1. Improving the Quality of Oral Healthcare through Case Management
Dental Case Management –
Motivational Interviewing
D9993
Welcome to Learning Module #9- Dental Case Management through Motivational Interviewing. This course will focus on information gained from state Medicaid dental programs and other case management experts over the last several years.
As you may know, the move to managed care by so many states has changed the way in which many states fulfill federal obligation and subsequent responsibilities to beneficiaries.
What we have come to realize is that all stakeholders in the delivery system are trying new strategies to achieve better access and health outcomes for their beneficiaries, clients, and patients.

2. Acknowledgements
Improving the Quality of Oral Healthcare through Case Management is a professional education and training program designed to advance the knowledge, skill, and competency of the dental workforce.
The curricula is made up of 6 training modules which have been made available through the generous support of the following organizations and agencies:
Rhode Island Department of Health
Rhode Island Executive Office of Health and Human Services
Rhode Island Dental Association
Medicaid|Medicare|CHIP Services Dental Association
Health Resources and Services Administration
Since this training program was developed to advance the knowledge, competency and skills of the dental workforce, a number of state-wide entities are responsible for its creation and implementation.
The curricula is made up of 6 training modules which have been made available through the generous support of the following organizations and agencies:
Rhode Island Department of Health
Rhode Island Executive Office of Health and Human Services
Rhode Island Dental Association
Medicaid|Medicare|CHIP Services Dental Association
Health Resources and Services Administration

3. Module 9 Learning Objectives Participants will:
Identify ways in which motivational interviewing can improve a patient’s desire to decrease or avoid oral disease;
Understand key components of delivering motivational interviewing services and how each effects the patient experience;
Develop a working knowledge of how community supports, the Medicaid Health Plans and the Medicaid agency contribute to effective communication and care coordination;
Understand the role each dental office professional plays in both assessing needs and in delivering case management services;
Effectively document and bill Medicaid for case management services delivered in the dental office setting to help monitor and track patient care.
Let’s review the Learning Objectives for this Module. After completing this course, participants will be able to:
Identify ways in which motivational interviewing can improve a patient’s desire to decrease or avoid oral disease;
Understand key components of delivering motivational interviewing services and how each effects the patient experience;
Develop a working knowledge of how community supports, the Medicaid Health Plans and the Medicaid agency contribute to effective communication and care coordination;
Understand the role each dental office professional plays in both assessing needs and in delivering appropriate and timely case management services; and
Effectively document and bill Medicaid for case management services delivered in the dental office setting to help monitor and track patient care.

4. Take Module 9 Pre-Test Now https://www.surveymonkey.com/r/M9Pre
Improving the Quality of
Oral Healthcare through
Case Management
Take Module 9 Pre-Test Now
Please Stop here to take the Pre-test for this Module first. Completing the Pre-test will help the Medicaid Agency measure the degree to which the training content fostered learning.
Simply cut and paste the hyperlink in the slide into a browser address line and the Pre-test will open for you in Survey Monkey.
Once done, please return to SLIDE 5 to begin Module 9.

5. RI EOHHS Case Management Policy
This next section of the Module focuses specifically on gaining a better understanding of the new Case Management billing codes, that is, their intent as described in Current Dental Terminology by the ADA and how the RI Medicaid Agency interprets them for billing and reimbursement to dental professionals.
A Toolkit for Billing

6. Implementation of Dental Case Management
Before launching more broadly, RI EOHHS will “test” the four new codes.
2017 Pilot Initiative
- volunteer dental practices
- services are billed, reimbursed and tracked
- certain outcomes will be evaluated
A decision for a full launch of codes will be made in 2018
Before launching more broadly, RI EOHHS (the Medicaid Agency in RI) will pilot or “test” the four new Dental Case Management codes.
The 2017 Pilot Initiative includes a small number of volunteer dental practices that will be involved in treating Medicaid-enrolled older (non-RIte Smiles) children and adults. The CM codes will be billed to Medicaid along with other covered dental procedures, then will be reimbursed for payment and tracked. Through monitoring, certain outcomes will be evaluated and a decision to launch the codes statewide to all populations will be made in 2018.

