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Delta Dental of New York ATTENDING DENTISTS STATEMENT One Delta Drive Mechanicsburg, PA 170556999 (717) 7668500 (800) 9320783 TTY/TDD 8883733582 www.MidAtlanticDeltaDental.com SIGN BELOW FOR PREDETERMINATION

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Who needs employee must complete items:

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What is employee must complete items?

Employee must complete items are tasks or forms that employees are required to fill out or complete in order to comply with company policies or legal regulations.

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Employees are usually required to file employee must complete items.

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