Dentistry. Daniel L. Orr GOLDEN RULES

Size: px
Start display at page:

Download "Dentistry. Daniel L. Orr GOLDEN RULES"

Transcription

1 Ch43-A /19/06 11:51 AM Page 489 C H A P T E R 4 3 Dentistry Daniel L. Orr GOLDEN RULES 1. Document treatment options, including no treatment, in the record as the treatment options are developed. 2. Document informed consent for the treatment options. 3. Be very wary of collegial criticism without at least consulting your colleague. 4. Document any extraordinary front office arrangements, such as financial planning, special after-hours appointments, etc., and always have at least one staff member present during any doctor patient interview or treatment. 5. Request that your staff advise you of any patient staff controversy. 6. Follow the ADA s Code of Professional Conduct recommendations regarding emergency or after-hours care. 7. Consider maintaining hospital staff privileges and when possible direct one s patient to one s own staff hospital. 8. Always be the primary decision maker with regards to dental-legal issues, such as requests for records. 9. Be knowledgeable regarding the requirements for effective coverage from your liability carrier. 10. Be cautious about turning patients over to a collection agency. Consider personally approving all such dispositions. Liability claims for alleged dental malpractice have been somewhat under the radar compared to medicine. However, dentists are held to the same set of rules as physicians and other health professionals with regard to the tort of malpractice, the most common legal theory used by plaintiff patients to secure remuneration for alleged wrongs. 1 One of the most common bases for claims for damages in dentistry is for removal of the wrong tooth, a somewhat limited scope of damage. However, often the damage associated with alleged dental malpractice can be more severe, e.g., the N2 paste endodontic sequelae of the 1980s. 2,3 Ultimately dental treatment can result in any complication seen with medical treatment, including death. Several reviews of the actual statistics related to alleged dental malpractice are available, although differing findings are seen. For instance, Seidberg reports that 15 25% of claims from various insurance sources include endodontics, simple extractions, and crown/bridge work

2 Ch43-A /19/06 11:51 AM Page Liability of Specialties Sanbar reports that private practitioners are those most often sued and that claims usually involve faulty management/performance of treatment, unsatisfactory technical/esthetic quality, and wrong diagnosis/indication. 5 Governmental reports from the U.S. National Practitioner Data Bank, the U.S. Department of Health and Human Services, and the U.S. Department of Justice are seen in Table The following case history will serve to illustrate several important legal considerations for office-based private dental practitioners to remember when faced with potential legal liability. CASE PRESENTATION A 34-year-old married father in relatively good health presented for an initial screening examination. The patient s chief complaint was of a chronic toothache associated with tooth number 20. Historically, the patient related that he had seen another dentist for the complaint and had been told that the best option was to remove the tooth because that was the least expensive way to go. The patient currently insisted that he preferred to save the tooth. Clinically, no.20 was moderately broken down, but restorable. Radiographically, a 2 3 mm periapical radiolucency was evident. There were no signs of inflammation or evidence of an acute infection during this examination. The practitioner opined that indeed the previous dentist was in error and that no.20 could likely be salvaged via endodontic therapy and a full-coverage restoration. When the patient was presented with the proposed treatment plan and associated fees, he shared that he couldn t afford the treatment at that time but would soon be in touch. The patient, also an artist, offered to exchange services. The screening appointment ended with an admonition to address the pathology in a timely manner. The patient paid one-half the examination fee and committed to submit the balance within two weeks. The patient did not follow up with an appointment for treatment or by remitting the balance of the examination fee and was subsequently turned over to a collection service by front office staff three months after the office examination. Six months after the screening appointment, the dentist s staff received a request from the patient s spouse for the patient s records. The front office staff promptly forwarded the patient s records without advising the defendant dentist of the request. At nine months after the screening appointment, the dentist was served with legal papers alleging dental malpractice including misdiagnosis, improper treatment planning, improper treatment, and abandonment, all resulting in significant morbidity. At this point in time the dentist notified his carrier about the claim. ISSUES Patient s Deposition During discovery, the dentist was apprised of additional allegations that he had previously been unaware of. At the patient s deposition, the patient sat

3 Ch43-A /19/06 11:51 AM Page 491 Dentistry 491 Table 43 1 Dentistry malpractice statistics Medical malpractice lawsuit payment statistics for dentist malpractice in the U.S.A: Roughly 5% of medical malpractice trials related to dentists in the 75 largest counties in the U.S (Bureau of Justice Statistics, U.S. Department of Justice) 12.1% of medical malpractice payment reports were against dentists in the U.S (2002 Annual Report, National Practitioner Data Bank, U.S. DHHS) Roughly 38.9% of medical malpractice trials against dentists were won by the plaintiff in the 75 largest counties in the U.S (Bureau of Justice Statistics, U.S. Department of Justice) Medical malpractice lawsuit payment report statistics for dentist malpractice in the U.S.A: 17,469 malpractice payment reports were made against dentists in the U.S (The National Practitioner Data Bank Public Use File) 15% of malpractice payment reports were made against dentists in the U.S (The National Practitioner Data Bank Public Use File) Medical malpractice lawsuit statistics for dental malpractice in the U.S.A: 8 medical malpractice reports were made to the National Practitioner Data Bank regarding dental assistants in the U.S (NPDB Summary Report, National Practitioner Data Bank, U.S. DHHS) 17 medical malpractice reports were made to the National Practitioner Data Bank regarding dental hygienists in the U.S (NPDB Summary Report, National Practitioner Data Bank, U.S. DHHS) 137 medical malpractice reports were made to the National Practitioner Data Bank regarding dental residents in the U.S (NPDB Summary Report, National Practitioner Data Bank, U.S. DHHS) 34,691 medical malpractice reports were made to the National Practitioner Data Bank regarding dentists in the U.S (NPDB Summary Report, National Practitioner Data Bank, U.S. DHHS) 19 medical malpractice reports were made to the National Practitioner Data Bank regarding denturists in the U.S (NPDB Summary Report, National Practitioner Data Bank, U.S. DHHS) Medical malpractice statistics for the U.S.A. 2003: 27,793 (13.5%) dentists had a malpractice report made against them in the U.S (2003 Annual Report, National Practitioner Data Bank, U.S. DHHS) 45,166 (13.1%) malpractice reports were made against dentists in the U.S (2003 Annual Report, National Practitioner Data Bank, U.S. DHHS) Dentists had an average of 1.63 malpractice reports made against each of them in the U.S (2003 Annual Report, National Practitioner Data Bank, U.S. DHHS) Medical malpractice statistics for the U.S.A. 2003: 24 (0.01%) dental assistants, technicians and hygienists had a malpractice report made against them in the U.S (2003 Annual Report, National Practitioner Data Bank, U.S. DHHS) 25 (0.01%) malpractice reports were made against dental assistants, technicians, and hygienists in the U.S (2003 Annual Report, National Practitioner Data Bank, U.S. DHHS) Continued

