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Original price was: $79.99.$54.39Current price is: $54.39.
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Easy-to-complete form guides patient to insert complete Medical History
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Special sections alert Dentist to certain diagnoses and medication history requiring medical clearance
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Use with every patient on initial visit. Here are some of the form s features:
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General patient profile includes employer, person responsible for payment and referral information
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Patient verifies insurance coverage and responsibility for payment of the remaining balance
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Authorization for release of Protected Health Information and authorization for treatment
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Patient specifies any dental-related problems that may be a concern for a first visit
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Dedicated list of medical conditions requiring medical clearance
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Expanded list of allergies; Patient certifies accuracy of medical history
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Size: 8-1/2×11″
| Brand | Medical Arts Press |
|---|---|
| Chart and Form Type | Standard Patient Registration Form |
| Color Family | Multicolor |
| Customizable | No |
| Height in Inches | 11" |
| Number of Pages | 250 |
| Series or Collection | General Health |
| Speciality Use | General Practice |
| True Color | Multicolor |
| Used For | Registration and History Form |
| Width in Inches | 8.5" |
Be the first to review “Buy 🤩 Dental Health History & Registration Forms Medical Arts Press® Patient Registration And History Form 🔥”
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