Temp RDH Request Form

Temp RDH Request Form

This form is only used for temp requests greater than 48 hours. For needs less than 48 hours; please contact your RM directly via phone/text.

Please complete this form to ensure we are tracking all temp hygiene requests accordingly. Temp requests will go to Regional Manager and Alexis Hall, RDH scheduler for review and approval. This is a great tool/exercise to also work through the need of the request before it is submitted.

Why is this critical? Most and foremost, we need to ensure we are providing quality patient care to our existing and new patients. Sometimes with outside agency temps they don't understand the Riccobene way, treatment planning philosophy to provide an outstanding experience for our patients.

Where can you help as Office Managers? Before requesting temp hygienists, are we able:

engage our existing hygienists to see more patients? incentivize them with extra pay.
if we have an existing hygienist that is regularly scheduled off on a certain workday to help pick up a shift (incentivize them with extra pay).
if it is a temp RDH that we are using, how are we maximizing their schedules? Are they replacing the current APD (Average Production per day) to cover their temp cost?

Questions

Should you have any questions, please reach out directly to your Regional Manager or Alexis Hall.

OM Requester*

First NameLast Name

OM Requester email*

example@example.com; Once the capex request is approved it will notify this email address

Office Location*

Other Office Location (if not listed above)

State*

Regional/Area Manager*

Director/VP*

RDH temp requested*

Why are we requesting temp RDH?*

Have you worked through this prior to requesting temp?

Timing requesting*

When are you requesting this equipment, etc. so we can ensure we are tracking it accordingly

Enter date(s) needed below:*

Select Dates needed for temp coverage?

Dates needed for temp coverage*

Select Dates needed for temp coverage?*

select dates needed for temp coverage

Temp hourly rate requested (enter details here):*

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