Dental registration form 2025

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The document is a Patient Registration Form for a dental office located in Snoqualmie, WA. It collects personal information, dental and health history, insurance details, and emergency contact information from patients. The form emphasizes confidentiality and includes an acknowledgment of privacy practices under HIPAA, ensuring patients are informed about the use of their health information.
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Dental readiness refers to a service personnels dental health as it relates to. his worldwide deployment status and is fundamental in maintaining unit. readiness and reducing non-combat casualties during deployment.
Dental clearance is communication between a healthcare provider and a patients dentist to validate that planned medical/surgical treatment is safe for the patient and to review the potential need for dental treatment before the medical/surgical treatment.
Department of Defense Active Duty/Reserve/Guard/Civilian Forces Dental Examination Form (DD Form 2813) This form is used to used to assist active duty and National Guard and Reserve members in documenting dental health for worldwide duty. It should be downloaded and given to the dental provider to complete.
Important: Dental Readiness Classifications The dental readiness classification (DRC) is a simple number 1, 2, or 3 that indicates whether a service member is ready for deployment worldwide, or if the service member is likely to experience a dental emergency within the next 12 months.
The dentist owns the physical record of the patient and is the legal guardian of the chart and its complete contents, including radiographs.

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Prior to surgery, it is important to verify that the patient has had a dental exam within the past 6 months, has no current dental infection, no active cavities, gum disease, abscessed teeth, fractured teeth or fillings, loose teeth or other oral pathology and no anticipation of dental care within the next 6 months.
The information collected during patient registration includes personal details such as name, address, contact information, date of birth, social security number, insurance details, medical history, and any relevant medical conditions or allergies.
This form is used to determine dental readiness as it relates to a National Guard and Reserve members worldwide deployment status. It answers the question: Is this NGR member dentally ready to deploy for worldwide duty?

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The following forms should be downloaded, filled out, and signed by all new patients. Registration Form Health History Form Consent Form Family Members

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