PATIENT FORMS

RED FLAG RULE COMPLIANCE effective November 1, 2009
 
It is the policy of John W. Clemenza, DMD, MD The Oral and Facial Surgical Center, LLC to follow all federal and state laws and reporting Requirements regarding identity theft. To help ensure we are protecting your identity, you will be required to provide to the office, at the time of your appointment the following:

1. Drivers license or other photo ID;
   
2. Current Health Insurance Card; and/ or
   
3. Utility bills or other correspondence showing current residence if the photo ID does not show your current address. If the patient is a minor, the patient’s parent or guardian should bring the information listed above