Search Results: MCHLine

Annotation: This manual is a dietary assessment tool used by licensed dietitians for WIC applicants and participants. The tool is divided into four sections, which are: 1) dietary questions, 2) food frequency, 3) nutrition risk assessment, and 4) space for a nutrition care plan. Each section has blank forms and instructions and suggestions.

Contact: Iowa Department of Public Health, 321 East 12th Street, Des Moines, IA 50319-0075, Telephone: (515) 281-7689 Secondary Telephone: (866) 227-9878 Contact Phone: (515) 281-5787 E-mail: https://www.idph.iowa.gov/Contact-Us Web Site: https://hhs.iowa.gov/ Price unknown.

Keywords: Dietary assessment, Dietitians, Food habits, Forms, Nutrition assessment, Nutrition education, Nutrition monitoring, Nutrition research, WIC Program

Annotation: This resource presents a collection of forms in use by safety-net oral health programs across the country. The forms are organized into the following categories: consent forms, dental practice policies and procedures, guidelines and instructions, human resources forms, and quality. Some of the forms are available in English and Spanish.

Contact: National Network for Oral Health Access, 181 East 56th Avenue, Suite 410, Denver, CO 80216, Telephone: (303) 957-0635 E-mail: [email protected] Web Site: http://www.nnoha.org Available from the website.

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Keywords: Forms, Oral health, Spanish language materials

Annotation: This document for recipients of the federal Maternal and Child Health Bureau's Discretionary Grant Program contains instructions and forms for submitting performance measure data. Contents include information about the goals, definitions, benchmark and grantee data sources, and significance for each measure by domain; instructions and forms for collecting budget and expenditure data and project abstract and summary data; and forms for tracking project performance and outcome measures.

Contact: U.S. Maternal and Child Health Bureau, Health Resources and Services Administration, 5600 Fishers Lane, Rockville, MD 20857, Telephone: (301) 443-2170 Web Site: https://mchb.hrsa.gov Available from the website.

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Keywords: Data collection, Federal grants, Forms, MCH programs, MCH research, MCH training, Measures, Outcome and process assessment, Program evaluation, Program improvement, Program planning, Progress reports

Annotation: This manual provides policies and procedures for Wisconsin Seal-A-Smile (SAS) grantees, with the goal of helping them administer programs and ensure consistency across programs. The purpose of SAS is to improve the oral health of Wisconsin children through school-based dental sealant programs. Topics include administrative and regulatory guidelines; program requirements; forms, reporting, and recording; and budget and funding information.

Contact: Children's Health Alliance of Wisconsin, 6737 West Washington Street, Suite 1111, West Allis, WI 53214, Telephone: (414) 292-4000 Secondary Telephone: (414) 337-4561 Fax: (414) 231-4972 Web Site: https://www.chawisconsin.org/ Available from the website.

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Keywords: Administration, Data collection, Dental sealants, Disease prevention, Forms, Grants management, Oral health, Prevention programs, Reimbursement, School age children, School health programs, School health services, Screening, State programs, Wisconsin

Annotation: This guide provides information on New York University’s (NYU’s) College of Teaching Oral Systemic Health (TOSH) Experience, an interprofessional program that brings together students across health professions. The program is conducted with NYU dental students and nurse midwifery, nurse practitioner, medical, and pharmacy students. Topics include the TOSH protocol, a TOSH flowchart, the time required to complete program activities, a script for a patient visit, a student assignment, student instructions, patient instructions, and sample forms.

Contact: New York University, Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010, Telephone: (212) 998-5300 Web Site: https://nursing.nyu.edu/ Available from the website.

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Keywords: Collaboration, Educational programs, Forms, Medical students, Nursing, Oral health, Pharmacy schools, Students

Annotation: This manual provides professional recommendations and states’ expectations for school-based dental sealant programs (SBSPs) under the Ohio Department of Health (ODH). Contents include local program operations, regulatory compliance, compliance with ODH policies, SBSP eligibility, sample program forms, site assessment, infection control, clinical materials and methods, quality assurance, performance benchmarks and standards, reporting, ODH program reviews, compliance with other ODH requirements, Medicaid billing and collection, reimbursement, and filing claims. The appendices contain sample forms, records, letters, and other practice-related materials.

Contact: Ohio Department of Health, 246 North High Street, Columbus, OH 43215, Telephone: (614) 466-3543 Web Site: http://www.odh.ohio.gov Available from the website.

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• Program Website

Keywords: Children, Dental sealants, Forms, Guideline adherence, Manuals, Ohio, Oral health, Parents, Resources for professionals, School based clinics, State programs

Annotation: This toolkit offers evidence-based guidance to help health professionals make health information easier to understand and act on, make health care easier to navigate, and increase support for people of all health literacy levels. Contents include 23 tools addressing the following five domains: path to improvement, spoken communication, written communication, self-management and empowerment, and supportive systems. Additional contents include resources such as sample forms, PowerPoint presentations, and assessment tools.

