4. Identify the components of a clinical record. A. Individual Patient File Folder Components of the clinical record are organized and B. Treatment Plan Form placed inside. Provides demographic and financial information. C. Telephone Information Form Documents probing, bleeding, mobility, and furcation D. Signature on File Form

Understanding Health Insurance: A Guide to Billing and Reimbursement
14th Edition
ISBN:9781337679480
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Publisher:GREEN
Chapter7: Cpt Coding
Section: Chapter Questions
Problem 25R
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The elec
of
4. Identify the components of a clinical record.
A. Individual Patient File Folder
Components of the clinical record are organized and
B. Treatment Plan Form
7. WI
a.
placed inside.
C. Telephone Information Form
b.
Provides demographic and financial information.
Documents probing, bleeding, mobility, and furcation
D. Signature on File Form
C.
conditions.
E. Registration Form
d.
reasonable results, and alerts the patient to complications that
may result.
Outlines the work that is going to be done, describes
F. Recall Examination Form
- G. Progress Notes Form
e.
Estimated cost of dental treatment and payment
8.
H. Problem/Priority List
schedule.
I. Periodontal Screening Examination Form
f.
Necessary to document the medical needs as well as
the dental needs of the patient.
Used to update and record conditions at the time of
J. Medical History Form
K. Financial Arrangements Form
each recall visit.
h.
Records treatment.
L. Dental Radiographs
Prioritizes treatment that needs to be performed.
M.Dental History Form
j.
Logs letters sent and received.
N. Correspondence Log
k.
Authorizes release of information about the patient.
O. Consent Forms
P. Clinical Examination Form
Illustrates the current dental condition of the patient at
1.
the time he or she is first seen in the dental practice.
m.
treatment.
Information about the patient's previous dental
Q. Acknowledgment of Receipt of Privacy
Practices Notice
Plan derived from information collected in the clinical
n.
record.
5. Identify the components
the patient clinical
DIXON TICONDEROGAS
6OFT
Transcribed Image Text:The elec of 4. Identify the components of a clinical record. A. Individual Patient File Folder Components of the clinical record are organized and B. Treatment Plan Form 7. WI a. placed inside. C. Telephone Information Form b. Provides demographic and financial information. Documents probing, bleeding, mobility, and furcation D. Signature on File Form C. conditions. E. Registration Form d. reasonable results, and alerts the patient to complications that may result. Outlines the work that is going to be done, describes F. Recall Examination Form - G. Progress Notes Form e. Estimated cost of dental treatment and payment 8. H. Problem/Priority List schedule. I. Periodontal Screening Examination Form f. Necessary to document the medical needs as well as the dental needs of the patient. Used to update and record conditions at the time of J. Medical History Form K. Financial Arrangements Form each recall visit. h. Records treatment. L. Dental Radiographs Prioritizes treatment that needs to be performed. M.Dental History Form j. Logs letters sent and received. N. Correspondence Log k. Authorizes release of information about the patient. O. Consent Forms P. Clinical Examination Form Illustrates the current dental condition of the patient at 1. the time he or she is first seen in the dental practice. m. treatment. Information about the patient's previous dental Q. Acknowledgment of Receipt of Privacy Practices Notice Plan derived from information collected in the clinical n. record. 5. Identify the components the patient clinical DIXON TICONDEROGAS 6OFT
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