SUBJECT:

VISUAL DISABILITY EXAMINATION REPORT (IM-68)

DISCUSSION:

Staff must review the IM-68 for completeness prior to submitting the form to the State Ophthalmologist. Each section on the front side of the form must be complete. If the client’s visual acuities are equal to or greater than 5/200 with or without correction, a visual field examination must be attached to the IM-68. The boxes for the examiner and the area to send the completed form must also be complete. Forms submitted to the State Ophthalmologist with incomplete information will be returned to the county office immediately without any recommendations.

NECESSARY ACTION:

• Review this memorandum with appropriate staff immediately.
  
  
• Verify the IM-68 is complete and a visual field examination is attached if necessary.

GLS