Exhibit_14q_Dental_Report_Card_4.4.5.1.xls
XLS spreadsheet 39 KB Posted
- Attached to
- Special Notice-Amendment 0009
- Solicitation number
- W15QKN-17-R-1042
About this file
This document contains a federal contract opportunity notice and related dental report card exhibits. The U.S. Army Contracting Command - New Jersey is seeking proposals for the Reserve Health Readiness Program III to provide health readiness services to Reserve and Active Components across the U.S., its territories, Germany and at group event sites. Services include immunizations, physicals, dental exams and treatment, mental health assessments, laboratory work and occupational health. The contract will be a single-award, five-year indefinite delivery indefinite quantity agreement with both fixed price and cost reimbursement task orders. The anticipated solicitation number is W15QKN-17-R-1042 with an estimated issue date of September 30, 2017. Offerors must register in the System for Award Management database. The point of contact is listed. The dental report card exhibits provide templates for summarizing and reporting details of dental exams, treatment, conversions and reasons for non-conversion at the event, group and individual service member level.
Exhibit 14q
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Text version
Summary
| Dental Report Card - Summary | ||||||||||
| Total Exam Events | Total Treatment Events | Exams Ordered | Exams Completed | Attendance Rate | Event DRC 3 Identified | DRC 3 SMs Receiving Treatment | Conversion Rate of Treatment Plans Executed | Overall Conversion Rate | ||
| Service Type and CDT Codes | In-Clinic | Group Event | ||||||||
| General Restorative: 2000-2999, 3310, 3320, 7140, 7210 | ||||||||||
| 2140: Amalgam 1 surface | ||||||||||
| 2150: Amalgam 2 surface | ||||||||||
| 2160: Amalgam 3 surface | ||||||||||
| 2161: Amalgam 4+ surfaces | ||||||||||
| 2330: Anterior Resin 1 surface | ||||||||||
| 2331: Anterior Resin 2 surface | ||||||||||
| 2332: Anterior Resin 3 surface | ||||||||||
| 2335: Anterior Resin 4+ surfaces | ||||||||||
| 2391: Posterior Resin 1 surface | ||||||||||
| 2392: Posterior Resin 2 surface | ||||||||||
| 2393: Posterior Resin 3 surface | ||||||||||
| 2394: Posterior Resin 4+ surfaces | ||||||||||
| 2931: Prefabricated stainless steel crown | ||||||||||
| 2932: Prefabricated resin crown | ||||||||||
| 2940: Sedative filling | ||||||||||
| 2950: Core Build-Up w/ Pins | ||||||||||
| 2954: Prefab Post & Core | ||||||||||
| 3310: Anterior RCT | ||||||||||
| 3320: Bi-Cuspid RCT | ||||||||||
| 7140: Simple Extraction [1st tooth] | ||||||||||
| 7210: Surgical Extraction | ||||||||||
| Specialty Endo: 3000-3999 (excluding 3310, 3320) | ||||||||||
| 3330: Molar RCT | ||||||||||
| 3332: Incomplete endodontic therapy | ||||||||||
| 3346: Retreatment of previous root canal therapy - Anterior | ||||||||||
| 3348: Retreatment of previous root canal therapy - Molar | ||||||||||
| 3410: Apicoectomy surgery - Anterior | ||||||||||
| Specialty Oral Surgery: 7000-7999 (excluding 7140, 7210) | ||||||||||
| 7220: Soft Tissue Extraction | ||||||||||
| 7230: Partial Bony Extraction | ||||||||||
| 7240: Complete Bony Extraction w/o complications | ||||||||||
| 7241: Complete Bony Extraction w/ complications | ||||||||||
| 7250: Surgical removal of residual tooth roots | ||||||||||
| 7285: Biopsy of oral tissue- hard tissue | ||||||||||
| 7286: Biopsy of oral tissue- soft tissue | ||||||||||
| 7450: Removal of odontogenic cyst/tumor-lesion diameter up to 1.25 cm | ||||||||||
| Non-Converted Class 3 Reasons | ||||||||||
| Reason | # of Occurences | |||||||||
| Clinical Rationale | ||||||||||
| Large Treatment Plan | ||||||||||
| Services Unavailable | ||||||||||
| Time Limitation | ||||||||||
| Service Member Refused | ||||||||||
| Command Exception | ||||||||||
| Service Member No Show | ||||||||||
| Continue Treatment At Event |
Group Event Detail
| Dental Report Card - Group Event Detail | |||||||||||||||||
| Treatment Service Type Total Number (CDT Codes) | |||||||||||||||||
| GE ID | Start Date | End Date | City | State | UIC/Command | Event POC | Exams Ordered | Exams Completed | Attendance Rate | Event DRC3 Identified | DRC 3 SMs Receiving Treatment | Conversions from Treatment Plans Executed | Conversion Rate of Treatment Plans Executed | Overall Event Conversion Rate | General Dentistry | Specialty Oral Surgery | Specialty Endo |
| 2140: 4 |
2150: 7 2160: 6 2161: 1 2940: 2 7140: 1 Total:
DRC 3 Remaining
| Dental Report Card - DRC 3 Remaning | |||||||||||||
| Class 3 Reasons | |||||||||||||
| GE ID | Start Date | End Date | City | State | UIC/Command | Clinical Rationale | Large Treatment Plan | Services Unavailable | Time Limitation | Service Member Refused | Command Exception | Service Member No Show | Continue Treatment At Event |
| Total: |
In Clinic Detail
| Dental Report Card - In Clinic Detail | ||||||||
| Treatment Service Type Total Number (CDT Codes) | ||||||||
| Order ID | Ordered Date | Last Name | First Name | Last 4 SSN | UIC/Command | General Dentistry | Specialty Oral Surgery | Specialty Endo |
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