ORAL SURGERY GROUP INC. 
8691 Connecticut Street, Merrillville, Indiana 46410  T. 219.757.5700  F. 219.757.5706  

ONJ Study

For more information on Factor 5 Leiden for our patients and their families from Hamilton Heath Services, click here.

Attachments Needed for all Entry Patients:                      
2, 00, 4, 5
Additional Attachments needed for “Yes” Patients:
000, 0, 1, 3, 7
Attachment needed for “Questionable” Patients:                      
3, Recall Appointment in 4-6 weeks
Attachments needed for “No” Patients:                      
None

​ List of Attachments for ONJ Study:                                                   000. Patient’s Instruction Sheet for ONJ Study
 00  a. Doctor’s Instructions for “In-Person” Interview
         b. Doctor’s Instructions for Phone Interview
         c. Doctor’s Checklist of Completed Attachments
   0. Patient Contact Information
   1. Diagram for ONJ Study
   2. Consent Document for ONJ Screening/Interview               
   3. HIPAA
   4. Medical Risk Factor Assessment Interview (4a)
         Section a. Osteoporosis 
         Section b. Steroid
         Section c. Cancer
   5a. Dental Questionnaire Interview
   5b. Timeline of Jaw Pain
   6. Patient # (Letter/Number/-Letter Identification Code)
   7. Informed Consent for Blood Draw
   8. Laboratory Results Form/Interview
   9. Log of Laboratory Results
 10. Doctor’s Order/Laboratory Instruction Sheet