Optical Examination Waiver Form for Alzheimer's and Dementia Patients
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The department shall develop an optical examination waiver form to permit any patient diagnosed with Alzheimer's disease, Alzheimer's related dementia, or vascular dementia, to obtain lenses, spectacles, eye glasses, or optical devices using an expired prescription when such patient's disease or dementia would preclude the patient from undergoing an optical examination. The department shall make such forms available on its web site.
Such optical examination waiver form shall be signed by a licensed physician who has determined:
The patient has Alzheimer's disease, Alzheimer's related dementia, or vascular dementia;
The symptoms of the disease or dementia significantly affect the patient's ability to sit for an optical examination to obtain a new optical prescription;
The patient's lenses, spectacles, eye glasses, or optical devices are lost, broken, or damaged to a degree that renders them unusable; and
The patient would derive significant benefit from replacement.
It is lawful for any optician, optometrist, or ophthalmologist licensed in this state to fill the most recent expired prescription for any lenses, spectacles, eye glasses, or optical devices for a patient; provided, that the prescription is filled once pursuant to an optical examination waiver form described in subsection (b).