Exhibit Z_Space Planning - Eye Clinic.pdf

PG-18-9 – SPACE PLANNING CRITERIA March 1, 2022 233 – Eye Clinic: Ophthalmology and Optometry Services

CHAPTER 233: EYE CLINIC: OPHTHALMOLOGY AND OPTOMETRY SERVICES

1 PURPOSE AND SCOPE .................................................................................................. 233-2

2 DEFINITIONS ................................................................................................................ 233-2

3 OPERATING RATIONALE AND BASIS OF CRITERIA .......................................................... 233-7

4 OPHTHALMOLOGY SERVICE INPUT DATA STATEMENTS (IDS) ...................................... 233-10

5 OPHTHALMOLOGY SERVICE SPACE PLANNING CRITERIA ............................................. 233-10

6 OPTOMETRY SERVICE INPUT DATA STATEMENTS (IDS)................................................ 233-18

7 OPTOMETRY SERVICE SPACE PLANNING CRITERIA ...................................................... 233-19

8 OPTICAL FITTING AREA INPUT DATA STATEMENTS (IDS) ............................................. 233-26

9 OPTICAL FITTING SPACE PLANNING CRITERIA ............................................................233-277

10 PLANNING AND DESIGN CONSIDERATIONS ................................................................. 233-28

11 FUNCTIONAL RELATIONSHIPS..................................................................................... 233-31

12 FUNCTIONAL DIAGRAM ............................................................................................. 233-32

1 PURPOSE AND SCOPE

This document outlines Space Planning Criteria for Chapter 233: Ophthalmology and Optometry Services. It applies to all medical facilities at the Department of Veterans Affairs

(VA).

The following policy documents have been reviewed, referenced and incorporated as appropriate:

VHA Handbook 1174.05: Outpatient Blind and Vision Rehabilitation Clinic Procedures, July 1, 2011

OMB Memorandum M-12-12: Promoting Efficient Spending to Support Agency Operations, May 11, 2012 (Section 3: Freeze the Footprint)

2 DEFINITIONS

Affiliated: An arrangement whereby a school of medicine or optometry agrees to staff a VA facility with faculty physicians (ophthalmologists), optometrists, residents, and interns / externs. In return, the VA provides the medical or optometry school with a venue to train new physicians / optometrists. In this arrangement, the VA retains responsibility for the care of its patients while the school of medicine or optometry retains responsibility for all graduate level education and training.

Basic Low Vision Services: Basic Low Vision services include prescription of optical low vision devices and a minimum level of visual skills and device training.

Blind Rehabilitation Outpatient Specialist (BROS): A BROS is a multi-skilled, university-trained, and experienced blind rehabilitation instructor who has advanced technical knowledge and competencies at the full performance level in at least two of the following disciplines: orientation and mobility, living skills, manual skills, and visual skills. (per VHA Handbook 1174.05)

Eye Care Provider: An Optometrist or Ophthalmologist who examines, diagnoses, treats, prescribes medication, and manages the care of patients within his or her clinical privileges as established by the governing body of a healthcare organization.

Low Vision: A combination of visual acuity, visual field loss, contrast sensitivity loss, loss of stereopsis, or eye motility impairment that impacts patient safety or impairs or restricts one or more activities of daily living.

Low Vision Therapy: Low Vision Therapy provides an individual with low vision to use his or her residual vision. This may also include training in the use of low vision and other aids in everyday situations and activities of daily living. Low Vision Services including Basic, Intermediate, Polytrauma Facility, Advanced, Visual Impairment Center to Optimize Remaining Sight (VICTORS), Polytrauma Rehabilitation Network Site, as well as Polytrauma Rehabilitation Center which may include Low Vision Services have separate staffing, space, and workload requirements based upon the level and intensity of vision rehabilitation care provided.

Ophthalmologist: An ophthalmologist is a physician who specializes in the comprehensive care of the eyes and visual system. An ophthalmologist is medically trained and qualified to diagnose and treat all eye and visual system problems. An ophthalmologist can deliver total eye care, as well as diagnose general diseases of the body. An ophthalmologist has completed 4 years of college premedical training, 4 or more years of medical school, 1 year of internship, and 3 years or more of specialized medical training and experience in eye care. An additional 1 to 3 years may be spent in sub-specialty fellowship training.

Optometrist: Doctors of Optometry are independent primary health care providers who examine, diagnose, treat, and manage diseases and disorders of the visual system, the eye and associated structures, as well as diagnose related systemic conditions. An optometrist typically completes 4 years of baccalaureate training and 4 years of optometry training.

Residency training is 1 year beyond attainment of the optometry degree, and fellowship training is for 1 to 2 years beyond the completion of residency training.

Visual Impairment Center to Optimize Remaining Sight (VICTORS): Advanced Low Vision Services that provides a full spectrum of optical devices and in-depth visual skills training, along with basic training in activities of daily living and in orientation and mobility.

VIST Coordinator: The VIST Coordinator is the case manager who has responsibility for the coordination of services for severely-disabled visually impaired Veterans and their families.

(per VHA Handbook 1174.05)

Space Planning / SEPS Accessible: A site, building, facility, or portion thereof that complies with provisions outlined in the Architectural Barriers Act of 1968 (ABA).

Architectural Barriers Act (ABA): A set of standards developed to ensure that all buildings financed with federal funds are designed and constructed to be fully accessible to everyone.

This law requires all construction, renovation, or leasing of sites, facilities, buildings, and other elements, financed with federal funds, to comply with the Architectural Barriers Act Accessibility Standards (ABAAS). The ABAAS replaces the Uniform Federal Accessibility Standards (UFAS).

Average Length of Encounter (ALoE): Averaged length of time, in minutes, a patient spends in an Exam / Treatment Room interacting with a provider and the clinical support team. It is accounted from room “set-up” to “clean-up” by staff. This metric is used to determine the number of annual patient / provider encounters that take place in an Exam / Treatment Room which, in turn, is used to calculate the number of Exam / Treatment Rooms needed in a facility based on projected annual workload. The ALoE is determined with VHA SME input during a PG-18-9 clinical chapter revision / update.

Average Length of Stay (ALoS): The average number of days a patient Veteran stays in an inpatient care unit. The ALoS is used to calculate the number of patient bedrooms for a specialty by dividing the site’s projected workload by the ALoS.

Building Gross (BG) Factor: A Factor applied to the sum of all the Departmental Gross Square Footage (DGSF) in a project to determine the Building Gross Square Footage. This factor accounts for square footage used by the building envelope, structural systems, horizontal and vertical circulation including main corridors, elevators, stairs and escalators, shafts, and mechanical spaces. The Department of Veterans Affairs has set this factor at

1.35 and included guidance in case of variance when developing a Program for Design (PFD) in SEPS.

Clinic Stop: Per these criteria, a clinic stop is the workload unit of measure for space planning. Clinic Stops are codified by VSSC, when applicable, they are referenced by number in the calculation of workload driven patient care spaces in this document.

Department Net to Gross (DNTG) Factor: A parameter, determined by the VA for each clinical and non-clinical department PG-18-9 space planning criteria chapter, used to convert the programmed Net Square Feet (NSF) area to the Department Gross Square Feet (DGSF) area.

Encounter: An interaction between a patient Veteran and a VA provider or providers in an Exam Room / Treatment Room / Consultation Room / Procedure Room, spaces where a patient Veteran received clinical care.

Full-Time Equivalent (FTE): A staffing parameter equal to the amount of time assigned to one full time employee. It may be composed of several part-time employees whose combined time commitment equals that of one full-time employee (i.e., 40 hours per week).

Functional Area (FA): The grouping of rooms and spaces based on their function within a clinical service or department.

Functional Area Criteria Statement (FACS): A verbalized mathematical / logical formulation assigned to a FA incorporating answers to Input Data Statements (IDSs) to determine the condition for providing the rooms / spaces listed in the FA in the baseline space program or Program for Design (PFD) for a project. Certain rooms / spaces may or may not have additional conditions.

Input Data Statement(s): A question or set of questions designed to elicit information about the healthcare project to generate a Program for Design (PFD) based on the parameters set forth in this set of documents. This information is processed through mathematical and logical operations in the VA Space and Equipment Planning System (SEPS).

JSN (Joint Schedule Number): A unique five alpha-numeric code assigned to each content item in the PG-18-5 Standard. JSNs are defined in DoD’s Military Standard 1691 and included in SEPS Content Table.

Net Square Feet / Net Square Meters (NSF/NSM): The area of a room or space derived from that within the interior surface of the bounding walls or boundaries.

Patient Unique: (or Unique Patient), A Veteran patient counted as a unique in each division from which they receive care. Patient Uniques are included in the Registry for a VA Medical Center.

Program for Design (PFD): A project specific itemized listing of the spaces, rooms, and square foot area required for the proper operation of a specific service / department, and the corresponding area for each. PFDs are generated by SEPS based on the PG-18-9 Standard.

PG-18-5: A Department of Veterans Affairs’ Equipment Guidelist Standard for planning, design, and construction of VA healthcare facilities; a Program Guide (PG) that lists assigned room contents (medical equipment, furniture, and fixtures) to each room in PG-18-9. PG- 18-5 follows PG-18-9’s chapter organization and nomenclature.

PG-18-9: A Department of Veterans Affairs’ Program Guide for the Space Planning Criteria Standard use to develop space planning guidance for the planning, design, and construction of VA healthcare facilities; a Program Guide (PG) that provides space planning guidance for VA Medical Centers (VAMCs) and Community Bases Outpatient Clinics (CBOCs). PG-18-9 is organized by chapters, as of September 2021 there are 56 clinical and non-clinical PG-18-9 chapters; they are implemented and deployed in SEPS so that space planners working on VA healthcare projects can develop baseline space programs.

PG-18-12: A Department of Veterans Affairs’ Design Guide Standard for planning, design and construction of VA healthcare facilities, a Program Guide (PG) that provides design guidance for VA Medical Centers (VAMCs) and Community Bases Outpatient Clinics (CBOCs).

The narrative section details functional requirements and the Room Template section details the planning and design of key rooms in PG-18-9. Not all PG-18-9 chapters have a corresponding PG-18-12 Design Guide; one Design Guide can cover more than one PG-18-9 chapter.

Provider: An individual who examines, diagnoses, treats, prescribes medication, and manages the care of patients within his or her scope of practice as established by the governing body of a healthcare organization.

Room Area: The square footage required for a clinical or non-clinical function to take place in a room / space. It takes into account the floor area required by equipment (medical and non-medical), furniture, circulation, and appropriate function / code-mandated clearances.

Room area is measured in Net Square Feet (NSF).

Room Code (RC): A unique five alpha-numeric code assigned to each room in the PG-18-9 Standard. Room Codes in PG-18-9 are unique to VA and are the basis for SEPS’s Space Table for VA projects.

Room Criteria Statement (RCS): A mathematical / logical formulation assigned to each room / space included in PG-18-9 incorporating answers to Input Data Statements (IDSs) to determine the provision of the room / space in the baseline space program or Program for Design (PFD) for a project.

Room Efficiency Factor: A factor that provides flexibility in the utilization of a room to account for patient delays, scheduling conflicts, and equipment maintenance. Common factors are in the 75% to 85% range. A room with 80% room efficiency provides a buffer to assume that this room would be available 20% of the time beyond the planned operational practices for this room. This factor may be adjusted based on the actual and/or anticipated operations and processes of the room/department at a particular facility.

SEPS: Acronym for Space and Equipment Planning System which produces equipment lists and Program for Design for a healthcare project based on specific information entered in response to Input Data Questions.

