HDC Manual Ay17-18.June2017

CLINICAL POLICIES AND
PROCEDURES MANUAL
AY2017-2018
Version 1
Updated June 2017
Office of Clinical Affairs and Clinical Operations

188 Longwood Avenue
Boston, MA 02115-5888
Table of Contents
SECTION I: LIST OF ACRONYMS ........................................................................................................................5
SECTION II: INTRODUCTION ............................................................................................................................. 12
SECTION III: FGP ON-CALL SCHEDULE, HDC HOLIDAY SCHEDULE, ACADEMIC
MEETING/CONFERENCE SCHEDULE, HDC ORG CHART .......................................................................... 13
SECTION IV: OVERVIEW ..................................................................................................................................... 16
SECTION V: COMPLIANCE WITH POLICIES AND PROCEDURES ........................................................... 17
SECTION VI: HARVARD LONGWOOD CAMPUS MAP, HDC FLOOR PLANS, AND HOURS OF
OPERATION ............................................................................................................................................................. 18
SECTION VII: FIVE-SESSION MODEL .............................................................................................................. 21
SECTION VIII: APPOINTMENTS AND COMMUNICATION ......................................................................... 24
TITLE IX AND PATIENT COMMUNICATION .................................................................................................. 29
LATE, CANCELLED, AND FAIL-TO-SHOW AT APPOINTMENTS ............................................................... 30
RESCHEDULING .................................................................................................................................................. 34
PAGING SYSTEM ................................................................................................................................................. 34
INTERPRETERS AND PATIENT VISITORS (IN THE OPERATORY)............................................................. 34
PARKING FOR PATIENTS .................................................................................................................................. 35
PATIENT PORTAL................................................................................................................................................ 35
SECTION IX: PATIENT RECORDS (ARCHIVED PAPER CHARTS AND DUPLICATION)...................... 37
SECTION X: PATIENT REGISTRATION, FRONT DESK FORMS, AND CONFIDENTIALITY ............... 38
FGP WELCOME PACKET .................................................................................................................................... 38
NEW HDC PATIENT PROCESS AND FORMS ..................................................................................................... 38
CONFIDENTIALITY ............................................................................................................................................. 45
HIPAA POLICIES ..................................................................................................................................................... 51
SECTION XI: WORKFORCE POLICIES............................................................................................................ 52
ATTENDANCE ...................................................................................................................................................... 52
DELIVERED MAIL AND EMAIL ........................................................................................................................ 52
IT TICKET SYSTEM ............................................................................................................................................. 53
DENTAL CARE FOR HSDM STUDENTS ........................................................................................................... 53
DENTAL CARE FOR HDC EMPLOYEES AND FAMILIES OF HSDM STUDENTS AND EMPLOYEES .... 53
STUDENT PATIENT REVIEWS FOR GRADUATION ...................................................................................... 53
GRIEVANCES ....................................................................................................................................................... 54
REQUESTS FOR ADDITIONAL CLINICAL TIME ............................................................................................ 54
STUDENT DENTAL ASSISTANTS ..................................................................................................................... 54
SECTION XII: CLINICAL PROCEDURES .......................................................................................................... 56
SCHEDULING PROTOCOLS FOR EMERGENCY APPOINTMENTS ............................................................. 56
PATIENT ASSIGNMENTS FOR TP PROVIDERS .............................................................................................. 56
MEDICAL EMERGENCIES THAT OCCUR DURING CLINIC APPOINTMENTS AND PATIENT CARE ... 57
ACCIDENT PROTOCOLS AND FORMS ............................................................................................................ 60
ANTIBIOTIC RECOMMENDATIONS................................................................................................................. 62
ADA PARAMETERS OF CARE ON BLOOD PRESSURE ................................................................................. 65
MATERIAL AND CHEMICAL SPILLS ............................................................................................................... 66
DISPOSAL OF EXPIRED CHEMICALS AND PHARMACEUTICALS ............................................................ 67
HSDM EMERGENCY EVACUATION PROCEDURES ...................................................................................... 67
INSTRUMENTS, EQUIPMENT (INCLUDING SENSORS), AND MATERIALS.............................................. 70
END USER RESPONSIBILITY POLICY ............................................................................................................. 70
HDC LABORATORY FACILITIES ...................................................................................................................... 79
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INTERNAL LABORATORY WORK.................................................................................................................... 79
OUTSOURCED/EXTERNAL LABORATORY WORK ....................................................................................... 80
DIGITAL DENTAL LAB (DDL) ........................................................................................................................... 81
CEREC .................................................................................................................................................................... 82
GUIDED SURGERY .............................................................................................................................................. 85
TP PROVIDER-SPECIFIC LAB PROCEDURES (PRE-DOC & AGE) ............................................................... 86
QUALITY ASSURANCE (QA) PROCESS FOR PRE-DOCS .............................................................................. 88
FGP LAB PROCEDURES...................................................................................................................................... 92
SHIPPING PROCEDURES .................................................................................................................................... 92
OTHER LAB COMPONENTS............................................................................................................................... 93
PROTOCOL FOR RESTORATIVE AND SURGICAL MATERIALS REQUESTS............................................ 93
RE-MAKE PROCEDURES .................................................................................................................................... 96
LAB QUESTIONS.................................................................................................................................................. 96
BOARD EXAMS .................................................................................................................................................... 96
SECTION XIII: PATIENT CARE .......................................................................................................................... 98
ORAL DIAGNOSIS, ORAL RADIOLOGY, AND NEW PATIENT INTAKE .................................................... 98
OTHER PRE-DOC ROTATIONS .......................................................................................................................... 99
PATIENT CARE IN GENERAL ............................................................................................................................ 99
POLICY ON EXTRACTIONS PERFORMED BY PRE-DOC STUDENTS ...................................................... 100
COMPREHENSIVE PATIENT ASSIGNMENT COORDINATION .................................................................. 100
QUALITY IMPROVEMENT ............................................................................................................................... 101
CARIES RISK ASSESSMENT AND MANAGEMENT ..................................................................................... 101
PROTOCOL FOR HANDLING DENTAL EMERGENCIES OF TP PATIENTS .............................................. 106
POLICY FOR USE OF IONIZING RADIATION FOR DIAGNOSTIC USES .................................................. 107
DOCUMENTATION OF ORAL RADIOLOGICAL FINDINGS ....................................................................... 110
STUDENT ROTATIONS IN ORAL RADIOLOGY ........................................................................................... 111
METHOD OF PAYMENT FOR RADIOGRAPHY ............................................................................................. 111
SCREENING/TREATMENT OF “LICENSURE-ELIGIBLE” PATIENTS AT HDC ........................................ 111
USE OF HDC PATIENTS AT OFF-SITE CLINICS ........................................................................................... 111
ROUTINE CASE DOCUMENTATION OF PHOTOGRAPHS .......................................................................... 112
PHOTOGRAPHING INSTRUCTIONS ............................................................................................................... 112
ORAL PATHOLOGY REQUISITIONS/BIOPSY AND CULTURE SPECIMENS ........................................... 113
MEDICAL GUIDELINES .................................................................................................................................... 113
TREATMENT PLAN ........................................................................................................................................... 115
REFERRALS ........................................................................................................................................................ 118
SECTION XIV: FINANCIAL PROCESS ............................................................................................................. 120
OVERVIEW ......................................................................................................................................................... 120
FINANCIAL TERMINOLOGY ........................................................................................................................... 121
MASS HEALTH (MEDICAID) ........................................................................................................................... 122
RYAN WHITE HIV/AIDS PROGRAM............................................................................................................... 122
INSURANCE ........................................................................................................................................................ 123
COLLECTIONS PROCEDURES ......................................................................................................................... 124
HSDM DISCOUNT POLICY ............................................................................................................................... 125
SECTION XV: ADMINISTRATIVE CONTACTS ............................................................................................. 126
PHONE DIRECTORY .......................................................................................................................................... 126
SECTION XVI: CREDENTIALING..................................................................................................................... 128
CREDENTIALING REQUIREMENTS FOR FACULTY MEMBERS............................................................... 128
CREDENTIALING REQUIREMENTS FOR AGE STUDENTS ........................................................................ 129
SECTION XVII: APPENDIX ............................................................................................................................... 131
1.1 HSDM STATEMENT OF CONFIDENTIALITY .......................................................................................... 131
1.2. REQUEST TO INSPECT AND/OR COPY HEALTH RECORDS .............................................................. 132
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1.3 PATIENT AUTHORIZATION FOR SPECIFIC DISCLOSURE OF PHI ...................................................... 133
1.4 ANNUALLY REQUIRED TRAINING ......................................................................................................... 134
1.5 TWO ACCIDENT FORMS ............................................................................................................................ 136
1.6 EVALUATION FOR ENDOCARDITIS PROPHYLAXIS FORM ............................................................... 140
1.7 PREVENTION OF BACTERIAL ENDOCARDITIS .................................................................................... 141
1.8 GUIDELINES FOR PRESCRIBING DENTAL RADIOGRAPHS ............................................................... 144
1.9 HSDM MEDICATION STORAGE PROTOCOL .......................................................................................... 147
4
SECTION I: LIST OF ACRONYMS USED IN THIS MANUAL AND/OR COMMONLY
AT HDC
A
AADR=American Association for Dental Research
AAE=American Association of Endodontists
AAFP=American Academy of Fixed Prosthodontics
AAID=Academy of Implant Dentistry
AAMI=Association for the Advancement of Medical Instrumentation
AAOMS=American Association of Oral and Maxillofacial Surgeons
AAP=American Academy of Periodontology
AAPD=American Academy of Pediatric Dentistry
ACLS=Advanced Cardiovascular Life Support
ACP=American College of Prosthodontists
ADA=American Dental Association
ADCA=American Dental Coders Association
ADEA=American Dental Education Association
ADEX=American Board of Dental Examiners
ADHA=American Dental Hygienists Association
AED=Automated External Defibrillator
AGE=Advanced Graduate Education
AHA=American Heart Association
AIU=Adopt/Implement/Upgrade
ANSI=American National Standards Institute
AO=Academy of Osseointegration
AOD=Academy of Operative Dentistry
AY=Academic Year (effective late August/early September)
5
BCBS=Blue Cross Blue Shield
BFACA=Business and Financial Administration and Clinical Administration (part of

