Hospital Dentistry Resources Survey - Agency Representatives Version

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 hospital or surgi-centers.

1. Please describe the type of resource(s) that are available in your area for patients needing general anesthesia or deep sedation.

Please describe the type of resource(s) that are available in your area for patients needing general anesthesia or deep sedation. a. Private dental office

b. Community clinic

c. Hospital clinic

d. Dentist working in a hospital operating room (Hospital Dentistry

e. Dentist working in a free standing surgery center (Hospital Dentistry)

f. I do not know of any resource(s) in my area where I can refer Patients needing general anesthesia or deep sedation (if you do not know of any resources, please skip to question #4)

2. If you know of resource(s) in your area for patients needing Hospital Dentistry, please list them below?

Please describe (list name/location of the hospital or facility and dentist who uses this facility)

If you know of resource(s) in your area for patients needing Hospital Dentistry, please list them below? Please describe (list name/location of the hospital or facility and dentist who uses this facility) Facility #1 - Name/Location
Facility #1 - Dentist Name
Facility #2 - Name/Location
Facility #2 - Dentist Name
Facility #3 - Name/Location
Facility #3 - Dentist Name
Facility #4 - Name/Location
Facility #4 - Dentist Name
Facility #5 - Name/Location
Facility #5 - Dentist Name

3. What is the availability of Hospital Dentistry treatment in your community for patients with the following sources of payment?

	Readily available	Occasionally available	Not available	Don't know
Private insurance	What is the availability of Hospital Dentistry treatment in your community for patients with the following sources of payment? Private insurance Readily available	Occasionally available	Not available	Don't know
Able to pay cash	Able to pay cash Readily available	Occasionally available	Not available	Don't know
Medi-Cal	Medi-Cal Readily available	Occasionally available	Not available	Don't know
Indigent with no insurance	Indigent with no insurance Readily available	Occasionally available	Not available	Don't know

1. Please describe the type of resource(s) that are available in your area for patients needing general anesthesia or deep sedation.

2. If you know of resource(s) in your area for patients needing Hospital Dentistry, please list them below?Please describe (list name/location of the hospital or facility and dentist who uses this facility)

3. What is the availability of Hospital Dentistry treatment in your community for patients with the following sources of payment?

2. If you know of resource(s) in your area for patients needing Hospital Dentistry, please list them below?

Please describe (list name/location of the hospital or facility and dentist who uses this facility)