SEPS Importer: A style-based format developed to allow upload of RCSs and IDSs to SEPS to implement and operationalize space planning criteria in PG-18-9 in the SEPS digital tool.

This format establishes the syntax used in the RCSs and allows the use of Shortcuts.

Shortcuts allow developers of space planning criteria statements to simplify RCSs making full use of their logical and mathematical functionality. A shortcut can refer to an RCS, a room in any FA or a formula. Shortcuts are [bracketed] when used in FAs and RCSs and are listed along with their equivalences at the end of the Space Planning Criteria section.

Space Planning Concept Matrix (SPCM): A working document developed during the chapter update process. It lists all the rooms organized by Functional Area and establishes ratios between the directly and the indirectly workload driven rooms for the planning range defined in this document. The matrix is organized in ascending workload values in ranges reflecting existing facilities and potential future increase. Section 5 of this document Space Planning Criteria reflects the values in the SPCM.

Stop Code: A measure of workload including clinic stops forecasted by the Office of Policy and Planning (OPP) for all Strategic Planning Categories at Medical Center and Outpatient Clinic levels.

Telehealth: The use of technology, such as computers and mobile devices, to manage healthcare remotely. It includes a variety of health care services, including but not limited to online support groups, online health information and self-management tools, email and online communication with health care providers, remote monitoring of vital signs, video, or online doctor visits. Depending on the concept of operations for this space, it may be equipped as an exam room or as a consult room with video/camera capability.

Utilization Rate: A factor used in the calculation of a directly workload-driven room throughput. It represents, in a percent value, the room is idle based on the planning assumptions. For example, if a directly workload-driven room is available for use 8 hours a day, the Utilization Rate represents the assumed time it will be used, an 85% utilization rate indicates, for planning purposes, the room will be used 6.8 hours a day. An additional directly workload-driven room will be provided in the calculation once the previous room has reached 100% utilization. The utilization Rate is embedded in the Room Throughput value calculated in Section 3 of this document.

VA Room Family (VA RF): An organizational system of rooms / spaces grouped by function, a ‘Room Family’. There are two “Orders” in the VA RF: Patient Care and Patient Care Support;

Patient Care features four sub-orders: Clinical, Inpatient, Outpatient and Residential Clinical.

There are also four sub-orders in the Patient Care Support order: Building Support, Clinical Support, Staff Support and Veteran Support. Each room in a Family has a unique Room Code and NSF assigned based on its Room Contents and function which correspond to the specific use of the room. The same RC can be assigned to different Room Names with the same function in this document and can be assigned an NSF that varies based on the PG-18-5 Room Contents assigned to the room.

VA Technical Information Library (TIL): A resource website maintained by the Facilities Standards Service (FSS) Office of Construction and Facilities Management (CFM) containing a broad range of technical publications related to the planning, design, leasing, and construction of VA facilities. VA-TIL can be accessed at: https://www.cfm.va.gov/TIL/

Workload: Workload is the anticipated number of procedures, clinic stops, clinic encounters etc. that is processed through a department/service area. The total workload applied to departmental operational assumptions will determine overall room requirements by modality.

Workstation: Area outfitted with equipment and furnishings, typically allocated 56 NSF each. Managers and other staff with no direct reports as well as part-time, seasonal, and job-sharing staff may qualify for a workstation. Such environments are particularly conducive to team-oriented office groupings. These environments work best when they have access to conference and small group meeting spaces.

3 OPERATING RATIONALE AND BASIS OF CRITERIA

A. Space planning criteria included in this Standard have been specifically developed for this Department / Service in a Department of Veterans Affairs healthcare facility based on established VHA policy and guidelines to define the scope of services provided for the existing workload demand as well as that in the foreseeable future. Rooms and Functional Areas are provided based on research of clinical and non-clinical activities performed in this Department.

B. Development / update of VA’s Program Guide (PG) standards is a research based effort executed with participation of VHA Subject Matter Experts (SMEs), VA-Construction and Facilities Management Office (CFM) professional staff and specialty consultants hired for the task. These space planning standards are based on current applicable VHA policies and guidelines, established and/or anticipated best practice standards, and latest medical technology developments. Workload metrics were tailored to satisfy current and anticipated veteran workload demand.

C. The space planning component of PG-18-9 is based on the Space Planning Concept Matrix (SPCM) which lists all the rooms organized by Functional Area and assigns room quantity (Q) and area (NSF) for a series of ranges corresponding to the smallest to the largest department for this service in the VA healthcare system in incremental size; each range corresponds to a workload parameter which determines the number and area of each directly workload-driven room. The remainder of the rooms in the range i.e., waiting, storage, staff workstations, etc. are determined by ratios to the resulting number of or NSF of the workload-driven rooms.

https://www.cfm.va.gov/TIL/

D. Sections 4 and 5 of these space planning standards as well as the PG-18-5 standard are implemented in the Space and Equipment Planning System (SEPS) and hosted at the MAX.gov website so planners working on VA Construction projects can develop single or multi-department projects based on these PG-18-9- and the PG-18-5 standards. Output from SEPS is through Space and Contents Reports; the Space Report is the Program for Design (PFD), the Content Report is the Project Room Contents (PRC). Inclusion of a Functional Area as well as Room quantity (Q) and determination of the room area (NSF) in the PFD is based on the projected Workload input which triggers calculations included in the Room Criteria Statements (RCSs). The RCSs are placed immediately after each room name, room code and baseline area (NSF). The PRC list the medical equipment, furniture and fixtures associated to each Room Code in the project. The PFD & PRC are the baseline requirements for the planning phase of a VA project based on a site’s projected workload for the target planning year. This chapter’s corresponding PG-18-12, Design Guide -if available- is intended for use during the design phase of the project.

