California Hospital Dentistry Resources Survey

California Hospital Dentistry Resources Survey - Dental Professional Version

Dear Dental Professional, we really need your help!

Please help us identify Hospital Dentistry resources and barriers to receiving dental care for patients who need general anesthesia or deep sedation to complete needed dental treatment. Thank you very much for your help.

For the purpose of this survey Hospital Dentistry refers to dental care delivered with general anesthesia or deep sedation, in a hospital environment including hospitals or surgi-centers.

1. Please indicate your training and credentials to be able to perform the following:
Check all that apply (credentials = hospital privileges, GA Permit)

I have training, credentials or privileges to perform the following:

	Training	Credentials	Neither training nor credentials
Hospital Dentistry	Please indicate your training and credentials to be able to perform the following: Check all that apply (credentials = hospital privileges, GA Permit) I have training, credentials or privileges to perform the following: Hospital Dentistry Training	Credentials	Neither training nor credentials
General Anesthesia	General Anesthesia Training	Credentials	Neither training nor credentials
Deep Sedation	Deep Sedation Training	Credentials	Neither training nor credentials

2. On average, how many patients do you see per month who require general anesthesia or deep sedation to complete needed dental treatment?

On average, how many patients do you see per month who require general anesthesia or deep sedation to complete needed dental treatment?

3. Please check all of the following that apply to your practice.

(choose the last option if none of the others apply)

	Private Insurance	Self-Pay	Medi-Cal
I treat patients in a hospital or surgi-center - (Hospital Dentistry)	Please check all of the following that apply to your practice. (choose the last option if none of the others apply) I treat patients in a hospital or surgi-center - (Hospital Dentistry) Private Insurance	Self-Pay	Medi-Cal
I administer general anesthesia in my office	I administer general anesthesia in my office Private Insurance	Self-Pay	Medi-Cal
I administer deep sedation in my office	I administer deep sedation in my office Private Insurance	Self-Pay	Medi-Cal
I have an anesthesiologist come into my office who administers general anesthesia	I have an anesthesiologist come into my office who administers general anesthesia Private Insurance	Self-Pay	Medi-Cal
I have an anesthesiologist come into my office who administers deep sedation	I have an anesthesiologist come into my office who administers deep sedation Private Insurance	Self-Pay	Medi-Cal
I refer patients needing general anesthesia or deep sedation to another resource	I refer patients needing general anesthesia or deep sedation to another resource Private Insurance	Self-Pay	Medi-Cal
I do not have a place to refer or treat patients needing general anesthesia or deep sedation	I do not have a place to refer or treat patients needing general anesthesia or deep sedation Private Insurance	Self-Pay	Medi-Cal

1. Please indicate your training and credentials to be able to perform the following:Check all that apply (credentials = hospital privileges, GA Permit)I have training, credentials or privileges to perform the following:

2. On average, how many patients do you see per month who require general anesthesia or deep sedation to complete needed dental treatment?

3. Please check all of the following that apply to your practice. (choose the last option if none of the others apply)

1. Please indicate your training and credentials to be able to perform the following:
Check all that apply (credentials = hospital privileges, GA Permit)

I have training, credentials or privileges to perform the following:

3. Please check all of the following that apply to your practice.

(choose the last option if none of the others apply)