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
Office Closure Checklist A checklist to help minimize property damage, secure the premise and protect assets during a closure April 12, 2024 Sample Forms State Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington 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
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
Patient Dismissal Letter Contact a Risk Management Advice Line analyst for one-on-one support with a patient dismissal letter February 08, 2017 Sample Forms State Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington
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