Get the free PERIODONTAL REFERRAL FORM

PERIODONTAL REFERRAL FORM Dr. Nanette Rise Killing 71 East Avenue Ste. A, Norwalk, CT 06851 Phone: 2038385322. ... 11/19/2007 5:05:58 PM ...

How to fill out periodontal referral form

How to fill out a periodontal referral form:

1. Start by identifying the patient's personal information such as their name, date of birth, contact information, and any relevant medical or dental history.
2. Indicate the referring dentist's information including their name, practice name, contact details, and any other necessary identification.
3. Provide details about the current dental condition of the patient that requires referral to a periodontist. This may include a description of the specific issue or concern, any diagnostic tests or results obtained, and the recommended treatment or procedures.
4. Include any relevant radiographs or imaging reports that support the referral. These can provide additional insight for the periodontist and aid in making an accurate diagnosis.
5. Specify any supporting documentation or additional notes that may be helpful for the periodontist, such as the patient's oral hygiene habits, previous treatments attempted, or relevant medical conditions.
6. Make sure to sign and date the referral form to verify that it has been completed and authorized by the referring dentist.
7. Submit the form to the periodontist's office through the preferred method – whether it be electronically, by mail, or in person.

Who needs a periodontal referral form:

1. General dentists: When patients present with advanced periodontal disease or complex periodontal issues that require specialized care, general dentists may need to refer them to a periodontist for further evaluation and treatment.
2. Dental hygienists: If during routine cleanings or periodontal maintenance appointments, dental hygienists notice signs of severe gum disease or any other periodontal conditions that require specialized attention, they may recommend the patient to see a periodontist and fill out a referral form.
3. Patients: In some cases, patients themselves may seek out a periodontist for specific periodontal concerns or treatment options. In such instances, they may need to request a referral from their general dentist or dental hygienist to ensure a smooth and coordinated transfer of care.

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What is periodontal referral form?

Periodontal referral form is a document used by dentists to refer a patient to a periodontist for specialized care related to gum disease.

Who is required to file periodontal referral form?

Dentists who diagnose a patient with periodontal issues requiring specialized care are required to file a periodontal referral form.

How to fill out periodontal referral form?

To fill out a periodontal referral form, dentists need to provide detailed information about the patient’s condition, treatment already provided, and reasons for referral to a periodontist.

What is the purpose of periodontal referral form?

The purpose of periodontal referral form is to ensure seamless communication between dentists and periodontists, and to provide specialized care to patients with gum disease.

What information must be reported on periodontal referral form?

Information such as patient’s medical history, current dental condition, treatment provided, and reasons for referral must be reported on periodontal referral form.