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Forms, Lists & Downloads

Forms and Protocols for Community Ophthalmic Services in Norfolk & Waveney.

Shown in the tables are links relating to NHS, GOS, and Community Ophthalmic Services in Norfolk & Waveney forms and protocols.

NHS Forms		GOS Forms
HC5(O)Refund Claim Form: Optical Costs		GOS Vouchers (England) 2024	GOS 4 Briefing Notes Oct 2024
NHS Mail/Egress Request Form		HC5(O) Refund Claim Form: Optical Costs	Application for second pair voucher GOS3 (Child) The completed form to be emailed to hweicbhv.optical@nhs.net
NHS Optometry Safeguarding Guide		GOS Application Form Second Pair Voucher(Feb 2024)
		GOS Application form - Non-tolerance

Wet AMD
Wet AMD images reference 2022	NNUH Wet ARMD Rapid Access Form (Electronic) 2023	QEH Wet AMD referral form
JUPH Wet AMD referral email: eyecas@jpaget.nhs.uk

Cataract

NNUH Cataract Patient Journey	NNUH PSCO form 2022	NNUH PCO Direct Referral Form Electronic 2022
Norfolk & Waveney ICB Cataract Referral Forms(Sept 2024) PDf - fillable	Norfolk & Waveney ICB Cataract Patient Referral Information v3 Word download doc.	Norfolk & Waveney ICB Cataract Threshold Policy
	QEH PCO/YAG Laser Form

Glaucoma (NCGSMS)

Glaucoma Suspect Monitoring Audit Form	Norfolk Community Glaucoma Suspect Monitoring Scheme (NCGSMS)Re-Referral Form - ELECTRONIC NOTE: Referrals for pts in NCGSMS who are thought unstable (considered to have developed glaucoma) to be sent to: OPServicesPostTeam@nnuh.nhs.uk Referrals for pts in the NCGSMS who have reached 5 years and are stable are to be sent to: nnu-tr.eyesec@nhs.net	Community Glaucoma Suspect Monitoring Scheme (NCGSMS)Re-Referral Form - MANUAL NOTE: Referrals for pts in NCGSMS who are thought unstable (considered to have developed glaucoma) to be sent to: OPServicesPostTeam@nnuh.nhs.uk Referrals for pts in the NCGSMS who have reached 5 years and are stable are to be sent to: nnu-tr.eyesec@nhs.net
Norfolk and Norwich Glaucoma Direct Referral Form 2022b.pdf MANUAL	Norfolk & Norwich University Hospitals NHS Foundation Trust Suspect Glaucoma Direct Referral Form ELECTRONIC	Norfolk & Norwich University Hospitals NHS Foundation Trust Suspect Glaucoma Direct Referral Form MANUAL
GRR Practice List	NNUH, QEH & JUPH - Guidance for Angle Closure Glaucoma Referrals

GOS Referral Form & Routine Referrals
GOS 18 referral Form - Electronic	QEH GOS18 Referral Form - Electronic	QEH GOS18 Signature Guidance
JUPH ALL Referrals email: eyecas@jpaget.nhs.uk	Anglia Community Eye Service (ACES) Referral Form NOTE: USE ONLY FOR NON-CATARACT CASES. All cataract cases go via Referral Centres

Covid Urgent Emergency Services (CUES
CUES Formulary	Advice on OTC Medicines	Dry Eye Pathway

Miscellaneous
Child Protection Guidance	Lid Lesion Advice - Mrs Bridget Hemmant
Letter For Patients Requesting Chloroquine or HydroxychloroquineRetinal Monitoring