TO HAVE AN OPTOMETRIST EVALUATION. HE REFUSED. REFUSAL FORM SIGNED. Copay Required:No Cosign Required: No TolophonoNerbal Order: No Completed by Boaudouin, Robert MD on 07/24/2019 15:17 Generated 0772472019 15:17 by Beaudouin, Robert MD Bursa l of Pawns -NY/4 Page 1 of 1 EFTA00049255 Bureau of Pri