Get the free Patient / Parent or Guardian Signature - Chartwell Dental Group
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ARE ANY OF YOUR FAMILY MEMBERS PATIENTS OF THIS PRACTICE? ...authorizes this Practice to submit insurance claim forms and receive payment...
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How to fill out patient parent or guardian
How to fill out patient parent or guardian:
01
Fill out the patient parent or guardian section with the required information.
02
Provide the full name of the patient's parent or legal guardian.
03
Add the contact details of the parent or guardian, including their phone number and email address.
04
Indicate the relationship of the parent or guardian to the patient, specifying if they are a parent, legal guardian, or other relationship.
05
If there are any specific instructions or preferences regarding the parent or guardian's involvement in the patient's care, include them in the appropriate fields.
06
Review the completed section for accuracy and legibility before submitting the form.
Who needs patient parent or guardian:
01
Patients who are minors and cannot give their consent for medical treatment on their own typically need a parent or guardian to fill out this section.
02
In some cases, even adult patients who may require assistance or have certain cognitive impairments may need a designated person to act as their parent or guardian.
03
Patients who have legal guardians appointed by the court will also require their guardian's information in this section.
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