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POA Member Resources

Each year, the Pennsylvania Optometric Association and the Vision Conservation Institute design coloring sheets in honor of Save Your Vision Month.

Member Materials

Save Your Vision Month - Children's Coloring Posters
2022-SYVM-POSTER

Each year, the Pennsylvania Optometric Association and the Vision Conservation Institute design coloring sheets in honor of Save Your Vision Month. There is no charge for members to use these coloring sheets. Simply click here to view and download this year's coloring sheet. 

Save Your Vision Month

Through the years, members have come up with many creative uses for the coloring sheets in promoting the importance of good eye health and vision care to youngsters. Use the coloring sheets to sponsor a coloring contest in your office or neighborhood, hand out a coloring sheet to students during a visit to a day care or elementary school, or distribute them in your office as kids or their parents get their eyes examined. Be sure to display the posters in your waiting room after they have been colored.

To aid your SYVM Celebration, VCI has designed a certificate of participation for use with the coloring posters. You can distribute it during your coloring contest so that all kids who participate are winners.

SYVM is also a perfect time to schedule visits to elementary school classrooms to remind children about the important role vision plays in their lives. Download a sample letter that you can personalize, copy on your letterhead and distribute to the kids when you visit their classrooms. The letter informs parents that you visited their child's classroom to educate them about their eyes, and the coloring posters are fun take-home reminders for the kids.

 












Kids Welcome Here Materials
Kids Welcome Here Poster

POA has designed pamphlets specific to optometry in Pennsylvania. There is no charge to members for these pamphlets. To order, e-mail the POA office or call (717) 233-6455. Click the links below to preview the materials.

Click here for additional information about Kids Welcome Here.

Brochure
Download this resource at no charge!

Poster
Download this resource at no charge!

Memorial Cards from Pennsylvania's Vision Conservation Institute (VCI)
Memorial Cards from Pennsylvania's Vision Conservation Institute (VCI)

Show your patients you care with Memorial Cards from Pennsylvania's Vision Conservation Institute (VCI). All bequests are used to support vision education and research. Your memorial card packet includes 10 ivory memorial cards, 10 matching envelopes, and 10 white, pre-addressed post cards. $40.00 per packet for members. $60.00 per packet for non-members.

Download the order form
Labor Act Improvement Benefits Veterans
Veterans Benefits Improvement Act Labor Poster

The Veterans Benefits Improvement Act of 2004, was signed into law by the President Bush on December 10, 2004. Among its provisions is a requirement that employers post notice of basic USERRA rights and duties in their places of employment. Download a PDF file of the required poster to print and post along with all your other employment posters.

Download this resource at no charge!

Forms

Third Party Payer Issue Reporting Form
Third Party Payer Issue Reporting Form

The POA office often gets calls asking for assistance from doctors when they are unable to get paid by a third party carrier. Sometimes, the information provided is incomplete and POA is less able to help than we would like. Therefore, we have developed this Third Party Payer Issue Reporting Form for those instances when members are unable to resolve payment issues on their own and are requesting help from POA.

Download this resource at no charge!
Misuse of DEA Number Complaint Form
Misuse of DEA Number Complaint Form

AOA has developed a form for doctors to use to report evidence of insurance companies and pharmacies inappropriately requiring DEA numbers to fill prescriptions for non-controlled substances. Please use this Misuse of DEA Number Complaint Form to report evidence of DEA number misuse to POA, and we will compile the information and provide it to AOA.

Download this resource at no charge!
POA Expense Voucher

Committee members who have been approved to submit a POA Expense Voucher can use this Excel spreadsheet. Save the form to your computer, fill it out, save it, and then e-mail it to your staff liaison or Ilene@poaeyes.org. The form can also be printed out and faxed (717-233-6833) or mailed to POA.

Download this resource at no charge!

Forms for Order

Rx Pads
POA Rx Pads

Purchase your Pennsylvania-compliant spectacle, contact lens, and drug Rx pads through POA.

NCR duplicate paper and anti-forgery tamper-resistant pads (required for Medicaid prescriptions) are also available.

 

Download the order form
CMS 1500 Forms
CMS 1500 Forms

Purchase CMS 1500 forms from Owen Business Systems by calling (800) 634-1876.

Download the order form
Student Excuse for Appointment with Doctor of Optometry Form
POA Excuse for Appointment with Doctor of Optometry Form

Use POA's Eye Examination Report to report exam results to schools, employers or other health care providers. Actual form size is 5 1/2" x 8 1/2". Cost is $6.25 per pad of 100, plus shipping.

Download the order form
Eye Exam Report Form
POA Eye Exam Report Form

POA's convenient Student Excuse Form doubles as a doctor excuse and a signed parent note. Actual size is 6 1/8" x 5 5/8". Cost is $8.25 per pad of 100, plus shipping.

Download the order form

Memorial Cards from Pennsylvania's Vision Conservation Institute (VCI)
Memorial Cards from Pennsylvania's Vision Conservation Institute (VCI)

Show your patients you care with Memorial Cards from Pennsylvania's Vision Conservation Institute (VCI). All bequests are used to support vision education and research. Your memorial card packet includes 10 ivory memorial cards, 10 matching envelopes, and 10 white, pre-addressed post cards. $40.00 per packet for members. $60.00 per packet for non-members.

Download the order form
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