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Quality Assurance Program. Samples – Forms 6 and 7. 6. CQI Activity Plan for the Year 20___. ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●. This is your Personalized Learning Plan. Self-assess your dental hygiene practice yearly .

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Quality Assurance Program

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Quality Assurance Program

Samples – Forms 6 and 7


6. CQI Activity Plan for the Year 20___

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  • This is your Personalized Learning Plan.

  • Self-assess your dental hygiene practice yearly.

  • Identify areas of your practice that need enhancement.

  • Develop learning goals that will enhance your practice.

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Form 6 Sample

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The number of goals you select will depend on your needs and the time and learning that is realistically required to complete them.


7. CQI Activities Evaluation for Goal # _____

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  • This form reports on your progress towards your goal.

  • A separate Form 7 must be completed for each goal.

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Form 7 Sample Goal #1

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…Researching and evaluating the PSR system as a periodontal screening tool.


Form 7 Sample Goal #1 cont’d

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Form 7 Sample Goal #2

● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●

…Investigating dentin hypersensitivity to better help clients who are presenting with tooth sensitivity.


Form 7 Sample Goal #2 cont’d

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Form 7 Sample Goal #3

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…Researching ways to better communicate with my clients so I can better establish their priorities and expectations for oral care.


Form 7 Sample Goal #3 cont’d

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Continuing Competency Means Making a Commitment to Lifelong Learning

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