4 Ch43-A /19/06 11:51 AM Page Liability of Specialties Table 43 1 Dentistry malpractice statistics cont d Dental assistants, technicians and hygienists had an average of 1.2 malpractice reports made against each of them in the U.S (2003 Annual Report, National Practitioner Data Bank, U.S. DHHS) Medical malpractice statistics for the U.S.A. 2003: 10 (0.005%) denturists had a malpractice report made against them in the U.S (2003 Annual Report, National Practitioner Data Bank, U.S. DHHS) 10 (0.003%) malpractice reports were made against denturists in the U.S (2003 Annual Report, National Practitioner Data Bank, U.S. DHHS) Denturists had an average of 1.0 malpractice reports made against each of them in the U.S (2003 Annual Report, National Practitioner Data Bank, U.S. DHHS) Medical malpractice statistics for the U.S.A. 2003: 4 (0.03%) dental assistants, technicians, and hygienists had a malpractice report made against them in the U.S (2003 Annual Report, National Practitioner Data Bank, U.S. DHHS) 3 (0.01%) malpractice reports were made against dental assistants, technicians, and hygienists in the U.S (2003 Annual Report, National Practitioner Data Bank, U.S. DHHS) Medical malpractice statistics for the U.S.A. 2003: 1418 (10.6%) dentists had a malpractice report made against them in the U.S (2003 Annual Report, National Practitioner Data Bank, U.S. DHHS) 2540 (9.6%) malpractice reports were made against dentists in the U.S (2003 Annual Report, National Practitioner Data Bank, U.S. DHHS in a wheelchair, was blind in the left eye, and had compromise of other motor and sensory nerves of the left face. During the deposition, the patient was unable to control salivary secretions and constantly used a towel in an attempt to control his drooling. The patient testified that at the screening appointment he asked the defendant dentist what he should do about his chronic toothache in no.20. The patient stated that he had previously determined to remove the tooth based on another dentist s advice but that the defendant had talked him into trying to save no.20. The defendant s root canal and crown treatment plan would have cost about ten times more than the extraction of no.20. The patient also testified that he told the defendant he could not afford to pay cash for the treatment but offered to trade artwork for the therapy. The patient then stated that he had called the office a week later to schedule an appointment and that the receptionist refused to schedule him as he did not have the cash balance for initial examination, let alone the planned root canal. Approximately a month later, the patient noted acute swelling near no.20 one evening. He called the defendant s office for help and was told by an answering service that the defendant was on vacation and to call back in a week. When the patient expressed his concern that he had a serious emergency, the answering service instructed him to call 911 or go to a hospital. The patient did go to a local emergency room and was admitted by a physician general practitioner. Within several hours the patient began to deteriorate

5 Ch43-A /19/06 11:51 AM Page 493 Dentistry 493 neurologically and was admitted to the ICU where multiple diagnostic procedures were initiated on an emergency basis. The diagnosis reached was that of an intracranial central nervous system abscess. Additional consults from Infectious Disease, Neurosurgery, and other specialties were obtained. The dental service, including Oral and Maxillofacial Surgery, was not consulted. The patient underwent a neurosurgical procedure in which a copious quantity of pus was drained. After the general anesthetic agents had been metabolized, the patient remained unconscious and comatose for several weeks until he slowly began to recover. When the patient was finally discharged to a long-term care facility, the admitting general practitioner opined in the discharge note that no one had definitively identified the etiology of the infection but that it was probably dental. In his deposition, the patient stated that he had never been informed that a toothache could cause a brain abscess. While in rehabilitation, the patient had applied for financial assistance for ongoing medical bills already totaling well into six figures. During this time frame, the family received notice that they had been turned over to collections by the defendant dentist s office for not paying half of his screening examination fee. Dentist s Deposition During the defendant dentist s deposition, the office records were produced to reconstruct the interaction between the plaintiff and the dentist. The records supported the plaintiff s statements that the defendant had opined that the first dentist was wrong and that the tooth could be saved with endodontic therapy. There was notation in the records about a follow-up as needed appointment. No writing about informed consent regarding the proposed treatment or alternative treatments, financial arrangements, or subsequent calls by the plaintiff were seen. The answering service did have a record of the after-hours emergency call placed by the plaintiff. Expert and Legal Counsel Evaluation The defendant s liability company retained an oral and maxillofacial surgeon as an expert witness to analyze the case. Part of the defense focused on plaintiff questions such as the lack of an antibiotic prescription at the initial appointment and the discharge note relating the central nervous system abscess to the dentition. However, the expert and defense counsel also agreed that several areas of legal, as opposed to dental, concern regarding the defendant s conduct existed: 1. A lack of documentation that although endodontic therapy was recommended, extraction was a viable option and observation was not recommended. 2. A lack of any documentation regarding informed consent about recommended treatment or alternative treatments, including no treatment, other than the follow up prn note.

6 Ch43-A /19/06 11:51 AM Page Liability of Specialties 3. The charted negative statement about the first dentist s treatment planning. 4. The lack of records regarding special financial arrangements. 5. The lack of office records memorializing any controversial contact with the front office and the fact that the defendant was not advised about any such contact. 6. The lack of more optimal coverage for the defendant s practice while he was unavailable and the fact that the defendant had not been advised about the plaintiff s call to his answering service. 7. The finding that although the defendant had hospital privileges, the patient had elected to go to a hospital where the defendant did not have privileges. 8. The fact that the defendant s front office staff had forwarded the plaintiff s records without advising the dentist of the request for records. 9. The concern that there was a significant delay in contacting the defendant s liability insurance carrier from the time that records were initially requested. 10. The fact that the doctor s billing office had turned the patient over to collections without the dentist s approval. In addressing the legal conduct concerns, the following opinions were formed relating to 1 10 above: 1. Optimally the records will reflect a considered evaluation and resulting opinion regarding the therapeutic options open to a patient. There is generally no single perfect treatment plan, but several viable treatment options, ultimately depending on the totality of the presenting signs, symptoms, patient history, and patient and doctor preferences. Records can be the most effective resource for the defense in a liability issue if carefully written. Careful writing would most likely include some evidence of the thought process including differential diagnosis, differing treatment options, and practitioner and patient preferences for treatment. 2. Part and parcel of the differential diagnosis and treatment options presented is the provision of informed consent. Informed consent entails advising the patient of the reasonable treatment options and the risks and benefits of each of those treatment options, including no treatment at all. 6 A lack of documented informed consent may be interpreted by a jury as evidence that such a discussion was never held. (A copy of the author s general written informed consent read as follows.) ORAL AND MAXILLOFACIAL SURGERY CONSENT The oral surgery procedure to be performed has been explained to me and I understand what is to be done. This is my consent to the oral surgery indicated on the surgery record and to any other surgery deemed necessary or advisable in addition to the planned operation. I agree to

7 Ch43-A /19/06 11:51 AM Page 495 Dentistry 495 the use of local or general anesthesia depending on the judgment of Dr. Daniel L. Orr II. I have been informed and understand that occasionally there are complications of the surgery, drugs, and anesthesia. The more common complications are pain, infection, swelling, bleeding, bruising, and discoloration, temporary or permanent numbness and tingling of the lip, tongue, chin, gums, cheeks or teeth. It has been explained to me that pain and numbness and occasionally inflammation of the vein (thrombophlebitis) may occur from the intravenous or an intramuscular injection. Mortality from anesthesia only has been estimated at 1/400,000. The possibility of injury to or stiffness of the neck and facial muscles, changes in the occlusion or temporomandibular joint have been explained. The doctor has discussed with me the possibility of injury to the adjacent teeth, restorations in other teeth, or injury to other tissues, referred pain to the ear, neck, head, bone fractures, and delayed healing. The combination of stress, anesthesia, and surgery may lead to nausea, vomiting, allergic sensitivity or psychological reactions. Sinus complications which may include a nasal-antral fistula or opening into the sinus from the mouth may occur from removal of upper teeth. Injury to tissues may occur secondary to instrument failure. Medications, drugs, anesthetics, and prescriptions may cause drowsiness and lack of awareness and coordination which could be increased by the use of alcohol or other drugs; thus I have been advised to not operate any vehicle or hazardous devices, or work while taking such medications and/or drugs or until fully recovered from the effects of the above. I understand and agree not to operate any vehicle or hazardous devices for at least 24 hours or until fully recovered from the effects of the anesthetic, medication, and drugs that may have been given me in the office for my care. I acknowledge the receipt of and understand the postoperative instructions and have been given an appointment date to return. It has been explained to me and I understand that there is no warranty or guarantee as to any result and/or cure. I understand that most complications can be rectified with proper follow-up care. I agree to follow up with Dr. Orr at any time as needed or advised for any complications. I understand I can ask for a full recital of any and all possible risks attendant to my care by just asking. I understand insurance, including Medicare, will not pay for all services requested and that I will be responsible for any financial obligations incurred in the course of diagnosis or treatment. Signature Signature Date Date 3. Practitioners would be well advised to be very circumspect with regard to offering any criticism of a colleague, particularly without personally communicating with that colleague. A patient s subjective history and recollection of prior health professional interactions are notoriously inaccurate. 4. Financial arrangements that are out of the ordinary for one s practice should be documented in the financial records. In today s world,

