Emailing Prescriptions And Medical Records DUTY TO WARN Health and Human Services states that covered entities are permitted to send individual unencrypted e-mails if they have advised the individual of the risks associated with unencrypted e-mail. If the patient wishes to receive emails, Morgan Vision Care is expected to notify the individual that there may be some level of risk that the information in the e-mail could be read by a third party. We can email exam summaries, contact and glasses prescriptions, and receipts. I understand the risks of receiving unencrypted emails. Email Date MM slash DD slash YYYY DIGITAL RETINAL PHOTOGRAPHIC EXAMINATIONMorgan Vision Care is proud to offer our patients a state of the art image of the inner eye, which provides a more thorough eye exam. Using our highly advanced Digital Retinal Photography, we are able to screen for eye diseases within the retina, which dramatically improves our ability to evaluate your retinal health.Some of the diseases we will be screening for include, but are not limited to: retinal detachments, glaucoma, macular degeneration, retinal holes, as well as diabetic retinopathy (all of which may lead to partial loss of vision and/or blindness). In addition, systemic diseases such as diabetes and the effects of high blood pressure may also be detected during this exam. However, if you have already been diagnosed with diabetes, you are required to be dilated at least once a year. Therefore, if this is your first visit for the year, we will plan to dilate you today and you are welcome to return within the year to receive the digital retinal photographic examination.EARLY DETECTION OF EYE DISEASE IS CRUCIALAn annual Digital Retinal Photograph is recommended in order to evaluate your retina at up to 100 times its normal size. You can expect the following from this exam: In depth view of the retinal surface (where diseases first manifest themselves)Evaluation and explanation of your retinal images from Dr. MorganPermanent record for your medical file for serial analysis, comparisons, and diagnosisFast, easy and comfortableTypically, no dilation drops are needed Insurance is designed to cover a basic eye exam, therefore, it does not cover this procedure. The additional fee is $39.00. I WOULD like to have my retinal health evaluated using Digital Retinal Photography. I DO NOT wish to have my retinal health evaluated using the Digital Retinal Photography, I wish to be dilated instead.Patient SignatureDate MM slash DD slash YYYY If you would like your photos e-mailed to you, please provide your e-mail address above.