sample letter patient treatment information release

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#Sample letter patient treatment information release manual#

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Job applicants - Position has been filled.

Labor and Industries - claim information and treatment plan.

Employer 2 - indicating a need for time off work.

Employer 1 - indicating time needed for dental treatment.

(You might also want to see some of these Dental Insurance Claims resources.).

Dental insurance company - when they request more documentation.

Dental insurance company - additional information being sent.

Dental insurance company - appeal of denied claim, with additional information.

Medical insurance - to support NTI device on medical insurance claim.

Attorney - in response to alcohol test failure.

Auto and Medical Insurance 2 - concerning injury to front teeth, and potential future treatment.

Auto and Medical Insurance 1 - concerning injury to front teeth, and potential future treatment.

Physician 3 - request for consultation on a few issues.

Physician 2 - request for evaluation for antibiotic prophylactic premedication.

Physician 1 - before hip replacement surgery.

Insurance explanation - patient frustrated because insurance benefits were used up.

Refund check enclosed - explanation for check.

Request for EOB - dual insurance, first EOB went to patient only.

Insurance check mailed to patient - requesting endorsement and forwarding.

Insurance not in effect - claim denied due to no coverage.

Need to return for post and crown after RCT by Endodontist.

Need to return for crown seat that has been prepped.

Need to complete treatment that has been started.

Need to complete treatment that has not been started.

(You might also want to refer to Tips on Terminating the Dentist-Patient Relationship).

Dismissal 6 - uncooperative orthodontic patient.

Dismissal 5 - unable to attain satisfactory doctor-patient relationship.

Dismissal 4 - unable to attain satisfactory doctor-patient relationship.

Dismissal 3 - due to repeated no-shows, cancellations.

No Show or repeated tardiness - informs of office policy.

Unused Insurance Benefits - sent towards end of year.

Uncooperative orthodontic patient - warning letter.Introducing a new dentist to a practice.Summary of records - for patients who have transferred to another office.Letter - to new general dentist where moving patient is transferring.Follow-up 2 - after fixing a loose implant screw.Follow-up 1 - after seeing his patient on emergency.Referral 2 - extractions in mixed dentition ortho case.Letter - follow-up to phone call about confusing case.Referral 2 - RCT and internal bleaching.Referral 9 - implant consultation, with photos in letter.Page sections: Letters To Dentists | Letters To Patients | Other Letters Letters To Dentists They are not copyrighted and are freely available for non-commercial use. These documents were either created by me or by other individuals who also want to share with the dental community.

#Sample letter patient treatment information release free#

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