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To:AmeriHealth Capital Pennsylvania Primary Care ProvidersDate: January 20, 2021, Re:Discontinuation of Dental referral fax format decrease your offices administrative burden, effective immediately
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How to fill out discontinuation of dental referral
How to fill out discontinuation of dental referral
01
To fill out discontinuation of dental referral, follow these steps:
02
Begin by entering the patient's personal information, such as their name, date of birth, and contact details.
03
Provide details about the referring dentist, including their name, address, and contact information.
04
Indicate the reason for discontinuation of the dental referral. This could be due to various reasons, such as change in treatment plan or transfer of care.
05
Include any relevant dental history or previous treatments that the referring dentist should be aware of.
06
Sign and date the discontinuation form to validate it.
07
Make a copy of the completed form for your records and provide the original to the referring dentist or dental clinic.
08
Please note that the exact form and requirements may vary depending on your location and specific circumstances. It is advisable to consult with your dentist or dental office for any additional instructions or forms specific to your situation.
Who needs discontinuation of dental referral?
01
Discontinuation of dental referral may be needed by patients who require a change in their dental treatment plan or wish to transfer their care to a different dentist.
02
Some common situations where discontinuation of dental referral might be necessary include:
03
- Patients who have decided to seek treatment from a different dental specialist or clinic
04
- Patients who have experienced a change in their dental needs or require a different type of dental treatment
05
- Patients who are dissatisfied with the care provided by their current referring dentist
06
- Patients who are relocating to a new area and need to find a new referring dentist
07
It is always best to consult with your dentist or dental office to determine if you need to fill out a discontinuation of dental referral form or discuss alternative options.
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What is discontinuation of dental referral?
Discontinuation of dental referral is the process of ending the referral of a patient to a dental specialist or clinic.
Who is required to file discontinuation of dental referral?
The dentist or healthcare provider who originally made the referral is required to file the discontinuation of dental referral.
How to fill out discontinuation of dental referral?
Discontinuation of dental referral can be filled out by providing the necessary patient information, reason for discontinuation, and any relevant documentation.
What is the purpose of discontinuation of dental referral?
The purpose of discontinuation of dental referral is to formally end the referral process and ensure proper documentation of the decision.
What information must be reported on discontinuation of dental referral?
The discontinuation of dental referral form must include patient details, reason for discontinuation, date of termination, and signature of the healthcare provider.
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