American Academy of Pediatric Dentistry - AAPD



American Academy of Pediatric Dentistry

2013 – 2014 Special Projects Fellowship Application

Personal Information

Candidate Name

Office or Program Address

City State Zip District

Office or Work Phone Fax Number

Home Phone E-mail Address

Education & Training (attach along a current curriculum vitae along with the application)

Name of Pediatric Dentistry Program

Address City State Zip

Name of Program Director

Address City State Zip

I am currently a member of the AAPD

Year of graduation or anticipated graduation date from pediatric dentistry residency program

Name of Dental School Year of graduation

Proposed Research Project Topic(s): Medicaid radiographic requirements and their relationship to FDA, ADA and AAPD radiographic guidelines

Current federal and professional recommendations for exposure of children to radiation in dental care are clear in their intent to reduce unnecessary and non-diagnostic radiographs. So-called administrative radiographs to either document treatment rendered or justify procedures performed, remain a common practice, placing children at unnecessary risk. Medicaid auditing has used the absence of radiographs as an indication of possible fraud in billing for services. The extent of conflict of administrative radiograph policy and established federal and professional guidelines within state Medicaid programs is not known. This project would provide a national picture of radiographic practices relative to: (1) justification of medically necessary care, (2) those procedures considered to require pre-operative radiographs, (3) areas of conflict, and (4) alternatives to ionizing imaging acceptable and under what circumstances.

Please describe how you will approach this topic and your time-line for completion:

Faculty Sponsor

Candidate Name

Office or Program Address

City State Zip District

Office or Work Phone Fax Number

E-mail Address

Pertinent activity and experience with the AAPD and / or other organizations

Please list any professional positions / activities in which you have served or have agreed to serve in the future.

Organization Position or Office Years(s)

Reminder:

Please include with this application, one letter of support which address your abilities and how you are likely to use this experience to better the oral health of children through advocacy, political action or investment in organized dentistry. One letter must be from your program director (if applicable). Also attach a current curriculum vitae.

Activities/Requirements of Program

I understand the following requirements of the program and will comply with these requirements if selected:

• Complete a project on a topic mutually agreed upon by AAPD and fellow.

• Complete process of submission of completed work to peer-reviewed journal and/or complete documents for member, press or legislative audiences.

Signature Date

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