Dental
Select a template's name to view more details or request templates for your ICE Health Systems environment.
6 Months Post#
This orthodontic letter template is available for the patient six months after treatment completion, upon the release from active retention care.
It mentions the value and importance of wearing the retainer, and automatically populates patient information.
Caries Risk Assessment#
This Caries Risk Assessment is part of a Collaboration with the ICDAS Foundation (ICCMS™ and CariesCare International) and ACFF.
It is designed to fit with the new CariesCare International “4D in Practice” model.
The form includes a patient and a provider component, the responses are tabulated automatically to provide a caries risk score.
Cemented Permanent Retainers#
This letter template outlines important reminders for orthodontic patients with a new permanent retainer.
Collection Letter - Initial#
This is the first collections letter to a patient, notifying them of an outstanding balance.
The template automatically populates the date, patient and office details, and includes editable text for a customizable message.
Collection Letter - Repeat#
This is a subsequent collections letter to a patient, repeating the notification that there is an outstanding balance on their account.
The template automatically populates the date, patient and office details, and includes editable text for a customizable message.
Consent for Treatment#
This letter outlines the risks associated with orthodontic treatment.
The consent template automatically populates patient and clinic information and provides both patient and witness signature boxes to adhere to the UETA and E-Sign acts for capturing electronic signatures.
Deband Letter#
This orthodontic template is a sample letter of gratitude for the patient and guardian for their cooperation throughout treatment.
It includes a reminder to wear the retainer, and a request for referrals.
Dismissal Letter#
This letter is notification that the clinic can no longer provide care for this patient.
The document template includes automatically populating patient and clinic information, as well as editable text for a custom message.
Elastics#
This letter is to notify the orthodontic patient there is concern they are not wearing the prescribed elastics as directed.
The template automatically populates patient and practice information, and provides editable text for a customized message.
Hygiene, Advanced#
This letter is to notify the orthodontic patient that the oral hygiene of the patient continues to be inadequate, and they are at risk of irreversible damage.
The template automatically populates patient and practice information, and provides editable text for a customized message.
Hygiene - to Dentist#
This letter is to notify the primary dentist of an orthodontic patient that there is concern for the oral hygiene of the patient.
The template automatically populates patient and practice information, and provides editable text for a customized message.
Letter to Dentist#
This letter is to notify the primary dentist of an orthodontic patient that the orthodontic treatment provided by this clinic is complete.
The template automatically populates patient and practice information, and provides editable text for a customized message.
Letter to Dentist - Phase I#
This letter is to notify the primary dentist of an orthodontic patient that the first phase of orthodontic treatment is complete.
The template automatically populates patient and practice information, and provides editable text for a customized message.
Maintenance / Compliance#
This clinical form is a progress note for the clinician to document the maintenance and compliance of an orthodontic patient.
The template automatically populates the patient and practice information.
OMFS Checklist#
This form includes a comprehensive Pre-Treatment, Pre-Anesthesia and Recovery checklist to be used for Oral and Maxillofacial surgery.
OMFS Clinical Notes#
This clinical document includes patient relevant medical history.
Fields include:
- Surgical reports, including procedure performed and diagnosis
- Operative Notes, including complications, recover and discharge
- Clinical Notes allows comprehensive documentation of procedure. Categories include biopsy, cosmetic, extraction, fracture, implants, incision and drainage, orthognathic, TMJ, and wisdom teeth
- Oral mucosal and soft tissue documentation which includes appearance, cosmetic, occlusion, oral habits, oral pathology, pain data and TMD
This template automatically populates clinical and patient information and date.
OMFS Pre-Treatment Checklist#
This comprehensive checklist provides guidance for ensuring of important details prior to OMFS treatment.
Orthodontic Diagnosis and Treatment Planning#
This detailed diagnosis and treatment planning form includes a specific workflow which supports thorough orthodontic examinations.
The template automatically populates patient and office information.
Orthodontic Progress Notes#
This clinical progress note includes customizable consultation notes, patient record checklist, and allows the documentation of bonding or debonding procedure.
The template automatically populates patient and practice information, and provides editable text for a customized message.
Pediatric Diagnosis and Treatment Planning#
This comprehensive form includes chief concerns, clinical findings with contributing factors, and treatment plan options.
Predetermination - Comprehensive#
This letter provides an overview of the treatment fee and associated charges. There is a disclaimer of the risks involved in of orthodontic treatment.
The template automatically populates patient and practice information, and provides editable text for a customized message.
Restoration#
Easily input restorative details including material and anesthesia. This clinical form ensures all aspects of the procedure are documented and reportable for future research.
Restorative Diagnosis and Treatment Plan#
This detailed diagnosis and treatment planning form includes a workflow which supports thorough examinations.
The template automatically populates patient and office information.
Treatment of Impaction#
This letter provides information on impaction with editable text to customize the message to the patient regarding their treatment.
The consent template automatically populates patient and clinic information and provides both patient and witness signature boxes to adhere to the UETA and E-Sign acts for capturing electronic signatures.