8 Ch43-A /19/06 11:51 AM Page Liability of Specialties barter for health services is usually not the norm. Aggressive plaintiff attorneys presented with an alleged barter have been known to even subpoena tax records to see if the value of such transactions was reported to the IRS. 5. Trusted office staff should be sensitive enough to know when the doctor needs to be advised about any confrontational or less than satisfactory patient/office staff interaction. Patient comments insisting that the doctor said or agreed to something out of the norm regarding finances or otherwise should not be summarily rejected by staff. Strong consideration should be give to advising the doctor about all such conversations. 6. The ADA Code of Professional Conduct mandates that dentists are responsible to provide reasonable arrangements for emergency or after-hours care 7 for their practices when they are unavailable. Call 911 or go to the ER instructions generally do not require any effort or special arrangements on the part of the practitioner who may be unavailable. In the author s opinion, it is unlikely that such instructions would satisfy the ADA s CPC recommendation. One needs to be cognizant of the potential attendant legal ramifications that follow such cavalier call arrangements. Additionally, part of the responsibility for reasonable arrangements likely includes mutual communication and follow-up between the individuals or other agents covering one another. 7. Hospital privileges certainly are not mandatory for many typical dental practices. However, if one does have hospital privileges, it seems reasonable that any practice patient hospitalized for a practice or other dental-related condition would be referred to a hospital that the practitioner has access to. Advantages to notifying staff, other covering dentists, answering services, and patients of the hospital of choice are obvious. Especially important is the fact that the dentist has convenient continued access to the hospitalized patient and is not on the outside looking in as his patient is evaluated and treated by others. 8. Prudent office policy might include direction to one s staff that any patient communications that are not uniformly positive should be reported to the dentist daily. Not only might patients be right, but occasionally dependable staff members may have bad communication days, something an insightful doctor cannot allow to occur without his knowledge. Almost any staff member can deal successfully with happy patients, but only the doctor should be responsible for rectifying unresolved non optimal interactions between staff and patients. 9. The injudicious unconsidered release of records is an occurrence related to a lack of communication for what is generally an unusual request, i.e., for records. Most often, requests for records should be passed on to the doctor for his approval prior to the records release. In addition, some liability policies allow insurers to defer or deny coverage for less than timely notification of possible incidents. A request for records may be indicative of a situation that one s liability carrier should be advised of.

9 Ch43-A /19/06 11:51 AM Page 497 Dentistry Similar to other adverse interactions, turning a patient over to a collection agency should probably only be done after careful consideration by the doctor, not by a potentially disgruntled, frustrated, or less informed staff member. The ten iterated legal concerns above had to be addressed during the course of discovery prior to trial in addition to the plaintiff s alleged treatment deficiencies. Fortunately, the defendant s insurer elected to provide coverage for the case in spite of the less than timely notification about the request for records. The defense expert s opinions about the dentist s actual treatment and about the causation and management of the CNS abscess truncated an in-depth plaintiff analysis of the legal concerns noted. Defense Expert s Deposition During the defendant expert s deposition, a strong opinion was proffered that it was not the standard of care to prescribe antibiotics for chronic odontalgia alone. In fact, he opined that it would be below the standard of care to do so whether a periapical radiolucency was present or not. The potentially problematic issue of a lack of informed consent was also addressed. The defense expert explained that reasonable informed consent for the endodontic therapy and extraction options available for chronic odontalgia in a broken-down tooth would include, optimally, the retention of a functional tooth versus, at worst, the loss of the tooth. He opined that it is not ordinary or reasonable to routinely advise chronic odontalgia patients that they could be exposed to a toothache-related brain abscess or near death. No objective literature that definitively related CNS abscess to chronic odontalgia was identified, confirming the rarity of the relationship if it occurs at all. Finally, the plaintiff treating physician/expert s opinion that the CNS infection was of odontogenic etiology needed to be addressed. The defendant OMS expert pointed out several non-sequiturs relative to this case. Included was the fact that in spite of the plethora of medical experts consulted and battery upon battery of diagnostic tests performed during the prolonged hospitalization, periapical or panoramic radiographic studies were never obtained. A dentist or oral and maxillofacial surgeon was never consulted during the patient s admission. No objective attempt was ever made to correlate the bacteria from the CNS abscess with any bacteria present in no.20, which was also asymptomatic during the hospital stay. The OMS expert mentioned that many more commonplace things than chronic odontalgia, such as toothbrushing, can cause transient bacteremia. 8 Finally, the defense expert pointed out that the plaintiff expert/treating physician who opined that the abscess was likely secondary to pathology in no.20 never addressed the treatment of this CNS and life-threatening tooth during hospitalization. Not only was no.20 never treated in the hospital, the physician s discharge orders never mentioned the need to follow up with a dentist for the still retained life-threatening no.20.

10 Ch43-A /19/06 11:51 AM Page Liability of Specialties Case Resolution The case was settled for a nominal four-figure amount within a week after the defense expert s deposition. In spite of the efficient disposition of this particular case, dentists would be well advised to avoid repetition of the questionable dental-legal related conduct seen in this defendant s office. REFERENCES 1. Malamed, SF; Orr DL, Handbook of Local Anesthesia, 5th ed., Legal Considerations chapter. Mosby, St. Louis: pp Orr DL, Paresthesia of the Trigeminal Nerve Secondary to Endodontic Manipulation with N2. Headache 25(6); (1985). 3. Orr DL Paresthesia of the Second Division of the Trigeminal Nerve Secondary to Endodontic Manipulation with N2. Headache 27(1); 21-22, (1987). 4. Seidberg, BH, Legal Medicine 6th Edition, (chapter 48, Dental Litigation: Triad of Concerns ), Philadelphia; Mosby, 6th ed. 2004, p Sanbar SS, personal communication, Orr DL; Curtis, WJ, Obtaining Written Informed Consent for the Administration of Local Anesthetics in Dentistry, JADA 136: (2005). 7. ADA Code Principles of Ethics and Code of Professional Conduct, Sec. 4B. 8. Orr DL, Controlling bacteremia, JADA, 109(6); 876,(1984).

Consent for the use of Private Health Information Informed Consent

Consent for the use of Private Health Information Informed Consent Consent for the use of Private Health Information Informed Consent Watertown Dental Care & Dakota Center for Dental Sleep Medicine 600 4 th Street NE, Suite 207 Watertown, SD 57201 Our office operates

More information

RICHARD D. FIORUCCI, ET AL. OPINION BY v. Record No. 131869 JUSTICE ELIZABETH A. McCLANAHAN OCTOBER 31, 2014 STEPHEN CHINN

RICHARD D. FIORUCCI, ET AL. OPINION BY v. Record No. 131869 JUSTICE ELIZABETH A. McCLANAHAN OCTOBER 31, 2014 STEPHEN CHINN PRESENT: All the Justices RICHARD D. FIORUCCI, ET AL. OPINION BY v. Record No. 131869 JUSTICE ELIZABETH A. McCLANAHAN OCTOBER 31, 2014 STEPHEN CHINN FROM THE CIRCUIT COURT OF THE CITY OF ALEXANDRIA James

More information

ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES

ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES *You may refuse to sign this acknowledgement* I, have received a copy of this office s Notice of Privacy Practices. Please Print Name Signature

More information

ORTHODONTIC TREATMENT

ORTHODONTIC TREATMENT ORTHODONTIC TREATMENT Informed Consent for the Orthodontic Patient As a general rule, positive orthodontic results can be achieved by informed and cooperative patients. Thus, the following information

More information

IMPLANT CONSENT FORM WHAT ARE DENTAL IMPLANTS?

IMPLANT CONSENT FORM WHAT ARE DENTAL IMPLANTS? IMPLANT CONSENT FORM WHAT ARE DENTAL IMPLANTS? Dental implants are a very successful and accepted treatment option to replace lost or missing teeth. A dental implant is essentially an artificial tooth

More information

Mobile Dental Care QUALITY ON-SITE DENTISTRY SINCE 1982

Mobile Dental Care QUALITY ON-SITE DENTISTRY SINCE 1982 CONCERNING MEDICAID For Patient: The process for Medicaid to approve the necessary dental treatment and to also fund for that treatment is a slow and confusing procedure. Essentially, Medicaid will make

More information

CLINICAL GOALS OF PATIENT CARE AND CLINIC MANAGEMENT. Philosophical Basis of the Patient Care System. Patient Care Goals

CLINICAL GOALS OF PATIENT CARE AND CLINIC MANAGEMENT. Philosophical Basis of the Patient Care System. Patient Care Goals University of Washington School of Dentistry CLINICAL GOALS OF PATIENT CARE AND CLINIC MANAGEMENT Philosophical Basis of the Patient Care System The overall mission of the patient care system in the School

More information

PATIENT INFORMATION PATIENT NAME (LAST, FIRST, MIDDLE) SEX DOB MAILING ADDRESS CITY STATE ZIP SSN

PATIENT INFORMATION PATIENT NAME (LAST, FIRST, MIDDLE) SEX DOB MAILING ADDRESS CITY STATE ZIP SSN PATIENT INFORMATION PATIENT NAME (LAST, FIRST, MIDDLE) SEX DOB MAILING ADDRESS CITY STATE ZIP SSN STREET ADDRESS (IF DIFFERENT FROM ABOVE) CITY STATE ZIP HOME PHONE NUMBER EMPLOYER CELL PHONE NUMBER WORK

More information

Informed Consent. Informed consent protects not only the patient, but the doctor as well.

Informed Consent. Informed consent protects not only the patient, but the doctor as well. Long gone are the days when patients would enter a dental office, sit quietly in an operatory and allow the dentist to perform whatever treatment he deemed necessary, and then pay the fee in full on the

More information

Dentistry. Specialty Report. Group. MedPro Group Patient Safety & Risk Solutions. Berkshire Hathaway's dedicated healthcare liability solution

Dentistry. Specialty Report. Group. MedPro Group Patient Safety & Risk Solutions. Berkshire Hathaway's dedicated healthcare liability solution Dentistry Specialty Report April 2015 MedPro Group Patient Safety & Risk Solutions Group Berkshire Hathaway's dedicated healthcare liability solution MedPro Group is a member of the Berkshire Hathaway

More information

DENTISTS PROFESSIONAL LIABILITY INSURANCE (Claims Made Basis)

DENTISTS PROFESSIONAL LIABILITY INSURANCE (Claims Made Basis) DENTISTS PROFESSIONAL LIABILITY INSURANCE (Claims Made Basis) APPLICANT S INSTRUCTIONS: 1. Answer all questions. If the answer requires detail, please attach a separate sheet. 2. Application must be signed

More information

Complications Following Extraction Cause Severe Infection and Hospitalization

Complications Following Extraction Cause Severe Infection and Hospitalization Malpractice Minute February 2015 Complications Following Extraction Cause Severe Infection and Hospitalization Mario Catalano, DDS, MAGD Background: Although unfortunate, part of practicing dentistry is

More information

TREATMENT REFUSAL FORMS

TREATMENT REFUSAL FORMS TREATMENT REFUSAL FORMS These forms are intended to be used when a patient refuses the treatment. These forms help confirm that the patient is informed and aware of the risks involved with not proceeding

More information

Residency Competency and Proficiency Statements

Residency Competency and Proficiency Statements Residency Competency and Proficiency Statements 1. REQUEST AND RESPOND TO REQUESTS FOR CONSULTATIONS Identify needs and make referrals to appropriate health care providers for the treatment of physiologic,

More information

Adramatic increase in the number of dental practitioners

Adramatic increase in the number of dental practitioners Risk Management Aspects of Implant Dentistry Navot Givol, DMD 1 /Shlomo Taicher, DMD 2 /Talia Halamish-Shani, LLB 3 /Gavriel Chaushu, DMD, MSc 4 Purpose: To categorize and review complications related

More information

RESIDENT TRAINING GOALS AND OBJECTIVES STATEMENTS

RESIDENT TRAINING GOALS AND OBJECTIVES STATEMENTS RESIDENT TRAINING GOALS AND OBJECTIVES STATEMENTS Evaluation and treatment of dental emergencies Recognize, anticipate and manage emergency problems related to the oral cavity. Differentiate between those

More information

ANGEL DENTAL CARE Implant Consent

ANGEL DENTAL CARE Implant Consent This information is to help you make an informed decision about having implant treatment. You should take as much time as you wish to make the decision in relation to signing the following consent form.

More information

PHYSICIANS RECIPROCAL INSURERS 1800 Northern Boulevard P.O. Box 9007 Roslyn, NY 11576. (516) 365-2855 Toll Free: (888) 526-4006 THE EXCHANGE

PHYSICIANS RECIPROCAL INSURERS 1800 Northern Boulevard P.O. Box 9007 Roslyn, NY 11576. (516) 365-2855 Toll Free: (888) 526-4006 THE EXCHANGE PHYSICIANS RECIPROCAL INSURERS 1800 Northern Boulevard P.O. Box 9007 Roslyn, NY 11576 (516) 365-2855 Toll Free: (888) 526-4006 THE EXCHANGE APPLICATION FOR DDS/DMD INDIVIDUAL PROFESSIONAL LIABILITY COVERAGE

More information

Toothaches of Non-dental Origin

Toothaches of Non-dental Origin Toothaches of Non-dental Origin This brochure is produced by the American Academy of Orofacial Pain The American Academy of Orofacial Pain is an organization of health care professionals dedicated to alleviating

More information

www.mlmic.com Application For Dentists Professional Liability Insurance

www.mlmic.com Application For Dentists Professional Liability Insurance Medical Liability Mutual Insurance Company NYSDA Endorsed Insurance Program www.mlmic.com Application For Dentists Professional Liability Insurance Home Office Two Park Avenue Room 2500 New York, NY 10016

More information

Understanding Dental Implants

Understanding Dental Implants Understanding Dental Implants Comfort and Confidence Again A new smile It s no fun when you re missing teeth. You may not feel comfortable eating or speaking. You might even avoid smiling in public. Fortunately,

More information

Medical Legal Issues in Pain Management: Lessons from Real Cases

Medical Legal Issues in Pain Management: Lessons from Real Cases Medical Legal Issues in Pain Management: Lessons from Real Cases Matthew J. Donnelly, Esq. Deputy Chief Legal Officer Law Department February 19, 2014 Fast Facts Lawsuits are inevitable - 6 out of 10 physicians

More information

Dental Malpractice: Learning the Rules of the Road

Dental Malpractice: Learning the Rules of the Road Dental Malpractice: Learning the Rules of the Road by Anne M. Oldenburg and Linda J. Hay Educational Objectives Upon completion of this course, participants should be able to achieve the following: 1.

More information

Position Classification Standard for Dental Officer Series, GS-0680

Position Classification Standard for Dental Officer Series, GS-0680 Position Classification Standard for Dental Officer Series, GS-0680 Table of Contents SERIES DEFINITION... 2 BACKGROUND... 2 TITLES... 3 GRADE-LEVEL EVALUATION CRITERIA... 3 NOTES ON THE USE OF THE STANDARDS...

More information

Health Professions Review Board

Health Professions Review Board Health Professions Review Board Suite 900, 747 Fort Street Victoria British Columbia Telephone: 250 953-4956 Toll Free: 1-888-953-4986 (within BC) Facsimile: 250 953-3195 Mailing Address: PO 9429 STN PROV

More information

Standard HR.7 All individuals permitted by law and the organization to practice independently are appointed through a defined process.

Standard HR.7 All individuals permitted by law and the organization to practice independently are appointed through a defined process. Credentialing and Privileging of Licensed Independent Practitioners The following standards apply to individuals permitted by law and the organization to provide patient care services without direction

More information

TMJ. Problems. Certain headaches and pain in. the ear, jaw, neck, tooth, and. sinus can be the result of a. temporomandibular joint (TMJ)

TMJ. Problems. Certain headaches and pain in. the ear, jaw, neck, tooth, and. sinus can be the result of a. temporomandibular joint (TMJ) DIVISION OF ORAL AND MAXILLOFACIAL SURGERY TMJ Problems Certain headaches and pain in the ear, jaw, neck, tooth, and sinus can be the result of a temporomandibular joint (TMJ) problem. People with TMJ

More information

Develop a specialist who is capable of correlation of basic sciences and clinical sciences, and challenge the requirements for certification.

Develop a specialist who is capable of correlation of basic sciences and clinical sciences, and challenge the requirements for certification. Course Specification Faculty : Dentistry Department : Endodontics Program Specification: Diploma Degree A-Basic Information 1-Programme Title: Diploma in Endodontics 2-Departments (s): Endodontics 4-Coordinator:

More information

A New Beginning with Dental Implants. A Guide to Understanding Your Treatment Options

A New Beginning with Dental Implants. A Guide to Understanding Your Treatment Options A New Beginning with Dental Implants A Guide to Understanding Your Treatment Options Why Should I Replace My Missing Teeth? Usually, when you lose a tooth, it is best for your oral health to have it replaced.

More information

Welcome to Happy Teeth Dental Care!

Welcome to Happy Teeth Dental Care! Happy Teeth Dental Care Registration Packet Welcome to Happy Teeth Dental Care! Thank you for choosing our office for your dental needs. We look forward to meeting and working with you! Happy Teeth Dental

More information

How to Professionally and Personally Survive a Malpractice Suit John Baillie, MB, ChB, FRCP, FACG

How to Professionally and Personally Survive a Malpractice Suit John Baillie, MB, ChB, FRCP, FACG How to Professionally and Personally Survive a Malpractice Suit John Baillie, MB, ChB, FRCP, FACG ACG Annual Meeting 2013 How to Professionally and Personally Survive a Malpractice Suit John Baillie, MB,

More information

Today I will discuss medical negligence following a number of recent high profile cases and inquests.

Today I will discuss medical negligence following a number of recent high profile cases and inquests. Tipp FM Legal Slot 29 th May 2012 Medical Negligence John M. Lynch, Principal Today I will discuss medical negligence following a number of recent high profile cases and inquests. Firstly, what is Medical

More information

KNEE LIGAMENT REPAIR AND RECONSTRUCTION INFORMED CONSENT INFORMATION

KNEE LIGAMENT REPAIR AND RECONSTRUCTION INFORMED CONSENT INFORMATION KNEE LIGAMENT REPAIR AND RECONSTRUCTION INFORMED CONSENT INFORMATION The purpose of this document is to provide written information regarding the risks, benefits and alternatives of the procedure named

More information

Dental Services. Dental Centre. HKSH Healthcare Medical Centre Dental Centre. For enquiries and appointments, please contact us

Dental Services. Dental Centre. HKSH Healthcare Medical Centre Dental Centre. For enquiries and appointments, please contact us Dental Services For enquiries and appointments, please contact us HKSH Healthcare Medical Centre Dental Centre Level 22, One Pacific Place 88 Queensway, Hong Kong (852) 2855 6666 (852) 2892 7589 dentalcentre@hksh.com

More information

Employed, Subcontracting or Volunteer Dentist Community Clinic Program Application for Professional Liability Insurance Additional Insured Basis

Employed, Subcontracting or Volunteer Dentist Community Clinic Program Application for Professional Liability Insurance Additional Insured Basis Employed, Subcontracting or Volunteer Dentist Community Clinic Program Application for Professional Liability Insurance Additional Insured Basis Please type or print. Answer all questions. Please note

More information

Dental and Oral Benefit

Dental and Oral Benefit Dental and Oral Benefit 2015 Overview This document explains the Dental and Oral Benefit for 2015. It gives you details about how Discovery Health Medical Scheme defines and pays dentistry both in the

More information

Acknowledgement of Receipt of Notice of Privacy Practices

Acknowledgement of Receipt of Notice of Privacy Practices Acknowledgement of Receipt of Notice of Privacy Practices **You May Refuse to Sign This Acknowledgement** I,, have received a copy of this office s Notice of Privacy Practices. Signature For Office Use

More information

10 things. sued 2010-11. A publication of Texas Medical Liability Trust

10 things. sued 2010-11. A publication of Texas Medical Liability Trust 10 things sued 2010-11 A publication of Texas Medical Liability Trust TEXAS MEDICAL LIABILITY TRUST 901 Mopac Expressway South Barton Oaks Plaza V, Suite 500 Austin, TX 78746-5942 P.O. Box 160140 Austin,

More information

Group Dental Benefits

Group Dental Benefits Group Dental Benefits FRONTIER SCHOOL DIVISION TEACHERS AND SUPPORT STAFF Sponsored By:: Table of Contents Introduction... 1 Eligibility... 2 Dental Benefits... 3 Basic Services Covered... 3-4 Major Services

More information

DENTAL TRIAGE ASSESSING AND TREATING THE TRUE DENTAL EMERGENCY

DENTAL TRIAGE ASSESSING AND TREATING THE TRUE DENTAL EMERGENCY DENTAL TRIAGE ASSESSING AND TREATING THE TRUE DENTAL EMERGENCY What constitutes a dental emergency? What does the patient call an emergency? Pain What does the patient call an emergency? Pain Swelling

More information

Role of dentistry in the health scciences, the dental team. Dr. Dézsi Anna Júlia

Role of dentistry in the health scciences, the dental team. Dr. Dézsi Anna Júlia Role of dentistry in the health scciences, the dental team Dr. Dézsi Anna Júlia The art of medicine Herodatus, a historian, described the medical art in Egypt: "The art of medicineis distributed thus:

More information

It s important to understand the process and react properly when it occurs.

It s important to understand the process and react properly when it occurs. Doctor, You ve Been Sued! It s important to understand the process and react properly when it occurs. By Howard S. Rosenbaum, DPM Malpractice suits are terrifying events for most podiatric physicians.

