Get the free PATIENT REFERAL FORM ORTHOGNATHIC amp CRANIOFACIAL

PATIENT REFERRAL FORM ORTHOGRAPHIC & CRANIOFACIAL Introducing: Appointment: Referred by: Ray Sent: With Patient By Mail Remarks: Directions: By Email: front desk fallonoralsurgery.com By Fax: 1.315.453.0150

How to fill out patient referal form orthognathic

How to fill out a patient referral form for orthognathic surgery:

1. Start by filling out the basic information section of the form. This typically includes the patient's full name, date of birth, contact information, and insurance details.
2. Provide information about the referring dentist or orthodontist. Include their name, contact information, and any relevant specializations or qualifications.
3. Indicate the reason for the referral. Specify the type of orthognathic surgery required and provide a brief explanation of the patient's condition or orthodontic concerns.
4. Include any relevant medical history of the patient. This may include allergies, chronic illnesses, or past surgeries that could impact the orthognathic procedure.
5. Document the patient's current orthodontic treatment plan, if applicable. This section is essential to align orthodontic treatment with the orthognathic surgery.
6. Specify any additional tests or examinations that have been performed, such as X-rays, CT scans, or other diagnostic imaging. Attach relevant reports or images to support the referral.
7. If necessary, provide additional information about the patient's oral health status, including any significant dental issues, oral hygiene practices, or concerns related to the proposed surgery.
8. Finally, don't forget to sign and date the referral form. This ensures that the referral is valid and authorizes the patient's transfer to a specialist or surgical center.

Who needs a patient referral form for orthognathic surgery:

1. Patients who have been diagnosed with severe malocclusion or misalignment of the jaw.
2. Individuals who have experienced facial trauma leading to jaw misalignment.
3. Patients requiring significant surgical and orthodontic intervention to correct functional and aesthetic issues associated with their bite and facial structure.

It is important to note that the specific requirements for a patient referral form may vary between different medical and dental practices, so it is always advisable to consult with the relevant healthcare professionals or facility regarding their specific requirements.

For pdfFiller’s FAQs

What is patient referal form orthognathic?

The patient referral form orthognathic is a document used to refer a patient to an orthognathic surgeon for assessment and treatment.

Who is required to file patient referal form orthognathic?

Dentists, orthodontists, or other healthcare providers may be required to file the patient referral form for orthognathic surgery.

How to fill out patient referal form orthognathic?

The patient referral form for orthognathic surgery typically requires information about the patient's medical history, dental records, and reason for referral.

What is the purpose of patient referal form orthognathic?

The purpose of the patient referral form for orthognathic surgery is to facilitate communication between healthcare providers and ensure the patient receives appropriate care.

What information must be reported on patient referal form orthognathic?

The patient referral form for orthognathic surgery may require information such as patient demographics, medical history, dental records, and reason for referral.

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