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REFERRAL FOR ORTHODONTIC TREATMENT Only HCA DEN2 is accepted. Any altered form by the provider will be rejected. REFERRING DENTIST: ADDRESS: TELEPHONE: FAX: EMAIL: SOONER CARE MEMBER: SOONER CARE
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How to fill out referral for orthodontic treatment
How to fill out referral for orthodontic treatment
01
Before filling out a referral for orthodontic treatment, make sure you have all the necessary information about the patient, including their full name, contact information, date of birth, and medical history.
02
Include a brief description of the orthodontic problem or reason for the referral.
03
Specify the urgency or priority level for the referral, if applicable.
04
Indicate any relevant pre-existing conditions or special needs of the patient.
05
Include any relevant dental records or X-rays, if available.
06
Provide your contact information and the contact information of the orthodontic specialist or facility to whom you are referring the patient.
07
Sign and date the referral form before sending it to the orthodontist.
Who needs referral for orthodontic treatment?
01
Referral for orthodontic treatment is typically required for individuals who require specialized orthodontic care beyond what a general dentist can provide.
02
Patients with moderate to severe malocclusions (misaligned teeth or bite) may need a referral for orthodontic treatment.
03
Individuals with complex dental cases or jaw abnormalities may also require a referral.
04
Patients who need specialized orthodontic appliances, such as braces or aligners, are likely to need a referral.
05
It is best to consult with a dentist or orthodontist to determine if a referral for orthodontic treatment is necessary.
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What is referral for orthodontic treatment?
Referral for orthodontic treatment is a recommendation from a general dentist or other healthcare provider for a patient to see an orthodontist to address issues with teeth alignment.
Who is required to file referral for orthodontic treatment?
Referrals for orthodontic treatment can be filed by general dentists, pediatric dentists, or other healthcare providers who identify the need for orthodontic intervention.
How to fill out referral for orthodontic treatment?
To fill out a referral for orthodontic treatment, the healthcare provider must include the patient's personal information, reason for referral, relevant medical history, and any other pertinent details.
What is the purpose of referral for orthodontic treatment?
The purpose of a referral for orthodontic treatment is to connect patients with the specialized care and expertise of an orthodontist to address specific dental issues.
What information must be reported on referral for orthodontic treatment?
Information that must be reported on a referral for orthodontic treatment includes patient's name, contact information, reason for referral, relevant medical history, and any other pertinent details.
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