Clinic Handbook - 6.21.2021 Highlite Seciont 9

DENTAL CLINIC HANDBOOK
REV. 6-21-21
Mission Statement
UCLA School of Dentistry’s Mission:
To improve the oral and systemic health of the people of California, the nation, and the world through
education, research, patient care, and public services.
Core Values
The UCLA School of Dentistry holds the following Core Values:
 Advancement of Knowledge – We promote the advancement of knowledge of the basic mechanisms,

determinants, diagnoses, management, and prevention of oral and craniofacial diseases and conditions,
and relationship between oral and systemic health.
 Diversity – We believe the School of Dentistry will be enriched by the diverse group of faculty, staff,
students, trainees, and patients; and firmly believe that embracing diversity is part of our basic
responsibility to the people of California, the nation, and the world.
 Excellence and Accessibility – As a premier dental school, we provide excellent education, conduct
innovative and impactful research programs, and deliver accessible, patient-centered care and service.
 Professionalism and Humanistic Culture – Our faculty, students, trainees and staff must possess and
exhibit the highest ethics and work collaboratively in an atmosphere of cordiality, collegiality, and
professionalism.
 Global Presence – We are proud of our international reputation of excellence and continuously seek to
expand and improve our global outreach in education, research, patient care, and public service.
 Innovation – We continuously seek to identify the problems and solutions that impact oral and systemic
health. WE thrive on creativity and entrepreneurship as critical elements in the successful attainment
of our mission and goals.
 Humanitarianism and Philanthropy – We seek to improve the oral health of those who do not have
access or do not have the means to afford care. These efforts occur through the generosity of our care
providers and through the generous support of our donors.
 Lifelong Learning – It is our duty to provide resources for the dissemination of the ongoing
advancements in knowledge to the profession and public we serve locally, nationally, and globally.
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[Revised 6-21-21_PMC]
Table of Contents
CHAPTER 1 PROFESSIONAL CONDUCT IN THE CLINIC .............................................................1

I. INTRODUCTION .......................................................................................................................1
II. SUPERVISION OF DENTAL TREATMENT ...........................................................................2
III. GREENSLIP PATIENTS ............................................................................................................3
IV. DENTAL STUDENT ADVERTISING GUIDELINES AND RESTRICTIONS .......................3
V. CLINIC INFECTION CONTROL PROTOCOL ........................................................................4
CHAPTER 2 COMPREHENSIVE PATIENT CARE .............................................................................8
CHAPTER 3 MEDICAL, DENTAL, & CLINIC EMERGENCIES ....................................................10

I. MEDICAL EMERGENCIES ....................................................................................................10
II. BLOOD BORNE PATHOGEN EXPOSURE INCIDENTS .....................................................11
III. DENTAL EMERGENCIES .......................................................................................................12
IV. URGENT CARE APPOINTMENTS ........................................................................................13
V. CLINIC FIRE EMERGENCIES ................................................................................................14
CHAPTER 4 PATIENT RISK MANAGEMENT ..................................................................................15

I. GENERAL INFORMATION ....................................................................................................15
COMMUNICATION .................................................................................................................15
INFORMED CONSENT ...........................................................................................................15
PATIENT BILL OF RIGHTS ....................................................................................................15
PATIENT RESPONSIBILITIES ...............................................................................................16
PROPER DOCUMENTATION/PATIENT RECORDS ...........................................................16
II. MD CONSULTS ........................................................................................................................17
III. DENTAL TREATMENT DURING PREGNANCY, POST-PARTUM AND
BREASTFEEDING ...................................................................................................................17
GENERAL CONSIDERATIONS .............................................................................................17
DENTAL TREATMENT...........................................................................................................18
IV. REFERRAL TO SPECIALISTS ...............................................................................................18
V. TRIAGE AND RESOLUTION OF PATIENT COMPLAINTS ...............................................19
TERMINATION OF DOCTOR-PATIENT RELATIONSHIP .................................................20
FEE REDUCTIONS ..................................................................................................................20
VI. CONFIDENTIALITY OF PATIENT RECORDS ....................................................................21
CONFIDENTIAL PATIENT INFORMATION ........................................................................21
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VIOLATION OF CONFIDENTIALITY ...................................................................................21
RELEASE OF PATIENT RECORDS .......................................................................................21
SUMMARY..........................................................................................................................................22
UCLA Dental CLINICS Privacy Notice Financial and Dental Records ..............................................23
UCLA Dental Center terms and conditions of services Medical and Dental Services Agreement ......24
CHAPTER 5 PATIENT ASSIGNMENTS, APPOINTMENTS, AND CUBICLE BREAKDOWN ..26

I. PATIENT STATUS ...................................................................................................................26
II. ELECTRONIC PATIENT RECORDS ......................................................................................27
III. PATIENT APPOINTMENTS ....................................................................................................27
IV. CANCELLATION POLICY .....................................................................................................28
V. CLIENTTELL – APPOINTMENT REMINDER ......................................................................28
VI. PAYMENT PROCEDURE BEFORE TREATMENT ..............................................................28
VII. PATIENT DATA UPDATE ......................................................................................................28
VIII. GENERAL CLINIC HOURS ....................................................................................................28
IX. TELEPHONE NUMBERS ........................................................................................................29
X. CUBICLE BREAKDOWN........................................................................................................29
XI. TECHNICAL REPAIR ..............................................................................................................29
CHAPTER 6 PATIENT ENTRY INTO TREATMENT .......................................................................30

I. INITIAL PATIENT CONTACT................................................................................................30
II. TREATMENT PLANNING ......................................................................................................30
PATIENT ASSESSMENT/TREATMENT PLANNING – STRUCTURE AND SESSIONS .30
NEW PATIENT WORKFLOW IN THE GROUP PRACTICE MODEL ................................30
TREATMENT PLANNING (TP) CLINIC SESSIONS PROCEDURE ...................................33
STEP SYNOPSIS ......................................................................................................................33
III. STUDENT/PATIENT – COMMUNICATION .........................................................................34
HOW TO CONTACT YOUR PATIENT ..................................................................................34
WHAT TO SAY TO PATIENTS ..............................................................................................35
MAKING THE APPOINTMENT .............................................................................................36
HOW TO INCREASE PATIENT CONFIDENCE IN YOU .................................................36
AFTER YOUR APPOINTMENT..............................................................................................37
IV. HOW TO ORGANIZE YOUR CLINIC TIME .........................................................................37
V. HOW TO UTILIZE YOUR TIME EFFECTIVELY .................................................................38
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CHAPTER 7 TREATMENT PLANNING ..............................................................................................39
CHAPTER 8 RECALL PATIENTS ........................................................................................................41

I. PERIODIC EXAMS ..................................................................................................................41
CHAPTER 9 FINANCIAL POLICIES ...................................................................................................43

I. UCLA DENTAL CLINICS FINANCIAL POLICY .................................................................43
II. PAYMENT REQUIREMENTS PRIOR TO SUBMITTAL OF LABWORK ..........................44
III. DENTI-CAL/INSURANCE ......................................................................................................44
IV. UCLA SCHOOL OF DENTISTRY PATIENT PAYMENT PLAN POLICY ..........................46
V. PRE-PAYMENT PLAN ............................................................................................................47
VI. FEE REDUCTIONS ..................................................................................................................47
VII. STUDENT SUBSIDIES ............................................................................................................48
VIII. ENDODONTIC PILOT PROGRAM ........................................................................................49
IX. RYAN WHITE POLICY ...........................................................................................................50
FEDERAL: PART F ..................................................................................................................50
LA COUNTY: PART A (CRW214) ..........................................................................................50
X. FRIENDS AND FAMILY DISCOUNT PROGRAM ...............................................................51
XI. DENTI-CAL SUBSIDY ............................................................................................................52
CHAPTER 10 CLINIC ARMAMENTARIUM ......................................................................................53

I. BASIC ARMAMENTARIUM ..................................................................................................53
II. TREATMENT PLANNING ......................................................................................................53
III. PERIODONTICS .......................................................................................................................53
1. PERIODONTAL SCALING ..............................................................................................53
IV. RESTORATIVE ........................................................................................................................54
1. AMALGAM PROCEDURE ..............................................................................................54
2. COMPOSITE PROCEDURE .............................................................................................54
3. CROWN & BRIDGE PREPARATION .............................................................................55
4. CROWN BUILD-UP add: ..................................................................................................55
5. CROWN & BRIDGE SEATING (CEMENTATION) .......................................................56
V. REMOVABLE PROSTHODONTICS ......................................................................................56
1. EXAM & PRELIMINARY IMPRESSION APPOINTMENT ..........................................56
2. RPD TOOTH MODIFICATION and FRAMEWORK FINAL IMPRESSION
APPOINTMENT ................................................................................................................56
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3. FINAL IMPRESSION APPOINTMENT ..........................................................................57
4. RPD FRAMEWORK TRY IN APPOINTMENT ..............................................................57
5. JAW RELATION RECORD & TOOTH SELECTION APPOINTMENT .......................58
6. WAX DENTURE TRY-IN APPOINTMENT ...................................................................58
7. INSERTION (DELIVERY) & CLINICAL REMOUNT APPOINTMENT ......................59
8. 24 HOUR CHECK & ADJUSTMENT ..............................................................................59
9. DENTURE REPAIR APPOINTMENT .............................................................................60
10. DENTURE RELINING IMPRESSION AND INSERTION .............................................60
VI. ENDODONTICS .......................................................................................................................60
1. ENDODONTIC PROCEDURE .........................................................................................60
CHAPTER 11 INTEGRATED ACADEMIC MANAGEMENT SYSTEM (axiUm) ..........................61

Components ..........................................................................................................................................61
1. Electronic Patient Record ...................................................................................................61
2. Rolodex...............................................................................................................................61
3. Loading a patient’s Electronic Health Record (EHR) ........................................................62
4. X-Rays ................................................................................................................................62
5. Personal Planner .................................................................................................................62
AXIUM EXAMPLE PAGE .................................................................................................................63
CHAPTER 12 PROFESSIONAL LABORATORY ...............................................................................64

1. FINANCIAL POLICY .......................................................................................................64
2. PROFESSIONAL LAB HOURS & CASE COMPLETION SCHEDULE .......................64
3. SERVICES PROVIDED BY THE PROFESSIONAL LAB .............................................67
II. LAB CASE PAPERWORK .......................................................................................................69
Restorative Casework – Crowns, Onlays, Inlays, 3/4 Crowns, 7/8 Crowns, Dowel Cores .......69
Removable Case Work – Complete and Immediate dentures, Removable Partial Denture and
Interim Partial Dentures......................................................................................................70
CHAPTER 13 POLICY FOR USE OF IONIZING RADIATION .......................................................72

c. Criteria for Exposure ..........................................................................................................72
II. CLINICAL EXPOSURE FACTORS GENDEX EXPERT .......................................................74
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CHAPTER 1
PROFESSIONAL CONDUCT IN THE CLINIC
I. INTRODUCTION
The following operational policies for professional conduct in the clinic have been derived from the Dentists
Pledge, the UCLA Dress and Conduct Code, the ADA Code of Ethics, and established standards of ethical
behavior and common courtesy with input from students, faculty, and staff. The goal is to promote a culture
of professionalism and personal responsibility, and it is expected that all students will support and adhere
to these policies.
Sanctions for noncompliance will depend on the frequency and severity of the infraction. Possible sanctions
include a verbal warning, a written warning in the form of a N/P/R, assigned clinic service, loss of procedure
credit, a reduced grade in Patient Management, Professional Responsibility and Doctoring, or Infection
Control and Regulatory Compliance in The Dental Care Environment courses, or referral to the Hearing
Officer for disciplinary action. If a student wishes to appeal an imposed sanction, he/she can request direct
referral of the case to the Hearing Officer.
It is difficult to cover all of the possible ethical decisions you may encounter during the course of your
clinical training. Therefore, you are encouraged to consult with a member of the clinic administration if you
have any questions regarding the correct course of action you should take in a given situation.
1. UNDER NO CIRCUMSTANCE SHOULD A STUDENT BE PAYING FOR PATIENT

TREATMENT. Students that do pay for a patient’s treatment either out of pocket or through subsidy
in order to advance the funds to submit case work to the lab or deliver other dentistry, WILL NOT BE
REFUNDED. The student will also be subject to discipline.
2. As your SOAP notes and treatment plans will be entered into axiUm (electronic record keeping system),
it is imperative that these progress notes be correct and ALWAYS signed off by a clinical instructor on
the day the treatment was rendered. Fraudulent entries or alterations of a dental record, or any other
clinic documents is considered a serious offense.
3. Professional behavior is expected at all times you are representing the UCLA Dental Clinics/School of
Dentistry. This includes treating patients, classmates, faculty, and staff with courtesy and respect
regarding language, actions, and choice of topic. Professional behavior also includes leaving your
cubicle and lab stations clean and ready for use by the next person.
4. Appropriate clinic attire must be worn whenever you are involved in patient care activities. Clean, well-
maintained UCLA scrub shirts and pants displaying the UCLA logo, closed shoes with socks or
stockings, and a clean disposable gown are the only acceptable attire. Please note that wearing the light
green scrubs issued by the UCLA Medical Center is allowed only during operating room assignments
while on Oral Surgery block. In addition, appropriate footwear (no open-toed shoes) must be worn in
the laboratories. Eye protection must be worn when using grinding or lathing tools.
5. All appointments for patient care must be scheduled with the Group Practice Administrators or Patient
Care Coordinators using the axiUm Appointment Scheduling Request System.
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6. You are responsible for providing timely and appropriate dental care for assigned patients, including
emergency services. You must be readily available to patients and the clinic staff by pager/cell phone.
Your cell phones/pagers MUST have a local area code: 310, 213, 323, 626, 818, 424, 909, 949, 805,
661, 562, and 714. In addition, you must provide patients with phone numbers and instructions needed
to obtain emergency care after hours and on weekends. Under no circumstances should you tell the
patient to walk in without arranging for their care in advance.
7. The Group Practice Directors are responsible for all patient assignments, transfers, and discharges. It is
not acceptable to trade or barter patients on your own in an effort to obtain needed procedures. Similarly,
it is unacceptable for 2nd or 3rd year students to complete procedures reserved for 4th year students
without the approval of the Group Practice Director.
8. Advertisements or flyers for the purpose of soliciting patients must be approved by the Clinic Director.
This review is to ensure that no false or misleading advertisements are distributed, that the material
submitted for review meets ethical standards (i.e., use of certain terminology such as “Free” is
prohibited), and that the process of patient recruitment is fair to all students.
9. Every effort must be made to make sure that the confidentiality of all patient health information is
maintained in our clinic environment. When interacting with patients and discussing sensitive
information such as alcohol/substance use and abuse, mental and emotional problems, history of
sexually transmitted diseases, HIV status (including the funding source for dental treatment, such as
Ryan White coverage), or any other similar health information, please:
a. Use as low a voice tone as possible

b. If necessary, bring the patient to a faculty or staff office or any other room/area where the
conversation is less likely to be overheard by others
c. If you are student, resident or trainee and have questions or need directions, communicate your
patient’s privacy needs to the faculty and/or staff so that they can assist you
Most of our clinic layouts do not allow us to create a completely private environment, but any practice
that we can adopt to limit unintended sharing of information should be emphasized. This includes but
is not limited to all clinical areas, public areas (like the Lobby) and elevator
10. Children under the age of seven who are not being treated as patients are not allowed chair-side in
UCLA Dental Clinics. The student and trainees who provide dental care need to devote their full
attention to patients and should not be distracted by external factors that may compromise quality of
care. Additionally, our dental clinic facilities contain potentially hazardous materials and equipment,
which can cause injury to unattended children. This policy is consistent with UCLA campus regulations
that do not allow bringing children into the workplace. Children under seven who are under the
supervision of an adult are allowed in waiting and other common areas of the building that are away
from the dental chairs.
II. SUPERVISION OF DENTAL TREATMENT

As a Student Dentist, all dental treatment you deliver prior to receiving your degree MUST BE
DELIVERED IN THE UCLA DENTAL CLINICS AND SUPERVISED BY A LICENSED
FACULTY MEMBER. Dental procedures include any diagnostic steps: extra-oral and intra-oral
examinations, fabrication/making of impressions, radiographs, and any act that involves physical
interaction between the provider and the patient.
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Supervision of dental treatment by faculty is provided in the form of an electronic start-check that must be
acquired from a faculty member before the procedure is initiated and a faculty member must provide an
electronic sign-off at the completion of the procedure; additionally, faculty interaction will occur during the
time the patient is being treated. Patient “house-calls” by students are absolutely not allowed as they
constitute non-supervised care.
Violation of any of the afore-mentioned policies is considered to be operating without a license. Delivering
dental treatment without a license is a criminal offense and punishable by state law and federal law.
III. GREENSLIP PATIENTS

Green slip patients are classified as either a patient who is referred to you by a friend, relative, (or is a
relative) or by another patient, and you are bringing this patient in to become a patient of record. These
patients are screened Monday through Fridays at 8:00 AM or 1:00 PM only.
You must be present for the screening appointment. NO OTHER APPOINTMENTS can be scheduled
in the clinic until the patient is processed through the patient assignment office, and is forwarded to your
Group Practice Director to be formally assigned to you.
Although these patients are your “Greenslip” patients, not everything can be accomplished in one
appointment; you CANNOT ask your Group Practice Director to assign a patient on the spot. All other
appointments are requested through axiUm the same way that you request all of your appointments in the
clinic. Please ask that your patients arrive “ON TIME” as we cannot see your patient if she/he is late.
IV. DENTAL STUDENT ADVERTISING GUIDELINES AND RESTRICTIONS
There are occasions when dental students may choose to create advertising material to recruit patients as
Greenslip. The action of creating advertising material is, in itself, acceptable; however, there are caveats
and guidelines that must be followed given the innumerable options to advertise that were not as readily
available or popular years ago.
Students are neither discouraged nor discouraged from posting physical advertisements. If physical
advertisements are used, these cannot be posted anywhere on UCLA campus buildings or anything on
UCLA campus grounds (e.g., trees, bust stations, lampposts, etc.)
Whether the advertisement is on paper or digital, there are certain words and phrases that the Dental
Regulation Act does not permit. For example, one cannot comment on the quality of care being delivered
(e.g., “High Quality”, “Excellent Quality”, “Best”, etc.) Words or phrases like “free of charge” and
“cheap” cannot be used either. You may say “low cost”, “complimentary screening”, and “fees at 50%
compared to those in the private sector”.
All advertisement material must also be submitted to the Clinic Director for editing/revision and approval
before posted, aired, or uploaded.
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V. CLINIC INFECTION CONTROL PROTOCOL
Details of the infection control protocols in the general clinic are found in the UCLA Dental Center
Infection Control Manual. Below is a summary of the infection control protocols used in the clinic.
General Principles
The goal of the clinic infection control protocol is to minimize or eliminate the transfer of microorganisms
by taking the necessary steps to prevent the spread of infectious agents. The prevention of cross
contamination from patient to the dental health care worker (DHCW); from patient to the treatment area
and from treatment area to treatment area is imperative. All patients must be treated under the concept of
“standard precautions” an approach intended to reduce the risk of blood borne pathogens transmission from
all body fluids including blood, saliva, mucous membranes, secretions, excretions (except sweat) and non-
intact skin. Standard precautions are used for all patients regardless of their perceived personal infectious
condition.
Clinic Protocol
All students, residents, faculty and staff who may come in contact blood and other potentially infectious
materials (OPIM) must comply with the following guidelines.
Eating, drinking, smoking, applying cosmetics or lip balm and handling contact lenses are not permitted in
work areas where there is a reasonable likelihood of an occupational exposure.
Food and drink shall not be kept on shelves, countertops, bench tops or in cabinets where blood or other
potentially infectious materials (OPIM) are present.
Personal Hygiene
1. Hair must be pulled back away from face.

