Oman insurance Dental Claim Form

Oman Insurance Dental Claim Form Download

The Oman direct Billing Claim form is not only useful in getting your Claim for dental Treatment but the document is actually the first report of your medical history. The dentist will write significant important details such as what type of diagnosis has been done, tests, x-ray details, extraction, root canal treatment, etc.

On the Oman Dental Claim form, there is a separate portion of the teeth diagram. The dentist will identify which teeth is treated for that moment and which treatment is performed on those teeth. Your dentist after all assessments make a report and prescribed the best medicines which he writes on the claim form hence you could always remember which medicine is best for you.

You can Download the Oman Dental Claim form in PDF format print it and give it to the Administrator of the facility

Oman Dental Claim Form

In case you need Outpatient Oman Insurance Direct Billing Claim Form to get it from here.

Oman Dental Claim Form Sections:

Provider Details:

This section is to be filled by Administrative personnel or receptionist of that medical facility. Provider details, treating Dentist or Assistant and his Facility license code.

Member Patient details:

Here the admin person will find patient details online after seeing your Oman Insurance Card. He might ask patient or patient relative for other details. This section is to be filled by Administrative personnel or receptionist of that medical facility.

Medical Section:

Once all other sections are filled, the claim form will be handed over to the Physician or in this case Dentist for filling of Diagnosis and Treatment Details.

Service Details and Prescribed Medicines:

In this section, the Dentist will fill out the detailed treatment and tests performed on the patient. As well as which medicines prescribed to the patient at that time.

Patient Declaration:

This is the only section to be filled by the Patient in which he writes his name signature and date.

 

 

 

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