More information

The Penn Dental Plan for Undergraduate and Graduate Students of the University of Pennsylvania

The Penn Dental Plan for Undergraduate and Graduate Students of the University of Pennsylvania The Penn Dental Plan for Undergraduate and Graduate Students of the University of Pennsylvania Effective August 1, 2015 Introduction The Penn Dental Plan of the University of Pennsylvania ( Penn Dental

More information

Medical Malpractice Insurance: The Implications and Complications By Philip R. Dupont & Maggie L. Nigro

Medical Malpractice Insurance: The Implications and Complications By Philip R. Dupont & Maggie L. Nigro Series: Malpractice From A-Z First of a Series of Five Medical Malpractice Insurance: The Implications and Complications By Philip R. Dupont & Maggie L. Nigro You ou should be aware that the new Missouri

More information

PATIENT INFORM CONSENT for IMPLANT RESTORATION Rev 04.2012

PATIENT INFORM CONSENT for IMPLANT RESTORATION Rev 04.2012 PATIENT INFORM CONSENT for IMPLANT RESTORATION Rev 04.2012 Implant placement and restoration involves two major stages: surgical placement of the implant(s) followed by the restoration of the implant after

More information

Name Last) (First) ( (M.I.) Birth Date Social Security Age Sex: Home Address. City State Zip. Complaint/ Area to be treated Email Address

Name Last) (First) ( (M.I.) Birth Date Social Security Age Sex: Home Address. City State Zip. Complaint/ Area to be treated Email Address PLEASE PRINT CLEARLY : NEW PATIENT FORM Name Last) (First) ( (M.I.) Birth Social Security Age Sex: M / F Home Address City State Zip Complaint/ Area to be treated Email Address Home Phone ( ) Drivers Lic

More information

MINI IMPLANTS FOR LOWER DENTURE STABLIZATION

MINI IMPLANTS FOR LOWER DENTURE STABLIZATION MINI IMPLANTS FOR LOWER DENTURE STABLIZATION From the Office of Dr. Michael J. Guy 511A Lakeshore Drive, North Bay ON, P1A 2E3 Mini dental implants (MDI) have become increasingly popular in the past decade

More information

Proving Causation and Damages in Spinal Fusion Cases

Proving Causation and Damages in Spinal Fusion Cases Page 1 of 7 Ben Brodhead on proving causation and damages in spinal fusion cases. Friend on Facebook Follow on Twitter Forward to a Friend Proving Causation and Damages in Spinal Fusion Cases By: Ben C.

More information

X-Plain Sinus Surgery Reference Summary

X-Plain Sinus Surgery Reference Summary X-Plain Sinus Surgery Reference Summary Introduction Sinus surgery is a very common and safe operation. Your doctor may recommend that you have sinus surgery. The decision whether or not to have sinus

More information

Risk Management for Oral Health Programs and HRSA FTCA Program

Risk Management for Oral Health Programs and HRSA FTCA Program Risk Management for Oral Health Programs and HRSA FTCA Program Angel L. Rodríguez-Espada, DMD Regional Dental Consultant Department of Health and Human Services Health Resources and Services Administration

More information

YALE UNIVERSITY SCHOOL OF MEDICINE: SECTION OF OTOLARYNGOLOGY PATIENT INFORMATION FUNCTIONAL ENDOSCOPIC SINUS SURGERY

YALE UNIVERSITY SCHOOL OF MEDICINE: SECTION OF OTOLARYNGOLOGY PATIENT INFORMATION FUNCTIONAL ENDOSCOPIC SINUS SURGERY YALE UNIVERSITY SCHOOL OF MEDICINE: SECTION OF OTOLARYNGOLOGY PATIENT INFORMATION FUNCTIONAL ENDOSCOPIC SINUS SURGERY What is functional endoscopic sinus surgery (FESS)? Functional endoscopic sinus surgery

More information

2009 Medical Malpractice Claims Report

2009 Medical Malpractice Claims Report 2009 Medical Malpractice Claims Report Department of Commerce & Insurance November 1, 2009 Table of Contents 2009 Tennessee Medical Malpractice Report INTRODUCTION...2 I. REPORTING ENTITIES...3 II. REPORTING

More information

Hong Kong Medical Law Brief

Hong Kong Medical Law Brief 9 July 2013 Hong Kong Medical Law Brief Welcome to the July edition of Kennedys' Hong Kong Medical Law Brief. Our team of dedicated lawyers had launched a series of informative seminars for medical practitioners

More information

General Dentistry Neuromuscular Dentistry Cosmetic Dentistry Sleep Medicine

General Dentistry Neuromuscular Dentistry Cosmetic Dentistry Sleep Medicine PO Box 297 Hedgesville, WV 25427 304 754-8803 KenBarneydds.com General Dentistry Neuromuscular Dentistry Cosmetic Dentistry Sleep Medicine WELCOME TO OUR PRACTICE Welcome to the office of Dr. Kenneth C.

More information

INFORMED CONSENT FOR SLEEVE GASTRECTOMY

INFORMED CONSENT FOR SLEEVE GASTRECTOMY INFORMED CONSENT FOR SLEEVE GASTRECTOMY This informed-consent document has been prepared to help inform you about your Sleeve Gastrectomy including the risks and benefits, as well as alternative treatments.

More information

ADA Dental Claim Form (2012 American Dental Association) Completion Instructions Page 1 of 17

ADA Dental Claim Form (2012 American Dental Association) Completion Instructions Page 1 of 17 Page 1 of 17 Introduction The ADA Dental Claim Form has been revised to incorporate key changes to the HIPAA standard electronic dental claim transaction. This version of the form, front and reverse sides,

More information

The United States currently has no federal statute which comprehensively addresses

The United States currently has no federal statute which comprehensively addresses Warning: This information is not intended to constitute legal advice and should not be relied upon in lieu of consultation with appropriate legal advisors in your own jurisdiction. It may not be current

More information

CHAPTER 2011-233. Committee Substitute for Committee Substitute for Committee Substitute for Committee Substitute for House Bill No.

CHAPTER 2011-233. Committee Substitute for Committee Substitute for Committee Substitute for Committee Substitute for House Bill No. CHAPTER 2011-233 Committee Substitute for Committee Substitute for Committee Substitute for Committee Substitute for House Bill No. 479 An act relating to medical malpractice; creating ss. 458.3175, 459.0066,

More information

Aesthetic Facial Plastic Surgery, PLLC 1810 116th Ave NE #102 Bellevue, WA 98004

Aesthetic Facial Plastic Surgery, PLLC 1810 116th Ave NE #102 Bellevue, WA 98004 Aesthetic Facial Plastic Surgery, PLLC 1810 116th Ave NE #102 Bellevue, WA 98004 GENERAL, HIPAA, PHOTO VIDEO INFORMED CONSENT FORM, AND RELEASE AGREEMENT Aesthetic Facial Plastic Surgery, PLLC s ("AFPS"),

More information

Dental Benefits. How Dental Benefits Work. Schedule of Benefits

Dental Benefits. How Dental Benefits Work. Schedule of Benefits Dental coverage under Stryker s healthcare plan helps pay dental bills for you and your family. It is designed to encourage good dental care. The plan covers preventive dental services and treatment for

More information

Basal Cell Carcinoma Affecting the Eye Your Treatment Explained

Basal Cell Carcinoma Affecting the Eye Your Treatment Explained Basal Cell Carcinoma Affecting the Eye Your Treatment Explained Patient Information Introduction This booklet is designed to give you information about having a Basal Cell Carcinoma near your eye and the

