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This form is to obtain information from a Community Health Aide/Practitioner (CHA/P) or Dental Health Aide Therapist (DHAT) Provider and confirm their agreement to comply with required federal and
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How to fill out community health aidepractitioner chap
How to fill out Community Health Aide/Practitioner (CHA/P) / Dental Health Aide Therapist (DHAT) Provider Enrollment Agreement
01
Obtain the Community Health Aide/Practitioner (CHA/P) / Dental Health Aide Therapist (DHAT) Provider Enrollment Agreement form from the official website or relevant authority.
02
Read the instructions and guidelines provided with the form carefully to understand the requirements.
03
Fill in personal information such as name, address, phone number, and email at the designated sections.
04
Provide your professional credentials, including any certifications and licenses relevant to CHA/P or DHAT roles.
05
Complete sections related to your employment history, highlighting past positions in healthcare settings.
06
Disclose any relevant training or continuing education courses completed.
07
Provide information about your supervising physician or healthcare organization if applicable.
08
Review the filled form for accuracy and completeness.
09
Sign and date the form to certify the information provided is true.
10
Submit the completed agreement to the designated authority via email, mail, or online submission as instructed.
Who needs Community Health Aide/Practitioner (CHA/P) / Dental Health Aide Therapist (DHAT) Provider Enrollment Agreement?
01
Healthcare professionals who wish to provide community health or dental health services in Alaskan rural areas.
02
Individuals seeking certification to work as a Community Health Aide/Practitioner or Dental Health Aide Therapist.
03
Organizations or clinics that require CHA/P or DHAT services in order to improve access to healthcare in underserved communities.
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People Also Ask about
How much do dental therapists make in Alaska?
How much does a Dental Therapist make in Alaska? As of Aug 18, 2025, the average annual pay for a Dental Therapist in Alaska is $68,864 a year. Just in case you need a simple salary calculator, that works out to be approximately $33.11 an hour. This is the equivalent of $1,324/week or $5,738/month.
How to become a Dental Therapist in the USA?
To become a Dental Therapist, you need to graduate from an accredited Dental Therapy Education Program prior to obtaining a license. Programs are approximately three years long. Because dental therapy is a newer profession, the Bureau of Labor Statistics doesn't currently provide salary information.
What is the dental health aide therapist program in Alaska?
ADTEP educates Dental Health Aide Therapists through a partnership between the Alaska Native Tribal Health Consortium, and Ilisagvik College. Students earn and Associate's of Applied Science Degree in Dental Therapy. The program is 3 academic years, taken over 2 calendar years, our classes start in May each year.
What's the difference between dental hygienist and Dental Therapist?
A dental hygienist is a healthcare professional who is dedicated to looking after the health of your teeth. They often provide a thorough teeth cleaning service called a scale and polish. Whereas a dental therapist can offer a wider range of care including checkups, fillings and children's dentistry too.
What is the dental therapy educational program in Alaska?
ADTEP educates Dental Health Aide Therapists through a partnership between the Alaska Native Tribal Health Consortium, and Ilisagvik College. Students earn and Associate's of Applied Science Degree in Dental Therapy. The program is 3 academic years, taken over 2 calendar years, our classes start in May each year.
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What is Community Health Aide/Practitioner (CHA/P) / Dental Health Aide Therapist (DHAT) Provider Enrollment Agreement?
The Community Health Aide/Practitioner (CHA/P) / Dental Health Aide Therapist (DHAT) Provider Enrollment Agreement is a formal document that establishes the qualifications and authority of health aides and therapists to provide healthcare services within designated communities, ensuring compliance with regulatory standards.
Who is required to file Community Health Aide/Practitioner (CHA/P) / Dental Health Aide Therapist (DHAT) Provider Enrollment Agreement?
Individuals who are seeking to become certified or are working as Community Health Aides/Practitioners (CHA/P) or Dental Health Aide Therapists (DHAT) are required to file the Provider Enrollment Agreement.
How to fill out Community Health Aide/Practitioner (CHA/P) / Dental Health Aide Therapist (DHAT) Provider Enrollment Agreement?
To fill out the Provider Enrollment Agreement, applicants should provide personal identification information, educational qualifications, relevant work experience, and any required endorsements or certifications. Detailed instructions are typically provided within the enrollment forms.
What is the purpose of Community Health Aide/Practitioner (CHA/P) / Dental Health Aide Therapist (DHAT) Provider Enrollment Agreement?
The purpose of the Provider Enrollment Agreement is to ensure that the enrolled individuals meet the necessary qualifications and standards to provide care, enhancing the quality of healthcare services in underserved communities.
What information must be reported on Community Health Aide/Practitioner (CHA/P) / Dental Health Aide Therapist (DHAT) Provider Enrollment Agreement?
The information required typically includes the applicant's full name, contact details, professional credentials, training history, and any disciplinary actions or malpractice claims, along with other relevant medical history that supports their eligibility.
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