At-Work Dentist Form Template m : Dentacōr

First Name

Last Name

Preferred Name/Nickname

TX Plan Bulletpoint Checklist:

Curve Recommended Treatments
Oral Eval Form
Slack Audio

Click here to watch instructional video:

Oral Eval Instructions:

After you have completed patient's recommended treatments on Curve, please fill out the following oral evaluation. Just click next start their evaluation.

Once oral exam is complete, just record the patient's audio on their Slack channel and push send.

The following is a Dr. Dax example of a patient's audio:

When you have completed the patient's treatment plan, click "Submit" at the end of the form.

For your reference, the patient's Slack link & Curve link are list on their oral evaluation form.

CARE Contact:

If you have any questions:

Slack the CARE Team:
Call or Text 1-801-701-DENT

Click to view instructions and CARE Team contact info

Curve Profile Link

Click here to see Curve Profile

Slack Channel Link

Click here for Slack Channel

Curve log-in details

Username: MR
Password: CorLSO23!

Oral Evaluation

Does this patient have any untreated caries that you diagnosed?

YES

Soft Tissue:

Within Normal Limits

Concerns Noted Below

Recommendation

Oral Cancer Screening:

Within Normal Limits

Concerns Noted Below

Recommendation

Airway:

Class 1 - Soft Palate, Uvula, Fauces, Pillars Visible

Class 2 - Soft Palate, Major Part of Uvula, Fauces Visible

Class 3 - Soft Palate, Base of Uvula Visible

Class 4 - Only Hard Palate Visible

Unable to Visualize

Recommendation

Periodontal

Location

Severity

Indication

Recommendation

Add 1 more Perio Eval

Location

Severity

Indication

Recommendation

Class:

Class 1

Class 2

Class 3

Orthodontic

Overjet

Recommendation Recommendation

Are there other issues you would like to indicate?

No Yes

Signs of GERD (Gastroesophageal Reflux Disease)

No Yes

Recommendation

Signs of Teeth Grinding

No Yes

Recommendation

Click to add another issue

No Yes

Indicate Issue:

Recommendation:

Click to add another issue

No Yes

Indicate Issue:

Recommendation:

Click to add another issue

Indicate issue:

Recommendation:

Mouth Minutes

Recommended Mouth Minutes

Fantastic Floss

Protect with Sealants

Optimizing Brushing

What is Gingivitis

Click "Submit" if the Following Actions Are Complete:

Current Treatment Recommendations Indicated on "Curve"
Oral Evaluation Complete
Patient Audio on Slack Sent