Preadmission / ScreeningPreadmission / Screeningfor Adultsfor Adults

August 3, 2009August 3, 2009CDS 824- Dr. TheissCDS 824- Dr. Theiss

Team Leaders- Team Leaders- Drs. Nihill, Harrison, Carroll, McConnell, RayDrs. Nihill, Harrison, Carroll, McConnell, Ray

Videos courtesy of Drs. Falace, Lindroth and HerrenVideos courtesy of Drs. Falace, Lindroth and Herren

PreadmissionPreadmission

• Determines if patient eligible for student clinicDetermines if patient eligible for student clinic• Reviews clinical policyReviews clinical policy• Establishes the patient’s needs and desiresEstablishes the patient’s needs and desires• Review health and dental historiesReview health and dental histories• Cursory examsCursory exams

– Head and Neck ScreeningHead and Neck Screening– Missing teeth, periodontal risk, Caries risk and oral Missing teeth, periodontal risk, Caries risk and oral

cancer riskcancer risk

• Informs patient of “generalized” estimate of Informs patient of “generalized” estimate of treatment needs treatment needs

• Provide “rough” estimate of costs and optionsProvide “rough” estimate of costs and options

Screening appointmentsScreening appointments

• Patients call 859-323-6525Patients call 859-323-6525– They will reach Donna Mason or Phyllis DeanThey will reach Donna Mason or Phyllis Dean

• They also tell patients that this first appt is screening only They also tell patients that this first appt is screening only to determine if their needs fit the needs of the dental to determine if their needs fit the needs of the dental students.students.

• This screening is for This screening is for – Comprehensive Care NOT Urgent Care… Comprehensive Care NOT Urgent Care…

• Urgent Care- different processUrgent Care- different process

• They will also inform patient that They will also inform patient that – ““we are NOT a free clinic”, but student fees are generallywe are NOT a free clinic”, but student fees are generally– one-half to one-third of private practice fees.one-half to one-third of private practice fees.

Screening appointments:Screening appointments: Donna and Phyllis also tell Donna and Phyllis also tell patientspatients

• This appointment will take 2-3 hoursThis appointment will take 2-3 hours

• You should bring any existing “x-rays”You should bring any existing “x-rays”

• You should bring a list of or a bag with You should bring a list of or a bag with your medicinesyour medicines

• The fee will be $40, that must be paid that The fee will be $40, that must be paid that day and will not be covered by insuranceday and will not be covered by insurance

TransitionsTransitions

• Paper to ElectronicPaper to Electronic• Review of all formsReview of all forms• Formal review of procedures this fall for Formal review of procedures this fall for

– ScreeningScreening– Oral Diagnosis Oral Diagnosis – Treatment Planning Treatment Planning – Will use Toyota “Lean” assessment and action tools.Will use Toyota “Lean” assessment and action tools.– Multiple faculty, staff and students will be involvedMultiple faculty, staff and students will be involved

• STAY TUNEDSTAY TUNED

Screening appointments:Screening appointments: Donna and Phyllis also tell Donna and Phyllis also tell patientspatients

• You will likely have a panoramic “x-ray” You will likely have a panoramic “x-ray” takentaken

• You will be seen both by faculty and by You will be seen both by faculty and by students during screeningstudents during screening

• At the end of the appointment will know if At the end of the appointment will know if eligible for comprehensive care at UK CODeligible for comprehensive care at UK COD

• If accepted into program, treatment is by If accepted into program, treatment is by students who are supervised by faculty and students who are supervised by faculty and residentsresidents

Appointments made in AxiUMAppointments made in AxiUMElectronic Patient RecordElectronic Patient Record

New to COD- get T-number until show New to COD- get T-number until show up then get a regular number assigned up then get a regular number assigned

Screening patients are Screening patients are appointedappointed

• AM- scheduled at 8 and 8:30 AM- scheduled at 8 and 8:30

• PM- scheduled at 1 and 1:30PM- scheduled at 1 and 1:30

Purposely staggered to help with Purposely staggered to help with long lines and urgent care patients long lines and urgent care patients who often arrive at 7:30who often arrive at 7:30

• Students scheduled at 9:00 and 2:00Students scheduled at 9:00 and 2:00

Preadmission introductionPreadmission introduction

Patient arrives….Patient arrives….11stst floor registration floor registration

Fee for Screening is $ 40 Fee for Screening is $ 40 NOT $15 as video from 2001 statesNOT $15 as video from 2001 states

Registration FormsRegistration Forms1A1A- form general - form general demographicdemographic information information used by registration staff to used by registration staff to enter into AxiUm electronic enter into AxiUm electronic Patient Record. Patient Record.