E. Space Planning parameters and metrics in this document are based on the Eye Clinic Space Planning Criteria Matrix (SPCM) developed as the basis for this chapter. The Eye Clinic SPCM lists all the spaces a VA Eye Clinic site would require for Ophthalmology Service, Optometry Service (Affiliated or Non-Affiliated), and Optical Fitting. The quantity and NSF for each room is calculated based on the projected workload for each Service, the workload throughputs for Affiliated and Non-Affiliated are different. The SPCM is organized in 30 ranges, 15 each for Ophthalmology and Optometry. Each range represents an incremental workload value equivalent to two Exam / Treatment Room.

All current VA Eye Clinic sites are covered in the SPCM. The upper ranges are calculated for future facilities in case a higher projected workload. The SPCM is organized as follows:

1. Ranges 1 to 15: Ophthalmology - Stop Code 407

a. Affiliated: each range represents 3,600 annual clinic stops generating two Ophthalmology Exam / Treatment Rooms at an annual throughput of 1,800 clinic stops each; minimum annual workload 450. Ranges 1 to 15 cover between 450 and 67,500 clinic stops.

b. Non-Affiliated: each range represents 4,500 annual clinic stops generating two Ophthalmology Exam / Treatment Rooms at an annual throughput of 2,250 clinic stops each, minimum annual workload 583. Ranges 1 to 15 cover between 563 and 54,000 clinic stops.

2. Ranges 1 to 15: Optometry - Stop Code 408

a. Affiliated: each range represents 3,840 annual clinic stops generating two

Optometry Exam / Treatment Rooms at an annual throughput of 1,920 clinic stops each; minimum annual workload 384. Ranges 1 to 15 cover between 384 and 57,600 clinic stops.

b. Non-Affiliated: each range represents 4,800 annual clinic stops generating two Optometry Exam / Treatment Rooms at an annual throughput of 2,400 clinic stops each, minimum annual workload 480. Ranges 1 to 15 cover between 480 and 72,000 clinic stops.

F. The SPCM metrics are translated into one (or more) Room Criteria Statement (RCS) for each room in Section 5 of this document. The SPCM Planning Range, the maximum number of directly workload-driven Exam / Treatment Rooms for both Ophthalmology and Optometry are 30 each. If a project shall require provision of workload driven rooms above the maximum range value refer to CFM for guidance. Rooms in this space planning document are organized in five Functional Areas (FAs) for Ophthalmology, five for Optometry and one for Optical Fitting.

G. Based on its intended function, each room / space is assigned a:

1. Room Name (RN),

2. Room Code (RC),

3. Room Area, the Net Square Feet (NSF) and its corresponding “soft metric” Net Square Meters (NSM),

4. Unique Room Criteria Statement(s) (RCSs) correlated to answers to Input Data Statements (IDSs), and

5. Room Comment as needed.

H. The Room Codes included in this chapter stem from the VA Room Family. A unique support space, that may have variable area, is assigned a unique Room Code, and adopts the square footage, as needed, correlated to the room contents assigned which in turn correspond to the range for those rooms. A unique clinical space or a direct clinical support room, i.e., control room, system components room, etc. typically does not feature variable NSF. Patient Care room names for rooms unique to this chapter end in “, Eye Clnc”. Patient Care Support room names end in “, Bldg Sprt”, “Clncl Sprt”, “Stff Sprt”, or “, Vet Sprt”, correlating to Building, Clinical, Staff or Veteran Support room families.

I. Section 5, Sub-Section F lists the SEPS Importer Shortcuts used for implementation of Sections 4 & 5 in SEPS. These shortcuts are inserted into the Room Criteria Statement (RCS) for each room which upon upload into the Space and Equipment Planning System (SEPS) allowing planners developing VA healthcare projects to determine quantity and square footage of each room by performing mathematical or logical calculations.

Shortcuts refer Input Data Statements (IDSs), Rooms or calculation parameters stemming from the SPCM.

J. SEPS is accessible to government healthcare planners and private sector consultants working on VA HC projects during their Period of Performance (PoP) through the MAX.gov website; government provided Training is a requisite for access.

K. SEPS incorporates a Net-to-Department Gross factor (NTDG) factor of 1.60 for Eye Clinic and a Building Gross factor of 1.35 in the space calculation to generate the Department Gross Square Feet (DGSF) and the Building Gross Square Feet (BGSF) respectively for the project based on the aggregate resulting Net Square Feet (NSF) for each range. Planners can adjust the BGSF factor in SEPS; the NTDG factor is fixed.

L. Refer to the chapter corresponding PG-18-5 Equipment Guidelist for the Room Content assignment for each room during the planning phase of a project.

M. Refer to the chapter corresponding PG-18-12: Design Guide, if available, during the planning and design phases of a project. Not all PG-18-9 clinical chapters have a corresponding PG-18-12 document, please refer to the VA-TIL.

N. The space planning and design Program Guides: PG-18-9, PG-18-5, and PG-18-12 are available at the Department of Veterans Affairs Office of Construction and Facilities Management (CFM) Technical Information Library (TIL) website.

4 OPHTHALMOLOGY SERVICE INPUT DATA STATEMENTS (IDS)

A. Is Ophthalmology Service authorized? (M)

1. Is Ophthalmology Service Affiliated? (M)

2. How many annual Ophthalmology Service clinic stops (Stop Code 407) are projected? (W) (Values: 450 to 67,500)

5 OPHTHALMOLOGY SERVICE SPACE PLANNING CRITERIA

A. FA 1: OPHTHALMOLOGY SERVICE RECEPTION AREA

FA Condition: [Ophthalmology Service is authorized]

