Personal Vision SolutionsTM Calculator
Everyday Pair
Patient Name (#{{PatientID}})
Name
Lens Type
everydayLensType
Single Vision
Multifocal
Plan Type
planType
Signature
Choice
Advantage
Private Pay
If Signature, Choice, or Advantage show dark gray row
If private Pay then show light gray row.
Plan Options (select all that apply)
everydayPlanOptions
Covered Premium Progressives (O, N)
Covered Polycarbonate
Covered Photochromic
Covered Anti-Reflective
If Signature, Choice, or Advantage show dark gray row
If private Pay then show light gray row.
Authorization #
everydayAuthCode
Frame Allowance
everydayFrameAllowance
Material Copay
everydayVSPMaterialCopay
Discount or Office Promotion
everydayDiscount
Discount Type
everydayDiscountType
Dollar Amount
Percentage
Occupational or Workplace Pair
Lens Type
taskOrientedLensType
Single Vision
Multifocal
Occupational or Workplace Pair Coverage
taskCoverage
Covered
Covered with additional copay.
Plan Discount
Insurance plan providing a discount (Value Added Benefits)
In-Office Promotion
Your office promotion or multiple pair offering.
Plan Options (select all that apply)
taskOrientedPlanOptions
Covered Occupational Lenses
Covered Polycarbonate
Covered Photochromic
Covered Anti-Reflective
If Signature, Choice, or Advantage show dark gray row
If private Pay then show light gray row.
Authorization #
taskAuthCode
Frame Allowance
taskFrameAllowance
Material Copay
taskVSPMaterialsCopay
Discount or Promotion
taskDiscount
Discount or Promotion Type
taskDiscountType
Dollar Amount
Percentage
Prescription Sunglasses
Lens Type
sunsLensType
Single Vision
Multifocal
Prescription Sunglasses Coverage
sunsCoverage
Covered
Covered with additional copay.
Plan Discount
Insurance plan providing a discount (Value Added Benefits)
In-Office Promotion
Your office promotion or multiple pair offering.
Plan Options (select all that apply)
sunglassPlanOptions
Covered Premium Progressives (O, N)
Covered Polycarbonate
Covered Anti-Reflective
Covered Polarized
If Signature, Choice, or Advantage show dark gray row
If private Pay then show light gray row.
Authorization #
sunsAuthCode
Frame Allowance
sunsFrameAllowance
Material Copay
sunsVSPMaterialsCopay
Discount or Promotion
sunsDiscount
Discount or Promotion Type
sunsDiscountType
Dollar Amount
Percentage
Safety Glasses
Lens Type
safetyLensType
Single Vision
Multifocal
Safety Glasses Coverage
safetyCoverage
Covered
Covered with additional copay.
Plan Discount
Insurance plan providing a discount (Value Added Benefits)
In-Office Promotion
Your office promotion or multiple pair offering.
Plan Options (select all that apply)
safetyPlanOptions
Covered Safety Lenses
Covered Polycarbonate
Covered Premium Progressives (O, N)
Covered Photochromic
Covered Anti-Reflective
If Signature, Choice, or Advantage show dark gray row
If private Pay then show light gray row.
Authorization #
safetyAuthCode
Frame Allowance
safetyFrameAllowance
Material Copay
safetyVSPMaterialsCopay
Discount or Promotion
safetyDiscount
Discount or Promotion Type
safetyDiscountType
Dollar Amount
Percentage
Lifestyle Pair
Lens Type
additionalPairLensType
Single Vision
Multifocal
Lifestyle Pair Coverage
additionalPairCoverage
Covered
Covered with additional copay.
Plan Discount
Insurance plan providing a discount (Value Added Benefits)
In-Office Promotion
Your office promotion or multiple pair offering.
Plan Options (select all that apply)
additionalPlanOptions
Covered Premium Progressives (O, N)
Covered Polycarbonate
Covered Photochromic
Covered Anti-Reflective
Covered Occupational Lenses
If Signature, Choice, or Advantage show dark gray row
If private Pay then show light gray row.
Authorization #
additionalPairAuthCode
Frame Allowance
additionalPairFrameAllowance
Material Copay
additionalVSPMaterialsCopay
Discount or Promotion
additionalPairDiscount
Discount or Promotion Type
additionalPairDiscountType
Dollar Amount
Percentage