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.

----------------------------------------------------
FOR SPECIFICATIONS PURPOSES ONLY (CAPI HANDLES
AUTOMATICALLY): CAPI DOES NOT ALLOW -7 OR -8 IN
COMBINATION WITH ANY OTHER CODE.
----------------------------------------------------

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)
----------------------------------------------------

----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS PERSON'S-PRESCRIBED-MEDICINES-
ROSTER FOR SELECTION AND ADDITION OF PRESCRIBED
MEDICINES.
----------------------------------------------------

----------------------------------------------------
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.
----------------------------------------------------

----------------------------------------------------
ROSTER FILTER:
NONE, DISPLAY ALL.
----------------------------------------------------

BOX_01
======

----------------------------------------------------
IF THE CHARGE/PAYMENT MODULE HAS NOT BEEN ASKED
FOR THE EVENT-PROVIDER PAIR BEING ASKED ABOUT, GO
TO THE CHARGE/PAYMENT (CP) SECTION.
----------------------------------------------------

----------------------------------------------------
OTHERWISE, GO TO THE EVENT DRIVER (ED) SECTION.
----------------------------------------------------

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