Follow the steps to successfully fill out the WA HCA 13-863 form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the client’s name in the designated field. This identifies the individual for whom the dental services are being reported.
3. Fill in the client’s ID number. This is important for record-keeping and identification purposes within the dental system.
4. Provide the name of the dentist or denturist who performed the services. This ensures that the correct provider is associated with the treatment provided.
5. Include the dentist or denturist’s phone number along with the area code. This allows for easy contact if further information is needed.
6. Enter the provider's NPI number, which is a unique identification number for healthcare providers.
7. Input the provider's fax number for any necessary communication related to the form.
8. Indicate whether all dental and periodontal services have been completed on all remaining teeth by checking 'Yes' or 'No'. If 'No' is selected, be prepared to submit a treatment plan and periodontal chart.
9. Mark the tooth chart as required. This visual reference is essential for understanding the current status of the client’s dental health.
10. Review all entered information for accuracy and completeness before finalizing the form.
11. Once all information is confirmed, save the changes, and choose to download, print, or share the completed form as needed.

Complete your documents online today for a seamless submission process.