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.

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.

• Link

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.

• PDF
• Program Website

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: The goal of this training for school nurses and non-oral-health professionals is to equip participants with the knowledge and tools they need to perform oral health screenings for school-age children, with a focus on identifying early signs of tooth decay. The training comprises three sections (tabs): sample letters, videos, and exam. Sample letters include a consent form, a risk-assessment report, a parent questionnaire, and a screening results letter. Videos include trainings with and without a fluoride-application component. The exam section includes a caries risk assessment, screening results letter, and an appendix of physical findings for oral health risk assessment.

• Link

Keywords: Dental caries, Fluoride, Forms, Health screening, Informed consent, Oral health, Prevention, Risk assessment, School age children, Training, Videos

Annotation: These forms are designed for oral health professionals to record key information from dental visits with children and pregnant women enrolled in Head Start. The forms include space to record dental home status, oral health status, and what oral health care services were delivered during the dental visit (e.g., diagnostic and preventive, counseling, restorative and emergency, referral to a specialist for care). The forms also serve as records of what oral health care services are needed and of information to share with others. They re available in English and Spanish.

• Link
• Link

Keywords: Spanish language materials, Children, Forms, Head Start, Oral health, Patient care management, Pregnant women, Screening

Annotation: This form is designed to assist school districts, oral health professionals, and parents in documenting the oral health status and service needs of children in kindergarten and second and third grades in Illinois. Topics include the presence of dental sealants, dental caries experience and restoration history, untreated caries, soft tissue pathology, and malocclusion; the need for urgent treatment, restorative care, and preventive care; and other service needs. The form is available in English and Spanish.

• English
• Spanish

Keywords: Compliance, Forms, Health examinations, Illinois, Oral health, Oral health care, Public schools, School age children, School districts, Spanish language materials, State legislation

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. It is available in English and Spanish. [Funded in part by the Maternal and Child Health Bureau]

• English
• Spanish

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

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.

• Link

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 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. It is available in Amharic, Chinese, English, French, Korean, and Vietnamese.

• English
• Other Languages

Keywords: Adolescent health, Asian language materials, Child health, Forms, Non English language materials, Oral health, School age children, Spanish language materials, Young children

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.

• PDF

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.

• PDF
• 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.

• Link

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.

• English
• Spanish

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

Annotation: This form is intended for parents to fill out before taking their child to a dental visit, and for an oral health professional to complete during the visit. The section for parents to complete provides space to insert the child's name, address, name of school or child care facility, grade, and other related information. The section for an oral health professional to complete includes space to insert information about the child's oral health status, dental insurance status, and what type of care, if any, is needed. The form is available in Amharic, Chinese, English, French, Korean, Spanish, and Vietnamese.

• English
• Other Languages

Keywords: Dental caries, Dental sealants, District of Columbia, Forms, Non English language materials, Oral health, Referrals, State information, Treatment

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.

• Link

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]

• PDF

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.

• Link

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.

• PDF

Keywords: Forms, Oral health, Oral health care, 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.

• Link

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.

• Link
• PDF

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