 |
|
|
|
ID |
Number |
Description |
|
|
154
|
1500 Claim Form
|
1500 Health Insurance Claim Form (100)
|
 |
|
|
|
155
|
201
|
Patient Progress Report (100)
|
|
|
|
|
156
|
202
|
TMJ Follow Up (100)
|
|
|
|
|
166
|
203
|
Patient Progress Report / Chart
|
|
|
|
|
115
|
401A
|
Head, Neck & Facial Pain Questionnaire (Long TMJ Form) (Corresponds with DentalWriter Software)
|
|
|
|
|
116
|
401B
|
Ortho Questionnaire (Correspond with DentalWriter Software)
|
|
|
|
|
117
|
401C
|
Implant Questionnaire (Correspond with DentalWriter Software)
|
|
|
|
|
159
|
401E
|
TMJ Questionnaire (Correspond with DentalWriter Software)
|
|
|
|
|
122
|
402A
|
Head, Neck & Facial Pain Exam (Long TMJ Form) (Correspond with DentalWriter Software)
|
|
|
|
|
123
|
402B
|
Ortho Exam (Correspond with DentalWriter Software)
|
|
|
|
|
124
|
402C
|
Implant Exam (Correspond with DentalWriter Software)
|
|
|
|
|
126
|
402E
|
TMJ Report Exam (Correspond with DentalWriter Software)
|
|
|
|
|
127
|
403A
|
TMJ X-Ray and Diagnostic Exam (Correspond with DentalWriter Software)
|
|
|
|
|
119
|
501A
|
Dental Sleep Medicine Questionnaire (Correspond with DentalWriter Software)
|
|
|
|
|
128
|
502A
|
Dental Sleep Medicine Exam (Correspond with DentalWriter Software)
|
|
|
|
|
129
|
NTIE1
|
Headache Exam (Correspond with DentalWriter Software)
|
|
|
|
|
120
|
NTIQ1
|
Headache Questionnaire (Correspond with DentalWriter Software)
|
|
|
|
|
165
|
PERIOE
|
Perio Exam
|
|
|
|
|
164
|
PERIOQ
|
Perio Questionnaire
|
|
|
|
|
130
|
TMJSE
|
TMJ Screening Exam (Correspond with DentalWriter Software)
|
|
|
|
|
121
|
TMJSQ
|
TMJ Screening Questionnaire (Correspond with DentalWriter Software)
|
|
|
|
|
131
|
X-RAY6
|
X-Ray Pack; TMJ Films, Tomography/Transcranial, Cephalogram, Lateral Cervial Spine, Panoramic, Paranesal Sinus.
|
|
|
|