ADEA)
BLS=Basic Life Support
BMI=Body Mass Index
BORID=Board of Registration in Dentistry
BP=Blood Pressure
BPHC=Boston Public Health Commission
BWH=Brigham & Women’s Hospital
C
CADR=Canadian Association for Dental Research
CAGE=Committee on Advanced Graduate Education
CAMBRA=Caries Management by Risk Assessment
CART=Communication Access Realtime Translation (Hearing Impaired Service)
CCE=Clinical Comprehensive Exam
CCR=Comprehensive Care Rotation (formerly ADR)
CDA=Certified Dental Assistant
CDC=Centers for Disease Control and Prevention
CDCA=Commission on Dental Competency Assessments (formerly NERB)
CDT=Current Dental Terminology
CHA=Cambridge Health Alliance
CMR=Code of Massachusetts Regulations
COA-Certified Orthodontic Assistant
CODA=Commission on Dental Accreditation
COHRI=Consortium for Oral Health Research and Informatics
CORI=Criminal Offender Record Information
CPR=Cardiopulmonary Resuscitation
6
CQM=Clinical Quality Measures
CRICO=Controlled Risk Insurance Company
CT=Computed Tomography
DAs=Dental Assistants
DANB=Dental Assisting National Board
DDL=Digital Dental Lab
DMC=Dental Materials Committee
DMD=Doctor of Dental Medicine
DDS=Doctor of Dental Science
DEA=Drug Enforcement Administration
DHCW=Dental Health-Care Workers
DPH=(Massachusetts) Department of Public Health

DTP=Diagnosis Treatment Planning and Prevention
EDIC=Eastern Dentists Insurance Company
EHR=Electronic Health Record
EH&S=Environmental Health & Safety
EMT=Emergency Medical Technician
EOB=Estimation of Benefits
EPA=(United States) Environmental Protection Agency
FCC=Foundational Continuity Clinic
FDA=(United States) Food and Drug Administration
FGP=Faculty Group Practice
FY=Fiscal Year (Effective July 1st through June 30th)
7
GKAS=Give Kids a Smile
GPR=General Practice Residency
HBV=Hepatitis B Virus
HDC=Harvard Dental Center
HIPAA=Health Insurance Portability and Accountability Act
HITECH=Health Information Technology for Economic and Clinic Health
HIV=Human Immunodeficiency Virus
HR=Human Resources
HRSA=Health Resources and Services Administration
HSDM=Harvard School of Dental Medicine
HUCTW=Harvard Union of Clerical and Technical Workers
HUHS=Harvard University Health Services
HUID=Harvard University Identification (number and card)
HUPD=Harvard University Police Department
IADR=International Association for Dental Research
ICC=Infection Control Committee
ICL=Internal Collections Letters
ICR=In-house Clinical Rotation
IDP=Introduction to the Dental Patient
MDS=Massachusetts Dental Society
MER=Medical Emergency Record
8
MGH=Massachusetts General Hospital
MMWR=Morbidity and Mortality Weekly Report
MSDS=Material Safety Data Sheet
MU=Meaningful Use (internal and unofficial acronym only)
NERB=North East Regional Board (now known as CDCA)
NPI=National Provider Identifier
NPI=New Patient Intake (TP rotation)
OD=Oral Diagnosis (TP rotation)
ODE=Office of Dental Education
OMFS= Oral and Maxillofacial Surgery
OPIM=Other Potential Infectious Materials
OR=“Oral” Surgery Suite in FGP
OR=Oral Radiology (pre-doc rotation)
OS=Oral Surgery (pre-doc rotation)
OSAP=Organization for Safety, and Asepsis Prevention

OSCE=Objective Structured Comprehensive Exam
OSHA=Occupational Safety and Health Administration
PBL=Problem Based Learning
PCP=Primary Care Provider
PD3=Patient Doctor III
PHI=Protected Health Information
PI=Principal Investigator
PLC=Preclinical Lab/Learning Center
9
POM=Patient of Medicine
PPE=Personal Protective Equipment
PSLs=Patient Services Liaisons
QI=Quality Improvement (Committee)
RAD=Radiology (FGP rotation)
RDH=Registered Dental Hygienist
REB=Research and Education Building
Rx=Prescription
STs=Sterilization Technicians
T
TAR=Treatment Adjustment Record
TP=Teaching Practices
Tx=Treatment
TxAD=Treatment of Active Diseases
WHO=World Health Organization
WREB=Western Regional Examining Board
YDC=Yankee Dental Congress
10
Additionally, the University has countless acronyms that can be found via:
http://www.harvard.edu/faqs/acronyms. These are not required to know, but can be very
helpful.
11
SECTION II: INTRODUCTION
This manual contains the current clinical practice and procedures for all full- and part-time
faculty, staff, students, and visitors of the Harvard Dental Center (HDC) within the Harvard
School of Dental Medicine (HSDM). HDC is a facility licensed by the Massachusetts
Department of Public Health (DPH) and, as such, is compliant with all the policies and
regulations within this state agency.
This manual is written with specific guidance for HDC’s Faculty Group Practice (FGP),
Teaching Practices (TP), and the Advanced Graduation Education (AGE) Prosth Lab, Preclinical
Lab/Learning Center (PLC), and Digital Dental Lab (DDL). All full- and part-time faculty, staff,
students, and visitors are expected to be compliant with all the policies. The manual is updated as
needed; each year at the onset of the new academic year, a formal edition is produced for
distribution.
12
SECTION III: FGP ON-CALL SCHEDULE, HDC HOLIDAY SCHEDULE, ACADEMIC
MEETING/CONFERENCE SCHEDULE, HDC ORG CHART
To get things started, Exhibits 1-4 detail important information to refer to:
Exhibit 1: FGP FY17 After Hours On-Call Schedule
13
Exhibit 2: HDC Holiday Schedule
HOLIDAY DATES HDC CLOSED*
Independence Day Tuesday, July 4, 2017
Labor Day Monday, September 4, 2017
Columbus Day Monday, October 9, 2017
Veteran’s Day Friday, November 10, 2017
Thanksgiving All Students: Wednesday, November 22, 2017, Thursday,

November 23, 2017 and Friday, November 24, 2017
Faculty and Staff: Thursday, November 23, 2017 and

Friday, November 24, 2017
Christmas and Winter Recess Christmas Eve ½ day Friday, December 22, 2017 through
Friday, December 29, 2017
New Year’s Day Monday, January 1, 2018
Martin Luther King Day, Jr. Monday, January 15, 2018
President’s Day Monday, February 19, 2018
Memorial Day Monday, May 28, 2018

*NOTE: This does not include other clinic closures. For more information on
other schedule items including the Academic Meeting/Conference Schedule, refer
to Office of Dental Education (ODE) Academic Calendar. Additionally, updates on
other potential clinic closures will be sent via email by HDC management.
14
Exhibit 3: The HDC Org Chart outlines the reporting structure and roles:
15
SECTION IV: OVERVIEW
Within HDC, the two clinics and the basement laboratories operate under license from DPH, and
it is here where faculty practice and/or provide clinical instruction and experience for students—
with the common goal to deliver comprehensive dental care for patients. Patients are accepted
for treatment (Tx) regardless of race, religion, color, sexual orientation, or national origin and are
treated to the extent permitted by available facilities, resources, and staffing.
Fees are charged for services rendered; these fees, in turn, help defray the cost of staffing,
materials, laboratory costs, and office expenses. Patients are expected to pay for charges due
at each appointment.
In TP specifically, patients should know (and sometimes, need to be reminded) that all dental
appointments and procedures take a considerably longer period of time to complete. Patients are
expected to cooperate concerning: availability/flexibility for appointments, keeping
appointments, following recommendations, and promptly paying bills.
Treatment provided by pre-doc students or AGE students is always done under the
supervision of licensed dentists.
16
SECTION V: COMPLIANCE WITH POLICIES AND PROCEDURES
Issues regarding compliance that arise and that could result in disciplinary action shall be
dealt with consistent to the appropriate collective bargaining agreement and/or School
and/or University policies. The HDC Clinical Policies and Procedures Manual should be read
in conjunction with the HDC Infection Control Manual (posted on eCommons and the HDC
Intranet page) covers the following topics as shown in Exhibit 4:
It is imperative that all HDC Dental Health-care Workers (DHCWs) and staff familiarize
themselves with the content written in both of these documents.
Some violations of policy and acts of misconduct may result in immediate suspension and a
recommendation to the Vice Dean, Associate Dean for Dental Education, and/or the Executive
Director of the Harvard Dental Center for further disciplinary actions. These acts may include,
but are not limited to: theft of HDC property; seriously improper conduct in relation to patients,
staff, students, or faculty; falsification of records; or violation of patient confidentiality.
17
SECTION VI: HARVARD LONGWOOD CAMPUS MAP, HDC FLOOR PLANS, AND
HOURS OF OPERATION
Exhibit 5 shows a Harvard Longwood Campus map, also noting facilities with access for
individuals with disabilities:
18
Exhibit 6 shows HDC is comprised of three floors: Basement, FGP (1st Floor), and TP (2nd
Floor):
BASEMENT Floor Plan
The three basement labs (AGE Prosth, PLC, and DDL) are staffed from 8am-5pm, Monday-
Friday. They are accessible 24 hours/7 days a week with an HUID of the appropriate individual
using the facility. Specifically, only AGE students and faculty can use the AGE Prosth Lab; only
pre-doc students and faculty can use PLC; and only AGE students, faculty, and staff (who make
formal reservations—with ODE and the Clinical Operations Labs and Materials Manager—for
classes and meetings) can use the DDL.
FGP Floor Plan
19
The FGP hours of operation are Monday and Wednesdays from 8:30am-8pm; and Tuesdays,
Thursdays, and Fridays from 8:30am-5pm. Schedules are set and confirmed by working closely
with the Assistant Director of Clinical Support Services. Eligible pre-doc students can only assist
in FGP—whether for the proper Endo rotation or via the Student Dental Assisting Program; for
more information on the latter, please see Assistant Director of Clinical Support Services.
TP Floor Plan
The TP hours of operation are from 8am-5pm, Monday through Friday. AGE students practicing
within the FGP must operate between 8:30am-5pm. Because of frequent variations in the
curriculum, careful attention must be paid to the weekly schedules. All schedules are subject to
change. Patients may not be treated at any time faculty supervisors are not present to
supervise the treatment; nor are patients allowed to be treated over the noon hour or after
5pm—when faculty supervisors are not present. This regulation is required by federal and
state accrediting agencies, and no exceptions will be allowed.
All patient care must be planned to assure completion during clinic hours. Whenever a student
knows in advance that s/he must be absent from a scheduled session, s/he must seek permission
from her/his Senior Tutor or AGE Program Director. Under no circumstances shall care be
provided beyond 5pm in TP or when there is no faculty supervising the procedure.
It is IMPERATIVE that appointments are placed into axiUm PRIOR to the patient
presenting at the front desk to the PSLs and being seated in an operatory! See more under
Section VIII: Appointments and Communication.
20
SECTION VII: FIVE-SESSION MODEL
Each year, ODE distributes a document entitled Teaching Practices Clinic Schedule AY 20xx-
20xx. This document shows the general outline for students’ clinical time for the 2nd floor, which
is guided by the five-session model. The five-session model guarantees (except in the rare cases
when there is an exam or another event happening on the clinic floor) that the five groups of
students who practice in TP (AGE Ortho, Perio, Prosth, and Pre-docs) are allotted at least five
opportunities per week to conduct patient care.
Exhibit 7 shows the current five-session model, per the Teaching Practices Clinic Schedule.
July – December
MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

