Eversight Services Information 2017 | Page 12

EVERSIGHT SERVICES TISSUE REQUEST GUIDE TISSUE REQUEST GUIDE Eversight offers multiple options for requesting tissue to deliver an exceptional transplant experience for you and your patients. Tissue Requests Surgical tissue Place your requests with Tissue Placement at least one week prior to surgery. Requests can be made via email, phone, fax or Midwire Match. Midwire Match is the Eversight online system that allows you to initiate tissue requests, accept offers, reschedule/cancel surgery, complete and submit post-operative outcome forms. Use the Surgery Scheduling Form* to provide the date, time, location and type of surgery, patient information, tissue preferences and delivery instructions. A confirmation will be emailed or faxed. Emergency tissue Call Tissue Placement at [phone]. Research or educational tissue Call our Reseach Coordinator at [phone]. Charitable services Eversight will waive or reduce its fees for patients without insurance or adequate coverage (approval required). Submit a Charitable Services Request Form* to Tissue Placement at least one week prior to the expected date of surgery. Tissue Offers Tissue offers are made two days prior to the surgery date, unless otherwise specified, using your preferred contact method. Delivery instructions are confirmed when an offer is accepted. Cancellations/Rescheduling Please notify Eversight as soon as possible if a surgery is cancelled or rescheduled. Prompt notification helps Eversight place the tissue with another recipient and fulfill our committment to honoring every donor's gift. Tissue Delivery and Storage • Tissue is delivered to the surgery location by local courier or FedEx on the morning of the surgery, unless otherwise requested. • Tissue is intended for single patient application only. It will arrive in a cooler validated for 24 hours and wet ice should be present. Tissue can remain in the closed cooler or removed and placed in a monitored refrigerator, 2°C to 8°C, away from freezing conditions. DO NOT FREEZE TISSUE. • If receiving sclera, the cooler may not have ice and should be stored at room temperature. • Save the delivery box and cooler in the event tissue needs to be returned to Eversight. Tissue Returns • Do not break or remove the shrink seal on the viewing chamber if surgery is cancelled or rescheduled. If seal is broken, the surgery center will be billed. • Call Eversight immediately for return instructions. A form will be faxed to the surgery center and must be completed and returned to coordinate shipping arrangements. Adverse Reactions, Positive Cultures • Report any adverse reactions to Eversight, including complications, operative or post- operative positive culture results or concerns.. Post-Operative Outcome Forms (POOFs) • Follow-up forms are sent three to six months following surgery to identify any post-operative complications. • Please return as soon as possible to the eye bank via Midwire Match, email, mail or fax. See reverse side for billing and patient services information. Tissue Placement: [phone] • Fax [phone] • [email protected]