1. OPH Waiting, Bldg Sprt (SB003)..................................................130 NSF (12.1 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 2

b. Provide one at 260 NSF if [OPH Exam / Treatment rooms] is between 3 and 4

c. Provide one at 370 NSF if [OPH Exam / Treatment rooms] is between 5 and 6

d. Provide one at 520 NSF if [OPH Exam / Treatment rooms] is between 7 and 8

e. Provide one at 575 NSF if [OPH Exam / Treatment rooms] is between 9 and 10

f. Provide one at 675 NSF if [OPH Exam / Treatment rooms] is between 11 and 12

g. Provide two at 440 NSF if [OPH Exam / Treatment rooms] is between 13 and 14

h. Provide two at 520 NSF if [OPH Exam / Treatment rooms] is between 15 and 16

i. Provide two at 535 NSF if [OPH Exam / Treatment rooms] is between 17 and 18

j. Provide two at 575 NSF if [OPH Exam / Treatment rooms] is between 19 and 20

k. Provide two at 625 NSF if [OPH Exam / Treatment rooms] is between 21 and 22

l. Provide two at 675 NSF if [OPH Exam / Treatment rooms] is between 23 and 24

m. Provide two at 705 NSF if [OPH Exam / Treatment rooms] is between 25 and 26

n. Provide three at 540 NSF if [OPH Exam / Treatment rooms] is between 27 and 28

o. Provide three at 575 NSF if [OPH Exam / Treatment rooms] is between 29 and 30

2. OPH Family Waiting, Bldg Sprt (SB051) ......................................225 NSF (21.0 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 30

Allocated area accommodates two standard chairs @ 9 NSF each, one bariatric chair at 14 NSF, one accessible space @ 10 NSF, one child table and chairs @ 50 NSF, and circulation; total eight people.

3. OPH Reception, Clncl Sprt (SC183)................................................. 85 NSF (7.9 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 14

b. Provide one at 260 NSF if [OPH Exam / Treatment rooms] is between 15 and 30

4. OPH Patient Check-in Kiosk, Clncl Sprt (SC165)............................ 105 NSF (9.8 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 14

b. Provide two if [OPH Exam / Treatment rooms] is between 15 and 30

Allocated area accommodates one Display Kiosk, patient privacy area, and circulation.

5. OPH Patient Education / Resource Room, Clncl Sprt (SC171) ....... 100 NSF (9.3 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 14

b. Provide two if [OPH Exam / Treatment rooms] is between 15 and 30

Allocated area accommodates two patients and two family members.

6. OPH Public Toilet, Bldg Sprt (SB191).............................................. 60 NSF (5.6 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 14

b. Provide two if [OPH Exam / Treatment rooms] is between 15 and 30

Allocated area accommodates one accessible toilet @ 25 NSF, one wall-hung lavatory @ 12 NSF, ABA clearances, and circulation.

7. OPH Wheelchair Alcove, Bldg Sprt (SB262).................................... 30 NSF (2.8 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 14

b. Provide two if [OPH Exam / Treatment rooms] is between 15 and 30

B. FA 2: OPHTHALMOLOGY SERVICE PATIENT AREA

FA Condition: [Ophthalmology Service is authorized]

1. OPH Dilation Waiting, Bldg Sprt (SB002) ....................................... 45 NSF (4.2 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 2

b. Provide one at 100 NSF if [OPH Exam / Treatment rooms] is between 3 and 4

c. Provide one at 130 NSF if [OPH Exam / Treatment rooms] is between 5 and 6

d. Provide one at 170 NSF if [OPH Exam / Treatment rooms] is between 7 and 8

e. Provide one at 215 NSF if [OPH Exam / Treatment rooms] is between 9 and 10

f. Provide one at 260 NSF if [OPH Exam / Treatment rooms] is between 11 and 12

g. Provide one at 290 NSF if [OPH Exam / Treatment rooms] is between 13 and 14

h. Provide one at 330 NSF if [OPH Exam / Treatment rooms] is between 15 and 16

i. Provide one at 370 NSF if [OPH Exam / Treatment rooms] is between 17 and 18

j. Provide one at 415 NSF if [OPH Exam / Treatment rooms] is between 19 and 20

k. Provide one at 465 NSF if [OPH Exam / Treatment rooms] is between 21 and 22

l. Provide one at 520 NSF if [OPH Exam / Treatment rooms] is between 23 and 24

m. Provide one at 530 NSF if [OPH Exam / Treatment rooms] is between 25 and 26

n. Provide one at 540 NSF if [OPH Exam / Treatment rooms] is between 27 and 28

o. Provide one at 575 NSF if [OPH Exam / Treatment rooms] is between 29 and 30

2. OPH Consult Room / Viewing Room, Eye Clnc (CEY01) ...............185 NSF (17.2 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 16

b. Provide two if [OPH Exam / Treatment rooms] is between 17 and 30

Allocated area accommodates four people, Tele-retinal Reading.

3. OPH Pre-Testing / Intake Room, Eye Clnc (CEY02) ......................130 NSF (12.1 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 4

b. Provide two if [OPH Exam / Treatment rooms] is between 5 and 8

c. Provide three if [OPH Exam / Treatment rooms] is between 9 and 12

d. Provide four if [OPH Exam / Treatment rooms] is between 13 and 16

e. Provide five if [OPH Exam / Treatment rooms] is between 17 and 20

f. Provide six if [OPH Exam / Treatment rooms] is between 21 and 24

g. Provide seven if [OPH Exam / Treatment rooms] is between 25 and 28

h. Provide eight if [OPH Exam / Treatment rooms] is between 29 and 30

Allocated area accommodates corneal tomography unit, autorefractor and tonometer.

