Operational Manual

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D ISCLAIMER
Great care was taken to make these policies and procedures comprehensive and compliant with requirements and
recommendations from organizations such as OSHA, CDC, and the ADA. References to source information are
footnoted where appropriate.
Laws and recommendations from these organizations are numerous and subject to change. SNS cannot
guarantee this document complies with any federal or state laws. SNS also cannot accept responsibility if any
information in this document is in conflict with these laws. SNS does not undertake to provide updates to this
document as any relevant laws or other requirements change over time. Before the policies and procedures in this
document are implemented at any dental clinic, we strongly encourage the organization to review federal and
local laws and have policies and procedures approved by health care professionals where appropriate.
Safety Net Solutions (SNS) created this template to assist safety net dental clinics in establishing their own policies
and procedures manual. We encourage clinics to carefully review the contents of this document and modify them
for their own circumstances. Each clinic may also have its own unique policies or procedures that should be
included in its manual. This template was not designed to directly substitute for a clinic’s own manual; it requires
that clinics add additional information throughout the document, referenced between brackets in the color blue
as:
[insert information here]
Great care was taken to make these policies and procedures comprehensive and compliant with requirements and
recommendations from organizations such as OSHA, CDC, and the ADA. References to source information are
footnoted where appropriate.
Laws and recommendations from these organizations are numerous and subject to change. SNS cannot guarantee
this document complies with any federal or state laws. SNS also cannot accept responsibility if any information in
this document is in conflict with these laws. Before the policies and procedures in this document are implemented
at any dental clinic, we strongly encourage the organization to review federal and local laws and have policies and
procedures approved by health care professionals where appropriate.
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TABLE OF CONTENTS
Disclaimer...................................................................................................................................................................2
DENTUS DENTINO...........................................................................................................................................................8
Mission/Vision Statements........................................................................................................................................9
Organizational Chart..................................................................................................................................................9
Principles of the Dental Practice................................................................................................................................9
Dental Services Provided..........................................................................................................................................10
Hours of Operation..................................................................................................................................................10
After-Hours Coverage...............................................................................................................................................10
PATIENT RIGHTS............................................................................................................................................................11
Posting of Notice of Patients’ Rights........................................................................................................................12
Patient Rights and Responsibilities..........................................................................................................................12
Our Commitment to Patients...................................................................................................................................14
Handling of Suspected Child Abuse Cases...............................................................................................................15
CONFIDENTIALITY.........................................................................................................................................................17
Confidentiality..........................................................................................................................................................18
Sample Confidentiality Agreement..........................................................................................................................19
Release of Information.............................................................................................................................................20
Sample Authorization to Release Patient Records..................................................................................................23
Informed Consent....................................................................................................................................................24
Interpreter Services..................................................................................................................................................25
Patient Complaints/Incidents...................................................................................................................................26
REFERRALS....................................................................................................................................................................29
Emergency Patients..................................................................................................................................................30
Specialty Services.....................................................................................................................................................31
Sample Patient Referral Form..................................................................................................................................32
SAFETY...........................................................................................................................................................................33
Medical Emergencies...............................................................................................................................................34
Non-Emergency Situations.......................................................................................................................................36
Emergency Contact Information..............................................................................................................................37
Fire and Safety Plan..................................................................................................................................................39
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Safety Management.................................................................................................................................................44
Sample Incident Report Form..................................................................................................................................45
Equipment Management.........................................................................................................................................47
Hazardous Materials Management.........................................................................................................................48
Emergency Preparedness Plan.................................................................................................................................49
Anaphylaxis..............................................................................................................................................................51
QUALITY MANAGEMENT..............................................................................................................................................53
Quality Management...............................................................................................................................................54
GUIDELINES FOR COMPLETING THE QUARTERLY CHART REVIEW FORM...............................................................62
QUARTERLY DENTAL CHART AUDIT TOOL...............................................................................................................74
CLINIC OPERATIONS......................................................................................................................................................76
Hours of Operation..................................................................................................................................................77
After-Hours Emergency Coverage............................................................................................................................77
Scope of Services Provided......................................................................................................................................77
Scheduling................................................................................................................................................................78
Eligibility...................................................................................................................................................................81
Prior Authorization...................................................................................................................................................82
Payment for Dental Care Policy...............................................................................................................................83
Sample Declaration of Income Form.......................................................................................................................85
Sample Notice of Patient Responsibility for Payment for Dental Services..............................................................86
Broken Appointments..............................................................................................................................................87
Sample Missed Appointment Agreement................................................................................................................88
Sample Final Letter...................................................................................................................................................90
Emergency Patients..................................................................................................................................................91
Sample Triage Form.................................................................................................................................................93
Clinical Protocols......................................................................................................................................................95
Sample Clinical Protocols.........................................................................................................................................98
Assessment of Vital Signs.......................................................................................................................................100
Guidelines for Patients Needing Antibiotic Prophylaxis........................................................................................106
Dental Record Keeping...........................................................................................................................................109
Handling of Tissue Specimens................................................................................................................................113
Patient Education...................................................................................................................................................116
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Patient Records......................................................................................................................................................117
Retention of Dental Records..................................................................................................................................120
INFECTION CONTROL..................................................................................................................................................122
Infection Control Plan............................................................................................................................................123
Sample Infection Control Training Log...................................................................................................................124
Federal Requirements............................................................................................................................................125
The Purpose of Infection Control...........................................................................................................................127
Employee Immunizations.......................................................................................................................................129
Engineering Controls..............................................................................................................................................130
Work Practice Controls..........................................................................................................................................131
Post-exposure management..................................................................................................................................132
Needle Sticks..........................................................................................................................................................134
American dental Association Post-Exposure Flow Chart.......................................................................................135
Work-Related Illnesses and Work Restrictions......................................................................................................136
Personal protective equipment (PPE)....................................................................................................................138
Hand Hygiene, Gloves, Nails, & Jewelry................................................................................................................140
Latex hypersensitivity and Contact Dermatitis......................................................................................................141
Sterilization and Disinfection of Patient-Care Items..............................................................................................143
Maintenance and Sanitation..................................................................................................................................144
Sterilization and Disinfection Methods..................................................................................................................147
Sterilization Monitoring.........................................................................................................................................151
Sample Sterilization Monitoring Log......................................................................................................................152
Owner’s Manuals for all equipment in Sterilization Area......................................................................................153
Contract with Spore Testing Company..................................................................................................................153
AED & Emergency Kit Information.........................................................................................................................153
Infection Control In the Operatory........................................................................................................................154
Medical Waste.......................................................................................................................................................156
Dental Unit Waterlines, Biofilm, Water Quality, and Boil-Water Advisories........................................................159
Digital X-Ray Sensors, Intraoral Cameras, and High-Tech Instruments.................................................................161
Parenteral Medications..........................................................................................................................................161
Handling of Biopsy Specimens...............................................................................................................................162
Infection Control In the Dental Laboratory...........................................................................................................163
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M. Tuberculosis (TB)..............................................................................................................................................164
ENVIRONMENT OF CARE............................................................................................................................................166
General Physical Environment...............................................................................................................................167
Lease Agreement...................................................................................................................................................168
Service Agreement.................................................................................................................................................168
Reception and Office Areas....................................................................................................................................169
Consultation, Examination and Treatment Areas..................................................................................................170
Sterilization Area....................................................................................................................................................170
Linens and Laundry................................................................................................................................................172
Floor Plans..............................................................................................................................................................173
Diagnostic Radiology Facilities...............................................................................................................................173
Hand washing and Toilet Facilities.........................................................................................................................174
Janitor’s Closet.......................................................................................................................................................174
Storage Space.........................................................................................................................................................175
Ventilation..............................................................................................................................................................176
Handicap Accessibility............................................................................................................................................176
Quantity and Type of Supplies and Equipment.....................................................................................................176
Fire Extinguisher Maintenance and Monitoring....................................................................................................178
Sample Fire Extinguisher Monitoring Log..............................................................................................................179
Sample Eyewash Monitoring Log...........................................................................................................................180
Sample Emergency Kit Monitoring Log..................................................................................................................181
Administration of Records.....................................................................................................................................182
HUMAN RESOURCES...................................................................................................................................................184
Clinic Administrator...............................................................................................................................................185
Professional Services Director...............................................................................................................................185
Health Care/Dental Services Staff..........................................................................................................................185
Sample Dental Job Descriptions.............................................................................................................................188
Orientation.............................................................................................................................................................208
Credentialing/Re-credentialing..............................................................................................................................211
In-service Training for Health Care Staff................................................................................................................214
EXPOSURE PREVENTION & MANAGEMENT...............................................................................................................217
Mercury Exposure..................................................................................................................................................218
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Cleanup of Spilled Mercury....................................................................................................................................219
Radiation Exposure................................................................................................................................................220
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DENTUS DENTINO
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M ISSION /V ISION S TATEMENTS

TO BE THE MOST INNOVATIVE DENTAL CLINIC INSITUTION CONSIDERING MEDICAL PROFESSIONALISM AND
NOVELTIES, PATIENTS APPROACH, PROCESS, PROCEDURES, TECHNOLOGIES AND MATHERIALS USED.
O RGANIZATIONAL C HART
P RINCIPLES OF THE D ENTAL P RACTICE

 To prevent, improve, restore and maintain the oral health of the community that is served by
DENTUS DENTINO.
 To provide dental services that are accessible to everybody’s needs by creating:

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A SLIDING FEE SCALE SC HEDULE
E XTENDED HOURS
I NTERPRETER S ERVICES
S PECIAL D ENTAL P ROGRAMS
 To treat patients professionally, confidentially and without discrimination based on income, race,
insurance status, religion, gender or sexual preference;
 To evaluate and treat dental emergencies via dental treatments, prescriptions, consultations or referrals;
 To decrease the incidence of caries by prescribing fluoride supplements, the application of topical
fluoride treatment and the application of pit and fissure sealants when indicated:
To educate parents and children on the appropriate oral care and the importance of a healthy nutritional
program:
 To introduce children to the dental clinic as early as possible; and
 To integrate oral health with overall health.

