Dental Data Exchange
1.0.0 - STU 1

Publication Build: This will be filled in by the publication tooling

## Example Bundle: Complete Dental Referral Note Document Bundle example

## Allergies and Intolerances Section

Allergen | Code | Manifestation | Severity
Penicillin G | 7908 | Skin rash | mild

## Medication Section

Medication | Directions | Start Date | Status | Indications | Fill Instructions
Lisinopril 10 mg tab | 1 tab once/day |  | Active |  | Generic substitution allowed

## Problem Section

Mild, Hypertension

Type 1 diabetes

Teeth covered in plague

Toothache

Swollen Gums

Bleeding Gums

At high risk for dental carries

## Reason for Referral Section

Toothache

Left lower quadrant pain

Bleeding gums

## Plan of Treatment Section

D0150 - Comprehensive Oral Evaluation

## Assessment Section

Patient has pain in his lower left jaw and occassional bleeding from his gums - referring for dental evaluation.

## History of Present Illness Section

The patient has not visited a dentist or received flouride treatments in the past 4 years while away at college

## Immunizations Section

Vaccine | Date | Status
--- | --- | ---
Hepatitis B vaccine | January 4, 2020 | Completed

## Medical Equipment Section

Device Type | Procedure | Implant Date
--- | --- | ---
Insulin Pump | Insertion of insulin pump (procedure) | November 3, 2013

## Procedures Section

No Procedures performed

## Social History Section

Social History Element | Description | Effective Dates
Smoking Status | NA | 2005/05/01 - 2020/03/28
Highest Education Received | Collect Education | 2010/05/01 - 2014/03/28
Employment | Full-time accountant | 2015/05/01 - current

## Vital Signs Section

Vital Sign | Date | Value
Temperature | 2020/04/15 | 98.5
Heart Rate | 2020/04/15 | 78
Respiration Rate | 2020/04/15 | 20
Blood Pressure | 2020/04/15 | 120/80

## Goals Section

No soda/sugary drinks/energy drinks

Use fluoride toothpaste

## Health Concerns Section

Neuropathy due to diabetes mellitus

## Instructions Section

Pt. Education. Advised to see dentist regularly, brush 2x/day w/ fluoride toothpaste, floss

## Payers Section

Aetna Comprehensive Medical /Dental Insurance

## Dental Findings Section

No Information