4. OPH Exam / Treatment Room, Eye Clnc (CEY03).........................130 NSF (12.1 NSM)

a. Provide two if [annual OPH clinic stops (Stop Code 407) projected] is between 563 and 4,500 and NOT [OPH is Affiliated] or [annual OPH clinic stops (Stop Code 407) projected] is between 450 and 3,600 and [OPH is Affiliated]

b. Provide four if [annual OPH clinic stops (Stop Code 407) projected] is between 4,501 and 9,000 and NOT [OPH is Affiliated] or [annual OPH clinic stops (Stop Code 407) projected] is between 3,601 and 7,200 and [OPH is Affiliated]

c. Provide six if [annual OPH clinic stops (Stop Code 407) projected] is between 9,001 and 13,500 and NOT [OPH is Affiliated] or [annual OPH clinic stops (Stop Code 407) projected] is between 7,201 and 10,800 and [OPH is Affiliated]

d. Provide eight if [annual OPH clinic stops (Stop Code 407) projected] is between 13,501 and 18,000 and NOT [OPH is Affiliated] or [annual OPH clinic stops (Stop Code 407) projected] is between 10,801 and 14,400 and [OPH is Affiliated]

e. Provide ten if [annual OPH clinic stops (Stop Code 407) projected] is between 18,001 and 22,500 and NOT [OPH is Affiliated] or [annual OPH clinic stops (Stop Code 407) projected] is between 14,401 and 18,000 and [OPH is Affiliated]

f. Provide 12 if [annual OPH clinic stops (Stop Code 407) projected] is between 22,501 and 27,000 and NOT [OPH is Affiliated] or [annual OPH clinic stops (Stop Code 407) projected] is between 18,001 and 21,600 and [OPH is Affiliated]

g. Provide 14 if [annual OPH clinic stops (Stop Code 407) projected] is between 27,001 and 31,500 and NOT [OPH is Affiliated] or [annual OPH clinic stops (Stop Code 407) projected] is between 21,601 and 25,200 and [OPH is Affiliated]

h. Provide 16 if [annual OPH clinic stops (Stop Code 407) projected] is between 31,501 and 36,000 and NOT [OPH is Affiliated] or [annual OPH clinic stops (Stop Code 407) projected] is between 25,201 and 28,800 and [OPH is Affiliated]

i. Provide 18 if [annual OPH clinic stops (Stop Code 407) projected] is between 36,001 and 40,500 and NOT [OPH is Affiliated] or [annual OPH clinic stops (Stop Code 407) projected] is between 28,801 and 32,400 and [OPH is Affiliated]

j. Provide 20 if [annual OPH clinic stops (Stop Code 407) projected] is between 40,501 and 45,000 and NOT [OPH is Affiliated] or [annual OPH clinic stops (Stop Code 407) projected] is between 32,401 and 36,000 and [OPH is Affiliated]

k. Provide 22 if [annual OPH clinic stops (Stop Code 407) projected] is between 45,001 and 49,500 and NOT [OPH is Affiliated] or [annual OPH clinic stops (Stop Code 407) projected] is between 36,001 and 39,600 and [OPH is Affiliated]

l. Provide 24 if [annual OPH clinic stops (Stop Code 407) projected] is between 49,501 and 54,000 and NOT [OPH is Affiliated] or [annual OPH clinic stops (Stop Code 407) projected] is between 39,601 and 43,200 and [OPH is Affiliated]

m. Provide 26 if [annual OPH clinic stops (Stop Code 407) projected] is between 54,001 and 58,500 and NOT [OPH is Affiliated] or [annual OPH clinic stops (Stop Code 407) projected] is between 43,201 and 46,800 and [OPH is Affiliated]

n. Provide 28 if [annual OPH clinic stops (Stop Code 407) projected] is between 58,501 and 63,000 and NOT [OPH is Affiliated] or [annual OPH clinic stops (Stop Code 407) projected] is between 46,801 and 50,400 and [OPH is Affiliated]

o. Provide 30 if [annual OPH clinic stops (Stop Code 407) projected] is between 63,001 and 67,500 and NOT [OPH is Affiliated] or [annual OPH clinic stops (Stop Code 407) projected] is between 50,401 and 54,000 and [OPH is Affiliated]

Allocated area accommodates patient exam chair, phoropter, slit lamp, refraction desk, and keratometer.

5. OPH PA Exam Room, Eye Clnc (CEY04) .......................................130 NSF (12.1 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 10

b. Provide two if [OPH Exam / Treatment rooms] is between 11 and 30

This space is for use of Physician Assistant (PA) and Nurse Practitioner to conduct patient evaluation prior to an Ophthalmic Procedure.

6. OPH Procedure Room, Eye Clnc (CEY11) .....................................225 NSF (21.0 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 30

Allocated area accommodates patient stretcher chair, operating microscope, exam light and medical distribution system.

7. OPH Visual Fields Room, Eye Clnc (CEY12)..................................130 NSF (12.1 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 8

b. Provide two if [OPH Exam / Treatment rooms] is between 9 and 16

c. Provide three if [OPH Exam / Treatment rooms] is between 17 and 24

d. Provide four if [OPH Exam / Treatment rooms] is between 25 and 30

Allocated area accommodates automated perimeter.

8. OPH Photography Room, Eye Clnc (CEY13) .................................185 NSF (17.2 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 8

b. Provide two if [OPH Exam / Treatment rooms] is between 9 and 16

c. Provide three if [OPH Exam / Treatment rooms] is between 17 and 24

d. Provide four if [OPH Exam / Treatment rooms] is between 25 and 30

Allocated area accommodates retinal imaging system, slit lamp, and fundus camera.

9. OPH Ultrasound Room, Eye Clnc (CEY14)....................................130 NSF (11.2 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 8

b. Provide two if [OPH Exam / Treatment rooms] is between 9 and 16

c. Provide three if [OPH Exam / Treatment rooms] is between 17 and 24

d. Provide four if [OPH Exam / Treatment rooms] is between 25 and 30

Allocated area accommodates an ophthalmic ultrasound.

10. OPH Tomography Room, Eye Clnc (CEY15) .................................130 NSF (12.1 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 8

b. Provide two if [OPH Exam / Treatment rooms] is between 9 and 16

c. Provide three if [OPH Exam / Treatment rooms] is between 17 and 24

d. Provide four if [OPH Exam / Treatment rooms] is between 25 and 30

Allocated area accommodates two OCTs.

