Dental Claim Form (2012 Version) The ADA Dental Claim Form was revised in 2012 to incorporate a significant change in the HIPAA standard, which now enables a dentist to include a diagnosis code when needed on a claim. The downloadable version of the ADA Dental Claim Form allows immediate access and requires no shipping. This is the most recent version of the form. Not for online use. J430 8½” x 11”, 100/pad | Members $15.00 Retail $22.50 J430D Downloadable PDF | Members $29.95 Retail $44.95 J431 8.5” x 11”, Two-part carbonless, 100/pack | Members $20.00 Retail $30.00 J432 8.5” x 11”, Bond Stock, 250/pack | Members $30.00 Retail $45.00 J434 Bond in Red Ink, 100/pad | Members $15.00 Retail $22.50 ADA MEMBERS ONLY Membership Plaque Add a touch of distinction to your office with this gleaming ADA membership plaque mounted on polished hardwood. Display plaques in your reception area as well as in each consultation room and operatory, inspiring patients’ trust. Plaques come ready to hang and make great gifts for the new dentist. Shipping to U.S. addresses only. N382 Bronze 12” x 9” | Members $89.95 Display your ADA pride to patients, staff and the community. 2019 ADA Appointment Books The hardbound appointment book features a single-column format with schedules from 7 a.m. to 9 p.m. Its rugged leather-grained vinyl stands up to constant use. Softbound appointment book features a double-column format with schedules from 7 a.m. to 5 p.m. Sturdy vinyl cover. The 2019 books are brown. E070 2019 Hardbound | Members $29.95 Retail $44.95 E071 2019 Softbound | Members $24.95 Retail $37.45 The 2019 books will be our last edition of appointment books. THE ADA PRACTICAL GUIDE TO DENTAL OFFICE DESIGN 87 This sample design program is a list of questions to help you determine the type of dental office that will best fit your needs. The answers to these questions will give the architect the information to begin planning the dental office you desire. This design program form has been adapted with permission from an original form developed by the Unthank Design Group. Sample Design Program What are the major goals you wish to achieve with your new office? ___________________________________ _______________________________________________________________________________________________ YOUR DENTAL TEAM 1. Projected number of staff in the new office: Who How Many? Dentists Business staff Hygienists Assistants Lab technicians Other: 2. What is the maximum number of dentists in practice at any one time? _______________________________ 3. What is the maximum number of hygienists in practice at any one time? _____________________________ 4. How many dentists in the dental practice are right-handed? _______ How many are left-handed? _______ Your Space 1. Choose your project type: New free-standing building for your practice only New free-standing building with additional lease space New lease space or condominium in: Existing building Building to be constructed Existing building to be remodeled or expanded Existing suite to be remodeled or expanded 2. What are the number of floors in the building? ____________________________________________________ 3. On which floor will your office be located? _______________________________________________________ 4. What is the estimated square footage of your new space? __________________________________________ Building or Refreshing Your Dental Practice: A Guide to Dental Office Design The design of your dental practice says a lot about you. You want to project an image of comfort, cleanliness and safety while expressing your personality and reinforcing your brand. This book covers all the bases for building, renovating or simply refreshing your space, with vibrant photos and insights from dental architects, design consultants and practicing dentists. It provides a road map for issues such as: Building an expert project team Financing your build or remodel Choosing a location Anticipating potential legal issues Determining your dental equipment needs Integrating your dental office décor with your brand Incorporating green dental office design tactics P091BT Book + e-Book, 226 pages | Members $59.95 Retail $89.95 Book ISBN# 978-1-941807-37-8 | e-Book ISBN# 978-1-941807-38-5 THE ADA PRACTICAL GUIDE TO DENTAL OFFICE DESIGN 219 FIGURE 13.7 Ballard open operatory area FIGURE 13.5 Floor-to-ceiling windows in operatory area FIGURE 13.6 Teen activity area 48 THE ADA PRACTICAL GUIDE TO DENTAL OFFICE DESIGN FIGURE 3.7 FIGURE 3.6 The main entry faces the parking lot but provide a clear and welcoming access for patients through a central courtyard. A central reception desk controls both entries. The street facing entry is just beyond the check-out desk behind the sculpture. 100 THE ADA PRACTICAL GUIDE TO DENTAL OFFICE DESIGN Clean, crisp colors were combined with natural materials, such as hickory wood veneer and Mexican beach pebbles. 100 THE ADA PRACTICAL GUIDE TO DENTAL OFFICE DESIGN Case Study #1: Holistic Principles and Natural Materials This established general dentist was quickly outgrowing his small, outdated office. He required an office environment that was consistent with the level of service and that highlighted the importance of the holistic principles on which the practice was founded. The architect’s job was to reflect and reinforce these principles through interior design and the use of sustainable (green) materials and practices where possible. Clean, crisp colors were combined with natural materials, such as hickory wood veneer and Mexican beach pebbles, in an attempt to achieve this goal (see Figures 6.3 and 6.4). The dentist wanted the message to be clear, whether you are visiting the website or walking through the front door of the office for the first time: this practice has made every effort to make the patient safe, comfortable and informed. The following project case studies each took a different path in drawing design inspiration: FIGURE 6.3 32 ORDER ONLINE: ADACATALOG.ORG 33 PRACTICE MANAGEMENT ORDER BY PHONE: 800.947.4746 MANAGING YOUR PRACTICE | FORMS AND OFFICE ESSENTIALS
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