsin 53708, or call (608) 266-2112.
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