7. Dental Provider Qualifications
RI Medicaid-enrolled
Complete 5 online Case Management Learning Module Series
Complete 5 Module Pre and Post-Tests
Certification from RI EOHHS
In order to qualify for reimbursement of the four new dental case management codes, dental professionals must first be enrolled with RI Medicaid. Anyone in the practice who is involved in delivering the case management services must complete the ten online learning modules and their accompanying post-tests. The Medicaid Agency will then provide a “certification” number for the practice to allow billing of the new codes to occur.

8. Who Provides the Services?
Employing a dedicated dental case manager can be difficult financially, which is why the dental case management services can be provided by a trained dental team.
Distribute the various dental case management functions among all trained and certified staff, such as receptionists, schedulers, translators, dental hygienists, and so forth. Thus, there would not be one dental case manager, but a network of individuals supporting dental case management.

9. Assessing Needs Focus Areas Sample Questions &/or Solutions
Dental Needs Assessment
Will motivational interviewing be useful?
Emergency care (urgent issues, severe pain)
• Is eating/nutrition impacted? (painful/difficult to eat?)
• Will patient need extensive care
Assess Patient Health Needs
•Will motivational interviewing be useful?
Chronic conditions (e.g. diabetes, heart disease)
•Medication use
•Mental Health status and treatment
•Clients' Cognitive/Functional Capacity
Is care coordination appropriate?
Assess Need for Social Support
• Literacy & oral health literacy levels (tool/s)
Areas of patient education?
Pre-Referral & Client “Contract”
Build rapport, trust, allay fears, provide patient education.
•Agree on expectations of dental treatment
Assessing the individual needs of the patient should ideally focus on four key areas:
Dental Needs
Health Needs
Need for Social Supports
A “pre-referral” and a patient “contract”
Corresponding to each of the four focus areas is a set of sample questions that can be asked as part of the assessment and/or solutions that may be offered for each specific area.

10. Tips for Conducting a Needs Assessment
Some important principles that apply to all assessment areas are:
Start with active listening and allow patients to express their needs and desires
Build a relationship on mutual respect and focus on strengths
All of the needs areas should be addressed and prioritized, as per the consumer’s ability to participate.
Ask open-ended questions.
Involve family members and appropriate social resources
Some important principles that apply to all assessment areas are to
1. Start with active listening and allow patients to express their needs and desires;
2. Build a relationship on mutual respect and focus on strengths
3. All of the needs areas should be addressed and prioritized, as per the consumer’s ability to participate.
4. Ask open-ended questions; and most importantly.
5. Involve family members and appropriate social resources.

11. Dental Treatment Case Management Considerations
Can take multiple visits for complex dental treatment plan
Management of covered vs. non- covered dental procedures
Patient Education, instructions, language, literacy
Transportation assistance
Advocacy/Education/Assurance: Does CM have to advocate on behalf of patient to dental provider? or educate and assure patient?
Behavioral issues, intervention management (lots of unknowns when patient is in new environment) •
Monitor co-occurring conditions (D/A, MH, chronic conditions)
Follow-up after extractions and intensive procedures (infection, pain management)
Coordination of treatment between emergency provider, hospital, dental provider, and outside referrals
Other life case management: Benefits, housing, substance use, medical, etc.
It’s important to be aware that dental treatment itself has some inherent case management considerations like the following:
Can take multiple visits for complex dental treatment plan
Management of covered vs. non-covered dental procedures
Patient Education, instructions, language, literacy
Transportation assistance
Advocacy/Education/Assurance: Does CM have to advocate on behalf of patient to dental provider? or educate and assure patient?
Behavioral issues, intervention management (lots of unknowns when patient is in new environment)
Monitor co-occurring conditions (D/A, MH, chronic conditions)
Follow-up after extractions and intensive procedures (infection, pain management)
Coordination of treatment between emergency provider, hospital, dental provider, and outside referrals
Other life case management: Benefits, housing, substance use, medical, etc.

12. Understanding Dental Case Management CDT Codes
Motivational Interviewing
Patient-centered, personalized counseling using methods such as Motivational Interviewing (MI) to identify and modify behaviors interfering with positive oral health outcomes. This is a separate service from traditional nutritional or tobacco counseling.
As the ADA definition for D9993 is implies a personal interaction with patients to focus on modifying any adverse behaviors that hinder improving oral health outcomes.

13. Understanding Motivational Interviewing
As we identified earlier, Motivational Interviewing can be an integral part of delivering case management services. This next section will give us a look at how this strategy can be useful in the dental practice setting.