DMD-40 CHAIRS AGE-30 CHAIRS Beginning 9/13/17: AGE-30 CHAIRS AGE-30 CHAIRS
30-YR 3 10-Perio AGE-24 CHAIRS 10-Perio 10-Perio
8:00- 10-YR 4-CCR/ICR 10-Prosth 8-Perio 10-Prosth 10-Prosth
12:00 10-Ortho 8-Prosth 10-Ortho 10-Ortho
DMD-10 CHAIRS 8-Ortho DMD-10 CHAIRS DMD-10 CHAIRS
10-YR 4-CCR/ICR DMD-16 CHAIRS 10-YR 4-CCR/ICR 10-YR 4-CCR/ICR
(cross coverage-Yr 16-YRS 1 & 4 –
3/4) (cross coverage CCR/ICR/FCC (cross coverage (cross coverage
DMD-AGE) (cross coverage DMD-AGE) DMD-AGE)
DMD-AGE)
AGE-30 CHAIRS DMD-40 CHAIRS AG-30 CHAIRS DMD-40 CHAIRS AGE-30 CHAIRS
10-Perio 30-YR 3 10-Perio 30-YR 3 10-Perio
1:00-5:00 10-Prosth 10-YR 4-CCR/ICR 10-Prosth 10-YR 4-CCR/ICR 10-Prosth
10-Ortho 10-Ortho 10-Ortho
DMD-10 CHAIRS 10-YR 4 CCR/ICR 10-YR 4-CCR/ICR
10-YR 4-CCR/ICR (cross coverage
(cross coverage-Yr DMD-AGE) (cross coverage-Yr
(cross coverage 3/4) EVERY OTHER 3/4)
DMD-AGE) WEEK-DMD
Pediatrics-32
(yr 3/4) and 8-ortho
Sep 6, 20 - Oct 4, 18
- Nov 1, 15, 29 - Dec
6, 13
21
January - May

DMD-40 CHAIRS AGE-30 CHAIRS AGE-24 CHAIRS DMD-40 CHAIRS AG-30 CHAIRS
30-YR 3 10-Perio 8-Perio 30-YR 3 10-Perio
8:00- 10-YR 4 CCR/ICR 10-Prosth 8-Prosth 10-YR 4 CCR/ICR 10-Prosth
12:00 10-Ortho 8-Ortho 10-Ortho
DMD-10 CHAIRS DMD-16 CHAIRS DMD-10 CHAIRS
10-YR 4 CCR/ICR 16-YRS 1 & 4 – 10-YR 4 CCR/ICR
(cross coverage-Yr CCR/ICR/FCC (cross coverage-Yr
3/4) (cross coverage (cross coverage 3/4) (cross coverage
DMD-AGE) DMD-AGE) DMD-AG)
AG-30 CHAIRS DMD-40 CHAIRS AG-30 CHAIRS DMD-40 CHAIRS AG-30 CHAIRS
10-Perio 30-YR 3 10-Perio 30-YR 3 10-Perio
1:00-5:00 10-Prosth 10-YR 4 CCR/ICR 10-Prosth 10-YR 4 CCR/ICR 10-Prosth
10-Ortho 10-Ortho 10-Ortho
DMD-10 CHAIRS 10-YR 4 CCR/ICR 10-YR 4 CCR/ICR
10-YR 4 CCR/ICR (cross coverage
(cross coverage-Yr DMD-AGE) (cross coverage-Yr (cross coverage
(cross coverage 3/4) 3/4) DMD-AG)
DMD-AG) EVERY OTHER
WEEK-DMD
Pediatrics -32(yr 3/4)
and 8-ortho
Jan 10, 17, 31 - Feb
1, 15 - Mar 7, ?? -
Apr 4, 18 - May 2,
16, 30
June – July
DMD-40 CHAIRS AG-40 CHAIRS Through 6/21/17: DMD-40 AG-30 CHAIRS
32-YR 3 13-Perio AGE-24 CHAIRS CHAIRS 10-Perio
8:00- 8-OPEN 13-Prosth 8-Perio 32-YR 3 10-Prosth
12:00 14-Ortho 8-Prosth 8-PERIO 10-Ortho
8-Ortho 10-YR 3 DMD
DMD-16 CHAIRS (cross coverage DMD-
16-YRS 1 & 3 – AGE)
CCR/ICR/FCC
(cross coverage
DMD-AGE)
AG-40 CHAIRS DMD-40 CHAIRS AG-30 CHAIRS DMD-40 AG-30 CHAIRS
13-Perio 32-YR 3 10-Perio CHAIRS 10-Perio
1:00- 13-Prosth 8-OPEN 10-Prosth 32-YR 3 10-Prosth
5:00 14-Ortho 10-Ortho 8-PROSTH 10-Ortho
___________________ 10-YR 3 DMD 10-YR 3 DMD
6/18/18 – 7/13/18 (cross coverage (cross coverage DMD-
16 CHAIRS– YR 2 DMD-AGE) AGE)
DMD EVERY OTHER ___________________
WEEK-DMD 6/18/18 – 7/13/18
Pediatrics -32 (yr 3) 16 CHAIRS – YR 2
and 8-Ortho DMD
(cross coverage
DMD-AG) June 6,
20
22
AGE Endo and Implant (in FGP) practice Monday through Friday.
These two groups, who practice in FGP, are not impacted by the five-session model;
instead:
Endo uses select and assigned chairs for the duration of rotation; any changes should be
communicated to the Assistant Director of Clinical Support Services.
There is daily emergency coverage for emergency patients ONLY. These appointments
should not be scheduled any more than 24-48 hours in advance. If an Endo student gets a
call after hours, s/he should email the Assistant Director of Clinical Support Services
with patient name and time of appointment so that this can be entered into axiUm.
Implant also uses assigned chairs, and if all of these are occupied, s/he should see the
Assistant Director of Clinical Support Services and not simply book another chair.
Other AGE Programs are allowed to use any other chairs that are available in FGP.
Any requests (from FGP providers or student providers) for an FGP Oral Surgery Suite
(OR) must be made directly with the Assistant Director of Clinical Support Services.
23
SECTION VIII: APPOINTMENTS AND COMMUNICATION
Appointments and ongoing communication keep everyone on track at HDC! All providers
(students and faculty) and staff tasked with scheduling must book/schedule patient appointments
in the Scheduler Module of axiUm. For specifics on how to do this, please defer to your axiUm
trainer, as well as the information below:
1. ALL STUDENTS MUST:
o PLAN their time efficiently and accurately reserve a chair and book an appointment
in axiUm with as much advance notice as possible (no more than seven mos. in
advance). Moreover, a booked chair with no patient appointment disappears from the
axiUm schedule 72 hours prior to the day the chair is booked for. E.g. One books a
chair on September 30th for October 25th. S/he forgets to schedule in the patient. The
once “reserved” chair goes away on October 22nd and is free for another to use.
o ASK a manager before booking her/himself into another group’s chair. If a pre-doc or
AGE student sees a conflict in axiUm with chair utilization and availability, then s/he
should see the Assistant Director of Clinical Support Services.
o UNDERSTAND our EasyMarkit auto-phone confirmation system will notify the
patient 48 hours prior. E.g. If one books the chair from 8am-12pm but tells the patient
to come at 9am, the patient will get a reminder for 8am, which can cause needless
confusion. Also, if one books an appointment appropriately, but in less than a 48-hour
window, the patient will not receive an auto-phone confirmation. The student, using
the available phone banks near ODE offices, should call the patient directly to remind
them.
o COMMUNICATE well with patients, using all available (and appropriate!)
resources. Students should state their full name when they schedule their patients for
an appointment. This allows patients to ask for the appropriate student when the
patient checks in at the front desk with the PSLs. If a patient has no telephone,
students can ask the PSLs for the HDC appointment postal cards for mailing out
appointment notices and reminders to patients. This should include the date and time
of the appointment, plus the names of the patient and student, and must be mailed in a
sealed envelope.
Exhibit 8:
24
If an appointment postal card is sent, sufficient advance notice must be provided to
permit mail delivery and any schedule adjustments required on the part of the patient.
Students must also record the mailing date information in the patient's chart (e.g. in
an axiUm Tx history note—“On 12/15/17, sent appointment postal card reminder RE
appointment on 1/10/18”).
o BOOK for the appropriate patient (always double check that you have the right
patient and correct eight-digit record number) as well as the appointment duration, as
HDC is a shared space with other providers. TP appointments should generally be
scheduled for: 8-10am; 10am-12pm; 1-3pm; 3-5pm or for the entire four hour block,
depending on the type of procedure. However, there are times when a shorter
appointment, e.g. 30 minutes or one hour are warranted. FGP appointments are
booked (beginning at 8:30am, as opposed to 8am—like in TP) for a variety of
timeframes, pending the procedure. Under no circumstances can an appointment be
booked from 12-1pm in either TP or FGP! And for TP (Monday-Friday) and for FGP
(with the exception of Mondays and Wednesdays), appointments cannot be booked
past 5pm! Lastly, there is never clinic over the weekend, unless it is a pre-approved
event like Give Kids a Smile (GKAS).
o UTILIZE ENTER/PHASE/SEQUENCE COMPONENT OF axiUm. Specific
steps will be covered in all axiUm training, albeit the key steps (with the phased and
sequenced areas in a red box) are available in Exhibit 9 below:
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o And finally…COMPLY. Failure to do so may result in delays and other operational
impacts, especially if rescheduling of patients is required.
2. FGP PROVIDERS, SPECIFICALLY:

o CAN BOOK patients directly into axiUm, as well as REQUEST an appointment and
have the PSLs confirm the appointment at the front desk.
o SHOULD WORK CLOSELY WITH THE Assistant Director of Clinical
Support Services (who may involve other HDC staff to help) to ensure adequate
communication to and from patients.
3. ALL PROVIDERS MUST:

o FAMILARIZE themselves (ahead of time, if possible) with patient needs and
anticipate questions.
o ENSURE her/himself and the patients are comfortable for the duration of treatment
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and allot reasonable breaks when necessary.
o WORK CLOSELY OTHER PROVIDERS involved in the treatment of the same
patient, as sometimes, there can be confusion; moreover, this helps to effectively and
efficiently address comprehensive care needs. Students, specifically, should work
with their Senior Tutor or AGE Program Director if help is needed and or if there is a
concern about the overall workload.
4. ALL PSLs AND TELEPHONE SPECIALISTS MUST:
o CONFIRM patient demographics (i.e. name, telephone, address) every time a patient
calls or presents at the front desk. This is imperative, especially as we utilize
automated systems AND will soon use an online Patient Portal that feeds to and from
axiUm—where we securely store patient demographics and clinical data.
All in all, attention to scheduling at the time of Treatment Planning is paramount to

successful dental care!
TITLE IX AND PATIENT COMMUNICATION
In an effort to protect student privacy as DHCWs, ODE, in accordance with the Title IX
policy and HDC management, states that students are prohibited from communicating with
patients via personal cell phone numbers, personal email addresses, or google
voice. Accordingly, student’s personal cell phone number and email address will not be printed
on student business cards.
In summary:
o Students are not to communicate with their patients directly by personal cell phone.
o Students are not to give out their cell phone number or personal email address.
o Students must use their HSDM email and/or the Patient Portal/axiUm email system
for any needed written correspondence.
o Rescheduling of appointments will be possible through the PSLs at the front desk and
the Phone Specialists ONLY WHEN treatments have been entered, phased, and
sequenced in axiUm.
o Excessive or inappropriate emailing from patients to providers or staff should be
reported to Senior Tutor or AGE Program Director AND clinic management. This
may result in the patient losing privileges in the Patient Portal.
In order to facilitate more options for patient communication, a student phone bank (with four
phones) was installed in the lobby outside of ODE near the four computers. The phone sets are
single line phones with no call waiting, caller ID, or voice mail. The phone numbers (as an FYI)
are: 617-432-5070; 617-432-5071; 617-432-5072; 617-432-5073. Calling is limited to
University-wide, local, and Massachusetts.
If students need to contact patients living out of state, s/he should work with a PSL to assist with
scheduling these patients. Students are strongly encouraged to set up their patient’s next
appointment before they leave the chair.
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LATE, CANCELLED, AND FAIL-TO-SHOW AT APPOINTMENTS
HDC strives to provide continuous and comprehensive care to our patients. We believe that in
order to provide the highest quality dental care to our patients, timeliness of treatment is
absolutely essential. The cooperation of each patient is imperative if we are to fulfill our
responsibility as a clinic.
Whether a patient is late, cancels (whether in advance of 24 hour or within 24 hours), or fails-to-
show at an appointment, all instances must be documented in axiUm (e.g. if a student is made
aware, then s/he records in Tx history note—“On 12/18/17, patient late 15 mins.; on 12/23/17,
patient cancelled w/i 24 hours; on 1/10/18, patient failed-to-show”; if staff is made aware, then
they should record a similar message in Contact Notes under the Patient Card). After three
instances of either of these situations, the provider must email Assistant Director of
Financial and Patient Services, and (if a student) cc her/his Senior Tutor or AGE Program
Director. The provider should request a warning letter to be sent and state the reason (steps
outlined below). This is why axiUm notes are important—to help document the history and back
up this request. In the case of the FGP Hygiene Team, s/he should work with the primary FGP
provider to determine how the case will be handled.
Only in rare cases, can a patient be immediately dismissed for their lack of cooperation and
behavior issues. In the case of a TP patient, this would be a joint decision by the Senior Tutor or
AGE Program Director and clinic management, and would never be the sole decision of a
student.
IN MOST CASES, however, there is a specific process that must be followed before further
action—such as a dismissal—would even occur.
The procedure is different for a patient who voluntarily/expresses directly that they are no longer
interested in treatment here (e.g. patient is moving out of state, or found another provider, or
cannot afford fees, or does not want to be treated, etc.). In that case, the does not send a Warning
Letter, but will send an Inactivation Letter upon hearing this from the provider, who, again, if a
student, must cc the Senior Tutor or AGE Program Director and Assistant Director of Financial
and Patient Services or Assistant Director of Clinical Support Services on the email request—so
that need-to- know parties are aware.
It is imperative that providers do not confuse “dismissal” and “inactivation” to mean the
same thing—and especially in front of the patient. Not all patients who are inactivated (after
30 days) were the result of a dismissal; but all patients who are dismissed will be inactivated
(after 30 days).
Exhibit 10 shows the workflows for the Warning, Dismissal, and Inactivation process.
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RESCHEDULING
When staff or students reschedule a patient by leaving a voice message (or sending an HDC
appointment postal card) with the time and date of the new/rescheduled appointment but did not
actually speak with the patient, they should assure that the patient actually confirms the
rescheduled appointment before this is put into the schedule. This will prevent the
impression that a patient failed-to-show, when in reality, the suggested time for the rescheduled
appointment was not suitable for the patient. The Phone Specialists or PSLs will assure that
when patients are rescheduled, the “cancelled” appointment is taken off the calendar.
Moreover, a staff member cancelling an appointment on behalf of a provider or a provider who

does this action her/himself, SHOULD always call the patient soon after to confirm a
cancellation. This could prevent future confusion.
PAGING SYSTEM
An intercom system is available to page DHCWs of HDC. DHCWs paged must respond
promptly to the PSLs at the front desk that is paging—whether TP or FGP. PSLs will page when
a phone call is described as an “emergency,”; if no response, a message will be taken and left for
the provider or staff member at the front desk. The PSLs will make the provider aware.
INTERPRETERS AND PATIENT VISITORS (IN THE OPERATORY)
Occasionally, an interpreter is needed at the beginning and end of the procedure. HDC furnishes
a service called LanguageLine. Tablets are available from either the Assistant Director of
Clinical Support Services, Assistant Director of Financial and Patient Services, and the Clinical
Applications Director.
Sometimes, a patient would like a visitor to accompany them into the operatory. The only
time this is acceptable is if the visitor is serving as a translator for treatment planning
purposes. Yet once the procedure commences, the visitor must return to the waiting area.
To ensure safety, privacy, and confidentiality to all our patients, only DHCWs are allowed in the
operatories. Adult patients cannot take their children into the operatory and must have arranged
for another appropriate means of supervision (e.g. family member or friend) for their children in
the waiting area. This also applies to our pediatric patients. Parents/guardians of our pediatric
patients can bring their child into the operatory if that eases transition, but are expected to return
to the waiting area while their child is being seen, unless the faculty provider or faculty
supervisor feels it would be in the best interest of the child to have a parent/guardian present
during the entire visit. It is expected that during routine orthodontic care, parents/guardians will
always wait in the waiting room. If a parent/guardian cannot abide by this policy and it is the
impression of the faculty provider or faculty supervisor that the child will do fine without their
presence in the operatory, the parent/guardian could be asked to seek care elsewhere.
In the case of deaf patients, requests for interpreter services should be made directly by the deaf
individual or a personal contact. However, the PSLs, once informed, can assist and initiate the
request by contacting the Massachusetts Commission for the Deaf and Hard of Hearing
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Interpreter/Communication Access Realtime Translation(CART) Referral Service at 617-740-
1600 and faxing a request, or by utilizing LanguageLine. Fax sheets for this are available in the
front desk areas.
PARKING FOR PATIENTS

1. General Parking
Patient Parking is available at the NRB Garage located at 77 Avenue Louis Pasteur, Monday-
Friday, 7am-8pm. Patients are required to stop at the NRB Garage Parking Attendant’s booth
to pick up a blue parking voucher. Upon checking out with the PSLs at HDC, payment for
parking will be collected. The PSLs will validate the blue parking voucher. The patient must
present the validated parking voucher to the NRB booth attendant to gain access out of the
NRB Garage. Cost of parking is $12.00 per visit, and effective July 1, 2017 will be $17. This
parking fee is for patients only. There are also other garages, including garages open 24
hours/seven days per week (like the 333, 350, and 375 Longwood Ave garages) where
patients may park for a fee:
• en.parkopedia.com/parking/188_longwood_avenue_boston_ma/
• http://www.masco.org/directions/lma-public-parking
• https://hms.harvard.edu/departments/campus-planning-and-facilities/campus-
operations/commuter-services-and-parking/parking/lma-public-parking
2. Designated Parking for Physically Challenged Patients
For patients who have a valid handicap sticker, only two handicap spaces are available,
therefore, it is imperative that advance reservations be made by notifying the PSLs.
Providers can also assist patients in making reservations and should notify the PSLs at the
time the appointment is made. When the patient arrives, they should pull up to the parking
kiosk located between 188 and 190 Longwood Ave. The Parking Attendant at the kiosk
assists the patient out of the vehicle. The attendant takes the vehicle to park, and the patient
walks to clinic. If a wheel chair is needed, the attendant calls Security, who will then dispatch
an available Security Officer, who will bring a wheelchair to the patient and direct them to
HDC. When the patient is ready to leave, the attendant retrieves the vehicle for them.
PATIENT PORTAL
In 2016, a new Patient Portal was launched at HDC. This opened up another avenue—a secure
internet portal, besides the current HSDM phone, HSDM email, or in-person mechanisms—for
faculty and students to communicate with patients. The portal interfaces with axiUm email.
Exhibit 10: Snapshot of Patient Portal Cards being distributed to patients.
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SECTION IX: PATIENT RECORDS (ARCHIVED PAPER CHARTS AND
DUPLICATION)
Patients can request their records via the following steps:

o Patient fully completes a Request to Inspect and/or Copy Health Records form (posted in
Appendix 1.2) that can be found online or available at the TP and FGP front desks. All
requests for records must be accompanied by this completed form– no exceptions!
o Records will be processed on a weekly basis. The timeframe is approximately14 days.
o If patient wants to communicate to the Business Office regarding this process, s/he can
email: clinical_affairs@hsdm.harvard.edu.
If a clinic manager or provider requests a patient record, s/he needs to email the Department
Coordinator for Clinical Affairs and Operations directly.
Once records are retrieved, the Department Coordinator for Clinical Affairs and
Operations will duplicate and send to the patient or loan the actual archived file (if it was
requested by a manager or an internal provider). In the case of the latter, the archived file
may never leave the BUILDING. Archived files must be returned to the Department
Coordinator for Clinical Affairs and Operations within three business days. Additionally, any
archived file not claimed within two business days will be returned to archives. Students are
allowed to make a duplicate copy of patient record for educational purposes only. It is the
student’s responsibility to comply with the Health Insurance Portability and Accountability Act
(HIPAA) regulations when de-identifying Protected Health Information (PHI) for copying.
Additionally, as the HSDM Student Handbook .
If an external provider requests a patient paper chart duplication, we require a referral from that
facility. An electronic referral is fine and can be sent to clinical_affairs@hsdm.harvard.edu.
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SECTION X: PATIENT REGISTRATION, FRONT DESK FORMS, AND
CONFIDENTIALITY
FGP WELCOME PACKET
FGP patients receive a welcome packet upon becoming a patient of HDC. This packet contains a
brochure, map, the Patient Rights and Responsibilities notice, and the required five forms to
complete: New Patient Info, Dental History, Medical History, Family History, and Medication
List. Additionally, at check-in, the new FGP patient review and signs: General Consent to
Examination, Financial Policy, Dental/Medical Coverage Notice and Disclaimer, aka 3rd party
insurance form, and the Notice of Privacy Practices (HIPAA).
NEW HDC PATIENT PROCESS and FORMS
There are multiple avenues for new patients to be scheduled:
1. Patient can call HDC main number 617-432-1434 and select #1 option for TP or #2
option for FGP. Telephone Specialists register and schedule appointment according to
age [Oral Diagnosis (OD) for 18+ or Pedo rotation for <18].
2. Patient, IF permitted by PSLs and security, are allowed up to the front desk so PSLs
can register and schedule a visit.
3. Patient can be referred by Community Health Centers (and then same as “1” & “2”).
4. Patient can be triaged to OD after Clinical Comprehensive Exam (CCE),
Commission on Dental Competency Assessments (CDCA), or Western Regional
Examining Board (WREB) screenings.
5. Self-Referrals are friends and family recruited by the provider.
a. They should call or come to the front desk PSLs to register patient. Information
required: Name, Address, Phone, and Date of Birth.
b. An account # will be issued.
c. If referral is from a pre-doc student, the student:
i. Will request the patient assignment from Pre-doc Clinical Curriculum
Coordinator (at least 48 hours prior to scheduled appointment).
ii. Will schedule patient for the New Patient Intake (NPI) rotation.
iii. AFTER NPI visit, will discuss case with her/his Senior Tutor for
acceptance into pre-doc care.
Upon arrival:
1. All patients MUST sign in on the clipboard at the front desks.

2. Patients are checked into axiUm by the PSLs.
3. All demographics are reviewed and updated (if necessary).
4. The patient must also review and sign four HDC forms, prior to being seated in the
operatory:
a. General Consent to Examination and Teaching Practices Information
b. Financial Policy
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c. Dental/Medical Coverage Notice and Disclaimer, aka 3rd party insurance form
d. Notice of Privacy Practices (HIPAA) (See Exhibit 9 for full text; this form also
posted in front desk area).
e. In TP specifically, there is one more form— Patient Authorization for Specific
Disclosure of Protected Health Information which is ONLY for AGE students
taking board exams and using patients.
5. Patient reads Patient Rights and Responsibilities notice.
6. Provider is paged over the intercom.
7. Patients are NEVER taken to the operatories until all of the above have been completed!
Exhibit 12: Notice of Privacy Policies (HIPAA) is provided to the patient and is signed; it is also
posted in the front desk area.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE

USED AND DISCLOSED AND HOW YOU MAY OBTAIN ACCESS TO THIS
INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. HARVARD SCHOOL OF DENTAL MEDICINE/HARVARD DENTAL CENTER

(“HSDM/HDC”) IS COMMITTED TO PROTECTING THE PRIVACY OF OUR
PATIENTS.
HSDM/HDC cares about you, our patients, and your privacy. We understand that health information
about you is personal, and protecting that information is important. We are required by law to maintain
the privacy of your health information (“Protected Health Information” or “PHI”) and to provide you
with this Notice of our legal duties and privacy practices with respect to your PHI, and to abide by the
terms of this Notice.
II. WHO WILL FOLLOW THIS NOTICE

This Notice applies to HSDM/HDC, all its departments, and offices. It applies to our employees,
students, residents, faculty, dentists, researchers, and volunteers who have access to PHI held by
HSDM/HDC.
III. USES AND DISCLOSURES WITHOUT YOUR WRITTEN CONSENT OR

