A dentist or hygienist may recall a patient as frequently as he/she feels it is necessary to maintain oral health.
To establish a procedure for referrals for oral health services for eligible recipients.
[Insert facility procedures]
Regular Working Hours
Emergency patients are referred to the dental clinic during regular work hours from any medical care department or school-nursing department using a PCC or facility referral. This referral can come from Out Patient Clinics, Community Health Nursing, WIC, or MCH
Patients who are experiencing severe pain may go to an emergency room or dental treatment facility, but must notify the Facility’s CHS office immediately or at least within 72 hours from time of treatment. Only emergency treatment services should be provided by an emergency room or dental treatment facility.
Routine Patients Referred to Dental
These patients can be self referred or referred in the same manner as above. The patient may present to the dental receptionist with an "in house" referral form or verbally request that an exam appointment be made.
All patient referrals made from the dental clinic to any department in the hospital are made using a PCC form. All demographic coding, dental subjective and objective findings must be completed.
Inter-Facility Referrals (For programs with multiple dental clinics)
Emergency Patients Referred to Dental
These patients can receive care as above. They can also self refer.
These patients can receive an appointment for routine care via self-referral, telephone request
, written request or as described above.
All Patients Referred from Dental
The dental records of that patient will accompany all patient referrals made from the dental clinic to another facility. HIPAA regulations that govern transfer of information within the facility network will be followed for information transfer.
[This needs to be established by Facility Management and CHS Office]
All Patients Referred from Dental to External Providers
These patients must
have a referral initiated, for work covered under the Facility
’s Contract Health Guidelines, that includes the reason for referral
, estimated cost, priority and third party eligibility entered on the form. The patient takes the form to Contract Health so that a contract can be written. Endodontics
, Oral Surgery and Pedodontic services done by an external provider must have a referral for services to be provided. The [Dental Program Director]
must first authorize emergency visits to external providers so that Contract Health Guidelines are met.
To external provider
The dentist completes an HSA 199 listing the procedure(s) needed. The completed form is then given to the dental receptionist. Referrals will be made to contract providers.
The [appropriate dental staff] calls the external provider and schedules an appointment.
The [appropriate dental staff] completes the HSA 199 and forwards the original to the Contract Health Services (CHS) clerk, placing one copy in the patient's record. The CHS clerk will complete the HRSA 57 form and mail it and one copy of the referral form (HSA 199) to the external provider.
CHS Office will be responsible for the allocation of Dental CHS funds.
When obligating these funds the following policies will be used:
Revise as needed to comply with CHS policies.
The patient must be registered for care at the facility to be eligible for contract funds.
Contract money may be used to pay for laboratory services.
Contract money will be used based on the Facility’s priorities for contract dental services.
Contract money will not be used to provide orthodontic treatment.
Contract funds will not be used to provide surgical TMJ "treatments" or care.
To establish procedures for using external dental laboratories and to establish guidelines for laboratory fees to be paid.