[optimal] Re: [**External**] Re: Perpetual Fluorescein Angiography Consents

  • From: Amy Goldstein <amydesireephoto@xxxxxxxxx>
  • To: optimal@xxxxxxxxxxxxx
  • Date: Tue, 20 Feb 2018 16:00:04 -0800

Hey Ryan,

We just began using a new consent form at Stanford that allows the doctor
to write in future use for up to 1 year, and designate intervals. The
consent also does not have a place for the doctor's signature, only the
patient's.

Best,

Amy

*Amy Désirée Goldstein, CRA, OCT-C*

Education Chair OPS Denver Mid Year Meeting 2018

Ophthalmic Photographer

Byers Eye Institute

Stanford Health Care

2452 Watson Court

Palo Alto, CA 94303

(650)723-6995

<agoldstein@xxxxxxxxxxxxxxxxxxxxxx>amydesireephoto@xxxxxxxxx
<agoldstein@xxxxxxxxxxxxxxxxxxxxxx>

On Tue, Feb 20, 2018 at 9:56 AM, CPMC Ophthalmic Diagnostic Center <
cpmceyelab@xxxxxxxxxxxxxxxx> wrote:

In a hospital setting, we are compelled to obtain a consent, every patient
every time



Private practices can do what they wish, with whatever risks they wish to
take legal wise- injections, consents, billing, etc



We have a vetted consent form from Sutter Health that we use.



Denice Barsness, CRA, COMT, CDOS, FOPS

CPMC Dept of Ophthalmology/ The Eye Institute

Ophthalmic Diagnostic Services

711 Van Ness Avenue Suite 250
<https://maps.google.com/?q=711+Van+Ness+Avenue+Suite+250%0D+San+Francisco+CA+94109&entry=gmail&source=g>

San Francisco CA 94109
<https://maps.google.com/?q=711+Van+Ness+Avenue+Suite+250%0D+San+Francisco+CA+94109&entry=gmail&source=g>

415-600-5781 <(415)%20600-5781>

FAX 415-558-7011 <(415)%20558-7011>



*From:* optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx]
*On Behalf Of *Eric Kegley
*Sent:* Monday, February 19, 2018 3:06 PM
*To:* optimal@xxxxxxxxxxxxx
*Subject:* [**External**] [optimal] Re: Perpetual Fluorescein Angiography
Consents



*WARNING: *This email originated outside of the Sutter Health email
system!
*DO NOT CLICK* links if the sender is unknown and never provide your User
ID or Password.



Ian,



I believe our consent states this, but I consent subjects every time I do
an FA on them. I don’t want there to be any question that I reviewed risks
with the patient.



*Thanks,*

*EK*



*Eric Kegley, CRA, OCT-C, FOPS,  COA*

*Director of Ophthalmic Imaging*

*Retina Consultants of Houston*

*6560 Fannin St., Suite 750
<https://maps.google.com/?q=6560+Fannin+St.,+Suite+750%0D+*Houston,+TX+77030*&entry=gmail&source=g>*

*Houston, TX 77030
<https://maps.google.com/?q=6560+Fannin+St.,+Suite+750%0D+*Houston,+TX+77030*&entry=gmail&source=g>*

*Main  713 524-3434 <(713)%20524-3434>*

*Direct   713 394-7531 <(713)%20394-7531>*

*Fax      713 524-3220 <(713)%20524-3220>*

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*From:* optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx
<optimal-bounce@xxxxxxxxxxxxx>] *On Behalf Of *Ian Ryan
*Sent:* Monday, February 19, 2018 4:47 PM
*To:* optimal@xxxxxxxxxxxxx
*Subject:* [optimal] Perpetual Fluorescein Angiography Consents



Optimal,

Any thoughts on AAO and OMIC's informed consents which have embedded
perpetual FA clauses? Are there sites out there that have this in place?





https://www.aao.org/Assets/a2d9a6b3-423e-42c5-8d90-225e6111631c/
635514157803170000/fluorescein-angiography-pdf
<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.aao.org%2FAssets%2Fa2d9a6b3-423e-42c5-8d90-225e6111631c%2F635514157803170000%2Ffluorescein-angiography-pdf&data=02%7C01%7Ccpmceyelab%40SUTTERHEALTH.ORG%7C073835517e3248497aad08d577ed540b%7Caef453eadaa243e0be62818066e9ff63%7C0%7C0%7C636546783568641079&sdata=0RBScAodq63kuxUA7gQVoG%2FBoKyLnDskb%2ByWHGhAA8Y%3D&reserved=0>

*"For patients who need repeat FAs, the consent is valid until it is
either revoked by the patient or the patient’s condition changes to the
point that the risks and benefits are significantly different."*





https://www.omic.com/wp-content/uploads/2012/12/
Fluorescein-Angiography-RMRL-01242008.pdf
<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.omic.com%2Fwp-content%2Fuploads%2F2012%2F12%2FFluorescein-Angiography-RMRL-01242008.pdf&data=02%7C01%7Ccpmceyelab%40SUTTERHEALTH.ORG%7C073835517e3248497aad08d577ed540b%7Caef453eadaa243e0be62818066e9ff63%7C0%7C1%7C636546783568641079&sdata=7n3JFgqEv8b74FntzdLD8s3FtolyIUrlrV7oBqnqsN0%3D&reserved=0>

*"This consent will be valid until I revoke it or my condition changes to
the point that the risks and benefits of this procedure for me are
significantly different."*




Best,



*Ian Ryan, *Research Photographer

Northern California Retina Vitreous Associates (NCRVA)

2485 Hospital Drive, Suite 200, Mountain View, CA 94040
<https://maps.google.com/?q=2485+Hospital+Drive,+Suite+200,+Mountain+View,+CA+94040&entry=gmail&source=g>

Direct: (650) 962-5934 | Main: (650)988-7467 <(650)%20988-7467> | Fax: (650)
962-5786 | Fax: (650) 966-9307

iryan@xxxxxxxxx

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