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IMPLANT REFERRAL Former. Martin HaywardGeneral & Implant Dentist
GDC Number: 68029
BDS Newcastle Before & After Example can accept all referral cases from a single
implant to complex sinus lift/ bone
augmentation
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How to fill out townley implant referral form
How to fill out townley implant referral form
01
Obtain the Townley implant referral form from the appropriate source (e.g. hospital, dentist office).
02
Fill out the patient's personal information including name, address, phone number, and date of birth.
03
Provide details about the implant procedure such as the reason for referral, previous dental work done, and any relevant medical history.
04
Ensure all sections of the form are completed accurately and legibly.
05
Obtain any required signatures from the patient or guardian.
06
Submit the completed form to the designated recipient according to the instructions provided.
Who needs townley implant referral form?
01
Patients who require an implant procedure at the Townley dental clinic.
02
Dentists or dental professionals referring a patient for an implant procedure at the Townley dental clinic.
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What is townley implant referral form?
The Townley implant referral form is a document used by healthcare providers to refer patients for Townley implants, ensuring they meet specific medical criteria.
Who is required to file townley implant referral form?
Healthcare providers, such as doctors or specialists recommending Townley implants for their patients, are required to file the referral form.
How to fill out townley implant referral form?
To fill out the Townley implant referral form, providers need to accurately complete patient information, medical history, referral reason, and any supporting documents required by the implanting facility.
What is the purpose of townley implant referral form?
The purpose of the Townley implant referral form is to facilitate communication between referring providers and implanting facilities, ensuring that all necessary information for the patient's eligibility and medical history is reviewed.
What information must be reported on townley implant referral form?
The information that must be reported includes patient demographics, medical history, reason for referral, and any relevant diagnostic tests or images.
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