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QuantityNameSKUEachTotal

Gingival Augmentation/Gum Graft Surgery $10.00 $10.00

Employment Agreement - Auxillary Staff $25.00 $25.00

Chart Audit / Inventory Rule 108.8 Compliance $10.00 $10.00

HIPAA Business Associate Agreement HPA2 $5.00 $5.00

HIPAA Consent to use and disclose protected health information HPA4 $5.00 $5.00

Informed Consent - Multi-Area Treatment (Spanish) $10.00 $10.00

Informed Consent for Crown & Bridge IC-C&B $10.00 $10.00

Duplication of Records Policy $10.00 $10.00

Informed Consent for Nitrous Oxide Anesthesia IC-ANS $10.00 $10.00

Spanish: General Dentistry Informed Consent $10.00 $10.00

Informed Consent for Dentures IC-DTR $10.00 $10.00

Informed Consent for Fixed Prosthodontics $10.00 $10.00

Consent for Teeth Whitening ldf.com white $10.00 $10.00

Employment Agreement - Auxillary Staff $25.00 $25.00

Informed Consent for General Dentistry IC-GEN $10.00 $10.00

Informed Refusal of Radiographs $10.00 $10.00

Consent for Prosthodontics - Long Form ldf.com prsth $10.00 $10.00

Informed Consent for Implants $10.00 $10.00

Informed Consent for Use of Local Anesthetic $10.00 $10.00

Informed Consent for Fixed Prosthodontics $10.00 $10.00

Release of Claims releaseusa $10.00 $10.00

Informed Consent for Use of Local Anesthetic $10.00 $10.00

Informed Consent for Implants $10.00 $10.00

Auxillary Employment Agreement $25.00 $25.00

Duplication of Records Policy $10.00 $10.00

Informed Consent for Periodontics $10.00 $10.00

Refusal of Radiographs ldf.com xrayref $10.00 $10.00

Duplication of Records Policy $10.00 $10.00

Patient Authorization to Release Dental Records $10.00 $10.00

Informed Consent - Multi-Area Treatment (English) $10.00 $10.00

Consent for Multiple Areas of Dentistry (English) ldf allincleng1 $10.00 $10.00

Informed Consent for Bone Regeneration $10.00 $10.00

Consent for Extractions ldf.com ext1 $10.00 $10.00

Informed Consent for Photography $10.00 $10.00

Informed Consent for Periodontics $10.00 $10.00

Informed Consent for Nitrous Oxide Anesthesia IC-ANS $10.00 $10.00

Consent for Teeth Whitening ldf.com white $10.00 $10.00

Informed Consent for Bone Regeneration $10.00 $10.00

 
Subtotal $415.00
Total $415.00

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