AUTHORIZATION
In certain situations, which are described in Sections IV and V, we must obtain your written consent or
authorization in order to use and/or disclose your PHI. However, in certain cases certain uses and
disclosures are permitted without your consent or authorization. The following categories show the
different ways we may use and disclose your PHI without your written consent or authorization. For
each category, we give some examples, but not every use or disclosure in a category is listed.
A. Use for Treatment, Payment, and Health Care Operations. We may use (but not disclose to a
third party) your PHI in order to treat you, obtain payment for services provided to you, and conduct
our “health care operations” as generally described below:
Treatment. To provide treatment and other services to you, for example, to diagnose and treat your
dental condition. We may contact you to provide appointment reminders or information about
treatment alternatives or other health-related products and services provided by HSDM/HDC that may
be of interest to you.
Payment. To obtain payment from you, for example, to identify our claims for payment from your
insurance company, MassHealth, or other company or organization that arranges or pays the cost of
some or all of your dental care (“Your Payor”).
39
Health Care Operations. To internally administer, plan, and improve the quality and cost-effectiveness
of the care and customer service that we deliver to you. For example, we may use your PHI to evaluate
the quality of your care and the competence of our staff. We may also use your PHI to educate and
train our students and residents and to ensure HSDM/HDC and former HSDM/HDC personnel
continue to earn professional accreditation. In addition, your PHI may be disclosed for any peer
review or utilization review activities we undertake.
B. Disclosure to Relatives, Close Friends, and Other Caregivers. We may disclose your PHI,
other than Highly Confidential Information (described below in Section IV.B), to a family member,
other relative, a close personal friend, or any other person identified by you when you are present for,
or otherwise available prior to, the disclosure, and do not object to such disclosure after being given
the opportunity to do so. We may also disclose your health information to such person with your
verbal agreement or written consent.
If you are incapacitated or in an emergency circumstance, we may exercise our professional judgment
to determine whether a disclosure is in your best interest. If we disclose information to a family
member, other relative, or a close personal friend in such circumstances, we would disclose only
information that is directly
relevant to the person’s involvement with your health care or payment related to your health care. We
may also disclose PHI in order to notify (or assist in notifying) such persons of your location, general
condition, or death.
C. Use and Disclosure for Fundraising Activities. We may contact you to request a tax-deductible
contribution to support important activities of HSDM/HDC. In connection with any fundraising, we
may disclose to HSDM’s Development Office, an institutional foundation, demographic information about
you (e.g., your name, address, and phone number) and dates on which we provided dental care to you,
without your authorization. If you wish to make a tax-deductible contribution now or do not wish to
receive any fundraising requests in the future, you may contact our Privacy Officer at 617-432-6894.
D. Other Types of Disclosures
1. As Required by Law. We may disclose your PHI when required to do so by federal, state, or local
law.
2. Public Health Activities. As required by law, we may disclose your PHI for the following public
health activities and purposes: preventing or controlling disease, injury or disability; to report
reactions to medications or problems with products and services under the jurisdiction of the Food
and Drug Administration; and to report venereal disease to your fiancé(e), spouse, or parents or legal
guardian, if you are a minor.
3. Abuse, Neglect, or Domestic Violence. We may disclose your PHI and notify the appropriate
government authorities of a reasonable belief of abuse, neglect, or domestic violence. This includes
child abuse and neglect, elder abuse, disabled persons abuse, or rape or sexual assault.
4. Health Oversight Activities. We may disclose your PHI to a health oversight agency for oversight
activities authorized by law. This includes, but is not limited to: audits, investigations or inspections.
These activities are necessary for the government to monitor the health care system and certain
government programs.
5. Judicial and Administrative Proceedings. We may disclose your PHI in the course of a judicial or
administrative proceeding in response to a legal order or other lawful process.
6. Law Enforcement. We may release PHI to the police or other law enforcement official as required or
permitted by law or in compliance with a court order or a grand jury or administrative subpoena
accompanied by a court order.
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7. Coroners, Medical Examiners, and Funeral Directors. We may disclose your PHI to a coroner or
medical examiner for the purpose of identifying a deceased person, or other duties as authorized by
law. We may also release your PHI to a funeral director, consistent with applicable law, as necessary to
carry out their duties.
8. Research. We may use or disclose your PHI for research when a waiver of authorization is obtained
from our Institutional Review Board or from a Privacy Board; or when we use or disclose only a
HIPAA-defined limited data set with a data use agreement. We may also use your PHI as necessary to
identify you as a potential subject for a research study, but will not conduct research without proper
authorization from you or a waiver of authorization from an Institutional Review Board.
9. Tissue Procurement. We may disclose your PHI to organizations that facilitate tissue procurement,
banking or transplantation.
10. To Avert a Serious Threat to Health or Safety. We may use or disclose your PHI when necessary
to prevent a serious and imminent threat to the health or safety of you or the public. Any disclosure
would be to someone able to prevent or lessen the threat, including the target of the threat.
11. Military and Veterans. If you are a member of the armed forces, we may release your PHI as
required by military command authorities.
12. National Security. We may disclose your health information to authorized federal officials for the
conduct of lawful intelligence, counterintelligence, and other national security activities authorized by
the National Security Act.
13. Inmates. If you are an inmate of a correctional institution or under the custody of a law
enforcement official, we may release PHI for your health care and the
health and safety of other individuals.
14. Worker’s Compensation. We may release your PHI authorized by and to the extent necessary to
comply with laws relating to worker’s compensation or other similar programs, established by law, that
provide benefits for work-related injuries or illness without regard to fault, including without
limitation to your insurer and/or the Massachusetts Industrial Accident Board as required under laws
addressing work-related illnesses and injuries or workplace health surveillance.
IV. DISCLOSURES REQUIRING YOUR WRITTEN CONSENT
The following categories require your written consent before we may disclose your PHI:
A. Disclosures for Treatment, Payment, and Health Care Operations. With your written
consent, we may disclose your PHI in order to treat you, obtain payment for services provided to you,
and conduct our health care operations as detailed below:
Treatment. We may disclose your PHI to provide treatment and other services to you. For example, we
may disclose your information to other providers involved in your treatment.
Payment. We may disclose your PHI to obtain payment for services that we provide to you. For
example, we may disclose information to file claims and obtain payment from your insurance
company.
Health Care Operations. We may disclose your PHI for our health care operations. For example, we
may disclose information to other health care providers to conduct certain health care operations, such
as quality assessment and improvement activities and reviewing the quality and competence of health
care professionals. We may also disclose PHI to your other health care providers when such PHI is
required for them to treat you, receive payment for services they render to you, or conduct certain
health care operations, such as quality assessment and improvement activities, reviewing the quality
and competence of health care professionals, or for health care fraud and abuse detection or
compliance.
B. Disclosures of Your Highly Confidential Information. Federal and state law require special
privacy protections for certain Highly Confidential Information about you, including: (1) your
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HIV/AIDS status; (2) genetic testing information; (3) treatment or diagnosis of emancipated minors;
(4) venereal disease
information; and (5) research involving controlled substances. In order for us to disclose your highly
confidential information for a purpose related to treatment, payment, or health care operations, we
must obtain your separate, specific written consent unless we are otherwise permitted by law to make
such disclosure.
In addition, if you are an emancipated minor, certain information relating to your treatment or
diagnosis may be considered Highly Confidential Information and as a result will not be disclosed to
your parent or guardian without your consent. Your consent is not required, however, if a physician
reasonably believes your condition to be so serious that your life or limb is endangered. Under such
circumstances, we may notify your parents or legal guardian of the condition, and will inform you of
any such notification.
Please note that if you are a parent or legal guardian of an emancipated minor, certain portions of the
emancipated minor’s dental record (or, in certain instances, the entire dental record) may not be
accessible to you.
V. USES AND DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION
The following categories require your written authorization before we may use or disclose your PHI:
A. Use or Disclosure with Your Authorization. For any purpose other than those described above,
we may only use or disclose your PHI when you give us your written authorization. For example, you
will need to provide us your signed Authorization before we can send your PHI to either your own
attorney or to the attorney representing the other party in litigation in which you are involved (unless
the attorney has obtained a court order for such PHI).
B. Uses and Disclosures of Your Highly Confidential Information. In order for us to disclose
your Highly Confidential Information for a purpose other than treatment, payment, or health care
operations (for which your separate, specific consent is required), we must obtain your separate,
specific Authorization, unless we are otherwise permitted by law to make such disclosure.
C. Marketing Communications. We must obtain your written authorization prior to using your
PHI to send you any marketing materials (“Marketing Authorization”), except if the communication is
face-to-face or in the form of a promotional gift of nominal value provided by us. Prior authorization is
not required for us to contact you regarding case management or care coordination, information about
treatment alternatives, or other health-related products and services provided by HSDM/HDC that
may be of interest to you.
VI. YOUR INDIVIDUAL RIGHTS
A. Right to Request Restrictions. You have the right to request restrictions or limitations on our use
or disclosure of PHI for treatment, payment, or health care operations. You also have the right to request
a limit on PHI disclosed to persons involved in your health care or payment of your health care, such as a
family member or friend. While we will consider all requests, we are not required to agree to your
request. If we do agree, we will comply with your request unless the information is needed to provide you
with emergency care. All requests for restrictions must be made in writing to our Privacy Officer by
filling out the appropriate form.
B. Right to Receive Confidential Communications. You have the right to request to receive PHI
by alternative means or at an alternative location. For example, you can ask that we only contact you
by mail. All requests must be made in writing to our Privacy Officer by filling out the appropriate form.
We will accommodate all reasonable requests.
C. Right to Inspect and Copy Your Health Information. You have the right to access your dental
records and request a copy of your PHI. All requests for access must be made in writing to our Privacy
Officer by filling out the appropriate form. If you request a copy of the information, we may charge a
fee for the costs of copying and postage.
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D. Right to Revoke Your Authorization. You may revoke your Authorization, your Marketing
Authorization, or any written authorization obtained in connection with your Highly Confidential
Information except to the extent that we have taken action in reliance upon it, by delivering a written
revocation statement to the Privacy Officer identified below.
E. Right to Request an Amendment to Your Records. You have the right to request that we
amend PHI maintained in your dental file or billing record. All requests must be made in writing to
the Privacy Officer by filling out the appropriate form, in which you must specify the reasons
supporting your request. We will comply with your request unless the information was created by
another health care provider, the information is accurate and complete, or other special circumstances
apply.
F. Right to Receive an Accounting of Disclosures. You have the right to request an accounting of
certain disclosures of your PHI that were made by us any period of time prior to the date of your
request, provided such period does not exceed six years and did not occur prior to April 14, 2003. The
first list you request within a twelve-month period will be free. For additional lists during the same
twelve-month period, we may charge you for the cost of providing the list. We will notify you of the
cost involved, and you may choose to withdraw or modify your request before any costs are incurred.
G. Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice at any
time, even if you have agreed to receive this Notice electronically. To obtain a paper copy of this
Notice, please request one at the patient reception desk.
VII. CHANGES TO THIS NOTICE
HSDM/HDC reserves the right to change the terms of this Notice and to make the new Notice
provisions effective for all PHI that HSDM/HDC already has about you, as well as any information
HSDM/HDC receives in the future. If we change this Notice, we will post the revised Notice in waiting
areas at HSDM/HDC, and on
our website, www.harvarddentalcenter.harvard.edu. An updated copy may also be obtained at the
patient reception desk.
VIII. FURTHER INFORMATION; COMPLAINTS
If you desire further information about your privacy rights, are concerned that we have violated your
privacy rights, or disagree with a decision that we made about access to your PHI, you may contact
our Privacy Officer. You may also file a written complaint to the Director, Office for Civil Rights, US
Department of Health and Human Services. The fact that a complaint has been made will not
negatively impact your dental care, and HSDM/HDC will not take any kind of retaliatory action
against you.
For Further Information, Please Contact:
Privacy Officer, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115 •
Telephone Number: 617-432-6894
IX. EFFECTIVE DATE OF THIS NOTICE
April 1, 2014
Exhibit 13: Patient Rights and Responsibilities notice is provided to the patient; it is also posted
in the front desk area.
Patient Rights and Responsibilities
At the Harvard Dental Center of the Harvard School of Dental Medicine, we are committed to
providing safe dental care and to treating each patient with dignity, compassion, and respect.
We recognize that a professional relationship based on confidentiality and trust between the
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dentist/students/providers/hygienists and the patient is essential for the provision of quality
oral health care. The following summary of Rights and Responsibilities serves as a framework
for successful care.
Patient Rights
• The patient has the right to receive care in a safe setting, free from any form of
abuse or harassment.
• The patient has the right to treatment that meets the standard of care in the
profession.
• The patient has the right to every consideration of privacy concerning his/her own
oral health care program. Case discussion, consultation, examination, and
treatment are confidential and shall be conducted discreetly. Those not directly
involved in the patient’s care must have permission of the patient to be present.
• The patient has the right to receive the information necessary to give an informed
consent prior to the start of any procedure/treatment. Except in emergencies, such
information for informed consent should include but not necessarily be limited to
the specific procedure/treatment, name and qualifications of the
dentist/students/providers/hygienists, significant risks (if any), probable duration
of incapacitation, estimated costs, and alternative treatments (if any).
• The patient has the right to refuse treatment and be informed of the oral health
consequences of such action.
• The patient has the right to obtain from the dentist/students/providers/hygienists
complete, current information concerning diagnosis, treatment, and prognosis in
terms that the patient can reasonably be expected to understand. When it is
deemed not professionally advisable to give such information to the patient, it must
be made available to a family member or appropriate person on behalf of the
patient.
• The patient has the right to obtain from a person designated by the Practice a copy
of any rules or regulations of the facility that apply to his/her conduct as a patient.
• The patient has the right to expect that all records and communications pertaining
to the patient’s dental care and financial information are treated as confidential.
• The patient has the right to emergency care as needed.
• Once accepted in the Practice, the patient has the right to reasonable, continuing
care.
• Once treated, the patient has the right to expect that the Practice will provide
instructions regarding continuing health care requirements following discharge.
• The patient has the right to decide to participate, or refuse to participate, as a
subject in a research project. The patient’s decision will not affect his/her access to
continuing dental care at the Harvard Dental Center. Agreement to participate in a
research project must be in writing.
• The patient has the right to request an itemized bill, and to examine it, and receive
an explanation of it, regardless of the source of payment for services rendered or
his/her conduct as a patient.
Patient Responsibilities
1. The patient is responsible for keeping appointments, and if unable to do so, to notify the
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Harvard Dental Center reasonably in advance.
2. The patient shall recognize and respect the rights of other patients, families, and staff.
3. The patient shall provide to the best of his/her knowledge accurate and complete information
regarding his/her present complaints, past illnesses, hospitalizations, medications, and other
information pertaining to his/her health. The patient also has the responsibility of reporting
unexpected changes in his/her condition to the responsible dentist/students/
providers/hygienists.
4. The patient is responsible for following instructions given by the dentist/students/
providers/hygienists, including the plan for continuing health care following discharge.
5. The patient should expect the Harvard Dental Center to provide only those services that the
dentist/students/providers/hygienists deem appropriate.
6. The patient is responsible for his/her actions if the patient refuses treatment.
7. The patient is responsible for prompt fulfillment of financial obligations.
The patient is encouraged to ask questions about any of these rights or responsibilities. Concerns may
be brought to the attention of the Harvard Dental Center at 617-432-1434 or, if further attention is
needed, the Compliance and Privacy Officer at 617-432-6894.
CONFIDENTIALITY
1. Purpose
The purpose of this confidentiality policy is:
• to formalize an ethical standard that will protect the privacy of all interactions and
records thereof for all patients of HSDM,
• to ensure that the patient has confidence that this will be so, and
• to fulfill ethical, legal, and regulatory requirements.
2. Principles
The policy reinforces state, federal and accrediting agencies’ requirements, which state
that patient information must be kept private, confidential, and secure. It shall apply to all
faculty, students, students and employees, and to all persons who in any way serve the
patients of HSDM. HSDM policies may occasionally be overridden by legal mandates
requiring the production of confidential information.
3. Definitions
Health Information: Oral, written, printed, or electronically stored information about a
patient’s medical and dental condition, including also relevant demographic,
psychosocial, or behavioral information.
Patient Record: The patient record is the means of storing original patient information
and is intended to provide the who, what, when, where, how, and why of care provided.
Extra-sensitive Information: Any type of information which a reasonable person would

consider to be particularly private or embarrassing if it were disclosed without his or her
knowledge is designated as extra-sensitive. Extra-sensitive information includes
information about:
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o Sexually Transmitted Diseases
o Sexual Practices and Orientation
o HIV Status and AIDS-related information
o Substance Abuse (42 USCS S. 4582)
o Emotional or Mental Health Problems
o Sexual Assault
o Information reported by an individual about family members or other persons
Confidentiality: A patient’s right to control access to and disclosure of private

information entrusted to her/his provider and/or supervising faculty.
Privacy: A patient’s right to have all records and information pertaining to her or his
health care treated as confidential.
Data Security: Protection of data from accidental or unauthorized access, disclosure, or

modification.
Disclosure of Information: Release of confidential patient/employee information to

another person or organization, regardless of whether the disclosure is written or oral, and
regardless of whether the disclosure was made intentionally or unintentionally.
Patient Legal Representative: shall be defined as follows:

a) For incompetent patients, the representative who shall provide a corroborating court
order;
b) For deceased patients, the executor or administrator of the estate with proof, or next
of kin with a court order, or the attorney for the executor or administrator;
c) For minors, the parent or legal guardian. A non-custodial parent shall be equally
entitled to the child’s information. Any medical information concerning a minor shall
be reviewed beforehand to determine that the record contains information pertaining
only to the child. Persons under 18 years of age shall be considered minors unless
they meet the criteria of emancipated minors (see below); and
d) Patient’s attorney, with written authorization.
Emancipated Minors: Persons who are:

