Documenting Standards of Care

1. Documenting Standards of Care Hilton Hosannah, DDS Region I Dental Consultant

2. Oral Health and Wellness Record The student health record (SHR) contains the following oral health documentation: • SF-603 and SF-603A • Mounted bitewing x-rays • Consultation requests • Oral health and wellness plan • Copies of dental laboratory prescription • Summaries of off-center oral health care • Oral health history form

3. Oral Health and Wellness Record (continued) The center dentist and the health and wellness manager are responsible for the maintenance, safeguard, and confidentiality of all oral health and wellness records.

4. Form SF-603 • Used to record all oral health and wellness information • Initial examination by the dentist or hygienist • All emergency visits and services provided • All treatment progress notes • All radiographs taken for a student • All medications administered to a student in the dental suite

5. Form SF-603 (continued) • May be separated, only temporarily, from the SHR to obtain third-party payments, and for referrals to off-center dental providers

6. Guidelines and Forms • Cursory oral inspection is recorded on the Cursory Medical History Form and/or the Medical inspection guide or on the SF-603 • Initial oral examination—the ADA Class II oral examination is recorded on SF-603 • Student’s oral health and wellness status and care provided while in Job Corps are recorded on SF-603 and SF-603A

7. TAG-AOral Health and Wellness Program • Oral health and wellness records must be kept as a part of the SHR • The oral health and wellness record must include x-rays and summaries of all other health and wellness care

8. Record Reviews • Regional Dental Consultants and the National Office are responsible for ensuring the quality of care • Quality of care is determined through record reviews and inspection of the work performed on students by on and off-center dentists and dental hygienists

9. Reporting Requirements The number of mandatory oral examinations are reported by the center on the monthly health utilization statistics report.

10. Productivity Indicators • Productivity indicators are management tools which constitute the basic formal measure for assessing minimal acceptable productivity and cost effectiveness • Four measures were developed and have been used successfully • Initial dental examination per hour • Other dental visits per hour • Broken appointment rate • Emergency/walk-in visit rate

11. Productivity Indicators (continued) • Initial Oral Examinations per Hour—This guideline suggests that the dentist should provide four initial examinations per hour • A rate less than four examinations per hour is considered underutilization in the dentist scheduled time

12. Productivity Indicators (continued) • Broken Appointment Rate—This guideline suggest that centers maintain a rate of less than 15 percent for broken scheduled appointments • A rate greater than 15 percent may indicate a need to examine staffing, scheduling, and center sanctions and incentives

13. Productivity Indicators (continued) • Emergency/Walk-in Visit Rate—This guideline suggests that centers maintain a rate of less than 25 percent for emergency walk-in visits. This includes all unplanned encounters between student and dentist. • A rate greater than 25 percent may require a look at the referral process and the non-health staff referrals to the health services

14. Priority Classification System for Job Corps Students • Initial oral examination is the oral inspection which the student receives between the 45th and 75th day on center • Establishes the sequence in which students will receive treatment • Determines what treatment is in the scope of the center’s immediate capabilities

15. Basis for the Priority Classification System • Allows for input of new students and for reclassification of individual students as appropriate • Access to and provision of necessary emergency dental care are mandatory and precedes the first level of service in the system • When permitted by the availability of appropriate auxiliary staff, preventive dental services for all students classified higher than corrective special dental services in Priority 3

16. Basis for the Priority Classification System (continued) • System has the the flexibility to allow for certain differences in patient conditions • As resources become limited decisions are forced towards those services that are more appropriate • For students with the most urgent needs, special dental services are those most cost-effective from a time or monetary standpoint

17. Basis for the Priority Classification System (continued) • As funds become available, the system permits an orderly and equitable increase in services that require more time, additional provider skills, or more expense

18. Limitation of the Priority Classification System • Serves as an overall guideline for providing oral health and wellness care but should not replace the professional judgment of the center dentist • Consideration of factors such as the availability of resources, skills of the provider, and certain difference in the patient conditions allow for flexibility in implementing the system

19. Form SF-603 • Form SF-603 is used to record all oral health and wellness information • Initial examination by the dentist or hygienist • All emergency visits and services provided • All treatment progress notes • All radiographs taken for a student • All medications administered to a student in the dental suite

20. Form SF-603 (continued) • All medications prescribed for a student • All entries must be dated and signed • Form SF-603 if properly completed contains all the information on which treatment decisions were made and follow up care was decided • Form SF-603 and other oral health and wellness forms are kept as the permanent record of the student’s oral health and wellness dental experience while in Job Corps. It remains a part of the student’s permanent medical record

21. Classifying Dental Pathology(see handout)