Dental Visit (DN) Section

BOX_00 (DN1000)

DN10 (DN1001)

BLAISE NAME: CodeAllDNProvTp

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE PROVIDER} {EVN-DT}

Question Text:

&DN-1.

Looking at card DN-1, what type of dental care provider did {you/{PERSON}} see during this visit?

PROBE: Any other type of dental care person?

ENTER ALL THAT APPLY

HELP: F1

Responses: GENERAL DENTIST 1 DN20 (DN1005)

PEDIATRIC DENTIST 2 DN20 (DN1005)

DENTAL SPECIALIST (E.G, ORTHODONTIST, ENDODONTIST,PERIODONTIST) 3 DN20 (DN1005)

DENTAL HYGIENIST 4 DN20 (DN1005)

OTHER 91 DN20 (DN1005)

REFUSED RF DN20 (DN1005)

DON'T KNOW DK DN20 (DN1005)

Programmer Instructions: For specifications purposes only (CAPI handles automatically) : CAPI does not allow RF or DK in combination with any other code.

Display Instructions:

DN20 (DN1005)

BLAISE NAME: CodeAllDNSvc

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE PROVIDER} {EVN-DT}

Question Text:

&DN-2.

Looking at card DN-2, what did {you/{PERSON}} have done during this visit?

PROBE: What else was done?

ENTER ALL THAT APPLY.

HELP: F1

Responses: GENERAL EXAM, CHECKUP, OR CONSULTATION 1

CLEANING, PROPHYLAXIS, OR POLISHING, PERIODONTAL RECALL VISIT (PERIODIC OR REGULAR) 2

X-RAYS, RADIOGRAPHS, OR BITEWINGS 3

FLUORIDE TREATMENT 4

SEALANT (PLASTIC COATINGS ON BACK TEETH) 5

FILLINGS, INLAYS, CROWNS OR CAPS 6

ROOT CANAL 7

PERIODONTAL SCALING, ROOT PLANING, OR GUM SURGERY 8

EXTRACTION, TOOTH PULLED OR OTHER ORAL SURGERY 9

IMPLANTS 10

FIXED BRIDGES, DENTURES OR REMOVABLE PARTIAL DENTURES, RELINING OR REPAIR OF BRIDGES OR DENTURES 11

ORTHODONTIA, BRACES, OR RETAINERS 12

OTHER 91

REFUSED RF

DON'T KNOW DK

Programmer Instructions: If code ‘91’ (OTHER) entered alone or in combination with any other code, continue with DN20OS.

Otherwise, go to BOX_10.

Headings and code categories will appear in the response pane (except for DIAGNOSTIC OR PREVENTIVE and ORAL SURGERY which are programmatically included in the info pane, but will look like they are part of the response list pane), on the help screen and show card DN-2. Headings should be associated with codes as follows:

*DIAGNOSTIC OR PREVENTIVE = CODES 1-5

*RESTORATIVE OR ENDODONTIC = CODES 6-7

*PERIODONTIC (GUM TREATMENT) = CODE 8

*ORAL SURGERY = CODES 9-10

*PROSTHETICS = CODES 11

*ORTHODONTICS = CODE 12

*ADDITIONAL PROCEDURES = CODE 91

The response pane should contain two even columns (as possible) with headers directly above response categories.

The headers should be underlined.

For specifications purposes only (CAPI handles automatically): CAPI does not allow RF or DK in combination with any other code.

Display Instructions:

DN20OS (DN1010)

BLAISE NAME: DNSvcOS

Question Text:

SPECIFY: OTHER TYPE OF DENTAL CARE:

Responses: 1 BOX_10 (DN1025)

REFUSED RF BOX_10 (DN1025)

DON'T KNOW DK BOX_10 (DN1025)

Display Instructions:

BOX_10 (DN1025)

Return to Top