An optometrist may, based upon the individual needs of a particular patient, collaborate with an ophthalmologist for the provision of care to the patient, for a fixed fee, regarding one or more surgical procedures if: 1. The collaborating parties prepare and maintain in their respective medical records regarding the patient, written documentation of each procedure and other service performed by each collaborating party which includes the date each procedure and other service is performed; 2. The fixed fee is divided between the collaborating parties in proportion to the services personally performed by each of them; 3. The collaborating parties agree that the collaborating optometrist will refer the patient back to the collaborating ophthalmologist or, if the collaborating ophthalmologist is not available, another ophthalmologist designated by the collaborating ophthalmologist to provide care to the patient if the medical needs of the patient necessitate the provision of care by an ophthalmologist; and 4. The collaborating parties provide to the patient and maintain in their respective medical records regarding the patient, a written document, signed by each of the collaborating parties and the patient, containing: (a) The name, business address and telephone number of each of the collaborating parties; (b) The amount of the fixed fee for the procedures and services; (c) The proportion of that fee to be received by each collaborating party; (d) A statement, signed by the patient and a witness who is not one of the collaborating parties, that the patient voluntarily, knowingly and willingly desires the performance of the postoperative care by the collaborating optometrist; (e) A statement that the patient is entitled to return to the collaborating ophthalmologist for postoperative care at any time after the surgery; and (f) A statement which: (1) Indicates that the practice of optometry is regulated by the Nevada State Board of Optometry and the practice of ophthalmology is regulated by the Board of Medical Examiners or the State Board of Osteopathic Medicine, as applicable; and (2) Contains the address and telephone number of each of those Boards.
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