The patient is then The patient is then assigned a regular AxiUmassigned a regular AxiUm patient numberpatient number..

1C- Preadmission summary 1C- Preadmission summary formform student record general student record general findings, missing teeth, findings, missing teeth, periodontal probing> 5mm, periodontal probing> 5mm, carious lesionscarious lesionsTeam Leaders or OD faculty Team Leaders or OD faculty review findings and help review findings and help determine fee estimatesdetermine fee estimates

At Radiology reception area- At Radiology reception area- patients review & complete patients review & complete

additional formsadditional forms• 3A- Medical History- Front and Back 3A- Medical History- Front and Back

– and signed by patientand signed by patient

• HIPPA- Notice of Privacy PracticesHIPPA- Notice of Privacy Practices

• Receipt of HIPPA form must be signedReceipt of HIPPA form must be signed

• Clinical Research Contact Form- Clinical Research Contact Form- – can consent to be contacted by Clinical can consent to be contacted by Clinical

Research Center for one year from Research Center for one year from signaturesignature

Other informed consentOther informed consent

• As we speak the UKDCB- University As we speak the UKDCB- University of Kentucky Dental Care Board is of Kentucky Dental Care Board is reviewing multiple consent forms to reviewing multiple consent forms to use for our patients.use for our patients.

• These may be available by the time These may be available by the time you start seeing your own patientsyou start seeing your own patients

Patients Rights and Patients Rights and ResponsibilitiesResponsibilitiesYou have the right to:

• Considerate, respectful and confidential treatment:

• Continuity and completion of treatment;

• Access to complete and accurate information about your condition;

• Advance knowledge of the cost of treatment, explanation of your treatment fees and informed consent to treatment;

Patients Rights and Patients Rights and ResponsibilitiesResponsibilitiesYou have the right to:

• Explanation of recommended treatment, treatment alternatives, the option to refuse treatment, the risk of no treatment and expected outcomes of treatment;

• Emergency, incremental and total patient care;

• Treatment that meets the standards of care in the profession;

• Access to a patient advocate;

Patients Rights and Patients Rights and ResponsibilitiesResponsibilitiesYour responsibilities include:

• Providing accurate and complete information about your medical history;

• Questioning treatment or instructions you do not understand;

• Keeping scheduled appointments and providing at least 48 hours notice if you need to cancel an appointment;

• Providing information about payment for services and working with the college of dentistry to ensure that financial obligations are met.

Team Leader in RadiologyTeam Leader in Radiology

• Meets patientsMeets patients

• Inquires Needs and DesiresInquires Needs and Desires

• Quick review of Medical HistoryQuick review of Medical History

• Quick review of Clinic policyQuick review of Clinic policy

• Intraoral ScreeningIntraoral Screening

• Prescribes Screening radiographsPrescribes Screening radiographs

Team Leader meet and Team Leader meet and prescribes screening prescribes screening radiographs usually panoramic radiographs usually panoramic and BW’sand BW’s

Radiographs then taken or Radiographs then taken or reviewed if bring x-rays with reviewed if bring x-rays with themthem• Typically most patients will get a Typically most patients will get a

Panoramic film and if teeth 2-4 Panoramic film and if teeth 2-4 Bitewing radiographsBitewing radiographs

• On occasion if one tooth in pain may On occasion if one tooth in pain may get periapical radiographsget periapical radiographs

• We don’t do full mouth radiographic We don’t do full mouth radiographic series during preadmissions series during preadmissions generallygenerally

Clinic PolicyClinic Policy

• Patients must be available for ½ day session every other week Patients must be available for ½ day session every other week AMAM session: 9-12 PMsession: 9-12 PM PM session: 2-5PMPM session: 2-5PM

• Patients must be on time, Patients must be on time, – Patients who are regularly late, cancel frequently or no show Patients who are regularly late, cancel frequently or no show

will likely be dismissed from Comprehensive Care programwill likely be dismissed from Comprehensive Care program

• Patients for Comprehensive Care must agree to Phase I Patients for Comprehensive Care must agree to Phase I treatment- Control of Dental Diseasetreatment- Control of Dental Disease

• If Patient dictates… I only want this… then they are not If Patient dictates… I only want this… then they are not Comprehensive Care patients, they are either urgent care or Comprehensive Care patients, they are either urgent care or on occasion – Endodontics only or Ortho only patients and will on occasion – Endodontics only or Ortho only patients and will be referred accordingly.be referred accordingly.

Clinic Policy- PaymentsClinic Policy- Payments

• Patients must either pay at time of Patients must either pay at time of treatment or arrange a payment plantreatment or arrange a payment plan

• Payment plans are arranged with Payment plans are arranged with • Jordan Kirby- financial counselor – Jordan Kirby- financial counselor – 22ndnd

floorfloor

• Payment Plans- 10% down, remaining balance Payment Plans- 10% down, remaining balance paid in monthly increments for 1 year- can be paid in monthly increments for 1 year- can be divided – Phase 1 only or divided – Phase 1 only or

both Phase 1 & Phase 2both Phase 1 & Phase 2

Radiology Technicians-Radiology Technicians-Jeanine, Lisa and MelodyJeanine, Lisa and Melody

• Radiographs will then be taken by Radiographs will then be taken by Radiology TechniciansRadiology Technicians

• Patients will wait until developed (until we Patients will wait until developed (until we have digital available) and clearedhave digital available) and cleared

• Patients will then report to either the 3Patients will then report to either the 3rdrd floor clinic or the 2nd floor clinic. floor clinic or the 2nd floor clinic. (wherever screening is scheduled that (wherever screening is scheduled that day)day)

Patient arrives to 2Patient arrives to 2ndnd/3/3rdrd floorfloor

• Depending on time (before 9 am or Depending on time (before 9 am or after)after)

• The patient paper chart and The patient paper chart and radiographs will arrive with faculty or radiographs will arrive with faculty or Angie Baxley, RDH for you to previewAngie Baxley, RDH for you to preview

• After 9 am, the patient may bring the After 9 am, the patient may bring the chart up with them and give it to chart up with them and give it to Phyllis Dean on the third floorPhyllis Dean on the third floor

In the meantime…..In the meantime…..you arrive after classyou arrive after class

• You will have been assigned a cubicle and You will have been assigned a cubicle and patient (look in Axium for where and who)patient (look in Axium for where and who)

• You should check out red, blue pencil and You should check out red, blue pencil and blood pressure cuff and blood pressure cuff and sphygmomanometersphygmomanometer

• You should You should sign up ahead of timesign up ahead of time

for a diagnostic exam cassettefor a diagnostic exam cassetteNote: different then last year when DAU set out Note: different then last year when DAU set out

cassettes… since 3 went missing, you now have to cassettes… since 3 went missing, you now have to sign out in your own name. sign out in your own name.

Your cubicle will be disinfected Your cubicle will be disinfected and ready for you and ready for you Thank you DAUThank you DAU

• Get Personal Protective EquipmentGet Personal Protective Equipment– Gown from back of clinicGown from back of clinic– GlovesGloves– Bring Eye protection, magnification if desiredBring Eye protection, magnification if desired

• Get Safety glasses for patientGet Safety glasses for patient• Place saliva ejector suction tip in holder Place saliva ejector suction tip in holder

on ‘assistant side’on ‘assistant side’• Verify unit functions: Light, water, suctionVerify unit functions: Light, water, suction

Continued operatory/ patient Continued operatory/ patient set upset up• Purge water lines- 3 minutes in air water Purge water lines- 3 minutes in air water

syringe. Not necessary for handpiece hoses syringe. Not necessary for handpiece hoses during screening since not using during screening since not using handpieces.handpieces.

• Get ONE packet of gauze Get ONE packet of gauze • after seating the patient, obtain an Oral after seating the patient, obtain an Oral

Diagnosis Guide form (1D) from the forms Diagnosis Guide form (1D) from the forms file at the rear of the clinic floor and follow file at the rear of the clinic floor and follow the instructionsthe instructions

• Verify have patient signature pad attached Verify have patient signature pad attached to your monitor… will need for electronic to your monitor… will need for electronic signaturessignatures

AxiUm- view if patient checked AxiUm- view if patient checked inin• Log in-Log in-• Click on Scheduler Click on Scheduler • Look at your schedule- IF patient checked in, Look at your schedule- IF patient checked in,

patient name will be in patient name will be in REDRED• Select patient by right clicking on appointment in Select patient by right clicking on appointment in

schedulerscheduler

New this year: staff (Donna and Phyllis) will be New this year: staff (Donna and Phyllis) will be calling and confirming screening appointments in calling and confirming screening appointments in addition to automatic reminders.addition to automatic reminders.

