02/2022

Health History Section.

Question Updates for the following:

1. Org. Question:  Do you have an alcohol use disorder?
   • Updated to:  Is there a history / treatment for an alcohol use disorder?
2. Org. Question:  Do you have a substance use disorder?
   
   • Updated to:  Is there a history / treatment for a marijuana or substance use disorder?

1. OMS
2. GD/Endo/Perio
3. Eaglesoft
4. HH Update
5. Canadian GP/Endo/Perio
6. Spanish OMS
7. Spanish GD/Endo/Perio
8. Spanish HH Update

01/2021

Eaglesoft PBHS Standard Form Changes:

• Increased medication fields from 14 to 20
• Added Covid Questionnaire as page 1

1. Eaglesoft

01/2021

Covid Questionnaire Changes:

• added "Have you been vaccinated for COVID-19? yes/no question
• added "If so, date of vaccination" text field
• added "Date of booster" text field

1. OMS
2. GD/Endo/Perio
3. Eaglesoft
4. Canadian GP/Endo/Perio
5. Covid

12/2020

Covid Questionnaire Changes:

• added "in the past 14 days" to the end of the two questions below:
  • Have you been in contact with someone who has tested positive for COVID-19
  • Have you been tested for COVID-19

1. OMS
2. GD/Endo/Perio
3. Eaglesoft
4. Canadian GP/Endo/Perio
5. Covid

9/2020

Medical History/Health History section:

• COVID-19? added as a yes/no question

1. OMS
2. GD/Endo/Perio
3. Eaglesoft
4. Canadian GP/Endo/Perio
5. Covid

06/2020

New Form Created:

• Canadian Covid Questionnaire Standard Form

06/2020

Located at the top of each Standard form page:

• Patient Name field added

1. OMS
2. GD/Endo/Perio

5/2020

New Form Created:

• US Covid Questionnaire Standard Form

1. Covid

04/2020

New Covid Page Added:

• Added Covid questionnaire as the first page on all standard forms

1. OMS
2. GD/Endo/Perio
3. Canadian GP/Endo/Perio

02/2020

Signatures - Authorization Section:

• Question Added:
  
  I permit the office to communicate with me via text message on my cell phone.

1. OMS
2. GD/Endo/Perio
3. Eaglesoft
4. Canadian GP/Endo/Perio

02/2020

Medication - Are You Now Taking section:

• Added Xgeva to Medication question below:
  
  Are you taking, or have you ever taken bone density meds, RANKL inhibitors or bisphosphonates such as Prolia, Fosamax, Boniva, Actonel, IV-Zometa, Aredia, Reclast, Xgeva, or Evista in the past 12 years?

1. OMS
2. GD/Endo/Perio

01/2020

New Form Created:

• Eaglesoft Standard Form

1. Eaglesoft

01/2019

Medical History/Health History section:

• Question modification: A history of marijuana or other drug use
• Question modification: Do you smoke or vape (if so, how much a day).

1. OMS
2. GD/Endo/Perio

Patient Information section:

• Question Added:  Preferred Pharmacy & Tel

1. OMS
2. GD/Endo/Perio

Are You Now Taking section for Medication:

• 2 part Question Added:
  • If you are under the care of a physician for pain management, or recovering from drug  addiction please select the medication you
    are currently taking:
    Methadone
    Suboxone
    Oxycodone
    Fentanyl
    Other
  • Treating doctor:

1. OMS