Individual providers at a mobile or portable dental unit shall not perform any service on a minor without having obtained, prior to the provision of services, a signed, written consent from the minor's parent or legal guardian, that includes, at a minimum, the:

1. (1) Name of the dental group and/or dentist providing the dental services at the mobile and/or portable dental unit;
2. (2) Permanent business mailing address of the dental group and/or dentist providing the dental services at the mobile and/or portable dental unit;
3. (3) Business telephone number of the dental group and/or dentist providing the dental services at the mobile and/or portable dental unit. This telephone number must be available for emergency calls;
4. (4) Full printed name of the child to receive services;
5. (5) Child's SoonerCare Member ID number; and
6. (6) An inquiry of whether the child has had dental care in the past twelve (12) months and if the child has a dental appointment scheduled with his/her regular dentist. If applicable, parent should list the name and address of the dentist and/or dental office where the care is provided.

Added at 37 Ok Reg 1616, eff 9-14-20

Amended at 40 Ok Reg 370, eff 11-4-22 (emergency)

Amended at 40 Ok Reg 2218, eff 9-11-23