11. OPH Imaging Room, Eye Clnc (CEY16).........................................130 NSF (12.1 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 13 and 30

Allocated area accommodates specular microscope and corneal topographer.

12. OPH YAG Laser Room, Eye Clnc (CEY21) .....................................130 NSF (12.1 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 30

Allocated area accommodates a YAG laser.

13. OPH Retinal Photocoagulation Laser Room, Eye Clnc (CEY22).........................................................................130 NSF (12.1 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 30

Allocated area accommodates a retinal photocoagulator laser.

14. OPH SLT Laser Room, Eye Clnc (CEY23).......................................130 NSF (12.1 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 30

Allocated area accommodates SLT laser.

15. OPH Electrodiagnostics Room, Eye Clnc (CEY24).........................130 NSF (12.1 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 30

Allocated area accommodates Electroretinography (ERG) and Visual Evoked Potential (VEP) devices.

16. OPH Specialty Testing Room, Eye Clnc (CEY25) ...........................130 NSF (12.1 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 30

Allocated area accommodates space for clinic specific equipment / emerging technology testing.

17. OPH Low Vision / Polytrauma Training Room, Eye Clnc (CEY26).........................................................................185 NSF (17.2 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 12

b. Provide two if [OPH Exam / Treatment rooms] is between 13 and 30

Allocated area accommodates three low vision training workstations.

18. OPH Low Vision / Polytrauma Training Storage Room, Eye Clnc (CEY31).........................................................................130 NSF (12.1 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 30

19. OPH Patient Toilet, Bldg Sprt (SB201)............................................ 60 NSF (5.6 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 12

b. Provide two if [OPH Exam / Treatment rooms] is between 13 and 30

Allocated NSF accommodates one accessible toilet @ 25 NSF, one accessible wall-hung lavatory @ 13 NSF, ABA clearances, and circulation. This Patient Toilet is associated with vestibulography.

C. FA 3: OPHTHALMOLOGY SERVICE SUPPORT AREA

FA Condition: [Ophthalmology Service is authorized]

1. OPH Clean Utility Room, Lgstcs Svc (SB737) .................................. 80 NSF (7.5 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 4

b. Provide one at 100 NSF if [OPH Exam / Treatment rooms] is between 5 and 8

c. Provide one at 120 NSF if [OPH Exam / Treatment rooms] is between 9 and 12

d. Provide one at 140 NSF if [OPH Exam / Treatment rooms] is between 13 and 16

e. Provide one at 160 NSF if [OPH Exam / Treatment rooms] is between 17 and 20

f. Provide one at 180 NSF if [OPH Exam / Treatment rooms] is between 21 and 24

g. Provide one at 200 NSF if [OPH Exam / Treatment rooms] is between 25 and 28

h. Provide one at 220 NSF if [OPH Exam / Treatment rooms] is between 29 and 30

2. OPH Soiled Utility Room, Lgstcs Svc (SB743).................................. 40 NSF (3.8 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 10

b. Provide one at 60 NSF if [OPH Exam / Treatment rooms] is between 11 and 20

c. Provide one at 80 NSF if [OPH Exam / Treatment rooms] is between 21 and 30

3. OPH Medication Room, Phrm Svc (SV583)..................................... 80 NSF (7.5 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 6

b. Provide one at 100 NSF if [OPH Exam / Treatment rooms] is between 7 and 12

c. Provide one at 120 NSF if [OPH Exam / Treatment rooms] is between 13 and 18

d. Provide one at 140 NSF if [OPH Exam / Treatment rooms] is between 19 and 24

e. Provide one at 160 NSF if [OPH Exam / Treatment rooms] is between 25 and 30

4. OPH Equipment Storage Room, Eye Clnc (CEY34) .......................... 80 NSF (7.5 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 4

b. Provide one at 100 NSF if [OPH Exam / Treatment rooms] is between 5 and 8

c. Provide one at 140 NSF if [OPH Exam / Treatment rooms] is between 9 and 12

d. Provide one at 180 NSF if [OPH Exam / Treatment rooms] is between 13 and 16

e. Provide one at 220 NSF if [OPH Exam / Treatment rooms] is between 17 and 20

f. Provide one at 260 NSF if [OPH Exam / Treatment rooms] is between 21 and 24

g. Provide one at 300 NSF if [OPH Exam / Treatment rooms] is between 25 and 28

h. Provide one at 340 NSF if [OPH Exam / Treatment rooms] is between 29 and 30

5. OPH Equipment Alcove, Clncl Sprt (SC079) .................................... 30 NSF (2.8 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 12

b. Provide two if [OPH Exam / Treatment rooms] is between 13 and 30

6. OPH Housekeeping Aides Closet (HAC), Bldg Sprt (SB244) ............. 60 NSF (5.6 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 30

7. OPH Supply Storage Room, Eye Clnc (CEY41)................................. 80 NSF (7.5 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 4

b. Provide one at 100 NSF if [OPH Exam / Treatment rooms] is between 5 and 8

c. Provide one at 120 NSF if [OPH Exam / Treatment rooms] is between 9 and 12

d. Provide one at 140 NSF if [OPH Exam / Treatment rooms] is between 13 and 16

e. Provide one at 160 NSF if [OPH Exam / Treatment rooms] is between 17 and 20

f. Provide one at 180 NSF if [OPH Exam / Treatment rooms] is between 21 and 24

g. Provide one at 200 NSF if [OPH Exam / Treatment rooms] is between 25 and 28

h. Provide one at 220 NSF if [OPH Exam / Treatment rooms] is between 29 and 30

8. OPH Reusable Medical Equipment (RME) Room, Eye Clnc (CEY48)............................................................................ 80 NSF (7.5 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 30

D. FA 4: OPHTHALMOLOGY SERVICE STAFF AND ADMINISTRATIVE AREA

FA Condition: [Ophthalmology Service is authorized]

1. OPH Service Chief Office, Stff Sprt (SS204) .................................. 100 NSF (9.3 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 30

2. OPH Assistant Chief Office, Stff Sprt (SS204) ............................... 100 NSF (9.3 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 30

3. Program Support Assistant Workstation, Ophthalmology (SS218) ................................................................ 56 NSF (5.3 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 30

4. OPH Program Support Assistant Workstation, Stff Sprt (SS218) .... 80 NSF (7.5 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 30

Allocated area accommodates one standard chair @ 9 NSF, one bariatric chair @ 14 NSF, one accessible space @ 10 NSF, and circulation; total three people.

