Get Inter-office E-referral Checklist - Aspire Family Dental

The Inter-Office E-Referral Checklist is a vital tool for ensuring the smooth transfer of patient information between dental offices. This guide provides a comprehensive, step-by-step process to help you fill out the checklist accurately and efficiently online.

Follow the steps to complete the checklist with ease.

1. Press the ‘Get Form’ button to access the checklist and open it in your form editor.
2. Begin by entering the name of the sender in the designated field at the top of the checklist.
3. For the X-rays section, select the type of X-rays being submitted by checking the appropriate boxes: Panoramic, BWS, or PA’s of the area involved.
4. In the e-Referral section, check all applicable patient information fields, including the patient's name, address, phone number, social security number, and birthdate.
5. Continue filling out the e-Referral section by checking off any missing teeth, patient alerts, existing and completed services, patient conditions, and current prescription information.
6. Check the box for any watch tooth information and select the appropriate specialist, ensuring you electronically mark the selected specialist.
7. Provide the patient's dental insurance information, including insurance company name, address, and phone number, as well as the policy holder information and group number.
8. Select a new treatment plan by checking the relevant option and adding the needed plan details.
9. For the Template Exam section, select an image or exam and provide the necessary additions.
10. In the Thumbnail Exam section, include any oral pictures by selecting the relevant images or exams and adding them accordingly.
11. Create the e-Referral by completing the necessary inputs, ensuring all required information is filled out.
12. For the Other Information section, check the applicable options to indicate whether patient notes, packets, the inter-office referral form, or the patient’s chart have been sent to SmartDoc.
13. For the receiving section, enter the name of the receiver and follow similar steps to complete the X-ray and e-Referral sections as outlined.
14. Finalize the checklist by reviewing all entries for accuracy before saving your changes, and choose whether to download, print, or share the completed form.

Start filling out the Inter-Office E-Referral Checklist online today for streamlined patient information transfer.