Nick Alexander, D.M.D. Dear Dental Hygiene Applicant,

Transcription

1 Dear Dental Hygiene Applicant, Enclosed is a packet of information about the dental hygiene program at Northeast Mississippi Community College. Please check to make sure that all of the following documents are included: 1. An application for the Dental Hygiene Program. 2. A copy of the "Department Policy on Bloodborne Pathogens." 3. A physical evaluation form. 4. A clinical observation form. 5. A projected student expenses list. 6. An example of the rating scale. A new application should be completed each year if you wish to be considered. The application deadline is April 1. Your final application will not be complete until you have complied with the following requirements: 1. A CURRENT application to Northeast Mississippi Community College Proof of immunization. See "Physical Evaluation Form." 3. Hepatitis B Antibody Titer, (is HIGHLY recommended). 4. A signed and completed "Physical Evaluation Form." Must be completed by a a physician, within six (6) months of application. 5. Official transcripts from each college previously attended must be on record in the admissions office. 6. ACT scores (minimum of 17) must be on file in the admissions office. 7. Three letters of recommendation. 8. Proof of 16 hours of clinical observation. If I can be of further assistance to you, please contact me at nealexander@nemcc.edu. Sincerely, Nick Alexander, D.M.D Nick Alexander D.M.D. Program Director Revised 06/17

2 Northeast Mississippi Community College Department of Dental Hygiene Application This information will be kept in a confidential manner. You may access the application packet at Acadamic Divisions, Division of Health Sciences, Dental Hygiene Technology. If you have questions or concerns, please contact Dr. Nick Alexander, Program Director, at nealexander@nemcc.edu. Please type or print in black ink. Correspondence may be delivered or mailed to NEMCC, 101 Cunningham Blvd. Childers Hall, Booneville, MS Full Name Last First Middle Permanent Address City, State, Zip Home Phone Cell Phone Date of Birth E- mail Address Person to Contact in Case of Emergency Name/Phone Number Class Applying For (Fall 2015, Fall 2016, etc.) Reason For Applying To The Program Previous High Schools and Colleges Attended From Years Attended To Miscellaneous Information Yes No Have you ever been convicted of a felony offense? Have you ever been arrested for drug use or abuse? Have you ever been treated for drug use or mental illness? Do you now use or have you ever used tobacco or tobacco products? Signature Date

3 Northeast Mississippi Community College Department of Dental Hygiene Physical Evaluation Form Applicant's Name Last Name First Name Middle Name Permanent Mailing Address City, State, Zip Phone Number Date of Birth Height Weight THE FOLLOWING INFORMATION IS TO BE PROVIDED AND SIGNED BY A PHYSICIAN. 1. Does the applicant have a history of Tuberculosis Medical History of Applicant Yes No Please indicate Yes or No to the following questions. If yes, is the disease inactive and closely Yes monitored? No Epilepsy or other seizure Disorder Headaches If yes, what type of seizure activity and how is it treated? If yes, please describe type of headache, duration and treatment. Hypertension Heart Disease Hay Fever, allergies or dermatitis related to an allergy, including drug reactions If yes, please give cause of the allergic reaction, extent and treatment. Asthma If yes, please indicate frequency and severity of attacks and treatment. Rheumatic Fever Mitral valve prolapse Hepatitis B or C. Childhood diseases Surgeries Injuries or disabilities If yes, is there regurgitation associated with the prolapse? If yes, what is applicant's status at the present time?

4 Northeast Mississippi Community College Department of Dental Hygiene Physical Evaluation Form 2. Physical Examination (Condition of) Eyes Sinuses Ears Skin Oropharynx Thyroid Lungs 3. Heart Size Sound Murmurs Rhythm 4. Abdomen Scars Tenderness Palpable Masses 5. Urine Specific Gravity Protein Sugar 6. Skeletal Alignment Musculature 7. Has the applicant any physical or mental disabilities? Yes No Would the nature of the disability(ies) prevent the applicant from being Yes No able to do the work of dental hygiene (i.e., dental hygiene requires good hand- to- eye coordination, sitting for long periods of time, repetitive motions of the hands and wrists, and the application of knowledge in the treatment of patients)? Explain: 8. Immunizations and Tests REQUIRED Test Date Given Results CBC Tuberculin Test Immunization Date Date Date Tdap Vaccine XXXXXX XXXXXXXX MMR Vaccine XXXXXXXX Hepatitis B Vaccine Polio Vaccine 9. In your opinion, is the applicant physically able to complete the course of study required for dental hygiene training? Date Physician's Signature Printed Signature Yes No Address

5 Northeast Mississippi Community College Department of Dental Hygiene CLINICAL OBSERVATION All pre- dental hygiene students are required to complete a minimum of 16 observation hours in a dental office or the Northeast Dental Hygiene Clinic. Student: Date: Hours: Date: Hours: Date: Hours: Date: Hours: Signature of Dentist or Hygienist

