Aesthetic Dental Studio · Marbella · Estepona · Riviera · acedntl.com
Reimbursement documentation
Regarding dental care provided to an international patient
This documentation is issued to substantiate dental care carried out at ACE DNTL STUDIO and is intended for submission to the competent health authority or insurer in the patient's home country. It sets out the patient's clinical need, the treatment performed and the total cost, so that the claim may be assessed against the applicable rules for cross-border care within the EU/EEA and internationally.
Patient and background
The patient is an international patient who sought and received dental care at ACE DNTL STUDIO.
The care was planned and carried out as a single, coherent course of treatment. Before treatment the patient was informed of the planned procedures, their purpose and the expected cost, and consented to the treatment plan. ACE DNTL STUDIO is an internationally renowned, aesthetically focused dental studio providing full-service dentistry for adults.
Diagnosis and clinical need
The clinical condition and the rationale for treatment are stated below.
The treatment was assessed as clinically warranted in light of the patient's oral condition and was directed at restoring function and oral health. It was carried out in accordance with accepted clinical practice and recorded in the patient's chart.
Treatment performed
The treatments performed are itemised in the accompanying invoice and clinical record.
Cost
The total cost of the treatment performed is set out below and corresponds to the invoice issued to the patient.
ACE DNTL STUDIO does not offer financing or instalment plans. The patient has paid for the treatment in full and is claiming reimbursement after the fact.
Dr. Arsalan Korkchi
Licensed dentist
ACE DNTL STUDIO, Marbella
Reg. no. / Nº colegiado: