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Patient Notifications and Disclosures Checklist

October 27, 2022 5095

This is a checklist of the required patient and public notifications and disclosures.

  • Advertising

    Advertising fees, discounts or dentures must include specific information. Refer to “Dental Practice Marketing and Advertising 101”.

  • Business License

    Many cities and counties require posting a business license in a conspicuous location.

  • Commercial Credit

    If you offer a patient commercial credit financing products (credit cards, lines of credit or loans), you must obtain the patient’s signature on a written disclosure notice and a written treatment plan, and comply with other requirements. Refer to “Offering Commercial Credit to Patients.”

  • Dental Materials Fact Sheet

    Provide to a patient at least once prior to performing a restorative procedure and obtain acknowledgment of receipt. The fact sheet is available on the Dental Board website.

  • Dispensing

    When dispensing medicine to a patient, you must provide the patient with a written disclosure that the patient has a choice between obtaining the prescription from you, the dispensing prescriber or obtaining the prescription at a pharmacy of the patient’s choice.

  • Informed Consent

    Obtaining informed consent is required for general anesthesia and conscious sedation procedures. Obtaining informed consent for other dental procedures is not required but is standard risk management protocol. It should be documented in the patient record. Informed consent is a process and the use of a written form can be helpful to the patient’s understanding of the procedure. Refer to Chapter 5 Patient Considerations of the “Legal Reference Guide for California Dentists.”

  • Opioid Prescription to a Minor

    Must discuss risks with a minor or the minor’s parent or guardian before issuing the first opioid prescription in a single course of treatment. Use “Consent to Prescribe Opioid to a Minor” (available in both English and Spanish).

  • Name, License Type and Academic Degree

    Comply with the requirement to notify patients of clinical staff names, licenses, and academic degrees by doing each of the following:

    1. Clinical staff wear nametags or have licenses or certificates posted.
    2. Post prominently the name, license type and highest level of academic degree of each licensed individual, or provide the information in writing in 24-pt type to the patient at the initial visit.
    3. Display prominently the name, license type and highest level of academic degree of each licensed individual on the practice website.
  • Notice of Licensure

    Post the notice accessible to the public view in all facilities where dental services are provided. The notice must state, in 48-pt type:
    Dentists are licensed and regulated by the Dental Board of California (877) 729-7789

  • Notice of Nondiscrimination

    Dental practices that receive payments from certain types of government programs, such as Denti-Cal, Healthy Families, Medicare or electronic health records incentive (“meaningful use”), must comply with the nondiscrimination rules of the Affordable Care Act Section 1557. This notice must be posted in a facility where patients may easily see it. This notice also must be prominently posted on the dental practice website, if the practice has a website. An abbreviated notice must be included in significant publications. See "Nondiscrimination Requirements Under the Affordable Care Act (Section 1557)."

  • Notice of Privacy Practices

    A HIPAA-covered entity, which includes most dental practices, must provide patients with a notice that explains the entity’s responsibilities and patient rights with regard to the use or disclosure of patient information, and obtain patient acknowledgment of receipt of the notice. The notice also must be posted at the entity’s facility and prominently on the entity’s website. When updating the notice, it is not necessary to obtain acknowledgment of receipt from current patients. Refer to "Sample Notice of Privacy Practices."

  • Proposition 65

    Businesses with nine or more employees must provide “clear and reasonable warning” prior to exposing any person to a chemical on the Proposition 65 list. Several chemicals used in dentistry, for example, mercury, nitrous oxide and chloroform, are on the list. Refer to “Proposition 65 Notices & FAQ” for more information and to download the required warning notices.

  • Radiation

    In areas where X-ray machines are operated, post a sign or signs that state: CAUTION X-RAY

  • Referrals to Other Organizations

    When you refer a patient to an organization in which you, or your immediate family, has a significant beneficial interest, you must disclose this interest in writing to the patient and must advise that the patient may choose any organization for the purpose of obtaining the service ordered or requested by you. Such disclosure and advice also must be provided if you charge, bill or otherwise solicit payment from a patient on behalf of an organization in which you, or your immediate family, has a significant beneficial interest. Disclosure requirements can be met by posting a conspicuous sign or by providing the patient with a written statement.

  • Right to Receive a “Good Faith Estimate”

    Information regarding the availability of a “Good Faith Estimate” must be prominently displayed in the office and on-site where scheduling and questions about the cost of health care items or services occur.

    This sample notice is considered by the Health and Human Services to be in compliance with the No Surprises Law requirements.

  • Telehealth

    Prior to delivery of health care via telehealth, a health care provider at the originating site shall verbally inform the patient that telehealth may be used and obtain verbal consent from the patient for this use. The verbal consent shall be documented in the patient’s medical record.

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