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DocuSign Envelope ID: 15AB37C62FEB41E383C66E8A7C6723B4Hospital Facility and Clinic Report Form Part A: Attestation of Financial Assistance Policy. To be completed by an officer of the hospital.I,
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01
Gather the necessary information of the member such as name, date of birth, and insurance information.
02
Schedule an appointment with a qualified dental provider.
03
Ensure the member is aware of the importance of preventive dental care.
04
During the appointment, the provider will conduct a thorough examination and may recommend cleanings, fluoride treatments, or other preventive measures.
05
After the appointment, follow up with the member to ensure they are following any recommended preventive care plans.

Who needs members receiving preventive dental?

01
Members of all ages who want to maintain good oral health and prevent dental issues
02
Individuals with dental insurance coverage that includes preventive care benefits
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Members receiving preventive dental are individuals who have received dental services to prevent dental problems.
Dental providers or insurance companies are required to file information on members receiving preventive dental.
Providers can fill out members receiving preventive dental information through an online portal or by submitting paper forms.
The purpose of members receiving preventive dental is to track and monitor preventative dental care services provided to individuals.
Information such as patient name, date of service, type of preventive dental service, and provider information must be reported on members receiving preventive dental.
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