- ALL FAMILY SUPPORT DIVISION OFFICES
- PATRICK LUEBBERING, ACTING DIRECTOR
- IM-68 VISUAL DISABILITY EXAMINATION REPORT
- FORM REVISION:#8
The Visual Fields reporting area on the IM-68, Visual Disability Examination Report has been updated to correctly reflect capturing the results in degrees rather than in percentages.
Effective immediately, use this version with a 05/2017 revision date. If a previous version is returned from the State Ophthalmologist, the Medical Review Team (MRT) must follow up with their office to confirm that the field entry is degrees rather than percentages and that this is noted as such.
- Review this memorandum with appropriate staff.
- Begin using the IM-68 with a revision date of 05/2017 immediately.
- MRT must monitor and obtain correct information for any IM-68’s submitted on the prior form.