2. Jewelry should not be worn on the hands and arms during patient treatment.
3. Nails must be clean and short.
Hand washing is one of the most effective ways to prevent the transfer of microorganisms. Hands should
be washed for 15 to 30 seconds at the beginning of each day, between patients, before and after going to
lunch or taking a break; at the end of the day, or anytime they may be contaminated.
Barriers. Disposable barriers are applied wherever practical, especially on surfaces where sufficient
cleaning and disinfection is difficult or impractical to accomplish.
Head Coverings. Student doctors are not allowed to wear any type of head cover when interacting with
patients, EXCEPT for cases where such head covers are worn for religious reasons or when surgical bonnets
are required for infection control purposes. This policy is based on the need to maintain a professional
appearance at all times while interacting with patients; therefore, wearing baseball caps, hats, hooded
sweatshirts, or other similar garments is NOT permitted.
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Personal Protective Equipment
 Gloves. Exam gloves are worn whenever there is a possibility of contact with blood or OPIM. Wash
hands prior to donning and after removing gloves. Gloves are to be removed or covered with plastic
over gloves if leaving the dental treatment room.
 Disposable Gowns. Disposable clinic gowns will be worn during patient treatment. Change gowns when
visibly soiled and discard gown after patient treatment. Remove disposable gown when leaving clinic
and laboratories. The disposable gowns may not be worn in the Clinic Lobby, Patient Elevators or in
the Administrative Office areas of the Dental School.
 Face Mask/Eye Protection. For all patient care, a face mask with protective eyewear or a chin length
face shield is to be worn. Every patient must wear eye protection during dental treatment.
 N95 Respirators/Full Face Shields. Are required in extraordinary periods of time (i.e., COVID-19
pandemic) as required by the Public Health and/or University authorities.
 Shoes. Closed toe shoes must be worn at all times in the clinic. The Croc/Clog type shoe is allowed
(solid style only, no holes).
Waterlines
 Dental unit water lines shall be anti-retractive. At the beginning of each workday, dental unit lines and
devices shall be purged with air or flushed with water for at least two (2) minutes prior to attaching hand
pieces, scalers, air water syringe tips, or other devices. The dental unit lines and devices shall be flushed
between each patient for a minimum of twenty (20) seconds.
Service Animals
We allow patients who require a service dog that is individually trained to do work or perform tasks for a
person with a disability. The task(s) performed by the dog must be directly related to the person's disability.
If the patient has a service dog that falls under Titles II and III of the Americans with Disabilities Act
(ADA), the patient can bring his or dog with him or her to all areas of the clinic where the public is allowed
to go.
However, if the patient has an animal that doesn’t perform a service, but provides emotional support,
therapy, comfort, or companion, he or she MUST stay in the clinic lobby. “Therapy Animals” are not
considered ADA Service Animals; and if the therapy animals are disrupting the clinic lobby, we may ask
the patient to remove them.
Note that a service dog/animal must be trained to take specific action when needed to assist the person with
a disability. Service animals are working animals – they are not pets. NOTE: The Department of Justice
and the ADA allow the following questions to be asked if the situation is not obvious that the dog is a
service animal:
1. “Is the dog a service animal required because of a disability?
2. “What work or specific task has the dog been trained to perform?”
Staff ARE NOT ALLOWED to ask for any documentation, require that the dog demonstrate its task or
inquire about the nature of the disability. If the individual refuses to answer the above question(s), they
may be asked to leave. Animals that accompany an individual who is “anxious or depressed” are emotional
support animals (and commonly pets and NOT service animals) are not permitted.
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Waste Management
Disposable needles, anesthetic carpules, disposable syringes, scalpel handles and blades, ViscoStat
applicators, acid etch applicators, Monojet endo irrigation syringes, and matrix bands MUST BE disposed
of in the puncture resistant “sharps/pharmaceutical” containers located throughout the clinic. Scrap
amalgam and capsules should be placed in the “Amalgam Waste” containers throughout the clinic and not
in the general trash.
Disposable Needle - Short Matrix Band
Disposable Needle - Long ViscoStat Applicator
Anesthetic Carpule Acid Etch Applicator
Monojet Endo Irrigation

Scalpel Handle and Blade Syringe
Bard-Parker Scalpel Blade
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Surface Disinfection
Clean and disinfect all surfaces and equipment not covered with disposable barriers. If barrier protection
was compromised, clean and disinfect the area. An acceptable method of cleaning and disinfecting is to use
CaviWipes, Optim 1 or similar products made available in the clinic. To prevent cross contamination, use
CaviWipes, Optim 1 or similar products to clean, disinfect, and decontaminate exterior, hard, non-porous
surfaces. Remember to use gloves when the CaviWipes/Optim 1/similar towelette is being used.
*Note: Comprehensive information regarding infection control can be found in the UCLA Dental Clinics
Infection Control Manual***
Failure to comply with infection control policies will result in discipline via the Infection Control and
Regulatory Compliance in The Dental Care Environment.
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CHAPTER 2
COMPREHENSIVE PATIENT CARE
Comprehensive Patient Care (CPC) is defined as care planned to address all oral and dental needs based on
thorough diagnosis and treatment planning. An initial screening appointment provides patients with an
overview of their treatment needs as well as a description of the school’s CPC philosophy. Our program
trains students in providing CPC so prospective patients who wish partial or limited treatment may not be
accepted as clinic patients. Episodic or fragmented care is provided only on an emergency basis and is
discouraged. Appropriate referrals are provided to both intramural and extramural resources for specific
patient needs.
For those accepted as comprehensive patients, all necessary radiographs are taken, and a physical evaluation
and medico-dental database is obtained by students performing Patient Assessment. Preliminary diagnoses
and listing of major needs are used to determine patient assignment to an appropriate provider or clinic. A
thorough diagnosis and treatment plan is subsequently developed by the assigned student dentist under the
guidance of faculty.
Dental treatment begins under the supervision of faculty instructors after approval of a sequential treatment
plan by the Group Practice Director. During the course of treatment, annual periodic exams are performed
as well as dental prophylaxis/periodontal maintenance at recommended intervals. Patients who complete
all recommended treatment are placed on a recall system.
A successful treatment outcome depends on mutual trust and respect in all interactions between the patient
and the student dentist. The patient has certain rights as described in our published Patient Bill of Rights:
 Be treated with courtesy, respect, and confidentiality.
 Be treated without discrimination based on race, color, national origin, religion, sex, sexual
orientation, age, or disability.
 Be given complete and current information about your dental condition and treatment.
 Know about treatment recommendations and estimated cost of treatment.
 Be informed about treatment alternatives, the advantages and disadvantages of each as well as the
risks of treatment.
 Expect treatment that meets the standard of care in dentistry including the use of appropriate
infection controls.
 Know the education and training of and what professional laws and ethics apply to members of your
dental team.
 Know what policies apply to your acceptance as a patient and to your continuance in care.
 Continuous and comprehensive dental care and emergency treatment.
In addition, the patient has certain responsibilities, and failure to comply may result in discharge from the
clinic. These responsibilities are:
 Give 48-hour notice for appointment cancellations.
 Provide payment on day treatment is rendered.
 Comply with our recommendations for improving your oral health.
 Arrive on time for scheduled appointments. And be able to stay for the duration of the appointment.
 Notifying the student dentist regarding any changes in health status, insurance coverage, or contact
information.
 Address concerns with Group Practice Administrator.
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All students are assigned in CPC teams in which members of each dental class and affiliated dental hygiene
programs assist one another in providing comprehensive care to patients assigned to their team. However,
students are individually responsible for patients for whom they provide treatment. Group Practice Directors
ensure that all students have an adequate pool of patients to obtain broad clinical experience and
competency. Patients with treatment and other concerns may be directed to the Group Practice
Administrators, Group Practice Directors, or the Clinic Director for resolution of any questions or problems.
Student progress toward achieving competency in providing comprehensive patient care will be monitored
by the Group Practice Director with input from the Group Practice Administrator. At least once each quarter
the electronic records of all assigned patients will be reviewed and discussed with the CPC team beginning
in the summer of the third year. Criteria used to assess student competency include:
 Timeliness of treatment and responsiveness to patient needs
 Appropriate sequencing of treatment
 Financial management
 Documentation, including SOAP notes and treatment plans
 Appropriate signatures
 Management of recall patients
 CPC communication
 Professional behavior
Each clinical Section has specific requirements that must be completed by each student to pass the clinical
courses and to be cleared for graduation. Generally, these requirements are procedural. Students are
responsible for obtaining current and specific information from individual sections regarding course and
graduation requirements.
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CHAPTER 3
MEDICAL, DENTAL, & CLINIC EMERGENCIES
All clinical faculty, staff, and students are required to complete a medical emergencies course as well as
hold current certification in basic life support (CPR). If you require information on fulfilling these
requirements, please see your Section Chair, supervisor, or the Clinic Director.
I. MEDICAL EMERGENCIES
If your patient has difficulty breathing, faints, or exhibits other medical distress, you must be able to
diagnose the severity of the incident. When in doubt, treat as a medical emergency:
There are three AED’s (Automatic External Defibrillator) in the Pre doctoral clinic. One is located
just outside New Patient Services. One is located on the second floor near the Central
Services/Sterilization Area. One is located on the third floor near the Central Services/Sterilization
Area.
Upon recognizing the need for medical assistance, immediately ask nearby individuals to:
a. Summon a faculty instructor over for a medical emergency
b. Inform the Group Practice Administrator to phone for emergency response team
c. Bring emergency oxygen tank to the operatory
d. Bring Medical Emergency Kit from the Group Practice Administrator’s Desk
YOU MUST STAY WITH YOUR PATIENT: Remain calm and institute basic life support Airway /
Breathing / Circulation
If you are asked or need to phone for emergency response teams, follow these procedures:
a. Call 911 (Campus Paramedic Team) from a house phone. Do NOT use a cell phone. You can
use a hardline phone located on the back wall of the clinic or the GPA’s phone (8-911).
b. Inform them of the nature of the medical emergency and your specific location (714 Tiverton).
c. State you are in the Dental Clinic, which floor, clinic, cubicle, and phone number.
d. Individuals will be stationed at nearby elevators to direct response teams to the cubicle. An
individual, preferably the Group Practice Administrator, should stay by the phone.
Emergency Oxygen Tanks are located in each Group Practice Administrators Desk.
To turn tanks ON:

a. Turn cylinder valve on top of tank ON by turning counterclockwise.
b. Turn regulator valve (black knob) ON by turning clockwise; adjust to 8-10 liters/minutes.
To turn tanks OFF:

a. Turn cylinder valve on top of tank clockwise until it is tight.
b. Turn regulator valve (black knob) counterclockwise until it stops turning. Do not force knob
beyond this point.
After the emergency has been resolved, contact the Environmental Health and Safety Specialist or GPA to
complete an Incident Report. A detailed chart entry must be made in the Progress Notes of the patient’s
record.
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II. BLOOD BORNE PATHOGEN EXPOSURE INCIDENTS
DEFINITION OF AN INCIDENT
An incident is when you are subject percutaneous injury or when a mucous membrane (eyes, oral mucosa)
is exposed to a fluid originating from the patient.
MOST COMMON INCIDENTS

Some of the common incidents include but is not limited to:
a. You scratched yourself with a contaminated burr.
b. You stuck yourself with a contaminated needle.
c. You cut yourself with a contaminated scalpel.
d. You splashed yourself with contaminated body fluid.
Any cut, scratch, or stick with a contaminated instrument (curette, explorer, etc.) must be reported.
WHAT TO DO WHEN AN INCIDENT OCCURS

Regardless of whether or not the receiving individual is the student or patient, a record of the incident should
be documented in the patient’s chart.
Whenever an incident occurs before 4PM, you should:

1. Stop what you’re doing, wash your hands with soap and water, and bandage if necessary.
2. Flush mucous membranes with water as necessary.
3. Notify your GPA. GPA will provide you with BBP Exposure Incident Report to fill out
4. The GPA will then contact the Environmental Health and Safety Specialist. The Environmental
Health and Safety Specialist (EH&S Specialist) can be found in 13-089D CHS. The phone number
is (310) 825-4306.
5. The EH&S Specialist will collect the report and walk you AND your patient (consent required) to
occupational health to have labs taken.
Whenever an incident occurs after 4PM, you should:

1. Stop what you’re doing, wash your hand with soap and water, and bandage if necessary.
2. Flush mucous membranes with water as necessary.
3. If a GPA is available, speak with the GPA to have the paperwork filed.
4. If a GPA is not available, notify the EH&S Specialist at 310-825-4306 or Pager #90996 (leave a
message if no answer)
5. The student reports to the Hospital Emergency Room at the Ronald Reagan Medical Center. Notify
ER staff to BBP exposure. The source patient is sent home. DO NOT SEND PATIENT TO ER.
6. Receive Post-Exposure Prophylaxis (PEP) for HIV by ER staff depending on the severity of
exposure and if source case is known to be HIV positive.
7. Next day: make an appointment at OHF to present for further testing and follow-up. Follow-up with
the EH&S Specialist so that s/he may contact source case to schedule an appointment for appropriate
testing as during business hours.
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III. DENTAL EMERGENCIES
Dental emergencies, although not usually of life-threatening nature, can be very urgent in that they
frequently require the alleviation of PAIN. Since you are the person responsible for the complete dental
treatment of your patients, you must attend to any emergency situation that occurs on any of your patients.
Dental emergencies usually fall into one of the following categories:
1. Dental Pain
Pulpal involvement; fractured root
2. Periodontal
Pain Abscess; necrotizing periodontal conditions; acute episodes of gingivitis/periodontitis
3. Trauma
Avulsed tooth; broken tooth; broken bone
4. Restorative
Temporary restoration: broken; fallen out crown, bridge, amalgam, composite: broken;
fallen out removable prostheses: sore spot; malocclusion
5. TMJ Symptomology
Muscular pain; joint pain; trismus
You must assess the true urgency of the patient’s emergency. If the patient can simply be reassured over
the phone, a timely appointment can be made to address the “emergency.” However, if your emergency
patient is in pain or severe discomfort, his or her immediate treatment must take priority over elective
treatment of your other patients. You must determine whether to “squeeze” this emergency patient into
your schedule (e.g., to re-cement a loose temporary), or re-schedule one of your already-appointed patients
if it appears a longer time is needed to resolve the emergency. You may also solicit the assistance of your
CPC team partner to appoint and treat your emergency patient. However, ensure that your partner is fully
informed of the nature of the emergency and is capable of resolving your patient’s difficulty. Under no
circumstances should you tell a patient to walk in without making prior arrangements for their care.
Please refer to Urgent Care Appointments below.
IN SUMMARY:
1. You must provide your entire list of active and recall patients with your phone number and instructions
to contact you directly in case of a dental emergency.
2. You should inform all of your patients to contact your Group Practice Administrator if you are
unavailable due to block rotation or quarter break.
3. After-hours, weekends, or holidays patients should call the UCLA Medical Center page operator (310)
825-6301, choose the option for the Ronald Reagan Medical Center and ask for the AEGD Resident
(Advanced Education in General Dentistry) on call and tell the operator that you are a dental clinic
patient.
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IV. URGENT CARE APPOINTMENTS
Urgent Care is a clinic rotation during the pre-doctoral students’ 4th year. This rotation provides students
with clinical experiences managing an urgent care patient. Assigned students treat and manage dental
emergencies and urgent dental situations typically encountered in the practice of general dentistry and must
provide a diagnosis, treatment and/or refer the patient.
1. Responsibilities of the assigned student

• Assigned student is responsible for their own urgent care patients
• Student must be on campus, available and reachable by phone unless they have another scheduled
patient, a verifiable schedule conflict or an excused absence cleared through the Office for Student
Services
• All students are responsible for providing their GPAs with an accurate cellphone number where they
can be reached
• If a student that should be available does not respond to a phone call from their GPA regarding their
UC patient, they will receive an NP in Clinical Patient Management for the quarter
2. Responsibility of the CPC team partner

• If the assigned student is unavailable, the CPC teammate (D3 or D4) will see the Urgent Care patient
(same rules apply as above)
3. Responsibilities of the students on Urgent Care block

• If neither the assigned student nor CPC teammate are available, then the student on Urgent Care
Block will see the patient
• Every attempt will be made to have the student on UC block see the patient in the group practice of
the UC patient, subject to chair availability and faculty coverage
• If no chair is available in the group practice of the patient, then the UC patient can be seen wherever
there is an available chair and adequate faculty coverage
• Three Students will be assigned to Urgent Care Block each day
• Students must check in with Dianne Fuller on the 1st Floor at 8am or 1pm
• Failure to do so results in NP grade in Urgent Care Rotation for the quarter
• One Urgent Care student will be assigned to the 1st floor for non-patients of record
• One Urgent Care student will be assigned to the 2nd floor clinic
• One Urgent Care student will be assigned to the 3rd floor clinic
• Urgent care patients who are not patients of record are scheduled and seen during screening sessions,
from 8-9am and 1-2pm Monday through Friday
• Only one urgent care patient who is not a patient of records can be scheduled per clinic session
• If there are no patients who are not patients of record, the assigned UC Block student will be sent
by Dianne Fuller to either 2nd or 3rd floor clinic, depending on need
• After discussion with the patient, the patient may be referred to a specialty clinic (internal referral
needed) or the block student may bring the patient up to the clinic to treat if appropriate (pulpectomy,
deep caries removal, etc.)
• If UC block student is to treat the patient, Dianne Fuller calls up to the GPA of the block student’s
group practice to see if there is an available chair and faculty coverage. If not, the GPA will find a
group practice where there is availability
• In all scenarios, GPD/GPL approves UC forms and internal referrals prior to any treatment being
rendered
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V. CLINIC FIRE EMERGENCIES
In the event of any fire that should occur in the School of Dentistry facilities:
 911 should be called immediately following any and all events involving a fire regardless of size and
scope (per University of California Fire Department). These notifications should include specifics of
the event (to the extent that it is available), including any injuries and/or exposures resulting from the
incident. (NOTE: Calling 911 from a campus phone will connect you to UCPD Dispatch, which allows
for an internal response in lieu of a large-scale response from the city).
 The injured party(ies) and any other individual(s) involved in the fire should remain in the area until the
emergency team and the fire department arrives. Individuals should not be sent or transported to a
medical care facility. Immediate palliative treatment, as available in First Aid kits, can be used.
 The fire scene must be fully preserved as to reflect the condition of equipment, materials and/or location
following an event until the emergency response team and fire department clear the area, because this
preservation is critical to investigatory proceedings (internal and external). Do not discard any item
(including ashes or debris), be that damaged or not. This preservation protocol also entails ceasing all
work being performed in the space following the occurrence of an event until the scene has been released
by the Fire Marshal or designee.
 EVACUATION IS MANDATORY ANY TIME THE FIRE ALARM GOES OFF. NO
EXCEPTIONS. This applies to trainees, staff, faculty and patients. Providers should assist their
patients in leaving the building through the 1st floor exits.
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CHAPTER 4
PATIENT RISK MANAGEMENT
I. GENERAL INFORMATION
Risk in health care is the chance for financial loss due to the negative outcome of patient treatment. Financial
loss can be due to costs related to the correction of unacceptable dentistry, investigatory costs, consultant
and expert witness fees, court costs, and defense legal fees. Risk Management is the process of identifying,
reducing, and eliminating risk exposures that can result in financial loss. Risk can be managed by:
1. Providing and maintaining a high standard of dental care.

2. Providing "Informed Consent" for all treatment.
3. Providing continuity of care, referring as necessary.
4. Reducing the probability of litigation after a negative outcome has occurred.
5. Preserving assets once a claim has been filed.
COMMUNICATION
The major key in risk management, however, is a strong positive doctor/patient relationship expressed
through accurate and active communication. Consider the following:
1. Use common language; avoid dental terminology.
2. Use active listening skills with appropriate eye contact.
3. Encourage and answer patient questions.
4. Make and return phone calls PROMPTLY.
5. Schedule and keep regular appointments.
6. Plan your chair time efficiently; respect your patient's time.
7. Ensure your patients have informed consent about their treatment.
8. Ensure patients know their rights as well as their responsibilities.
9. Be honest about all care, even when something goes wrong.
10. Recognize your own limitations; patient expectations must be consistent with your ability to meet them:
refer when necessary.
INFORMED CONSENT
The principle of informed consent is to ensure patients are not only fully informed about your treatment
recommendations and consent to them, but also informed of the clinics’ financial policies. Copies of Dental
Clincs documents outlining general informed consent statements are included in this chapter. After
diagnosis and treatment planning, patients are fully informed as described above in an organized case
presentation.
PATIENT BILL OF RIGHTS

Patients accepted for comprehensive dental care at the UCLA Dental Clinics have a right to:
1. Be treated with courtesy, respect, and confidentiality
2. Be treated without discrimination based on race, color, national origin, sex, sexual orientation, age,
or handicap
3. Be given complete and current information about their dental condition and treatment
4. Know about treatment recommendations and estimated cost of treatment
5. Be informed about treatment alternatives, the advantages and disadvantages of each, as well as the
risks of no treatment
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6. Expect treatment that meets the standard of care in dentistry including the use of appropriate
infection controls
7. Know the education and training of and what professional laws and ethics apply to members of the
dental team
8. Know what policies apply to their acceptance as a patient and to their continuance in care
9. Continuous and comprehensive care and emergency treatment
PATIENT RESPONSIBILITIES
Patients accepted into care must accept the UCLA Dental Clinics’ "Terms and Conditions of Service."
Separate consents are required for acceptance of the overall Treatment Plan as well as for other specific
treatment procedures such as Periodontics, Endodontics, Restorative Dentistry, Removable Prosthodontics,
Oral Surgery, Esthetic Dentistry and other procedures. You must become familiar with these patient
responsibilities in order to establish an even and balanced doctor/patient relationship. A successful
relationship demands that each party recognizes and respects the needs of the other.
PROPER DOCUMENTATION/PATIENT RECORDS

In addition to tracking and recording patient care, the patient’s electronic health record (EHR) and other
records are crucial in risk management. The UCLA Dental Clinics uses the axiUm software to manage the
electronic records of individual patients. sxiUm has a detailed operational manual that is published and
circulated separately and that should serve as a reference document for users.
The following are all part of a patient's complete record:
1. Current Medical History

2. Dental History and Clinical Database
3. Treatment Records: Exam notes, diagnoses, treatment plan, progress notes
4. Radiographs, photographs, and video recordings
5. Models and impressions
6. Laboratory and Drug Prescriptions
7. Signed Consents and Release Documents
8. Contact notes and phone messages
All written documentation must be factual, comprehensive, and non-judgmental. Proper dental treatment
documentation follows the SOAP format which should accurately and completely describe the patient's
subjective complaint, the objective signs and symptoms, your assessment of differential diagnoses, and
the plan recommended or procedure performed to resolve the original complaint. All predoctoral progress
notes (SOAP) are recorded electronically in axiUm. The start check and sign off by the covering faculty
are also electronic. Both are accomplished using a card reader (in each cubicle), which is connected to the
operatory computer.
Patient interactions and conversations about problems, disagreements, or dissatisfaction must also be
properly documented. Examples: patient repeatedly fails, cancels, or is tardy to appointments; refuses
necessary treatment; does not adhere to preventive regimen; has unreasonable expectations of treatment or
process of care in the clinic environment. All of this should be entered in the CONTACT NOTES sections
of the patient’s axiUm chart. Incidents in which anger, hostility, or other behavioral difficulties must
likewise be documented, but great care must be exercised to insure the documentation of objective facts
and statements, not judgmental or psychological assessments such as paranoid, schizophrenic, or crackpot.
Simply describe the facts of the incident and record any conversations verbatim whenever possible. Keep
to unembellished facts and non-judgmental statements about the patient. Remember that your attitude,
16
reflected in your documentation as the writer, is subject to interpretation and judgment by any potential
reader, including a malpractice attorney.
When a patient refuses recommended treatment that (in the professional judgment of the faculty) must be
performed, that patient should be referred to private dental care. Likewise, referral is mandatory for a
patient who insists on treatment deemed professionally inappropriate. However, if alternative treatment is
professionally acceptable and agreeable or a given procedure is elective, then specific statements must be
included on the Treatment Plan or Progress Notes to document the patient's full understanding of the
consequences of such alternative treatment.
II. MD CONSULTS
When performing a Patient Assessment work-up, it may be necessary to get an MD Consult for your
patient. The MD consult forms are located on the cart in the Group Practices at the GPAs’ desks. They
are completed with the patient when additional information is necessary from his or her physician. These
forms are for patients of the Predoctoral Clinic only, and should be filled out and signed by the instructor
who is covering the Patient Assessment work-up.
Medical Consult Workflow

1. GPD/GPL decides a medical consult is needed. If unsure, GPD calls in the Patient Assessment
faculty to make the decision
2. If warranted, GPA generates the Medical Consult form in axiUm
3. GPD/GPL and student work together to complete the form so the physician knows what is
needed
4. Patient takes the paper form to her/his physician or have GPA fax it to physician (need fax
number) via e-fax
5. Physician completes the form and sends it back to us either via e-fax
6. GPA receives e-fax, files it in the patient’s record, and forwards it to GPD
7. Medical consult form is approved by GPD or Patient Assessment faculty
If your patient does require an MD consult, YOU WILL NOT BE ABLE TO TREAT THE PATIENT,
or HAVE ACCESS to the ELECTRONIC CHART until the PHYSICIAN returns the information we
are requesting, and the authorized instructor signs off on the MD Consult for the patient to receive
treatment.
The axiUm record of the MD Consult can be found in the following pathway: EHR > Attachments >
Medical Consults > Received.
III. DENTAL TREATMENT DURING PREGNANCY, POST-PARTUM AND

BREASTFEEDING
GENERAL CONSIDERATIONS
Women who are in optimal prenatal care are generally healthy and are not considered medically
compromised; therefore, provision of dental care is considered generally safe for them. However, one
should keep in mind that pregnancy is associated with physiologic changes in several organ systems.
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In addition, women who are not in optimal prenatal care may have significant and undiagnosed conditions.
Obtain adequate history, ask about potential complications and, if needed, contact patient’s obstetrician or
physician to ascertain patient’s medical status if complications are suspected. These may include
cardiovascular presentations (e.g., hypertension), hematopoietic defects (e.g., anemia or a
hypercoagulable state), and endocrinopathies (e.g., hyperthyroidism or gestational diabetes).
Postpartum: consider patient’s lack of sleep, possible depression, and transient thyrotoxicosis (5%)
DENTAL TREATMENT
Radiographs: dental radiographs such as panoramic and intraoral series are generally safe during pregnancy.
Although, the risk of teratogenicity is exceedingly low with dental radiographs, the amount of radiation to
a pregnant woman and her fetus should be kept to minimum. Use only selected radiographs necessary for
optimal diagnosis, properly collimated beams and lead aprons over the abdomen.
Drugs: whenever possible, select from FDA Category A and Category B drugs only. Dose adjustment may
be required for category C drugs. Avoid Category D drugs and long-acting local anesthetics. The use of
epinephrine in the local anesthetic is generally safe for use during both pregnancy and lactation. Nitrous
oxide has not been classified into any category by the FDA and its use in pregnancy should be limited. For
women who are breastfeeding, the use of most medications is generally safe as the drug concentration in
breast milk is usually at 1-2% of maternal serum levels. In general, when prescribing medications, have
mother take the medication after breast feeding and avoid nursing for ~ 4 hrs. Medications to be avoided
during this period include lithium, antineoplastic drugs and radioactive pharmaceuticals.
Timing: Other than a good plaque control program including periodontal prophylaxis, elective dental care
is best avoided during the first trimester. For emergency care, establish patient’s medical status.
The second trimester is the safest period for dental care. Aim at controlling active disease and eliminating
potential problems that may occur in the latter part of pregnancy or shortly after delivery. Postpone
extensive reconstruction and significant surgical procedures until after delivery.
The early part of the third trimester is still a good time for providing elective dental care but after the middle
of the third trimester, elective dental care is best postponed. For emergency procedures be mindful of
supine hypotension, hypoxia, patient’s gag reflex and the level of discomfort.
IV. REFERRAL TO SPECIALISTS

General dentists must refer to or consult a specialist where another general dentist in similar circumstances
would do so; where the general dentist does not have a specialist's knowledge or skill to perform specialty
treatment to the specialist's standard; or where:
1. Diagnosis remains unclear

2. Usual treatment methods have been ineffectual
3. Required care is more appropriately handled by a specialist
4. Another therapy may be more beneficial to the patient
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When referring to a specialist:
1. Discuss the possible referral with the faculty member supervising the student.
2. If appropriate, refer to specialists (residents and trainees) at graduate clinics within the school using
the internal referral forms in axiUm.
3. Clearly state to the patient your reasons for making the referral.
4. Make the referral in axiUm.
a. Define the specific scope of the referral.
b. Alert the specialist of medical needs, e.g., prophylactic antibiotic coverage.
5. Emphasize to the patient the need for immediate action. Follow up promptly with the specialist to
confer about recommended treatment.
6. Establish a protocol for coordinating dental procedures between you and the specialist. In the event
you or the patient chooses not to follow a specialist's advice, document reasons in the patient's chart.
Dentists also have a duty to refer a patient to a physician when a physician's evaluation and care may be
more appropriate than continued dental treatment.
V. TRIAGE AND RESOLUTION OF PATIENT COMPLAINTS

In the event a patient is not satisfied with his or her care, it is important to follow the proper protocol to
ensure that the patient’s concerns are handled reasonably and promptly. Patient complaints should be
handled by you, the student, in conjunction with appropriate support staff and faculty. The order of
escalation for patient complaints is as follows:
1. Student Provider
2. Group Practice Administrator
3. Group Practice Director
4. Clinic Director
Patient complaints should generally not skip levels when escalating. This is to prevent patients from
becoming used to the idea of “jumping the line” whenever they are upset.
Document any and all interactions and potential resolutions in the contact notes of the patient’s electronic
record. Patient complaints not of a clinical nature should not be record in the SOAP notes. Appropriate
documentation is essential in tracking the progression of a patient’s concern and allows you, the provider,
and administrative/executive staff and faculty to better understand how to address a patient’s concerns or
complaints. Remember to use an objective and neutral tone when documenting patient complaints.
Example 1 demonstrates an objective/neutral tone. Example 2 demonstrates documentation in an
inflammatory tone.
Example 1:
“The patient indicated that she was not satisfied with the way her case was progressing. She
indicated that did not expect her crown to take so long to finish. I reminded the patient that this is
an educational institution and that dental care progresses slower here compared to private practice.
The patient became upset and demanded to speak with the clinic director. I informed the patient
that I would relay her concern to my GPA and GPD as they were best positioned to address her
concern. The patient was satisfied with this course of action.”
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Example 2:
“The patient was extremely rude and disrespectful and refused to listen to anything that I said. She
screamed at me while I tried to explain how complaints work. I don’t feel the patient should be a
patient anymore because she’s an inconsiderate person and has no idea how the school of dentistry
operates.”
TERMINATION OF DOCTOR-PATIENT RELATIONSHIP
In some instances, it is necessary or desirable to terminate the doctor/patient relationship. Such an

assessment should be made as early as possible to minimize treatment that can increase additional
responsibility and risk; however, it is the dental professional's obligation not to “abandon” patients or place
any patient of record in jeopardy through non-treatment. Abandonment is the withdrawal of the dentist
without the consent or knowledge of the patient, leaving the patient in a vulnerable position, e.g., when
treatment is in progress.
Therefore to withdraw care, you must inform the patient of your intention as well as provide a referral for
continuation of dental care, in the form of a discharge letter. Any professional or personal reason is valid
so long as it does not violate anti-discrimination laws. For example, non-compliance to recommended
treatment, chronic non-payment of bills, repeated failure to present for appointments, and overt personality
conflicts are all acceptable reasons.
The Group Practice Directors are responsible for terminating doctor-patient relationships in the
general clinic. They will ensure that the following guidelines are met:
1. Inform the patient of the intent to terminate care in writing, using a return receipt-requested letter.
File a copy in the patient's EHR.
2. State reasons if desired. Avoid stating subjective reasons such as hostile behavior, incompatible
personality, etc.
3. Advise the patient emergency dental care services will be available for the next 30 days and that
fess for such services apply.
4. Provide referral sources such as local dental society or yellow pages.
5. Provide instructions for requesting copies of the patient's chart and radiographs.
6. If appropriate, advise the patient of the need for any specific urgent care and the consequences of
failure to obtain such care.
FEE REDUCTIONS
Occasionally, there may be requests by patients for a reduction in fees for unsatisfactory or unsuccessful
treatment. Redoing previously delivered treatment at no charge is a form of fee reduction. The necessary
signatures for approval include the clinical floor faculty and the Clinic Director. Submit a completed and
faculty approved “Request for Reduction in Patient Fee” form via axiUm to the Clinic Director. Fee
Reductions are treatment specific. No representation or commitment to a reduced fee shall be made by
the student or faculty instructor prior to a written response.
Regardless of the approval or denial of a fee reduction request, the student completes the patient’s
SOAP notes by entering the treatment code and usual and customary fee. The financial office will
make any approved adjustments from the patient’s account. This process ensures proper documentation,
tracking of procedures, and provides quality assessment.
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VI. CONFIDENTIALITY OF PATIENT RECORDS
CONFIDENTIAL PATIENT INFORMATION
California Law defines Patient Medical Information as: "Any individually identifiable information in
possession of or derived from a provider of health care regarding a patient’s medical history, mental or
physical condition or treatment."
Confidential Patient Information includes the following:

1. Physical medical records including paper, photo, video, diagnostic and therapeutic reports, laboratory
and pathology samples
2. Patient business records
3. Mainframe and department-based computerized patient data and alpha numeric radio pager messages,
4. Visual observation of patients receiving medical care or accessing services
5. Verbal information-provided by or about a patient
6. Other such information the disclosure of which would constitute an unwarranted invasion of privacy
All patient records are confidential and must be treated as personal medical records used for and in the
context of patient care and treatment. Medical Center policies, outlined on the following page, dictate strict
adherence to professional standards demanding compliance to confidentiality of all patient records. All
providers and relevant staff are required to understand, acknowledge, and agree to these policies.
Dental students are viewed by the University of California as members of the “workforce” for purposes of
HIPAA compliance. Any violations of the applicable policies or laws regarding confidentiality of patient
information, including inappropriate access to paper or electronic records on site or remotely (or sharing of
information contained therein), shall be subject to discipline up to and including dismissal in accordance
with the School of Dentistry Policy on Student Conduct and Discipline. Violations shall also be disclosed
to the campus and medical center HIPAA Compliance Officers.
VIOLATION OF CONFIDENTIALITY
1. Access, discussion, or disclosure of confidential patient information when not required to perform
assigned duties, without the explicit authorization from the patient, is a breach of confidentiality and
a violation of HIPAA and UCLA Policy.
2. Breach of patient confidentiality may be subject to civil or criminal action for invasion of privacy
by the individual to whom the information pertains and subject to disciplinary action by
management up to and including dismissal.
3. The UCLA Dental Clinics Administration performs audits and reviews of patient records in order
to identify inappropriate access.
4. Consult your supervisor if you have questions as to the confidentiality of any information.
RELEASE OF PATIENT RECORDS
Proper patient records are crucial to the effective delivery of health care. While such records are the property
of the UCLA Dental Clinics, patients may request copies of their treatment records at any time. Since patient
records are confidential, requests for copies must be properly handled.
For General Clinic patient records, all requests are made to the Patient Custodian of Records, who works
in the first floor Patient Records Office. Patients should be directed to this office for all record releases.
The patient or responsible party will be required to complete a release form. The release of patient record
21
information regarding HIV status, drug or alcohol abuse history or treatment, psychiatric care, spousal or
child abuse, or other sensitive issues requires the execution of separate and specific releases. There are fees
associated with duplication of records and duplication of radiographs.
Patient records requested by third parties, such as in subpoena cases, should be directed to the Patient
Custodian of Records.
SUMMARY
Sound patient and practice management skills are also sound risk management skills. By recognizing and
addressing the need for solid communication skills combined with a genuine concern for your patients'
welfare, you can establish and maintain a positive professional rapport with your patients. If you add to
this a consistently high standard of care, moderate you’re own and your patients' expectations, and are
vigilant about your patients' concerns and frustrations, you will minimize your exposure to risk and
malpractice allegations.
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UCLA DENTAL CLINICS
Privacy Notice
Financial and Dental Records
The State of California Information Practices Act of 1977 (effective July 1, 1978) requires the Dental Center
to provide the following information to individuals who supply information about themselves.
The principal purpose for requesting the information is to assure accurate identification and continuity of
dental care, and payment therefore, from whatever source. University policy, California Administrative
Code Title 22, Division 5, Licensing and Certification of Health Facilities and Referral Agencies, and
Federal statutes authorize our maintenance of this information.
Furnishing all information requested is mandatory unless otherwise noted. Failure to provide such
information may affect your dental care and/or any insurance benefits and coverage. This information may
be provided to: your referring dentist or other health care professionals involved in your dental care; others
to the extent required in connection with collection of accounts or a claim for aid, insurance, or dental
assistance to which you may be entitled; University faculty and students for research and educational
purposes; and may be released as provided by State and Federal law. The privacy of your record will be
safeguarded.
Individuals have the right to review their own records, in accordance with the Information Practices Act
and University policy. Information on these policies can be obtained from the officials responsible for
maintaining the information.
Your dental record is maintained by: Your billing information is maintained by:
DENTAL PATIENT RECORDS DENTAL PATIENT BILLING OFFICE

UCLA Dental Center UCLA Dental Center
Rm. 10-137 CHS Rm. 10-138 CHS
10833 Le Conte Avenue 10833 Le Conte Avenue
Los Angeles, CA 90095-1668 Los Angeles, CA 90095-1668
Phone: (310) 825-3195 Phone: (310) 825-9805
NON-DISCRIMINATION STATEMENT
In accordance with applicable Federal laws, including, without limitation, Section 504 of the Rehabilitation
Act of 1973, the Americans with Disabilities Act of 1990, and Title IX of the Education Amendments of
1972, and University policy, the University of California does not discriminate in any of its policies,
procedures, or practices on the basis of race, color, national origin, sex, sexual orientation, age, or disability.
Inquiries regarding the University’s equal opportunity policies may be directed to the Campus Counsel, 405
Hilgard Avenue, Los Angeles, CA 90024-1405. Speech- and hearing-impaired persons may call (310) 206-
6083 TDD. Inquiries regarding 504 Compliance may be directed to the 504 Compliance Officer at the same
address above, or call (310) 825-2242 voice/CRS or (310) 206-3349 TDD.
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UCLA DENTAL CENTER
TERMS AND CONDITIONS OF SERVICES
MEDICAL AND DENTAL SERVICES AGREEMENT
GENERAL INFORMATION AND CONSENT: Read Carefully Before Signing
A. TEACHING INSTITUTION
The University of California, including the UCLA Dental Center, is a teaching institution. Post-graduate
fellows, residents, dental students, and other students, under the supervision of faculty dentists, may
participate in care as part of the educational program.
B. CONSENT FOR PHOTOGRAPHY, TELEVISION, AUDIO/VIDEO TAPING

The UCLA Dental Center is authorized to photograph, televise, audiotape or videotape the patient while
he/she is receiving dental care in the Dental Center. The patient agrees that the negatives, prints, audiotapes,
or videotapes prepared there from may be made a part of the dental record, and/or may be used for teaching,
educational publication or research purposes without publication of the name of the patient.
C. RELEASE OF INFORMATION
The UCLA Dental Center is authorized to furnish information from the patient's record to referring
physicians/dentists and others to the extent required in connection with a claim for aid, insurance, or
medical/dental assistance to which the patient may be entitled. The patient or his/her representative
authorizes the Dental Center to release information to a collection agency to which the patient's account
may be referred or assigned for collection.
MEDICAL AND DENTAL CONSENT

The patient is under the care of faculty dentists. The patient or his/her representative consents to treatments
or procedures (except invasive procedures requiring special consent), radiographic examinations, intraoral
photographs, laboratory procedures, local anesthetic administration, and other services rendered under
general and special instructions of faculty dentists or other UCLA Dental Center personnel assisting in
patient care.
1. Patients in the teaching clinics are accepted into care based upon assessment of radiographs and the
intake screening. Acceptance is based upon needs and abilities of students, and desires, needs, and
availability of patients. Patients who are not accepted subsequent to their screening appointment will
be advised in writing. Upon receipt of a signed release by an unaccepted patient or his/her legal
representative, a copy of his/her radiographs will be sent to the dental provider of his/her choice.
2. Because students who treat patients in pre-doctoral clinics are learning to provide comprehensive dental
care, persons desiring partial or limited treatment may not be accepted as clinic patients. While every
effort is made to recommend a comprehensive treatment plan, additional or unforeseen needs may arise
during the course of treatment that will require additional procedures at additional cost. Patients will
be referred to specialists when the required treatment is complex, difficult, or demands specialized
training.
3. Patients are encouraged to discuss their concerns and expectations, and to ask questions to promote the
highest level of care. The risks and benefits of recommended as well as alternative treatment procedures
are discussed so that informed decisions may be made. However, due to the variability of patient
responses and limitations of treatment, no guarantee or warranty is made for any procedure.
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4. Patients must be available for 3-hour appointments, as often as twice a week, and must provide a phone
number where they can be reached daily. Because patients are assigned to students working under the
close supervision of faculty dentists, treatment proceeds at a significantly slower pace than in a private
dentist's office, and completion of procedures cannot be assured within a given period of time.
5. Patients must give a minimum of 48-hours’ notice to cancel appointments; otherwise appointments will
be considered "broken." If patients fail to show up for scheduled appointments or arrive more than 30
minutes late, appointments will be considered “failed.” Four or more “broken” and/or “failed”
appointments in a six month period constitute grounds for terminating treatment and referring the patient
to care elsewhere. Patients may also be charged for “failed” or "broken” appointments.
6. Charges in the clinic fee schedule apply to all clinic patients. The clinic reserves the right to revise the
fee schedule at any time. Revised fees will apply to all procedures started after the effective date of the
revised fees.
7. Full payment for each procedure must be made prior to the start of the procedure with the exception of
certain appliances. Medi-Cal patients are subject to clinic policies governing payment of fees for all
procedures not covered by Medi-Cal. Persons with dental insurance also pay for procedures prior to
the start of treatment. The clinic will process insurance claims for reimbursement for your convenience.
8. No procedure may be started unless all prior treatment is paid in full. If a patient discontinues treatment
before completion of a procedure, a percentage of the total fee for the procedure will be retained by the
clinic.
9. All patient records are property of the Dental Center; however, all information contained in records is
available to patients. Upon receipt of established fees and a release signed Holidays are accepted. Fees
may be charged. After hours and on weekends, patients may call the UCLA Medical Center Page
Operator, (310) 825-6301, to contact the AEGD (Advanced Education in Dentistry) Resident on call.
Should a patient decide to visit the UCLA Medical Center emergency room, he/she should expect to be
charged a substantial emergency room fee for which he/she will be personally responsible.
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CHAPTER 5
PATIENT ASSIGNMENTS, APPOINTMENTS, AND CUBICLE BREAKDOWN
I. PATIENT STATUS
Patients are assigned to teams composed of dental students who together deliver comprehensive patient
care. However, each student dentist is individually responsible for the patients he or she has under active
treatment. Dental hygiene students from the West Los Angeles College may be assigned to comprehensive
patient care teams. It is important for all members to work cooperatively to provide continuous and timely
professional care.
Active Patients
Active Patients are coded with an “Active Patient” status in the computer system (axiUm pathway: Rolodex
> Patient Card > Status). Patients under active treatment require initial periodontal as well as regular
maintenance appointments. Their initial Phase I needs are met by the assigned dental student and are
indicated in the progress notes by the dental student; maintenance Phase I treatment is normally performed
by the dental students on the same team. However, Phase I treatment on an active patient may be delegated
to dental hygiene students if Phase I requirements have been met by all dental students on the team. It should
be noted in the progress notes and axiUm chart by the dental student that the patient can be seen by the
hygiene student.
Recall Patients
Recall Patients are coded with a "Perio Recall" on the patient status Patient Card screen in axiUm. All
patients who have completed recommended treatment are termed recall patients. All maintenance
(prophylaxis or periodontal maintenance) needs of recall patients are met by the dental student or dental
hygiene students. Dental students are responsible for coordinating regular hygiene visits with annual
Periodic Exams that are required for patients to continue in our program.
Recall Patients with a "Denture Recall" have complete dentures and should not be recalled for Phase I
treatment.
Discharged Patients
Patients are discharged for a variety of reasons. These patients may not be appointed without approval from
your Group Practice Director or Clinic Director. Any treatment provided on inactivated patients is denied
as clinical credit.
Personal Recruitment
Students are encouraged to recruit patients on their own; however, all patients must be informed of and
accept our school's policy of comprehensive patient care. Specifically, they cannot be seen solely for dental
hygiene services, but must be willing and be able to afford to follow through with dental treatment as
diagnosed and recommended. Please check with the Screening Clinic in New Patient Services for proper
appointment information, fees, and approval form.
Assignment Requests
Students may request patients through their Group Practice Director. The assignment process should be
accomplished in one week or less.
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II. ELECTRONIC PATIENT RECORDS
All Pre-doctoral patient records are electronic and can be found via our electronic record keeping system
(axiUm). If a patient is discharged and you wish to re-admit her/him, you must obtain approval from a
Group Practice Director to treat that patient.
III. PATIENT APPOINTMENTS

Before scheduling patients, please ensure the patient has not been discharged. If you have any doubt, check
with any Group Practice Administrator who can verify the patient's status through the computer.
Before scheduling recall patients, please ensure that the patient has had an annual, periodic examination by
a dental student within a year's time. If not, schedule an appointment for a Periodic Exam (which includes
bitewings and/or other radiographs taken on the Clinic floor). Annual periodic examinations are required
of all recall patients of record. This appointment should be coordinated with a hygiene visit whenever
possible. If a patient refuses an annual Periodic Exam, please advise them they cannot continue under our
care and will be discharged.
When scheduling appointments, patients should be given the following information:

1. Time and date of appointment.
2. Location; patients should wait in the first-floor lobby if it is their first visit. Any fee they should expect
to pay. Please review the fee-for-service and prepayment policies. Check with your Group Practice
Administrator for current balance.
3. Student dentists full name and student number and/or hygienist’s name and number.
If you can't reach a patient to schedule an appointment after several phone calls, enter appropriate entries
in the patient's electronic record under the Contact Notes. Then mail an "I can't reach you" letter (available
through your GPA’s). If you do not hear back from the patient by the date you designated in the letter (14
working days), document this in the Contact Notes of the patient's chart, and notify your Group Practice
Administrator so that the patient can be properly discharged.
Appointments in the General Clinic are made with the GPA’s. The GPA’s will try and accommodate your
requests on a first-come, first-served basis and enter the appointment into axiUm scheduler.
It is the student’s responsibility to check the appointment schedule to verify that the appointment has, in
fact, been scheduled and he/she should then confirm that with his/her patient. If the request(s) was unable
to be honored, you must make another request. Because cubicle availability may be limited, you MUST
INFORM THE GPA’s (or Patient Appointment Coordinators in the Lobby) OF ALL CANCELLATIONS
AT LEAST 48 HOURS IN ADVANCE. This allows other students to schedule patients in canceled
cubicles.
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IV. CANCELLATION POLICY
1. Patients who no-show (appointment failure) or cancel any appointment FEWER than 48 hours in
advance FOUR or more times in six-months (two-quarters) will be dismissed from our care and
be discharged from the predoctoral clinic.
2. Patients who cancel multiple appointments regardless of the amount of notice may be dismissed
from the predoctoral clinic.
3. A patient who cancels their appointment with less than 48 hours’ notice may be subject to a $25
charge.
V. CLIENTTELL – APPOINTMENT REMINDER

ClientTell is an automated appointment reminder system. The system will deliver an appointment reminder
to the patient 48 hours before the appointment. Cancellations less than 48 hours before the appointment
(after the reminder is delivered) can only be made by the patient. Students can only cancel appointments
to the 48 hours reminder (this is to avoid phantom appointments).
For example, if a patient is scheduled to be seen on January 5, 2016, ClientTell will issue an appointment
reminder on January 3rd of the same week. If a student wishes to cancel the appointment, the cancellation
has to be confirmed before January 3rd.
VI. PAYMENT PROCEDURE BEFORE TREATMENT

If your patient has a balance due or needs to make a pre-payment for treatment in progress, escort him or
her to the Cashier BEFORE treatment. Patients covered by Denti-Cal (see chapter on Financial Policies)
must present a current Denti-Cal identification card, which they must submit on the day of treatment, to the
Billing Office.
VII. PATIENT DATA UPDATE

Before you begin treatment, please verify your patient's registration data are correct and current. Remember
to ask patients if they have moved or changed phones since they were last seen. Have they gotten married
or changed their name for any other reason? If any registration information needs updating, change it in the
electronic record, and inform a GPA, cashier, or Records Office personnel of the changes so that the
patient’s record can be updated in the computer system.
VIII. GENERAL CLINIC HOURS

The General Clinic is open:
Morning Sessions 9:00 AM - 12:00 PM

Afternoon Sessions 2:00 PM - 5:00 PM
Students may not treat patients at any other time than those specified for clinic appointments or without
faculty coverage. Any student found working on a patient during non-appointment hours for any reason or
without faculty coverage at any time will be subject to disciplinary procedures.
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IX. TELEPHONE NUMBERS
General Information: (310) 825-2337
Emergency Care-8am to 5pm: (310) 206-2816
Emergency Care-After hours & Sat/Sun: (310) 206-6766*
Dental Center Administration: (310) 206-6376
Initial Screening Appointment: (310) 206-3904
Group Practice Administrators - 5 Groups

Group 1 (310) 267-0548
Group 2 (310) 206-8945
Group 3 (310) 267-0502
Group 4 (310) 206-8945
Group 5 (310) 206-8947
*ACCESS TO EMERGENCY DENTAL CARE

This telephone number connects callers to the UCLA Medical Center page operator. Our patients should
identify themselves as UCLA Dental Center Clinics patients, and ask for the Advanced Education General
Clinic (AEGD) resident on call.
X. CUBICLE BREAKDOWN
1. Move all stools out of the way and make sure the bracket table is clear of anything that may cause
damage when the chair is being raised or lowered
2. Raise the chair to its maximum height
3. Move the dental lamp towards the headrest
4. BE CAREFUL when raising the chair and ensure that no objects are in the way that may
contribute to damaging the unit
5. Place the rheostat/foot pedal on the base of the chair (off the floor)
6. Make sure all barriers including blue tape barriers on lamp handles and stools are removed and
any portion of the cubicle covered (with plastic, paper (headrest) or wax paper) is wiped down
with Cavi-wipes
XI. TECHNICAL REPAIR

Any malfunction in the dental unit, light, chair, sinks, etc. should be marked on the clipboards with the
cubicle number and a brief descriptor of the problem so facilities can address the issue.
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CHAPTER 6
PATIENT ENTRY INTO TREATMENT
There will be no treatment of patients during non-clinic hours or without faculty coverage.
Violation of this policy will result in disciplinary measures.
I. INITIAL PATIENT CONTACT

Patients come to the UCLA Dental Clinic referred from friends, relatives, private dentists, physicians, social
service agencies, etc. Reasons for seeking treatment at UCLA vary from limited patient finances to faculty
assurance of quality dental work. The patient's first contact with the clinic is usually through a phone call
to get information or schedule a Screening Appointment in the Screening Clinic. Each person who calls,
either for information or to schedule an initial appointment will directed to the UCLA Dental Clinics
website for comprehensive information.
II. TREATMENT PLANNING

In light of the UCLA School of Dentistry’s continued pursuit of higher quality and more efficient patient
care, much of the process by which patients are screened, accepted, and treated has been restructured in the
Group Practice model. This is aimed towards consolidating the new patient process.
PATIENT ASSESSMENT/TREATMENT PLANNING – STRUCTURE AND SESSIONS
1. Accepted: If a patient is accepted, they will be escorted directly to radiology to get their radiographs
taken AFTER THE PATIENT SEES THE CASHIER TO PAY. The first two patients of the session
will have their radiographs taken by an Oral Radiology technician. All other patients on will have their
radiographs taken by a block student with the assistance of other students. Oral Radiology technicians
will assist should the queue become too long.
2. TP Sessions include: all treatment planning for all patients are done in the Group Practices by the
Group Practice Director (GPD) or Group Practice Leader (GPL). Additionally, all periodic exams are
to be completed in the Group Practices.
3. Patient Assignment: Patients who have been accepted and radiographed will be assigned to the Group
Practice Directors (GPDs) by the New Patient Services supervisor. Once the GPDs have been given
their patient pool, they will then assign these patients to their student providers within 72 hours. GPDs
will notify both the student and the student’s Group Practice Administrator (GPA) simultaneously.
NEW PATIENT WORKFLOW IN THE GROUP PRACTICE MODEL
(1) Patient Enrollment

a. Patient calls, provides requested info to receptionist who then instructs the patient to
register in the axiUm Patient Access Portal, where patient can complete the Health History
Questionnaire (my.dentistry.ucla.edu)
b. Patient schedules screening appointment
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(2) 1st Appointment – Screening and Oral Radiology
a. Patient either completes medical history at home (using her/his own device – preferable) or
when they come for the screening appointment (using lobby kiosks – less preferable)
b. Insurance verification if needed
c. Consents obtained at screening (by Susan Gerski – some before screening and the rest after
acceptance of patient)
i. Email
ii. Notice of Privacy
iii. Terms and Conditions
iv. Grievances
v. Patient Screening Notice, Terms and Consent
vi. Disability-Required Accommodation
vii. Cancellation and No-Show Policy
viii. Prop 65
d. Screening by GPD/GPL – completion of screening form with radiograph order if accepted
e. GPD/GPL assigns the patient a preliminary American Society of Anesthesiology (ASA)
classification to provide initial information for Patient Assessment in the 2nd appointment
f. Insurance CDT codes entered for comprehensive exam and films (by Susan)
g. Accepted patient pays cashier
h. Radiographs are taken
i. Patient is dismissed*
* Green Slip Patients (patients brought into the clinic by a student). The student must accompany
their green slip patient to the screening appointment, and depending on time and chair availability,
could be allowed to bring her/his patient to the Group Practice to begin the 2nd appointment tasks
(3) Between the 1st and 2nd Appointment

a. Patient is assigned to Group Practice by Dianne Fuller; in some situations Dianne may try
to assign the patient on the spot if needed (i.e. – “green slip” patient)
b. Patient assignment by GPD to student
c. GPD should inform student if patient needs pre-treatment planning visit
i. If a pre-treatment plan visit IS NOT needed, 2nd appointment has to be made in one
of the treatment planning operatories in the Group Practice
ii. If a pre-treatment plan visit** IS needed, 2nd appointment can be made in:
1. One of the treatment planning operatories in the Group Practice, in which
case Patient Assessment can occur in the same appointment, if time allows.
Coverage is provided by GPD/GPL
OR
2. Any open chair in the Group Practice, where coverage is provided by the
discipline-based faculty. The pre-treatment plan appointment and related
procedures is before Patient Assessment. The start check is provided by the
discipline-based faculty based on the medical history information provided
by the patient
** Study models/facebow transfer require a pre-treatment plan visit and include the need
for an implant crown or other prosthesis, complex fixed prosthodontics, any case of
removable prosthodontics, TMD/MPD cases or any situation at the discretion of the GPD
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d. Student contacts patient, makes appointment request with GPA. Appointment is booked
e. Student reviews chart and completes the radiograph tab of the Treatment Planning
Considerations form; GPD approves the form after discussing with the student
f. Student can begin to enter existing restorations on the odontogram
g. Student begins to enter medications based upon what patient lists in medical history form,
and these will need to be reviewed and confirmed at the 2nd appointment
(4) 2nd Appointment

a. Start check from GPD/GPL
b. Patient assessment
c. Review of medical history/enter medications
d. Complete all 9 Tabs of Patient Assessment Form (ORALDX)
There may a student in Patient Assessment Block assisting the student provider
e. Consult with Patient Assessment faculty if needed
f. Generate medical consult as needed***
***Medical Consults are required most often when:

