Give Kids a Smile Day Forms and Helpful Downloads

Thank you for your upcoming participation in “Give Kids a Smile Day” on Friday, Feb. 5, 2010.

Dentists and dental staff all over Colorado, and nationwide, are supporting this ADA and CDA effort to give free dental services to low-income children. The Colorado Dental Association has prepared several forms and information pieces for this event for reporting and to assist you in your volunteer efforts.

Patient Treatment Information:

Give Kids a Smile Day Superbill. If you are treating patients, please make copies of the superbill and fill one out for each patient you treat on Give Kids a Smile Day. Please mail or fax these forms back to the CDA for record keeping purposes (patients will not be charged for any services you provide). Forms can be faxed to 303-740-7989. This is the ONLY method the CDA has to record and track how much treatment was donated on Give Kids a Smile Day. Please send us this treatment tracking superbill so we can have an accurate report of Colorado’s Give Kids a Smile Day activities and donated services.

Patient Appointment Reminder Letter. If you are providing treatment in your office for Give Kids a Smile Day, we strongly encourage you to remind your patients of their appointments. Programs of this nature typically produce a higher than normal number of “no show” patients. This letter has been produced to provide your office with a tool to help minimize “no shows.” You are welcome to modify it for your office’s use.

Give Kids a Smile Day Consent Forms in English and Spanish. You are welcome to use your own patient consent and health history forms. If you would prefer not to, the above consent form and this health history form is available for your use.

Additional Treatment Information:

The Colorado Foundation of Dentistry Donated Dental Services Program will provide Follow-up Care for GKAS Patients who need additional, immediate treatment. Simply make copies of the form, fill out the appropriate information and mail/fax the forms to the foundation’s Donated Dental Services Program. Your patient(s) will be contacted by the program and will be scheduled for additional treatment. Please also note the enclosed Patient Notification Flyer. Make copies and give this flyer to each family who you refer for additional treatment through the Foundation – this is a measure to assist with communication between the foundation and the patient.

Kids in Need of Dentistry (KIND) Information Sheet: Please make copies of this English/Spanish, two-sided flyer and give it to ALL of your GKAS patients, regardless of whether or not they need additional care. This is a resource to help them later, should they need dental care in the future.

School Presentation Information and Education Materials:

Give Kids a Smile Day School Presentation Tracking Form: If you are visiting schools/community centers to provide education about good oral health, please fill this form out with the appropriate information. The CDA would like to keep track of the schools and areas of the state that have received dental education for future educational outreach purposes. Completed forms can be faxed to the CDA at 303-740-7989.

Educational Supplies: A selection of activity sheets are included for you to reproduce and keep in your waiting room or take to schools for presentations.

CU School of Dental Medicine Information:

If you are volunteering for GKAS at the CU School of Dental Medicine, please click here for chair assignments, directions and a campus map.

We hope your Give Kids a Smile Day event is a success, and we would love to hear your feedback and comments. Please feel free to call Molly Pereira at the CDA if you have ANY questions regarding the event or this packet, 303-740-6900 or 800-343-3010.

Thank you again for your participation in this national access day, we greatly appreciate your dedication and generosity!