Ind. Admin. Code tit. 828, r. 4-3-9 – Information for patients

Sec. 9. (a) During or at the conclusion of each patient's visit to the mobile dental facility or portable dental operation, the patient shall be provided with an information sheet. If the patient has provided consent to an institutional facility to access the patient's dental health records, the institution shall also be provided with a copy of the information sheet. An institutional facility includes, but is not limited to, a long term care facility or school.

(b) An information sheet shall include the following:
(1) Pertinent contact information as required by this article.
(2) The name of the dentist and other dental staff who provided services.
(3) A description of the treatment rendered, including billed service codes and fees associated with treatment, and tooth numbers when appropriate.
(4) If necessary, referral information to another dentist as required by this article.

(State Board of Dentistry; 828 IAC 4-3-9; filed May 2, 2002, 10:24 a.m.: 25 IR 2738; readopted filed Sep 26, 2008, 10:49 a.m.: 20081015-IR-828080336RFA; readopted filed Dec 1, 2014, 8:31 a.m.: 20141231-IR-828140388RFA; readopted filed Nov 30, 2020, 11:18 a.m.: 20201230-IR-828200291RFA)