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Authorization for Caretaker to Accompany a Minor

Sample authorization for a non-legal guardian to accompany a minor patient to dental appointments

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Updated

Consent to Disclose Personal Health Information (PHI)

Form and recommendations for obtaining consent to disclose patient health information to a third party.

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 Updated

Dispensing Products Acknowledgment

Form to document products that are dispensed to a patient (does not apply to medications)

Sample Forms State Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington General Liability Patient Care

Informed Consent Declaration: Minor Patient

Form for a non-legal guardian to authorize dental treatment on a minor patient

Sample Forms State Washington Topic Documentation Patient Care

Office Closure Checklist

A checklist to help minimize property damage, secure the premise and protect assets during a closure

Sample Forms State Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington General Liability

Contact a Risk Management Advice Line analyst for one-on-one support with a patient dismissal letter

Sample Forms State Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington

Premises Incident Report

Form for documenting injuries involving patients or visitors inside or outside the practice

Sample Forms State Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation General Liability