6 Northeast Mississippi Community College Department of Dental Hygiene Departmental Policy on Bloodborne Infectious Diseases The most recent guidelines set forth by the Center for Disease Control in regard to bloodborne infectious diseases such as HIV and Hepatitis B state that every healthcare worker who performs exposure- prone procedures (including scaling and root- planning) should know his/her HIV status. If the healthcare worker becomes HIV- positive, he/she must inform the governing professional body of the State. For dental hygienists in Mississippi, this is the State Board of Dental Examiners. The Board of Dental Examiners will convene a meeting that will include experts in infectious diseases in order to determine which procedures the dental hygienist may continue to perform. The State of Mississippi's legislature voted in 1996 to make the CDC guidelines (updated December 2003) official for the State. Other states may have different solutions. However, the CDC has required every state to have a written policy to deal with HIV- positive healthcare workers. Since you are training in Mississippi while at Northeast, you must abide by this State law. In addition, you must realize that every patient has certain legal rights. Specifically, if a dental hygienist knows that she/he is HIV- positive but does not disclose this information to her/his patients before performing exposure- prone procedures, she/he has denied the patients their right to informed consent and would be liable in a court of law. Dental hygienists who are found by the State Board of Dental Examiners to pose a risk to patients while performing exposure- prone procedures may choose alternative careers that use a dental hygiene background such as pharmaceutical sales, education, insurance claims, or research. The dental hygiene department does not intend to discriminate against any student with a bloodborne infectious disease. However, it is our intent to follow current CDC guidelines in order to insure the welfare of the patients who choose to obtain dental hygiene services through the program. Hepatitis B is a potentially deadly disease and the infectious disease of gravest concern to healthcare workers. As a student in the dental hygiene program, you should also be aware that the dental hygiene clinic at Northeast routinely treats all patients for whom it is in their best interest to be treated. Therefore, we treat patients who are HIV- positive, who have Hepatitis B and who have other infectious diseases. This is our legal, moral and ethical responsibility. We do not discriminate against these patients in any way, nor do we discriminate on the basis of race, creed, national origin, sexual orientation or religion. We will insist that you^tjeat gatiejts with no display of hesitation chscrimination or aversion. You are expected to use "universal standard precautions" on every patient. "Universal standard precautions" may be defined as the routine use with every patient of barrier protection such as gloves, masks, safety glasses and fluid- resistant lab coats and the use of sterilization and disinfection methods for maintaining instruments and working surfaces which will not harbor the transmission of pathogens. We do reserve the right to refuse treatment to patients with active tuberculosis. The CDC has stated that these patients pose unique risks due to the difficulty in killing the sputum- borne organism and the development of drug- resistant strains. If you have questions about these policies, please contact Dr. Nick Alexander at nealexander@nemcc.edu.

7 Northeast Mississippi Community College Department of Dental Hygiene Estimated Expenses Additional to Tuition Semester Description of Items Cost st Instrument Kit $ Books (ebooks) Supplies* Malpractice Insurance Lab $40.00 * Radiology Badges IPAD (required) SADHA Dues (Student American Dental Hygienist's Assn.) * nd Dental Handpiece^ Books (ebooks) Supplies * Radiology Badges Eye Magnification (Loupes) rd Instrument Kit Books (ebooks) Supplies * Radiology Badges Malpractice Insurance SADHA Dues * th Books (ebooks) Supplies * Radiology Badges Total Costs $ Students are required to wear scrub suits in clinic and white shoes of their choosing. Scrub suits range from $18 to $30 and can be purchased where ever desired. All items listed are required expenses in order for a student to complete the curriculum with the exception of the SADHAdues. All graduating students apply to take the National Board Examination prior to licensure with a fee of $400. All students must take this examination. Clinical Examination $1200- $1500 and is accepted by 41 states. *Does NOT include tution & fees at NEMCC * Incidentals not covered by Financial Aid.

8 "FOR OFFICE USE ONLY" NORTHEAST MISSISSIPPI COMMUNITY COLLEGE Rating Scale for Dental Hygiene Technology Applicant Name Date of Application CRITERIA VALUE POINTS TOTAL 1 ACT Composite (list actual score) ACT Composite Score MIMINUM of 17 ACT e.g. 20 ACT=20 points, 16 or below = 0 points 2 Overall College GPA Academic courses taken with assigned point value as follows: A = 5 points B = 3 points C = 1 point All D's, F's, and W's in the required pre- requisite courses will receive a one point deduction per grade. BIO 2514 (A & P I) BIO 2524 (A & P II) FCS 1253 (Nutrition) BIO 2924 (Micro) ENG 1113 PSY 1513 COURSE GRADE REPEAT GRADE MAT 1233 SOC 2113 CHE or CHE 1213 SPT 1113 Fine Art Elective Art/Music/or Theatre Apprec. Subtotal POINTS Points POINTS 4 Professional Commitment: Documentation must be in the Program Director's office by deadline dates to earn point. This is the student's responsibility High School Allied Health/Health Sciences Course (Vo- Tech) Survey of Healthcare Careers Course 1 1 GRAND TOTAL OF POINTS