Medical/Dental Integration Tool Kit

  • Directions
      (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.)