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Mobile Dental Cardinal Referral Formulas fax this completed referral form and the residents current face sheet to 800.986.1139NOTE: Both pages 1 & 2 of the ORIGINAL, signed H1263B are required for
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How to fill out mobile dental care

01
Gather all necessary documents and information, such as your personal identification, dental insurance details, and any relevant medical history.
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Research mobile dental care providers in your area and choose one that suits your needs.
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Follow any specific instructions provided by the mobile dental care provider, such as fasting before certain procedures.
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Who needs mobile dental care?

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Mobile dental care is beneficial for various individuals, including:
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- Elderly individuals who may have difficulty traveling to a traditional dental office.
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- Individuals with physical disabilities or limited mobility who require dental care at their location.
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- Individuals residing in rural or remote areas with limited access to dental services.
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- People with busy schedules who find it challenging to take time off for dental appointments.
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- Individuals who are homebound or bedridden due to illness or injury, requiring dental care at their place of residence.
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Mobile dental care refers to dental services provided in a non-traditional setting, often using a mobile unit to visit patients at home, schools, or community centers, enhancing accessibility for individuals who may have difficulty accessing dental services.
Dental providers and organizations that operate mobile dental clinics or provide mobile dental services are typically required to file mobile dental care documentation.
To fill out mobile dental care documentation, providers must gather patient information, treatment details, and service location, and complete the required forms according to the guidelines set by the relevant health authorities.
The purpose of mobile dental care is to improve access to oral health services for underserved populations, promote preventive care, and reduce barriers to receiving dental treatment.
Information that must be reported includes patient demographics, types of services provided, outcomes of the treatments, and any relevant follow-up actions.
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