Medicates, Medication Administered by Staff) Does the individual require sedation for Special Needs Screen 42 medical or dental appointments? for clinical visits’ – ‘Sedation Past Medical History - Evaluations Annual Physical Examination Date Screen 49 (Editable in the Health and Dental Field - EXAM Status’ ‘PHYSICAL Assessment) (MM/DD/YYYY or YYYY allowed in HCR) Past Medical History - Evaluations Dental Examination Date (Editable in the Screen 51 Health and Dental Assessment) - EXAM Status’ ‘DENTAL (MM/DD/YYYY or YYYY allowed in HCR) Past Medical History - Evaluations Screen 53 Colonoscopy/ Sigmoidoscopy Field - or ‘SIGMOIDOSCOPY COLONSCOPY Status’ (Only Year is stored in HCR. No Date) Past Medical History - Evaluations Screen 54 Bone Density Field - DENSITOMETRY EXAM ‘BONE Status’ (Only Year is stored in HCR. No Date) Past Medical History Screen Field - (Prostate Cancer ‘PSA 55 Prostate Screening) Status’ (Only Year is stored in HCR. No Date) Past Medical History - Gynecologic Screen 56 Pap smear Field - Smear Status’ ‘PAP (MM/DD/YYYY or YYYY allowed in HCR) Past Medical History - Gynecologic Screen 57 Mammogram Field - Status’ ‘Mammogram (MM/DD/YYYY or YYYY allowed in HCR) Past Medical History - Evaluations Screen 58 Lipid Panel - Panel Status’ ‘Lipid (Only Year is stored in HCR. No Date) Past Medical History - Evaluations Screen 59 EKG - ‘EKG’ (Only Year is stored in HCR. No Date) Past Medical History - Evaluations Screen 60 Drug Level - Level’ ‘Blood (Only Year is stored in HCR. No Date) The following services require a Health and Dental assessment to be completed: Placement Services (also referred to as Shared Living) 24-hour Residential Supports Community Living Supports State Operated Residential Supports
Medicates, Medication Administered by Staff) 42 Does the individual require sedation for medical or dental appointments? Special Needs Screen – ‘Sedation for clinical visits’ 49 Annual Physical Examination Date (Editable in the Health and Dental Assessment) Past Medical History - Evaluations Screen Field - ‘PHYSICAL EXAM Status’ (MM/DD/YYYY or YYYY allowed in HCR) 51 Dental Examination Date (Editable in the Health and Dental Assessment) Past Medical History - Evaluations Screen - ‘DENTAL EXAM Status’ (MM/DD/YYYY or YYYY allowed in HCR) 53 Colonoscopy/ Sigmoidoscopy Past Medical History - Evaluations Screen Field - ‘SIGMOIDOSCOPY or COLONSCOPY Status’ (Only Year is stored in HCR. No Date) 54 Bone Density Past Medical History - Evaluations Screen Field - ‘BONE DENSITOMETRY EXAM Status’ (Only Year is stored in HCR. No Date) 55 Prostate Past Medical History Screen Field - ‘PSA (Prostate Cancer Screening) Status’ (Only Year is stored in HCR. No Date) 56 Pap smear Past Medical History - Gynecologic Screen Field - ‘PAP Smear Status’ (MM/DD/YYYY or YYYY allowed in HCR) 57 Mammogram Past Medical History - Gynecologic Screen Field - ‘Mammogram Status’ (MM/DD/YYYY or YYYY allowed in HCR) 58 Lipid Panel Past Medical History - Evaluations Screen - ‘Lipid Panel Status’ (Only Year is stored in HCR. No Date) 59 EKG Past Medical History - Evaluations Screen - ‘EKG’ (Only Year is stored in HCR. No Date) 60 Drug Level Past Medical History - Evaluations Screen - ‘Blood Level’ (Only Year is stored in HCR. No Date) The following services require a Health and Dental assessment to be completed: Placement Services (also referred to as Shared Living) 24-hour Residential Supports Community Living Supports State Operated Residential Supports