 The medical history is unreliable, or require clarification from a physician
 Laboratory parameters are required prior to giving medical clearance
 Medical consults for hypertension are the most frequent ill-advised reason for med consults
 Medical consult workflow
o GPD/GPL decides a medical consult is needed at appointment #2. If unsure, GPD calls in the
Patient Assessment faculty to make the decision
o If warranted, GPA generates the Medical Consult form
o GPD/GPLand student work together to complete the form so the physician knows what is
needed
o Patient takes the paper form to their physician or have GPA fax it to physician (need fax
number) via e-fax
o Physician completes the form and sends it back to us either via e-fax
o GPA receives e-fax and forwards it to GPD
o Medical Consult form is approved by GPDs or Patient Assessment faculty
o GPD/GPL approves Patient Assessment, unless medical consult is required
 Complete odontogram
 Oral hygiene options form
 Consult 1 Form – Perio and any other needed disciplines
 TPC Form - CAMBRA Tab with corresponding risk assessed
 TPC Form – patient identifiers/initial plan (tooth by tooth assessment and
plan)/removable/implants
 TPC Form – faculty attestation that treatment options and material options were
discussed with the patient and that this was a patient-centered process
 Faculty approval of all forms
 If time allows, student can start entering treatment plan; otherwise dismiss patient
Note: GPDs and GPLs will work with discipline-based faculty in the formulation of treatment plans,
at the discretion of the GPD or GPL
(5) Between the 2nd and 3rd appointments

a. Student enters treatment plan in phase and sequence into axiUm
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b. Student discusses case with GPD/GPL and finalize treatment plan, with options if
appropriate
c. GPD/GPL approves the treatment plan
(6) 3rd Appointment

a. Start check from GPD/GPL
b. Conduct formal treatment plan presentation to the patient, and invite patient to ask
questions about the plan
c. GPD/GPL marks complete any planned procedure codes
d. Patient signs treatment planning
e. Patient signs informed consent
f. Student starts treatment if time allows and faculty coverage is available
TREATMENT PLANNING (TP) CLINIC SESSIONS PROCEDURE
Depending on your patient’s dental needs and medical history, procedure for screening to Patient
Assessment or Treatment Planning Clinic will vary.
STEP SYNOPSIS
 Registration – Everyone receiving treatment of any type at the UCLA Dental Clinic must be a
registered patient. The registration process is simple, involving the patient's completion of registration
and health history forms, and a Medical and Dental Services Agreement form, and the assignment of a
UCLA Dental Clinic patient number.
 Screening Examination – The screening appointment takes place in the first floor clinic. The patient
or student (if the student is “green-slipping” a patient) must make an appointment with any of the New
Patient Services staff in the first floor lobby. The patient must complete a Health Questionnaire, and
then be screened by a faculty member to ascertain the patient's overall dental needs, and to determine if
the patient is a suitable teaching case.
If accepted, patients will have appropriate radiographs taken by students after the patient sees the cashier
on Oral Radiology clinical rotation, or by the Oral Radiology staff.
 Oral Radiology – The patient’s appropriate radiographs will be taken by students on Oral Radiology
Clinical Rotation or by the Oral Radiology staff. If a patient has recently had a set of radiographs taken,
they may request that these radiographs be sent to the UCLA Dental Center (Patient Records
Department, P.O. Box 951668, Los Angeles 90095-1668). If this set of radiographs is not adequate,
supplemental radiographs will be taken.
 Patient Assessment/Treatment Planning – A complete, initial patient evaluation is performed as part

of the data collection and treatment plan. Patient’s medical status is determined by a systematic review
of established diagnoses or signs and symptoms related to major organ systems, related to
hospitalizations, and a current medications history. A physical assessment process is also completed
including the examination of vital signs and extra oral and intra oral examinations. For patients with
complex medical conditions, written medical consultations and recommendations for specific dental
management, modifications will be developed. All patients’ data will be recorded in axiUm, the school’s
electronic record keeping system. A comprehensive dental treatment plan is developed with the
GPD/GPL/clinical faculty.
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III. STUDENT/PATIENT – COMMUNICATION
1. Patients are assigned by Group Practice Directors based on the needs and requests of student dentists.
Patients with specific treatment procedures such as complete dentures and bridges will be selectively
assigned to meet individual student needs. Students are informed of their new patient assignments via
axiUm messenger.
2. This first contact is important in establishing rapport with the patient. Be prepared to welcome the new
patient and to answer questions about the clinic in general: appointment hours, procedure for dental
emergencies that occur when you are not available, etc. You should also arrange a place to meet your
patient for the first appointment -- usually the first floor lobby (if this will be your first meeting, ask the
patients to describe him/herself; because of the COVID-19 pandemic, students should meet patients
outside the building for the time being).
3. If you are unable to reach your patient by phone, send a "contact" letter (available from the GPAs). We
suggest using your cell phone number rather than your home phone number. Please be sure to indicate
that a letter was sent in the Contact Notes of the patient’s EHR.
4. The student should evaluate clinical and radiographic findings to develop possible treatment
recommendations and alternatives to be discussed with the patient. Students are encouraged to be
prepared prior to contacting their patients in order to converse knowledgeably about their case,
especially in extensive and costly reconstructions. At first you will overlook some things and
misdiagnose others. As you work with your Group Practice Directors and Group Practice Leaders, you
will begin to develop clinical judgment in determining treatment recommendations.
Consults with physicians should be obtained at this time in preparation for treatment planning. Forms are
available in the GPAs’ desks.
HOW TO CONTACT YOUR PATIENT
Under no circumstance should you use text messaging to communicate with your patients. Any
written communication with patients becomes part of his/her health care records, and the school does not
have a mechanism to store these messages. When possible, please use the messenger function in axiUm
(preferred) or e-mail for electronic communication with patients. Both require a one-time authorization by
the patient. Otherwise:
1. CALL THE HOME PHONE NUMBER:

a. Leave a message on the voice mail or answering machine: who you are, why you called, when
you will call back, how, when and where they can reach you. REMEMBER HIPAA
GUIDELINES regarding privacy. You do not know who may be listening to the messages.
b. Place an entry for your message in the Contact Notes Tab in the axiUm electronic chart
(Pathway: Rolodex > Patient Card > Contact Notes). (Example: 6-1-08 called pt. home #, left
message to call me tomorrow at 11:30 am (310) 206-1744.)
2. IF NO Voice Mail or answering machine, note your telephone call in the axiUm Chart.
a. Call the work #; if no work #, call home after 5 pm.
b. Place an entry in the Note Tab. Example: 6-1-08 called pt. work # no longer employed here.
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3. IF UNABLE TO CONTACT THE PATIENT WITHIN TWO DAYS OF CALLING
a. Place a proper entry in the Contacts Notes of the axiUm Chart.
4. STILL UNABLE TO CONTACT THE PATIENT:

a. Send an Unable to Contact Letter/Continuing Tx Letter.
b. Place an entry in the Contact Notes of the patient’s electronic record indicting the date the letter
was sent and allowing ten working days for the patient to respond before considering discharging
the chart. Example: “I have called pt. home in three different occasions, no response. I sent
letter today pt. asking for a response by a ‘a specific date’ to respond regarding continuing
treatment at UCLA. If no response I will discharge patient. The student identification number
will automatically be noted electronically.
c. Ask your GPD to discharge the patient. See chapter on Recall Patients.
ALL CALLS, MESSAGES, AND INACTIVE PATIENT INFORMATION MUST BE PROPERLY

DOCUMENTED IN THE PATIENT’S RECORD IN THE CONTACT NOTES.
WHAT TO SAY TO PATIENTS
Welcome the patient. Engage patient with introductory comments: How did you find out about the School,
are there specific reasons why you came to UCLA, do you have any immediate dental problems? Introduce
yourself as part of a Vertical Team assigned to take care of all of their dental needs. Indicate that you look
forward to working with them. Emphasize your excitement with dentistry. Compliment them on their
interest in taking care of their teeth.
1. Review the benefits and inconveniences of coming to UCLA for dental care.
a. BENEFITS:
i. High quality dentistry
ii. Highly supervised by faculty
iii. Less expensive than private practice.
b. INCONVENIENCES:
i. All appointments are 3 hours long; always.
ii. Should be available for appointments at least 2 times per week.
iii. Treatment will take longer to complete, because it is a teaching institution.
iv. School goes on Quarter breaks every ten weeks and students have Block Rotations. That
adds to the rate at which treatment can be accomplished.
2. Explain the Team treatment approach. Multiple students will be available to care for them, on-call,
during Rotations and emergencies.
3. Explain how their treatment will start, in plain English.
a. Treatment planning begins with a complete evaluation of their medical and dental conditions.
(Pre-treatment data gathering)
b. Consultations with Group Practice Directors, Group Practice Leaders and specialists will
identify treatment recommendations based on needs and desires of the patient. (Treatment
Planning)
c. A sequential treatment plan will be presented along with estimated fees prior to starting
treatment. (Presentation of approved treatment plan)
d. If the patient expresses concerns about costs or if you expect their overall treatment costs to
exceed $1,000, you should discuss their financial ability to follow through with care in a timely
fashion. There are Payment Plans (specific guidelines) that may be available. We also accept
all major credit cards. See chapter on Financial Policies for details.
35
4. Ask the patient if they have any questions. If they ask something you do not know tell them you will
find out and have an answer at your next encounter. Be certain you follow through with a timely and
adequate response.
MAKING THE APPOINTMENT
1. Let the patient know you would like to see them and give them several appointment choices to start.
For example: “Mr. Jones, if there are no further questions I would like to see you on Monday, August
1, at 9:00 am or Thursday, August 4, at 2:00 pm.”
2. For your first appointment, establish a meeting place outside the clinic building or in the first floor
lobby. It is not very comforting to be one of the many patients in the lobby, awaiting your name to be
called out. It is more personable and reassuring to have the dental student come straight to you and
introduce him/herself. You can provide this personal touch by agreeing to meet by the drinking fountain,
page phone, etc… Tell your patient what you look like, some unique characteristic that sets you apart
from others. Example: Red hair, very tall, very short, other distinguishing features.
3. Greet your patient by Mr. or Mrs. and with a handshake (post-pandemic). Introduce yourself at that time
again. Thank them for having been on time and/or having come to the appointment.
4. In general, treat your patients as the individual persons they are and you will have a very rewarding
relationship.
HOW TO INCREASE PATIENT CONFIDENCE IN YOU
Verbal and Non-Verbal Communication
1. Be on time! Be well-groomed and professional in your demeanor.

2. Introduce yourself at the first encounter with a warm and courteous handshake.
3. Greet your patient respectfully, usually by Mr. or Mrs.
4. Treat your patient like any other person you would like to get to know.
a. Find out about the individual, family, hobbies etc. and not just the dental problems.
b. Make notes so that you will remember to ask at following visits.
Example: “Mr. Smith how was your granddaughter’s dance show?”
5. Ask for and listen to the patients' complaints and concerns.
a. Write them down; make certain you address the concerns or complaints.
b. What items are most important to them? What options can you provide to meet them?
6. Return calls promptly.
7. Don’t make promises! Rather, “I will do my best to ….”
MOST PATIENTS RELATE THESE ITEMS TO YOUR CLINICAL ABILITY & COMPETENCY
1. Dress professionally and maintain personal hygiene at all times.

2. Set up a clean and efficient cubicle before you go to meet your patient!
3. Be prepared for the procedure you are to perform by reviewing the night before.
4. Be organized with all instruments and supplies before seating your patient.
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AFTER YOUR APPOINTMENT
1. Schedule the next appointment with the patient before they leave.
a. Let them know what you plan to do at the next visit, and the appropriate fee.
b. Patients will feel that you are concerned if you are well aware of their needs.
2. Thank the patient for having come in that day.
3. Simple things to do that demonstrate you care:
a. Acknowledge difficult appointments: “I know today’s appointment was tough on you, I
appreciate your efforts.”
b. Call the patient after extractions and endodontic procedures. Ask them how they feel? Reassure
them of post-operative symptoms resolving; let me know how to contact you.
MOST PATIENTS SIMPLY NEED REASSURANCE THAT IF A PROBLEM DEVELOPS SOMEONE

WILL BE THERE FOR THEM.
IV. HOW TO ORGANIZE YOUR CLINIC TIME

Evaluate the procedure and determine how many appointments will be needed. Do not forget to take
laboratory time into consideration. Be sure to consider available faculty coverage for the procedures
needed.
Avoid telling your patients that any procedure is simple and only takes one visit. If you tell them it will
only take one visit and for some reason it takes two or three, the patient will wonder why. If you did not
tell them it would take one appointment, and you encounter difficulties, you can explain that the problem
was bigger than could be foreseen and in order to be thorough, you will need to see them again for this
problem.
Do not rush through your appointments. The “Rush Factor” usually makes things more difficult and the
results are often of unsatisfactory quality. This necessitates the procedure being re-done and loss of patient
confidence and the time you had hoped to save.
Anticipate reasonable time for each step and budget this time over each 3-hour appointment. Develop time
guidelines for yourself.
Example: 10 - 15 minutes Start Check and Anesthesia

15 - 30 minutes Rubber Dam
1 1/4 hours Removal of old Restoration, Preparation, Decay
Removal, Base Placement, Refinement of preparation
45 minutes Matrix Placement, Condensation, Carving Occlusion
check and adjustment
15 minutes Write SOAP notes
YOU CAN QUICKLY SEE HOW THERE IS NO ROOM TO WASTE TIME BY NOT BEING
PREPARED AND HAVING TO RUN AROUND GETTING SUPPLIES, ETC.
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V. HOW TO UTILIZE YOUR TIME EFFECTIVELY
Organize each Quarter by assessing all of your current patient needs to be met during the Quarter:
1. Start by looking at the entire quarter of available clinic session times.
2. Develop a dental practice calendar for the quarter.
3. Evaluate based on patient availability, what procedures you will complete over what period of time for
each individual patient.
4. Account for processing and fabrication times when planning your lab case submissions.
5. Consider the faculty coverage available for all procedures.
USING THE ABOVE INFORMATION YOU CAN THEN PROCEED TO FIGURE OUT WHAT
APPOINTMENTS WILL BE NEEDED AND WHEN. YOU WILL THEN BE ABLE TO SET ALL
THESE APPOINTMENTS WITH YOUR PATIENT IN ADVANCE. DON’T FORGET HOLIDAYS
AND BREAKS
EXAMPLE: For a three-unit porcelain bridge.
Week Appointment Procedure
1 First Appt Preparation & Temps

2 Second Appt Impressions & Records
Lab Time Models, pindex, wax-up, casting control approval, investment
Prof. Lab Lab to cast and return to student
Lab time Seat on dies, finish, casting control approval
4 Third Appt Coping try in; bridge index and soldering
Prof. Lab to stack porcelain (5 working days + one day per
Prof. Lab
additional unit)
Lab time Finish, check occlusion, casting control approval
6 Fourth Appt Contour, Stain, and Cement bridge
BY ORGANIZING AND PLANNING A SCHEDULE FOR ALL PROCEDURES FOR THE QUARTER,
YOU WILL MAXIMIZE YOUR CLINIC TIME AS WELL AS PROVIDE TIMELY CARE FOR YOUR
PATIENTS.
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CHAPTER 7
TREATMENT PLANNING
The goals of treatment planning are to identify problems of concern based on the defined database, develop
a plan of action for each problem, specify all necessary procedures in a logical sequence, all in concert with
the patient’s concerns and desires, and obtain informed consent from the patient. This process is fully
defined in the Treatment Planning curriculum. Students should refer to this course material for a review of
treatment planning principles.
While the patient may not agree or be able to afford all of the recommended procedures, a complete
Treatment Plan must be documented and presented. This insures proper informed consent and provides
knowledge for future dental treatment. If the patient refuses procedures that are deemed urgent and
necessary, consideration should be given to terminating the care of that patient. The dental provider can
exercise the right to refuse treatment if the patient refuses to comply with recommended treatment or insists
on receiving treatment that is below the standard of care. All informed consent discussions must be
documented in the progress notes.
1. Basic Dental cases are those that require or have only the following:
 Moderate periodontal needs (i.e. no anticipated extractions other than 3rd molars)
 Ten or fewer fixed units
 One 3-unit bridge or single tooth implant only
 No partial dentures
 Reasonable occlusion
 No TM disorder or severe attrition
2. Pre-TP Cases include:

a. Cases are considered basic unless one or more of the following complex case criteria are met.
All complex cases are required mounted casts for the purpose of treatment planning
b. 2 or more missing teeth within any single quadrant (excluding 3rd molars(
c. Edentulous span >7mm or >2 teeth
d. Advanced periodontal disease/needs with presence or anticipated soft tissue defects,
horizontal bone loss
e. Immediate dentures/Interim removable prosthesis
f. Moderate attrition or mild TMJ disorder
g. Moderate to severe occlusal plane or vertical dimension discrepancies
h. Moderate to high esthetic risk (e.g. medium-high smile line, medium biotype, etc)
i. Pre-existing implants that need restorations
j. Implant cases – single and multiple units with adequate hard and soft tissue support
3. Review the dental record prior to any treatment planning appointment. You must understand the
medical history and its relevance to dental treatment. Review the chief complaint and be prepared to
discuss this with your patient.
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4. On the day of the appointment: introduce yourself and get to know the patient. Start to build trust and
rapport. Perform the patient assessment and obtain approval from the Group Practice Director or Group
Practice Leader. Using the electronic Perio chart and odontogram, chart the periodontal and dental
findings and complete the periodontal consult. The periodontal examination includes pocket depths,
bleeding, suppuration, mobility, furcation involvement, gingival height, and mucogingival problems.
Determine the amount and location of calculus (mild, moderate, heavy; supra- and/or subgingival).
Evaluate the appearance of the gingiva (edematous, erythematous, firm, stippled, and pink). Dental
findings (hard tissue) should be charted and noted on the Odontogram in your patient’s electronic
record. Dental findings include missing teeth, existing restorations, existing root canals or implants,
caries, fractures and other anomalies. Collect and record the preventive indices on the electronic perio
chart (marginal bleeding and plaque free surfaces). Also record your recommendation for treatment or
restoration.
5. For Basic Dental cases, present your patient to the Group Practice Director or Group Practice Leader.
State the patient’s age, current medical status, problems, and your intended treatment. Each team of
instructors will review your patients electronic record and initial plans and provide a consultation that
you will document in axiUm. Expected treatment outcomes, prognosis, treatment alternatives, and
informed consent must be discussed with the patient. Specifics of this discussion are recorded in the
axiUm SOAP notes.
6. For Complex Dental cases, make alginate impressions for study casts and obtain a face bow transfer.
If the case is partially edentulous and casts cannot be hand articulated, then record bases must be
fabricated and an interocclusal record will need to be obtained at the next visit. This can be done by
scheduling a late Pre-TP appointment and completing your mandibular mounting during the first two
hours.
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CHAPTER 8
RECALL PATIENTS
Upon completion of all recommended procedures on the patient’s Sequential Treatment Plan, a status
disposition is made. For most patients, their dental records will be “changed to Recall status.” This means
the patient is to be followed up for regular maintenance care which consists of annual periodic exams and
perio/hygiene treatment care at pre-determined intervals, e.g., every six months. Patients who should not be
retained must be referred to the Group Practice Administrator or Group Practice Director for proper
disposition.
This change is entered in axiUm “Contact Notes” section and a letter of completion of Tx is placed in the
patient’s chart is given to the Group Practice Administrator.
Phase I interval: The recommended interval, in months, is recorded here.
Date: After completion of each Phase I therapy, regardless of number of visits to complete, only the last
date is recorded; the dental or dental hygiene student records his or her ID number. By adding the interval
months to the last date recorded, one can tell at a glance when the next Phase I therapy is due. When Phase
I therapy is due and completed, that completion date is recorded on the next line, and so forth.
Tx completed: Whenever the "current" Treatment Plan is completed and the patient is placed on recall
status, the date is recorded. The next Periodic Exam is due one year from that date. When that Exam is due
and completed, that date is recorded on the Exam line along with the student's ID number. The next Exam
is due one year from the last periodic exam. If restorative treatment is required, a new Treatment Plan is
approved by both the patient and Treatment Plan Group Practice Director as usual.
Please note that 3rd year students are required to complete a recall chart review with their Group Practice
Administrator every quarter.
Annual Periodic Exams are the responsibility of Third Year students. All patient records due for
recall must be examined to determine whether a given patient is due for his or her annual exam. The
Quarterly Recall Patient Review assists in this requirement.
I. PERIODIC EXAMS
1. Advise the patient of the current Periodic Exam fee and separate radiology fee for bitewings or FMX
depending on the patient’s circumstances. The patient’s appointment is made in the Treatment Planning
chairs of the Group Practice. Review the patient’s record, noting especially the latest treatment plan and
maintenance phase recommendations.
2. Radiographs
a. Confer with the instructor to determine if current bitewing or FMX radiographs are
recommended.
b. If you are not qualified to take radiographs, take your patient to Oral Radiology where the staff
will make the necessary radiographs on a walk-in basis.
c. If a FMX is required, an appointment needs to be made in Oral Radiology after an instructor’s
approval and signature. The patient must pay the Radiology fee first. In this case, a second
appointment may be necessary to complete the Periodic Exam in order to review the FMX.
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3. Clinical Examination
4. Develop a tentative comprehensive treatment plan
5. Presentation of Treatment Plan:

a. If a new treatment plan is found to be necessary at the periodic exam, present the approved
treatment plan to the patient for consent and signature. Start or complete the patient’s prophy if
appropriate. If you proceed with a prophy after a patient’s treatment planning appointment, you
must be covered by a perio faculty and remember to get a new start check
6. You should appoint your patient for his/her prophy. If time permits at this first appointment, you may
begin the prophy under Periodontics faculty coverage. A periodontist’s signature indicating that the
patient’s periodontal health is acceptable to proceed with restorative care.
If the prophy has already been completed or will be completed (e.g., by the dental hygiene student), you
may begin any restorative procedure (as long as hygiene faculty or perio faculty has provided approval)
needed.
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CHAPTER 9
FINANCIAL POLICIES
I. UCLA DENTAL CLINICS FINANCIAL POLICY

1. Students ARE NOT TO MAKE PAYMENTS ON BEHALF OF THEIR PATIENTS. Patients are
personally responsible for their treatment costs. Students that do choose to go against clinic policy
and advance a patient’s payment either to proceed with treatment or submit case work to the lab,
WILL NOT BE ISSUED REFUNDS OUT OF THE PATIENTS ACCOUNT EVEN IF THE
PATIENT HAS PAID INTO THE ACCOUNT AFTER THE FACT.
2. Patients are required to pay for our services at the time such services are rendered. Remind
your patient to bring a check, money order or credit card to each appointment.
3. Patients must be informed by the dental student of the fees associated with their Treatment Plans.
4. When a Treatment Plan is changed, the patient must be informed by the student of any change in fees
related to the new treatment. The student must also obtain the patient’s authorizing signature for this
change in Treatment Plan and fees. This signature must be on the Finalized Treatment Plan Form on
the electronic treatment plan in axiUm (in the “Forms” Tab).
5. If the patient has a balance by the end of the business day, the patient’s electronic chart will be
automatically locked, and appointments may not be scheduled for the patient in the computer
appointment system. The student should prompt any patient who is delinquent in his/her
payments to pay immediately so that treatment can continue. If a patient is delinquent in
payments over 90 days, the account will be sent to a collections agency, and all treatment will be
stopped.
6. Certain Payment Requirements must be made by patients before treatment can be started. These
requirements are discussed in “Payment Requirements” below.
7. For detailed information on dental insurance policies, inquire in the Business Services Office (Billing
Office).
8. Patients who do not give us at least 24-hour’s notice of a canceled appointment, or do not show up for
an appointment, may be charged a “no-show” fee.
9. Patients whose treatment plan is over $500 or is covered by dental insurance or Medi-Cal should be
accompanied by the student to the Business Services (Billing) Office. Any questions regarding the
type of account (i.e., Self-Pay, and Other Insurance) and method(s) of payment can be answered by a
financial advisor at this time.
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II. PAYMENT REQUIREMENTS PRIOR TO SUBMITTAL OF LABWORK
Certain dental procedures require partial or total pre-payment before treatment can begin. The total fee
for procedures needing Professional Lab services must be paid in full prior to acceptance by the Lab.
The following are examples of procedures requiring pre-payment:
Fixed: All Gold Castings & Porcelain crowns 50% BEFORE starting procedure
100% BEFORE Lab will accept case
Removable: All full, immediate, partial, 50% BEFORE starting procedure
Treatment partial dentures and relines 100% BEFORE Lab will accept case
Gnathology: Splints 100% BEFORE Lab will accept case
Dental Hygiene Services 100% BEFORE treatment begins
Emergency/Patient Assessment/Radiology 100% BEFORE treatment begins
Oral Surgery 100% BEFORE treatment begins
Periodontal Surgery 100% BEFORE treatment begins
Graduate Endodontics 100% BEFORE treatment begins
FEE SCHEDULES: Fee Schedules listing the procedure codes and fees for all procedures are available to
students in axiUm “links” or in Patient Records.
III. DENTI-CAL/INSURANCE
1. You must inquire of all patients whether or not they are “on Denti-Cal.” If the answer is yes, continue
with step (2). If they have private dental insurance coverage by Delta Dental of California, the
Business Services Office will bill directly to Delta Dental. If covered by any other private dental
insurance company, the patient is responsible to pay the fees (as if they were a self-pay patient) and
the Business Services Office (Billing Office) will bill the patient’s insurance carrier as a courtesy after
the procedure has been charged out by the student. The insurance reimbursement for any covered
benefit will be sent directly to the patient. In either case, they are responsible for paying their share of
the total costs, known also as the patient’s co-payment. Direct all patient billing inquiries to the
Business Services Office. Additionally, most insurance carriers have an annual deductible that
must be met by the patient at the beginning of every calendar year.
2. Instruct Medi-Cal (Denti-Cal) patients to go to the Business Services Office ON HIS/HER FIRST
VISIT EACH MONTH TO VERIFY ELIGIBILITY FOR THAT MONTH. This is especially
important if you anticipate charges for completed treatment that month as eligibility for payment is
made on a monthly basis. Some patients have a “share of costs” where they must pay out of pocket
until their share of costs has been met. This amount may vary widely from month to month.
REMEMBER, it is your responsibility to make sure your patient demonstrates eligibility for
dental benefits until all treatment is completed. Ask if you have any questions!
3. Periodically check with your patients regarding their billing status. Some may lose their Medi-Cal
benefits during treatment, while others may become eligible. BENEFITS ARE ONLY VALID
DURING AN AUTHORIZED MONTH OF ELIGIBILITY.
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4. Whenever you have any question regarding the handling of Medi-Cal patients, please go to the
Business Services Office. The proper policies and procedures must be followed to insure the
maximum benefits for your patients.
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IV. UCLA SCHOOL OF DENTISTRY PATIENT PAYMENT PLAN POLICY
Patient’s Eligibility for Monthly Payment Plans (Effective April 1, 2012)
1. The patient’s account must be current and in good standing in all clinics operated by the UCLA
School of Dentistry
2. The total cost of treatment must be at least $500.00 and NOT greater than $3000.00.
3. The patient or guarantor and guardian must be able to provide a valid US Driver’s License or
government issued photo ID and Credit Card.
Student Dentist Requirements
1. The patient’s treatment plan must be signed by the student, patient/guardian, and the student’s Group
Practice Director.
2. The payment plan option is for the Pre-Doctoral Clinic ONLY. For the payment policies of other
clinics within the School of Dentistry, please contact that clinic’s respective coordinators.
3. Payment Plans CANNOT be approved after March 1st for those students that are graduating in June
of the same year.
4. Procedures covered on a payment plan CANNOT begin until a payment plan has been approved and
signed.
5. The patient down payment must be a MININUM of 25% of the proposed treatment. Laboratory
procedures CANNOT BEGIN until 50% of the payment plan total has accrued.
6. The student and patient are charged with prioritizing the components of the treatment to be covered by
the Payment Plan
7. The student must bring the patient’s final treatment plan to the Payment Plan Coordinator within three
days PRIOR to the Payment Plan signing meeting (i.e., if the Payment Plan Signing Meeting is March
9th on a Friday, the final treatment plan must be presented to the Payment Plan Coordinator on March
5th at THE LATEST).
8. The terms of the Payment Plan will be given to the student. Students are responsible for contacting
their patient for the following:
a. Discuss the specific guidelines and the 25% initial and 50% Laboratory Start Down Payments
b. Discuss the requirements
c. Schedule an appointment with patient
d. Notify and set an appointment with Payment Plan Coordinator
9. The Patient/Guarantor is required to complete and sign the Payment Plan form
Patient Appointment with Payment Plan Coordinator

1. The patient or guarantor and guardian must bring a valid US Driver’s License or Government Issue
Photo ID and Credit Card.
2. The total cost of the treatment plan must be a minimum of $500 and cannot exceed $3000
3. The following are due by the patient at the Payment Plan Signing Meeting:
a. 25% for the initial down payment
b. 50% will be required before any Laboratory work can be started.
4. Initial Payments can be paid with the following:
a. Cash
b. Check
c. Credit Card
d. Debit Card
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5. The remaining balance must be charged to a valid CREDIT CARD. The Payment Plan guidelines are
below:
a. 3 Months – total cost of $500 - $1,500
b. 6 Months – total cost of $1,501, $3,000
6. Monthly installments will be automatically processed on the 15th day of each month. If the 15th day
falls on a weekend or holiday, payment will be processed two days prior or after the due date.
7. Any declined credit cards will automatically suspend the Payment Plan. The Guarantor must notify
the General Clinic (i.e., the Cashier of the Payment Plan Coordinator) as soon as possible if there are
changes on the account (i.e., credit card has been reported lost or stolen)
8. For any questions and/or concerns, please contact:
Lizeth Gonzalez-Garetty
First Floor Lobby, Room 10-139
Contact #: (310) 825-7363
Email: [email protected]
Hours: Monday through Friday from 7:30 AM to 4:00 PM
V. PRE-PAYMENT PLAN
For those patients who are unable or unwilling to sign a Patient Payment Plan Contract, there are options
available. Pre-Payment Plans are to be established between the patient and the student. These patients
can pre-pay for their treatments in installments prior to the actual procedure. Please keep in mind that
regardless of what the patient chooses, TREATMENT IS NOT TO BE INITIATED UNTIL THE
PROCEDURE IS PAID FOR IN FULL.
To make a payment, patients can call the cashier at (310) 825-5253 to make payments over phone or they
can write a check made out to the UC Regents and Mail it to the following address:
UCLA Dental Clinic Patient Accounts Office

Box 951668
Los Angeles, CA 90095-1168
VI. FEE REDUCTIONS

On occasion, there may be a dental procedure that the clinical faculty believes may need to be redone: i.e.
a crown, composite inlay, or RPD. If that appears to be the case, there are appropriate steps that must be
followed. Once that determination has been made, complete a fee reduction form in axiUm by right
clicking the procedure and select “Add/Edit Tx Form…” in the drop down menu. That form MUST be
approved in axiUm by the covering faculty RECOMMENDING that the particular restoration or
prosthesis be redone. This approval must be given DURING the necessary consult appointment for the
redo (i.e., endo, restorative, perio, removable, etc.). Neither the faculty nor the student provider should
indicate or promise a patient that the restoration or prosthesis will be done at no charge. That would be
premature and inappropriate.
Fee reductions, once approved by the appropriate faculty member, must then be actioned to the Clinic
Director via the “Add Action” function on the form.
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At this time, Fee Reductions for Removable Prosthesis are to be submitted to Dr. Ting-Ling Chang first.
Dr. Chang will submit the Fee Reduction form to the Clinic Director pending her approval.
VII. STUDENT SUBSIDIES

Through donations by the Apollonian Society, each student, beginning in his or her third year has a
student subsidy of $1500.00 to use to help their patients accept treatment that might otherwise be
unaffordable to them. It is important to note that there are very specific guidelines controlling how
subsidy dollars can be used.
To submit a subsidy request, select the procedure in the “Tx History” of the patient’s electronic health
record (EHR) in axiUm for which you wish to apply subsidy. Right click the procedure and select
“Add/Edit Tx Form…” from the menu. Select from the window that appears the form coded “FEE 2.”
Assign the amount that you wish the patient to be responsible in the text field labeled “Requested
Charge.” Hit the “Calculate” button to fill in the rest of the fields, and then submit the form to the clinic
director via the “Add Action” function (running man).
1. Subsidy dollars can only be applied before treatment starts. Once a procedure has been started,
subsidy for that procedure becomes invalid.
2. Patients should NEVER be told that there is money available to them for this purpose
3. Students should never promise a patient that they will help them with subsidy dollars
4. If a student wishes to take advantage of subsidy dollar, they may want to tell their patient that they
will try and help them by taking the case to their GPD or clinic director to see if they may be able to
obtain some type of financial courtesy.
5. Subsidy can only be used IF THE REQUESTING STUDENT IS PERFORMING THE
PROCEDURE. This means, you cannot subsidize another student’s procedure even if the patient is
in the same CPC team. (E.g., if you are a 4th year and have remaining subsidy dollars, you are not
allowed to request subsidy dollars for your 3rd year to perform your patient’s procedure before you
graduate).
6. It is generally recommended that the subsidy dollars be used sparingly and wisely. If it is completely
used up in the 3rd year, you may not have those dollars to help a patient when it is needed the most in
the 4th year.
7. REMEMBER that the subsidy was established to help patients that truly need financial aid and NOT
to be used to “talk a patient into having a procedure done” by promising a fee reduction or rewarding
a “nice patient.”
8. Additionally, subsidies WILL NOT BE approved unless the procedure is on the treatment plan with
all necessary approvals in place: patient approval, Perio signature (if necessary), and Tx Option
approval signature by GPD (Note: items will not populate to the Tx History without patient approval
and GPD approval).
9. A STUDENT MAY NOT BORROW SUBSIDY FROM A FELLOW STUDENT. The Business
Services Office (Billing Office) keeps track of all subsidy dollars and it is highly recommended that
you track your own subsidy dollar use so that you remain aware of the balance.
10. The Maximum Allowance a patient can receive in subsidy dollars is $1000.00 within a two-year
period.
11. In your 4th year, you will be allowed to submit a subsidy request to cover 100% of a single
procedure of your choice.
12. Categories eligible for clinic subsidy include
a. Immediate or Complete Dentures. 70% max towards the procedure.
b. Removable Partial Dentures. 70% max towards the procedure.
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c. Fixed Partial Dentures. 70% max towards the procedure.
d. Predoctoral Endodontic Procedures. 70% max towards the procedure.
e. Implant Restorations. 70% max towards the procedure.
f. Inlays, Onlays, or Crowns (including CAD/CAM). 70% max towards the procedure.
g. Periodontal surgery (when performed by a predoctoral student). 70% max towards the
procedure.
h. Extractions. 70% max towards the procedure.
i. Direct Restorations. 50% max towards the procedure.
j. Scaling and Root Planing. 50% max towards the procedure.
13. CLNIC SUBSIDY DOLLARS MAY NOT BE USED FOR ANY RADIOGRAPHS, PROPHIES,
PERIODONTAL MAINTENANCE, OR RUSH FEES.
14. PATIENTS WITH PRIVATE INSURANCE DO NOT QUALIFY FOR SUBSIDY.
15. Subsidy dollars CANNOT be used for student treatment (if the student is the patient)
16. Subsidy dollars cannot be combined with programs like “Friends and Family”, “Endo Pilot Program”,
and “Fee Reductions”.
17. If a student pays for part of or all of his or her patient’s treatment (which is against policy), the student
CANNOT request a refund from the patient’s account to repay himself or herself while substituting
the difference with subsidy dollars.
VIII. ENDODONTIC PILOT PROGRAM

A program has been established to help students increase their endodontic experience with patients. This
is accomplished through a program called the “Endo Pilot Program”. The guidelines are simple. Again,
like the student subsidy, this program is designed for the patient that cannot afford the endodontic
procedure, post (or build up) and crown and would opt for an extraction. This program gives our students
more endo experiences on actual patients and improves the quality of dental care that the patient receives
(endo, post and crown vs. extraction).
Therefore, if your patient pays for the crown and post (or build) up BEFORE the endodontic procedure is
started; they will receive the root canal at 50%. Once the RCT is started, this program cannot be used.
To submit an Endo Pilot Program Fee Reduction request, open up the patient’s EHR and navigate to the
“Tx History” tab. Select the procedure for which you wish to apply the fee reduction (the root canal) and
right click the procedure. Select the “Add/Edit Tx Form…” option from the menu that appears and make
sure the form coded “FEE” is selected. Select the “Fee Reduction Category” and double-click the row.
Select “Endo Pilot Program” from the check list and then press “Calculate” to auto-fill the form.
The student must get the approval of the endodontic faculty (the faculty must sign the form in axiUm)
indicating that endodontic procedure that is necessary, is appropriate for a pre-doctoral student to do, and
is for a tooth that is restorable. All endo procedures are not necessarily appropriate for a pre-doctoral
student.
Once you have the approval of the endodontic faculty, the clinic director is the only other person that
needs to approve the reduction request. To acquire the clinic director’s approval, send the fee reduction to
request to the clinic director via the “Add Action” function on the EPR form (running man). Your
request will only be approved if the patient has paid his or her responsibility in full (100% of the crown,
100% of the build-up/core if necessary, and 50% off the Endodontic procedure). Once that is
accomplished, proceed with the endodontic treatment.
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There is a maximum of two root canals per student in this program. They will receive a RCT at a 50%
reduction of the normal fee. Each RCT cannot be done on the same patient.
Finally, it is imperative that the patient understand that, should a problem arise and the procedure
needs to be completed by a resident in Grad Endo that this program cannot be honored. It is
appropriate that you reassure the patient that problems or difficulties are not anticipated but there is
always a slight possibility that complications could arise. The patient needs to know this BEFORE you
begin the procedure – not after.
IX. RYAN WHITE POLICY

