Get A-not

This guide provides a comprehensive overview of the A-Not form, specifically designed for addressing complaints related to implant failures and fractures. Follow the instructions to efficiently complete the form online.

Follow the steps to effectively fill out the A-Not form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the customer information section, including details such as account number, name, address, postal/zip code, country, and telephone or email contact.
3. In the restorative doctor information section, provide the relevant details similarly, ensuring they are clearly written or stamped.
4. List the returned products by providing the lot number, article number or Procera file number, quantity, and product description. Be sure to confirm the tooth position using the provided configuration chart.
5. Complete the problem description section. Indicate the type of complaint and when it was discovered. If there was any patient injury, answer accordingly and provide a clear explanation.
6. Fill in the patient information details, including patient ID, gender, age, and relevant dates for the implant's placement, exposure, loading, and removal.
7. Assess and define the patient's oral hygiene using the gingival health index. Indicate if granulated tissue or infection was identified around the implant.
8. Describe the patient's bone quality and quantity in the area where the implant was placed, selecting the appropriate options provided.
9. Document any health conditions and habits that may affect the implant, as well as your evaluation of the cause of the problem.
10. Add any additional comments as necessary and request any replacement components, ensuring that the value does not exceed that of the returned products.
11. Finally, add the signature confirming the conditions stated in the questionnaire, along with the date and place of signature.
12. Save your changes, download, print, or share the completed form as necessary.

Complete your A-Not form online today to ensure a smooth filing process.