Screening Protocol

  1. Welcome the patient to the school and inform then this is an “interview to determine if we can meet each other’s needs”
  2. Chart Add a “Screening” form.
  3. Follow the questions on the screening form.
  4. When you get to the BP/Pulse stage, Chart Add a “Medical History” form
  5. In Medical History:
    • Take/enter blood pressure
    • Go over ALLERGIES section
    • Go over MEDICAL CONDITIONS section
    • Enter medications that the patient is taking in the Medication List tab
    • Grab a Med Consult form if you think we’re going to need one
  6. Under attachments -> Intake, pull up the “NP intake” pdf and scroll to the Patient’s Rights and Responsibilities page. Review the entire document with the patient.
  7. Proceed on the screening form with “availability”
  8. If patient is available less than 4 appointment slots per week, discuss that treatment will take even longer. (Crowns could take 3+ months, dentures could take more than a year).
  9. Take a brief look in the moth to determine what kind of x-rays we will prescribe (FMX or pano).
  10. Create a treatment plan:
    1. D0190 – screening code
    2. X-ray codes
      1. D0210 – FMX
      2. D0210A – FMX Cash paying patient
      3. D0330 – Pano
      4. D0330 (Pano) + D0274 (4 bitewings) + D0220 (1st PA) + D0230 (every PA after that)
    3. D0150 – Comprehensive exam
    4. D0011 Caries Risk Assessment
    5. D0012 Saliva Test
  11. Review and have the patient sign the treatment plan.
  12. Write a SOAP note describing anything unique about the patient.
  13. Mark D0190 as “complete” and get completion and note, screening form, and medical history swiped.

SOAP Note Template

D0190 Screening
Sterile strips checked, all instruments sterile. Operatory disinfected  (double wipe 10 minutes prior to operation).
Worked with Dr(s).
MedHx: Non-contributory
Meds: Non-contributory
Allergies: NKDA

Vitals:       mmHg RAS,       bpm ;
Last time at Dentist, why so long?:
Last FMX:
​Radiographs needed: FMX / Pano + BWX

Our clinic takes up to 4X longer and 4X more appointments to get treatment.
Pt. understands that he/she will be treated by students chosen at random.
Pt. agrees to get FMX. 2 appointment failure policy. Fee for service.

Pt Needs:
Endo ;
Operative ;
Fixed (advanced / minimal) ;
Perio (advanced / minimal) ;
Oral Surgery ;
Removable ;
Additional Needs/Comments: