Dispensing Products Acknowledgment Form to document products that are dispensed to a patient (does not apply to medications) November 23, 2022 Sample Forms State Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington General Liability Patient Care
Emergency Phone Screening to Determine Appointment Immediacy Form to facilitate patient screening by phone and determine immediacy, appointment need or emergency care January 25, 2017 Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation Patient Care
Employee Informed Refusal of Post Exposure Medical Evaluation Form to document an employee’s informed refusal of a medical evaluation after a bloodborne pathogen exposure October 23, 2015 Sample Forms Alaska Arizona California Hawaii Illinois Minnesota Nevada New Jersey North Dakota Pennsylvania Documentation Employment General Liability
Esthetic Approval (Crowns, Veneers, Bridges) Form for esthetic approval of crowns, veneers or bridges October 23, 2015 Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation General Liability Patient Care
Esthetic Approval and Case Completion (Dentures and Partials) Form for esthetic approval of dentures or partials and permission to proceed with their completion October 23, 2015 Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation General Liability Patient Care
Failed Appointments Letter Sample letter to a patient who continues to miss dental appointments to address needs and consequences October 23, 2015 Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation General Liability
Follow Up for Biopsy Letter Sample letter to a patient about referral for evaluation and/or biopsy of a suspicious area or lesion October 24, 2018 Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation Patient Care
Health History Sample form for capturing a patient's health concerns and medical history October 23, 2015 Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Topic Documentation General Liability Patient Care
Image and Likeness Authorization Form to document a patient's authorization and release for the practice to use their photos and recordings October 23, 2015 Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation General Liability
Informed Consent Declaration: Minor Patient Form for a non-legal guardian to authorize dental treatment on a minor patient August 08, 2023 Sample Forms State Washington Topic Documentation Patient Care