17.4 Filing and Inventory Systems, Equipment Records, Financial Records, Referrals & Office Policies

17.4 Filing and Inventory Systems, Equipment Records, Financial Records, Referrals & Office Policies

Quick Answer: Domain 6 (Practice Management, 5 to 10% of the exam) also covers:

• filing and inventory systems (6.1)
• referrals and consultations (6.2)
• financial records (6.3)
• equipment records, manuals and service contracts (6.4)
• the office policies and procedures manual (6.5).

Patient records may be filed alphabetically or numerically (with an alphabetical cross-index). Colour coding makes misfiles easy to spot. Inventory control depends on knowing the rate of use, the lead time and a safety stock. These give the reorder point: stock is reordered when it falls to (rate of use × lead time) + safety stock. Stock is rotated first in, first out. Every financial transaction is posted to the patient's ledger and to the day sheet. The day is balanced so that the accounts receivable total is correct.

1. Filing Systems (6.1)

Common alphabetical filing rules (follow the office's written rules):

• Unit by unit: surname first, then the given name, then the middle initial.
• "Nothing comes before something": Brown, J. is filed before Brown, John.
• Hyphenated surnames are treated as one unit (for example, Smith-Jones is filed as Smithjones).
• Prefixes such as Mac, Mc, O' and Van are filed as written, letter by letter.
• Titles (Dr., Mrs.) are ignored for filing or used only as the last unit.

Colour coding: coloured labels for the first two letters of the surname (or the last digits of a chart number) form colour bands on the shelf. A folder in the wrong place shows up immediately.

Active and inactive records: records of patients who have not attended for a set period (office policy) are moved to inactive storage. They are still kept for the retention period set by provincial rules (section 7.3).

Electronic records:

• Use unique user log-ins and strong passwords, and lock screens when you step away.
• Keep audit trails of access and changes.
• Make regular, encrypted back-ups and store a copy off-site. Test that back-ups can be restored.
• Scanned documents and images must be linked to the correct patient and date.
• Paper and electronic systems must both protect privacy (section 2.1).

2. Inventory Control (6.1)

Types of supplies:

• Consumable and disposable supplies: used up or discarded after use (gloves, masks, anesthetic cartridges, cotton rolls).
• Expendable items: relatively inexpensive items replaced when worn (for example, some hand instruments, burs).
• Major (capital) equipment: costly items with a long life (dental chairs, sterilizers, x-ray units, compressors).

Key terms:

• Rate of use: how much is used per week or month.
• Lead time: the time between placing an order and receiving it.
• Safety stock: extra stock kept to cover delays or unusual use.
• Reorder point: (rate of use × lead time) + safety stock.
• Reorder quantity: the amount ordered to bring stock back to its maximum level.
• Shelf life: how long a product remains usable (watch expiry dates on anesthetics, bonding agents, impression materials and biological indicators).

Worked example: the office uses 2 boxes of gloves a day. The supplier's lead time is 3 days and the office keeps 4 boxes as safety stock. The reorder point is (2 × 3) + 4 = 10 boxes.

Good practice:

• One person is responsible for ordering, using a manual card or tag system or an electronic (barcode) system.
• Rotate stock (first in, first out): place new stock behind older stock.
• Store products according to the manufacturer's directions (temperature, light, humidity).
• Avoid overstocking (money tied up, products expire) and understocking (emergency orders, cancelled procedures).
• Obtain the Safety Data Sheet for every new hazardous product and label workplace containers (section 17.3).

Ordering and receiving documents:

• Purchase order: the office's written order.
• Packing slip: lists what is in the box. Check it against the order and the contents as soon as the delivery arrives.
• Back order: an item not in stock that will be shipped later. Note it, so it is not ordered twice.
• Invoice: the bill for the goods shipped.
• Statement: a monthly summary of all invoices, payments and the balance owing.
• Returns: usually need authorization from the supplier. Keep a record of credits.

3. Equipment Records, Manuals and Service Contracts (6.4)

Keep an equipment record for each major item with:

• the name, model and serial number
• the date of purchase, the supplier and the cost
• warranty dates
• the service company's contact details
• a maintenance and repair log.

Other requirements:

• Manufacturer's manuals and instructions for use must be kept where staff can find them. They set out the cleaning, maintenance, approved chemicals and operating limits. Ignoring them can void the warranty and injure staff or patients.
• Routine maintenance logs cover daily, weekly and monthly tasks: sterilizer cleaning and monitoring (section 6.3), evacuation-trap and line cleaning, waterline treatment and testing (section 5.3), compressor draining, handpiece lubrication and amalgam separator checks.
• Service contracts cover preventive maintenance and repairs. Track the renewal dates and record each service call.
• Radiographic equipment must be registered and inspected as required by the province, and records of the tests and inspections must be kept (section 8.1).

4. Financial Records (6.3)

• Patient (account) ledger: records every charge, payment and adjustment for a patient or family, and the balance owing.
• Day sheet (daily journal): lists all of the day's charges, payments and adjustments.
• Balancing the day (proof of posting):
  • previous accounts receivable (A/R) total
  • plus today's charges
  • minus today's payments
  • plus or minus adjustments
  • equals the new A/R total.
• Accounts receivable: money owed to the practice. Accounts payable: money the practice owes to suppliers and others.
• Payments:
  • Accept cash, cheque, debit, credit card and assigned insurance payments according to office policy.
  • Issue a receipt for each payment.
  • Prepare the bank deposit daily and keep the deposit records.
• NSF (non-sufficient funds) cheque: post the returned amount (and any office fee) back to the patient's account as a charge, and contact the patient courteously.
• Credit balances and refunds: document them and handle them according to office policy.
• Petty cash: a small fixed fund for minor purchases. Each purchase needs a receipt or voucher. At any time, cash + vouchers = the original amount of the fund. Replenish the fund by the total of the vouchers.
• Collections:
  • Send regular statements and review the aging report (30, 60, 90 days or more).
  • Make polite follow-up calls at reasonable times, discuss balances only with the responsible person, and agree on payment arrangements in writing.
  • Follow office policy and provincial law before involving a collection agency.

5. Referrals and Consultations (6.2)

Outgoing referral to a specialist (for example, endodontist, periodontist, oral surgeon, orthodontist):

• Obtain the patient's consent to share information.
• Send a referral letter or form with the patient's details, the reason for the referral, the urgency and relevant health history.
• Send copies of radiographs through a secure method.
• Record the referral in the chart and in a referral log.
• Follow up to confirm the patient booked the appointment and that the consultation report was received and filed in the record.

Incoming referrals: confirm receipt, book the patient and send the report or a thank-you letter to the referring dentist.

6. Office Policies and Procedures (6.5)

A written policies and procedures manual keeps the team consistent and helps orient new staff. It usually includes:

• job descriptions, hours, dress code and personnel policies
• IPAC and sterilization protocols, the WHMIS program and the SDS inventory, and the exposure (sharps injury) protocol
• the medical emergency plan, team roles and the emergency kit checks
• the privacy policy and the records retention policy
• appointment, cancellation and payment policies

Administrative support tasks that keep the manual current:

• drafting or updating procedures and dating each revision
• tracking staff licences, CPR certification and immunization records
• keeping the SDS binder up to date
• preparing agendas and minutes for staff meetings
• making sure staff read and sign off on changes.