Contact: U.S. Agency for Healthcare Research and Quality, 5600 Fishers Lane, Rockville, MD 20857, Telephone: (301) 427-1104 Secondary Telephone: (301) 427-1364 Web Site: http://www.ahrq.gov Available from the website. Document Number: AHRQ Publication no. 23-0075.

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Keywords: Communication, Empowerment, Forms, Health care systems, Health literacy, Patient care, Primary care, Resources for professionals, Self care, Social support

Annotation: This form allows parents to share information on their child with the child’s oral health professional. Topics include concerns about the child’s oral health, whether the child has a dentist, the last dental visit, and oral health care received in the past year. The form also includes questions on whether the child goes to bed with a drink other than water, what the child usually drinks, whether the family drinks water with fluoride, frequency of parents brushing the child’s teeth, whether the child’s toothpaste contains fluoride, and how many sugary snacks or drinks the child consumes per day. The form is available in English and in Spanish.

Contact: American Academy of Pediatrics, 345 Park Boulevard, Itasca, IL 60143, Telephone: (630) 626-6000 Secondary Telephone: (847) 434-4000 Fax: (847) 434-8000 Web Site: https://www.aap.org Available from the website.

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• Spanish

Keywords: Dental caries, Fluoride, Forms, Health care utilization, Oral health, Prevention, Spanish language materials

Annotation: This screening form, which is intended for school health programs, can be used to record children’s oral health status and treatment needs. Space is provided to enter the school district number; the school name; and each child’s name, classroom, and grade. In addition, there is space to note whether each child has treated and/or untreated tooth decay or other oral health problems, has dental sealants and/or needs sealants, and needs an oral exam and/or urgent treatment.

Contact: Kansas Department of Health and Environment, Bureau of Oral Health, Curtis State Office Building, 1000 S.W. Jackson Street, Suite 200, Topeka, KS 66612-1274, Telephone: (785) 296-5116 Web Site: https://www.kdhe.ks.gov/619/Oral-Health Available from the website.

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Keywords: Dental sealants, Forms, Health screening, Oral health, School health, Tooth decay, Treatment

Annotation: This form for parents to complete at well-child visits for infants and children ages 6 months to 6 years includes space to provide the infant’s or child’s name and date of birth and the current date. It also provides a list of questions about the infant’s or child’s oral health and oral hygiene, their eating and drinking behaviors, whether they have seen an oral health professional in the past 6 months, whether they have a special health care need that makes it difficult to brush their teeth, and whether the parent thinks there is something they could do better to keep their infant’s or child’s teeth healthy. [Funded by the Maternal and Child Health Bureau]

Contact: Denver Health and Hospital Authority, 301 West 6th Avenue, Denver, CO 80204, Web Site: https://www.denverhealth.org/ Available from the website.

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Keywords: Children, Forms, Infant health, Infants, Nutrition, Oral health, Oral hygiene, Special health care needs

Annotation: This consent form for parents to fill out allows students to receive care at school-based health centers in Washington, DC. It provides space to add contact information for the student and their parents and health professionals and information about health insurance. A description of services offered at school-based health centers is included. The form is available in Amharic, Chinese, English, French, Korean, Spanish, and Vietnamese.

Contact: District of Columbia Department of Health, 899 North Capitol Street, N.E., Washington, DC 20002, Telephone: (202) 442-5955 Fax: (202) 442-4795 E-mail: [email protected] Web Site: http://doh.dc.gov/ Available from the website.

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Keywords: Forms, Non English language materials, Parental consent, School age children, School health, Spanish language materials

Annotation: This form for school oral health programs includes information to share with parents about their child’s oral health screening. In addition to space to insert the child’s school, name, grade, and classroom, the form allows school oral health programs to indicate whether the child has no obvious oral health problems, has problems that should be evaluated by a dentist, or needs immediate care by a dentist. Space for notes and additional comments as well as the screener’s name and screening date is included.

Contact: Rhode Island Department of Health, Three Capitol Hill, Providence, RI 02908, Telephone: (401) 222-5960 Web Site: http://www.health.state.ri.us

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Keywords: Dental care, Forms, Oral health, Rhode Island, School age children, School health services, State programs

Annotation: This chartbook presents Centers for Medicare & Medicaid Services Form CMS-416 annual data submitted by states for federal fiscal years 2015 to 2019. This form measures states’ efforts to ensure that children who are eligible for services, including oral health services provided through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program, receive these services. The chartbook includes background and provides an overview of EPSDT, describes the scope of EPSDT, and presents EPSDT reporting requirements.

Contact: National Health Law Program, North Carolina Office, 1512 E. Franklin St., Suite 110, Chapel Hill, NC 27514, Telephone: (919) 968-6308 Fax: (919) 968-8855 E-mail: [email protected] Web Site: http://www.healthlaw.org Available from the website.

