Faculty Handbook

SUNY College of Optometry

Faculty Handbook 2022-23

APPENDIX L:

AGREEMENT TO PARTICIPATE IN PRE-CLINICAL TEACHING LABORATORIES This Form is to be provided to participants Approved by Dean’s Council 22 October 2014

The SUNY College of Optometry is a four-year doctoral program committed to excellence in clinical education. To learn many clinical procedures and techniques it is important that our students work with actual patients. This is done through clinical care in the University Eye Center and affiliated external clinics, as well as in teaching laboratories. During the first two years of training students begin applying their education to patient care in pre clinical teaching laboratories, first on each other, and then on participating patients with particular conditions. These examinations provide an important opportunity for students to receive feedback from supervising clinical instructors and patients helping to prepare them for direct clinical care. You have been invited to participate in the SUNY College of Optometry’s pre-clinical teaching program. The laboratory you have been invited to participate in is designed to provide students with first-hand experience on eyes like yours. Your participation is voluntary, is not a replacement for, and will not affect, your regular care. Please read this agreement carefully before agreeing to participate. Should you elect to participate, you will receive details about your involvement from the faculty supervisor. You are encouraged to ask questions about how the laboratory works and you are free to change your mind at any time. You will be asked to attend one or more laboratory teaching sessions. Laboratory sessions typically run from 90 mins to 3 hrs. You will be compensated for your time. You will need to bring your corrections and wear any contact lenses and/or ocular prosthetic device. During the time of your participation, students will examine you under the supervision of clinical faculty. This may require the instillation of a topical drug or dye, in a manner no different than would be used if you were being examined in our clinic. Students will also be given the opportunity to ask questions about your condition and/or general eye health history, which is considered under Federal Privacy Law to be part of your protected health information (PHI). Such information will not be recorded or shared in any manner with anyone outside of the teaching laboratory. In signing this agreement, you are indicating your consent to utilize your PHI as described above. In return for your participation, you will be reimbursed at $Click or tap here to enter text. per hour. You will need to do certain necessary paperwork and agree to the conditions for reimbursement from New York State. Although there is minimal risk associated with participation in these laboratories, unexpected serious eye injury could occur. If any injury requiring treatment should occur, you will be directed to either your eye care provider or to the University Eye Center for treatment. If you have insurance, this treatment will be billed to your medical plan and you will be responsible for the payment of any applicable deductibles or co-pays and for the payment of any non-covered services. If you do not have health insurance, you will be billed for these visits. The College shall not be responsible for paying for the cost of medical care or other damages resulting from your participation in these laboratories. In signing this agreement, you agree to assume all the risks and responsibilities of participation in the College’s pre-clinical teaching laboratory and release the State of New York and the SUNY College of Optometry, their employees and students from any and all claims and any and all liability arising from or incurred as a result of your participation in this program.

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