**[VIST PREFERRED PRACTICE PATTERNS]{.underline}**

**1.0 VISUAL IMPAIRMENT SERVICES TEAM (VIST)**

**1.1 VIST REVIEW**

**1.1.1 DEFINITION OF PROCEDURES**

> Formal review procedures are completed including but not limited to:
>
> 1\) Eye exam
>
> 2\) Complete History and Physical Examination
>
> 3\) Hearing Evaluation
>
> 4\) Review of benefits, services **and adjustment to blindness**

**1.1.2 WHO PERFORMS**

> Members of the VIS Team **or designated health care providers.**

**1.1.3 EXPECTED OUTCOMES**

> The **VIST Coordinator will obtain documentation of the veteran's
> status of legal blindness.**
>
> The VIS Team and/or VIST Coordinator will determine needs for blind
> aids and prosthetic equipment related to sight loss.
>
> The VIS Team assessment will include patient history, current skill
> levels, adjustment to blindness and current needs. It will result in a
> description of the veteran's functional capabilities and limitations.
>
> The VIST Coordinator will develop a treatment plan which will include
> recommendations for other examinations, services and follow-up as
> indicated.
>
> The VIST Coordinator will inform each veteran of the full range of
> services for which he/she is eligible.
>
> Veterans **and/or their caregivers** will be able to identify and
> access national and community resources essential to enhancing their
> involvement in the home and community.
>
> **1.1.4 CLINICAL INDICATION FOR PROCEDURE**
>
> **Upon referral, legally blind veterans are assessed for VIST
> services.**

**1.1.5 CLINICAL PROCESS**

> **Each veteran legally blind veteran will be invited to participate in
> a review of VIST services.**
>
> **Each VIST eligible veteran will be invited to participate in an
> annual review.**
>
> **A review of the veteran\'s medical records will be completed by the
> appropriate VIS Team member.**
>
> **The review components are to be offered at VA facilities and
> arranged by the VIST Coordinator.**
>
> VIST medical exams will be conducted by assigned medical staff. All
> VIST medical exams will routinely include cholesterol, diabetes, and
> colo-rectal cancer screening **and other tests as indicated.** VIST
> exams should contain the required elements for blind rehabilitation
> referrals whenever possible.
>
> VIST eye exams will be conducted by assigned eye care professionals to
> assist in determining legal blindness. The exam will include best
> corrected central visual acuities and, when indicated, visual field
> testing will be conducted using a Goldmann III4e target.
>
> VIST hearing exams will be conducted by assigned audiology
> professionals to determine whether or not
>
> the veteran would benefit from hearing aids.

**1.1.6 SETTING**

> All elements of the VIST review will offered at
>
> a VA facility.
>
> **1.1.7 DOCUMENTATION**
>
> Documentation contains assessment results, veteran\'s goals, and
> specific recommendations.
>
> Recommendations may address the need for further assessment, follow up
> or referral.
>
> Results will be recorded in the medical record.
>
> The VA Record 10-1371, or an electronic equivalent, will be completed
> and filed on each veteran.
>
> **1.1.8 PROFESSIONAL POLICY AND RELATED REFERENCES**
>
> M-2, Part XXIII
>
> VIST Desk Reference Manual, Volumes 1-3.

**[VIST PREFERRED PRACTICE PATTERNS]{.underline}**

**2.0 VISUAL IMPAIRMENT SERVICES TEAM (VIST)**

**2.1 VIST REFERRAL FOR VA BLIND REHABILITATION TRAINING**

**2.1.1 DEFINITION OF PROCEDURES**

> Formal referral procedures for VA Blind Rehabilitation are completed.

**2.1.2 WHO PERFORMS**

> VIS Team Coordinator and appropriate Team members.

**2.1.3 EXPECTED OUTCOMES**

> The VIST Coordinator will inform veterans of the full range of
> services and opportunities provided at VA blind rehabilitation
> facilities.
>
> Eligible blinded veterans will be encouraged and motivated by the VIS
> Team to apply and participate in VA blind rehabilitation programs.
>
> All **required** evaluations and examinations will be
>
> completed in a timely manner (not to exceed 6 months prior to the date
> of application).
>
> **The VIST assessment will include in a description of the veteran's
> functional capabilities and limitations.**
>
> BRC applications will be completed for those veterans expressing a
> desire to participate in a VA blind rehabilitation program.

**2.1.4 CLINICAL INDICATION FOR PROCEDURE**

> Eligible veteran's expressing an interest in blind rehabilitation.

**2.1.5 CLINICAL PROCESS**

> During the VIST Review evaluation, blinded veterans will be counseled
> and assessed as to the need for blind rehabilitation training.
>
> Blinded veterans should be encouraged and motivated to explore the
> benefits of blind rehabilitation by the VIS Team.

