Provider
Select a template's name to view more details or request templates for your ICE Health Systems environment.
Caries Risk / BMI#
How does body mass index relate to caries risk?
View the BMI of low, moderate and high caries risk patients, with age decade group and gender.
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.
Findings#
What were the reasons for treatment in the clinic this month?
View the diagnostic finding code, clinic and treating provider, as well as the patient name and date for all findings in the last 30 days.
Health History#
This comprehensive template includes all medical and dental history, highlighting health facts and automatically including them in the patient chart. The form also incorporates a smoking cessation component.
Hemodialysis - Prescription#
This document template provides a clinical workflow of hemodialysis prescriptions, including dialysate.
Hemodialysis Workflow#
This is a clinical form for hemodialysis diagnosis and treatment planning, with an organized workflow to increase efficiency.
The document template includes automatically populating patient information, health update, vitals, data chart, laboratory procedures, discharge assessments with clinical input of customized notes.
Laser Clinic Notes#
Clinical progress note document for laser treatment.
Form includes consent, material, post op and treatment details.
It automatically populates clinical and patient information and date.
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.
Ophthalmology Nursing Record#
This clinical document allows comprehensive charting of ophthalmology nursing records.
The form includes vitals, medication administration and assessments.
The template automatically populates clinic and patient information and date.
Ophthalmology Operative Record#
This clinical document allows comprehensive charting of ophthalmology operative records.
The form includes patient history, medication administration and vasoelastics.
The template automatically populates clinic and patient information and date.
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.
Pediatric Diagnosis and Treatment Planning#
This comprehensive form includes chief concerns, clinical findings with contributing factors, and treatment plan options.
Periodontal Finding#
What patients have diagnosed periodontal involvement?
View patient information with periodontal diagnosis, area, and date.
Periodontal Risk Levels#
What are the periodontal risk assessment scores of my patients?
View the results of the periodontal risk assessment form and compare low, moderate and high risk patients.
Periodontal Risk Report#
Who has completed a periodontal risk assessment form?
View the score, submission date and time, as well as the patient name and age, and the submitting provider.
Radiograph Report#
Which radiographs have been taken?
View the date and code description, as well as the patient and provider names of all clinical radiographs.
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.
Screening Report#
Which patients have been screened?
View the date, name of patient and provider for screening assessment.
Urology Charting: Female Incontinence#
This form provides a complete diagnosis and treatment plan for female incontinence. It includes chief concern, secondary concerns, symptoms, history, physical examination, impression and treatment plan.
The template automatically populates patient and practice information.
Work in Progress#
What treatment has been started but not completed?
View the treatment date, code with description, clinic, patient and provider information for all procedures that with an "in progress" status.