(a)

1. (1) A written protocol to be used by the collaborative care dental hygienist to treat patients must be established by the consulting dentist and dental hygienist prior to the delivery of patient care.

2. (2) The written agreement must include the following elements:

   1. (A) Be signed and dated by both the consulting dentist and the dental hygienist;
   2. (B) Address, telephone number, and license number of both the consulting dentist and the dental hygienist;
   3. (C) Contain the dentist and dental hygiene license numbers;
   4. (D) The date on which the agreement becomes effective;
   5. (E) A provision addressing the availability of the consulting dentist for:

(i) Emergency situations;

1. (ii) Consultation; and

   1. (iii) Referral;
   2. (F) The name, address, telephone number, and license number of a designee for the dental hygienist to contact in cases where the consulting dentist is not available;

   3. (G)

      1. (i) Location or locations where the dental hygiene services will be provided.
      2. (ii) The agreement must be updated when new locations are added or listed locations are discontinued; and

   4. (H)

      1. (i) Plan for retrospective chart reviews conducted within seven (7) days of the most recent hygiene service date by the consulting dentist.
      2. (ii) Reviews must include:

(b) (b) Documentation;

1. (c) (c) Type and appropriateness of services rendered;

   1. (d) (d) Review of patient consent forms;

(f) (f) Evaluation of the quality and appropriateness of radiographs.

1. (3) The protocol must include but is not limited to:

   1. (A) Medical history;
   2. (B) Record keeping;

   3. (C) Criteria for the provision of:

      1. (i) Prophylaxis;
      2. (ii) Sealants;
      3. (iii) Fluoride therapies;
      4. (iv) Radiographs; and
      5. (v) Other services within the scope of practice of the dental hygienist; and
   4. (D) Infection control procedures.

(b) In accordance with this protocol a consulting dentist must:

1. (1) Be available to provide emergency communication and consultation with the dental hygienist or appoint another dentist as a designee for those times when the consulting dentist cannot be reached;

2. (2)

   1. (A) Maintain records of patients treated.
   2. (B) If another dentist provides follow-up treatment, the consulting dentist is responsible for the transfer of records;
3. (3) Maintain a copy of the collaborative agreement and the protocol on file; and

4. (4) Notify the Arkansas State Board of Dental Examiners if:

   1. (A) The collaborative agreement between dentist and hygienist dissolves; or

   2. (B) Contact information changes.

      1. (c) In accordance with this protocol a collaborative care dental hygienist must:
5. (1) Maintain contact capabilities with the consulting dentist;
6. (2) Secure information consent from all patients or the parent/guardian of the patient before providing services;
7. (3) Provide to the patient, parent, or guardian a written plan for referral to a dentist for assessment of further dental treatment needs;
8. (4) Provide copy of collaborative care record of services to the institutional facility responsible for patient’s care, when applicable;
9. (5) Secure release of information forms from the patient or parent/guardian of the patient if the care is provided in an institutional facility allowing the dental hygienist to access the patient’s medical and dental records;
10. (6) Create and maintain all patient records and forward all records and radiographs or duplicates to the consulting dentist within seven (7) days of services rendered;
11. (7) Maintain a copy of the collaborative agreement and the protocol on file;

12. (8) Notify the board if:

    1. (A) The collaborative agreement between dentist and hygienist dissolves; or
    2. (B) Contact information changes;
13. (9) Maintain a malpractice liability policy for the provision of services; and

14. (10) The collaborative care dental hygienist may use or supervise a dental assistant but shall not permit assistants to provide direct clinical services to patients.

    1. (d) A copy of the protocol must be sent to the board’s office to have on file with the corresponding permit.