This form can be used with the C-301R
Record - Progress Notes (Piggyback Option) or with the C-101R
Treatment Record - Progress Notes.
Fees, accounts receivable, patient contracts, insurance
company notes, interoffice communication and personal notes which are not
a part of treatment, can be kept separate from treatment notes. Messy,
inefficient paper-clipped notes containing non-treatment information can
If a record is requested by a patient, a specialist,
another dentist or third party insurance, only the top form C-101R or
C-301R need be provided. Order separately from Starter Kit.
- Fee - Not part of "Progress Notes"
- Confidential notes - not part of patient record
(Not part of patient record)
||$18.00 / 200
||$34.00 / 400
||$64.00 / 800
||$120.00 / 1600
In case of litigation, consult legal counsel concerning Confidential
Notes portion of record.
Sample Form in PDF format
If you are having