**2.1.6 SETTING**

> VA facility

**2.1.7 DOCUMENTATION**

> **Documentation contains required VA forms, clinical evaluations,
> assessments and specific recommendations by VIS Team members and other
> healthcare providers. It will also include the veteran\'s goals.**
>
> Recommendations may address the need for BRC program modifications to
> meet special needs of applicants.
>
> Appropriate documentation will be recorded in the medical record.
>
> The VA Record 10-1371, or an electronic equivalent, will be updated to
> reflect the status of the referral.

**2.1.8 PROFESSIONAL POLICY AND RELATED REFERENCES**

> M-2, Part XXIII
>
> VIST Desk Reference Manual, Vol. 3.

**[VIST PREFERRED PRACTICE PATTERNS]{.underline}**

**3.0 VISUAL IMPAIRMENT SERVICES TEAM (VIST)**

**3.1 REVIEW OF BENEFITS & SERVICES**

**3.1.1 DEFINITION OF PROCEDURES**

> Blinded veterans will be offered an annual review for VA and blindness
> related benefits and services for which they are eligible.

**3.1.2 WHO PERFORMS**

> **VIST Coordinator, VIS Team members and designated staff.**

**3.1.3 EXPECTED OUTCOMES**

> Veterans **and/or their caregivers** completing a VIST Review will be
> aware of all VA and blindness related services for which they are
> eligible.
>
> VIST will assist veterans in obtaining additional information,
> benefits and/or services for which they are eligible.
>
> The VIST Coordinator will inform veterans of the full range of
> services and opportunities provided at VA blind rehabilitation
> facilities.

**3.1.4 CLINICAL INDICATION FOR PROCEDURE**

> Veterans participating in a VIST Review or those veterans who express
> an interest in receiving benefits and services available for the
> blind.

**3.1.5 CLINICAL PROCESS**

> Based on the results of the VIST Review evaluations, blinded veterans
> will be counseled and educated concerning all VA and non-VA blindness
> related benefits and services for which they are eligible.
>
> **VIST will provide assistance and guidance in helping veteran's
> receive desired services and/or benefits for which they is eligible.**

**3.1.6 SETTING**

> VA facility

**3.1.7 DOCUMENTATION**

> The medical record and or the VIST file will be updated to reflect the
> veteran's status for all VA and blindness related services and
> benefits.
>
> Comprehensive rating data needs to be updated on VA Record 10-1371, or
> an equivalent electronic record.

**3.1.8 PROFESSIONAL POLICY AND RELATED REFERENCES**

> M-2, Part XXIII
>
> VIST Desk Reference Manual, Volumes 1-4.

**[VIST PREFERRED PRACTICE PATTERNS]{.underline}**

**4.0 VISUAL IMPAIRMENT SERVICES TEAM (VIST)**

**4.1 EDUCATION & TRAINING OF VA STAFF**

**4.1.1 DEFINITION OF PROCEDURES**

> VIST will provide **initial and** ongoing education and training on
> VIST and blindness to VA staff and volunteers.

**4.1.2 WHO PERFORMS**

> VIS Team Coordinator and appropriate Team members.

**4.1.3 EXPECTED OUTCOMES**

> Increased awareness of VIST and BRS services among VA staff.
>
> Increased referral of blinded veterans to VIST.
>
> Improved care and service to blinded veterans in VA facilities.

**4.1.4 CLINICAL INDICATION FOR PROCEDURE**

> All VA clinical and administrative personnel who may come in contact
> with blinded veterans.
>
> **4.1.5 CLINICAL PROCESS**
>
> VIST will arrange and conduct in-service educational programs on VIST
> and blindness.
>
> VIST would target key clinical or administrative services that may
> have an impact on blinded veterans.
>
> **4.1.6 SETTING/EQUIPMENT SPECIFICATIONS**
>
> Educational programs will take place in VA facilities.
>
> Demonstration devices may include:
>
> Vision simulators
>
> Audio-visual equipment
>
> Canes
>
> Watches
>
> Low vision aids

**Other appropriate prosthetic devices**.

> VIST should also develop and maintain educational material, including:
> brochures, posters, handouts, etc.

**4.1.7 DOCUMENTATION**

> VIST will maintain a record of in-service and educational programs
> conducted during the fiscal year.
>
> In-service and educational programs will be documented in the VIST
> Annual Narrative Report.

**4.1.8 PROFESSIONAL POLICY AND RELATED REFERENCES**

> M-2, Part XXIII
>
> VIST Desk Reference Manual, Volumes 1 and 4.