A dentist examining a worker with a work-related dental injury completes this two-page report and faxes it to WorkplaceNL immediately after the examination. It records where the worker was seen, the mechanism of injury, a tooth chart combining dental codes with pre-injury, injury and post-injury codes, subjective and objective findings, diagnosis, investigations and a treatment plan with expected dates and cost estimates.
The dentist completes and signs it, certifying the report is complete and accurate and that no prior payment was received from WorkplaceNL for the visit. The worker does not sign.
Download the current version from the source each time; forms change without notice.
Dentist's Report (DR)
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
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For non-emergency treatment, yes. The Dentist's Report states that before proceeding, the dentist must obtain prior approval from WorkplaceNL by submitting a written estimate of the recommended dental work. The report itself should be faxed immediately after the examination.
Combine the dental code with an injury code. The form's examples: FR1 is a tooth fractured or broken before the injury, FR2 a tooth fractured as a result of the injury or incident, and FR3 a tooth fractured after the injury. The same pattern applies to codes such as avulsion, luxation and intrusion.