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Ronald McDonald CARE MOBILE A PROGRAM OF THE CONTRA COSTA DENTAL COLLABORATIVE Mobile Dental Clinic Referral Person: Referral Origin: Children's Oral Health Program Phone: Email: Date: / / Patients

How to fill out mobile dental clinic referral

How to fill out a mobile dental clinic referral:

1. Gather your personal information: Start by providing your name, address, phone number, and any other contact details required.
2. Provide your dental insurance information: If you have dental insurance, include the name of your insurance company, your policy number, and any other relevant information.
3. Describe your dental issue: Clearly explain the reason for seeking dental care and the specific problem you are experiencing. This will help the dental clinic understand your needs and prioritize your appointment.
4. Mention any relevant medical history: If you have any medical conditions or take medications that may impact your dental treatment, include this information. It is important for the dental team to be aware of any existing health conditions.
5. Specify your preferred appointment date and time: Indicate your availability and any preferences you may have regarding the appointment schedule. This helps the clinic in scheduling your visit accordingly.
6. Include any additional notes or instructions: If there are any specific instructions or requests you have for the dental clinic, make sure to mention them to ensure the best possible care.
7. Submit the referral: Once you have completed the referral form, make sure to submit it to the mobile dental clinic according to their preferred method, such as by email, fax, or in person.

Who needs a mobile dental clinic referral?

1. Individuals without regular access to dental care: Mobile dental clinics often serve communities or populations that have limited access to traditional dental practices. These can include underserved areas, remote locations, or individuals with transportation challenges.
2. People in need of specialized dental services: Mobile dental clinics may provide specialized services such as pediatric dentistry, geriatric dentistry, or oral surgery. Individuals who require these specific services may need a referral to be seen at the mobile clinic.
3. Patients requiring follow-up or ongoing dental care: Mobile dental clinics may partner with local dental practices or health care providers to provide follow-up or ongoing care to patients. In such cases, a referral may be necessary to ensure continuity of treatment.

Remember, it is essential to check with the specific mobile dental clinic or your healthcare provider to determine their referral requirements and procedures.

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What is mobile dental clinic referral?

Mobile dental clinic referral is a form used to refer patients to a mobile dental clinic for dental services.

Who is required to file mobile dental clinic referral?

Dentists or medical professionals who identify a patient in need of dental services from a mobile dental clinic are required to file the referral.

How to fill out mobile dental clinic referral?

To fill out a mobile dental clinic referral, the referring dentist or medical professional must provide the patient's information, reason for referral, and any relevant medical history.

What is the purpose of mobile dental clinic referral?

The purpose of mobile dental clinic referral is to connect patients in need of dental services with mobile dental clinics that can provide those services.

What information must be reported on mobile dental clinic referral?

The mobile dental clinic referral form must include the patient's name, contact information, reason for referral, relevant medical history, and any other pertinent details.