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*DENTAL* 2401 N. Lincoln Blvd., Ste. 300, Oklahoma City, OK 73105 Phone 4057178879 or 8005436044, ext. 8879 Fax 4059495459 or 4059495501ORAL SURGERY REQUEST This form must be completed and accompany

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How to fill out oral surgery request

01

Begin by filling out your personal information section, including your name, address, phone number, and date of birth.

02

Next, provide details about your insurance coverage. Include your insurance provider, policy number, and any relevant information about your plan.

03

In the medical history section, disclose any existing medical conditions, allergies, or medications you are currently taking.

04

For the oral surgery portion, accurately describe the reason for your request. Include any symptoms you are experiencing, the location of the issue, and the duration of the problem.

05

If you have had any previous oral surgeries or dental procedures related to the current issue, provide details about them.

06

If any diagnostic tests have been performed, mention them along with their results.

07

Finally, include any additional information that you think would be relevant for the oral surgeon to know.

08

Review the entire form to ensure all sections have been filled out correctly and completely.

09

Sign and date the form at the designated section.

10

Submit the completed oral surgery request to the appropriate recipient or follow the instructions provided by your healthcare provider.

Who needs oral surgery request?

01

The people who require an oral surgery request are individuals who are facing oral health issues that require surgical intervention.

02

This can include patients with impacted teeth, severe tooth decay, gum diseases, facial trauma, jaw misalignment, oral infections, or other conditions that cannot be treated through non-surgical methods.

03

The need for oral surgery may also arise for individuals seeking dental implants, wisdom teeth removal, or corrective jaw surgery.

04

A dentist or oral surgeon will evaluate the specific case and determine whether an oral surgery request is necessary.

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What is oral surgery request?

An oral surgery request is a formal document submitted by a patient or a healthcare provider to request a surgical procedure on the mouth, teeth, or jaw.

Who is required to file oral surgery request?

Either the patient or a healthcare provider can file an oral surgery request.

How to fill out oral surgery request?

To fill out an oral surgery request, the individual must provide personal information, medical history, reason for the surgery, consent for the procedure, and any other relevant details.

What is the purpose of oral surgery request?

The purpose of an oral surgery request is to formally request a surgical procedure on the mouth, teeth, or jaw for medical reasons.

What information must be reported on oral surgery request?

Information such as personal details, medical history, reason for surgery, consent for the procedure, and any other relevant information must be reported on an oral surgery request.

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