Date Received 08/12/14 Oral Health Task Force



Download 17.39 Kb.
Date conversion18.11.2016
Size17.39 Kb.

Date Received __________ 08/12/14

Oral Health Task Force


Providing oral health care to the children

of Cook County and the Grand Portage Reservation.





Task Force:
Rita Plourde, CEO

Sawtooth Mountain Clinic


Paul Nelson, Board Member

North Shore Health Care Foundation


Alyssa Hedstrom, D.D.S.

Ex officio Member,

North Shore Health Care Foundation
William Heitzman, Dental Therapist

Grand Marais Family Dentistry


Joni Kristenson, RN

Cook County Public Health

and Human Services

Public Health Coordinator.


Teresa Borak, RN

Sawtooth Mountain Clinic


Paula Schaefbauer, Director,

Grand Portage Health Services


Advisory Committee:
Kay Borud, School Nurse

Cook County School District


Amy James, RN,

Great Expectations Charter School


Allison Heeren RN,

Cook County Public Health and Human Services


Chris Angelo

Sawtooth Mountain Clinic


Karl Hansen, Executive Director

North Shore Health Care Foundation


Staff:

Georgene Daubanton


Oral Health Task Force

North Shore Health Care Foundation

PO Box 454

Grand Marais, MN 55604

218-387-2334 oralhealth@boreal.org

Sliding Fee Scale Application

The sliding fee scale program is income based – funded by grants through the Oral Health Task Force of the North Shore Health Care Foundation. It is available to all – regardless of existing insurance coverage.



For more information, contact the Oral Health Task Force at 387-2334.

.

A. Sliding Fee Scale Program.



  1. This program is available on a yearly basis, and is dependent on grant funding. It covers restorative dental care for children up to grade twelve provided by Drs. Hedstrom and Lindquist’s office, Grand Marais Family Dentistry. (Preventative dental care is covered through the Sawtooth Mountain Clinic sliding fee program.)

  2. The patient will pay a minimum of $5.00 per visit.


B. Eligibility: Income must be within federal guidelines for family size (see attached chart). You may have other insurance and still be eligible.
C. Instructions for Application:

  1. Obtain application form from the receptionist from Grand Marais Family Dentistry or at the Sawtooth Mountain Clinic or the North Shore Health Care Foundation, lower level of the clinic (387-2334).

  2. Read sliding scale program description and complete the application.

  3. Attach proof of income to application. Examples of proof of income: Photocopy of W-2 form, front two pages of federal income tax return, social security check, pay stubs, or unemployment letter.

  4. Attach treatment plan from Grand Marais Family Dentistry.

  5. Submit complete application to the Oral Health Task Force. Call 387-2334 to set up a meeting. You may also give it to the receptionist at the Sawtooth Mountain Clinic.

  6. (If you have already completed a sliding fee application for the Sawtooth Mountain Clinic, you may sign a release to have a copy of that application be forwarded to Oral Health Task Force staff.)

*The Oral Health Task Force reserves all rights to review what will be eligible for sliding scale discount. Extensive needs are reviewed on an individual basis.


D. Other Area Services:

  1. Sawtooth Mountain Clinic Sliding Fee Scale Program covers oral health exams: (Twice a year, cleanings as recommended, x-rays, sealants & fluoride provided by Dr. Hedstrom’s office, Grand Marais Family Dentistry.)

  2. Minnesota Care, if you are eligible, covers most dental work. Information available at Cook County Public Health and Human Services (387-3620).

  3. Indian Health Service covers most dental work.

This program is made possible because of the financial support from the North Shore Health Care Foundation, Lloyd K. Johnson Foundation, Mardag Foundation, Grand Marais Lions Club, Minnesota Dental Foundation, and the Cook County Community Fund



The database is protected by copyright ©dentisty.org 2016
send message

    Main page