Sample Notification Letter To Patients Regarding Dentist's Death or Incapacity
To avoid claims of abandonment, dentists who are separating from practice (or the families of deceased or incapacitated dentists) must notify patients in writing.
Credit Card Authorization Form
Utilize this form when offering patients automatic credit card payments. Be certain to comply with your merchant card processor's security standard for this type of payment.
Financial Agreement and Consent Form
Tool to utilize during the patient financial discussion to document financial options presented, patient obligation and financial consent.
Informed Refusal Form
Informed Refusal of Treatment to be signed by patient, provider and witness to document the discussion between the patient and provider on risks of declining recommended treatment.
Sample Withdrawal Letter Dentist Retiring or Relocating
To avoid claims of abandonment, dentists who are separating from practice must notify patients in writing. Use this sample letter when a dentist is retiring or relocating, and be sure to include the Request for Access to Patient Records form.
Dental Benefit Plan Handbook – Chapter 01: Understanding Dental Benefit Plan Coverage
Overview of the types of dental coverage and the differences between dental and medical coverage, in order to aid dentists in explaining dental coverage to patients.
Dental Benefit Plan Handbook – Chapter 02: Understanding Dental Benefit Plan Contracts & Fees
Defines the types of plans to consider for your practice, contracting & contract analysis, billing & how to establish fees and more.
Dental Benefit Plan Handbook – Chapter 03: Verification and Explanation of Dental Benefit Coverage
Tips for verifying coverage with a patient's plan and providing explanation to help patients interpret benefits, limitations, exclusions, financial responsibility and how to maximize coverage.
Dental Benefit Plan Handbook – Chapter 05: Working with Patients and Their Plans
Help patients understand the relationship the practice holds with plans; overview of: in network, out of network, pre-authorization, predetermination, discounts, dual coverage and claims.
Dental Benefit Plan Handbook – Chapter 07: Billing Medical Plans
Learn cross-coding: billing medical insurance in a dental office; how to select the correct CPT code and ICD-10 codes when billing medical plans.
Dental Benefit Plan Handbook – Chapter 08: Explanation of Benefits
Understand the elements of the Explanation of Benefits and what to look for.
Dental Benefit Plan Handbook – Chapter 09: Managing Payment Problems
Learn about your rights and actions you must take when dealing with refund demands made by dental benefit plans.
Dental Benefit Plan Handbook – Chapter 10: Understanding the Claim Appeal Process
California law requires every dental plan to have a formal procedure that providers can use to dispute/challenge actions/decisions made by the plan. Overview of plan legal requirements, steps to appealing claims, filing a payment disputes.
Dental Benefit Plan Handbook – Chapter 11: Understanding Dental Benefit Plan Audits
Understanding dental plan authority in quality assurance assessment audits, requirements for the dental practice and best practices for patient records.
Personal Protective Equipment: Questions and Answers
This document is intended to address frequently asked questions about personal protective equipment (PPE).
Face Covering Exemption Medical Certification Form
Employers should develop a policy to accommodate any worker who meets one of the exemptions from wearing a face mask. If a worker is unable to wear a mask due to a medical condition, they should be provided with a non-restrictive alternative, such as a face shield with a drape attached to the bottom edge, for example. Employers may provide this form to an employee to obtain medical certification from their health care provider supporting their request for an accommodation.
Mask and Respirator Types
A visual resource that provides information on various masks and respirators. A downloadable and printer-friendly version is available.
July 1, 2020: New requirements for users of commercial credit program
A dental practice that offers patients the option of using a third-party credit program for treatment payment must comply with new requirements. A news article and updated California Commercial Credit Law resource are forthcoming.
July 1, 2020: Minimum wage increases across several cities effective
On July 1, 2020, minimum wage increases take effect in several California localities and require updated postings. Employers in Santa Rosa should be aware of a new increase and required notice effective July 1, 2020.
See Minimum Wage and Paid Sick Leave Ordinances by City/County on cda.org
Practice Startup Checklist
Guidelines to bring practice equipment on line after closure.
Introduction to Hand Hygiene
Intro to Hand Hygiene to help protect you and your patients.
Opening & Closing Dental Facilities Checklist
How-to for office closure, reopening; product-specific use.
July 1, 2020: Paid family leave extended from six to eight weeks
The benefit available through California’s State Disability Service program provides wage replacement to workers who take time off from work for an ill child, spouse, parent, grandparent, sibling, or domestic partner, or to bond with a child within one year of birth or adoption. Employers should update practice policies to reflect the increase.
Sample Employee Photograph Authorization Form
Form to gain consent when using employee images or video in your practice marketing materials.
Patient Financial Responsibility for Elective Upgraded Services
Additional lab costs don't always have to be written off when a patient selects an upgraded service or material. Follow these tips and utilize this form to inform patients of their potential additional financial responsibility.