Established Patients

Welcome Back!

Inquiries regarding the website should be directed to portal@shields.md


Reason For Visit

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What is the reason for your upcoming appointment with us?

 

Please FILL OUT, PRINT, and BRING the following form with you to your appointment.

 

DOWNLOAD FORM

Medical History

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Your medical history will need to be updated through our patient portal prior to your visit.

Activate Your Patient Portal: If you have successfully accessed your patient portal previously, you may skip this step.

Trouble accessing your Patient Portal? Contact portal@shields.md

Name:*
Date of Birth:*
 / 
 / 
Appointment Date:*
E-mail:*
Word Verification:
Click submit to activate "My Wills Eye Patient Portal"

You can only activate your portal AFTER you have an appointment date.

After submission you shouldimmediatelyreceive a confirmation email.

Within the next 24 hours, instructions on how to access your account will be sent from Modernizing Medicine.

 

Patient Information & History:
Once you click the patient portal below and log in a new screen will show tabs on the left side. You may review Contact Information and Insurance but please DO NOT make changes. You will need to  review the remaining tabs and make necessary changes, then click save & continue each time.

1.) Pharmacy: Click “Add Surescripts Pharmacy” and add your home pharmacy. If your pharmacy is not listed click “Add Manual Pharmacy.”
2.) Past History & Ocular History: Fill out information under both tabs by checking personally relevant boxes in each section.
3.) Medication: List all medications you are currently taking by typing them into the search bar and selecting them. Fill in all referring blanks such as frequency, date started, etc.
4.) Allergies: If applicable click “Add Allergies.” Search for and select any allergies that you have. You will need to describe the reaction, date when the allergy was recorded, and state if the allergy is still active.

Access Patient Portal:

modmed

Trouble accessing your Patient Portal? Contact portal@shields.md

Insurance Authorization

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If insurance is not accepted, you will need an out of network authorization from your referring physician.

It is the patient’s responsibility to contact your insurance carrier regarding your benefits and to be sure that Shields & Shields (not Wills Eye) is in your network. If you find that we are not in your network, please give the following authorization letter to your referring doctor’s office to obtain an out of network authorization.

 

DOWNLOAD AUTHORIZATION LETTER

 

DOWNLOAD PATIENT VISIT INSURANCE CPT CODES

 

All out of state Medicaid insurances must have an out of network authorization AND a single case agreement.

 

We need all out of network authorizations to be done immediately, they take a few days to obtain! All authorizations must be given to our office by 3:00PM on the Thursday before your appointment. Please call our office immediately with your authorization number and information when obtained. You may contact Marie at 215-928-3105. If you come to Shields & Shields without your authorization or referral you will be considered self pay. We do not accept personal checks.

 

Physical Exam

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Getting surgery? You will need a physical. Please have your physician fill out the Physical Evaluation form. Your physical exam needs to be less than 30 days old. This form is for all patients and is required for all patients undergoing surgery. No other form will be accepted by our surgery center. Should patients not have the physical form complete, it would delay any surgical procedure that may be required. For a child, their pediatrician must complete the form prior to your initial visit.

 

DOWNLOAD FORM

Insurance CPT Codes

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Not sure of what CPT codes we use?

 

DOWNLOAD PATIENT VISIT INSURANCE CPT CODES

You’re Complete!

Once you have completed every item on the list then you’re ready for your next appointment! We look forward to seeing you at your scheduled time.






Are You A Conjunctival Melanoma Patient?

Since your initial diagnosis of conjunctival melanoma, research has shown that there are special mutations (changes in DNA) that can occur in the cancer cells. If these mutations are detected, there are certain medications that can be used in the treatment of metastasis (spread to other places in the body).

Getting Here

The Ocular Oncology Service at Wills Eye Hospital is only about a 30 minute drive from the airport. Amtrak runs often and Wills Eye Hospital is easily accessible by public transportation. Philadelphia has an excellent transit system with trains, buses, and subways.