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Click ‘Get Form’ to open the printable dentical hld form in our editor.
Begin by entering the Provider Name and Patient Name in the designated fields at the top of the form.
Record the date and patient number as required. Ensure all entries are accurate for proper documentation.
Position the patient's teeth in centric occlusion, then proceed to measure and record each condition from #1 to #6A, marking an ‘X’ if present and scoring no further for automatic qualifying conditions.
For conditions #6B to #13, carefully follow the scoring instructions provided. Measure using a Boley Gauge or ruler, rounding off measurements to the nearest millimeter as specified.
Complete any additional documentation required for EPSDT–SS exceptions by indicating with an ‘X’ and attaching necessary medical evidence.

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What is HLD index score sheet?

SCORING INSTRUCTIONS The intent of the HLD index is to measure the presence or absence, and the degree, of the handicap caused by the components of the Index, and not to diagnose 'malocclusion. ' All measurements are made with a Boley Gauge (or a disposable ruler) scaled in millimeters.

What is a HLD form?

The Handicapping Labio-Lingual Deviations Form (HLD) is a quantitative, objective method for measuring malocclusion. The HLD provides a single score, based on a series of measurements that represent the degree to which a case deviates from normal alignment and occlusion. You will need this form and a Boley Gauge.