Get Pr 01042016 R6 Practice Record Form - Patient 2020-2025

Filling out the PR 01042016 R6 Practice Record Form - Patient is essential for ensuring accurate documentation of dental care provided under the NHS. This guide offers a straightforward approach to completing the form online, helping users navigate each section with confidence.

Follow the steps to accurately complete the form online:

1. Click ‘Get Form’ button to obtain the form and access it in the online editor.
2. Provide the provider's name, address, and location number as indicated in the appropriate sections.
3. Fill in the required patient information including surname, forename, and date of birth using capital letters.
4. Enter the ETD claim reference number alongside any evidence of exemption or remission that has been seen.
5. Complete the sections regarding the acceptance date and date of completion or last visit by entering the day, month, and year.
6. The patient must read the declaration carefully and give consent to the dental provider by signing the form and dating it.
7. If applicable, fill out the details for the person signing on behalf of the patient, stating their relationship.
8. Select the appropriate ethnic group from the list provided and indicate the choice in the designated area.
9. If claiming for free or reduced cost NHS dental services, ensure to complete that section accurately; check eligibility and fill in any relevant certificates or benefits.
10. Complete the form by reviewing all entered information for accuracy before saving, downloading, printing, or sharing the completed document.

To ensure the smooth processing of your dental declarations, complete your forms online today.