First and last name
Please save the referral form in pdf or image format and attach it to this form.
If patient is collaborative, open mouth, sitit on the chair and does not overreact during hygiene care (3), make an appointment as normal for the PMS patient. As soon as one of the 4 questions demonstrates difficulties for the child, send the triage form to Sandy and mention:“The clinical coordinator will take care of establishing the most suitable course of care for your child by giving him a personalized appointment sequence. If deemed necessary, an additional form will be emailed to you and must be returned to the clinic. »
If you assess that a patient is in a financial or social vulnerability, mention: “We will transfer your request to the community coordinator, who will call you to inform you of the process and the eligibility criteria for access the SDC program – an assistance program that offers all free dental care through an authorized referring organization."
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