|
|
 |
|
|
|
|
|
|
 |
|
|
|
|
|
|
|
 Handouts and Forms
- 2012 OSHA Course Flyer and Sign Up Form - click here
- 2012 OSHA Handout - click here to view or print
- Here’s the ADA’s medical history form.
It’s very complete, it’s easy to use, and you can either order it from the ADA or
you can configure it to work for your individual office.
Click here to see a copy of the adult medical history form:
Click here to see a copy of the child’s medical history form:
- OSHA Employee Forms
There are various requirements for how long employee records must be kept. For example, employee medical records and Hep B declination forms are supposed to be kept for the term of employment plus 30 years, training records have to be kept for 3 years, etc. For the sake of ease, just keep all OSHA related records indefinitely. click here
Employee Medical Records
Keep training records in your OSHA notebook under the “record keeping section and all employee medical-related records should be kept separate from the OSHA materials (in order to protect employees’ privacy). Medical records must be kept on every employee who has potential occupational exposure. These medical records can either be maintained on-site by the employer, or off-site at the physician’s office who provides care to that employee. Employee medical record - for example record click here
Hepatitis B declination form
If you have an employee who refuses to take a hepatitis B vaccine, have them sign the Hepatitis B declination form and file it in their employee medical record.
Informed refusal for postexposure evaluation
The “Informed Refusal of Postexposure Evaluation” is not required by law. However, this form is additional documentation that you offered to evaluate the employee after an exposure incident and the employee refused. click here to view/print the forms
Steps After A Stick
In the event of a stick, here are the steps to follow ( "steps after a stick").
Exposure Report
There is also a copy of an "Exposure Report", which must be filled out and presented to the medical doctor performing the post-exposure evaluation.
I've also included the “HIV Post-Exposure Prophylaxis Recommendations" and the "Hepatitis B Post-Exposure Prophylaxis" which gives information about what to do in the event of exposure to an HIV+ and/or a Hep B+ patient.
- Click here for sharps evaluation forms and information about selecting safer sharps (an evaluation must be done annually, according to OSHA’s Needlestick and Prevention Act). Remember, you only have to evaluate any new technology, you don't have to use it if you don't feel it's safer. Document your findings and and decisions and place it in your OSHA notebook.
Every year, we are supposed to evaluate any new technology that comes out that could possibly make us safer while performing our duties. Here is an evaluation of a safety syringe that you can print out, go over with your office staff, and if you agree with the findings, place it in your OSHA notebook:
(click here - sharps evaluation form for OSHA notebook)
 Here are some information sheets for you and patients that you may find helpful: American Heart Association pre-medication guidelines for doctors and patients; American Heart Association guidelines for individuals with joint replacements; and an Osteonecrosis fact sheet.
American Heart Association premedication guidelines - Antibiotics
AHA guidelines for individuals with joint replacements
Prevention of infective endocarditis: Guidelines from the American Heart
Association
Osteonecrosis fact sheet
X-ray patient fact sheet from the ADA
HIPAA AUTHORIZATION FORM: Here is a form you can alter for use for any patient whose dental work is paid for by another person (so you can disclose information but still make an effort to comply with HIPAA requirements).
We run into situations all the time where HIPAA prevents us from disclosing information but, for practical reasons, we need to disclose information so we can get paid (examples: moms who bring in college-age kids for dental work and they're still paying the bill, divorced parents who don't want the other to get information but they want us to bill them for payment, 40 year olds who are getting their dental work paid for by their parents, etc.) Make it a policy in your office that anyone who has a financial interest in another person gets information and then have them sign this Authorization.
If a patient doesn't like this policy he can pay the bill himself or he can choose to go somewhere else. (Please note that you can’t refuse treatment specifically because a patient refuses to sign an authorization, but you can dismiss a patient for violating office policies, so long as you follow state and federal laws and make sure you don’t “abandon” your patient.) Anyway, it takes us out of the middle and will (hopefully!) help protect us from HIPAA complaints.
- Model Hazard Communication Plan
This model Hazard Communication Program is taken from OSHA, but it’s edited to apply only to dentistry. Fill it out and place it with your OSHA materials.
click here to view / print the Communication Plan
- Model Exposure Control Plan for Dentistry ONLY:
The Model Exposure Control Plan is intended to serve as an employer guide to the
OSHA Bloodborne Pathogens standard. A central component of the requirements of
the standard is the development of an exposure control plan (ECP).
This model is taken from OSHA, but edited to apply only to dentistry.
click here to view / print Model Exposure Control Plan for Dentistry only.
- Model Exposure Control Plan for Patient Care Facility:
The Model Exposure Control Plan is intended to serve as an employer guide to the OSHA Bloodborne Pathogens standard. A central component of the requirements of the standard is the development of an exposure control plan (ECP).
This model, taken directly from OSHA, is for any type of patient care facility.
click here to view / print Model Exposure Control Plan for any facility.
- TB Risk Assessment
(Print and fill out -- this will tell you your office's potential risk of exposure for TB.
Place it with your OSHA materials in a section called 'TB Risk Assessment'."
click here to print
- Model TB Infection Control Plan and TB fact sheets
(Since we are low-risk environments according to the CDC, we are generally not required to have a written TB infection control plan. However, some states ask for this as part of the infection control plan, so here's a sample one for you to use as necessary, along with fact sheets on TB). click here to print
 HIV and HBV
Postexposure Prophylaxis Recommendations
click here to view / print handout
- Outline of Florida Laws, Rules & Errors and
Medical Errors and Omissions Courses
click here to view / print the Florida Laws Summary.
- Florida Course Handout
click here to view / print the Florida Course Handout.
This is a large 11 MB file so please allow time for download
Sample Dismissal Letters
Here are some sample letters you can use as guidelines for your own dismissal letters. Please note that copying costs of records depend on state and HIPAA law, so be aware that the costs may vary, but all law agrees that the cost should be pretty much limited to the actual costs of duplication and mailing. Also be aware that you cannot withhold records just because a patient has a balance. Finally, the usual legal stuff... these letters are not comprehensive, they are not representative of every situation, they are not meant to constitute legal advise, blah, blah. Anytime you're not sure about how to handle a situation, always consult your attorney.
Sample Dismissal Letters
click here to view / print these samples
You never have to pay for required posters for your workplace!
Call the US Department of Labor (1-888-9SB-REFA) or go to the Department of Labor Poster Page at http://www.dol.gov/osbp/sbrefa/poster/matrix.htm
Sometimes your malpractice insurance will send you an entire packet if you just ask! For state posters, call your state department of labor and worker's compensation board and they'll send them to you at no charge.
( In Georgia: go to http://www.dol.state.ga.us/em/required_posters.htm and http://www.laborlawtalk.com/showthread.php?t=3655 )
|
|
