Get Nc Dhb-0007 2020-2025

Filling out the NC DHB-0007 form can seem daunting, but this guide will break down the process into simple steps. By following these instructions, users will be able to efficiently complete the Orthodontic Treatment Termination Request form online.

Follow the steps to complete the NC DHB-0007 form online.

1. Press the ‘Get Form’ button to access the form. This will open the document in an online editor for you to begin filling it out.
2. Enter the date on which you are filling out the form in the designated space at the top of the document.
3. Input the recipient's full name in the section labeled 'Recipient name.' This should be the individual whose orthodontic treatment is being terminated.
4. Fill in the recipient's Medicaid ID number in the appropriate field to ensure accurate processing.
5. Specify the date of termination in the corresponding section. This is the date when the orthodontic treatment will officially end.
6. Record the date of debanding in the designated area if applicable.
7. Indicate how many months the recipient has been in treatment by entering that number in the 'Months in treatment' section.
8. Estimate the remaining months needed to complete treatment and enter that figure in the provided space.
9. Complete the field indicating the number of paid maintenance visits conducted during the treatment period.
10. Fill in the date when the retainers were delivered along with checking the boxes for whether upper and lower retainers were delivered.
11. Select the reason for termination from the provided options. If necessary, utilize the blank lines to specify any 'other' reasons.
12. Use the comments section to provide any additional relevant information regarding the treatment or termination.
13. Complete the fields for the billing provider NPI, provider name, service location address, and service location phone number.
14. Review all filled information for accuracy before saving your changes. Once confirmed, you can save, download, print, or share the completed form as required.

Start completing the NC DHB-0007 form online to ensure a seamless termination process for orthodontic services.