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D ENTAL S ERVICES P ROVIDED

This clinic offers oral, diagnostic, preventive, and restorative services, as well as emergency services. Services
provided here include:
-X-ray
-Dental bonding
-Dental crowns
-Bridgework
-Dental veneers
-Teeth cleaning
-Dentures
-Root canal therapy
-Teeht whitening
-Tooth extractions
-Dental implants
-Bone grafting
-Endodontic retreatment
-Dental braces
-Lingual braces
-Bad bite treatment
-Smile designing
-invisalign treatment
-pediatric dentistry
-Laser teeth whitening
Patients needing services not offered at Dentino Dentus are referred to other sources of care.
Laboratory work for the fabrication of removable and fixed prosthetics will be referred to outside laboratories
based on the quality of their services and their ability to meet infection control standards established by the
appropriate governing bodies.
H OURS OF O PERATION
 09:00 AM - 06:00 PM
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A FTER -H OURS C OVERAGE

După ora 18:00 la telefon răspunde robotul care anunță pacientul să revină cu un apel în intervalul 09:00-18:00 sau
să scrie un mesaj pe paginile de Facebook și Instagram.
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PATIENT RIGHTS
2400 Computer Drive Westborough, MA 01581 T: 508.329.2280 W: dentaquestinstitute.org

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P OSTING OF N OTICE OF P ATIENTS ’ R IGHTS
P OL ICY
 The clinic shall have visibly posted a notice which has the heading "NOTICE OF PATIENTS' RIGHTS" which
contains all the rights provided.
 The notice will be posted in at least one central area where all patients are likely to see it.
P ROCE DURE
 “Patient Rights and Responsibilities” will be posted in the clinic area.
 “Our Commitment to Patients” will be posted in the clinic area.
P ATIENT R IGHTS AND R ESPONSIBILITIES

As part of our strong commitment to quality care and customer service, the Dentus Dentino wants to keep you
informed about your rights and responsibilities:
 You have the right to be provided with appropriate information about providers, policies and procedures;
 You have the right to be informed by your dentist regarding your diagnosis, treatment and prognosis in
terms you can understand;
 You have the right to receive sufficient information from your dentist to enable you to give informed
consent before beginning any dental procedure or treatment;
 You have the right to be treated with respect, dignity and with recognition of your privacy;
 You have the right to refuse treatment, drugs or other procedures recommended by [name of clinic]
providers and to the extent permitted by law and to be made aware of the potential consequences of
refusing recommended treatment;
 You have the right to reasonable access to dental services;

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 You have the right to expect that all communications and records pertaining to your health will
be handled in the most confidential manner;
 You have the right to choose a personal care dentist and to expect that he/she will provide
and/or arrange for the provision of dental services;
 You have a right to obtain a copy of your dental record from Dentus Dentino in accordance with the
law.
 You have the right to express any concern with the staff of Dentus Dentino
 You have the responsibility to treat others with the same respect and courtesy that you expect for
yourself;
 You have the responsibility to ask questions and to seek clarification in order to understand your dental
condition and/or treatment;
 You have the responsibility to weigh the potential consequences of not following the advice of your
dentist;
 You have the responsibility to cooperate with Dentus Dentino so that we may administer benefits in
accordance with your dental plan. Since Dentus Dentino has many different payer sources, it is your
responsibility to know what your dental plan coverage allows, the deductibles and co-insurance
payments;
 You have the responsibility to keep scheduled appointments with providers or give adequate notice of
cancellation to Dentus Dentino;
 You have the responsibility to express concerns to Dentus Dentino;
 You have the responsibility to become familiar with your dental plan benefits, policies, and procedures by
reading materials distributed by the respective dental plan. For clarification, you should call the customer
service department of the respective dental plan with any questions;
 You have the responsibility to provide information needed by your dentist to enable him/her to provide
the most appropriate and effective care;
 You have the responsibility to meet your financial obligations in a timely fashion;
 You have the responsibility to perform visual in mouth examinations on yourself and the responsibility to
follow the provider’s instructions regarding home care treatment; and
 Periodically, the Dentus Dentino will conduct patient surveys as part of our continuous
improvement initiatives. By completing these surveys, you are part of the solution.

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O UR C OMMITMENT TO P ATIENTS
 We provide quality dental care;
 We value each patient as an individual. We take responsibility and initiative to address concerns, issues
and feedback to ensure patient satisfaction;
 Our patients’ dental and personal information is treated with respect and the utmost confidentiality
 We facilitate all aspects of our patients’ dental care by informing and educating them about internal
resources and guiding them through our processes; and
 We conduct ourselves in a professional manner at all times and contribute to the maintenance of a
professional environmen

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CONFIDENTIALITY

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C ONFIDENTIALITY
P URPOS E
To protect the confidentiality of patient information and patient medical records as required by federal and state
laws.
P OL ICY
Information known or contained in the patient’s medical or dental record shall be treated as confidential and will
be released in appropriate circumstances only with the written consent of the patient or legal guardian. All
employees who have access to patient information, including temporary personnel, must review the Protocol for
Release of Medical Information. In addition, the Confidentiality Agreement will be signed by all employees at the
time of orientation to reflect their understanding of the policy. All persons providing services at Dentus Dentino
who have access to information concerning patients, including employees, staff, students and volunteers, must
hold such information in strict confidence.
E nevoie de inserat exemplu de acordul de confidențialitate
P ROCE DURE
Discussions/Conversations
In the provision of quality care, dialogues involving patient care and treatment are inherent; however, discretion in
public areas is very important. It is the responsibility of all employees, staff, students and volunteers to refrain
from discussing patients in inappropriate places (e.g., elevators, corridors). This information should not be
discussed with anyone in the clinic unless it pertains directly to their job, and then the discussion should be away
from public areas. Confidential information should never be discussed with persons outside the health center.
Conversations regarding patients in elevators, corridors, or other public areas of the health center are considered a
breach of patient confidentiality.
Medical Records
Information gathered through contact between patients and health care providers at the Health Center is
privileged and confidential. This privilege extends to all forms and formats in which the information is maintained
and stored, including, but not limited to, hard copy, photocopy, microfilm or automated/electronic form. The
information on a patient’s chart is confidential and cannot be disclosed without the patient’s knowledge and
consent. There are occasions when there is a legal obligation or duty to disclose information.
Requests for patient information will be directed to the Medical Records department. Disposition of such requests
will be in accordance with the Health Center’s established policy and procedures for Release of Information.

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S AMPLE C ONFIDENTIALITY A GREEMENT
I agree that it is my responsibility to protect and preserve the confidential nature of all information concerning the
patients of Dentus Dentino. I agree to use all information to which I may have access as an employee of the
Dentus Dentino] only in the performance of my duties as specified by my supervisors. I shall not release such
information or any other confidential information concerning clients to any outside source unless specifically
authorized to do so.
Therefore,
 We should be very careful where we collaborate. No discussions should ever take place in
elevators, corridors, the staff lounge, etc.
 We should not, under any circumstances, discuss patients with family, friends or acquaintances inside or
outside of the clinic; and
 Except in situations where a patient is discussed on a professional-to-professional basis, patient

permission must be obtained before interdepartmental discussions regarding their cases may take place.
I understand that if I violate this agreement, such violation may be considered grounds for disciplinary action, up to
and including termination of service and may reflect on any further references given by Dentus Dentino.
Print Name
Signature Date

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R ELEASE OF I NFORMATION
P URPOS E
To define the policy of Dentus Dentino , in accordance with applicable law, regarding the release of medical
record information.
P OL ICY
All information contained in the medical record is confidential and shall be disclosed only to authorized persons in
accordance with this policy. All requests for copies of information shall be handled by the Medical Records
Department .
This policy shall in no way interfere with the appropriate exchange of information between Health Center
departments. However, all Health Center staff should be aware of the patient’s right to privacy and the Health
Center’s (and therefore Health Center employees’) obligation to maintain the confidentiality of patient medical
records and to act accordingly when responding to requests for information.
Judgments about what, when, and how to release confidential medical information must be made with the
following considerations:
 Protection of the patient’s right to privacy; and
 Pertinent statutes, regulations and legal rulings.
P ROCE DURE
A properly signed Authorization for the Release of Medical Information form is required before information can be
released to anyone other than the subject of the medical record. This includes but is not limited to requests from
the following:
 Attorneys;
 Governmental agencies (Social Security Administration, Veterans Administration, etc.);
 Relatives (including spouse) and friends;
 Private insurance companies; and
 Physicians, if not the attending or a member of the Health Center medical staff who requires the record
for patient care.

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A signed release of information is usually not required in the following situations:
 Review by a third party payer;
 Inspection upon order by authorized representatives of the Department of Public Health;
 Release to a medical staff member who attended the patient;
 Release to organized Health Center committees (e.g., Medical Records, Quality Assurance, etc.)
 Response to subpoenas; and
 At the request of reviewers from the Joint Commission of the Accreditation of Healthcare Organizations.
T HE P ATIENT ’ S R IGHT TO H IS /H ER M EDICAL R ECORD

Although the medical record is the property of the Health Center, the patient has the right of access to
information contained within the medical record. If the patient requests copies of his/her medical record, the
Medical Records Department shall be notified and upon presentation of a signed patient authorization and proper
identification, the Medical Records Department will process the request.
Content of the Authorization
To be valid, a patient’s authorization to release medical information must:
 Identify the patient;
 Generally describe the health care information to be disclosed;
 Identify the person or entity to whom the health care information is to be disclosed;
 Be given by one of the following means:
o In writing, dated and signed by the patient or the authorized patient representative, or
o In electronic form, dated and authenticated by the patient or patient representative using a
unique identifier

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 Not have been revoked by the patient or the patient’s legal representative, either of whom may revoke
their authorization at any time upon proper notice to the Health Center, provided that the Health Center
has not already acted in reliance on the authorization.
All authorizations must be permanently retained within the medical record.
Verbal Requests
All requests for medical record information should be in writing. The only exception is a request from another
health care provider currently treating the patient. In such a situation, the medical record information may be read
over the telephone to the physician treating the patient after Medical Records has verified the identification of the
requesting party and the fact that the patient is receiving treatment from that party. A written authorization from
the patient should be requested after the fact.
When medical record information is disclosed verbally, it must be documented within the medical record.
Documentation should include the name of the requesting party, the date and time the information was released,
generally describe the information disclosed over the telephone and the method of verification.

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S AMPLE A UTHORIZATION TO R ELEASE P ATIENT R ECORDS

Consemță mînt cu privire la folosirea imag CORINA JURISTA
Patient Name:
Date of Birth: Phone number:
I authorize Dentus Dentino to transfer my dental records to:
Print Name
Employee Signature Date

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I NFORMED C ONSENT
P URPOS E
To ensure that any patient receiving dental surgery or procedures that involve risk will be fully informed as to all
risks, benefits and alternatives prior to giving consent.
P OL ICY
Patients undergoing any dental surgery or procedures that are invasive (e.g., extractions) will be given full
information as to the risks, benefits and alternatives of the procedure by a person knowledgeable and experienced
about the procedure or surgery. Appropriate informed consent will be obtained in all cases. If the patient is a
minor or not competent to make such decisions, such information will be given to and consent obtained from the
parent or legally appointed guardian. The consent form must be documented in the patient’s medical record. A
patient may withdraw consent at any time prior to treatment regardless of whether a consent form has been
signed.
P ROCE DURE
The dental staff will obtain a signed consent form for all dental surgical or other procedures that involve risk to the
patient before the procedure is begun. All patients will be informed of the risks, benefits and alternatives by the
provider performing the procedure or a qualified designee who is knowledgeable about the procedure. The patient
(or legal guardian) may sign the form after being informed about the procedure. The signed informed consent
form will become part of the patient’s permanent medical record.

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P ATIENT C OMPLAINTS /I NCIDENTS
P URPOS E
To ensure that all serious complaints and incidents involving patients are investigated and resolved. A serious
complaint is defined as one involving violation of federal, state, and/or local laws, standards of care for dentistry or
ethical standards.
P OL ICY
The clinic has developed a formal process that assures prompt and complete investigations of all serious
complaints that are filed against employees of the clinic or members of its professional staff. The process shall
include, at a minimum, the following provisions:
 The Dental Director will be the person responsible for overseeing the investigation of serious complaints
lodged against an employee or member of the professional staff.
 A reporting procedure will be established which assures that the Dental Director will receive within one
day from clinic staff, in writing, reports of serious complaints.
 The Dental Director will develop a written process of investigation which shall include the following:
 A fact-gathering process that will be utilized, including provision for interviewing of a patient complainant
 Creation of a complaint file that includes the original report of complaint, progress reports as the
investigation is carried out and the outcome of investigation including action taken, if any;
 Notification of the complainant of the outcome of the investigation.
 The serious complaint files are kept in a locked cabinet in the Dental Director’s office. They will be made
available at the request of the appropriate agents.
P ROCE DURE
Dentus Dentino prides itself in providing service and care that meets or exceeds the standard of care for the
dental profession as well as maintaining compliance with all applicable federal, state and local laws and
regulations. Failure to meet these standards is a serious matter. Staff members are required to report any serious
complaints to the Dental Director within one day of the occurrence of the incident. This is necessary to ensure that
corrective action can be taken and will be facilitated by the following process:

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 The Dental Director has oversight in the investigation of serious complaints lodged against an employee
or member of the professional staff.
 All individuals (professional staff, administrative staff, patients and guests of the clinic) are encouraged to
report such serious matters since they can have a significant impact on patients and team members.
Resolving complaints is in the best interest of the patients we serve.
 Reports should be in writing and either mailed, faxed or emailed to:
o [Gladei Angela, Gheorghe Asachi street 4, +37368966969]
 Upon receipt of serious complaints, the Dental Director will immediately create a file and begin a process
of investigation. The process includes:
o Gathering of facts, including interviewing the complainant. All efforts will be made to arrange for
a time and place convenient for the complainant. Confidentiality will be assured so that only
those individuals with a need to know will be informed about the complaint.
o The file will contain at a minimum, the original report of complaint, progress reports as the
investigation is carried out and the outcome of the investigation, including actions taken.
o Serious complaints will be processed as expeditiously as possible, and all attempts will be made
to complete the process within 15 days.
o Upon completion of the investigation, the complainant will be informed about the outcome
of the investigation.
o The clinic pledges not to make retribution against person(s) filing the complaint.

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S ERIOUS I NCIDENTS
P URPOS E
To establish a process for the investigation and response to serious incidents involving patients of Dentus
Dentino.
P OL ICY
The clinic shall file a written report with the appropriate authorities of any serious incident occurring on the
premises covered by its license and which seriously affects the health and safety of its patients. This written report
shall be filed within one week of the occurrence of the incident; provided however, that the clinic also immediately
reports by telephone to the appropriate authorities any of the following which occurs on premises covered by its
license:
 Fire;
 Suicide;
 Serious criminal acts; or
 Pending or actual strike action by its employees, and contingency plans for operation of the clinic.
P ROCE DURE
Any patient death that occurs in the clinic will be reported to the State Board of Dentistry. This includes any deaths
that occur in another facility to which the patient was referred by the clinic so long as the clinic is made aware of
the death by the referral facility.
When a patient death occurs in the clinic, the dentist who was treating and/or responsible for the said patient
must submit a completed written report to the State Board of Dentistry.
The report must be submitted within 14 days of the death. The report will be sent to the Board via Certified Mail.
Failure to comply with laws governing the practice of dentistry in the State could result in the license, certificate or
registration of the dentist being revoked, suspended or placed on probation for failure to comply with the
reporting requirements.

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REFERRALS

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E MERGENCY P ATIENTS
P URPOS E
To provide referral information on local sources of care to patients needing emergency care when the clinic is
closed or when a dentist is not available.
P OL ICY
The clinic will provide referral information for patients who need emergency services during hours when it is not
open or when a dentist is not available. This information will be available on the clinic’s answering machine or
provided by the clinic’s answering service. Every attempt will be made to refer patients to another dental provider
that is as geographically close as possible and that is open at those hours. As a last resort, patients will be referred
to the closest hospital that has an Emergency Department. This referral information will be in a written
communication that is made available to all the clinic's patients.
P ROCE DURE
 The clinic will post the after-hours protocol to include the number for the patient to call for after-hours
emergencies and the location of the nearest hospital with an Emergency Department. This information
will be posted where it will be visible to patients when they arrive at the closed clinic.

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SAFETY

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M EDICAL E MERGENCIES
P URPOS E
To provide clear directions to the clinical and non-clinical dental staff in the management of medical emergency
situations occurring at Dentus Dentino. A medical emergency refers to a situation in which a patient, visitor or
staff member presents and becomes medically unstable. The medical emergency can range from seizures to
respiratory distress to cardiopulmonary emergencies.
P OL ICY
 The clinic will call to 112.
 The clinic will have a written plan and procedures for the emergency transfer, including the transport of
clinic patients;
 All licensed clinical staff will be certified in first aid treatment
P ROCE DURE
 The first responding staff person will check for unresponsiveness and/or breathlessness. If the person is
found to be unresponsive and/or not breathing or labored breathing, the staff person will:
o If alone, initiate ambulance response by calling 112, then resume care to the person in
emergency state and continue in accordance with level of training until relieved by a more
qualified person.
o Information to give to the 911 operator: “I am calling from the Dentus Dentino. We have an
emergency (state emergency) and we need an ambulance.” Stay on the line until the operator
hangs up.
o If not alone, alert nearest staff person to call 112.

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o The nearest doctor (hygienist or assistant if the dentist is not available) stays with patient at all
times and runs the code.
o A dental assistant and/or hygienist immediately gets oxygen and the emergency kit located in the
clean room. Only those certified to administer oxygen will do so. The emergency kit will be kept
fully stocked at all times. Only those certified to administer medications will do so.
o The receptionist proceeds to the front door to direct the emergency crew. Reception staff will
oversee patients in waiting room and make sure a pathway is cleared for emergency personnel.
The receptionist directs the emergency team to the site of the emergency.
o At no time will clinical assessment of an unstable patient be postponed for the purpose of
verifying registration information/insurance status.

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N ON -E MERGENCY S ITUATIONS
P URPOS E
To provide clear direction to the clinical or non-clinical staff in situations that may require medical intervention,
but are not considered to be emergency situations occurring at the clinic. A non-emergency situation refers to a
clinical situation in which a patient, visitor or staff member presents in the clinic in a stable clinical status but may
need medical treatment. Examples of a non-emergency situation could be nosebleed, laceration, fall, dizziness, etc.
P ROCE DURE
Upon identification of an individual presenting to the clinic with a non-emergency situation, a staff member
nearest to the person will either assist the individual or call a qualified person on the clinic staff to assist. The
individual’s condition will be treated to the best of the ability of the clinic staff; however, the individual will be
given the opportunity to contact and be transported to their own medical practitioner.

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E MERGENCY C ONTACT I NFORMATION
P URPOS E
To ensure clinic staff can promptly call for help in emergency situations.
P ROCE DURE
In the event of an emergency, clinic staff should be directed to call the following numbers. This information should
be posted near all clinic phones.
E MERGENCY P HONE N UMBERS
IN ALL LIFE THREATENING EMERGENCIES>>>>DIAL 112
Fire Department
For Emergency 112
Police Department
For Emergency 112

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For any serious emergency:
 Call for medical help immediately;
 Bring help to the victim, don’t bring the victim to help;
 Don’t move any injured person unless necessary to save his/her life;
 Know the location of First Aid Kits;
 Don’t use medication without the appropriate supervision; and
 If you are not sure what to do, wait for medical assistance.

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F IRE AND S AFETY P LAN
P URPOS E
To develop and maintain a written plan for dealing with fire.
P OL ICY
The clinic will make a copy of the plan available to all staff members.
The clinic will designate a Safety Coordinator.
The fire safety plan specifies persons to be notified, locations of alarm signals and fire extinguisher, evacuation
routes, procedures for evacuating handicapped and non-ambulatory patients, and assignments of specific tasks
and responsibilities.
A copy of the plan will be posted in a conspicuous area of each separate clinic premises.
P ROCE DURE
1) The following will be present in the dental clinic:
a) Smoke alarms.
b) Sprinklers.
c) Fire Extinguishers.
2) All staff will be trained on how to use the fire extinguishers. Extinguishers will be in plain sight and will be in
accordance with fire and safety regulations.
3) Fire Alert
a) When a fire is spotted, the first response must be to sound the alarm.
b) When the alarm sounds, follow posted evacuation procedures and routes.
c) Evacuation procedures should proceed immediately and quickly, but calmly.
d) The designated Safety Coordinator will lead all persons out of the dental clinic.
e) All persons will congregate at the safe meeting place which will be established.
f) Attendance will be taken by the Safety Coordinator.

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g) Once the fire department has evaluated the building and deems it safe, the Safety Coordinator will lead
all persons back in the building.
4) Routine Fire Drills
a) Routine fire drills evacuation will be conducted to ensure that all staff are familiar and comfortable with
the process.
b) The practice drills will be done at a minimum of twice a year.
c) The scheduling will be done by the Safety Coordinator.
d) The drills will include all staff.
e) A log will be kept in the “Training Manual”.
f) The log will include the date of the drill and all staff participating in the drill.
5) Fire Evacuation Procedures
a) In the event of a fire, the posted evacuation route will be followed.
b) This evacuation route will be posted and visible to staff and patients.
c) Evacuation routes and procedures will be included in staff training for new hires.
6) Fire Evacuation Procedures for Handicapped and Non-Ambulatory Patients
a) For individuals requiring assistance, clinical staff responsible for that individual will accompany them in
the evacuation.
b) If needed, staff will accompany them down the ramp and to the safe meeting place.
c) In the event of any emergency requiring assistance, call 911 for medical assistance.

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FIRE EVACUATION PROCEDURES
Trebuie de inserat planul de avacuare
In the event of a Fire Alarm:
 The strobes and alarms will go off within the suite;
 Exit promptly, escorting all personnel and patients to the appropriate exit doors;
 Use either the Primary Exit or Secondary Exit;
 Proceed to the outside assembly area located in front of the clinic

 Remain there until notified by either fire or building personnel that it is safe to return to the building or
other details are provided.
In the event of fire:
 Pull the fire alarms;
 Exit promptly, escorting all personnel and patients to either the Primary or Secondary Exits;
 Proceed to the outside assembly area located in front of clinic
In the event the door is blocked:
 If the Primary Exit is blocked, proceed to the Secondary Exit;
 If the Secondary Exit of the building is blocked, proceed to the Primary Exit; and
 Proceed to the outside assembly area located in front of clinic. Remain there until notified by either
fire or building personnel that it is safe to return to the building or other details are provided.
Handicapped Accessibility

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 For individuals requiring handicap accessibility, proceed to the Primary Exit and down the ramp;
 If the Primary Exit is blocked, proceed to the Secondary Exit and assist handicap individual to exit;
 Proceed to the outside assembly area located in front of clinic
In the event of any emergency requiring assistance, call 112 only after reaching safety.

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E QUIPMENT M ANAGEMENT
P URPOS E
To ensure the operational quality and safety of clinical equipment in use at Dentus Dentino . In addition, to
ensure that staff is educated on the proper operation of various technologies.
P OL ICY
It is the policy of Dentus Dentino to maintain an equipment management program to promote the safe and
effective use of clinical equipment.
P ROCE DURE
It is the responsibility of the Dental Director to ensure that all dental equipment is inspected annually by the
appropriate outside vendors. Documentation of inspections will be maintained in the Dental Department.
Dental equipment requiring inspection more frequently than once per year are as follows:
 Hidrometru—every 3 years
 Autoclave—every year
 Tonometru- every year
 Termomentru-every year

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H AZARDOUS M ATERIALS M ANAGEMENT
P URPOS E
To describe the program at Dentus Dentino that has been developed to identify, evaluate and inventory
hazardous materials used and waste generated in accordance with applicable laws. For the purposes of this policy,
hazardous materials includes chemical and infectious waste.
P OL ICY
It is the policy of Dentus Dentino to maintain a Hazardous Materials and Waste Management plan to safely
control hazardous materials and wastes. The policy provides processes for selecting, handling, storing, using and
disposing of hazardous materials and waste.
P ROCE DURE
Biohazard sharps are collected in puncture-resistant sharps containers in the clinical areas.
Any patient, visitor, student or staff exposure must be reported in accordance with clinic policy.
Staff are initially trained through the new employee orientation program on safety and infection control and
annually through general safety and infection control education programs.

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A NAPHYLAXIS
In serious cases, allergic reactions to certain chemicals (antibiotics, latex, etc…) can lead to anaphylaxis or even
death. Dentus Dentino takes steps to mitigate the risk of such emergencies from occurring, but in the case of
anaphylactic shock, the following procedure is recommended:
Preparation
All patient known allergies are updated in patients’ charts. These include known latex allergies.
Symptoms of Anaphylaxis
The following table describes common symptoms of anaphylaxis. Only some symptoms may be present, and the
severity of symptoms can change quickly.
Symptoms of Anaphylaxis2
Location Symptom
Mouth Itching, swelling of lips and/or tongue
Throat Itching, tightness / closure, hoarseness
Skin Itching, hives, redness, swelling
Gut Vomiting, diarrhea, cramps
Lung Shortness of breath, cough, wheeze
Heart Weak pulse, dizziness, passing out
Action Plan In the Event of Anaphylaxis in a Dental Practice
1. Terminate Treatment;
2. Alert a staff member to call 112 or the emergency service and to retrieve clinic’s anaphylaxis
emergency kit

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3. Provide basic life support;
4. Administer Adrenaline 0,1 %, 0.3 ml s/c*;

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QUALITY MANAGEMENT

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 There will be an evaluation of the continuity and coordination of care that patients receive.
Q UALITY M ANAGEMENT
PURPOSE
To establish systems and processes within Dentus Dentino that will help assure the provision of high quality oral
health care as well as identify any deficiencies in the patient care process as opportunities for performance
improvement. The Quality Management Program also establishes, monitors and reports on metrics designed to
measure the outcomes of oral health care provided on both an individual and population basis.
PROGRAM OVERVIEW
The Quality Management Program at Dentus Dentino is based on the report by the Institute of Medicine (IOM). In
this report, the IOM urges providers to adopt a shared vision of six specific aims for improvement. These aims are
built around the core need for health care to be:
 Safe: avoiding injuries to patients from the care that is intended to help them.
 Effective: providing services based on scientific knowledge to all who could benefit, and refraining from
providing services to those not likely to benefit.
 Patient-centered: providing care that is respectful of and responsive to individual patient preferences,
needs, and values, and ensuring that patient values guide all clinical decisions.
 Timely: reducing waits and sometimes harmful delays for both those who receive and those who give
care.
 Efficient: avoiding waste, including waste of equipment, supplies, ideas, and energy.
 Equitable: providing care that does not vary in quality because of personal characteristics such as gender,
ethnicity, geographic location, and socioeconomic status.
The Quality Management Program is intended to provide Dentus Dentino with a tool to aid in the improvement of
quality within our practice. In no way should it be construed as a punitive system. We developed it, for ourselves
and our patients, so that we can systematically monitor and improve the care provided as well as the satisfaction
of such, by both the patient and ourselves.
CHARTING SPECIFIC PATIENT TYPES/SCENARIOS
Adult Charting
All adult patients (18 or older) of record must have the following in their chart notes:

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 There will be an evaluation of the continuity and coordination of care that patients receive.
 An initial/ recall exam with recording of both the hard and soft tissue findings
 X-ray

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 A sequenced treatment plan
 Signed consents for the following procedures:
 Root canals
 Any surgical procedures
 Endodontic procedures
 All medications prescribed including the name, amount prescribed and directions for use
 Type and amount of anesthetic used
 Description of the procedure(s) completed including all materials used
 A note to indicate that post-op or pre-op instructions were given
Pediatric Charting
All pediatric patients (younger than 18) of record must have the following in their chart notes:
 An initial/ recall exam with recording of both the hard and soft tissue findings.
 A sequenced treatment plan
 Blood pressure only as needed (e.g.- sedation appointments or specific medical issues)
 X-ray

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 Complete medical history with the alert box filled in as appropriate for any medical issue that could affect
the dental care provided. The history needs to be reviewed at each appointment with a new history
completed once per year.
 A description of their periodontal condition and a periodontal diagnosis.
 Signed consents for the following procedures:
 Root canals
 Any surgical procedures
 Endodontic procedures
 All medications prescribed including the name of the drug, amount prescribed and directions for use
 Type and amount of anesthetic used
 Description of the procedure(s) completed including all materials used
 A note to indicate that post-op or pre-op instructions were given.
Emergency Charting
All Dental Emergency Patient chart notes must include the following:
 A complete medical history with the alert box filled in, as appropriate, for any medical issue that could
affect the dental care provided.
 The patient’s description of pain
 All diagnostic tests required to diagnosis the problem (e.g. – EPT, cold/heat sensitivity, percussion,
mobility, swelling/fistula)
 All radiographs needed to diagnose the problem. The apex of the root must be visible on any periapical
film.
 A specific diagnosis based on subjective and objective findings
 A complete description of any procedure done during the appointment

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 All medications prescribed including the name of the drug, amount prescribed and directions for use.

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CLINIC OPERATIONS

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H OURS OF O PERATION
09:00-18:00
A FTER -H OURS E MERGENCY C OVERAGE

[re-insert information on After-Hours Emergency Coverage here]
S COPE OF S ERVICES P ROVIDED
-Dental bonding
-Dental crowns
-Bridgework
-Dental veneers
-Teeth cleaning
-Dentures
-Root canal therapy
-Teeht whitening
-Tooth extractions
-Dental implants
-Bone grafting
-Endodontic retreatment
-Dental braces
-Lingual braces
-Bad bite treatment
-Smile designing
-invisalign treatment
-pediatric dentistry
-Laser teeth whitening

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S CHEDULING
P URPOS E
To maintain consistency and efficiency in the scheduling of patients for dental services.
P OL ICY
Patients who call the clinic seeking care will be offered the first available appointment for their type of visit.
Appointments are scheduled using easyplan.pro .
P ROCE DURE
All scheduling will be done by front desk staff. Other dental staff are not permitted to schedule or change
appointments already in the system. Dental appointments are not scheduled out beyond 30 days.
T HE FOLLOWING GUIDELI NES ARE TO BE USED I N SCHEDULING PATIENTS :
Emergency Care
Front desk staff will follow the Clinic’s Emergency Policy in triaging patients seeking emergency care (pain,
swelling, fever, trauma, hemorrhage, complaint related to recent treatment in the Clinic, etc.)
One emergency patient can be worked into each session (morning and afternoon). Other patients with bona fide
emergencies can be offered the opportunity to come to the Clinic and wait in case a scheduled patient fails to
show for an appointment. At the conclusion of each morning and afternoon session, any emergency patients
remaining unseen will be seen. Care must be taken by the front desk staff not to overwhelm the clinical staff with
emergency patients. The rule of thumb should be for only one waiting patient per session per dentist available.
The duration time for Emergency appointments is 15-30 minutes. Emergency patients can be seated in any open
chair. Dental assistants or hygienists can prepare the patient for examination by the dentist (record the patient’s
complaint and take any necessary x-rays).
The dentist will assess the patient and provide all necessary palliative care. If definitive care can be provided in the
time available, it should be done whenever possible. Patients needing follow-up services will be offered an
appointment. In the event multiple visits are needed to complete the treatment plan, schedule only one
appointment at a time. When the patient shows for that appointment, schedule him or her for the next
appointment, and so on.

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New Patient Appointments
All new patients will be given 15 minutes appointments for a consulation.
Patients will receive full-mouth x-rays ,prophy (cleaning), exam and treatment planning. In addition, children will
receive fluoride treatment.
Patients needing follow-up services will be offered an appointment. In the event multiple visits are needed to
complete the treatment plan, schedule only one appointment at a time. When the patient shows for that
appointment, schedule him or her for the next appointment, and so on.
Recall Appointments
All recall patients will be given 15-60 minute appointments .
Patients needing follow-up services will be offered an appointment. In the event multiple visits are needed to
complete the treatment plan, schedule only one appointment at a time. When the patient shows for that
appointment, schedule him or her for the next appointment, and so on.
Restorative or Periodontal Services
Patients needing restorative services (amalgam or composite fillings, extractions or denture adjustments) or
periodontal services will be given 60 or more-minute appointments with a dentist.
Endodontic Services
Patients needing root canal treatment will be given 60-minute or longer appointment with a dentist.
Dentures
Patients needing dentures (full or partial) will be 30-60 minute appointments with a dentist. In order to provide
continuity and timeliness in the fabrication of the denture(s), appointments can be scheduled in 10-day intervals
with up to four appointments to be made. This is, of course, a risk to the practice. If the patient misses any one of
the prescheduled appointments, all others are cancelled and the patient is required to come to the office and
meet with the practice manager to reappoint. When the multiple appointments are initially made, a document
should be signed and placed in the patient`s chart indicating that they understand the arrangement.

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Post and Cores
Patients needing post and core services will be given 45-minute appointments with a dentist.
Crown and Bridge
The initial appointment for a crown and bridge visit is 60 minutes for a single crown, one hour for two abutments,
and one and a half hours for three abutments . The visit length for delivery of the crown or bridge is 30-90
minutes.
Both types of visit are booked with a dentist.

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E LIGIBILITY
P URPOS E
To ensure that the dental clinic is reimbursed for all oral health services provided to patients.
P OL ICY
Dental staff will determine the eligibility of all patients who are scheduled to receive oral health services before
services are provided. The method by which eligibility will be determined may vary depending on the insurer
(telephone, point-of-service machine or internet). Patients who are determined to be ineligible for services will be
offered the opportunity to reschedule to a time when they will be eligible for services or pay out-of-pocket at the
time services are delivered, using the Health Center’s sliding fee scale, if appropriate. Patients needing urgent or
emergent care will be seen as soon as possible regardless of eligibility for services.
Procedure
Determination of eligibility is the primary responsibility of the dental registration/reception staff.
When an appointment is scheduled for a patient, the reception/registration staff will update the patient
demographics (e. g., name, address, and contact information) and verify the source of primary and any secondary
insurance coverage.
The dental reception/registration staff will then determine the patient’s eligibility for the services to be provided
using the fastest and most accurate method available for the patient’s insurer.
If the patient is determined to be ineligible for the proposed services, he or she will be offered the opportunity to
reschedule the appointment for a time when they will be eligible or pay out-of-pocket at the time services are
delivered, using the Health Center’s sliding fee scale, if appropriate.
Patients with bona fide emergency dental needs (pain, swelling, infection, trauma or hemorrhage) will be seen as
soon as possible regardless of eligibility for services.

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P AYMENT FOR D ENTAL C ARE P OLICY
P URPOS E
To guide the management of patients who are required to pay for services provided in the dental program (either
uninsured patients or patients with insurance co-payments). Dentus Dentino encourages patient education to
ensure that patients are informed about their financial and other responsibilities in the dental care process.
P OL ICY
All patients and families are educated about their payment for care as well as their required insurance co-
payments for each dental visit as outlined in their dental insurance contracts. Patients are also advised of their
Annual Dental Benefit allowance per insurance contract if it applies and services that are not covered under their
plan. In addition, patients are made aware of procedures that are NOT covered by their insurance plan and/or
Medicaid insurance guidelines. Patients are responsible for any insurance claims denied as a result of lack of
eligibility or termination of coverage of services as well as additional fees that are not covered by their plan.
Notices regarding Dentus Dentino’s Payment Policy will be posted prominently in the Dental Department.
N EW P ATIENTS
 When a new patient arrives at Dentus Dentino, the front desk gives him/her a copy of the Dental Patient
Information Sheet and Signature Page which outlines the Assignment of Benefits, Financial Agreement,
Authorization of Dental Treatment and Medical Dental History Attestation.
 Based on the patient’s insurance status, the patient receives information about his/her responsibilities.

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B ROKEN A PPOINTMENTS
P URPOS E
To guide the management of dental patients who do not keep appointments or cancel without sufficient notice
(defined as less than 24 hours) and maximize access to care for those patients who are responsible about keeping
appointments.
P OL ICY
Patients who fail to keep 3 of appointments within will have all pending dental appointments cancelled. They will
be notified that they will not be allowed to schedule any further appointments .
P ROCE DURE
As a courtesy, patients will be reminded of their scheduled appointments. Patients, however, are still responsible
for their appointments regardless of a successful reminder.
Patients who do not arrive for an appointment (or cancel with less than 24 hours’ notice) will be documented as
having missed their appointment and advised of the consequences of missing a second appointment.
Patients who miss a second appointment Dentus Dentino (or cancel with less than 24 hours’ notice) will be
documented. All future appointments for these patients will be cancelled.

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E MERGENCY P ATIENTS
P URPOS E :
To guide the care of patients calling or walking in to Dentus Dentinon for emergency treatment
P OL ICY :
Patients presenting with pain, swelling, acute infection, fever, hemorrhage or trauma will receive a 15-60-minute
appointment for diagnostic evaluation and definitive treatment. Palliative care will only be provided if definitive
care is contraindicated or if the provider does not have sufficient time in the schedule to provide definitive care. If
further treatment is needed, the patient will be advised to call the clinic one or two days after the visit to schedule
the appointment. Patients seeking emergency care who were recently treated in the clinic will also be seen the
same day they call or walk in. Front desk staff will be responsible for the triage and scheduling of all emergency
patients.
P ROCE DURE :
 All calls or walk-ins for emergency care will be triaged by the front desk staff. Patients with the following
complaints will be seen the same day:
o Pain
o Swelling
o Acute infection
o Fever
o Hemorrhage
o Trauma
o Patients with any complaint related to recent treatment in the clinic

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 In the absence of any of these complaints, patients with such problems as lost fillings or broken teeth or
patients seeking a denture adjustment (unless recently fitted in the clinic) do not constitute emergencies
and will be scheduled for a regular appointment or double booked at the request of the treating dentist.
 If there are unfilled slots in the daily schedule, emergency patients will be given a 15-60-minute
appointment for diagnostic evaluation and palliative treatment. If all the slots are filled, patients calling
in the morning will be told to come in and wait for a slot to open (as the result of a no-show or
cancellation). If no slots open up, the patient will be seen by the dentist at the conclusion of the morning
session (i.e., during the lunch break). Patients calling after lunch will also be told to come in and wait for
an open slot. If no slots open up, the patient will be seen by the dentist at the conclusion of the afternoon
session. Under no circumstances will a patient who was told to wait be turned away from the clinic
without being seen.
 To facilitate the evaluation and treatment of emergency patients, dentists can use unfilled chair time.
Either hygienists or dental assistants (if not currently assisting a dentist) can prepare the patient and
take any necessary x-rays.

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C LINICAL P ROTOCOLS
P URPOS E
To ensure that all patients of Dentus Dentino receive the same level of care.
P OL ICY
Dental staff will consistently follow clinical protocols which are designed to standardize the types of
services provided to patients. These clinical protocols will be reviewed annually by the Dental Director
and any changes made will be communicated to clinical staff. Through the Quality Assurance audit
process, the Dental Director will monitor the clinical staff’s success in consistently following clinical
protocols.
P ROCE DURE
Dental registration/reception staff will determine the eligibility of each patient for scheduled services
each time they come in for treatment. All patients will be considered self-pay (full pay) patients until
their state or private dental insurance has been confirmed or their eligibility for the sliding fee discount
schedule has been determined.
When patients are scheduled for appointments, the dental reception/registration staff will identify the
services to be provided based on the treatment plan and the following protocols unless otherwise
directed by the patient’s dental provider.
R ADIOGRAPH G UIDELINES :
A LL N E W P A TI E NTS :
 All new patients with clinical evidence of generalized oral disease or a history of extensive
dental treatment will receive a full mouth intraoral radiographic exam. Otherwise patients will
receive an individualized radiograph examination consisting of posterior bitewings with
panoramic exam or posterior bitewings and selected periapical images.

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D ENTAL R ECORD K EEPING
P URPOS E :
To have complete dental records with accurate information.
P OL ICY :
Records contain certain forms and charts which support treatment of the patient
P ROCE DURE :
The safety of each patient record is the provider’s responsibility while in his/her care. Any lost records must be
accounted for. All records must be returned after each appointment to the designated box in the reception room.
All record forms, whether paper or electronic, should be completed and signed.
 Patient information and consent from treatment must be done for every patient;
 The parent or guardian will sign a consent form for any patient under 18 years of age;
 Work of any nature must not be initiated without a signed consent form;
 Tell the parent at the time when the appointment is made to come in with the child at least 15 minutes
earlier to sign this form and the medical history;
 Emphasize the child will be sent home untreated unless we have this information; and
 Completed health questionnaires (medical history).
Most medical emergencies can be prevented by taking an accurate medical history and by updating the
information every time the patient has an appointment at the dental office. The dental team should be aware and
alerted of the following:
 Specific physical conditions that may lead to an emergency.
 Diseases for which the patient has been under the care of a physician with type and/or
treatment including medications.
 Allergies or drug reactions.

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Significant conditions and allergies must be flagged with the following stickers:
Allergic to or Medical alert both of which are red and white in color
T HE F OL L O W I NG STE PS M U ST BE F OL L OW E D :
Records document recommends the following be included:
• Database information, such as name, birth date, address, and contact information;
• Place of employment and telephone numbers (home, work, mobile);
• Medical and dental histories, notes and updates;
• Progress and treatment notes;
• Diagnostic records, including charts and study models;
• Medication prescriptions, including types, dose, amount, directions for use and number of refills;
• Radiographs;
• Treatment plan notes;

Treatment Planning
Once all the information is gathered and recorded, the dentist will make a diagnosis of the patient’s conditions. A
treatment plan is documented and the patient is informed of his /her needs.
Dental Progress Notes
Once the procedure is completed, the treatment provided to the patient needs to be documented. Documentation
is accomplished by abiding to the following steps:
 Medical History updates and vital signs, if taken
 Type and amount of anesthetic used, if applicable
 Tooth treated and the surfaces involved
 Types of dental materials used
 And a brief, concise note on how well the patient tolerated the treatment
 The notes must be clear, short and using ink
 Signature and title of the provider must be entered at the end of the progress note

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 rdinator will keep a log with information on biopsies to assure proper follow

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P ATIENT R ECORDS
P URPOS E
To establish guidelines for the creation, updating and storage of patient records.
P OL ICY
 A medical/dental record will be retained on all patients accepted for treatment to the clinic. The
medical/dental record is the property of the clinic. The medical/dental record is maintained for the
benefit of the patient, the professional staff and the clinic.
 The clinic will keep in one centralized location on its premises records indicating all the services rendered
to clinic patients. Active Medical Records (records of patients with a visit date within three years) will be
retained on site within the clinic. These records will be located in the records area.
 The professional staff will have access to the medical/dental records for the clinical analysis and
treatment plan development. The administrative staff will have access to the medical/dental records for
bookkeeping and billing.
 Records will contain sufficient information to justify the diagnosis (es) and treatment, and to document
the results accurately.
 Each patient shall have a single integrated record.
 Each entry into each patient record shall be dated and authenticated by the staff member making the
entry, indicating name and title
 Each page of each patient's record shall have two unique forms of identification.
 The record with respect to each patient shall include the following:
o Patient's name, date of birth, sex, home address and telephone number, and sponsor or
responsible party, if any;
o Date of each patient visit with clinic staff at the clinic or satellite clinic;
o Medical or dental history, as appropriate;
o Diagnostic observations, evaluations, and therapeutic plans;

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o Orders for any medication, test, or treatment;
o Records of any administration of medications, treatment, or therapy;
o Laboratory, radiology, and other diagnostic reports;
o Progress notes;
o Reports of any consultations, special examinations, or procedures;
o Operative and anesthesia records;
o Referrals to other providers and/or agencies;
o Documentation that informed consent has been obtained for surgical procedures and other
treatment where required by law; and
o Discharge summary, when appropriate.
P ROCE DURE
 The clinic will keep records indicating all the services rendered to clinic patients
 All patient records will be kept in the records file cabinet located in the administrative area of the clinic;
 Special care and attention will be taken by all staff to ensure patient privacy and security of patient
records. Patient records will be locked in the records room. The Practice Manager will have responsibility
for the safeguarding of patient records;
 When Electronic Dental Records (EDR) are utilized, the main server will be housed on site in a locked
room. Access to the server will be limited to the IT Director, Practice Manager and Dental Director. The
EDR will be password protected and only accessed by the necessary designated staff. Passwords will
automatically be required to be changed every 60 days. When computers and monitors are within
each operatory, the monitor screen will go to screen saver within 5 minutes of idle;
 Records will be documented to include diagnosis(es), treatment, and to document the results accurately;
 When mobile or portable services are utilized, the records for services provided by the mobile or portable
dental service will be maintained on the premises of the clinic and not at host locations;
 Each patient has a single integrated record, except those that may be filed separately on the premises,
provided there is an effective cross-referencing system

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 Patient records will be dated and authenticated with each entry by the staff member making the entry,
indicating name and title;
 The patient's record will be filed by patient name and chart number;
 See the example of the patient record in this section showing all pertinent information required.

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R ETENTION OF D ENTAL R ECORDS
P OL ICY
 Inactive Medical/Dental records (records of patients who haven’t had a visit to the clinic within 3 years)
will be retained on site within the clinic.
 The clinic does not consider radiological films, scans, other image records as part of the medical record
subject to the retention requirements provided that any signed narrative reports, interpretations or,
sample tracings that are generated to report the results of such tests and procedures shall be maintained
as part of the record. Such records as described will be retained for a period of at least five years
following the date of service. The purpose of this requirement is to establish a minimum retention period
and does not preclude clinics from maintaining records for a longer period of time.
 Dental/medical records retained by the clinic will be made available, for inspection and copying, upon
written request of the patient or his/her authorized representative. The clinic may charge a reasonable
fee for copying, not to exceed the rate of copying expenses.
 Each clinic maintains patient records under lock or code and uses them in a manner to protect the
confidentiality of the information contained therein.
 Printed copies of electronically stored records will be disposed of in a manner which assures
the confidentiality of patient information.
 Any time patient health information is discarded, it will be placed in a special secure receptacle and
shredded appropriately.
P ROCE DURE
 The clinic will maintain records of the diagnosis and treatment of patients under their care for 30 years
after the discharge or the final treatment of the patient to whom it relates.
 Dental/medical records retained by the clinic will be made available, for inspection and copying, upon
written request of the patient or his/her authorized representative. The clinic may charge a reasonable

P a g e | 99
fee for copying, not to exceed the rate of copying expenses. Patients will be required to sign this form
when they request copies of their records or request copies be sent to another practice. Patients will be
charged the cost of copying for those records being released to either the patient or another practice.
This signed form will be kept in the patient’s record at the clinic.
 All records beyond the retention time will be shredded and discarded in accordance will all laws and
regulations to protect patients’ privacy.

100
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S TERILIZATION AND D ISINFECTION OF P ATIENT -C ARE I TEMS

Proper sterilization and disinfection of patient-care items is of utmost importance in an infection-control program.
Patient-care items (instruments, equipment and devices) are placed in one of the following three categories,
depending on their risk for causing infection:
Critical items are used to penetrate soft tissue or bone. Examples include surgical instruments and
periodontal instruments. These have the greatest risk of transmitting infection and therefore must be
sterilized by heat.35
Semicritical touch mucous membranes inside of the mouth. Examples include dental hand pieces, mouth
mirrors, x-ray holders, and amalgam/composite instruments. These also should be sterilized by heat. 36 If
the equipment is not heat-stable, it should be processes with a high-level disinfectant. Although dental
hand pieces are considered semi-critical, they must always be heat sterilized between patients.
Four levels of disinfection or sterilization are used depending on the level of contamination and the categories of
equipment or surfaces: sterilization, high-level disinfection, intermediate-level disinfection, and low-level
disinfection. Sterilization is a process of destroying all forms of microbial life, including bacterial spores. 37
Disinfection is a process of eliminating most or all pathogenic microorganisms except bacterial spores. Cleaning is
the process of removing foreign matter from an object. The following table, adapted from CDC
recommendations,38 outlines Dentus Dentino’s infection/sterilization methods.

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M AINTENANCE AND S ANITATION
P URPOS E
To keep supplies and equipment safe, sanitary and in good working condition as necessary for the dental services
performed by dental clinic staff.
To insure the safety of patients and staff from contaminates caused by infectious and hazardous waste.
P OL ICY :
 The clinic will keep supplies and equipment safe, sanitary and in as good working condition as necessary
for the dental services performed by dental clinic staff.
 The clinic assures the safe disposal of infectious and hazardous waste
P ROCE DURE
Shelf Life
 The clinic staff responsible for supplies will inventory and discard supplies used for examination or
treatment of patients when beyond their shelf life;
 Weekly Inventory for supply shelf life will be conducted;
 All expired items will be discarded and reordered as necessary; and
 In general, if a dentist, assistant, hygienist or office staff at any time notes that a dental supply is expired
or that the integrity of the packaging is damaged, she/he will discard the item and notify the designated
dental staff member to reorder such supplies.
Disinfection
The clinic will disinfect diagnostic and therapeutic equipment after each use in accordance with recognized
standards of practice.
Sterilization
 The clinic will sterilize after each use, non-disposable equipment and supplies that require sterilization.

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 Single use disposable items will be discarded.
 Sterilized materials will be packaged and labeled to assure sterility.
 For those items with less frequent use, the date sterilized will be indicated.
Sterilization Equipment
 The clinic maintains sterilization equipment adequate to the needs for the purpose of
sterilizing equipment and supplies as required.
 The clinic has an arrangement to obtain such services from a vendor who is credentialed to conduct such
services.
 A log will be maintained recording spore testing submission and results.

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Safety of Equipment
 The clinic has a preventive maintenance program to ensure all equipment is in safe working order;
 A maintenance check is performed annually on all mechanical and electronic medical equipment;
 All electrical equipment is properly grounded and calibrated and consistent with
manufacturer's recommendations;
 On the first day of each month, the designated maintenance staff will evaluate all non-electrical
equipment used in the clinic areas for safety of use;
 Equipment to be inspected will include, at a minimum: chairs, lights, electrical equipment, equipment
carts, uniforms, and etc.;
 If an item is believed to be unsafe and cannot be repaired immediately, the maintenance staff person will:
 Notify the Dental Director immediately;
 If possible, remove the item from the clinic area;
 Notify the landlord or appropriate vendor to arrange for repair or replacement; and
 The Log will remain in the possession of the practice manager and will be reviewed monthly by the
Quality Assurance Officer.

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Processing Contaminated Equipment
The sterilization area at Dentus Dentinois roughly divided into four areas. They are:
 receiving, cleaning, and decontamination;
 preparation and packaging;
 sterilization; and
 storage.
D IGITAL X-R AY S ENSORS , I NTRAORAL C AMERAS , AND H IGH -T ECH

I NSTRUMENTS
The taking of x-rays can easily create cross-contamination problems if proper technique is not followed. The x-ray
tube head and control panel/button are covered with a barrier cover. Should barrier covers not be in place and
contamination occurs, the equipment is disinfected with the same disinfectant we use for clinical contact surfaces.

107
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C ONSULTATION , E XAMINATION AND T REATMENT A REAS
P URPOS E
The clinic provides consultation, examination, and treatment areas appropriate to the services provided by the
clinic.
P OL ICY
The clinic has furnished and arranged the areas in a manner that is consistent with their use and that safeguards
the personal dignity and privacy (in terms of both sight and sound) of the patient during interview, examination
and treatment. If separate consultation or interview rooms are not provided, the treatment area shall have floor
to ceiling partitions to assure minimum sound transmission
The clinic provides consultation in an area that is private.
The area where x-rays are taken are in compliance with all state and federal regulations.
S TERILIZATION A REA
P URPOS E
The clinic provides a utility area which is apart from any examination, or treatment area.

P a g e | 110
P OL ICY
The utility area has a clean work area with a counter hand washing sink with hot and cold water and storage for
clean supplies and instruments
The soiled workroom area shall contain a work counter, a clinical service sink, and if physically separate from the
clean work area, a hand washing sink with hot and cold water.
P ROCE DURE
 Each dental assistant and dental hygienist will be responsible for the cleaning, disinfecting and
sterilization of instruments;
 Instruments and disposable items from each patient will be brought to the soiled area after each patient.

P a g e | 111

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F LOOR P LANS
[insert floor plans)
D IAGNOSTIC R ADIOLOGY F ACILITIES
P OL ICY
 The clinic provides diagnostic radiology services in adequate and suitable form for the services provided;
 X-ray equipment is appropriate to the diagnostic services offered by the clinic; and
 At a minimum, the clinic will provide at least one radiographic room of adequate size for the
equipment provided.
P ROCE DURE
 The clinic will obtain all necessary certificates as required by state law for radiology facility and
equipment.

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 The clinic will provide adequate storage space for exposed films which will be located in the patient’s
dental record.
H AND WASHING AND T OILET F ACILITIES
P URPOS E
The clinic provides conveniently located hand washing and toilet facilities adequate for patients and personnel, as
appropriate to the services provided by the clinic.
P OLICY
 A soap dispenser, disposable towels or electronic hand dryers, and a waste receptacle shall be provided at
each hand washing sink;
 The clinic provides a hand washing facility with hot and cold water and blade type operating handles or
knee or foot controls, immediately available and convenient to each examination and treatment area.
P ROCE DURE
 A staff member will be assigned to maintain the soap and towel dispensers in the toilet facilities unless
this responsibility is outlined in a contract with a cleaning company;
S TORAGE S PACE
P URPOS E
The clinic needs storage space adequate and suitable for equipment and bulk office supplies.
P OL ICY
The clinic provides storage space adequate and suitable for equipment and bulk office supplies
P ROCE DURE
 The office manager is responsible for maintaining and ordering office supplies.
P a g e | 114
 A member of the clinical staff will be responsible for maintaining adequate clinical supplies and
equipment and ordering when clinical supplies are needed.

P a g e | 115
 A weekly inventory will be taken to insure adequate supplies. Items whose date has expired will be
discarded and new material ordered.
V ENTILATION
P URPOS E
The clinic provides all rooms with satisfactory mechanical ventilation that do not have direct access to the outside,
including toilets and utility areas.
P OL ICY
[insert Floor Plan showing ventilation and explanation from contractor on ventilation]
A DMINISTRATION OF R ECORDS
P URPOS E
The clinic maintains current, complete, and accurate administrative records in a safe location.
P OL ICY
 Updated articles of organization and by-laws, partnership agreement or trust instrument, as appropriate.
The document specifies the organizational structure of the governing body and the methods of the
selection of its members;
 Minutes of meetings of the governing body and of the members;
 An organizational chart for the entire organization;

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 Written policies and procedures designed to safeguard the health and safety of patients and staff. These
policies and procedures are reviewed and updated annually. At a minimum the policies address:
 Selection of personnel and the qualifications for each position;
 A job description for each position is included in the administrative records;
 Employee health policies that assure employees are free of communicable disease.
 Patient admission criteria;
 The provision of emergency care and the retention of emergency equipment appropriate to the clinic’s
patient population;
 Obtaining informed consent for surgical procedures and other treatment where required by law;
 A policy for off-hour coverage posted conspicuously in the clinic and any of its satellite clinics.
 The disposal of hazardous and infectious waste;
 Infection control;
 Services which the clinic provides;
 Smoking on the premises. Such policies shall assure the comfort of all patients including patients in
waiting areas;

P a g e | 117
 Procedures for complying with laws and regulations relating to reportable diseases and conditions;
 Procedures for assuring that all patients of a clinic that provides mobile or portable medical services at
host locations are provided with written information that clearly identifies the clinic, and not the host
location, as the licensed health care facility responsible for the service provided; and
 Personnel records for each employee, including evidence of any required license or registration number;
documentation of any specialty certification, education and job experience.

