CHECKLIST SITE VISIT

Transcription

1 CHECKLIST SITE VISIT SECTION 4 - ARRIVING AT DENTAL CLINIC 1. Is the dental clinic s sign visible from the road? 2. Is the building s main entrance clearly marked? 3. Is the parking area clearly marked? 4. Is parking free at the clinic? What is the cost? 5. Is the walk to the main entrance clearly marked? The walk includes: Signs that have arrows/symbols Signs that use consistent language Signs in language other than English 6. Is the clinic accessible to those with disabilities? 7. How many blocks is the clinic from the public transportation stop? Additional Comments: < (>5) 1

2 SECTION 5 SECURITY & RECEPTION Security 1. Is security present in lobby? (SKIP to Reception Section) 2. Did security Search your bag Request identification Provide name tag 3. Did security direct you to: reception area? 4. How would you describe your interaction with security? Helpful NOT helpful Additional Comments: Reception 1. If there is a main clinic reception desk, is it clearly marked? 2. Main Reception Staff are they: (Check ONLY ONE) Helpful NOT helpful 3. If there is a dental reception desk, is it clearly marked? 4. Dental Reception Staff are they: (Check ONLY ONE) Helpful NOT helpful 5. Are translation services available? Which languages? 6. Is there a clinic map? t needed 7. Describe the reception staff did they: (Check ALL that apply) a. Acknowledge you/greet you b. Ask if they can assist you c. Ask you to sign in d. Ask you to show ID e. Speak slowly f. Speak clearly g. Answer your questions h. Direct you to next step (waiting area; wait for staff to call you) i. Other 2

3 SECTION 6(A) ORAL HEALTH INFORMATION 1. What type of oral health information is displayed in the clinic? For each oral health topic displayed in the clinic, check the location (clinic main lobby, dental lobby, hallway or operatory) where the information is displayed. Check if the information is displayed on the wall or is available in a leaflet for the patient. Oral Health Topic Fluoride Water fluoridation Fluoride varnish Fluoride tablets Brushing w/ fluoride toothpaste and flossing Brushing & flossing NO mention of fluoride toothpaste Preventing dental caries Pit and fissure sealants Periodontal disease Endodontics Early childhood caries Child s oral health Infrequent sugar consumption Preventing injuries Proper nutrition Pregnancy and oral health Diabetes and oral health Oral cancer Cosmetic dentistry Other (dental): Where is the information located? Is information on the wall or available as a leaflet? Clinic Main Dental Hallway Other Wall Leaflet Wall Leaflet Wall Leaflet 3

4 Oral Health Topic Fluoride Water fluoridation Fluoride varnish Fluoride tablets Brushing w/ fluoride toothpaste and flossing Brushing & flossing NO mention of fluoride toothpaste Preventing dental caries Pit and fissure sealants Periodontal disease Endodontics Early childhood caries Child s oral health Infrequent sugar consumption Preventing injuries Proper nutrition Pregnancy and oral health Diabetes and oral health Oral cancer Cosmetic dentistry Other (dental): Operatory Where is the information located? Is information on the wall or available as a leaflet? Operatory Operatory Operatory Wall Leaflet Wall Leaflet Wall Leaflet Wall Leaflet 4

5 SECTION 6(B) OTHER HEALTH INFORMATION 2. What other types of health information is displayed in the clinic? For each type of health information displayed in the clinic, check the location (clinic main lobby, dental lobby, hallway or operatory) where the information is displayed. Check if the information is displayed on the wall or is available in a leaflet for the patient. Other Health Topic Cancer: (type) Child Safety Colon test Diabetes Diet / Proper nutrition Exercise Flu / Flu shot / H1N1 HIV HPV Immunizations Infection Control Infant health Men s Health Osteoporosis Pregnancy Prevent transmission of flu/cold Quit Smoking Senior health Special Needs Children TB Violence / Abuse Women s Health Where is the information located? Is information on the wall or available as a leaflet? Clinic Main Dental Hallway Other Wall Leaflet Wall Leaflet Wall Leaflet 5

6 Clinic: 3. What type of information about the clinic is displayed? Mission Objectives History Services Patient s Bill of Rights Patient s Right to Privacy Images of the community ne of the above 4. Is there information about the following types of insurance? MCHP Medicaid health insurance information is displayed 5. Does the clinic use videos to educate patients? Where: Reception Operatory Education Room 6. What is the sound level in the reception area? Quiet isy 7. Additional comments: 8. May we take examples of pamphlets, insurance forms, consent forms? 9. May we take pictures of posters/flyers? 6