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| Procedures | Referral
process | Statement of purpose | Confidentiality
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Monday and Wednesday Clinic: Thursday Clinic at UCSF Dental School: Students must bring their own instruments to perform operative care. Reviewing medical history and patient chart Performing restorative treatment. Patient Registration Form: Double sided sheet filled out by the patient. Biographic Data, including name, date of birth, sex, race, housing status, financial resources, and medical resources. Chief Complaint in the patientís own words. Current Health Status, Medical History, and Medications in the Questionnaire. Comprehensive History: SOAP form filled out by the provider. Subjective, including chief complaints, present illness, past medical history, dental history, family history & psychosocial history. Objective, including head and neck exam, intra-oral exam, clinical findings, diagnostic tests, and evaluation. Assessment (differential diagnosis and clinical impression). Plan, including treatment, follow-up, and/or referrals. If patient needs ongoing/specialized or emergency care, they must be referred to other providers. The referral process is important for getting people aligned with more permanent medical and dental services. When trying to decide where to refer someone it is helpful to know: What type of dental care have they received in San Francisco? Have they been to any dental clinic in San Francisco? Would they go back? If not, what was the problem? Do they want to go to a dental care provided in that part of town? Other considerations: How comfortable will the patient be in the neighborhood? Be sensitive to patient's ethnicity, language, street-sense, assertiveness and ability to keep appointments. Can they get there? How soon will they be seen? Final Step: After deciding on the referral, fill out the referral form with name, date of birth, race, housing status, financial resources and medical resources. Also, indicate presenting problems and reasons for referral. Referral form should be reviewed and signed by the attending before releasing it to the patient. Please write the name of the patient, the place referred, and reasons for referral on the SOAP form and Patient Record Book. For Patients Appointed for Thursday Clinic at UCSF: Fill out a bus pass with date of screening, location of screening, date of treatment, specific type of treatment, specific number of tooth needing treatment, and other important requests. Bus pass should be reviewed and signed by the attending before releasing it to the patient. Please write the name of the patient, the place referred, and reasons for referral on the SOAP form and Patient Record Book. [return to the top ] As collaboration between faculty members, students, and volunteers like you, Tom Waddell Health Center/ UCSF Community Health Clinic has been working to improve the health of homeless San Franciscans for over a decade. The Philosophy of the Dental Clinic is to motivate patients to seek healthcare and to prevent dental disease through education and preventive dentistry. The Dental Clinic is guided by three mutually supportive sets of aspirations: For the Client To provide free oral heath education and treatment. To make a positive impact on the lives of homeless people. For the Student To create a setting, in which students can learn, teach, and practice clinical skills. To cultivate sensitivity and comfort in interactions with the underserved population. For the Community To use the Dental Clinic as a forum for education & health care service. To promote advocacy for the needs of this population. Ultimately, we hope this experience will broaden our vision and make us more able and compassionate heath care providers for any population we choose to serve for years to come. Thank you for volunteering! [return to the top ] Confidentiality of all patientsí information must be maintained. We must be conscious that our patient data sheets are accounted for and stored at all times and consultations with the attending and fellow students done as discreetly as possible. [return to the top ] I. Systemic Blood Pressure: Record systolic blood pressure at gauge reading when faint blowing sound is first heard. Record diastolic blood pressure at gauge reading when sound from artery disappears. Open valve to deflate cuff completely. Record systolic & diastolic values and the side of arm used for measuring blood pressure, either left arm sitting (LAS) or right arm sitting (RAS). Note: If blood pressure reading is systolic > 140; diastolic > 90, recommend evaluation by a primary care physician. If blood pressure reading is systolic > 200; diastolic > 110, defer any elective dental treatment and refer to medical clinic and/or to ER. This is a medical emergency. II. Pulse Rate & Rhythm: III. Temperature: IV. Respiration: V. Physical Examination: Constitutional: Fever, chills, sweats, weight loss, fatigue, malaise, loss of appetite. Head: Headache, dizziness, fainting, insomnia. Ears: Decreased hearing, tinnitus, pain Eyes: Blurring, double vision, excessive tearing, dryness, pain Nose & Sinuses: Rhinorrhea, epistaxis, problems breathing through nose, pain, change in sense of smell. Temporomandibular joint area: Pain, noise, limited jaw motion. Oral: Dental pain or sensitivity, lip or mucosal sores, chewing problems, speaking problems, bad breath, loose restorations, sore throat, loud snoring. Neck: Difficulty swallowing, change in voice, pain or stiffness. Inspection and Palpation: Head & Face: General shape, symmetry, hair distribution. Eye: Symmetry, size, movement. Neck: Size of thyroid, lymph nodes, jugular veins Oral: Salivary glands, floor of mouth, lips, muscles of mastication Teeth, mucosa, pharynx, lips, tonsils, ventral & lateral sides of tongue. TMJ: Crepitus, tenderness Paranasal: Pain over sinuses Brief Intraoral Examination: Endodontic Diagnosis: Percussion: Tap the crown of the tooth gently with the tip of the middle finger or an instrument. Note the presence and indication of pain or discomfort. Palpation: Palpate the consistency of tissue beneath the fingertips. Find out whether swelling is present on the involved tissue Mobility Test: Move a tooth with two metal handles in order to determine its looseness. Note the class type of mobility (Class 0, 1, 2, 3). Cold Test: Spray frigident (Endo ice) on a cotton swab. Apply the cold cotton swab to tooth surfaces in the middle 1/3 of the crown. Note the onset, duration, and intensity of pain. Hot Test: Light the heating torch. Pick up a small piece of gutta percha with any metal instrument. Heat it in a flame. Place it in the middle 1/3 of the buccal surface of the wet clinical crown enamel. Note the onset, duration, and degree of pain. Toluidine Blue Staining Test: Apply 1% aqueous toludine blue with cotton swab to lesion. Decolorize with 1% acetic acid. Note any selective dye uptake. Note: Should be aware that false negative reactions can result from dye retention by filliform papillae and dorsum of tongue as well as mechanically in fissures. [return to the top ] Beginning of each quarter, we will take requests for specific clinic dates and have clinic assignments distributed within one week. Once assigned, it is your responsibility to find a replacement. Absence without a replacement is considered patient abandonment. It is inexcusable and unacceptable. Since this is a student-run clinic, it is important for students to come prepared and on time. Times for Tuesday, Wednesday and Thursday Clinic sessions are from 6:00 PM till 9:00 PM. Students participating on Tuesdays and Wednesdays should come to 3rd floor parking area by 5:30 PM. It is important to arrange rides in advance. The coordinator for the evening will assist you if you have any problems. Once again, it is important to show up to the session that you have been scheduled for. In case of emergency, please find a substitute. [return to the top ] The care slip has 3 parts. At the end of the clinic session, the care slip must be returned to the coordinator. No RVUs will be credited to Comp Care. Below is an explanation of the information found on the care slip. Patient number and name. Patient chart number Doctor number (112): Do not use your student number. [return to the top ] Student's team: Homeless Clinic Procedure code number Procedure description UCSF COMMUNITY HEALTH CLINIC STUDENT MANUAL FOR DENTAL TEAM Written by: Sang Park Edited by: Dennis Song |
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