Standards of Professional Conduct, Patient Care Obligations, and Recordkeeping
Professional conduct questions are rarely about exotic ethics; they test whether the patient's interest governed the decision and whether the record proves it.
Core duties
- Non-abandonment. Once you accept a patient you must continue care or formally terminate: give written notice, supply records to the successor, and allow reasonable time to transfer. Dismissing a patient mid-treatment for nonpayment without that process is abandonment.
- Scope and referral. When findings exceed optometric scope, refer and document the referral and the patient's response, including informed refusal.
- Informed consent. Dilation, contact lens wear, therapeutic prescribing, and any procedure with material risk require a documented discussion of benefits, risks, and alternatives.
- Billing integrity. Diagnoses and procedure codes must match the record; coding to maximize reimbursement is fraud.
Recordkeeping
Each record should show the date, chief complaint and history, examination findings (visual acuity, refraction, health assessment), diagnosis, treatment or plan, medications, and the licensee's signature. Records are the practice's property, but the patient has a right of access: HIPAA requires a copy within 30 days of a request and permits only a reasonable, cost-based fee.
Worked example
A patient finishes an exam, buys glasses elsewhere, and later asks for a copy of the prescription. The front desk says it will release the prescription after the balance is paid. Wrong twice: the FTC Ophthalmic Practice Rules require the prescription to be released immediately after the exam, at no charge, with no purchase requirement, and release cannot be conditioned on payment.
Traps
- Confusing the free prescription release with a full-record request, which may carry a cost-based fee.
- Documenting a referral without noting whether the patient followed through.
- Terminating a patient by letter alone, with no records transfer and no transition time.