Consent to Disclose Personal Health Information (PHI) Form and recommendations for obtaining consent to disclose patient health information to a third party. July 12, 2024 Sample Forms State Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation General Liability Patient Care
Premises Incident Report Form for documenting injuries involving patients or visitors inside or outside the practice May 03, 2024 Sample Forms State Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation General Liability
Informed Consent Declaration: Minor Patient Form for a non-legal guardian to authorize dental treatment on a minor patient August 08, 2023 Sample Forms State Washington Topic Documentation Patient Care
Sample Employee Manual A comprehensive, customizable employee manual template to effectively document and share workplace expectations June 30, 2023 Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation Employment Featured
Orthodontic Forms Set A full set of sample forms: early removal of braces, lack of progress and statement of satisfaction March 03, 2020 Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation Patient Care
Acknowledgment of Surveillance Camera Installation Notice, acknowledgement/release and policy to inform patients and staff that surveillance cameras are in use March 03, 2020 Sample Forms Alaska Arizona California Hawaii Illinois Minnesota Nevada New Jersey North Dakota Pennsylvania Documentation General Liability
Follow Up for Biopsy Letter Sample letter to a patient about referral for evaluation and/or biopsy of a suspicious area or lesion October 24, 2018 Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation Patient Care
Sensory Recording Chart Sample chart for recording a neurological examination, including symptoms and clinical findings July 12, 2018 Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation General Liability Patient Care
Emergency Phone Screening to Determine Appointment Immediacy Form to facilitate patient screening by phone and determine immediacy, appointment need or emergency care January 25, 2017 Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation Patient Care
Authorization for Caretaker to Accompany a Minor Sample authorization for a non-legal guardian to accompany a minor patient to dental appointments June 30, 2016 Sample Forms State Alaska Arizona California Hawaii Illinois Nevada New Jersey North Dakota Pennsylvania Documentation General Liability Patient Care