View Insurance Form Printing - page 1, page 2 screens. View Video, 0 min. 31 sec.

Changing The Data That Will Print On The Form
You may desire something other than what is recorded into the permanent patient record to print on the insurance form. You may click into the following fields on this screen and make changes: Tooth, Surface, Description, Date, Code, and Fee. You may change what is on the screen within these fields to whatever you want. What you enter is what will print on the insurance form. However, none of the changes you make in this manner will permanently be recorded into the patient's record. The only effect will be to the insurance form that is about to print.

Page 2 Screen Information
After all the items of page 1 are entered properly you may click on the Down Arrow page button at the bottom of the Insurance Form Printing screen to go to Insurance Form Printing - page 2.

Yes/No Questions
The familiar series of Yes/No questions seen on insurance forms is seen at the top of page 2.  Questions such as "Occupational illness or injury?" and "Treatment result of automobile accident?" etc., are included. You may click on the Yes or No buttons for each question as appropriate.  Some of these questions have associated short descriptions or date entries. These items are modeled after what is seen on the standard ADA insurance claim form.  you may fill in these fields as appropriate.

Place Of Treatment
The default for Place of Treatment defaults to "Office", but treatment was rendered outside of the office, click on the "Place of Tx" drop down list to select from numerous other choices.

X-Rays Yes/No, and How Many, #Images, #Models
Fill in this option as you want it to appear on the insurance form that is about to be printed.

Signature On File
The standard ADA insurance form has a signature area for the patient to sign for the release of information. Next to that is an area for the insurance subscriber to sign to allow payment to be made directly to the dentist (assignment of benefits). Most insurance carriers accept the words "Signature On File" to be placed in these areas in lieu of the actual signature. It is assumed that you have the patient's signature and the subscriber's signature somewhere on file in your office. If you want the program to print the words "Signature On File" in these areas, click Yes for the Release and or Assignment signature option boxes. The default if for Signature On File to print.