14. What is Motivational Interviewing (MI)?
A method that works on facilitating and engaging intrinsic motivation within the patient in order to change behavior.
…MI is a goal-oriented, patient-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence.
Motivational interviewing (MI) refers to a counseling approach in part developed by clinical psychologists Professor William R Miller, Ph.D. and Professor Stephen Rollnick,Ph.D. The concept of motivational interviewing evolved from experience in the treatment of problem drinkers, and was first described by Miller (1983) in an article published in Behavioural Psychotherapy. These fundamental concepts and approaches were later elaborated by Miller and Rollnick (1991) in a more detailed description of clinical procedures. Motivational Interviewing is a method that works on facilitating and engaging intrinsic motivation within the client in order to change behavior. MI is a goal-oriented, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. Compared with non-directive counseling, it's more focused and goal-directed. 
- Motivational Interviewing- A Communication Style:
Motivation to change is elicited from the patient, and is not imposed from outside forces
It is the patient's task, not the counselor's, to articulate and resolve his or her ambivalence
Direct persuasion is not an effective method for resolving ambivalence
The counseling style is generally quiet and elicits information from the client
The counselor is directive, in that they help the patient to examine and resolve ambivalence
Readiness to change is not a trait of the client, but a fluctuating result of interpersonal interaction
The therapeutic relationship resembles a partnership or companionship

15. Ambivalence: “The Dilemma of Change”
“I want to, and I don’t want to”
Ambivalence is a normal aspect of human nature
Passing through ambivalence is a natural phase in the process of change
Ambivalence is a reasonable place to visit but you wouldn’t want to live there!
Motivational interviewing (MI) is non-judgmental, non-confrontational and non-adversarial. The approach attempts to increase the patient's awareness of the potential problems caused, consequences experienced, and risks faced as a result of the behavior in question. Alternately, therapists help clients envision a better future, and become increasingly motivated to achieve it. Either way, the strategy seeks to help patients think differently about their behavior and ultimately to consider what might be gained through change.
MI is a goal-oriented, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. Compared with non-directive counseling, it's more focused and goal-directed. 

16. The Righting Reflex
The desire to set things right … …often leads to acting on the inclination to advise, teach, persuade, counsel or argue for a particular resolution to a patient’s ambivalence
The “Righting Reflex” is a reflex that people have to correct someone/something. To offer advice/info/tips, etc. to correct whatever is “wrong” or “help by offering advice you would preferably do”.
This is a struggle providers go through…”to correct” their patients vs. assessing what patients are really wanting for themselves. For patients to come up with their own goals and for them to be accountable. This in a sense, the providers “guide” patients vs. correcting them.

17. Strategies for the Dental Team
The RULE mnemonic is easy to remember:
Resist the righting reflex. (Correcting or offering alternatives rather than providing guidance to patients is a common flaw that I’m certainly guilty of.)
Understand the patient’s motivations.
Listen to your patient.
Empower your patient.

18. Four General Principles of Motivational Interviewing
Express Empathy
Develop discrepancy
Support self-efficacy
Roll with resistance
There are four General Principles of Motivational Interviewing that have been widely recognized by SAMSA, HRSA and the National Council for Community Behavioral Healthcare. They are to:
Express Empathy;
Develop discrepancy;
Support self-efficacy; and
Roll with resistance
Remembering these four principles and using them as you actively engage patients in a dental office setting will contribute to a successful MI session.

19. This example of a real-world conversation is included to illustrate each of the four principles of MI. You can easily imagine this scenario to be one of many in a dental practice setting…

