Adverse Reaction Report

Per W. Va. Code St. R. §14-11-2.2 “Adverse Reaction” shall be defined as any reaction that causes injury to a patient as the result of the medical intervention by injection. 

Injection Adverse reactions must be reported to the Board within five (5) days per W. Va. St. R. §14-11-8.8.

Optometry Injection Adverse Reaction Report Form (PDF requires Adobe Reader software)

Laser Adverse reactions must be reported to the Board within ten (10) days per W. Va. Code §30-8B-6(f).

Optometry Laser Adverse Reaction Report Form (PDF requires Adobe Reader software)