Checklist for Referring Patients

Patient Eligibility: If the patient is over 18 years of age, he or she must have one year's continuous residency in the state of utah and must be a legal resident of the United States. If a patient is under 18 years of age, he or she is eligible to receive care as long as parental consent is obtained and the patient currently resides in Utah.

Income: Guidelines as of January 1, 2007 (Net Income) Single person/married couple $22,800, single parent/parent with one child $25,200, single parent/patent with two children $27,600, single patent/parent with three children $30,000, add $2,400 for each additional child.

Insurance: The patient has no insurance or coverage for surgical eye care.

Doctor Referral: It must first be determined that the patient does indeed have an eye problem that requires surgical treatment. A referral from an eye doctor (M.D. or O.D.) stating the patient's diagnosis is required.

Please see the form: Utah Eye Care Initiative Application Process for additional requirements.