Lesson 3.2: Dental Records Flashcards
NAVMED 6150/21-30
Dental Record Jacket (DRJ)
This is a file of continuous care given to active duty, reserve members, and their families
NAVMED 6150/21-30 (DRJ)
This contains all documents of dental care provided during a member’s career
NAVMED 6150/21-30 (DRJ)
This is a permanent dental record that is the documented history of dental care provided
NAVMED 6150/21-30 (DRJ)
How are Dental Records filed
By Social Security Numbers
Last number of the Member’s SSN
Terminal Digit
TRUE OR FALSE:
Black tape covers the last digit of the Member’s SSN on the right side of the record
False
Located on the LEFT side of the record
Color of the Record is determined by what
The second to last digit of the Member’s SSN
Record Jacket Color by digit:
0
Orange
Record Jacket Color by digit:
1
Green
Record Jacket Color by digit:
2
Yellow
Record Jacket Color by digit:
3
Gray
Record Jacket Color by digit:
4
Tan
Record Jacket Color by digit:
5
Blue
Record Jacket Color by digit:
6
White
Record Jacket Color by digit:
7
Almond (Brown)
Record Jacket Color by digit:
8
Pink
Record Jacket Color by digit:
9
Red
Parts of the Dental Record:
Part I - Inside Front Cover (Bottom to Top)
- Pencil Entries
- Full Mouth Radiographs (FMX) and Panorex (Pano)
- Bitewing Radiographs (Mounted)
- Unmounted Radiographs
- Compact Disc
- Charge-Out Form/Health Record Receipt, NAVMED 6150/7
Parts of the Dental Record:
Printed on the inside of the front cover, updated upon check-in and kept up to date
Pencil Entries
Parts of the Dental Record:
For periodontal treatment, view unerupted teeth, view jaw relations, and body identification
Full Mouth Radiographs (FMX) and Panorex (Pano)
Parts of the Dental Record:
Mounted in chronological order with the patient’s: last name, first name, middle initial, and full SSN
Bitewing Radiographs (Mounted)
Parts of the Dental Record:
A copy of all digital radiographs taken; may be recorded on compact for viewing
Compact Disc
Parts of the Dental Record:
“Pink Card” for filing system for checked out records
Charge-Out Form/Health Record Receipt, NAVMED 6150/7
NAVMED 6150/7
Charge-Out Form/Health Record Receipt
“Pink Card”
Charge-Out Form/Health Record Receipt, NAVMED 6150/7
Parts of the Dental Record:
Part II - Front of Center Page (Bottom to Top)
- Privacy Act Statement, DD Form 2005
2. Dental Health Questionnaire (HQR), NAVMED 6600/3
Parts of the Dental Record:
Pre-printed on front of the center page, DTF’s Rights and Obligations
Privacy Act Statement DD Form 2005
DD Form 2005
Privacy Act Statement
TRUE OR FALSE:
Privacy Act Statement DD Form 2005 is a consent form
False
NOT a consent form
Chronological order, recent on top, kept current, updated during each visit, and reviewed by the dentist
Dental Health Questionnaire (HQR), NAVMED 6600/3
NAVMED 6600/3
Dental Health Questionnaire (HQR)
Parts of the Dental Record:
Part III - Back of Center Page (Bottom to Top)
- Record of Disclosure
2. Dental Exam Form, NAVMED 6600/13
Parts of the Dental Record:
Pre-printed on back of center page
Record of Disclosure
Parts of the Dental Record:
S.O.A.P. (Subjective, Objective, Assessment, Plan) note format - Chronological order, recent on top, kept current, updated during each visit, and reviewed by the dentist
Dental Exam Form, NAVMED 6600/13
NAVMED 6600/13
Dental Exam Form
Parts of the Dental Record:
Part IV - Inside Back Cover (Bottom to Top)
- Forensic Examination
- Top
- Bottom
Parts of the Dental Record:
Pre-printed on back cover; for charting pre-existing conditions prior to entering military service
Forensic Examination
Parts of the Dental Record:
Charting of teeth, to include impacted or missing teeth
Top
Parts of the Dental Record:
Soft tissue conditions, normal and abnormal
Bottom
NAVMED 6600/14
Dental Treatment Form
NAVMED 6600/15
Current Status Form
Dental Treatment Forms:
Top is the treatment recommended and fill out only in
Pencil
Dental Treatment Forms:
Bottom is the treatment completed and fill out only in
Pen
NAVMED 6600/12
Reserve Dental Assessment and Certification Form
NAVPERS 5510/1
Record Identifier for Personnel Reliability Program
SF 513
Clinical Record/Consultation
Specialty referrals, medical/dental condition clarification, medical consult, and dental consult
Clinical Record/Consultation; SF 513
SF 515
Tissue Examination
Specimen submission, record, and oral tissue example facts
Tissue Examination; SF 515
SF 522
Request for Administration and Performance
Operations and other procedures; obtains authorization
Request for Administration and Performance; SF 522
Form that obtains authorization for General Anesthesia