FEDERAL PROGRAM (PART F) & LA COUNTY PROGRAM (PART A)
FEDERAL: PART F
The UCLA SOD participates in the Health Resources and Services Administration (HRSA) Dental
Reimbursement Program that is funded through the Ryan White Treatment Modernization Act Part F.
This mechanism of funding is targeted to accredited dental or dental hygiene education programs for
defraying their unreimbursed costs associated with providing oral health care to people living with
HIV/AIDS (PLWHA). The reimbursement program is partial and is accomplished through a competitive
annual application to HRSA. Since 1999, the SOD has had a policy in place to utilize funds received
through the Dental Reimbursement Program to support oral health services to PLWHA. This support may
be through credit to general clinics or other cost centers or subgroups. All Newly registered patients who
self-disclose as HIV seropositive are eligible to benefit from this program. As the level of funds set aside
for this program at the SOD are limited, only essential and cost-effective treatments may be provided
through this program and each recipient has a maximum allowable amount for each fiscal year.
The procedures involved are as follows:

 Patient is registered through initial screening in New Patient Services or by direct referral to a SOD
specialty clinic from a community AIDS organization
 Patient completes an initial assessment for his/her medical status and appropriate laboratory tests
(Patient Assessment clinic or other SOD specialty clinics)
 A treatment plan is developed and approved by patient
 Dr. Younai reviews the treatment plan and the level of fee reduction request for approval
LA COUNTY: PART A (CRW214)
The procedures involved are as follows:

 New Patients: all new HIV positive patients referred to our General Clinic must be directed to the
County Ryan White Program Coordinator
 Active Patients & Recall Patients: inquire about Part A eligibility assessment with County Ryan
White Program Coordinator
 Patients are screened for eligibility and then registered into the program by the County Ryan
o Eligibility requirements include:
 A one-time HIV Diagnosis
 Residency in Los Angeles County
 An individual income at or below 400% of the Federal Poverty level
 Not having any other payer source for dental services, (Denti-Cal eligibility OK)
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 If patient is new, he or she must complete an initial assessment for his or her medical status. He or
she must also provide appropriate laboratory tests.
 All patients: a treatment plan is developed and approved by the patient
 Students MUST submit via axiUm a sequenced treatment plan to Dr. Younai via the County Ryan
 Dr. Younai reviews and approves the treatment plan, indicating all procedures to be covered by
the County Ryan Whine funding
 Student will be notified and the treatment plan will be uploaded to axiUm for record keeping
purposes.
X. FRIENDS AND FAMILY DISCOUNT PROGRAM

The Friends and Family discount is a program designed to encourage students to bring in patients and is a
20% of a patient’s entire treatment plan for treatment delivered in the General Clinic until the patient
enters recall status. Like any other discount program, the Friends and Family discount program cannot be
combined with any other offer (such as Endo Pilot Program, Ryan White funding, or Subsidy).
Friends and Family discounts ONLY apply to patients that have been GREEN SLIPPED. You cannot
apply the Friends and Family discount to patients that have already been green-slipped by other students.
Students are allowed to apply Friends and Family discounts to a maximum of three, GREEN SLIPPED
patients over the course of those patients’ treatments.
To apply for a Friends and Family discount, you must complete a fee reduction form via axiUm (pathway:
patient EHR > Forms > Create a New Record > “FEE6”) and list the procedures (up to three per form)
that you intend to discount BEFORE you deliver the treatment. Once you have completed the form, send
the completed form to the Clinic Director (faculty approval is not necessary) for approval.
Once the Friends and Family request has been approved by the Clinic Director, the forms will be
automatically transferred to the billing office to be processed. Please inform the billing office when you
have charged out the specific procedure so that the account can be balanced.
Friends and Family discounts only apply to treatment delivered in the general clinic. Periodontal surgery,
oral surgery, endodontic, and implant cases (the implant crown, if delivered in the general clinic) are not
covered under the Friends and Family discount.
Faculty are eligible to receive the friends and family reduction of 20% (the student delivering the
procedure would use the Friends and Family (Form code: FEE6) Fee Reduction form. Note that faculty
must be a patient of record to receive the fee reduction, which means that he or she would need to be
screened and complete the Patient Assessment process.
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XI. DENTI-CAL SUBSIDY
Currently, there is a grant that helps subsidize patients that are eligible for Medi-Cal/Denti-Cal. The
parameters to use this subsidy are as follows:
Protocols
1. Acquire Patient Approval, Perio Approval (if the procedure for which the subsidy is requested is a
direct restoration, endodontic, or periodontic, this may not be necessary), Provider Approval, and
Group Practice Director Approval on the Treatment Plan Consent Form.
2. Acquire Informed consents for the relevant procedures (if you’re delivering a root canal, your patient
needs to sign an Endo Informed Consent).
3. Speak with Elizabeth Perez in the Billing Office to confirm patient eligibility.
4. Complete the Denti-Cal Subsidy Request in the Forms tab of the patient’s Electronic Health Record in
axiUm.
5. Action (running man) the form to the Elizabeth Perez in the Billing Office for Denti-Cal approval.
6. The Billing Office will forward it to the Clinic Director for final approval.
Restrictions
1. Each patient that qualifies can receive a maximum of $400.00
2. Patient must be 60 years of age or older
3. The Denti-Cal Subsidy must be generated and approved prior to initiating treatment
4. There are no dollar limitations per procedure (you can fully subsidize an entire procedure if you so
choose, up to the $400.00 maximum per patient)
5. Any procedures delivered in the general clinic are eligible
6. Denti-Cal Subsidy dollars cannot be applied to procedures delivered in other clinics.
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CHAPTER 10
CLINIC ARMAMENTARIUM
Efficiency in patient treatment and infection control demand that all needed armamentaria to be obtained
and arranged prior to each patient appointment. The Listing below provides guidelines for all routine
procedures.
Basics for all appointments:
I. BASIC ARMAMENTARIUM
 Barriers for cubicle
 Personal protective equipment
 Patient napkin (bib) and bib clip
 Air/water syringe tips
 Suction tips: High Volume Evacuator (HVE) and Saliva ejector
 Cotton rolls
 2 x 2 gauze
 Patient Chart w/ current radiographs
 Blood pressure cuff and stethoscope
 Patient Eye Protection
II. TREATMENT PLANNING

 Basic armamentarium
 Necessary paperwork
 EXAM CASSETTE
 Mouthwash
 Impression trays
 Tray Adhesive (TAC adhesive spray)
 Periphery wax
 Alginate mixing bowl
 Alginate spatula (round edge)
 Water measurer
 Alginate
III. PERIODONTICS
1. PERIODONTAL SCALING
 2 x 2 gauze
 Disposable prophy angle
 Polishing agents
 Topical and local anesthesia
 PERIO CASSETTE
 SLOW SPEED HANDPIECE W/ SRAIGHT ATTACHMENT
 Dental Floss
 Oral hygiene aids to dispense to patients
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IV. RESTORATIVE
1. AMALGAM PROCEDURE
 2 x 2 gauze w/ alcohol (moistened)
 Vaseline
 Rubber dam
 Rubber dam napkin
 Hurriseal or Gluma
 Dental cements (bases, liners)
 Matrix band
 Wedges
 Amalgam
 Dental floss
 Articulating paper
 RESTORATIVE CASSETTE
 RUBBER DAM CASSETTE
 HIGH SPEED & SLOW SPEED (W/ ATTACHMENTS) HANDPIECES
 BURS & MANDRELS
2. COMPOSITE PROCEDURE
 Vita Classical Shade Guide
 Vaseline
 Rubber dam
 Chx 2%/Cavity Cleanser
 Dental cements (bases, liners)
 Plastic matrix strip
 Wedges
 Etchant
 Bonding agent
 Composite material
 Composite gun (Centrix)
 Light cure unit
 Polishing (finishing) strips and disc
 Dental floss
 RUBBER DAM CASSETTE
 BURS & MANDRELS
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3. CROWN & BRIDGE PREPARATION
 Barrier armamentarium
 Vaseline
 Dry angles
 Hygroformic (saliva ejector)
 Shade guide (tooth colored restoration-Classical or 3D)
 Alginate (Template for provisional)
 Alginate bowl
 Alginate spatula
Or
 Diagnostic cast (study model)
 Water measurer
 Impression tray (final impression)
 Tray adhesive (Caulk adhesive)
 Retraction cord
 Hemostatic solution
 Final impression material (heavy & light bodied)
 Impression gun
 Plastic impression syringe
 Bite registration material
 Integrity gun and material
Or
 Jet acrylic material
 Temporary cement
 Dental floss
 BURS & MANDRELS
4. CROWN BUILD-UP add:

 Core build up material
 Pin kit (if necessary)
 Para post kit (if necessary)
 Matrix band
 Wedges
 X ray film (if necessary)
 Collimator (x ray holder)
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5. CROWN & BRIDGE SEATING (CEMENTATION)
 Vaseline
 Dry angles
 Hygroformic (saliva ejector)
 Mylar strips
 Bite stick
 Cement
 Dental floss
 BURS & MANDRELS
V. REMOVABLE PROSTHODONTICS
1. EXAM & PRELIMINARY IMPRESSION APPOINTMENT
 4 x 4 gauze
 Mouthwash
 “Information for Denture Patients” booklet (Central Service)
 Water bath at 110oF
 Small spatula (student issue)
 Edentulous metal perforated trays (sterile) or Plastic impression trays
 Soft periphery wax (Red utility wax)
 Alginate
 Water measure
 Alginate bowl
 Alginate spatula (round edge)
 Alginate adhesive (TAC spray)
 Hanau alcohol torch
 #7 wax spatula
2. RPD TOOTH MODIFICATION and FRAMEWORK FINAL IMPRESSION

APPOINTMENT
 Approved Definitive RPD design
 Surveyed Study Cast at MAP on the surveyor, surveying accessary
 High speed hand piece
 Red & blue pencil
 UCLA RPD bur kit
 Plastic stock impression trays, preselected based on the study casts
 Soft periphery wax (Red utility wax)
 Alginate
 Water measure
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 Alginate bowl
 Alginate spatula (Round edge)
 Alginate adhesive (TAC spray)
 Water bath at 123°F
 Green compound cake
 ZOE Superbite by Bosworth
3. FINAL IMPRESSION APPOINTMENT

 4 x 4 gauze
 Mouthwash
 Water-bath at 110F
 Approved Maxillary & Mandibular custom trays
 Low speed headpiece with straight attachment
 Denture Bur Kit (Acrylic Bur Kit)
 Modeling plastic impression compound (Pink ISO compound)
 #11 sterile blade
 Scalpel (large, red handle)
 #7 wax spatula
 Wood handle scraper (Kingsley type)
 Indelible marking sticks
 Rubber base (polysulfide) adhesive
 Acid brush
 Disposable dipping dish
 Rubber base (polysulfide) impression material
 Masking tape
 Mixing pad (Large)
 Mixing Spatula (Straight or angled)
4. RPD FRAMEWORK TRY IN APPOINTMENT

 4 x 4 gauze
 Mouthwash
 Wire bending pliers
 Master cast and RPD framework
 Chloroform
 Glass dipping dish
 Rouge
 Bender brush
 Disclosing wax
 Alcohol (70% Isopropyl alcohol)
 High speed hand piece
 Carbide burs/stone burs/diamond burs
 Disclosing wax
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 Boley gauge or Iwanson Gauge
 Metal polishing kit
5. JAW RELATION RECORD & TOOTH SELECTION APPOINTMENT

 4 x 4 gauze
 Mouthwash
 Approved master casts and record bases with occlusion rim
 Denture Bur Kit (Acrylic Bur Kit)
 Pressure Indicating Paste (PIP)
 Acid Brush
 Disclosing Wax
 Vaseline
 Pink baseplate wax
 Buffalo knife (Small wood handle lab knife)
 #7 and #31 wax spatula
 Occlusal rim former (Hot plate)
 #11 sterile blade
 Fox Occlusal Plane
 Registration Materials: Aluwax or Iso-compound
 Tongue blade
 Fine marker (Sharpie)
 #2 Pencil
 Flexible Denture Ruler (millimeters)
 Facebow assembly
 Denture tooth mold guides
 Denture tooth shade guides
6. WAX DENTURE TRY-IN APPOINTMENT

 4 x 4 gauze
 Mouthwash
 Articulator, wax trial dentures, extra mounting ring
 Water bath 110F
 Hand mirror
 Tongue blade
 Horseshoe articulating paper
 Pink baseplate wax
 Buffalo knife (Small wood handle lab knife)
 #7 and 31 wax spatula
 Wax Master
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 Fox Occlusal Plane
 Fine marker (Sharpie)
 #2 Pencil
 Flexible Denture Ruler (millimeters)
 Sticky Wax (Yellow)
 Quick setting plaster
 Denture adhesive powder or paste
7. INSERTION (DELIVERY) & CLINICAL REMOUNT APPOINTMENT

 4 x 4 gauze
 Mouthwash
 Hand mirror
 Approved Dentures
 Facebow Remounting jig
 Articulator with extra mounting rings
 Slow speed headpiece with straight attachment
 Denture Bur Kit
 Acid Brush
 Disclosing Wax
 #11 blade
 #7 and 31 wax spatula
 Quick setting plaster
 Rag wheels
8. 24 HOUR CHECK & ADJUSTMENT

 4 x 4 gauze
 Mouthwash
 Hand mirror
 Denture Bur Kit
 Acid Brush
 Disclosing Wax
 Rag wheels
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9. DENTURE REPAIR APPOINTMENT
 4 x 4 gauze
 Mouthwash
 Pressure pot
 Quick set plaster or Lab putty
 Cold cure acrylic (monomer and polymer)
 Cement Spatula
 Disposable medicine cup
 Denture Bur Kit
 Cyanoacrylates (super glue)
 Bender brush
 Rag wheels
10. DENTURE RELINING IMPRESSION AND INSERTION

 Same as complete denture final impression and insertion except: using existing dentures
instead of a custom trays and horseshoe articulating paper for final impression
VI. ENDODONTICS
1. ENDODONTIC PROCEDURE
 Vaseline
 Endodontic rubber dam
 Dental floss
 Cavit
 ENDODONTIC TRAY SET UP
 ENDODONTIC CASSETTE
 BURS
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CHAPTER 11
INTEGRATED ACADEMIC MANAGEMENT SYSTEM (axiUm)
The axiUm system is an integrated academic management information system with five components:
Clinic billing system, appointment management system, electronic patient record, academic management,
and laboratory management. Note that there is a specific axiUm User Manual and Guide located on the
SOD Website in the same location as this Dental Clinic Handbook.
COMPONENTS
 Rolodex
 Patient Care
 Scheduler
 Electronic Health Record
 Perio Chart
 Patient Attachments
 Personal Planner
 X-Ray
 Imaging
Academic Management System:

1. Student grades
2. Faculty Course Management
1. Electronic Patient Record

Logging in to the System
Double clicking on the axiUm icon, one enters Username and password.
2. Rolodex
Selecting your patient:
The Rolodex allows you to search and “select” your patient lists. Enter the patient’s identifying
information in the search bar and press enter to begin a search. If you wish to search for your patient by a
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specific identifier, you can press any of the column labels to search by that identifier (e.g., search by chart
#, name, phone number, birthdate, etc.)
3. Loading a patient’s Electronic Health Record (EHR)
The EHR allows you to view much of your patient’s medical/dental information. From the EHR you can
view the patient’s Tx History, the various forms attached to the patient, and any of the patient’s lab orders
completed/pending/closed. You can also create treatment plans through the EHR as well as review any
attached documents (e.g., scanned documents, IDs, medical consults, legacy documents imported from
GSD).
4. X-Rays
XDR/X-rays can be viewed through axiUm.
If you have issues with loading XDR, loading a patient’s images, or saving images that were restored
from an improper/unexpected shutdown of the computer, please contact axiUm support (Cheryll Andico).
If you cannot find Cheryll, please contact the Clinic Director’s office (Vincent Chan).
5. Personal Planner
The personal planner allows you to access most if not all of the axiUm functions you will use day to day.
From the personal planner you can see any forms assigned to your SID that are unapproved, assigned
patients, appointments, patient needs, overdue patients, and lab orders.
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AXIUM EXAMPLE PAGE
FAQ: “Why couldn’t I access the patient’s chart?”

Three common mistakes that prevent one from accessing the patient chart are: not being assigned to the
patient, not clearing the patient’s Patient Assessment hold, and not having correct contact information for
the patient (address, SSN, and guarantor).
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CHAPTER 12
PROFESSIONAL LABORATORY
The goal of the Professional Lab is to fulfill an educational role as well as providing service for the
completion of lab cases. Through a cooperative effort with faculty, lab technicians, and staff, students are
taught how to use a dental lab to achieve the best possible result for prosthetic cases. Students will learn
effective methods of prescription writing and lab communications, how to prepare cases for presentation to
a dental lab, and in certain cases, alternative lab techniques.
1. FINANCIAL POLICY
The UCLA Dental Clinic Financial Policy outlines certain pre-payment requirements that must be secured
before procedures will be accepted by the Professional Lab. THESE PREPAYMENT REQUIREMENTS
ARE STRICTLY ADHERED TO AND WILL BE VERIFIED BEFORE ACCEPTANCE OF ALL LAB
CASES. No lab work will be released unless the Prepayment requirement has been paid or prior
arrangements have been made with and approved in writing by the Billing Department.
2. PROFESSIONAL LAB HOURS & CASE COMPLETION SCHEDULE
The Professional Lab makes every effort to be available to students during its regular working hours and to
complete lab cases in a timely fashion as outlined on the following schedule. However, due to occasional
heavy caseloads, there are times in which the case completion schedule must be extended. This is often true
toward the end of a quarter and especially true during the spring quarter when Fourth Year students are
trying to complete graduation requirements. Please be patient during these times (perhaps even trying to
plan ahead to avoid the last minute rush).
The length of time the laboratory needs to process restorations and prosthesis follow below. Fixed
restorations are delivered and retrieved, according to the completion scheduled below, in the office of the
assistant to the clinic director. Fixed restorations are fabricated off site in a professional laboratory and
removable prostheses are fabricated on sight. There is a laboratory representative on site for help, guidance
and support.
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TIME TABLE: COMPLETE AND FIXED PARTIAL DENTURES/PROSTHODONTICS
To ensure your case will be completed properly:

 Fill out the prescription form completely and properly (Your case may be delayed if the
prescription is not completed properly.
 Ask lab staff for best possible finish dates
 Allow additional finish time during high volume
Day of receipt does NOT count as a working day!
DENTURES 7 working days for EACH procedure.

