Lesson 3.2: Dental Records Flashcards
(96 cards)
1
Q
NAVMED 6150/21-30
A
Dental Record Jacket (DRJ)
2
Q
This is a file of continuous care given to active duty, reserve members, and their families
A
NAVMED 6150/21-30 (DRJ)
3
Q
This contains all documents of dental care provided during a member’s career
A
NAVMED 6150/21-30 (DRJ)
4
Q
This is a permanent dental record that is the documented history of dental care provided
A
NAVMED 6150/21-30 (DRJ)
5
Q
How are Dental Records filed
A
By Social Security Numbers
6
Q
Last number of the Member’s SSN
A
Terminal Digit
7
Q
TRUE OR FALSE:
Black tape covers the last digit of the Member’s SSN on the right side of the record
A
False
Located on the LEFT side of the record
8
Q
Color of the Record is determined by what
A
The second to last digit of the Member’s SSN
9
Q
Record Jacket Color by digit:
0
A
Orange
10
Q
Record Jacket Color by digit:
1
A
Green
11
Q
Record Jacket Color by digit:
2
A
Yellow
12
Q
Record Jacket Color by digit:
3
A
Gray
13
Q
Record Jacket Color by digit:
4
A
Tan
14
Q
Record Jacket Color by digit:
5
A
Blue
15
Q
Record Jacket Color by digit:
6
A
White
16
Q
Record Jacket Color by digit:
7
A
Almond (Brown)
17
Q
Record Jacket Color by digit:
8
A
Pink
18
Q
Record Jacket Color by digit:
9
A
Red
19
Q
Parts of the Dental Record:
Part I - Inside Front Cover (Bottom to Top)
A
- 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
20
Q
Parts of the Dental Record:
Printed on the inside of the front cover, updated upon check-in and kept up to date
A
Pencil Entries
21
Q
Parts of the Dental Record:
For periodontal treatment, view unerupted teeth, view jaw relations, and body identification
A
Full Mouth Radiographs (FMX) and Panorex (Pano)
22
Q
Parts of the Dental Record:
Mounted in chronological order with the patient’s: last name, first name, middle initial, and full SSN
A
Bitewing Radiographs (Mounted)
23
Q
Parts of the Dental Record:
A copy of all digital radiographs taken; may be recorded on compact for viewing
A
Compact Disc
24
Q
Parts of the Dental Record:
“Pink Card” for filing system for checked out records
A
Charge-Out Form/Health Record Receipt, NAVMED 6150/7
25
NAVMED 6150/7
Charge-Out Form/Health Record Receipt
26
"Pink Card"
Charge-Out Form/Health Record Receipt, NAVMED 6150/7
27
Parts of the Dental Record:
| Part II - Front of Center Page (Bottom to Top)
1. Privacy Act Statement, DD Form 2005
| 2. Dental Health Questionnaire (HQR), NAVMED 6600/3
28
Parts of the Dental Record:
| Pre-printed on front of the center page, DTF's Rights and Obligations
Privacy Act Statement DD Form 2005
29
DD Form 2005
Privacy Act Statement
30
TRUE OR FALSE:
| Privacy Act Statement DD Form 2005 is a consent form
False
| NOT a consent form
31
Chronological order, recent on top, kept current, updated during each visit, and reviewed by the dentist
Dental Health Questionnaire (HQR), NAVMED 6600/3
32
NAVMED 6600/3
Dental Health Questionnaire (HQR)
33
Parts of the Dental Record:
| Part III - Back of Center Page (Bottom to Top)
1. Record of Disclosure
| 2. Dental Exam Form, NAVMED 6600/13
34
Parts of the Dental Record:
| Pre-printed on back of center page
Record of Disclosure
35
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
36
NAVMED 6600/13
Dental Exam Form
37
Parts of the Dental Record:
| Part IV - Inside Back Cover (Bottom to Top)
1. Forensic Examination
2. Top
3. Bottom
38
Parts of the Dental Record:
| Pre-printed on back cover; for charting pre-existing conditions prior to entering military service
Forensic Examination
39
Parts of the Dental Record:
| Charting of teeth, to include impacted or missing teeth
Top
40
Parts of the Dental Record:
| Soft tissue conditions, normal and abnormal
Bottom
41
NAVMED 6600/14
Dental Treatment Form
42
NAVMED 6600/15
Current Status Form
43
Dental Treatment Forms:
| Top is the treatment recommended and fill out only in
Pencil
44
Dental Treatment Forms:
| Bottom is the treatment completed and fill out only in
Pen
45
NAVMED 6600/12
Reserve Dental Assessment and Certification Form
46
NAVPERS 5510/1
Record Identifier for Personnel Reliability Program
47
SF 513
Clinical Record/Consultation
48
Specialty referrals, medical/dental condition clarification, medical consult, and dental consult
Clinical Record/Consultation; SF 513
49
SF 515
Tissue Examination
50
Specimen submission, record, and oral tissue example facts
Tissue Examination; SF 515
51
SF 522
Request for Administration and Performance
52
Operations and other procedures; obtains authorization
