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a. C. d. e. 4. Identify the components of a clinical record. Components of the clinical record are organized and placed inside. b. Provides demographic and financial information. Documents probing, bleeding, mobility, and furcation conditions. Outlines the work that is going to be done, describes reasonable results, and alerts the patient to complications that may result Estimated cost of dental treatment and payment schedule. f. Necessary to document the medical needs as well as the dental needs of the patient 8 Used to update and record conditions at the time of each recall visit. h. Records treatment Prioritizes treatment that needs to be performed. Logs letters sent and received, K. Authorizes release of information about the patient. 1. Illustrates the current dental condition of the patient at the time he or she is first seen in the dental practice Information about the patient’s previous dental treatment. Plan derived from information collected in the clinical record A. Individual Patient File Folder B. Treatment Plan Form C. Telephone Information Form D. Signature on File Form E. Registration Form F. Recall Examination Form G. Progress Notes Form H. Problem/Priority List 1. Periodontal Screening Examination Form J. Medical History Form K. Financial Arrangements Form L Dental Radiographs M. Dental History Form N. Correspondence Log O. Consent Forms P. Clinical Examination Form Q. Acknowledgment of Receipt of Privacy Practices Notices m n
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