Sample weekly scheduleSample weekly schedule

Receptionists check in patientReceptionists check in patientNameName turns turns redred in Axium and in in Axium and in

SchedulerScheduler

Scheduler information- name, Scheduler information- name, gender, age, Axium number, gender, age, Axium number, type of appt, who scheduled, type of appt, who scheduled, phone #phone #

When paged or chart When paged or chart delivereddelivered• Review radiographs in general, some Review radiographs in general, some

patients have been previous patients and patients have been previous patients and may have other films to review.may have other films to review.

• If return patient -check chart entries (may If return patient -check chart entries (may have been in urgent care or oral surgery have been in urgent care or oral surgery recently and now wants comprehensive recently and now wants comprehensive carecare

• Verify x-rays belong to your patientVerify x-rays belong to your patient• Review medical history for “Review medical history for “redred flags” flags”(remember patient is waiting so seat them(remember patient is waiting so seat them

OK to review with the patient in the chair)OK to review with the patient in the chair)

Review Panoramic and other Review Panoramic and other films- films- can mark missing teeth in Axium HER and/ can mark missing teeth in Axium HER and/ oror

1 C Preadmissions form1 C Preadmissions form

Find and bring patient to Find and bring patient to OperatoryOperatory

• Go to waiting room,Go to waiting room,

• Call out patient name and introduce Call out patient name and introduce yourselfyourself

• Escort patient back to your cubicleEscort patient back to your cubicle

• Patient may have spouse or companionPatient may have spouse or companion

• OK to bring 1 person back not family of OK to bring 1 person back not family of 55

• Seat patient, give eyewear protectionSeat patient, give eyewear protection

IF patient checked in but no IF patient checked in but no chartchart

• See Team Leader or Angie Baxley to See Team Leader or Angie Baxley to inquireinquire

• Sometimes patients check in but we Sometimes patients check in but we dismiss them in radiology for a dismiss them in radiology for a variety of reasons.variety of reasons.

• You will likely be assigned to assist You will likely be assigned to assist another student or work in another another student or work in another discipline (urgent care or oral surgerydiscipline (urgent care or oral surgery

Seat patient and view Seat patient and view Axium Axium

• Try to position yourself you are able Try to position yourself you are able to enter findings in Axium at the to enter findings in Axium at the same time you can make eye contact same time you can make eye contact with patientwith patient

• Open patients Chart in Axium select Open patients Chart in Axium select Electronic Health Record Icon Electronic Health Record Icon

• Select Forms TabSelect Forms Tab

Initiating Data Collection:Initiating Data Collection:In Forms tab…. In Forms tab…. Add a new formAdd a new form

• Chief Complaint formChief Complaint form– Fill out chief complaint form as interview patientFill out chief complaint form as interview patient

• Medical History formMedical History form– Will then need to ADD A NEW FORM to add Will then need to ADD A NEW FORM to add

Medical History (unless already completed Medical History (unless already completed previously in Axium) then will only updatepreviously in Axium) then will only update

– Use paper 3A and review as enter into Use paper 3A and review as enter into AxiumAxium

– Every positive response requires a Every positive response requires a “dialogue box” explanation“dialogue box” explanation

• Dental History formDental History form

Forms tab in Axium- add Forms tab in Axium- add formform

Chief Complaint form- Chief Complaint form- when select ADD Chart form will get drop down menuwhen select ADD Chart form will get drop down menu

Chief Complaint formChief Complaint form

Medical History Form= Medical History Form= MEDGPRMEDGPR

Medical History Positive Medical History Positive findingsfindings

• Note medical alerts Note medical alerts • Bottom in Bottom in REDRED• Top under alertsTop under alerts• COMMENTS ADDED HERECOMMENTS ADDED HERE

Medical History Resources- Medical History Resources- Micromedex for drugsMicromedex for drugs

• IN AxiUm are links for IN AxiUm are links for pharmacological references that you pharmacological references that you can look up medicationscan look up medications

• In Urgent Care office have additional In Urgent Care office have additional reference texts to use for Medical reference texts to use for Medical HistoryHistory

• DO NOT REMOVE from office without DO NOT REMOVE from office without permission.permission.

