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Discontinuation of orthodontic treatment form

Discontinue orthodontic treatment letter 2025

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The document is a termination request form for orthodontic treatment under the North Carolina Medicaid Program. It includes sections for recipient information, reasons for termination, details about retainers, and provider information. The form must be returned to the EDS Prior Approval Unit and outlines potential reasons for treatment termination such as relocation, transfer, death, non-compliance, or other specified reasons.

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Click ‘Get Form’ to open the discontinue orthodontic treatment letter in the editor.
Begin by entering the date at the top of the form. This is essential for record-keeping and processing.
Fill in the recipient's name and Medicaid ID number. Ensure accuracy to avoid delays in processing.
Indicate the months already spent in treatment and estimate how many more months are needed to complete it.
Specify the date of termination and select a reason for termination by checking the appropriate box. Attach any necessary documentation if required.
Circle 'yes' or 'no' for whether retainers were delivered, and provide the date they were delivered.
List the number of paid maintenance visits, as this may be relevant for Medicaid’s review process.
Complete the provider information section, including provider number, name, address, and phone number.

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2020	4.7 Satisfied (29 Votes)
2009	4 Satisfied (47 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Can you write off orthodontics?

The IRS allows deductions for medical expenses, including orthodontics, if they exceed 7.5% of your adjusted gross income (AGI).

Can I just stop going to the orthodontist?

If you are 18 or older, you have the right to terminate treatment. Simply tell the orthodontist you want your braces off, and request the paperwork that you must sign that releases the orthodontist from any further obligations to your treatment.

Can you tell the orthodontist to take braces off?

Sticking to your orthodontists recommendations and the prescribed treatment plan is the key to achieving that healthy and beautiful smile youve been dreaming of. Premature removal, as tempting as it may be for upcoming events or simply to fit in, can lead to several complications.

Can I ask another orthodontist to remove my braces?

Can I Get My Braces Off Early? The timeline for braces removal primarily depends on each individuals unique orthodontic needs and treatment plan. In some cases, patients may be eligible for early braces removal. However, its important to note that this decision should be made by an experienced orthodontist.

Can I choose to take off my braces?

Yes any orthodontist will remove the bracesyou may just have to sign a release form before they do it and pay a charge, but there is not law that says the original orthodontist owns the braces! you can go to whoever you want as long as they will accept you and you will pay their fee.

orthodontic non compliance letter

Discontinuation of orthodontic treatment form Discontinue braces treatment Braces removal letter orthodontic non-compliance letter Early debond Consent form AAO Invisalign end of treatment Consent form Sample orthodontic letters to patients Fixed retainer removal consent form

How do I tell my orthodontist I want my braces off?

If you want to have your braces removed early, you will need to follow these steps: 1. Consult with your orthodontist: Schedule an appointment with your orthodontist to discuss the possibility of removing the braces early.

Can I stop my orthodontic treatment?

Orthodontic treatment is a significant commitment that requires patience, dedication, and collaboration between you and your orthodontist. While it is possible to stop treatment midway, its essential to carefully consider the implications and consult with your orthodontist before making any decisions.