Access to Patient Records This training guides staff through the state and HIPAA requirements for providing access. Instructions on staff presentation are included. View resource Access to Patient Records
Authorization for a Caretaker to Accompany a Minor Patient Form to be completed by legal guardian to authorize a caretaker (non legal guardian) to accompany a minor to his/her dental appointment. View resource Authorization for a Caretaker to Accompany a Minor Patient
Authorization for Agent to Consent to Dental Treatment of a Minor This form allows for a non-legal guardian to consent to a minor patient’s treatment. It must be signed by a parent or legal guardian. View resource Authorization for Agent to Consent to Dental Treatment of a Minor
California State Mandated Reporting Summary of legal obligations of dental licensees and certain dental practice employees as mandated reporters to report known or suspected cases of abuse. View resource California State Mandated Reporting
Caregiver’s Authorization Affidavit A minor patient who does not have a parent in their life may be under the care of a family member who is not a legal guardian. Use the affidavit when the family member seeks dental treatment for the minor. View resource Caregiver’s Authorization Affidavit
Communicating Radiation Safety to Your Patients Are you confident your patients understand the necessity of diagnostic X-rays? Here are some of the questions you may get from patients and guidance on how to best respond. View resource Communicating Radiation Safety to Your Patients
Confidential Health History Form (English & Spanish) This form should be completed by each new patient or a new patient’s legal guardian. Additionally, this form should be reviewed at each patient appointment with changes noted and signed for. Used with permissions from TDIC. View resource Confidential Health History Form (English & Spanish)
Consent Form for Use or Disclosure of Patient Health Information Use this sample form to obtain patient consent for use or disclosure of patient information as required by HIPAA and state law. View resource Consent Form for Use or Disclosure of Patient Health Information
Credit Card Authorization Form Utilize this form when offering patients automatic credit card payments. Be certain to comply with your merchant card processor's security standard for this type of payment. View resource Credit Card Authorization Form
Dental Health History Form Form designed for a provider who wishes to collect more in-depth dental health history that is not covered on the Confidential Health History Form, as well as assess the patient’s oral health and/or cosmetic concerns. View resource Dental Health History Form
Diagnostic X-rays are Required Letter Sample letter to patient discussing the necessity of radiographs. Courtesy of TDIC. View resource Diagnostic X-rays are Required Letter
Divorced Parents Sample Letter (Existing Minor Patients of Record) Use for existing minor patients whose legal guardians of record have experienced a relationship change (divorce). Send a letter to both parents; responses will help you determine if you need to update the patient information and patient financial agreement. View resource Divorced Parents Sample Letter (Existing Minor Patients of Record)
Face Masks for Children During COVID-19 Questions and answers from the American Academy on Pediatrics on masks for children during COVID-19. View resource Face Masks for Children During COVID-19
Financial Agreement and Consent Form Tool to utilize during the patient financial discussion to document financial options presented, patient obligation and financial consent. View resource Financial Agreement and Consent Form
Informed Consent Forms Sample informed consent forms to aid in the face-to-face informed consent discussion between the dentist and patient. Available in English, Chinese, Japanese, Korean, Russian, Spanish, Tagalog, Traditional Chinese, and Vietnamese. View resource Informed Consent Forms
Informed Refusal Form Informed Refusal of Treatment to be signed by patient, provider and witness to document the discussion between the patient and provider on risks of declining recommended treatment. View resource Informed Refusal Form
Legal Reference Guide for California Dentists - Chapter 5, Patient Considerations This chapter addresses Patient Considerations including but not limited to: Examination and Diagnosis, Communications and Records. View resource Legal Reference Guide for California Dentists - Chapter 5, Patient Considerations
Managing Emergency Patients When Your Office is Closed Dentists are obligated to make reasonable arrangements for the emergency care of patients of record. Dental benefit plans require the same of contracted providers. Failure to make such arrangements may result in charges of patient abandonment. Resource in View resource Managing Emergency Patients When Your Office is Closed
Managing Minor Patients: Questions & Answers Questions and answers on obtaining consent for minor children with divorced parents or no parents, coordination of insurance plans between parents and step-parents, and who can access records of minor children. View resource Managing Minor Patients: Questions & Answers
Medical Consultation Request Sample form to request a consultation with a patient’s physician which may be necessary particularly for patients who have chronic conditions. View resource Medical Consultation Request
New Patient Information Collection Information a dental practice should collect when creating a New Patient Form. Annual verification should be done to verify if any changes are needed, such as employer or contact info. View resource New Patient Information Collection
New Patient Information Forms Bundle Comprehensive guidance and templates for gathering new patient information. View resource New Patient Information Forms Bundle
Offering Commercial Credit to Patients Dental practices that offer patients commercial credit financing products (credit cards, lines of credit or loans) in the dental office are required to disclose certain information and are prohibited from specific practices. View resource Offering Commercial Credit to Patients
Patient Acknowledgements and Authorizations This document provides sample language for obtaining a patient’s acknowledgment of responsibilities and receipt of information, for obtaining a patient’s affirmation that provided information is correct and the patient agrees to treatment and payment terms. View resource Patient Acknowledgements and Authorizations
Patient Financial Protocols: Determining The Practice's Patient Financial Options There are many options to choose from, and when researching which options your practice will offer, you will likely come across practice owners who have had much success with certain methods and others who have had negative experiences with the same systems. View resource Patient Financial Protocols: Determining The Practice's Patient Financial Options