1. Manatee County Rural Health Services Health Express Mobile Dental Team

2. MCRHS “Health Express” Mobile Van The “Health Express” Mobile Dental Pediatric Services include: Diagnosis of urgent dental needs Dental Exams Dental Cleanings Dental Sealant application Fluoride Varnish application Simple dental extractions X-rays

3. “Health Express” Health Care Team MCRHS “Health Express” team can visit schools on-site to provide services to qualifying students. Parent/guardian does not need to be present when services are provided. A letter will be sent home after his/her visit indicating what services were provided and instructions for follow-up services. Parents can be notified by: ConnectEd, Newsletters, Posters/Banners, Student Planners, School Websites or a simple question to student or parent, “Do you have a dentist or dental care?” School nurses have MCRHS Consent Forms to send home Minimum of 20 qualifying students per site

4. How to Identify Students Clinic visits with c/o dental pain Free/Reduced lunch list in FOCUS (run report from classified tab) Medicaid Eligibility List (located in “Medicaid Billing” moodle) Classroom Presentation Newsletters, Connect Ed, School Websites, Student Planners OR Teacher, Nurse or Staff ask “Who has/hasn’t seen a Dentist?”

5. Obtain MCRHS “Consent Forms” Consent Forms are available in English & Spanish Contact Lawton Chiles Dental @ (941) 708-7607 (Rachel) Contact Manatee County Rural Health Services Offices Forms are in “Dental Services” Moodle

6. Consent Form

7. “Consent Form” Completion Instructions Front Page 1.Check every box that is appropriate for the child, and fill in all appropriate blanks. 2.Sign and date by the smiling tooth with a toothbrush. Do not check anything in the blank after the words Chart # or Code #. Back Page 1.If the child has Medicaid, parent/guardian signs blank after the words Guarantor Signature so that information can be released to the insurance company. 2.A copy of the insurance card must be attached to the consent form. 3.Parent/guardian checks the box before the words I hereby attest that I am insured…. 4.Parent/guardian signs blank after the words Policy Holder and includes parent’s date of birth so that the insurance company can pay the doctor directly. 5.Parent/guardian signs by the smiling tooth with a toothbrush at the top of the page after the words Signature of Policyholder (Insured) and includes the relationship to the child, i.e., mother, father, grandmother, etc. and includes the date. 6.Under the section titled Demographic Data, the parent/guardian will answer the three questions. For question 1, if the answer is no, go directly to question 2 and question 3. 7.Parent/guardian will check the box before the words Authorization For Release of Medical Information and check the blank before the words My child’s entire dental record as required… 8.If applicable, check the blank before the words Except for the following which expressly may not be disclosed if not applicable please write the word “None” in the blank provided. 9.If your child does not have insurance and you want him/her to be seen by the dentist on the Health Express bus, write Parent/Guardian name in the blank after the words I hereby attest that I… 10.Check all of the boxes that apply to the sources of support you receive. 11.Parent/Guardian is responsible for the $20.00 payment due at the time the child receives services on the dental bus that day. 12.Sign the blank after the words Signature of parent or guardian and include the date.

8. Additional MCRHS Forms Notices of Privacy Practices (parents keep 2 page form) Client Survey (4 questions that parents answer & return)

9. Arrangements Prior to On-Site Visit NEED SCHOOL ADDRESS – include any “specific” instructions that may be useful (construction, road closure) SCHOOL MAP - with location of “Health Express” bus parking LOCATION - need convenient but SAFE location with minimal trees, wires, no vehicle traffic, etc. Need to schedule around food service delivery, waste disposal pick-up, etc. ARRIVAL TIME – need arrival time that will not interfere with student arrival for school (30 – 60 min) DEPARTURE TIME – need departure that will not interfere with student departure from school Services only during school hours – mobile team will take lunch at end of day Extended hours – need lunch during school hours if but will provide services during extended day Designate a “SITE COORDINATOR” with cell phone number and email address

10. Day of On-Site Visit Needs You will receive an appointment schedule from Lawton Chiles Dental prior to visit Work appointment times around “remediation”, testing, fine arts or etc. PreK, Kdg, or some ESE students may require staff to stay with them for services Two students are serviced at a time (Exam 25-30 min. & Sealants 15-20 min) Each student must have nametag with NAME, DOB unless accompanied by parent Nametags are then applied to “goodie bag that goes home”

11. “EXTRA TIPS” Many students will have 2 appointments - 1 for exam & 2 for sealants Dental puppets can be used with students Encourage students/parents to brush several days prior to sealants so gums do not bleed Advocate for staff participation

12. QUESTIONS????????????