More information

New Patient Registration Form

New Patient Registration Form New Patient Registration Form Welcome to Bayside Dental Care! We look forward to giving you the best dental experience possible. Please complete both sides of this form. Let us know if you need any assistance

More information

Sedadent Anesthesia Services Jarom Heaton D.D.S., M.S. Instructions:

Sedadent Anesthesia Services Jarom Heaton D.D.S., M.S. Instructions: Sedadent Anesthesia Services Jarom Heaton D.D.S., M.S. Instructions: To Dental Staff: Please fill out the Anesthesia Patient Information form and fax to Dr. Heaton s office @ 512-246-3678 or drop in the

More information

VIRGINIA ACTS OF ASSEMBLY -- 2015 SESSION

VIRGINIA ACTS OF ASSEMBLY -- 2015 SESSION VIRGINIA ACTS OF ASSEMBLY -- 2015 SESSION CHAPTER 585 An Act to amend and reenact 38.2-2206 of the Code of Virginia and to amend the Code of Virginia by adding in Article 7 of Chapter 3 of Title 8.01 a

More information

Dental. Covered services and limitations module

Dental. Covered services and limitations module Dental Covered services and limitations module Dental Covered Services and Limitations Module Covered Dental Services for Patients Under the Age of 21...2 Examinations...2 Radiographs and Diagnostic Imaging...2

More information

Tuition and Fees Dentists - Full time (per annum): 20,000

Tuition and Fees Dentists - Full time (per annum): 20,000 Diploma of Oral Surgery Residency Training Program in preparation for the Fachzahnarzt in Oral Surgery Specialty Examination in the Republic of Germany Degree awarded: - Diploma of Oral Surgery - Fachzahnarzt

More information

CAMARILLO AQUATICS AND REHABILITATION SERVICES

CAMARILLO AQUATICS AND REHABILITATION SERVICES CAMARILLO AQUATICS AND REHABILITATION SERVICES Last Name First M.I. Address Apt.# City State Zip Code Phone # SS# Date of Birth Sex M F Driver s License # Marital Status: S M D W Spouse s Name How did

More information

2. Are you allergic to penicillin, codeine, local anesthetics, tranquilizers or any other drugs or medicine?

2. Are you allergic to penicillin, codeine, local anesthetics, tranquilizers or any other drugs or medicine? PATIENT NAME: BIRTH DATE: DATE: LAST FIRST DENTAL HISTORY 1. Reason for Visit / Main Concern? Check-Up Cleaning Toothache Other 2. Are there other conditions of which we should be aware? YES NO If yes,

More information

Portage La Prairie School Division. Dental Plan

Portage La Prairie School Division. Dental Plan Portage La Prairie School Division Dental Plan Eligibility Dental benefits are available to all regular full-time or part-time teachers signed to a Teacher General Contract, teachers on a Limited Term

More information

Guardian/Patient Name. Family Dental Care NC. 1701 Country Club Rd---Jacksonville, NC 28546 Telephone: (910) 346-2345 SIGNATURE ON FILE

Guardian/Patient Name. Family Dental Care NC. 1701 Country Club Rd---Jacksonville, NC 28546 Telephone: (910) 346-2345 SIGNATURE ON FILE Guardian/Patient Name Family Dental Care NC 1701 Country Club Rd---Jacksonville, NC 28546 Telephone: (910) 346-2345 Date/Initial SIGNATURE ON FILE I authorize use of this form on all my insurance submissions.

More information

CHAMBERS MEDICAL GROUP 5108 15th Street East, Suite 205 * Bradenton, FL 34203 * (941) 727-9057 * (941) 727-3981 fax

CHAMBERS MEDICAL GROUP 5108 15th Street East, Suite 205 * Bradenton, FL 34203 * (941) 727-9057 * (941) 727-3981 fax CHAMBERS MEDICAL GROUP 5108 15th Street East, Suite 205 * Bradenton, FL 34203 * (941) 727-9057 * (941) 727-3981 fax PERSONAL INFORMATION: PLEASE PRINT MISS/MRS/MS/MR: AGE: FIRST MIDDLE MAIDEN LAST DATE

More information

Delta Dental Individual and Family Dental Plans. EHB Certified DELTA DENTAL OF NORTH CAROLINA

Delta Dental Individual and Family Dental Plans. EHB Certified DELTA DENTAL OF NORTH CAROLINA Delta Dental Individual and Family Dental Plans EHB Certified DELTA DENTAL OF NORTH CAROLINA You ll benefit from: Freedom Enjoy access to two Delta Dental networks Delta Dental PPO and Delta Dental Premier.

More information

Name: Birthdate: Age: Address: City, State, ZIP: Preferred Phone # (Home)(Cell)(Work): Marital Status: M S W D

Name: Birthdate: Age: Address: City, State, ZIP: Preferred Phone # (Home)(Cell)(Work): Marital Status: M S W D Be Fit Physical Therapy & Pilates, LTD Patient Registration Form Date: Name: Birthdate: Age: Address: City, State, ZIP: Preferred Phone # (Home)(Cell)(Work): Marital Status: M S W D Secondary Phone# (Home)(Cell)(Work):

More information

Dental Professional Liability Insurance Application - Individual Dentist

Dental Professional Liability Insurance Application - Individual Dentist Dental Professional Liability Insurance Application - Individual Dentist With your fully completed, signed and dated application, you must submit the following information: 1. Current insurance policy

More information

IN THE SUPREME COURT OF MISSISSIPPI NO. 1998-CA-01231-SCT JOYCE SHEFFIELD v. DR. KEN GOODWIN, D.M.D., INDIVIDUALLY AND d/b/a KEN GOODWIN, D.M.D., P.A.

IN THE SUPREME COURT OF MISSISSIPPI NO. 1998-CA-01231-SCT JOYCE SHEFFIELD v. DR. KEN GOODWIN, D.M.D., INDIVIDUALLY AND d/b/a KEN GOODWIN, D.M.D., P.A. IN THE SUPREME COURT OF MISSISSIPPI NO. 1998-CA-01231-SCT JOYCE SHEFFIELD v. DR. KEN GOODWIN, D.M.D., INDIVIDUALLY AND d/b/a KEN GOODWIN, D.M.D., P.A. DATE OF JUDGMENT: 03/23/1998 TRIAL JUDGE: HON. FRANK

More information

CHAPTER 34 INFORMED CONSENT FOR THE NURSE

CHAPTER 34 INFORMED CONSENT FOR THE NURSE CHAPTER 34 INFORMED CONSENT FOR THE NURSE I. INTRODUCTION The goal of informed consent is patient autonomy or self-determination. To be autonomous, individuals must be able to control their bodies by controlling

More information

Department of Oral and Maxillofacial Surgery and Orthodontics Removing wisdom teeth Information for patients

Department of Oral and Maxillofacial Surgery and Orthodontics Removing wisdom teeth Information for patients Department of Oral and Maxillofacial Surgery and Orthodontics Removing wisdom teeth Information for patients The information in this leaflet will help you to understand your treatment. It contains answers

More information

ACKNOWLEDGEMENT OF RECEIPT OF WESTERN DENTAL S NOTICE OF PRIVACY PRACTICE

ACKNOWLEDGEMENT OF RECEIPT OF WESTERN DENTAL S NOTICE OF PRIVACY PRACTICE ACKNOWLEDGEMENT OF RECEIPT OF WESTERN DENTAL S NOTICE OF PRIVACY PRACTICE By signing this document, I acknowledge that I have received a copy of Western Dental s Joint Notice of Privacy Practices. Name

