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 mandated reporter’s legal requirements. Individuals licensed by the Dental Board are “mandated reporters” of known or suspected abuse or neglect of a child, elder, and dependent adult, and incidents of violence. View resource California State Mandated Reporting
Clinical Chart Documentation Guidelines This guide demonstrates patient record best practices. Thorough and accurate patient records are one of your most important tools for telling the story of what happens during treatment. View resource Clinical Chart Documentation Guidelines
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
Consultation Request for Dental Treatment Sample consultation request for dental treatment fax communication form. Used with permissions from TDIC. View resource Consultation Request for Dental Treatment
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
Credit Card Chargeback and Release of Patient Information A credit card company may request information when a patient disputes a charge to a dental practice. Use this to respond: sample letter, copy of applicable sections of state law, and consent form for use or disclosure of patient health information. View resource Credit Card Chargeback and Release of Patient Information
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