WEBThis form collects the opinions and observations of dental health care personnel (DHCP) who screen a safer dental device to determine its acceptability for use in a clinical setting. This form can be adapted for use with multiple types of devices.
WEBThis form determines fitness for prolonged duty without ready access to dental care and is not intended to document comprehensive dental needs. (1) Patient has good oral health and is not expected to require dental treatment or reevaluation for 12 months.
NCDHHS
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WEBD9912 pre-visit patient screening. Capture and documentation of a patient’s health status prior to or on the scheduled date of service to evaluate risk of infectious disease transmission if the patient is to be treated within the dental practice.
Patient Registration and Forms | American Dental Association
WEBThe American Dental Association (ADA) offers a comprehensive health history form, for adults or children in both English and Spanish, that covers both medical and dental issues. The form is available in a digital, downloadable version or in print.
WEBPatient Screening Form. Patient Name: Positive responses to any of these would likely indicate a deeper discussion with the dentist before proceeding with elective dental treatment. • For testing, see the list of State and Territorial Health Department Websites for your specific area’s information.
Oral Health Forms - ECLKC
WEBAug 30, 2024 · Use these forms to document dental home information and current oral health status and services; such as diagnostic and preventive services, counseling, restorative and emergency care, and referral to a specialist.
WEBPatient Screening Form. Do you/they have fever or have you/they felt hot or feverish recently (14-21 days)? Are you/they having shortness of breath or other difficulties breathing? Do you/they have a cough? Any other flu-like symptoms, such as gastrointestinal upset, headache or fatigue?
WEBDental Screening Form. When the Health Assessment Transmittal Form issued by NCDPI is used to complete the NC Pre-K child’s health assessment, a separate dental screening must also be completed due to it not being included on the NCDPI form.
Dental Screening Form Template | Jotform
WEBWhether you’re a dentist or dental hygienist, use this free Dental Screening Form to screen and diagnosis your patients’ dental health. Just customize the questions to fit your needs and watch as the form is automatically filled out on your computer screen!