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SAC AND FOX NATION
RAP ASSISTANCE APPLICATIONORTHODONTICFAX: 9189684207
PH: 9189683526
EXT: 2001
EMAIL: sfnrap@sacandfoxnationnsn.gov
ADDRESS: 920963 S. Hwy 99
Shroud, OK 74079
RAP APP
Form#201101
BC
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How to fill out orthodontic revised app 92920pub
How to fill out orthodontic revised app 92920pub
01
Obtain the Orthodontic Revised Application Form 92920pub from the appropriate dental or orthodontic office.
02
Fill out your personal information accurately, including your name, address, contact number, and insurance details if applicable.
03
Provide information about your orthodontic treatment plan, including the reason for needing orthodontic treatment, the proposed treatment plan, and any relevant medical history.
04
Sign and date the form to certify the accuracy of the information provided.
05
Submit the completed form to the dental or orthodontic office as required.
Who needs orthodontic revised app 92920pub?
01
Individuals who are seeking orthodontic treatment and are required to provide detailed information about their treatment plan and medical history.
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What is orthodontic revised app 92920pub?
Orthodontic revised app 92920pub is an updated application form for orthodontic treatment.
Who is required to file orthodontic revised app 92920pub?
Orthodontists and dental offices providing orthodontic treatment are required to file the revised app 92920pub.
How to fill out orthodontic revised app 92920pub?
The app can be filled out online or manually with all relevant patient information and treatment details.
What is the purpose of orthodontic revised app 92920pub?
The purpose of the app is to document and report orthodontic treatment provided to patients.
What information must be reported on orthodontic revised app 92920pub?
Information such as patient demographics, treatment plan, progress notes, and fees charged must be reported on the app.
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