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GREENE AREA MEDICAL EXTENDERS, INC School Health Services P.O. Box 160, Lakeville, MS 39451 20152016 Preventive Dental Consent September 25, 2015, Dear Parent×Guardian, Your child is eligible to
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How to fill out 2015-2016 preventive dental consent:

01
Start by carefully reading the consent form to understand the information and requirements.
02
Provide your personal information accurately, including your full name, date of birth, address, and contact details.
03
If applicable, fill out the section regarding your dental insurance information, including the policy number and provider name.
04
Read the terms and conditions section carefully and check any boxes or sign where required to indicate your consent.
05
If there is a section for medical history, provide any relevant information about your health or dental conditions.
06
If there is a section for medications, list any medications you are currently taking, including dosage and frequency.
07
Review the form for completeness and accuracy before signing and dating it.
08
Return the completed form to the appropriate dental office or healthcare provider.

Who needs 2015-2016 preventive dental consent?

01
Patients who are visiting a dental office or receiving dental treatment during the 2015-2016 period may need to fill out the preventive dental consent form.
02
This form is typically required for individuals undergoing preventive dental procedures such as cleanings, exams, X-rays, and other routine dental treatments.
03
The consent form is safeguarding the patient's rights by ensuring they understand the procedures, potential risks, and benefits before undergoing any dental treatment within the stated time frame.
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Preventive dental consent is obtaining permission from a patient to perform necessary preventive dental procedures.
Dentists and dental professionals are required to file preventive dental consent for their patients.
Preventive dental consent is filled out by providing the necessary information about the patient and the recommended preventive dental procedures.
The purpose of preventive dental consent is to ensure that patients are informed about the recommended preventive dental procedures and give consent for the treatment.
Information such as patient’s name, date of birth, recommended procedures, and the risks and benefits associated with the procedures must be reported on preventive dental consent.
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