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Medical/Dental Integration Tool Kit

Tools and forms for dentists and physicians to help integrate oral and systemic health. Please share these forms with your medical colleagues. If you have other forms that have proven effective, please feel free to share them with us.

Title PDF Word
  (Important information on use of the following forms.)
Dental Medical Consultation Form
  (For use in referring your patients to medical providers.)
Pregnancy Consultation Form
  (To share with your patients' Obstetricians.)
Medical Dental Consultation Form
  (For medical colleagues to use in requesting dental evaluation or treatment prior to medical procedures such as cancer treatment, organ transplant, joint replacement or heart surgery.)
Blood Glucose Values
  (A blood glucose test measures the amount of sugar, called glucose, in your blood.)
Blood Pressure Classification for Adults
  (This hypertension chart provides basic guidelines for medical referral of your patients for treatment. Feel free to print for use in your office.)
Hemoglobin A1c Values
  (The A1c test is a blood test that provides information about a person's average levels of blood glucose–also called blood sugar–over the past three months.)
Physical Status Classification System
  The purpose of this grading system is simply to assess the degree of a patient's "sickness" or "physical state" prior to selecting the anesthetic or prior to performing surgery.)
Universal Pain Scale
  (The universal pain scale may help you receive more accurate pain assessments from your patients.)