Enclosure (1) to COMDTINST 6010.18A
ENCLOSURE - Center (lower half) - Place provider initials in
Status- the box by any referral(s) made or ordered. Initial Profile the
FED (federal facility, e.g., USMTF, USTF) or NFED (non-federal,
e.g., non-fed med, supplemental care, CHAMPUS, outside contract,
etc.) column, as appropriate. In-house referrals to contract providers as
well as referrals to other Coast Guard clinics are exempt from this
reporting. DO NOT mark a referral box for one of these.
ENCLOSURE - Check the box for any tickler items performed.
Check the box for third party, if applicable. (For
third-party liability guidelines, see COMDTINST 6010.16.)
Right side (lower half) - Dental follows the same general guidelines
as the left (medical) side, e.g., the initials of the attending dental
ENCLOSURE - extern, health services technician, or dental hygienist
Status- (see below) go in the OPV Caregiver box, whereas t the
Profile person who performs a simple prophylaxis initials the box
labeled Prophy Giver.
When a dental officer or hygienist provides deep scaling and/or
curettage along with prophylaxis, they shall initial the (dental) OPV
Caregiver box and indicate the number of quadrants in the non-surg
perio box. In the case of the hygienist, credit for a non-surg perio
treatment may be taken only if the dental officer administered a local
Check the exam box only when a comprehensive, diagnostic oral
examination (Type 1 or 2) is performed and documented in the dental
record using SOAP format. In most cases, this will be an annual or
semi-annual dental examination or a periodic physical examination.
ENCLOSURE - All work completed by the dental OPV care giver
Status- will be recorded by numerals in the corresponding Profile
boxes to indicate the number of work units finished within each
category. If a dental procedure is begun, but not finished, during a
visit, the dental care giver shall initial the (dental) OPV Caregiver box
for an OPV credit, but shall not put a number in a box below until the
work is completed during a subsequent visit.