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To:Keystone First Primary Care ProvidersDate: January 20, 2021, Re:Discontinuation of Dental referral fax format decrease your offices administrative burden, effective immediately Keystone First will
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How to fill out discontinuation of dental referral
How to fill out discontinuation of dental referral
01
Start by gathering all the necessary information and documents related to the dental referral.
02
Carefully read through the discontinuation form to understand the required information.
03
Fill out the patient's personal information section, including their name, address, contact number, and insurance details.
04
Provide the details of the dentist or dental office that made the original referral, including their name, contact information, and referral date.
05
Clearly state the reason for discontinuing the dental referral in the designated section.
06
Review the completed form for any errors or missing information.
07
Sign and date the form to certify its accuracy and completeness.
08
Submit the filled-out discontinuation form to the appropriate authority or entity as instructed.
Who needs discontinuation of dental referral?
01
Discontinuation of dental referral may be needed by individuals who have changed their dentist or dental office and no longer wish to be referred to the previous provider.
02
It may also be required if there is a change in insurance coverage or if the patient decides to seek dental care from a different provider.
03
In some cases, discontinuation of dental referral may be necessary due to dissatisfaction with the previous dental care received or any other personal reasons.
04
It is important to consult with the new dental provider or insurance company to determine if a discontinuation of dental referral is required in specific situations.
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What is discontinuation of dental referral?
Discontinuation of dental referral refers to the process of terminating a patient's referral to a dental specialist.
Who is required to file discontinuation of dental referral?
The dentist or healthcare provider referring the patient is required to file discontinuation of dental referral.
How to fill out discontinuation of dental referral?
Discontinuation of dental referral can be filled out by providing patient information, reason for discontinuation, and any relevant details.
What is the purpose of discontinuation of dental referral?
The purpose of discontinuation of dental referral is to notify the specialist that the patient's referral has been terminated.
What information must be reported on discontinuation of dental referral?
Patient details, reason for discontinuation, date of referral termination must be reported on discontinuation of dental referral.
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