Patient Management & Forms

This training guides staff through the state and HIPAA requirements for providing access. Instructions on staff presentation are included.

Form to be completed by legal guardian to authorize a caretaker (non legal guardian) to accompany a minor to his/her dental appointment. 

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.

California law designates certain individuals as "mandated reporters” for known or suspected abuse or neglect of a child, elder and dependent adult and incidents of violence. Dentists, and many members of the dental team, are required to acknowledge their responsibility and make reports as well as consider training for their teams.

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.

Answering frequent questions about third party collection agencies. Things to know to stay in compliance with HIPAA and CMIA while working to collect past due patient balances.

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.

Sample form to obtain patient consent for use or disclosure of patient information as required by HIPAA and state law.

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.

This resource may be shared with patients to address some of the common questions about dental coverage and where to go when they are experiencing challenges with their dental plan. 

Sample letter to patient discussing the necessity of radiographs. Courtesy of TDIC.

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.

This FAQ offers do's and don'ts on how to have patient discussions regarding their dental benefit plans.

Tool to utilize during the patient financial discussion to document financial options presented, patient obligation and financial consent.

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.

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.

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.

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.

This chapter addresses Patient Considerations including but not limited to: Examination and Diagnosis, Communications and Records.

Creating a welcoming and safe place for LGBTQ+ patients begins with education and training. Here are some reputable resources to help you learn more about LGBTQIA+ oral health and better serve your LGBTQIA+ patients.  

Helping navigate some of the best practices you can utilize in your office to manage delinquent accounts and collect past due balances.

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

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.

Sample form to request a consultation with a patient’s physician which may be necessary particularly for patients who have chronic conditions.

Information a dental practice should collect when creating a New Patient Form during the initial new patient phone call.

List of forms and information needing completion prior to the patient’s first appointment.