3 day process only
Rush fee (case by case)
DENTURE RELINES Make appointment ahead of time; in by 12:00 noon, out

by 2:00 the next day
PARTIAL DENTURE 7 working days
CHROME FRAMES 7 working days - NO rushes
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TIME TABLE: FIXED RESTORATIONS
SUBMISSION TYPE:
Single Crown to Completion 8 working days

Full Contour Wax up for RPD 5 working days
Metal Try-in for Bridges 7 working days
Apply Porcelain to Existing Bridge 7 working days
Casting Dowel Core Patterns 5 working days
From Wax up to Completion 6 working days
Pour up and Pindex 2 working days
Re-Solder 3 working days
Rushes 4 working days
 Combination and long span cases are subject to additional time

 Weekends and Holidays are not working days.
 Due date is not considered a working day.
 The day you drop off the case does not count as a working day, nor does the day you pick it up
RUSH PROCEDURE: EURODENT CASES ONLY
 Payment MUST be made at the cashier’s office before any rush processing can be submitted.
 Once payment for Rush Processing has been made, proof of payment must be presented WITH your
lab slip to the billing office for Billing Approval.
 When Billing Approval has been acquired, the signed lab slip must be signed off by the Clinic
Director before being submitted to Eurodent
The Rush Fee is $50.00 per tooth (i.e., a single PFM crown will be $50.00 where a three-unit bridge will
be $150.00) and is NOT REFUNDABLE. Rush processing reduces the number of working days a case
will take down to 4 days. Please note that this is NOT a guarantee. Should you choose to pay for Rush
Processing, be sure to inform your patient that while the case is processed earlier, you are not promising
delivery on the date the case arrives in the General Clinic.
***Please note that the standard delivery schedule guidelines apply to Rush Processing. The dates
of Drop-Off and Delivery are not calculated into the delivery estimate***
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PROFESSIONAL LABORATORY HOURS:
7:00 AM-12:00 PM Open

12:00 PM – 1:00 PM Closed for Lunch
1:00 PM – 3:00 PM Open
3:00 PM – 3:30 PM Closed for break
3:30 PM – 5:00 PM Open
WORKING TIMES: DAY OF RECEIPT DOES NOT COUNT AS A WORKING DAY
All items to be received by the Professional Laboratory must be properly disinfected and sealed in a plastic
bag or in a denture cup covered by an iodophor-soaked towel or placed in a lab pan.
3. SERVICES PROVIDED BY THE PROFESSIONAL LAB
The use of the Professional Lab is a cooperative effort between the student and the Professional Lab staff.
By making oneself familiar with the following guidelines, a student can use the Professional Lab in an
efficient, hassle-free manner.
OROFACIAL PAIN
The student will fabricate TMJ splints including the wax-up stage. After a Gnathology instructor has
checked and signed-off the wax-up, the student may submit the case to the Assistant to the clinic director.
Cases must be clean and neat when turned in to the lab and must be accompanied by a complete and signed
prescription. There must be a billing signature for the lab case to be processed and sent to the lab.
REMOVABLE PROSTHODONTICS
1. Casts - All casts are to be clean and dense. The base must be completely trimmed, with land areas
rather than rough projections. Denture adhesives used on denture registration bases for try-in must be
cleaned from the base and cast. This should be done immediately at the end of the patient visit.
Adhesives transmit oral micro-organisms to the technician, harbor a black pigment-producing fungus,
and damage the master cast surface.
2. Mountings - Mountings are to be complete and smooth. Mounted casts or casts to be mounted must
have four adequate V grooves with definite edges in the cast base to positively assure accurate
remount.
3. Wax-ups, set-ups, and festoons - The student will complete the wax-up, set-up, and festoon of each
case. These must be neatly done, clean and ready for processing.
4. Teeth - Porcelain posterior teeth are not to be over-ground such that the diatoric or retention holes are
destroyed. Areas with little room for the teeth should have the resin trial base thinned or removed in
that area or plastic posterior teeth should be used.
5. Partial Dentures - Partial denture set-ups submitted for processing are to have the framework rests
and proximal plates completely seated onto the stone teeth. The major connector should have a
definite, unalterable indexing to the altered cast area. NOTE - The temporary resin registration bases
must be relieved from retention areas on the tissue side before final set-up of the teeth and turn-in to
the laboratory. (The framework is flasked so that it is locked down on the master cast consequently
there is no way to retrieve a registration base at boilout!)
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6. Special Procedures - Certain procedures will require additional steps or information. Example:
Manufactured facings to be incorporated into a partial denture framework require 1) an opposing
model, 2) a wax try-in of the facings, and 3) an articulator mounting or in some case a registration so
that the technician can mount the refractory cast. All corrections and alterations with facings must be
done at the refractory wax-up, including occlusion.
7. Alternative Methods - All removable and fixed procedures should follow the methods and
philosophies taught at our school. Necessary alternatives and deviations should be noted by the faculty
with a brief explanation and any additional required directions in writing on the work authorization
(lab prescription) and signed by the authorizing faculty member.
8. Incomplete Cases -Removable and fixed cases that are submitted to the Professional Lab in an
incomplete or unfinished manner will be returned to the student for further clinical endeavor and
consultation with appropriate faculty.
REMOVABLE PARTIAL DENTURE FRAMEWORKS

1. Casts - All casts must be neat and trimmed. To trim the casts: first wet the cast with tap water, trim,
rinse off and dry.
a. Master Casts - Master casts must be smooth, dense, vacuum-mixed yellow stone only. Do not
coat casts with any solution! Using Super-sep, etc. (No Vaseline) prevents wax block-out for
refractory duplication! Such coating means that the patient must be recalled for another
master cast impression. Tri-Pod marks clearly visible on master cast.
b. Design Casts - The design cast must be clearly and accurately drawn.
2. Cusp Tip Index - The cusp tip index must be made in the patient's mouth - NOT FROM THE
MASTER CAST! (Taking the index from the master cast defeats the entire purpose of the index,
namely, verifying the accuracy of the cast!)
3. Processing
a. Framework - The lab prescription for an RPD framework must be complete, accurate and
signed by billing & instructors before you turn it in.
b. Position mastercast on surveyor using surveyed marks for the laboratory to check. The
surveyor will be returned immediately after reviewed.
c. Enclose occlusal index.
d. Process time for framework is usually 7 working days, not counting the day you turn it in, or
the day you pick it up. More time should be allowed for difficult cases.
e. No Rushes on frameworks.
4. Do not promise a patient a finished partial denture for a given date. While most frameworks are
coming out acceptable, a student may get involved in one or more frameworks remakes (due to
various reasons: distorted casts, laboratory difficulties, etc.). Rather than panic, if a framework needs
to be redone, inform the patient that this step constitutes a difficult, involved fabrication and that we
wish to try for an improvement to get the very best for the patient.
RELINES
1. Scheduling - Relines must be scheduled with the Professional Lab as well as in the General Clinic
computer appointment system. In order to minimize the amount of time that your patient is without
his/her denture, these guidelines must be followed:
a. Schedule an AM appointment for the patient on Monday, Tuesday, or Wednesday. You will be
taking impressions at this appointment.
b. Schedule an appointment with the Professional Lab to turn in the case by 12:00 noon on that
day.
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c. Schedule a PM appointment for the patient on the following day. The reline will be ready at
2:00 PM for pick-up from the lab.
d. Schedule a PM appointment on the third day for the 24 hour check.
2. Impressions - Impressions must be centered in the denture, of adequate thickness, adherent to the
denture base, and neatly trimmed.
3. Post-Palatal seal - The student will be paged to the Professional Lab when the post-palatal seal is
ready to be carved in the stone. Must be prompt.
REPAIRS
1. Acrylic - Simple acrylic repairs can be done either by the student or the Professional Lab. More
involved cases should be handled by the Lab. In all cases, repairs must be authorized by a faculty
member of the Removable Department.
2. Framework - All framework repairs or soldering must be authorized by a Removable Department
faculty member. Check with the Professional Lab for specifics.
***All Denture Teeth are to be retrieved from the Clinic Directors office. Complete a Denture
Teeth Request EPR Form in axiUm***
II. LAB CASE PAPERWORK

Restorative Casework – Crowns, Onlays, Inlays, 3/4 Crowns, 7/8 Crowns, Dowel Cores
All fixed restorations are to be submitted through the axiUm lab module. Lab Orders can be created in
the labs tab of the patient’s EHR. Below is a screenshot of the lab prescription form:
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For more detailed instructions on the submitting of lab cases, please refer to the “axiUm Lab Procedure
Training Manual.”
It is your responsibility to acquire the necessary signatures and information for submitting lab cases:
Billing signature and faculty approval. Cases will not be accepted without these signatures.
Removable Case Work – Complete and Immediate dentures, Removable Partial Denture and
Interim Partial Dentures
Removable Case Work is submitted much

the same way as Restorative Case work.
Students are to properly fill out the

“Complete Denture & Removable Partial
Denture Department” Professional
Laboratory Request form (pictured to the
left).
These forms also come in an NCR booklet

with corresponding colors: WHITE,
YELLOW, PINK, ORANGE.
Removable Case work is dropped off and

picked up from the 2nd Floor lab. Students
will retain the PINK and ORANGE copies
when dropping off cases and must present
both when picking up their case work.
When you pick up any removable case, you

will be given the YELLOW copy of the
form, which will be stamped by the 2nd
Floor lab personnel. This form MUST be
presented to PROS faculty before he or she
can sign off the office consult and/or
provide a start check. This step must be
completed prior to the framework try-in
and/or insertion appointment.
For all Complete Dentures (not Immediate Dentures or RPDs), there is a space that allows patients to
include initials for the identification of their denture. You are REQUIRED to ask your patients
whether or not they wish to include their initials. Your patient must then SIGN the form to indicate
“YES” they wish to include their identification initials or “NO” they do not wish to include this
identification. The lab will not accept your case work if they do not.
70
COMPLETE DENTURE AND PARTIAL DENTURE REQUEST FORM
Processing Instructions
1. General Information: Must be filled-in (Printed) completed and accurately by the student.
2. Billing OK and Medi-Cal Re-approved: Must be approved and signed by Billing Department
Personnel.
3. Professional Laboratory Use Only: Professional Laboratory Manager must approve Lab work
delivery.
4. Prescription Writing and RPD Design: Must be filled-in (Printed with additional instructions or
Drawings) completely and accurately by the student.
5. Enclosed with case: Must be filled-in by student before items are delivered to the Professional
Laboratory
6. Complete Denture and Partial Denture Treatment Plan: Lab work must be reviewed and signed by
Advanced Prosthodontics faculty prior to clinical try-in. (For REMAKES, please bring the
“Laboratory Request Form” signed by the Clinic Instructor who disapproved the work to the
Professional Lab for a remake.) After patient’s Final appointment, file the "Pink" copy in patient’s
records.
Lab Prescriptions: For Full Dentures only: Require a patient’s signature to opt in or out of having
identification placed on the Full Denture.
71
CHAPTER 13
POLICY FOR USE OF IONIZING RADIATION
1. Policy for the Use of Ionizing Radiation

a. Patients should receive the minimal amount of radiation consistent with excellent quality
radiographs. The underlying assumptions are that every exposure carries with it some risk.
Accordingly, patients should only be exposed when there is the expectation of benefit. These
policies are thus intended to assure the most effective use of ionizing radiation
b. Physical Facilities
i. All radiographic equipment and facilities are in compliance with all applicable state
regulations including:
1. NCRP Report No. 177: Radiation protection in dentistry and oral and
maxillofacial imaging
2. California State Radiation Safety Handbook
3. ADA recommendations and guidelines on acceptable radiographic practices
ii. All radiographic equipment will be calibrated as per the maintenance schedule of the
manufacturer and following regulatory and institutional requirements.
iii. All radiographic facilities in the Oral Radiology Clinic are under the supervision of the
Section of Oral Radiology. The Section of Oral Radiology will provide technical
support as resources allow
iv. The use of X-ray emitting devices (wall-mounted or handheld) on the 2nd and 3rd floors
in the general clinic is supervised by clinic instructors
c. Criteria for Exposure
i. Every patient exposure must carry the expectation of diagnostic benefit which is
judged to exceed the risk of the x-ray exposure.
ii. Patient Qualification
1. All radiographs will be ordered by a dentist or physician (faculty member)
2. Radiographs for new patients will only be ordered after clinical examination of
the patient, consideration of the dental history, and availability of prior suitable
radiographs
3. Additional radiographs, including recall bitewings, may be prescribed during
patient treatment only when they are judged to be required for patient diagnosis.
4. Individuals will not be exposed for teaching or training purposes unless there is
a concomitant documented diagnostic need as determined by a member of the
faculty.
5. Patients will not be exposed following restorative treatment to document
procedure completion routinely, unless it is determined that such exposure is
necessary by the dentist/physician
6. Ordinarily a full-mouth survey will not be repeated in less than 3 years and
bitewings will not repeated in less than 12 months unless there are specific
indications requiring more frequent radiographic examination
d. Operator Qualifications
i. Exposures may only be made by individuals on the faculty of UCLA School of
Dentistry possessing a DDS, DMD or MD degree, or by students or staff under the
supervision of such individuals
72
ii. Students will demonstrate technical competence on mannequins before they may
expose patients and will receive appropriate training on safe use of radiation.
iii. Students will be allowed no more than three retakes on a full-mouth survey without the
direct supervision of faculty or staff
e. Exposure Procedures
i. Generally, only the patient will be in the operatory during radiation exposure. If
assistance is required for children or handicapped patients, a member of the patient’s
family should assist
ii. All patients will be draped with a leaded apron and thyroid shield
iii. Sensor holding instruments, usually Rinn Holders, will be used. Specifically, the
fingers of the operator will not be used
iv. Extraoral machines will be collimated so that the beam size does not exceed the image
receptor
v. Patients will not be subjected to retakes solely to demonstrate technical perfection.
Each set of full-mouth radiographs will usually demonstrate each contact area and each
apex at least once
vi. The number of radiographs should be limited to the minimum required for a complete
diagnostic workup
vii. Patients will be observed during each exposure to ionizing radiation
2. Maintenance of Radiographic Records

a. Every patient exposure is recorded in the patient’s electronic chart
b. Radiographs will be released to other dentists upon written request and authorization by the
patient
c. Radiographs will be maintained in the patient’s electronic record
3. Workflow for Radiographs Taken on the Clinic Floors (not in the Oral Radiology Clinic)
a. The faculty member determines that radiographs are necessary
b. All radiographs needed in the Group Practices will be taken using a handheld x-ray emitting
device (Nomad)
c. Each GPA will store/charge a Nomad unit and a #2 sensor (large size)
i. #1 sensors (small size) and additional #2 sensors are available in Central Sterilization
and can be checked out to students as needed
d. Student checks out a Nomad/sensor from her/his Group Practice GPA; GPAs will use gun
scanner to keep track of devices
e. Student applies the clear plastic sleeve to the sensor and its cable
f. Student places a patient bib on the bench to rest the Nomad when preparing the patient
before/in between/after exposures
g. Student connects sensor to operatory computer, obtains a start check for the radiographic
survey from faculty, and takes radiographs using the Nomad device according to training
received in the Oral Radiology curriculum/block
h. Student disinfects Nomad and sensor according to clinical protocol – currently Optim 1 wipes
i. Student returns Nomad and sensor to GPA, who scans barcodes to indicate the return
73
II. CLINICAL EXPOSURE FACTORS GENDEX EXPERT
65 kVp, 7 mA using Rinn Holder for Periapicals using Bitewing Tabs for Bitewings
USING INSIGHT FILM

Time in RAP’s* w/ RAP’s* w/o
Impulses Collimator Collimator
ADULT PERIAPICALS
Incisors 0.160 --- 3.8
Canine-Premolar 0.200 --- 4.8
Molar 0.250 --- 6.1
Occlusal 0.250 --- 6.1
ADULT BITEWINGS
Premolar 15 --- 4.8
Molar 18 --- 6.1
EDENTULOUS
PERAPICALS
Incisors 0.160 --- 3.8
Canine-Premolar 0.160 --- 3.8
Molar 0.200 --- 4.8
Occlusal 0.250 --- 6.1
CHILDREN
Anterior 0.160 --- 3.8
Posterior 0.160 --- 3.8
Bitewing 0.160 --- 3.8
Occlusal 0.200 --- 4.8
MULTIPLE PROJECTIONS ADULT 21 FILM SURVEY 90.6

2
*RAP's = Product of skin exposure (R) times exposure area (cm ). California Average Background
Radiation per year = 1,836 RAP's.
74

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DENTAL CLINIC HANDBOOK

UCLA School of Dentistry’s Mission:

The UCLA School of Dentistry holds the following Core Values:

 Advancement of Knowledge – We promote the advancement of knowledge of the basic mechanisms,

CHAPTER 1 PROFESSIONAL CONDUCT IN THE CLINIC .............................................................1

CHAPTER 2 COMPREHENSIVE PATIENT CARE .............................................................................8

CHAPTER 3 MEDICAL, DENTAL, & CLINIC EMERGENCIES ....................................................10

CHAPTER 4 PATIENT RISK MANAGEMENT ..................................................................................15

CHAPTER 5 PATIENT ASSIGNMENTS, APPOINTMENTS, AND CUBICLE BREAKDOWN ..26

CHAPTER 6 PATIENT ENTRY INTO TREATMENT .......................................................................30

CHAPTER 8 RECALL PATIENTS ........................................................................................................41

CHAPTER 9 FINANCIAL POLICIES ...................................................................................................43

CHAPTER 10 CLINIC ARMAMENTARIUM ......................................................................................53

CHAPTER 11 INTEGRATED ACADEMIC MANAGEMENT SYSTEM (axiUm) ..........................61

CHAPTER 12 PROFESSIONAL LABORATORY ...............................................................................64

CHAPTER 13 POLICY FOR USE OF IONIZING RADIATION .......................................................72

1. UNDER NO CIRCUMSTANCE SHOULD A STUDENT BE PAYING FOR PATIENT

a. Use as low a voice tone as possible

II. SUPERVISION OF DENTAL TREATMENT

III. GREENSLIP PATIENTS

IV. DENTAL STUDENT ADVERTISING GUIDELINES AND RESTRICTIONS

1. Hair must be pulled back away from face.

Disposable Needle - Short Matrix Band

Disposable Needle - Long ViscoStat Applicator

Anesthetic Carpule Acid Etch Applicator

Monojet Endo Irrigation

Bard-Parker Scalpel Blade

To turn tanks ON:

To turn tanks OFF:

MOST COMMON INCIDENTS

WHAT TO DO WHEN AN INCIDENT OCCURS

Whenever an incident occurs before 4PM, you should:

Whenever an incident occurs after 4PM, you should:

1. Responsibilities of the assigned student

2. Responsibility of the CPC team partner

3. Responsibilities of the students on Urgent Care block

1. Providing and maintaining a high standard of dental care.

PATIENT BILL OF RIGHTS

PROPER DOCUMENTATION/PATIENT RECORDS

The following are all part of a patient's complete record:

1. Current Medical History

Medical Consult Workflow

III. DENTAL TREATMENT DURING PREGNANCY, POST-PARTUM AND

IV. REFERRAL TO SPECIALISTS

1. Diagnosis remains unclear

V. TRIAGE AND RESOLUTION OF PATIENT COMPLAINTS

TERMINATION OF DOCTOR-PATIENT RELATIONSHIP

In some instances, it is necessary or desirable to terminate the doctor/patient relationship. Such an

CONFIDENTIAL PATIENT INFORMATION

Confidential Patient Information includes the following:

RELEASE OF PATIENT RECORDS

DENTAL PATIENT RECORDS DENTAL PATIENT BILLING OFFICE

GENERAL INFORMATION AND CONSENT: Read Carefully Before Signing

B. CONSENT FOR PHOTOGRAPHY, TELEVISION, AUDIO/VIDEO TAPING

MEDICAL AND DENTAL CONSENT

III. PATIENT APPOINTMENTS

When scheduling appointments, patients should be given the following information:

V. CLIENTTELL – APPOINTMENT REMINDER

VI. PAYMENT PROCEDURE BEFORE TREATMENT