PATIENTS' BILL OF RIGHTS AND RESPONSIBILITIES

Post the Patients' Bill of Rights and Responsibilities next to the Patient Contact Representative's picture in the reception area. Figure 2-5 illustrates the Patients' Bill of Rights and responsibilities.

PATIENT SURVEYS

Patient survey forms should also be located at the front desk area. These forms are originated at each clinic and ask the patients different questions regarding their visit. These forms will also ask for any suggestions that might improve the services provided. Completed forms are turned into the front desk personnel or may be placed in a suggestion box located in the reception area. Surveys are compiled and submitted with the command's annual assessment of the QA Program per BUMEDINST 6010.13.

DENTAL TREATMENT RECORDS

An essential part of the receptionist or clerical duties of a dental assistant is preparing and maintaining the dental record jacket and associated forms. Please note that the old Dental Treatment Record (NAVMED 6150/10-19) is being replaced by the new dental record jacket (NAVMED 6150/21-30). Instructions for completing the NAVMED 6150/21-30 can be found in the Dental Treatment Record Manual dated December 1997. This manual will eventually be incorporated into MANMED, Chapter 6.

PREPARATION OF THE DENTAL RECORD JACKET

A Dental Record Jacket, (NAVMED 6150/21-30) should be established for every individual receiving dental care in a Navy DTF, except when dental care is limited to participation in a group preventive dentistry program. Dental records prepared for eligible beneficiaries should be placed in the custody of the DTF responsible for the individual's dental treatment. The following procedures for establishing dental records apply to all eligible beneficiaries receiving outpatient dental care. Figure 2-6 is a sample of the front cover of a dental record jacket (NAVMED 6150/21-30). Refer to figure 2-6 for guidance for preparing dental records using the specific instructions discussed next.

Use an indelible, black, felt-tip pen, black ink, or pencil, as indicated to record all patient identifying data sections.

Social Security Number (SSN)

The second to the last digit of the SSN is preprinted on the dental record jacket. The preprinted digit also matches the last digit of the form number (e.g., the preprinted digit on NAVMED 6150/26 is a 6). The color of the treatment record jacket corresponds to the preprinted digit as follows:

Jacket Selection and Entries

Select a prenumbered NAVMED 6150/21-30 jacket matching the second to last number of the

Figure 2-5.\Patients' Bill of Rights and Responsibilities.

Figure 2-6.\Sample front cover of a Dental Record Jacket (NAVMED 6150/21-30).

sponsor's SSN. Enter the first seven digits and the ninth digit of the sponsor's SSN on the top right portion of the jacket. Using a l-inch long, 1/2-inch wide strip of black tape, tape over the number that corresponds to the last digit of the SSN in each of the two number scales. The tape must completely blacken out the number and extend around the edge of the jacket to the back.

Patients Without SSNs

For patients who do not have an SSN (e.g., foreign personnel and their family members), create a "substitute" SSN by coding the first three digits with 800 and the last six digits as the month, day, and year of the patient's birth (i.e., MM-DD-YY). As an example for a patient who was born on July 10, 1945, assign SSN 800-07-1045. For patients with the same birth date, assign the first three digits sequentially starting with 801, followed by the birth date. Select a prenumbered NAVMED 6150/21-30 jacket, matching the second to the last number of the patient's "substitute" SSN, and complete the jacket from the instructions in this section.

Family Member Prefix (FMP) Codes

Enter the patient's FMP code in the two diamonds preceding the SSN using Table 1-1.

DATA ON FRONT COVER OF THE DENTAL RECORD JACKET

All entries on the front cover, except "Pencil Entries" are made with black felt-tip pen. Use the following instructions to complete the next sections.

Name

Enter the patient's name in the upper-right corner in the following sequence: last, first, middle. Indicate no middle name by the abbreviation "NMN." The name should be written on the line provided. For all retired flag and general officers (i.e., 0-7 and above), enter the phrase "FLAG OFFICER" or "GENERAL OFFICER," as appropriate, in the lower portion of the patient's identification box.

Alert

Immediately below the instruction box, indicate in the alert box whether the patient has sensitivities or allergies by entering an "X" in the appropriate boxes (if none, leave blank).