Overview

Data triage form
Information


Sheet 1: Data triage form

Instructions to fill out data triage form for NHS111, referring dentists, Clinical Triage Service and Urgent Dental Care systems. An nhs.net account will be required to disseminate this form further. For further instruction, see the information sheet.















A separate form is required to be completed and saved for each individual patient, along with a Patient Triage System- Care Record (where applicable)




















Each completed form is to be sent to:

england.covid19triageeast@nhs.net























A)      Section A in green is to be filled by NHS111 service or general dental practitioner. See Information sheet for further guidance.

















































B)      Section B in yellow is to be filled by the Clinical Triage Service. See information sheet for further guidance.

















































C)      Section C in orange is to be filled by the Urgent Dental Care System See information sheet for further guidance

















































SECTION A to be filled by 111 or referring Dentist













SECTION B to be filled by Clinical Tirage Service





SECTION C to be filled by Urgent Dental care System


































Patient name D.O.B. Patient contact no. COVID-19 risk Y/N Patient complaint Checked referral to CTS meets guidelines and there is no other appropriate route for treatment Y/N Referred to Emergency Dental Care Y/N Medical History Summary Drug Allergies Shielded risk group Y/N Vulnerable/increased risk group Y/N Name of referring dentist Name of General Dental Practice Post Code Contract/performer no. For those referred by GDP - email contact details of GDP. Alternatively, advise if referred by NHS111 Appropriate referral Y/N Advice given, including analgesia advice Y/N. Further details to be provided in Patient Triage System- Care Record Px Given Y/N Email sent to GDP (where applicable) to advise on care provided Y/N. N.B. To include Patient Triage System- Care Record and this spreadsheet in email Referred to Emergency Dental Care Y/N Referred to Urgent Dental Care Service Y/N Appropriate referral Y/N Notes from clinical appointment completed in Patient Triage System- Care record Y/N. N.B. To include Patient Triage System- Care Record and this spreadsheet in email returned to GDP (where applicable) Advice given, including analgesia advice Y/N. Further details to be provided in Patient Triage System- Care Record Px Given Y/N Email sent to GDP (where applicable) to advise on care provided Y/N. N.B. To include Patient Triage System- Care Record and this spreadsheet in email Referred to Emergency Dental Care Y/N Referred to Urgent Dental Care Service Y/N








































Only fill in these boxes if referred by dentist













Patient Triage System- Care Record

















































































Sheet 2: Information

Section A
Section A in green is to be completed by NHS111 service or the referring general dental practitioner. The referring dental practitioner is also required to fill out the Patient Triage System - Care record, (link found at the bottom left of the spreadsheet) and also email this with this spreadsheet. Incorrectly completed forms will be returned. The spreadsheet must then be e-mailed using the following address: england.covid19triageeast@nhs.net to the Clinical Triage Service. (Please note information to up-to-date links to identify shielded and vulnerable/increased risk patient groups are provided in the Standard Operating Procedure or below. Columns K,L,M and N are to be completed by the referring dentist only i.e. NHS111 do not need to fill out these columns).

Section B
B)      Section B in yellow is to be completed by the Clinical Triage Service. Column O is to contain the contact details of the referring dentist. If treatment is completed, Column W indicates a confirmation email has been sent back to the dentist. This spreadsheet and the Patient Triage System - Care Record (link found at the bottom left of the spreadsheet) are to be attached to this email. The subject heading should read “Clinical Triage Service Patient Treatment Details For Your Records”.


Section C
C)      Section C in orange is to be filled by the Urgent Dental Care system. Included in this section is confirmation that an email has been sent back to the dentist at column AA. This email should include details from the Patient Triage System - Care Record (link found at the bottom left of the spreadsheet), along with attachment of this spreadsheet for the dental records. The subject heading should read “Urgent Dental Care System Patient Treatment Details For Your Records”.


Vulnerable Groups
For information on Vulnerable/increased risk patients refer to: https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people


Shielded Groups
Sheilded patients refer to: https://digital.nhs.uk/coronavirus/shielded-patient-list#spl-clinical-algorithm