20. Core Motivational Interviewing Steps
“OARS”
Open-Ended Questions
Affirmations
Reflections
Summaries
The practice of Motivational Interviewing involves the skillful use of certain techniques for bringing to life the MI spirit, demonstrating the MI principles, and guiding the process toward eliciting client change talk and commitment for change. Change talk involves statements or non-verbal communications indicating the client may be considering the possibility of change.
OARS
Often called micro-counseling skills, OARS is a brief way to remember the basic approach used-in Motivational Interviewing. : Open-Ended Questions, Affirmations, Reflections, and Summaries are core counselor behaviors employed to move the process forward by Establishing a therapeutic alliance and eliciting discussion about change.
• Open-ended questions are those that are not easily answered with a yes/no! or short Answer containing only a specific, limited piece of information. Open-Fended questions invite
Elaboration and thinking more deeply about an issue. Although closed questions have their place and are at times valuable (e.g., when collecting specific information in an assessment),
Open-ended questions create forward momentum used to help the client explore the reasons for and possibility of change. Patients should do most of the talking (avoid “yes/no” questions) ‰ Useful earl y pp p in session to build rapport & provide direction ‰ Ask for “both sides of the coin” ‰ The general pattern in MI is to ask an open question, setting the topic of exploration, and then follow with reflective listening.
• Affirmations are statements that recognize client strengths. They assist in building rapport
And in helping the client see themselves in a different, more positive light. To be effective they must be congruent and genuine. The use of affirmations can help clients feel that change is possible even when previous efforts have been unsuccessful. Affirmations often involve reframing behaviors or concerns as evidence of positive client qualities. Affirmations are a key element in facilitating the MI principle of Supporting Self-efficacy.
• Reflections or reflective listening is perhaps the most crucial skill in Motivational Interviewing. It has two primary purposes. First is to bring to life the principle of Expressing Empathy. By careful listening and reflective responses, the patient comes to feel that the Counselor understands the issues from their perspective. Beyond this, strategic use reflective listening is a core intervention toward guiding the patient toward change, supporting the goal-directed aspect of MI in this use of reflections.
• Summaries are a special type of reflection where the provider recaps what has occurred in all or part of a counseling session(s). Summaries communicate interest, understanding and call attention to important elements of the discussion. They may be used to shift attention or direction and prepare the client to move on.

21. MotivationaI Interviewing Resources
Lastly, these are some great resources that can be used for staff training and professional development.

22. Video Examples
Watch the next four brief videos to illustrate the concepts we’ve been learning about Motivational Interviewing strategies that illicit behavior change.
Please watch the next four brief videos to illustrate the concepts we’ve been learning about Motivational Interviewing strategies that illicit behavior change.

23. This demonstration video will help to accentuate some of he concepts we’ve been learning about Motivational Interviewing.
Please cut and paste the link in the slide into your browser’s address line and watch the short video.

24. Video https://www.youtube.com/watch?v=8i2XDHZi7GA
This next video illustrates the MI traps to be avoided specific to a dental practice setting. Please cut and paste the link in the slide into your browser’s address line to watch it now.

25. This video is an example of a conversation with a dental patient about flossing her teeth. Please copy and paste the link in the slide to your browser’s address line to view the video now.

26. This final MI example is a video that involves talking with a patient about the effects of her oral piercing. Please copy and paste the link to your browser’s address line to watch the video now.
The four videos you just watched a good examples of some of the day-to –day opportunities that exist in the dental office setting to use Motivational Interviewing with patients to work with them to diminish and/or eliminate unhealthy or harmful behaviors. The skills you need for delivering MI enhance over time as patient’s needs are assessed and MI techniques are used repeatedly to decrease negative outcomes.

27. Typical Delivery of D9993 Patients receive a comprehensive assessment
- identifies potential barriers to care
Services are developed based on assessment
- patient’s interest in receiving case management services.
3. The intent is for Case Management services like D9993 to be provided with other dental services on the same day.
Here’s how a typical delivery of D9993 service would work to support a Medicaid patient.
Patients presenting in your office receive a comprehensive assessment which identifies potential barriers to care.
Case management services are developed based on this assessment and the patient’s interest in receiving case management services.
And lastly:
The intent is for Case Management services like D9993 is to be provided with other dental services on the same day.

28. EXAMPLE- Case Study 1
Motivational Interviewing to Address Severe Cheek- biting
Issue: A young Medicaid-insured adult female exhibits bilateral cheek biting of the oral mucosa. A needs assessment reveals the patient has a number of stressful life experiences resulting in this unconscious nervous habit.
Solution: Through motivational interviewing techniques, the hygienist works with the patient to assess the patient’s needs and develop a reasonable plan of action to eliminate the habit and to follow-up at the next appointment.
Billing: D9993 is billed to Medicaid along with the CM Pilot Form and the appropriate notes are entered into the patient record.
Example #1 is a motivational interviewing situation that attempts to affect a negative cheek-biting behavior. Please be sure to document these encounters well in the patient record and on the EOHHS CM Data Collection Form so that patient outcomes can be tracked.

