7.2 Dental Records, Patient Access, Practice Closure & the Amalgam Pamphlet
Key Takeaways
- New Hampshire dentists must keep paper or electronic and radiographic records at least 7 years from the patient's last treatment, and minors' records at least 7 years past the age of majority (RSA 317-A:27-a).
- When a patient requests a copy of the dental record, the dentist must provide it within 20 days for no more than $15 for up to 30 pages and $0.50 per page thereafter, whether or not the account is paid (Den 501.01(e)).
- A dentist closing a practice must give patients 3 months' notice when possible and tell the Board who will hold the records (Den 501.01(g)).
- Before restorative procedures, a dentist must give the patient the Board's standardized pamphlet on dental materials, including mercury amalgam, and discuss the choices (RSA 317-A:38).
- Dentists must destroy discarded dental records by a method that keeps them confidential (Den 501.01(m)).
Dental Records, Patient Access, and Practice Closure
Making and keeping the record — RSA 317-A:27-a
- Dentists and dental hygienists must record all examinations and treatments performed or recommended.
- The record must be detailed enough to be used for identification purposes. Dental records are a recognized means of identifying people.
- The dentist must keep the patient's paper or electronic, and radiographic, records:
| Patient | Minimum retention |
|---|---|
| Adult | 7 years from the time the dentist or hygienist last treated the patient |
| Minor | 7 years past the age of majority |
Den 501.01(h) adds that, under RSA 317-A:27-a, dentists have an ongoing obligation, for at least 7 years, to give prior patients access to records not previously provided to the patient or a new dentist.
Copies for patients — Den 501.01(e)
On a patient's request, the dentist must provide a copy of the records:
- within 20 days;
- for a nominal fee not to exceed $15 for up to 30 pages and $0.50 per page after that (RSA 332-I:1, I);
- with radiographs and models at a reasonable cost;
- whether or not the patient's account is paid in full and whether or not the patient has paid for the records.
The ADA Code says the same thing. Advisory Opinion 1.B.1 requires dentists to furnish records or copies, including X-rays, gratuitously or for nominal cost, "whether or not the patient's account is paid in full."
Fee example
A patient asks for a 90-page chart:
| Pages | Charge |
|---|---|
| First 30 pages | $15 maximum |
| Remaining 60 pages × $0.50 | $30 |
| Maximum | $45, plus reasonable cost for radiograph or model copies |
Refusing to release the copy until the patient pays an outstanding treatment balance violates Den 501.01(e).
Other record duties in Den 501.01
| Rule | Duty |
|---|---|
| (d) Patient lists | A dentist may not aid or encourage an employee to use patient lists from a former office, and no dentist, hygienist, or assistant may use such lists without the previous employer's prior written consent |
| (g) Closing a practice | Inform patients of record of the closure to allow 3 months, when possible, to get copies or transfer records. Notify the Board in writing of the intent to close and give the name, address, and phone number of the licensee who will receive the records |
| (k) Ending treatment | When discontinuing a course of treatment, be available for emergency care for up to 30 days or until the patient finds another dentist, whichever comes first |
| (m) Disposal | Destroy discarded dental records by a method that maintains confidentiality |
| (n) Financial consent | A dentist may not, directly or through a third-party creditor, make a patient financially responsible for the entire cost of a treatment plan before the patient gives informed consent, with all financial responsibilities clearly explained |
Anesthesia records
Sedation facilities keep additional records: anesthesia consent, time-based anesthesia records, emergency records, and transfer forms (Den 304.09; section 6.3).
Dental materials and the amalgam pamphlet — RSA 317-A:38
Before using restorative materials, a dentist must:
- give patients having restorative procedures a standardized pamphlet developed by the Board in consultation with the Department of Health and Human Services, covering the risks and benefits of dental materials, including mercury amalgam; and
- discuss the choices of restorative materials with the patient before using them.
The ADA Code adds an ethical limit. Under Advisory Opinion 5.A.1, removing amalgam from a non-allergic patient for the alleged purpose of removing toxins from the body, when done solely at the dentist's recommendation, is improper and unethical.
Death or incapacity of a dentist — RSA 317-A:30
When a registered dentist dies, the spouse, executor, or administrator may continue the business under a registered dentist. The spouse of an incapacitated dentist may do the same. The records duties above continue to apply to whoever holds the records.
Confidentiality and the ADA Code
ADA Code 1.B requires dentists to safeguard record confidentiality and to share information that will benefit a patient's future treatment when the patient or another dental practitioner asks, in accordance with applicable law. Advisory Opinion 1.B.2 advises getting the patient's written permission before forwarding sensitive information, such as HIV status, chemical dependency, or sexual preference, unless the dentist is certain local law permits it.
Worked scenario
Dr. Reyes is retiring and selling her equipment but not her patient base. She should:
- notify patients of record so they have 3 months, when possible, to get copies or transfer records;
- notify the Board in writing and name the licensee who will receive the records;
- make sure records remain available for the full retention period: 7 years from last treatment for adults, and 7 years past majority for minors; and
- destroy any records later discarded in a way that preserves confidentiality.
A patient with an unpaid balance asks for a copy of her 50-page dental record. Under Den 501.01(e), what may the dentist charge, and may he withhold the copy until the balance is paid?
A dentist treated a patient from age 9 until her last visit at age 14. Under RSA 317-A:27-a, how long must he keep her paper or electronic and radiographic records?
A dentist decides to close her practice with no buyer. Which step does Den 501.01(g) require?