Add Employee

Employee's PCP

Allow Carrier to assign PCP

ID #

PCP Name (Optional)

Existing Patient

Yes No Unknown

Address

Spouse's PCP

Allow Carrier to assign PCP

Same as Applicant's PCP

ID #

PCP Name (Optional)

Existing Patient

Yes No Unknown

Address

Child's PCP

Allow Carrier to assign PCP

Same as Applicant's PCP

ID #

PCP Name (Optional)

Existing Patient

Yes No Unknown

Address

Preferred Dentist Organization (PDO)

Allow Carrier to assign PDO

PDO #

Existing Patient

Yes No Unknown