• Married, widowed, or divorced;
• Parent or pregnant;
• Members of the armed forces;
• Living apart from parents and managing own affairs; or
• Suffering from a condition deemed to warrant extraordinary protection such as extra-
sensitive information; and/or
• Any additional, or different, criteria for emancipated minor adopted by the
Massachusetts legislature or the Massachusetts Appeals or Supreme Judicial Court.
A Harvard student under the age of 18 who does not meet the above criteria of emancipation
shall be considered to be emancipated in most non-urgent treatment, at the discretion of the
46
clinician and of the HSDM administration, as appropriate.
4. HSDM Policy
• All staff, faculty, students and students having access to patient records and patient
information are committed to protecting the patient’s right to privacy and
safeguarding the original clinical information contained in their medical record.
• All staff, faculty, students and students having access to patient records and
information may exercise this access only on a need-to-know basis.
• Patients should feel comfortable at all times to give accurate and personal information
about them to receive appropriate health care, relying on the knowledge that this
information will remain confidential within HSDM.
• Confidential patient information may be disclosed to others only as necessary to
perform patient care, teaching and approved research activities, on a need-to-know
basis, and in compliance with written HSDM policy and in accordance with all
applicable legal, accrediting and regulatory agency requirements.
• Details of the patient record may not be released to anyone outside of HDC and
HSDM without a Request to Inspect and/or Copy Health Records form signed by the
patient or her/his legal guardian.
• Failure to maintain confidentiality of patient information may be cause for immediate
termination of employment, or suspension of clinical privileges.
• Personnel, payroll, insurance, and demographic information such as address and date
of birth are also considered to be confidential. This information is covered by the
same rules pertaining to health information.
5. Procedural Matters
Ownership of the Patient Record. The patient’s electronic health record (EHR) is the
property of the HSDM and may be removed from its jurisdiction and safekeeping only in
accordance with a court order or subpoena duces tecum, or by statute or specific written
authorization of Administration, i.e., for review by its general counsel. All retired paper
records are kept off-site in accordance with the DPH and University Policy and Procedures.
Any electronic or paper record shall be released only on a need-to-know basis to authorized
students, students, faculty, staff, or authorized outside requesters. The patient has a right to
access her or his patient record, but it may be in the best interest of the patient to have her or
his provider available for discussion and interpretation of data and reports.
HSDM complies with the regulations of the HIPAA, effective April 14, 2003. A copy of
HSDM’s Notice of Privacy Practices is given to all patients of record at the time of appointment.
All students, students, faculty and staff must complete annual training and agree to abide by the
policy.
Disclosing Information. All requests for release of health and dental information to persons,
institutions, and/or agencies of HSDM should be referred to the Office of Clinical Affairs. A
completed Patient Authorization for Specific Disclosure of Protected Health Information (posted
in Appendix 1.3) must be properly signed (by the patient or a legal guardian, executor or an
appropriate court order) and included with a payment for release of all information except:
• As required by law,
47
• For dental care evaluation, quality assurance or risk management,
• For official survey for school compliance with accreditation, regulatory, and licensing
standards,
• For approved research and education. Medical and dental information used for research and
education must be made impersonal before dissemination, unless the patient voluntarily and
consents by writing to the use of her or his identity. Whenever identifiable medical or dental
information is used in research, patient privacy and confidentiality shall be protected and
further disclosure of information shall be prohibited.
• For inspection by any authorized representative of the DPH, Division of Health Facilities.
(See Licensure Rules and Regulations, 105 CMR 140.110, DPH).
• In some cases after receipt of a court order or a subpoena duces tecum. When a medical or
dental record is subpoenaed, the Assistant Dean for Clinical Affairs and Special Projects or
designee will release a copy to the court after a review by Harvard University’s Office of
General Counsel. The patient will be notified (where possible). However, sensitive
information shall be released only upon receipt of a properly executed court order and after
the judge has been notified. A receipt must be procured and filed in the original copy of the
medical record.
• For review by attorneys or patient advocates/patient representatives for HSDM concerning a
patient complaint or legal claim.
• For review by the Medical Examiner concerning investigation into a suspicious death.
• For disclosure to a third-party reimburser in the ordinary course of determining eligibility for
or entitlement to benefits.
• In connection with any peer review or utilization review procedures applied and implemented
in good faith.
• For reporting suspected child abuse/neglect. Chapter 119, section 51-A of Massachusetts
General Laws mandates the Department of Social Services to receive reports of possible
abuse or neglect by mandated reporters.
According to the law, the following professionals are mandated reporters:

o physicians, medical interns, hospital personnel engaged in the examination, care or
treatment of persons,
o medical examiners,
o psychologists,
o emergency medical technicians,
o dentists,
o nurses,
o osteopaths,
o chiropractors,
o public or private school teachers,
o educational administrators,
o guidance or family counselors,
o day care workers,
o probation officers,
o clerks/magistrates of district courts,
o social workers,
o firefighters,
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o police officers.
All students and faculty should notify the Office of Clinic Affairs if abuse/neglect is
suspected.
The Authorization to Use and Disclose Protected Health Information form shall include the
following information: HDC’s name and address; patient’s name and date of birth; the type of
information to be released and to whom; applicable dates of treatment; the signature of the
patient or her or his legal representative; and the date on which the authorization was signed for
photocopies for a set of written records and duplication of dental x-ray films and models.
Information will be released only upon presentation of identification and collection of payment.
In case of doubt as to the validity of the release, the Business and Financial Coordinator will be
consulted. Authorization to Use and Disclose Protected Health Information shall be held valid
only once, only for the dates requested, and for a period of 90 days from the date of signing.
HDC does not accept a blanket release from non-health care providers.
Any disclosure of information must be traceable for both electronic and paper records and logged
in the patient record.
Patients have the right to review the information requested prior to any disclosure.
Respecting Patient’s Right to Privacy. Every discussion and consultation by HSDM staff about
patients shall be conducted in a discreet and confidential manner. Respect and common courtesy
shall be extended to all patients. When faculty, students, students, or staff interview or examine
patients, every effort shall be made to afford the patient with reasonable audio and visual
privacy.
Patients have the right to know what role an observer may have in their care and to request that
an observer other than a supervising faculty member leave.
Personal or medical details of a patient’s condition or treatment shall not be casually

disclosed to others nor shall such discussions be conducted in public areas such as
elevators, lobbies, cafeterias, or other building locations that lack privacy. Detailed clinical
information shall not be left on an answering machine or voice mail. Information contained in a
medical or dental record must not be verbally communicated to anyone outside of the HDC,
other than to authorized individuals.
Facsimile (Fax) Transmission. Facsimile transmission (faxing) of certain types of information

shall be restricted due to its extra-sensitive nature. Faculty, staff, or students who transmit via fax
shall be responsible for ascertaining that their receiving machine is the right number and is in a
secure location, and that the confidentiality of the material is preserved to the best of their ability.
Fax cover sheets should contain wording, along the lines of:
49
“The document accompanying this fax transmission contains confidential patient
information belonging to the sender that is legally privileged. This information is intended
only for the use of the individual (or entity) named above. The authorized recipient of this
patient information is prohibited from disclosing the information to any other party. If you
have received this transmission in error, please notify the sender immediately and arrange
for the return of these documents.”
Extra-sensitive information (sexually transmitted diseases, sexual practices and gender

preferences, HIV status and AIDS-related information, substance abuse, emotional and mental
health problems) must not be faxed or reproduced except in cases of medical emergency and
then only with the approval of the Medical Director, Assistant Dean for Clinical Affairs and
Special Projects or designee. The release of extra-sensitive information requires a specific
request and separate signature. Be sure the correct number and receiving fax machine is in a
secure location.
All fax machines should be out of public access. When receiving faxed patient information,
immediately remove the fax transmission from the fax machine and deliver it to the
recipient. Manage patient information received via fax as confidential in accordance with policy,
destroy all patient information faxed in error, and immediately inform the sender of any
information received in error.
Physical Security of Off-Site Paper Records. Areas used for storage of inactive records shall
be secured against unauthorized access at all times. Contracts with off-site storage companies
shall specify measures taken to ensure security. Contracts with disposal companies for
destruction of confidential materials shall have a Business Associate Agreement on file with the
Office of Clinical Affairs. Only authorized persons shall have access to “off-site” record storage
areas.
Computer Use. Your password must not be written down where others can find and/or use it.
Always log off the computer when leaving. Avoid comments in patient related message that are
not relevant for patient needs and care. Never make any comment on extra-sensitive information
in an email or a patient’s EHR.
Patient Authorization for Specific Disclosure of PHI for Board Exams.

