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NC Division of Medical Assistance Physician Fluoride Varnish Services Medicaid and Health Choice Clinical Coverage Policy No.: 1A23 Amended Date: October 1, 2015Table of Contents 1.0Description of
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How to fill out physician fluoride varnish services:

01
Gather the necessary information: Before filling out physician fluoride varnish services, ensure you have the required details such as the patient's name, age, medical history, and any specific instructions from the dentist or physician.
02
Complete the patient information section: Start by filling out the patient information section accurately. Include the patient's name, contact information, and any relevant medical history. This will help the healthcare provider determine if the fluoride varnish is suitable for the patient.
03
Document the physician's instructions: If the physician has provided specific instructions regarding the fluoride varnish application, make sure to document them accurately in the appropriate section of the form. This can include details about the type of fluoride varnish to be used, the frequency of application, and any precautions or contraindications.
04
Document the application process: Include a step-by-step description of the fluoride varnish application process. This may include information about preparing the patient, applying the varnish, and any necessary post-application instructions. Be sure to follow any guidelines or protocols provided by the physician or dental professional.
05
Obtain patient consent: Ensure that the patient or their guardian understands the purpose and potential risks of fluoride varnish application. Obtain their consent by having them sign the appropriate section of the form. This is crucial for legal and ethical reasons.
06
Note any additional recommendations: If the physician has suggested any additional oral hygiene practices or lifestyle changes to complement the fluoride varnish treatment, include them in the recommendations section. These can help improve the effectiveness of the treatment and overall oral health.

Who needs physician fluoride varnish services?

01
Children and adolescents: Physician fluoride varnish services are often recommended for children and adolescents as they are more prone to tooth decay and cavities. The varnish helps strengthen the tooth enamel and protect against acid attacks.
02
Individuals with high cavity risk: Adults who have a higher risk of developing cavities, such as those with poor oral hygiene habits, dry mouth, or a history of dental caries, may benefit from physician fluoride varnish services. It can provide added protection and prevent tooth decay.
03
Patients with special needs: People with special needs or disabilities often face challenges in maintaining optimal oral hygiene. Physician fluoride varnish services can help protect their teeth from decay and improve their oral health.
04
Seniors: Older adults may experience a decline in oral health due to aging, medical conditions, or medication use. Physician fluoride varnish services can be beneficial in preventing tooth decay and maintaining oral hygiene in this population.
05
Individuals undergoing orthodontic treatment: Patients wearing braces or other orthodontic appliances may find it more difficult to clean their teeth properly. Physician fluoride varnish services can be beneficial in minimizing the risk of tooth decay during orthodontic treatment.
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Physician fluoride varnish services involve the application of fluoride varnish by a healthcare provider to prevent tooth decay.
Healthcare providers who administer fluoride varnish are required to file physician fluoride varnish services.
Physician fluoride varnish services can be filled out by providing details on the patient, procedure, and outcomes of the fluoride varnish application.
The purpose of physician fluoride varnish services is to protect teeth from decay and strengthen tooth enamel.
Information such as patient demographics, date of service, provider details, and procedure specifics must be reported on physician fluoride varnish services.
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