29. EXAMPLE - Case Study 2
Motivational Interviewing to Support Treatment for Drug Addiction
Issue: A Medicaid-insured adult male’s Medicaid History indicates he is in treatment for drug addiction. Many years of oral neglect have left the man in need of ongoing dental treatment.
Solution: After a needs assessment, it is apparent the patient could benefit from staff support through motivational interviewing techniques to understand the nature of the patient’s behaviors and his drug treatment plan and to assist him in modifying the unhealthy behaviors that caused his oral disease.
Billing: D9993 is billed to Medicaid along with the CM Pilot Form and the appropriate notes are entered into the patient record.
Example #2 is a motivational interviewing situation that deals with support treatment for substance abuse. Please be sure to document these encounters well in the patient record and on the EOHHS CM Data Collection Form so that patient outcomes can be sufficiently tracked.

30. EOHHS Policy-Code Use During Pilot
May be billed for all non-RIte Smiles enrollees (older children & adults (ages 21+)
Initial Assessment should be completed and filed
- Dental Needs Assessments: part of medical history or supplemental
D9993 code may be billed to EOHHS one time per date of service for the same patient
Additional dental services (including other case management) may be billed on the same day
Please be aware that during the Pilot phase of this demonstration project, the following policy guidelines are required for billing case management codes:
May be billed for all non-RIte Smiles enrollees (older children & adults (ages 21
2. Initial Assessment should be completed and filed
- Dental Needs Assessments: part of medical history or supplemental
3. D9993 code may be billed to EOHHS one time per date of service for the same patient
4. Additional dental services (including other case management) may be billed on the same day

31. EOHHS Policy-FQHC Code Use During Pilot
May be billed for all non-RIte Smiles enrollees (older children & adults (ages 21+)
Initial Assessment should be completed and filed
- Dental Needs Assessments: part of medical history or supplemental
D9993 code may be billed to EOHHS one time per date of service for the same patient
D9993 must be billed with at least one other covered dental service (besides the other 3 CM codes) on the same day in order to qualify as a dental encounter
Please be aware that during the Pilot phase of this demonstration project, the following policy guidelines are required for billing case management codes:
May be billed for all non-RIte Smiles enrollees (older children & adults (ages 21+)
2. Initial Assessment should be completed and filed
Dental Needs Assessments: part of medical history or supplemental
3. D9991 code may be billed to EOHHS one time per date of service for the same patient
4. D9991 must be billed with at least one other covered dental service (besides the other 3 CM codes) on the same day in order to qualify as a dental encounter

32. EOHHS Guide for Billing During the Pilot
RI Medicaid has authorized you to bill for CM services, so your practice’s claims will be monitored and tracked as they are submitted
Submit Medicaid dental claim using the same process as all other Medicaid adult claims
Exception: FQHCs must bill D9993 with another Medicaid-covered dental service on same day
Including NOTES on the claim will always enhance the quality and integrity of your documentation
Please be advised of the following billing guidelines per EOHHS for the pilot use for case management codes:
RI Medicaid has authorized you to bill for CM services, so your practice’s claims will be monitored and tracked as they are submitted
Please submit Medicaid dental claim using the same process as all other Medicaid adult claims
Exception: FQHCs must bill D9991 with another Medicaid-covered dental service on same day
Including NOTES on the claim will always enhance the quality and integrity of your documentation

33. Recordkeeping
From a recordkeeping perspective, you should maintain the security of records necessary for rendering professional services to your patents and as required by applicable laws, regulations, or agency/institution procedures, (including but not limited to secured or locked files, data encryption, etc.). Subsequent to file closure, records will be maintained for the number of years consistent with jurisdictional requirements or for a longer period during which maintenance of such records is necessary or helpful to provide reasonably anticipated future services to the client. After that time, records will be destroyed in a manner assuring preservation of confidentiality, such as by shredding or other appropriate means of destruction.

34. Recordkeeping
Maintain patient records, whether written, taped, computerized, or stored in any other medium, in a manner designed to ensure confidentiality.
From a recordkeeping perspective, you should maintain the security of records necessary for rendering professional services to your patents and as required by applicable laws, regulations, or agency/institution procedures, (including but not limited to secured or locked files, data encryption, etc.). Subsequent to file closure, records will be maintained for the number of years consistent with jurisdictional requirements or for a longer period during which maintenance of such records is necessary or helpful to provide reasonably anticipated future services to the client. After that time, records will be destroyed in a manner assuring preservation of confidentiality, such as by shredding or other appropriate means of destruction.