Request for Administration and Performance; SF 522
53
Form that obtains authorization for General Anesthesia
Request for Administration and Performance; SF 522
54
Form that obtains authorization for Intravenous Sedation
Request for Administration and Performance; SF 522
55
Form that obtains authorization for Nitrous Oxide Sedation
Request for Administration and Performance; SF 522
56
Form that obtains authorization for Other Specific Procedures (EX: Cyst Removal)
Request for Administration and Performance; SF 522
57
Form that explains Operation and Other Procedures
Request for Administration and Performance; SF 522
58
Form that explains and obtains authorization for the Nature of Treatment
Request for Administration and Performance; SF 522
59
Form that explains Risks of the Operation and Other Procedures
Request for Administration and Performance; SF 522
60
Form that explains Benefits of the Operation and Other Procedures
Request for Administration and Performance; SF 522
61
Form that explains the Anticipated Outcome of the Operation and Other Procedures
Request for Administration and Performance; SF 522
62
Form that explain Alternative Treatments
Request for Administration and Performance; SF 522
63
DD Form 877
Request for Medical/Dental Records
64
Form used to Transfer Medical/Dental Records permanently to another Dental facility and maintained alphabetically
Request for Medical/Dental Records; DD Form 877
65
DD Form 2322
Dental Laboratory Work Authorization
66
Requests Service and Document responses from Dental Lab
Dental Laboratory Work Authorization; DD Form 2322
67
DD Form 2808
Report of Medical Examination
68
Active Duty and Reserve Report with 3-page Dental Exam
Report of Medical Examination; DD Form 2808
69
Report of Medical Examination:
| Dental Information to be noted in Block 43; required for these requests
1. Overseas Duty
2. Special Duty
3. Commission Program
70
Report of Medical Examination:
| Medical Information is located on what page
Page 2
71
Report of Medical Examination:
| Dentist Notes are located on what page
Page 3
72
NAVMED 6600/6
Dental Appointment Card
73
Record of Dental Appointment Information:
| Top copy is given to the
Patient
74
Record of Dental Appointment Information:
| Second copy is given to be
Filed in Member's Record
75
Record of Dental Appointment Information:
| Bottom copy is given to
The Liasion Coordinator
76
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)
77
Dental Examinations:
| Routine, annually and appropriate, treatment plan
Periodic Dental Examination; Type 2 (T2)
78
Dental Examinations:
| Consultation for staff and residents (diagnostic procedures, consult between staff observation)
Other Dental Examination; Type 3 (T3)
79
Dental Examinations:
| Least comprehensive, performed by Doctor of Dental Science (DDS) or Registered Dental Hygienist (RDH)
Screening Evaluation; Type 4 (T4)
80
Dental Examinations:
| Type 1
Comprehensive Dental Examination
81
Dental Examinations:
| Type 2
Periodic Dental Examination
82
Dental Examinations:
| Type 3
Other Dental Examination
83
Dental Examinations:
| Type 4
Screening Evaluation
84
Dental exam results; when dental provider determine status and determines the patient's priority
Dental Classifications
85
Dental Classification:
| No treatment required
Dental Class 1
86
Dental Classification:
| Treatment needed and emergency care NOT required within 12 months
Dental Class 2
87
Dental Classification:
| Treatment needed and emergency care REQUIRED within 12 months
Dental Class 3
88
Dental Classification:
| Exam required, or unknown classification
Dental Class 4
89
Dental Classification:
| Which Dental Classes are NON-DEPLOYABLE
1. Dental Class 3
| 2. Dental Class 4
90
Dental Care Eligibility Requirements and Treatment Priorities:
Members of the uniformed services on active duty
Category 1A
91
Dental Care Eligibility Requirements and Treatment Priorities:
Members of a Reserve Component of the Armed Forces and National Guard personnel
Category 1B
92
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
93
Dental Care Eligibility Requirements and Treatment Priorities:
Members of the Senior Reserve Officers' Training Corps
Category 3
94
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
95
Dental Care Eligibility Requirements and Treatment Priorities:
Civilian employees of the Federal Government
Category 5
96
Dental Care Eligibility Requirements and Treatment Priorities:
All others
Category 6
