Unsaved-work protection. Discard draft Kept in this browser only, cleared once the subject is created. It restores what was typed — it does not undo a typing mistake.
Load Sites
Load Pre-Visit Intake Information Search by last name only, date of birth only, or both. Everything the patient entered fills the form; verify each field with the patient present , since the intake was completed unsupervised.
Found intakes: Load Selected
Established Patient
Load an Established Patient (already enrolled) For a patient who has ALREADY been enrolled: search by last name, date of birth, or both. Their record loads with their existing Subject ID locked in — no new ID is created. All fields can be edited after loading.
Found Patients: Select a patient to load... Load Selected
Insurance (optional) Carrier and plan type feed de-identified research covariates. The member ID is optional and is stored only in the restricted patient linkage — never with de-identified data.
Insurance carrier Select one Blue Cross Blue Shield of Texas UnitedHealthcare Aetna Cigna Humana Ambetter / Superior HealthPlan Molina Healthcare Oscar Health Baylor Scott & White Health Plan Medicare Texas Medicaid (STAR/STAR+PLUS) TRICARE Other
Plan type Select one Medicare Advantage Traditional Medicare Commercial Medicaid Self-pay Unsure
Member ID (optional)
Next → Healthcare Providers
Primary Care Physician
Search NPI Registry
PCP unknown — patient does not know their primary care doctor; fields record “Not known to patient”.Save PCP details Also saved automatically when you press Next.
Pharmacy Search
No result? Type the details below by hand — they save with the packet either way.
Pharmacy unknown — patient does not know their pharmacy; fields record “Not known to patient”.Save pharmacy details Also saved automatically when you press Next.
← Back Next → Medical History
Study Subject Identifier Format: two-digit site number + five-character randomly generated code. Example: 01-K7M2Q . The code is random — it is not sequential and encodes no patient information, consistent with the approved consent form. Record each ID in the restricted Master Linkage sheet as it is assigned; that sheet remains the source of truth.
If the Subject ID is blank, open this box. ▸
Generate New Subject ID
Click only if Subject ID is blank. A returning patient keeps their existing ID — load them above instead.
This browser has generated: no codes yet for this site. Used only to catch an accidental repeat; the restricted Master Linkage sheet remains the source of truth.
Required consent-process attestation
Participant’s ID verified — ID image not saved. Complete this section for the SpectOcular Patient Services Consent, Medical Release, and Research Consent/HIPAA Authorization packet. The attestation will print with each document cover sheet.
Identification Verified: I confirm that I reviewed the participant’s official identification or clinic-approved identity source, verified that the participant is the individual signing this consent, and did not retain a copy or image of the identification document.No photograph, scan, copy, ID number, barcode, or ID image was retained in the website, packet, or study file. The participant had an opportunity to ask questions and/or contact SpectOcular research personnel before signing. The participant was informed that participation is voluntary and clinical care is not affected by the decision. The participant signature applies to the packet documents being executed today, as applicable: SpectOcular Patient Services Consent, Medical Release, and Research Consent/HIPAA Authorization.
SpectOcular research staff may countersign/review later. The printed packet includes a separate SpectOcular research-staff review line for asynchronous completion.
Check all — I attest to all of the above
Print two copies of the packet: one set for wet signatures and the site research binder, one set for the patient to take home (the patient must receive a copy of everything they sign). Scan and upload the entire signed packet, not just the signature pages.
Submit Enrollment Information
Print Signing Packet (short) Full Packet — All Documents Email Full Packet Available once the enrollment is submitted and the review is confirmed.
Upload the signed packet
Uploading happens on its own page — anytime after the visit. Print the packet, obtain wet signatures, then scan and upload the entire signed packet from the upload page. It can be done later, on any device — only the Subject ID printed on the packet is needed.
Retina IQ
Request a Retina IQ report Requires a completed SpectOcular Patient Services Consent — patients must consent to SpectOcular's practice services before a Retina IQ report can be requested for them.
Consent packet PDF created. Print, obtain wet signatures on the signature pages, file the originals in the site research binder, and scan/upload the entire signed packet to restricted Google Drive.
← Back Restart enrollment
