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U of M Maxillofacial Imaging Clinic 7-238 Malcolm Moos Health Sciences Tower 515 Delaware Street S.E., Minneapolis, MN 55455 Apt. Phone: 612-624-6061 Apt. Fax: 612-625-5758 Consult Phone: 612-624-1791
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How to fill out referral form_jul09ai - dentistry:

01
Begin by entering the patient's personal information, such as their full name, date of birth, and contact details.
02
Provide the patient's medical history, including any relevant allergies, past surgeries, and current medications being taken.
03
Specify the referring dentist's information, including their name, clinic or practice name, and contact details.
04
Indicate the reason for the referral, whether it is for a specific dental procedure or consultation with a specialist.
05
Include any additional information or notes that may be relevant to the referral, such as specific concerns or requests.

Who needs referral form_jul09ai - dentistry?

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Dentists who require specialist consultation for complex cases or specific dental procedures may need to fill out the referral form_jul09ai - dentistry.
02
Patients who are referred to a specialist or need further dental treatment beyond the scope of their current dentist may also need this referral form.
03
Dental clinics or practices that have a referral system in place may use this form to refer patients to other dental professionals or specialists.
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Referral form_jul09ai - dentistry is a document used in the field of dentistry to refer a patient to another dental specialist or healthcare provider.
Dentists or dental practitioners who need to refer their patients to another dental specialist or healthcare provider are required to file referral form_jul09ai - dentistry.
To fill out referral form_jul09ai - dentistry, you need to provide the patient's information, reason for the referral, recommended healthcare provider, and any additional relevant details.
The purpose of referral form_jul09ai - dentistry is to facilitate the smooth transfer of a patient's care from one dental professional to another, ensuring effective communication and continuity of treatment.
The referral form_jul09ai - dentistry typically requires reporting of the patient's personal details, medical history, reason for the referral, recommended provider, and any relevant diagnostics or treatment plans.
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