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KBV Prescription for magnifying aid Template 8A

- 9/6/17 - 1 form, 10 itemgroups, 71 items, 1 language
Itemgroups: Header, Billing documentation, Prescription visual aid, Refractometry, Accounting, Footer, Statement of insured, Decision of insurance company, Acknowledgment of receipt, Certificate of service provider
Muster 8A - Verordnung von vergrößernden Sehhilfen (Freigabe: 01.09.2014) - 10.2014, Formulare für die vertragsärztliche Versorgung Freigabe durch Dezernat 4 - Ärztliche Leistungen und Versorgungsstruktur Geschäftsbereich Sicherstellung und Versorgungsstruktur Abteilung Sicherstellung Herbert-Lewin-Platz 2 10623 Berlin Tel: + 49 (0) 30 - 4005 -1418 Fax: + 49 (0) 30 - 4005 - 271418 Email: SJohn@KBV.de Web: www.kbv.de Quelle: http://www.kbv.de/html/formulare.php Forms for contract medical care Released by Department 4 - Medical treatment and structure of supply, division ensurance and structure of supply, department ensurance Herbert-Lewin-Platz 2 10623 Berlin Tel: + 49 (0) 30 - 4005 -1418 Fax: + 49 (0) 30 - 4005 - 271418 Email: SJohn@KBV.de Web: www.kbv.de Source: http://www.kbv.de/html/formulare.php

KBV Prescription for visual aid Template 8

- 9/6/17 - 1 form, 10 itemgroups, 70 items, 1 language
Itemgroups: Header, Billing documentation, Prescription visual aid, Refractometry, Accounting, Footer, Statement of insured, Decision of insurance company, Acknowledgment of receipt, Certificate of service provider
Muster 8 - Sehhilfenverordnung (Freigabe: 01.09.2014) - 10.2014, Formulare für die vertragsärztliche Versorgung Freigabe durch Dezernat 4 - Ärztliche Leistungen und Versorgungsstruktur Geschäftsbereich Sicherstellung und Versorgungsstruktur Abteilung Sicherstellung Herbert-Lewin-Platz 2 10623 Berlin Tel: + 49 (0) 30 - 4005 -1418 Fax: + 49 (0) 30 - 4005 - 271418 Email: SJohn@KBV.de Web: www.kbv.de Quelle: http://www.kbv.de/html/formulare.php Forms for contract medical care Released by Department 4 - Medical treatment and structure of supply, division ensurance and structure of supply, department ensurance Herbert-Lewin-Platz 2 10623 Berlin Tel: + 49 (0) 30 - 4005 -1418 Fax: + 49 (0) 30 - 4005 - 271418 Email: SJohn@KBV.de Web: www.kbv.de Source: http://www.kbv.de/html/formulare.php

Use of Eye Glasses- Adult PhenX Toolkit

- 4/26/16 - 1 form, 1 itemgroup, 9 items, 1 language
Itemgroup: PhenX - use of eye glasses - adult protocol
The interviewer asks the respondent if he/she wears glasses of any kind. If so, additional questions are asked regarding type of glasses, duration of use, ability to read newspaper print, and use of a magnifier. If respondent indicates he/she does not wear glasses, additional questions are only asked regarding ability to read newspaper print, and use of a magnifier. ODM derived from: https://cde.nlm.nih.gov Primary source: https://www.phenxtoolkit.org/ Recent publication: Hendershot, T., Pan, H., Haines, J., Harlan, W.R., Marazita, M.L., McCarty, C.A., Ramos, E.M., and Hamilton, C.M. (2015) Using the PhenX toolkit to add standard measures to a study. Curr. Protoc. Hum. Genet. 86:1.21.1-1.21.17. doi: 10.1002/0471142905.hg0121s86 Permission to publish granted by Carol M. Hamilton.

Use of Glasses and/or Contact Lenses as a Child PhenX Toolkit

- 4/26/16 - 1 form, 1 itemgroup, 13 items, 1 language
Itemgroup: PhenX - use of glasses - contact lenses as child protocol
The respondent is asked a series of 5 questions to assess their child’s current and past use of glasses and contact lenses, duration of use, and reason for use. ODM derived from: https://cde.nlm.nih.gov Primary source: https://www.phenxtoolkit.org/ Recent publication: Hendershot, T., Pan, H., Haines, J., Harlan, W.R., Marazita, M.L., McCarty, C.A., Ramos, E.M., and Hamilton, C.M. (2015) Using the PhenX toolkit to add standard measures to a study. Curr. Protoc. Hum. Genet. 86:1.21.1-1.21.17. doi: 10.1002/0471142905.hg0121s86 Permission to publish granted by Carol M. Hamilton.

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