MicroMedEx linkMicroMedEx link

Take Blood pressure readingTake Blood pressure reading

• Record in AxiumRecord in Axium

• Take pulse- record in AxiumTake pulse- record in Axium

• Bottom of Medical HxBottom of Medical Hx

Dental History FormDental History FormNot yet in Axium (will inquire)Not yet in Axium (will inquire)Can use paper form until Can use paper form until resolvedresolved

Perform Oral Cancer Perform Oral Cancer ScreeningScreening• Oral and paraoral soft tissue examinationOral and paraoral soft tissue examination• Record findings unusual findings in top of Record findings unusual findings in top of

1D form1D form• Answer questions:Answer questions:

– Is patient in Pain, etc.Is patient in Pain, etc.– Do they need immediate or preliminary care Do they need immediate or preliminary care

prior to comprehensive care?prior to comprehensive care?– Is there a medical concern that needs to be Is there a medical concern that needs to be

addressed?addressed?– Etc.Etc.

STOP- Call faculty to review STOP- Call faculty to review before proceeding before proceeding

• Do not proceed until faculty have Do not proceed until faculty have reviewed chief complaint, medical reviewed chief complaint, medical history and your initial findings.history and your initial findings.

• After discussing with facultyAfter discussing with faculty• HAVE THEM HAVE THEM SWIPE approval

– Chief Complaint Form in AxiumChief Complaint Form in Axium– Medical History Form in AxiumMedical History Form in Axium– Dental History Form in AxiumDental History Form in Axium

Signatures / Swipes / Signatures / Swipes / ApprovalsApprovals

Once approved can proceed Once approved can proceed with hard tissue examinationwith hard tissue examination

• With radiographs on viewboxWith radiographs on viewbox

• Review hard tissue clinical findings tooth by Review hard tissue clinical findings tooth by tooth to determine clinical needs: caries, tooth to determine clinical needs: caries, broken teeth, defective restorationsbroken teeth, defective restorations

Use 1C preadmission form to document Use 1C preadmission form to document

(later will enter in Axium and will be able to (later will enter in Axium and will be able to differentiate radiographic vs. clinical differentiate radiographic vs. clinical findings) findings)

Hard tissue examinationHard tissue examinationcaries, defective caries, defective

restoration,broken, missing restoration,broken, missing teeth etc under teeth etc under

FINDINGSFINDINGS

Once review hard tissue can Once review hard tissue can proceed to soft tissue proceed to soft tissue Periodontal exam and Periodontal exam and OcclusionOcclusion

• Will “spot” probe and Will “spot” probe and mark and probing mark and probing depths > than depths > than

• 5 mm on 5 mm on 1C preadmission form.1C preadmission form.

ANGIE BAXLEY, RDH can ANGIE BAXLEY, RDH can assist you in perio and assist you in perio and other chartingother charting

• Review OCCLUSIONReview OCCLUSION

Previser- Risk assessment Previser- Risk assessment tooltool

• Evidence Based toolEvidence Based tool

• For assessing risks:For assessing risks:– Oral CancerOral Cancer– Dental Caries and Tooth FractureDental Caries and Tooth Fracture– Periodontal DiseasePeriodontal Disease

http://www.previser.comhttp://www.previser.com//

Discuss findings with Team Discuss findings with Team Leader or OD faculty member Leader or OD faculty member

• If time permits will obtain preliminary If time permits will obtain preliminary consultations NOT definitive since do consultations NOT definitive since do not yet have diagnostic casts, not yet have diagnostic casts, additional radiographs etc.additional radiographs etc.

• EndodonticsEndodontics Oral SurgeryOral Surgery

• PeriodonticsPeriodontics Oral PathologyOral Pathology

• ProsthodonticsProsthodontics

Consults at screeningConsults at screeningAre General not specificAre General not specific

Consult findingsConsult findings

• Open Axium forms tabOpen Axium forms tab

• ADD Consult Form 5A for faculty or ADD Consult Form 5A for faculty or residents to fill out. residents to fill out.

• They can do it at another operatory They can do it at another operatory as long as they have the patient as long as they have the patient axium number and name.axium number and name.

