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Dental Provider Dental Care Followup Request Form Child Health and Disability Prevention (CHIP) Program Fax this form to the Local SUCH Program fax number (628) 2177596 Patient will be contacted.
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How to fill out chdp dental care coordantion
How to fill out chdp dental care coordantion
01
Obtain a CHDP Dental Care Coordination Form.
02
Fill out the patient's personal information including name, date of birth, and contact information.
03
Provide information about the patient's medical history and any relevant medical conditions.
04
Include details about the dental services needed and any recommendations from the dentist.
05
Obtain any necessary signatures from the patient or guardian.
06
Submit the completed form to the appropriate healthcare provider or agency.
Who needs chdp dental care coordantion?
01
Children and adolescents who are eligible for CHDP (Child Health and Disability Prevention) services.
02
Patients who require coordination of dental care services due to complex dental issues or medical conditions.
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What is chdp dental care coordination?
Chdp dental care coordination is a program designed to ensure that children enrolled in the Child Health and Disability Prevention (CHDP) program receive appropriate dental care.
Who is required to file chdp dental care coordination?
Dentists and healthcare providers who are participating in the CHDP program are required to file chdp dental care coordination.
How to fill out chdp dental care coordination?
Chdp dental care coordination can be filled out by providing information about the child's dental care history, treatment services provided, and any follow-up recommendations.
What is the purpose of chdp dental care coordination?
The purpose of chdp dental care coordination is to ensure that children receive timely and appropriate dental care to maintain good oral health.
What information must be reported on chdp dental care coordination?
Information such as the child's dental history, treatment services provided, and any follow-up recommendations must be reported on chdp dental care coordination.
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