More information

Medical Malpractice: What You Don t Know Can Hurt You

Medical Malpractice: What You Don t Know Can Hurt You Medical Malpractice: What You Don t Know Can Hurt You O. William Brown, MD, JD Chief, Division of Vascular Surgery William Beaumont Hospital Interim Chief, Division of Vascular Surgery Wayne State University

More information

Cultural Vistas Inbound Frequently Asked Claim Questions (FAQ) (For New J-1 Visa Holders in the U.S.A. as of 5-1-2012)

Cultural Vistas Inbound Frequently Asked Claim Questions (FAQ) (For New J-1 Visa Holders in the U.S.A. as of 5-1-2012) Specializing in international health insurance for groups. TOLL FREE: 866-433-7462 (within USA) Phone: 607-272-2707 (collect from overseas) FAX: 607-272-2703 EMAIL: claims@iees.com WEB: www.iees.com PO

More information

Removal of impacted wisdom teeth

Removal of impacted wisdom teeth Ambulatory Care & Local Networks Removal of impacted wisdom teeth Information for patients This leaflet aims to help you understand the treatment you are going to have and contains answers to many commonly

More information

AN ACT RELATING TO DENTISTRY; CHANGING THE LICENSING OF DENTISTS AND DENTAL HYGIENISTS BY CREDENTIAL; EXPANDING THE SCOPE OF PRACTICE OF DENTAL HYGIENISTS. BE IT ENACTED BY THE LEGISLATURE OF THE STATE

More information

[PAGE HEADLINE] Improve your Health and Change Your Smile with Complete Dental Services in One [CITYNAME] Location

[PAGE HEADLINE] Improve your Health and Change Your Smile with Complete Dental Services in One [CITYNAME] Location Eddie Stephens//Copywriter Sample: Website copy/internal Dental Services Pages [PAGE HEADLINE] Improve your Health and Change Your Smile with Complete Dental Services in One [CITYNAME] Location [LEAD SENTENCE/PARAGRAPH]

More information

Medical Malpractice Reform

Medical Malpractice Reform Medical Malpractice Reform 49 This Act to contains a clause wherein the state legislature asks the state Supreme Court to require a plaintiff filing a medical liability claim to include a certificate of

More information

and skillful dental surgeon, capable of properly and skillfully treating and caring for

and skillful dental surgeon, capable of properly and skillfully treating and caring for 3. The Lilburn Dental Group is a Georgia limited liability company may be served through its registered agent, Dr. Richard Gangwisch at 912 Killian Hill Rd SW, Suite 100, Lilburn, GA 30047. 4. Dr. Gangwisch

More information

PATIENT INFORMATION FORM

PATIENT INFORMATION FORM 737 Pearl Street, Suite 108 Phone: 858.456.2114 Fax: 858.456.2103 www.abilityrehabsd.com PATIENT INFORMATION FORM Please print and complete ALL items. If an item doesn t apply, put N/A Patient Name: Age:

More information

Application for Coverage Professional & Business Liability Insurance

Application for Coverage Professional & Business Liability Insurance Application for Coverage Professional & Business Liability Insurance Please type or print Please read this before filling out your application for Professional & Business Liability insurance. You warrant

More information

Updated as of 05/15/13-1 -

Updated as of 05/15/13-1 - Updated as of 05/15/13-1 - GENERAL OFFICE POLICIES Thank you for choosing the Quiroz Adult Medicine Clinic, PA (QAMC) as your health care provider. The following general office policies are provided to

More information

X Guarantor/Parent/Guardian Signature

X Guarantor/Parent/Guardian Signature Patient Name: Last First Address City State Zip Phone# (C) (H) (W) Date of Birth Social Security# (REQUIRED FOR BILLING) If Patient is a Minor, a Parent s Name & Social Security# are Required Emergency

More information

FURR & HENSHAW. 1900 Oak Street, P.O. Box 2909 Myrtle Beach, SC 29578 Phone: (843) 626-7621. and

FURR & HENSHAW. 1900 Oak Street, P.O. Box 2909 Myrtle Beach, SC 29578 Phone: (843) 626-7621. and FURR & HENSHAW 1900 Oak Street, P.O. Box 2909 Myrtle Beach, SC 29578 Phone: (843) 626-7621 and 1534 Blanding Street Columbia, SC 29201 Phone: (803) 252-4050 YOUR AUTOMOBILE ACCIDENT CASE The purpose of

More information

Welcome to the practice of Paolo Incampo, DMD and Associates

Welcome to the practice of Paolo Incampo, DMD and Associates Welcome to the practice of Paolo Incampo, DMD and Associates We have been providing exceptional and comprehensive dental treatment to families of the greater Merrimack Valley community for over a decade.

More information

Arlington Dental Associates Ira Stier DDS PC 876 Dutchess Tpk 2 Lafayette Ct. Poughkeepsie, NY 12603 Fishkill, NY 12524 845-454-7023 845-896-4977

Arlington Dental Associates Ira Stier DDS PC 876 Dutchess Tpk 2 Lafayette Ct. Poughkeepsie, NY 12603 Fishkill, NY 12524 845-454-7023 845-896-4977 Home Sleep Test Liability Form Study Equipment Due: @ I, accept responsibility for the sleep monitoring device while it is in rny possession. I understand that if I fail to return the device or I return

More information

FURR & HENSHAW. http://www.scmedicalmalpractice.com

FURR & HENSHAW. http://www.scmedicalmalpractice.com FURR & HENSHAW http://www.scmedicalmalpractice.com 1900 Oak Street Post Office Box 2909 Myrtle Beach, South Carolina 29578 (843) 626-7621 (800) 849-2525 fho@sc.rr.com and 1534 Blanding Street Columbia,

More information

OVERVIEW The MetLife Dental Plan for Retirees

OVERVIEW The MetLife Dental Plan for Retirees OVERVIEW The MetLife Dental Plan for Retirees IN NETWORK: Staying in network saves you money. 1 Participating dentists have agreed to MetLife s negotiated fees which are typically 15% to 45% below the

More information

Galerie Dental Care. Patient Information. Emergency Contact Relationship: Phone:

Galerie Dental Care. Patient Information. Emergency Contact Relationship: Phone: Galerie Dental Care Patient Information Date: Patient Name: Last First Middle Initial (Preferred Name) Gender: Birth Date: Marital/Family Status Address: Street Apartment # City Province Postal Code Phone

More information

Medical Malpractice Litigation. What to Expect as a Defendant

Medical Malpractice Litigation. What to Expect as a Defendant Medical Malpractice Litigation What to Expect as a Defendant Being named as a defendant in a malpractice suit may be your first exposure to civil litigation. You will probably wish it would just go away.

More information

The Malpractice Lawsuit:

The Malpractice Lawsuit: The Malpractice Lawsuit: Process and Prevention Advocate Health Care 7 th Annual Advocate Trauma Symposium Wyndham Lisle - Chicago November 18, 2010 Rogelio Lasso The John Marshall Law School BACKGROUND

More information

Dental health following cancer treatment

Dental health following cancer treatment Dental health following cancer treatment Treatment for cancer often increases the risk for dental problems. As a cancer survivor, it is important for you to understand the reasons why dental care is especially

More information

The dental profession s peer review program is a process to resolve disputes between a

The dental profession s peer review program is a process to resolve disputes between a HOW THE DENTAL PEER REVIEW SYSTEM WORKS AND WHAT YOU EXPECT FROM IT Introduction The dental profession s peer review program is a process to resolve disputes between a patient and a dentist or a third

More information

What is Balloon Sinuplasty?

What is Balloon Sinuplasty? What is Balloon Sinuplasty? The painful symptoms associated with chronic sinusitis can be overwhelming. If symptoms are difficult to control with medications alone, your primary doctor may refer you to

More information