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DVbubbleForm indd Letterhead - ncdhhs 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the 'Date of Visit' and 'Patient DOB' in the designated fields. Ensure accuracy for proper record-keeping.
- Fill in the 'Patient Name', 'Medicaid ID #', and demographic details such as 'Race' and 'Sex'. Use the provided options to select appropriately.
- In the section labeled 'Teeth and Conditions Present', indicate how many teeth are present and perceived cavities by coloring in the corresponding bubbles.
- For intraoral soft tissue pathology, check 'Y' or 'N' and specify any conditions that apply by marking them clearly.
- Complete the oral healthcare questions, ensuring to mark responses accurately regarding daily dental care practices.
- Finally, review all entries for completeness before signing as a provider. Ensure all necessary referrals are noted.
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See more DVbubbleForm indd Letterhead - ncdhhs versions
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2007 | 4.6 Satisfied (56 Votes) |
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