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HUMAN RESOURCES

P a g e | 185
C LINIC A DMINISTRATOR
P OL ICY
The clinic will designate a person to administer the clinic and who will assume responsibility that it complies with
applicable statute and regulations.
P ROCE DURE
 The Practice Manager will serve as the Clinic Administrator. This title is interchangeable with Office
Manager.
 The job description is found at the end of this section.
P ROFESSIONAL S ERVICES D IRECTOR
P OL ICY
The clinic will designate a professional services director, who will be responsible for the clinical services provided
at the clinic. The professional services director must be a health care professional possessing academic training and
experience in direct patient care and shall be qualified to direct the services provided by the clinic.
P ROCE DURE
1. The Dental Director will serve as the Professional Services Director.
2. The job description is found at the end of this section.
H EALTH C ARE /D ENTAL S ERVICES S TAFF
P OL ICY
 The clinic will retain sufficient qualified professional health/dental care staff to render adequately and
appropriately to each patient's needs.

P a g e | 186
 Professional health/dental care staff shall be registered or licensed as required by law.
 Professional health/dental care staff will comply with the regulations of their registration or licensing
boards.
P ROCE DURE
 At least one professional health care staff member will be present when the patient health care services
are being provided in the clinic.
 The clinic will be staffed with one or more dentists as necessary to provide or supervise the provision of
dental services.
 Dental hygienists employed by the clinic shall be registered by the state dental board.
 Dental assistants employed shall meet the requirements of the state dental board.
 It is the individual responsibility of the dentists and dental hygienists to maintain authenticated records of
continuing education completed and to submit evidence of completion of the above requirement to the
Board when requested. These records must be retained in compliance with the state dental licensing
board.
 Individual Personnel Files contain detailed information on each staff person including credentials, PHI and
Professional Liability Insurance where appropriate.

P a g e | 187
O RIENTATION
P URPOS E
To ensure that new employees of Dentus Dentino are comfortable in their new work environment and can
perform their job functions efficiently and effectively from their first date of hire.
P OL ICY
Every new employee will participate in an orientation program that will include a tour of the clinic, a tour of the
Dental Department and a review of all relevant policies and procedures. This orientation will take place as soon as
possible after the date of hire.
P ROCE DURE
The new employee will attend the mandatory orientation program for all new hires of the clinic. In addition, the
Dental Practice Manager will provide an orientation to the Dental Department. The following is a list of potential
topics for the orientation of new dental staff:
 Where to turn for information and guidance;
 How to operate the health record system;
 Which employees they will supervise and which employee is their supervisor;
 The availability of clinic resources (supplies, equipment, money, contracts, laboratories, consultation,
patient referrals);
 Performance evaluation metrics;
 Standards of conduct and performance;
 Dress code;
 Contents of employee handbook;
 Community culture, social, and economic information; and
 Any necessary cross-cultural training.

P a g e | 188

P a g e | 217
EXPOSURE PREVENTION & MANAGEMENT

P a g e | 218
M ERCURY E XPOSURE
While the FDA has recently ruled that mercury amalgams pose no health threat to patients, dental personnel need
to use caution in the use, storage and disposal of mercury amalgam. [insert name of clinic]’s amalgam protocols
follow the recommendations of the National Maternal and Child Oral Health Center’s online Safety Net Dental
Clinic Manual:63
 Only precapsulated alloy is used so that there are no bottles of mercury to store. If, for some reason,
elemental mercury must be stored, it is stored in an unbreakable, tightly sealed containers on stable
surfaces.
 All operations involving mercury are conducted in an area with an impervious and suitable lipped surface
so as to confine and facilitate recovery of spilled mercury or amalgam.
 Any spilled mercury is cleaned immediately.
 A no-touch technique is used for handling amalgam. If contact is made with mercury, the area affected is
be washed with soap and water to reduce the time that the microscopic particles cling to the skin.
 Only tightly-closed disposable capsules are used during amalgamation.
 Non-contact, scrap amalgam is placed into a wide-mouthed, airtight container.
 Salvage contact amalgam pieces from restorations after removal. Store and label contact amalgam waste
separately from non-contact waste. Recycle the contact amalgam waste according to instructions
provided by your recycler.
 Amalgam scraps are recycled through refiners who are properly licensed by the EPA. [insert clinic name]
contracts with [environmental company].
 Water spray and high-volume evacuation is used when removing old amalgam restorations or finishing
new ones. A fiber-type mask should is worn when cutting out old amalgams. Evacuation systems have
traps or filters.
 No excess mercury is expressed from amalgam.
 Disposable items contaminated with mercury are discarded in properly sealed containers.
[Before implementing this policy, check with local and state laws]
63
Safety Net Dental Clinic Manual . National Maternal and Child Oral Health Center.
http://www.dentalclinicmanual.com/docs/Mercury.doc

P a g e | 219
C LEANUP OF S PILLED M ERCURY

In the event of a mercury spill, [insert name of clinic] follows the protocols recommended by the EPA64 and the
National Maternal and Child Oral Health Center:65
If the spill is more than the amount of mercury present in a thermometer or thermostat, the room is ventilated
and evacuated and the following environmental company is called: [name of environmental company].
If the spill is less than the amount of mercury in a thermometer or thermostat, then personnel may clean the area
while wearing a mask and gloves The spilled area is cleaned immediately with a wash-bottle trap, handheld pump,
aspirator bulb, or plastic syringes. Adhesive tape, tin foil, or a fresh mix of dental amalgam can remove droplets of
mercury if undisturbed. Commercially available clean-up kits may be used. The area is ventilated and evacuated for
24 hours. If there is any concern that not all of the mercury has been removed, or that the area has not been
properly cleaned or ventilated, [name of environmental company] is consulted.
[Before implementing this policy, check with local and state laws]
64
Mercury Spills. EPA. Retrieved 10/2014. http://www.epa.gov/hg/spills/index.htm#morethan
65
Safety Net Dental Clinic Manual . National Maternal and Child Oral Health Center.
http://www.dentalclinicmanual.com/docs/Mercury.doc

P a g e | 220
R ADIATION E XPOSURE
P OL ICY
[consult state and federal laws with regards to radiation requirements with regards to:
 Inspection and testing for the facility, X-ray machine, radiation monitoring equipment and radiograph
processing equipment
 Permits or licensing
 Supervision of personnel
 Use of dosimetry badges
 Training or certification
 Dental office design and radiation shielding
 Record keeping
 Equipment]
P ROCE DURE
[state procedures for operating radiation equipment]
-telefon de urgenta dupa ora 18:00, simbata si duminica

-simbata medici de garda pentru a acorda primul ajutor medical
Standard de procedura

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[insert information here]

M ISSION /V ISION S TATEMENTS

P RINCIPLES OF THE D ENTAL P RACTICE

 To provide dental services that are accessible to everybody’s needs by creating:

A SLIDING FEE SCALE SC HEDULE

 To introduce children to the dental clinic as early as possible; and

 To integrate oral health with overall health.

D ENTAL S ERVICES P ROVIDED

A FTER -H OURS C OVERAGE

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P OSTING OF N OTICE OF P ATIENTS ’ R IGHTS

 “Patient Rights and Responsibilities” will be posted in the clinic area.

 “Our Commitment to Patients” will be posted in the clinic area.

P ATIENT R IGHTS AND R ESPONSIBILITIES

 You have the right to reasonable access to dental services;

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 You have the responsibility to express concerns to Dentus Dentino;

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2400 Computer Drive Westborough, MA 01581 T: 508.329.2280 W: dentaquestinstitute.org

2400 Computer Drive Westborough, MA 01581 T: 508.329.2280 W: dentaquestinstitute.org

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E nevoie de inserat exemplu de acordul de confidențialitate

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S AMPLE C ONFIDENTIALITY A GREEMENT

 Except in situations where a patient is discussed on a professional-to-professional basis, patient

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 Protection of the patient’s right to privacy; and

 Pertinent statutes, regulations and legal rulings.

 Governmental agencies (Social Security Administration, Veterans Administration, etc.);

 Relatives (including spouse) and friends;

 Private insurance companies; and

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A signed release of information is usually not required in the following situations:

 Review by a third party payer;

 Inspection upon order by authorized representatives of the Department of Public Health;

 Release to a medical staff member who attended the patient;

 Response to subpoenas; and

T HE P ATIENT ’ S R IGHT TO H IS /H ER M EDICAL R ECORD

Content of the Authorization

To be valid, a patient’s authorization to release medical information must:

 Identify the patient;

 Generally describe the health care information to be disclosed;

 Be given by one of the following means:

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All authorizations must be permanently retained within the medical record.

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S AMPLE A UTHORIZATION TO R ELEASE P ATIENT R ECORDS

Date of Birth: Phone number:

I authorize Dentus Dentino to transfer my dental records to:

Employee Signature Date

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P ATIENT C OMPLAINTS /I NCIDENTS

 Notification of the complainant of the outcome of the investigation.

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 Reports should be in writing and either mailed, faxed or emailed to:

o [Gladei Angela, Gheorghe Asachi street 4, +37368966969]

2400 Computer Drive Westborough, MA 01581 T: 508.329.2280 W: dentaquestinstitute.org