Trade Name Transfer

Per K.A.R. 65-9-4. Transfer. (a) The approval to use a trade or assumed name shall not be transferable except with the approval of the board.

(b) Any applicant seeking to transfer the approval for the use of a trade or assumed name to another licensee which is authorized to engage in the practice of optometry in this state shall file a completed application with the secretary-treasurer on a form prescribed by the board.

(c) If the transfer is approved, the transferee shall become responsible for compliance with the applicable requirements of K.A.R. 65-9-1, et seq.

Do you intend to practice or are you currently practicing under the name of a professional corporation or professional limited liability company authorized by either KSA 17-2706 or KSA 17-7668? If yes, provide the name of the entity, the owners of the entity (shareholders or members) and all licensees practicing under the name of the entity. Also, provide a copy of the draft or filed articles of incorporation or articles of organization.

Articles of Incorporation
Do you intend to actively engage in the practice of optometry under the trade or assumed name upon obtaining approval from the board?

Do you intend to practice through virtual or remote means?

If yes provide a description and describe how you intend to comply with the standards required by K.A.R. 65-8-1:
65-8-1. Examination and adaptation procedures. (a) The following minimum standards for examination procedures shall be performed by a licensee during any examination conducted to determine if a prescription for corrective lenses should be provided:
(1) visual acuity testing of each eye at far and nearpoint;
(2) external examination;
(3) refraction (objective and subjective);
(4) coordination testing;
(5) ophthalmoscopy;
(6) biomicroscopy; and
(7) Tonometry (if the patient is age 25 or over).
(b) In addition to the minimum standards in (a), the following additional minimum standards for procedures shall be performed during any contact lens evaluation:
(1) measurement to determine anterior curvatures of the cornea by use of an instrument capable of producing and providing reliable findings;
(2) evaluation of appropriate eye variables and biomicroscopic evaluation of lid health and corneal integrity;
(3) application of known diagnostic lenses to each eye to include evaluation of acuity, over-refraction, and biomicroscopic evaluation of lens fit with use of chemical dyes, as indicated; and
(4) discussion with the patient of the probable success and risks of contact lens wear.
(c) In addition to the minimum standards for examination and evaluation procedures set out in (a) and (b), the following are additional minimum standards for procedures to be performed during any contact lens adaptation to determine a patient’s first contact lens prescription:
(1) provide patient adequate training in lens care, lens application and removal, lens wear, lens care solutions and products, and proper disinfection procedures;
(2) provide patient adequate training in proper wearing schedule, warning signs and recall intervals;
(3) provide for a minimum of two follow-up visits over a minimum period of the two months prior to determining the contact lens prescription; and
(4) visual acuity testing and biomicroscopic evaluation of each eye with and without lenses at each follow-up visit. (Authorized by K.S.A. 74-1504(a)(6); implementing K.S.A. 1991 Supp. 65-1501; effective May 18, 1992.)

SIGNATURE OF Transferor and Transferee. Each person listed above must provide an electronic signature by typing their name below.

Perjury statement. I hereby swear or affirm under penalty of perjury that the information given herein is true and correct to the best of my knowledge or belief.