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?
CODE ALL THAT APPLY.
GENERAL DENTIST ........................ 1
DENTAL HYGIENIST ....................... 2
DENTAL TECHNICIAN ...................... 3
DENTAL SURGEON ......................... 4
ORTHODONTIST ........................... 5
ENDODONTIST ............................ 6
PERIODONTIST ........................... 7
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
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? CODE ALL THAT APPLY.
FOR DEFINITIONS OF ANSWER CATEGORIES, PRESS F1.
*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
REF .................................... -7
DK ..................................... -8
[Code All That Apply]
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| IF CODE ‘91’ (OTHER) ENTERED ALONE OR IN |
| COMBINATION WITH ANY OTHER CODE, CONTINUE WITH |
| DN04OV |
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| OTHERWISE, GO TO DN05 |
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| HEADINGS AND CODE CATEGORIES WILL NOT FIT ON ONE |
| SCREEN. THEREFORE, HEADINGS WILL ONLY APPEAR ON |
| F1 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 |
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DN04OV
======
ENTER OTHER TYPE OF DENTAL CARE:
[Enter Other Specify]..................
REF ................................... -7
DK .................................... -8
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
NO ..................................... 2 {BOX_01}
REF ................................... -7 {BOX_01}
DK .................................... -8 {BOX_01}
PRESS F1 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?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Prescribed Medicine]
[2. Prescribed Medicine]
[3. Prescribed Medicine]
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| ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON’S- |
| PRESCRIBED-MEDICINES-ROSTER. |
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| ROSTER BEHAVIOR SPECIFICATIONS |
| |
| 1. INTERVIEWER MAY SELECT A MEDICINE(S) ALREADY |
| LISTED ON THE ROSTER. |
| 2. INTERVIEWER SHOULD BE ABLE TO ADD ANY NUMBER OF|
| MEDICINES AT THE ROSTER QUESTIONS (I.E., NO |
| LIMIT TO THE NUMBER OF MEDICINES). |
| 3. INTERVIEWER SHOULD BE ABLE TO DELETE A MEDICINE|
| THAT WAS RECORDED ON THE SCREEN WHERE DELETE IS|
| USED. THAT IS, AS LONG AS THE INTERVIEWER HAS |
| NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO |
| DELETE A MEDICINE ENTERED IN ERROR. IF DELETE |
| IS ATTEMPTED AT A TIME WHEN IT IS NOT ALLOWED |
| (I.E., AFTER THE LINK IS ESTABLISHED), DISPLAY |
| THE FOLLOWING ERROR MESSAGE: ‘DELETE ALLOWED |
| ONLY WHEN MEDICINE IS FIRST ENTERED.’ |
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BOX_01
======
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| IF THE CHARGE/PAYMENT SECTION HAS NOT BEEN ASKED |
| FOR THE EVENT-PROVIDER PAIR BEING ASKED ABOUT, GO |
| TO THE CHARGE/PAYMENT SECTION. |
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| OTHERWISE, GO TO THE EVENT DRIVER (ED) SECTION. |
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