Dental Data Exchange
1.0.0 - STU 1

This page is part of the Dental Data Exchange (v1.0.0: STU1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Example Bundle: Complete Dental Referral Note Document Bundle example

Allergies and Intolerances Section

Allergen Code Manifestation Severity
Penicillin G 7908 Skin rash mild

Medication Section

Medication Directions Start Date Status Indications Fill Instructions
Lisinopril 10 mg tab 1 tab once/day Active Generic substitution allowed

Problem Section

Mild, Hypertension

Type 1 diabetes

Teeth covered in plague

Toothache

Swollen Gums

Bleeding Gums

At high risk for dental carries

Reason for Referral Section

Toothache

Left lower quadrant pain

Bleeding gums

Plan of Treatment Section

D0150 - Comprehensive Oral Evaluation

Assessment Section

Patient has pain in his lower left jaw and occassional bleeding from his gums - referring for dental evaluation.

History of Present Illness Section

The patient has not visited a dentist or received flouride treatments in the past 4 years while away at college

Immunizations Section

Vaccine Date Status
Hepatitis B vaccine January 4, 2020 Completed

Medical Equipment Section

Device Type Procedure Implant Date
Insulin Pump Insertion of insulin pump (procedure) November 3, 2013

Procedures Section

No Procedures performed

Social History Section

Social History Element Description Effective Dates
Smoking Status NA 2005/05/01 - 2020/03/28
Highest Education Received Collect Education 2010/05/01 - 2014/03/28
Employment Full-time accountant 2015/05/01 - current

Vital Signs Section

Vital Sign Date Value
Temperature 2020/04/15 98.5
Heart Rate 2020/04/15 78
Respiration Rate 2020/04/15 20
Blood Pressure 2020/04/15 120/80

Goals Section

No soda/sugary drinks/energy drinks

Use fluoride toothpaste

Health Concerns Section

Neuropathy due to diabetes mellitus

Instructions Section

Pt. Education. Advised to see dentist regularly, brush 2x/day w/ fluoride toothpaste, floss

Payers Section

Aetna Comprehensive Medical /Dental Insurance

Dental Findings Section

No Information