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Orthodontic Continuation of Care Submission Form and Instructions Date: Member Information (Required) Name (First & Last) Date of Birth: SS or ID# Address: City, State, Zip Area code & Phone number:

How to fill out orthodontic continuation of care

How to fill out orthodontic continuation of care:

1. Start by filling out your personal information, including your name, address, phone number, and date of birth.
2. Provide your orthodontist's name and contact information, as well as the date of your last visit.
3. Indicate any changes in your medical history since your last visit, such as new medications or allergies.
4. Next, detail any concerns or current issues you are experiencing with your orthodontic treatment.
5. If applicable, list any updates or changes to your insurance information.
6. Sign and date the form to acknowledge that the information provided is accurate and up to date.

Who needs orthodontic continuation of care:

1. Individuals who are currently undergoing orthodontic treatment, such as braces or aligners, would need orthodontic continuation of care.
2. Patients who have completed their orthodontic treatment but require ongoing monitoring and maintenance may also benefit from this continuation of care.
3. Those who have previously had orthodontic treatment but are experiencing relapse or have concerns about their dental alignment might also require orthodontic continuation of care to address these issues.

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What is orthodontic continuation of care?

Orthodontic continuation of care is a process where a patient continues their orthodontic treatment with the same orthodontist or a new orthodontist after the initial treatment has been completed.

Who is required to file orthodontic continuation of care?

The orthodontist who provided the initial orthodontic treatment is required to file orthodontic continuation of care.

How to fill out orthodontic continuation of care?

Orthodontic continuation of care can be filled out by providing the necessary patient information, treatment details, and future treatment plans, and submitting it to the relevant authorities.

What is the purpose of orthodontic continuation of care?

The purpose of orthodontic continuation of care is to ensure that the patient's orthodontic treatment is properly documented and followed up on by the orthodontist.

What information must be reported on orthodontic continuation of care?

Orthodontic continuation of care must include patient information, details of the initial treatment, future treatment plans, and any relevant notes or recommendations by the orthodontist.