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Keywords: Access to health care, EPSDT, Forms, Medicare, Oral health, State programs, Statistical data

Annotation: These forms are intended for use in implementing a school-based oral hygiene program to provide preventive oral health services (screenings, cleanings, fluoride varnish applications, dental sealant application, and education) for children from families with low incomes in Nevada. Contents include a consent form, a data-collection form, a parent letter, and a privacy notice.

Contact: Future Smiles, 3074 Arville Street, Las Vegas, NV 89102, Telephone: (702) 889-3763 E-mail: [email protected] Web Site: https://www.futuresmiles.net Available from the website.

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Keywords: Dental sealants, Fluoride varnish, Forms, Low income groups, Nevada, Oral health, Oral hygiene, Prevention, School health programs, State programs

Annotation: This guide is a tool to encourage common understanding among educators, families, and health professionals about infectious diseases in group settings for children. The guide identifies the role of educators, families, public health officials, and health professionals in preventing and controlling the spread of communicable infections; symptoms of infections commonly found in group settings for children; how infections are spread (route of transmission); when to seek medical attention; inclusion and exclusion criteria; strategies and sample forms for communications involving directors/caregivers, parents/guardians, and health professionals; and resources for professional development for directors/teachers/caregivers related to infectious diseases.

Contact: American Academy of Pediatrics, 345 Park Boulevard, Itasca, IL 60143, Telephone: (630) 626-6000 Secondary Telephone: (847) 434-4000 Fax: (847) 434-8000 Web Site: https://www.aap.org . Document Number: ISBN 978-1-61002-050-3.

• E-book Preview

Keywords: Child care, Child health, Communicable disease control, Communicable diseases, Forms, Infection control, Infections, Prevention, Resources for professionals, Schools

Annotation: This form, to be completed by parents and oral health professionals, provides space to write information about children over age 3 to give the student's child care facility or school. Part I, for parents to fill out, is for the child’s name, age, birthdate, grade, and child care facility or school name. Part II, for an oral health professional to fill out, is for the child’s oral health status and insurance status. Space for the oral health professional’s name, signature, and stamp, as well as the date of the oral examination, is included.

Contact: District of Columbia Department of Health, 899 North Capitol Street, N.E., Washington, DC 20002, Telephone: (202) 442-5955 Fax: (202) 442-4795 E-mail: [email protected] Web Site: http://doh.dc.gov/ Available from the website.

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Keywords: Adolescent health, Child health, Forms, Oral health, School age children, Young children

Annotation: This form is designed as a tool for pregnant women to provide information to help dental office staff understand and meet their needs. The form includes information about prenatal care received, what the woman does to take care of her mouth and teeth, and what questions she has about taking care of her mouth and teeth. It also includes information about problems experienced during pregnancy and whether the woman smokes, vapes, or drinks alcohol. [Funded in part by the Maternal and Child Health Bureau]

Contact: National Center on Early Childhood Health and Wellness, American Academy of Pediatrics, 345 Park Boulevard, Itasca, IL 60143, Telephone: (888) 227-5125 E-mail: [email protected] Web Site: https://eclkc.ohs.acf.hhs.gov/ncechw Available from the website.

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Keywords: , Forms, Health care utilization, Oral health, Pregnant women, Prevention, Treatment

Annotation: This checklist was developed as a tool to assist states in completing Form CMS-416 (the annual Early and Periodic Screening, Diagnostic, and Treatment [EPSDT] program report) and help them improve the accuracy, completeness, consistency, and documentation of data reported for federal fiscal year (FFY) 2019. The checklist includes common issues noted in the data reported for FFY 2018 and earlier years.

Contact: U.S. Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, MD 21244, Telephone: (877) 267-2323 Secondary Telephone: (410) 786-3000 Fax: Web Site: https://www.cms.gov Available from the website.

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Keywords: EPSDT, Forms, Medicaid, Oral health, State materials, Statistical data

Annotation: This tool is designed to help health organizations identify and rate health-literacy-related factors within their organization. Such factors include organizational policies, institutional practices, navigation, culture and language, and communication. A form for scoring each factor, as well as a discussion of how to interpret the scores, is included. Planning for action is also addressed.

Contact: Harvard University, T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, Telephone: (617) 495-1000 Web Site: https://www.hsph.harvard.edu Available from the website. Document Number: ED606503.

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Keywords: Cultural competence, Forms, Health literacy, Languages, Oral health, Oral health equity, Policy

Annotation: This document includes forms that health professionals can use to help children and adults, including pregnant women, set oral health self-management goals, as well as in introduction to the forms. The forms are two-sided, with one side for the health professional and the other side to show the patient. Instructions for how to use the form are provided, and additional oral health resources in English and in Spanish are included.

Contact: University of New Mexico Center for Development and Disability, 2300 Menaul Boulevard, NE, Albuquerque, NM 87107, Telephone: (505) 272-3000 Fax: (505) 272-5280 Web Site: http://cdd.unm.edu Available from the website.

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• Manual That Contains This Chapter

Keywords: Adult health, Forms, Health education, Oral health, Pregnant women, Prevention, Spanish language materials