Communication in the Dental Office

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Across
  1. 4. STATEMENT OF FORM SIGNED BY PATIENT OR PATIENTS GUARDIAN TO AUTHORIZE CONFIDENTIAL INFORMATION TO BE SENT TO A THIRD PARTY
  2. 6. INSURED PERSON
  3. 7. AMOUNT DETERMINED BY INSURANCE COMPANY FOR SURVEY OF PROVIDERS IN AREA OR ORIGIN
  4. 8. AREA OR SPACE ON INITIAL REGISTRATION FORM INDICATING CONTINUED PERMISSION FOR PAYMENT AND RELEASE OF INFORMATION
  5. 10. ORGANIZATION OR PERSON WHO MAKES PAYMENTS BUT WHO IS NOT PART OF PROVIDER PATIENT CONTRACT
Down
  1. 1. RECORD OF TRANSACTION, CHARGES, FEES PAID AND ANY ADJUSTMENTS
  2. 2. PREPRINTED FORM LISTING PROCEDURE NUMBERS AND SERVICES RENDERED TO PATIENT.
  3. 3. CODE SYSTEM CONSTRUCTED TO PROVIDE SPECIFIC NUMBER TO EACH TRAETMENT OR PROCEDURE PERFORMED.
  4. 5. ALLOTTED BENEFITS FOR SPECIFIC PROCEDURES, SAME AS FEE SCHEDULE
  5. 9. AVERAGE FEE CHARGED BY PROVIDER FOR SPECIFIC SERVICES
  6. 11. THE PARTY WHO RENDERS PROFESSIONAL SERVICES.