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Forms - Screening & GP Reporting

Patient oral health screener 

Patient screener form

The adapted SIdP screener serves the useful purpose of documenting the basics of a patient’s overall and oral health, in an easy and accessible manner for patients and dental hygienists alike:

  • The key objective is to determine the urgency with which a patient should be referred for professional periodontal care, and to evaluate additional co-morbidities and lifestyle/life events related risks in order to select the appropriate patient checklist.
  • The central 8 questions should take about 40 seconds to complete, while completing the entire form, including the 5 short demographic questions, should take about 1 minute.
  • It is foreseen that the screener be revisited with the patient yearly so as to validate what may have changed with respect to the patient’s self-reported oral and systemic health.

Oral and systemic health feedback loop with treating physician 

Oral health form

The oral health feedback forms are provided to facilitate communication between the oral health practice and the treating physician if, and when, this may be desirable or warranted to ensure optimal patient care.

It is suggested that the oral health professional empower the motivated patient by providing them with the feedback form which they can share with their treating physician.

Systemic health form

The oral health feedback form is accompanied by the systemic health feedback form which contains questions about the patient’s general health status.

The treating physician is encouraged to fill out this form and return it to the dental practice.