35. Recordkeeping Tips
Document the type of support your office provided for the patient on that day in:
-- the paper record
and/or
-- the electronic record
Don’t forget to indicate the staff person’s name who provided the CM support
Complete the RI EOHHS Data Collection Form
It is critical from a Program Integrity perspective to document the type of support your office provided for the patient on a given day in:
-- the paper record
and/or
-- the electronic record
Don’t forget to indicate the staff person’s name who provided the CM support
Lastly,
For the Pilot data collection process, a Pilot Data Collection Form will be completed for each patient receiving CM services in your practice. This form will help the state track the level of need for these services as well as health outcomes, which will justify the cost of covering theses service codes more widespread in the future.

36. Data Collection Forms
You will receive an Excel Workbook when you become authorized to bill for Dental Case Management services. This Workbook will contain four Data Collection Forms, one for each CDT case management service code. Documentation of the specific service is done using the Forms and one is printed on paper and sent in for billing, which the other is saved and sent electronically. The following few slides illustrate how to complete and submit a Data Collection Form.

37. Data Collection Form Instructions
Complete each of the required boxes on the Form.
Don’t forget to include the date and the baseline score and all subsequent scores to track change over time.
Please complete the Form in Excel and save it for each individual Case Management patient with name and the initial date of service in the file name.
This is a screen shot of the D9993 Pilot Data Collection Form that you will be using to record patient activity and outcomes for the test phase. Each section of the Form must be completed including a score for each date that a Case Management service is provided. The narrative boxes titled” Record Patient’s Need”, “Provider Intervention (What you do)” and “Desired Outcome” are more for your practice’s recordkeeping purposes to document and be reminded of three very important aspects of care. The “Patient Need” and the “Desired Outcome” boxes may not need to be updated at each Case Management visit; however, the “Provider Intervention” box may need additional documentation if something different is carried out by the staff for each subsequent date of service (DOS).
Please complete the Form in Excel and save the file with the individual’s name. These Case Management Data files will be sent electronically to EOHHS on the first of each month for the previous month.

38. Data Collection Form Instructions
A critical step to data collection for this Pilot is the scoring for each Case Management case and submitting it to EOHHS for tracking purposes.
To track patient progress, please choose the most appropriate score.

39. Data Collection Form Instructions
The Form should be used as a patient agreement to engage patients in their care and updated on their progress.
During the Pilot, please save the Form electronically.
The Form should be submitted to Medicaid’s fiscal agent DXC (formerly HPE) with the paper claim form via fax or mail.
Below are some key Data Collection Form Instructions:
The Form should be used as a patient agreement to engage patients in their care and updated on their progress.
During the Pilot, please save the Form electronically.
The Form should be submitted to Medicaid’s fiscal agent DXC (formerly HPE) with the paper claim form via fax or mail.

40. Data Collection Form Instructions
The saved electronic Forms should be sent weekly to the following address:
Electronic files are due either by close of business (COB) on Fri. of the current week, or by COB the following Mon.
Remember, data collection for this Pilot is critical and will determine whether Case Mgmt. codes will be covered across all population in the future. Each week any Case Management e-files that were saved for billing purposes should be sent electronically to Electronic files are due either by close of business (COB) on Fri. of the current week or by COB the following Mon.
Although there should be one file for each individual patient, if the volume warrants it, files can be zipped (condensed) for easier transmission.

41. In Closing…
The bottom line is that there are a number of ways to integrate dental case management into your organization, no matter your size or resource limitations.
The most important thing is to make dental case management an integral part of clinic/practice operations. 
In summary, dental case management services can be integrated into the dental practice/clinic in any number of ways, regardless on the number of employees the physical size of the practice. As dental case management becomes more comfortable for the staff, will consider it to be a useful and important service offering.

42. Take Module 9 Post-Test Now https://www.surveymonkey.com/r/M9Post
Improving the Quality of
Oral Healthcare through
Case Management
Take Module 9 Post-Test Now
Please Stop here to take the Post-test for this Module. Cut and paste the blue link into a browser address line and the Post-test will open for you in Survey Monkey.
Thanks for your participation!