Get the free Dental Specialty Referral Request Form - Health Choice Arizona

Health Choice Arizona, Inc. Dental Specialty Referral Request Form Print Form Complete all Member I n f o r m a t i o n Please print a copy of t h i s form and Fax to 4803502217, Send it to HCADentalDepartment

How to fill out dental specialty referral request

How to fill out dental specialty referral request

1. Gather all necessary information such as patient's name, contact details, and dental history.
2. Identify the specific dental specialty required for the referral.
3. Obtain the referral request form from the appropriate source, such as the dental office or the specialist's office.
4. Make sure to fill out all the required fields on the referral request form accurately.
5. Provide any relevant additional information or notes that may assist the specialist in understanding the patient's condition or needs.
6. Include any applicable dental records or diagnostic test results that support the referral.
7. Double-check the completed referral request form for any errors or missing information.
8. Submit the referral request to the designated recipient, either by fax, email, or in person as instructed.
9. Keep a copy of the referral request for your records.
10. Follow up with the patient to ensure they have received the necessary appointment details from the specialist.

Who needs dental specialty referral request?

1. Patients who require specialized dental treatment beyond the scope of general dentistry.
2. Dentists who identify a need for their patients to receive care from a dental specialist.
3. Dental hygienists, oral surgeons, or other dental professionals who recognize the need for referring patients to a specialist.
4. Insurance companies or healthcare providers that require a formal referral for coverage purposes.

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