5. OPH Provider Workarea, Stff Sprt (SS218) ..................................... 65 NSF (6.1 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 4

b. Provide two if [OPH Exam / Treatment rooms] is between 5 and 8

c. Provide three if [OPH Exam / Treatment rooms] is between 9 and 12

d. Provide four if [OPH Exam / Treatment rooms] is between 13 and 16

e. Provide five if [OPH Exam / Treatment rooms] is between 17 and 20

f. Provide six if [OPH Exam / Treatment rooms] is between 21 and 24

g. Provide seven if [OPH Exam / Treatment rooms] is between 25 and 28

h. Provide eight if [OPH Exam / Treatment rooms] is between 29 and 30

Allocated area accommodates a two-person touchdown workstation.

6. OPH Social Worker Office, Stff Sprt (SS203)................................130 NSF (12.1 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 30

Intake / Adjustment Counseling

7. OPH Low Vision Provider Workstation, Stff Sprt (SS218) ............... 56 NSF (5.3 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 30

8. OPH Clinic Manager Office, Stff Sprt (SS204) ............................... 100 NSF (9.3 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 30

9. OPH Administration Support Workstation, Stff Sprt (SS218) ......... 56 NSF (5.3 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 14

b. Provide two if [OPH Exam / Treatment rooms] is between 15 and 30

Allocated workstations for call center / surgery scheduler.

10. OPH Support Equipment Room, Eye Clnc (CEY49).......................120 NSF (11.2 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 14

b. Provide one at 180 NSF if [OPH Exam / Treatment rooms] is between 15 and 30

11. OPH Copy / Supply Room, Stff Sprt (SS272) ................................. 100 NSF (9.3 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 30

12. OPH Staff Conference Room, Educ Svc (SS101) ...........................240 NSF (22.3 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 4

b. Provide one at 300 NSF if [OPH Exam / Treatment rooms] is between 5 and 12

c. Provide one at 500 NSF if [OPH Exam / Treatment rooms] is between 13 and 20

d. Provide one at 675 NSF if [OPH Exam / Treatment rooms] is between 21 and 30

Allocated area accommodates six conference chairs @ 7.5 NSF each, two 5’-0” x 2’- 0” tables at 10 NSF each, one credenza @ 8 NSF, and circulation; total six people.

13. OPH Staff Breakroom, Stff Sprt (SS262) ......................................120 NSF (11.2 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 6

b. Provide one at 140 NSF if [OPH Exam / Treatment rooms] is between 7 and 12

c. Provide one at 160 NSF if [OPH Exam / Treatment rooms] is between 13 and 18

d. Provide one at 180 NSF if [OPH Exam / Treatment rooms] is between 19 and 24

e. Provide one at 200 NSF if [OPH Exam / Treatment rooms] is between 25 and 30

14. OPH Staff Personal Property Locker Room, Stff Sprt (SS251) ......... 60 NSF (5.6 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 30

Allocated area accommodates twenty-two two-tier or thirty-three three-tier personal property lockers.

15. OPH Staff Toilet, Bldg Sprt (SB191)................................................ 60 NSF (5.6 NSM)

a. Provide two if [OPH Exam / Treatment rooms] is between 1 and 30

Allocated area accommodates one accessible toilet @ 25 NSF, one wall-hung lavatory @ 12 NSF, ABA clearances, and circulation.

E. FA 5: OPHTHALMOLOGY SERVICE EDUCATION AREA

FA Condition: [Ophthalmology Service is authorized]

1. OPH Residency Director Office, Stff Sprt (SS204) ......................... 100 NSF (9.3 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 30

2. OPH Resident / Fellow Team Room, Clncl Sprt (SC243)...............180 NSF (16.8 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 30

Allocated area accommodates six people.

3. OPH Resident Training Room, Educ Svc (SS111)..........................545 NSF (50.7 NSM)

a. Provide one if [OPH Exam / Treatment rooms] is between 1 and 30

Allocated area accommodates sixteen task chairs @ 7.5 NSF each, eight 5’-0” x 2’- 0” tables at 10 NSF each, one credenza @ 8 NSF, one lectern @ 9 NSF, and circulation;

total sixteen people.

6 OPTOMETRY SERVICE INPUT DATA STATEMENTS (IDS)

A. Is Optometry Service authorized? (M)

1. Is Optometry Service Affiliated? (M)

2. How many annual Optometry Service clinic stops (Stop Code 408) are projected? (W)

(Values: 384 to 72,000)

7 OPTOMETRY SERVICE SPACE PLANNING CRITERIA

A. FA 6: OPTOMETRY SERVICE RECEPTION AREA

FA Condition: [Optometry Service is authorized]

1. OPT Waiting, Bldg Sprt (SB003) ..................................................130 NSF (12.1 NSM)

a. Provide one if [OPT Exam / Treatment rooms] is between 1 and 2

b. Provide one at 260 NSF if [OPT Exam / Treatment rooms] is between 3 and 4

c. Provide one at 370 NSF if [OPT Exam / Treatment rooms] is between 5 and 6

d. Provide one at 520 NSF if [OPT Exam / Treatment rooms] is between 7 and 8

e. Provide one at 575 NSF if [OPT Exam / Treatment rooms] is between 9 and 10

f.…