EstimatesEstimates

• After consults with specialty faculty or residentsAfter consults with specialty faculty or residents

• Review findings with Team Leader or OD faculty. Review findings with Team Leader or OD faculty.

• Discuss general treatment options Discuss general treatment options

• Determine if patient eligible for Student clinicDetermine if patient eligible for Student clinic

• If not, refer to graduate clinics or faculty practiceIf not, refer to graduate clinics or faculty practice

• If so, determine treatment and fee estimate. If If so, determine treatment and fee estimate. If possible estimate # appointmentspossible estimate # appointments

Fees are available in Axium Fees are available in Axium linkslinks

• Team Leaders and OD faculty will Team Leaders and OD faculty will assist you in looking up fees onlineassist you in looking up fees online

• Remind patients this is an ESTIMATE Remind patients this is an ESTIMATE onlyonly

• Review findings with patientReview findings with patient

• Have patient sign bottom of 1 C form Have patient sign bottom of 1 C form that they understand is an estimate that they understand is an estimate onlyonly

VerifyVerify

• Patient has signed 1 C form (estimate Patient has signed 1 C form (estimate only) Give them second copy keep only) Give them second copy keep originaloriginal

• Patient has signed online forms with Patient has signed online forms with signature padsignature pad– Medical HistoryMedical History– Dental HistoryDental History

• You will also sign and You will also sign and

• Faculty will sign or swipe Faculty will sign or swipe

After reviewing findingsAfter reviewing findings

• Ask patient what they think about what you Ask patient what they think about what you discusseddiscussed

• Ask if they have any questionsAsk if they have any questions

• (may need to bring team leader back to (may need to bring team leader back to discuss)discuss)

• Determine if interested in returning for Determine if interested in returning for Comprehensive Care as regular patientComprehensive Care as regular patient

• Review again Clinical policy on availability Review again Clinical policy on availability and cancellations etc.and cancellations etc.

Complete 1 D form = Complete 1 D form = Oral Diagnosis Guide FormOral Diagnosis Guide Form

• Will determine which additional Will determine which additional radiographs neededradiographs needed

• Need for Diagnostic CastsNeed for Diagnostic Casts

• Need for additional consultsNeed for additional consults

• Etc.Etc.

Patient eligible and Patient eligible and interestedinterested• Determine if needs additional radiographs- Determine if needs additional radiographs-

if so have faculty sign for or swipe if so have faculty sign for or swipe • Discuss with Team Leader if best assigned Discuss with Team Leader if best assigned

to you or another member of your teamto you or another member of your team• Assignments based on student experience Assignments based on student experience

and patient needsand patient needs• Take patient to Team CoordinatorTake patient to Team Coordinator• They will schedule Radiology/ OD They will schedule Radiology/ OD

appointmentappointmentNote: when multiple appts in one session Note: when multiple appts in one session must be made by Team Coordinatormust be made by Team Coordinator

Simple patientsSimple patients

• If screening patient has minimal diseaseIf screening patient has minimal disease

• May be able to screen quickly and May be able to screen quickly and proceed immediately to Comprehensive proceed immediately to Comprehensive Data collection (all hard and soft tissue Data collection (all hard and soft tissue charting)charting)

• Won’t need more than panoramic or Won’t need more than panoramic or BW’sBW’s

• Can treatment plan same sessionCan treatment plan same session

All patientsAll patients

• Go to Axium Treatment history and Go to Axium Treatment history and – ATTACH Progress Note to Screening procedure in AxiumATTACH Progress Note to Screening procedure in Axium

• SHAPED formatSHAPED format– S= Section and faculty (ie. Screening/Dr. Ray)S= Section and faculty (ie. Screening/Dr. Ray)– H= Health statusH= Health status– A= Assessment or Diagnosis- include patient chief A= Assessment or Diagnosis- include patient chief

complaint here and general description of findings, what complaint here and general description of findings, what tx options discussed tx options discussed

– P/E= Screening and consultsP/E= Screening and consults– D= Disposition or what planned next (ie x-ray and OD)D= Disposition or what planned next (ie x-ray and OD)

• If not eligible- whyIf not eligible- why• If no longer interested-whyIf no longer interested-why

Attach SHAPED note in AxiumAttach SHAPED note in Axiumto existing SCREENING CODEto existing SCREENING CODE

QUESTIONSQUESTIONS