Request for Administration and Performance; SF 522
Form that obtains authorization for Intravenous Sedation
Request for Administration and Performance; SF 522
Form that obtains authorization for Nitrous Oxide Sedation
Request for Administration and Performance; SF 522
Form that obtains authorization for Other Specific Procedures (EX: Cyst Removal)
Request for Administration and Performance; SF 522
Form that explains Operation and Other Procedures
Request for Administration and Performance; SF 522
Form that explains and obtains authorization for the Nature of Treatment
Request for Administration and Performance; SF 522
Form that explains Risks of the Operation and Other Procedures
Request for Administration and Performance; SF 522
Form that explains Benefits of the Operation and Other Procedures
Request for Administration and Performance; SF 522
Form that explains the Anticipated Outcome of the Operation and Other Procedures
Request for Administration and Performance; SF 522
Form that explain Alternative Treatments
Request for Administration and Performance; SF 522
DD Form 877
Request for Medical/Dental Records
Form used to Transfer Medical/Dental Records permanently to another Dental facility and maintained alphabetically
Request for Medical/Dental Records; DD Form 877
DD Form 2322
Dental Laboratory Work Authorization
Requests Service and Document responses from Dental Lab
Dental Laboratory Work Authorization; DD Form 2322
DD Form 2808
Report of Medical Examination
Active Duty and Reserve Report with 3-page Dental Exam
Report of Medical Examination; DD Form 2808
Report of Medical Examination:
Dental Information to be noted in Block 43; required for these requests
- Overseas Duty
- Special Duty
- Commission Program
Report of Medical Examination:
Medical Information is located on what page
Page 2
Report of Medical Examination:
Dentist Notes are located on what page
Page 3
NAVMED 6600/6
Dental Appointment Card
Record of Dental Appointment Information:
Top copy is given to the
Patient
Record of Dental Appointment Information:
Second copy is given to be
Filed in Member’s Record
Record of Dental Appointment Information:
Bottom copy is given to
The Liasion Coordinator
Dental Examinations:
Most extensive and lengthy clinical evaluation. Used in treatment planning for full-mouth reconstruction; determination of the etiology or differential diagnosis of a patient’s chief complaint
Comprehensive Dental Examination; Type 1 (T1)
Dental Examinations:
Routine, annually and appropriate, treatment plan
Periodic Dental Examination; Type 2 (T2)
Dental Examinations:
Consultation for staff and residents (diagnostic procedures, consult between staff observation)
Other Dental Examination; Type 3 (T3)
Dental Examinations:
Least comprehensive, performed by Doctor of Dental Science (DDS) or Registered Dental Hygienist (RDH)
Screening Evaluation; Type 4 (T4)
Dental Examinations:
Type 1
Comprehensive Dental Examination
Dental Examinations:
Type 2
Periodic Dental Examination
Dental Examinations:
Type 3
Other Dental Examination
Dental Examinations:
Type 4
Screening Evaluation
Dental exam results; when dental provider determine status and determines the patient’s priority
Dental Classifications
Dental Classification:
No treatment required
Dental Class 1
Dental Classification:
Treatment needed and emergency care NOT required within 12 months
Dental Class 2
Dental Classification:
Treatment needed and emergency care REQUIRED within 12 months
Dental Class 3
Dental Classification:
Exam required, or unknown classification
Dental Class 4
Dental Classification:
Which Dental Classes are NON-DEPLOYABLE
- Dental Class 3
2. Dental Class 4
Dental Care Eligibility Requirements and Treatment Priorities:
Members of the uniformed services on active duty
Category 1A
Dental Care Eligibility Requirements and Treatment Priorities:
Members of a Reserve Component of the Armed Forces and National Guard personnel
Category 1B
Dental Care Eligibility Requirements and Treatment Priorities:
Family member or active duty members of the uniformed services; family members of persons who died while in such a status: OVERSEAS
Category 2
Dental Care Eligibility Requirements and Treatment Priorities:
Members of the Senior Reserve Officers’ Training Corps
Category 3
Dental Care Eligibility Requirements and Treatment Priorities:
Retired members of the uniformed services and their family members (including family members of deceased retired members)
Category 4
Dental Care Eligibility Requirements and Treatment Priorities:
Civilian employees of the Federal Government
Category 5
Dental Care Eligibility Requirements and Treatment Priorities:
All others
Category 6