Periodontal Referral Form 2007-2025 free printable template

Reason for Referral o Periodontal Evaluation Only o Bone Graft o Implant o Osseous Surgery o Crown Lengthening o Gingivectomy o Tissue Grafts.

How to fill out periodontal referral form

How to fill out Periodontal Referral Form

1. Begin by entering the patient's basic information, including their name, age, and contact details.
2. Specify the referring dentist's information, such as name and contact number.
3. Indicate the reason for referral, detailing any specific periodontal issues observed.
4. Complete the patient's medical history, noting any relevant conditions that may affect periodontal treatment.
5. Include any recent radiographs or clinical information that may assist the periodontist.
6. Signature and date the form to validate the referral.

Who needs Periodontal Referral Form?

1. Patients with signs of periodontal disease, such as gum inflammation, pockets around teeth, or bone loss.
2. Dentists who identify complex periodontal cases requiring specialized evaluation and treatment.
3. Individuals experiencing symptoms like persistent bad breath, loose teeth, or gum recession.

People Also Ask about

What are 3 conditions that a periodontist may treat?

Conditions a Periodontist Can Treat Periodontitist. First and foremost, a “periodontist” treats “periodontitis.” This oral health condition is where the profession derives its name, so you can rest assured that as a periodontist in Kentucky, Dr. Gum Recession. Bone Loss. Loose or Missing Teeth. Cosmetic Gum Surgery.

How do I write a referral letter for dentistry?

Referring dentist's name, address and a telephone number. The patient's name, date of birth, address and telephone number. An indication of the urgency of the referral. The presenting complaint. History of the presenting complaint. Clinical findings. Relevant medical history. Whether an opinion or management is sought.

Why refer to a periodontist?

Your dentist may refer you to a periodontist if they determine that: Your gums have receded or you complain of them being sensitive. You have bad breath that does not improve even after you have brushed your teeth. Your gums bleed while you are eating or brushing your teeth.

What is the difference between D4341 and D4342?

Difference between D4341 and D4342 and Benefits The only difference between these codes is four or more teeth per quadrant or one to three teeth per quadrant. D4342 set your fee at 75% of the quadrant, while D4341 set your practice fee at 40-50%.

What are the benefits of seeing a periodontist?

The Benefits of Seeing a Periodontist Who is a Periodontist? First things first. Key Benefits of Visiting a Periodontist. Periodontists Can Help Prevent Unnecessary Tooth Loss. A Periodontist Will Provide Specialized Dental Care. Replacement of Missing Teeth. Handling Advanced Cases of Gum Disease. Bottom Line.

When should a dentist refer to a periodontist?

In the course of a regular dental check-up, if the general dentist or hygienist finds symptoms of gingivitis or rapidly progressing periodontal disease, a consultation with a periodontist may be recommended. However, a referral is not necessary for a periodontal consultation.

Why would I be referred to a periodontist?

When Will A Dentist Refer You To A Periodontist? Your dentist may refer you to a periodontist if they determine that: Your gums have receded or you complain of them being sensitive. You have bad breath that does not improve even after you have brushed your teeth.

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What is Periodontal Referral Form?

The Periodontal Referral Form is a document used by dental professionals to refer patients to a periodontal specialist for evaluation or treatment of gum diseases.

Who is required to file Periodontal Referral Form?

Typically, general dentists or oral health practitioners are required to file the Periodontal Referral Form when they identify a patient with periodontal issues that need specialized care.

How to fill out Periodontal Referral Form?

To fill out the Periodontal Referral Form, the referring dentist needs to provide patient information, clinical findings, and the reason for the referral, and ensure that all sections of the form are completed accurately.

What is the purpose of Periodontal Referral Form?

The purpose of the Periodontal Referral Form is to communicate specific patient information and treatment needs to the periodontal specialist to ensure effective care.

What information must be reported on Periodontal Referral Form?

The information that must be reported on the Periodontal Referral Form includes patient demographics, medical history, periodontal examination findings, treatment history, and the specific reasons for the referral.