Community Dental Service by fT6u90

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									               Community Dental Services Referral Criteria

Adults and Children with Special Needs
Many children and adults with special needs are normally treated within the General Dental service.
However, because of a patient’s particular needs a GDP may not have the specialist skills or
equipment and facilities to provide the high quality care appropriate to the needs of the patient and
they may wish to make a referral to CDS.

Acceptance criteria for patients with special needs include:-

      People with a moderate or severe medical disability

      People with a moderate or severe physical disability

      People with moderate or severe learning disabilities

      People with moderate or severe dementia

      Adults with mental illness who cannot be treated in primary care

      In-patients and patients staying in secure units due to their mental status

      People with a group of sensory, medical, physical, emotional, mental, intellectual, social
       disabilities that in combination make them unable to access general dental services

      Patients where treatment under sedation has been attempted but failed

      Patients whose eligibility is uncertain may be accepted subject to a clinical assessment

In addition the service accepts children who have:-

      Dental anomalies that affect the structure and development of the dentition

      Dental trauma

      Behavioral problems / limited co-operation

These criteria exclude adult patients referred for sedation because of anxiety alone i.e. without any
of the other criteria outlined above.


This service is provided at: all CDS clinics
                                          Referral of
                                 CHILDREN & ADULTS
                                 WITH SPECIAL NEEDS
                                   Please complete all sections

  PRACTICE NAME & ADDRESS                               REFERRING DENTIST

                                             Name: ……………………………………………

                                             Tel: ………………………………………………

                                             Signature: ………………………………………

                                             Date: ……………………………………………


                  PATIENT DETAILS                        PATIENT’S GP DETAILS

Name: ………………………………………………                           GP Name: ……………….………………….

Address: …………………………………………..                        Practice name: ……..………………………

………………………………………………………                              Practice Address: ……..…………………..

Postcode: …………………………………………                         ……………………………………………….

Tel (preferred): …………………………………….                   ……………………………………………….

Tel (alternative): …………………………………….                 Postcode: ……………..……………………

Date of Birth: ………………………………………                     Practice tel: …………………………………


                           RELEVANT MEDICAL & DENTAL HISTORY




For use from 1 July 2012                                                     Page 1 of 2
                REASON FOR REFERRAL AND TREATMENT REQUESTED
    Please include details of any dental care you are currently undertaking on this patient, not
                                    requring CDS involvement




                                     ADDITIONAL INFORMATION
Reason referral indicated:
Poor cooperation / anxiety                      Complex medical history 
Physical disability/ access                     Domiciliary Visits              
Mental health / dementia                        Learning disabilities           

May require sedation or general anaesthesia? Yes/No

Is the referral for:         This course of treatment              Long term care 

Would you like to be informed if the treatment plan needs to be changed?                             Yes/No

Patient’s preferred CDS clinic ……….……………………………………..

Radiograph(s) enclosed 
If paper copies of digital radiographs are sent, these must be of adequate quality to allow proper radiographic
assessment of the case. Digital radiographs can be sent electronically to cds.referrals@nhs.net but please be
aware that any message sent with patient identifiable information should only be sent from an NHS.net email.
(If images are being sent by email please ensure that the image is sent in a standard image format, or
please contact us if any specific viewer software is required.)


Please send referrals to:
         The Referrals Administrator
         Community Dental Services CIC
         Bedford Heights
         Manton Lane
         Bedford MK41 7PH
or from a secure encrypted NHS.net email to cds.referrals@.nhs.net



For use from 1 July 2012                                                                                   Page 2 of 2

								
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