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NORTH CAROLINA MEDICAID PROGRAM. ORTHODONTIC TREATMENT TERMINATION REQUEST. Date: Return this letter to: PA. PO Box 31188. Raleigh ...

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What is orthodontic treatment termination request?

Orthodontic treatment termination request is a formal request to end orthodontic treatment for a patient.

Who is required to file orthodontic treatment termination request?

Orthodontic treatment termination request must be filed by the patient or their legal guardian.

How to fill out orthodontic treatment termination request?

To fill out orthodontic treatment termination request, the patient or legal guardian must provide their personal information, treatment details, reason for termination, and signature.

What is the purpose of orthodontic treatment termination request?

The purpose of orthodontic treatment termination request is to formally request to end orthodontic treatment for a patient.

What information must be reported on orthodontic treatment termination request?

Orthodontic treatment termination request must include personal information of the patient, treatment details, reason for termination, and signature.

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