Get Evaluation Form For Comprehensive Orthodontic Treatment

Filling out the Evaluation Form For Comprehensive Orthodontic Treatment online is a straightforward process. This guide provides detailed instructions for each section of the form to ensure that you complete it accurately and efficiently.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the Evaluation Form For Comprehensive Orthodontic Treatment. This action will open the form in your online document editor.
2. Begin by entering the member’s name in the designated field, followed by their date of birth. Make sure to double-check the accuracy of these entries.
3. In the conditions section, assess each listed condition for the member. For conditions 1 to 3, if you select 'Yes,' you do not need to complete the subsequent conditions and should instead document the findings supporting severe handicapping. If answering 'No,' proceed with filling out the remaining conditions as required.
4. For condition 4, record the overbite percentage, and specify if there are any deep impinging overbites that cause tissue damage, ensuring to document such instances in your workup.
5. For anterior open bite, enter the measurement in millimeters and list the affected tooth numbers in the provided space for condition 7.
6. In condition 10, indicate if there is an anterior crossbite involving more than two teeth, and list the tooth numbers. Follow this with any observations regarding the posterior crossbite in condition 11.
7. For condition 13, assess if there are impacted cuspids or incisors that will not erupt without surgical intervention and provide the tooth numbers if applicable.
8. For conditions regarding speech problems and temporomandibular joint involvement, ensure appropriate documentation is available before finalizing your entries.
9. Next, certify your role as the treating health partner by signing in the designated field and including the date of certification.
10. Finally, review all entries for accuracy. Save your changes, and utilize download or print options as needed for your records or to share the form with relevant parties.

Complete your Evaluation Form For Comprehensive Orthodontic Treatment online today to ensure seamless processing and care.