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
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
Dispensing Products Acknowledgment Form to document products that are dispensed to a patient (does not apply to medications) November 23, 2022 Sample Forms State Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington General Liability Patient Care
Responsible Parent Declaration Form for treating minors whose parents are divorced or separated July 27, 2022 Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Patient Care
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
Swallowed or Aspirated Object Letter Sample letter to a patient regarding the discussion of and next steps for a swallowed or aspirated object October 24, 2018 Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada North Dakota Oregon Pennsylvania Tennessee Washington General Liability Patient Care
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