Dental Care (DN) Section
DN01
====
OMITTED.
DN02
====
OMITTED.
DN03
====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-DT}
What type of dental care provider did (PERSON) see during this
visit?
PROBE: Any other type of dental care person?
CHECK ALL THAT APPLY.
GENERAL DENTIST ........................ 1 {DN04}
DENTAL HYGIENIST ....................... 2 {DN04}
DENTAL TECHNICIAN ...................... 3 {DN04}
DENTAL SURGEON ......................... 4 {DN04}
ORTHODONTIST ........................... 5 {DN04}
ENDODONTIST ............................ 6 {DN04}
PERIODONTIST ........................... 7 {DN04}
OTHER ................................. 91 {DN04}
REF ................................... -7 {DN04}
DK .................................... -8 {DN04}
[Code All That Apply]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
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| FOR SPECIFICATIONS PURPOSES ONLY (CAPI HANDLES |
| AUTOMATICALLY): CAPI DOES NOT ALLOW -7 OR -8 IN |
| COMBINATION WITH ANY OTHER CODE. |
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DN04
====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-DT}
SHOW CARD DN-1.
What did (PERSON) have done during this visit?
PROBE: What else was done?
CHECK ALL THAT APPLY.
*DIAGNOSTIC OR PREVENTATIVE
GENERAL EXAM, CHECKUP OR CONSULTATION .. 1
CLEANING, PROPHYLAXIS, OR POLISHING .... 2
X-RAYS, RADIOGRAPHS, OR BITEWINGS ...... 3
FLUORIDE TREATMENT ..................... 4
SEALANT (PLASTIC COATINGS ON BACK
TEETH) ................................. 5
*RESTORATIVE OR ENDODONTIC
FILLINGS ............................... 6
INLAYS ................................. 7
CROWNS OR CAPS ......................... 8
ROOT CANAL ............................. 9
*PERIODONTIC (GUM TREATMENT)
PERIODONTAL SCALING, ROOT PLANING, OR
GUM SURGERY ............................ 10
PERIODONTAL RECALL VISIT (PERIODIC OR
REGULAR) ............................... 11
*ORAL SURGERY
EXTRACTION, TOOTH PULLED ............... 12
IMPLANTS ............................... 13
ABSCESS OR INFECTION TREATMENT ......... 14
OTHER ORAL SURGERY ..................... 15
*PROSTHETICS
FIXED BRIDGES .......................... 16
DENTURES OR REMOVABLE PARTIAL DENTURES . 17
RELINING OR REPAIR OF BRIDGES OR
DENTURES ............................... 18
*ORTHODONTICS
ORTHODONTIA, BRACES, OR RETAINERS ...... 19
*ADDITIONAL PROCEDURES
BOND, WHITEN, OR BLEACH ................ 20
TREATMENT FOR TMD OR TMJ ............... 21
OTHER .................................. 91 {DN04OV}
REF .................................... -7
DK ..................................... -8
[Code All That Apply]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
| HEADINGS AND CODE CATEGORIES WILL NOT FIT ON ONE |
| SCREEN. THEREFORE, HEADINGS WILL ONLY APPEAR ON |
| HELP SCREEN AND SHOW CARD DN-1. HEADINGS SHOULD |
| BE ASSOCIATED WITH CODES AS FOLLOWS: |
| *DIAGNOSTIC OR PREVENTATIVE = CODES 1-5 |
| *RESTORATIVE OR ENDODONTIC = CODES 6-9 |
| *PERIODONTIC (GUM TREATMENT) = CODES 10-11 |
| *ORAL SURGERY = CODES 12-15 |
| *PROSTHETICS = CODES 16-18 |
| *ORTHODONTICS = CODE 19 |
| *ADDITIONAL PROCEDURES = CODES 20-21 AND 91 |
----------------------------------------------------
----------------------------------------------------
| FOR SPECIFICATIONS PURPOSES ONLY (CAPI HANDLES |
| AUTOMATICALLY): CAPI DOES NOT ALLOW -7 OR -8 IN |
| COMBINATION WITH ANY OTHER CODE. |
----------------------------------------------------
----------------------------------------------------
| IF CODE ‘91’ (OTHER) ENTERED ALONE OR IN |
| COMBINATION WITH ANY OTHER CODE, CONTINUE WITH |
| DN04OV |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO DN05 |
----------------------------------------------------
DN04OV
======
OTHER TYPE OF DENTAL CARE:
[Enter Other Specify].................. {DN05}
REF ................................... -7 {DN05}
DK .................................... -8 {DN05}
DN05
====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-DT}
During this visit, were any medicines prescribed for
(PERSON)? Please include only prescriptions which were
filled.
YES .................................... 1 {DN06}
NO ..................................... 2 {BOX_01}
REF ................................... -7 {BOX_01}
DK .................................... -8 {BOX_01}
HELP AVAILABLE FOR DEFINITION OF PRESCRIBED MEDICINE.
DN06
====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-DT}
Please tell me the names of the prescriptions from this
visit that were filled.
PROBE: Any other prescriptions from this visit filled?
[1. Prescribed Medicine]
[2. Prescribed Medicine]
[3. Prescribed Medicine]
----------------------------------------------------
| ROSTER DETAILS: |
| TITLE: PERSON'S-PRESCRIBED-MEDICINES_1. |
| |
| COL # 1 HEADER: PRESCRIBED MEDICINE |
| INSTRUCTIONS: DISPLAY PMED NAME (PMED.PMEDNAME) |
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----------------------------------------------------
| ROSTER DEFINITION: |
| THIS ITEM DISPLAYS PERSON'S-PRESCRIBED-MEDICINES- |
| ROSTER FOR SELECTION AND ADDITION OF PRESCRIBED |
| MEDICINES. |
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----------------------------------------------------
| ROSTER BEHAVIOR: |
| 1. MULTIPLE SELECT AND ADD ALLOWED. |
| |
| 2. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE |
| A PMED ADDED ON THIS SCREEN AS LONG AS CAPI HAS |
| NOT YET CREATED THE LINK BETWEEN THIS PMED AND THE|
| EVENT. |
| |
| 3. EDIT DISALLOWED. |
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| ROSTER FILTER: |
| NONE, DISPLAY ALL. |
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BOX_01
======
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| IF THE CHARGE/PAYMENT MODULE HAS NOT BEEN ASKED |
| FOR THE EVENT-PROVIDER PAIR BEING ASKED ABOUT, GO |
| TO THE CHARGE/PAYMENT (CP) SECTION. |
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| OTHERWISE, GO TO THE EVENT DRIVER (ED) SECTION. |
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