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ClearPrintNonInsured Health Benefits Completion of Active Orthodontic Treatment Form Provider Information Name:Provider Number: Mailing Address: Client Information Name: Client Registration Number:
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How to fill out completion of active orthodontic

01
To fill out completion of active orthodontic, follow these steps:
02
Gather all the necessary information and documents related to the patient’s orthodontic treatment.
03
Start by filling out the patient's personal information, such as their name, date of birth, and contact details.
04
Specify the dates of the initial orthodontic treatment and the expected completion date for the active treatment.
05
Indicate the type of orthodontic appliance used, such as braces or aligners.
06
Describe any special instructions or precautions that need to be followed during the completion phase.
07
Include any additional notes or comments relevant to the patient's orthodontic treatment.
08
Once all the required information is provided, review the completion form for accuracy and completeness.
09
Obtain the necessary signatures from the patient, their guardian (if applicable), and the orthodontist.
10
Keep a copy of the completed form in the patient's orthodontic records and provide a copy to the patient.

Who needs completion of active orthodontic?

01
Completion of active orthodontic is typically needed by patients who have undergone orthodontic treatment and are now in the final phase of completing their treatment.
02
This includes individuals who have worn braces, aligners, or any other orthodontic appliances to correct dental misalignments.
03
Completion of active orthodontic is necessary to document the patient's progress, verify the successful completion of treatment, and plan for post-treatment orthodontic care if required.
04
Orthodontists, dental professionals, and orthodontic clinics also require completion of active orthodontic forms for record-keeping and treatment documentation purposes.
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