Skip to Main Content
Updated

Authorization for Release of Dental Records

Form for a patient to authorize release of records to another dentist, physician or authorized representative

Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation General Liability Updated
Updated

Consent to Disclose Personal Health Information (PHI)

Form and recommendations for obtaining consent to disclose patient health information to a third party.

Sample Forms State Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation General Liability Patient Care Updated
Updated

Cybersecurity Reference Guide

An overview of cyber risks, common data breach and cyberattack targets, investigations, preparation and prevention
Reference Guides General Liability Updated
Updated

Diagnostic X-rays Are Required Letter

Sample letter to inform and educate a patient of necessary X-rays for comprehensive care.

Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation Patient Care Updated
Updated

Failed Appointments Letter

Sample letter to a patient who continues to miss dental appointments to address needs and consequences

Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation General Liability Updated
Updated

Informed Refusal of Recommended Dental Treatment

Form acknowledging a patient's refusal of recommend dental treatment, test, or evaluation.

Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation Patient Care Updated
Updated

Referral Follow-Up for Evaluation and/or Biopsy of Suspicious Area/Lesion Letter

Sample patient letter for follow-up on referral for evaluation or biopsy of suspicious lesion.

Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation Patient Care Updated
Updated

Referral Letters (set of three)

Letters providing referrals to patients, a follow up letter and letter to the referral provider.

Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation General Liability Patient Care Updated
Updated

Treating Minor Patients Whose Parents Are Divorced

Practical guidance for navigating consent and treatment challenges involving divorced or separated parents.

Reference Guides Patient Care Updated