HDC and/or the HSDM (each individually, and jointly, “Harvard”) is able to disclose certain PHI
about patients to any Harvard dental student or graduate for the exclusive use of a Board
examination, (e.g., the American Board of Orthodontics, the American Board of Periodontology,
the American Board of Endodontics, the American Board of Oral Implantology /Implant
Dentistry and/or the American Board of Prosthodontics) (each, the “Specialty Board”). In order
to provide this information the patient must have a Patient Authorization for Specific Disclosure
of Protected Health Information for Specialty Exams on file in the EHR. The consent will expire
five years from the date of signature by the patient. Additionally, students/students must also
sign a Statement of Confidentiality and will be held responsible for full compliance with the
policy.
Faculty, Students, and Staff Conduct. Faculty, students, and staff with access to patient
information may obtain only information that is necessary for job performance and for which
50
they are privileged to view. The same confidentiality rules apply to all information formats–oral,
written, and electronic. Accessing any information other than that required to do your job is a
violation of the HSDM Statement of Confidentiality, even if you do not tell anyone else.
Accessing data must not occur simply to satisfy a curiosity. It is unacceptable to look up data,
such as a friend’s birthday, address or telephone number. View only what is required for your
job. Respect patient privacy and always identify yourself when addressing a patient.
HIPAA Policies
HIPAA’s privacy and security rules require that the workforce maintain patient confidentiality,
adhere to the commitments stated in our HSDM/HDC Notice of Privacy Practices (discussed
above), and follow our privacy and security policies and procedures.
All of the workforce will be required to complete mandatory HIPAA training as well as sign
annually (via PeopleSoft) an acknowledgement of understanding of HSDM/HDC’s policies and
procedures related to HIPAA.
The HSDM Intranet contains more information on HIPAA requirements. One of the five
required training modules covers HIPAA Overview, Security, and Sanctions. For a list of all five
trainings, refer to policy on Annually Required Training (posted in Appendix 1.3).
Failure to comply with all relevant HIPAA regulations and HSDM/HDC policies and procedures
will result in sanctions as appropriate to the severity of the violation.
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SECTION XI: WORKFORCE POLICIES
ATTENDANCE
Regular attendance is crucial for a successful clinic team, as well as for individual performance.
All HDC staff and DHCWs are expected to be in attendance when assigned to work in HDC. If
ill:
• Staff must immediately report absences to her/his clinic manager. If a staff
member is out sick for three or more days, s/he must present a doctor’s note (which will
be housed in HR) in order to return to work.
• Student providers must immediately report absences to her/his Senior Tutor or AGE
Program Director and ODE at 617-432-1447. Students must also notify the patients
affected by their absence and the PSLs, should s/he need help with rescheduling, with as
much advance notice as possible.
• Faculty providers must immediately report absences to the Department Chair, the
Assistant Director of Clinical Support Services, the Director of Clinical Operations, and
the PSL Coordinator.
Staff are also required to refer to the HDC Paid-Time Off policy for absence request information,
and consult with their clinic manager as needed.
If a student is assigned to HDC and (for any number of reasons) does not have a scheduled
patient, s/he is expected to remain at HDC and assist/observe fellow students. After checking
with the appropriate faculty supervisors and her/his Senior Tutor or AGE Program Director, and
with permission, the student may work in the basement labs, at the library, or on a research
project. If a student needs to be absent from HDC for an extended period of time, s/he must
inform ODE and HDC management.
DELIVERED MAIL AND EMAIL
Not all HDC DHCWs and staff have mailboxes, and hence, will receive mail directly from a staff
member from the Office of Administration and Finance. Those who do have mailboxes,
however, should check their mailboxes frequently. These are located in FGP. Mailboxes for pre-
doc students are located on the basement level in B024. These boxes are the means of
communication with the students by all departments and must be checked and emptied regularly.
Mailboxes for AGE students and part-time clinical faculty are designated by each department.
HSDM is not responsible for personal mail that is sent to the school.
Some packages will be kept with the Lab Coordinators (Room 009), and they will notify you.
HSDM and axiUm emails are used as a means of communication by most members of the HDC
community. They should be checked daily for important messages. If there is any issue with
HSDM email, please see:
o ODE—for students
o HR & IT—for staff and faculty
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If any issue with axiUm email, please see IT.
IT TICKET SYSTEM
In order for HDC to help DHCWs and other staff with technical issues, everyone must
understand and follow the school and clinic polices for “logging a ticket”, which starts by
sending an email to hsdm_support@hsdm.harvard.edu.
More information on other IT polices can be found at the HSDM Intranet under the IT section.
DENTAL CARE FOR HSDM STUDENTS
Emergency dental care is available for all HSDM students and can be arranged by dialing the
main number (617-432-1434, extension #1). For all non-emergency dental care, students must
follow all HSDM policies for patients.
HSDM students may also elect to be treated in the FGP, using their dental insurance and/or
paying the regularly associated fees.
Absence from any scheduled educational activity for any dental treatment (whether a student is a
patient of TP or FGP) is not permitted, except in the case of an emergency. In the case where
students are FGP patients, and since the FGP has evening hours, there should be ample
opportunity for students to obtain dental care without having to missing classes.
Financial information, including discount procedures for students is described in pages 120-125.
DENTAL CARE FOR HDC EMPLOYEES AND FAMILIES OF HSDM STUDENTS AND
EMPLOYEES
For all dental care, all patients must be registered in axiUm. Emergency dental care is available
for all employees. Patient acceptance for treatment is the same as with other patients: It depends
on our anticipated capacity to fulfill the patient's needs at HDC.
HSDM staff may elect to be treated in the TP, where services are offered at a reduced rate
compared to FGP; all fees are charged at the regular rate—as is customary with all other
patients. As an FYI, appointments with a General Practice Resident (GPR) student may be
made at the front desk with the PSLs. For appointments with a student, a staff member must
contact the AGE Program Director for appropriate assignment. It is highly recommended that the
patient should not be assigned to a dentist or student with whom s/he is closely associated.
The regularly associated fees will be charged for all services provided to the employee in the
FGP.
STUDENT PATIENT REVIEWS FOR GRADUATION
Several times per year, each pre-doc and AGE student will be required to meet with her/his
53
Senior Tutor or AGE Program Director to discuss the status of every patient assigned to her/him,
as well as to review each assigned patient record. Before graduating, and as part of the
Graduation Check-Out Form process, each student must perform a final patient record review
and, together with her/his Senior Tutor or AGE Program Director, discuss the status of each
patient, review each patient’s record, and decide upon the need to reassign patients requiring
further dental treatment. The student, then, must officially check-out with appropriate clinic staff
and upon completion (including, review of the axiUm Personal Planner) will be permanently
deactivated in axiUm. Once this has occurred, there is absolutely no admittance on the clinic
floor for patient care. An email is sent out prior to graduation to inform graduating students
regarding this entire process.
GRIEVANCES
Students should refer to the HSDM Student Handbook, for a full description of the HSDM
policy.
1. Faculty: Any student with a grievance is urged to discuss it and seek resolution of the
problem with the clinical faculty on the floor involved, before going to his or her Senior
Tutor or AGE Program Director. If the student feels that these discussions are unsatisfactory,
s/he can then present the problem to the Associate Dean for Dental Education (617-432-
1449). If still unsatisfactory, the student/student can then present the problem to the Dean of
HSDM (617-432-1401).
2. Patients: Students must learn to develop good and professional doctor-patient rapport
with all patients. If a problem develops, the student must discuss it with the assigned
clinical faculty, the Senior Tutor or AGE Program Director, and the Assistant Director of
Financial and Patient Services or Assistant Director of Clinical Support Services.
REQUESTS FOR ADDITIONAL CLINICAL TIME
If a student is not scheduled to be in HDC, but needs extra clinical time and an operatory/chair to
use, the student should:
1. Make a request via her/his Senior Tutor or AGE Program Director and get approval.
2. Secure proper faculty coverage, per the Senior Tutor or AGE Program Director.
3. Notify the Assistant Director of Clinical Support Services (617-432-0917) and request an
operatory/chair.
4. Enter patient appointments into axiUm.
For FGP providers hoping for additional clinical time, please see Assistant Director of Clinical
Support Services.
STUDENT DENTAL ASSISTANTS
HSDM occasionally serves as a clinical rotation site for Dental Assistant Trainees from
accredited programs. DA Trainees are assigned to assist the students in TP in the treatment of
patients, as well as to develop the students' experience in working with other DHCWs.
Assistants may be asked to seat and escort patients, obtain needed supplies, and assist at chair-
54
side. The trainees may not be asked to perform any activity, which necessitates their leaving the
TP floor, and compromising patient care.
HSDM pre-doc students in their 2nd year of dental school who want to serve as assistants for
exams [e.g. for Clinical Comprehensive Exam (CCE) or Commission on Dental Competency
Assessments (CDCA)] or volunteer for clinic events [e.g. Give Kids a Smile (GKAS)] must go
through the proper training prior to entering the clinic floor. The same applies to 3rd and 4th year
students who want to participate in the FGP Student Dental Assistant Program, managed by the
Assistant Director of Clinical Support Services. In all of these cases, clinic management will
instruct you on what exactly needs to be completed and make arrangements for training.
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SECTION XII: CLINICAL PROCEDURES
SCHEDULING PROTOCOLS FOR EMERGENCY APPOINTMENTS
Pre-doc Program
Students are assigned at intervals to the Comprehensive Care Rotation (CCR), which provides
emergency and recall services for TP. Before rendering any emergency treatment, the student
will take a medical history, examine the patient and take radiographs (if possible), make a
tentative diagnosis, and then consult with a faculty instructor. No emergency treatment may be
provided until a faculty instructor has reviewed the history and indicated approval in the record.
Following completion of any treatment, the faculty instructor must again be consulted to approve
the treatment, sign the record, and recommend any further procedures deemed necessary. The
student escorts their patient to the PSLs at the front desk for payment of fees and to make
arrangements for further required services. In situations where the CCR is not scheduled, dental
emergencies should be referred to the GPR program.
AGE Programs
Each AGE Program Director is responsible for developing full coverage of dental emergency
treatment options for the patients seen by their students during all the hours TP is open. This
includes having a student cover emergencies during periods when the majority of the specialty
may be at dental meetings/conferences.
FGP
The patients of the FGP are seen by their individual faculty provider, whenever they are in
practice and available. If the dental emergency occurs when a faculty provider is not available,
the patient will be seen by the GPR or referred to the nearest emergency room or urgent care
facility.
PATIENT ASSIGNMENTS FOR TP PROVIDERS
All patient assignments for TP providers are coordinated through the Senior Tutors and AGE
Program Directors. All patients must have an OD Screening Examination prior to assignment
for treatment, except in an emergency as explained earlier. It is expected that the student to
whom any patient is assigned will be responsible for the patient’s treatment, as well as, updating
the patient record in axiUm. If the patient sees multiple student providers within a program (e.g.
in AGE Perio), only one will serve as the primary provider and carry out the treatment planning;
conversely, if a patient sees multiple student providers in a variety of disciplines/programs, then
it is understandable that this patient will have multiple Treatment Plans. For any Treatment Plan,
students MUST obtain prior approval by their Senior Tutor or AGE Program Director. It is
absolutely imperative that as part of comprehensive care, the patient has either a general provider
here at HDC or elsewhere. Hence, those patients treated in AGE may be assigned to a pre-doc
student for some aspects of treatment, so long as this is agreed to and coordinated by the Senior
Tutor and AGE Program Director.
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The Senior Tutor and AGE Program Director have final authority over patient assignments and
must be consulted for any questions, which arise in this area.
Students must be punctual for patient appointments. After some experience, a student will be
better able to judge the length of time required for appointments and the number of appointments
to be made per session.
Sometimes, a student wishes to have friends or relatives assigned to her/him for treatment;
arrangements MUST first be made with ODE. If these are new patients, they MUST first
be admitted and registered as a patient and screened in OD, so that suitability for
treatment can be determined.
MEDICAL EMERGENCIES THAT OCCUR DURING CLINIC APPOINTMENTS AND

PATIENT CARE
A medical emergency is defined as any serious illness or injury such as syncope,

unconsciousness, convulsions, seizures, severe bleeding, or chest pain. In most medical
emergencies, success in treatment will depend on quick assessment, judgment, and efficient
institution measures. The proper steps in the initial management of medical emergencies at HDC
are discussed in detail are outlined below in Exhibit 14:
57
Office of Clinical Affairs.
58
59
ACCIDENT PROTOCOLS AND FORMS
Accidents—namely related to needlestick and sharps exposures—occur at HDC. Though the

event can be stress for all—regardless of clinical level or experience—it is important to remain
calm and seek the appropriate attention. The following in Exhibit 15 details the procedures if
such an accident occurs at HDC:
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These two accident forms (posted in Appendix 1.5) are available throughout the clinic, and it is
important that the proper form is completed, as well as the online PMA Accident Form.
If there is an exposure with a patient—we, internally, refer to the patient as “a source patient.”
The individual in a supervisory role handling the case will speak with the patient directly. The
affected DHCW does not need to do this albeit, it is important that the DHCW does not simply
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abandon the patient at the operatory. If a DHCW has an accident, they can either send another
DHCW to help and seek someone in a supervisory role or s/he can excuse her/himself by telling
the patient, “Apologies, but I had an accident and need to report it. I will be right back…” and
then seek out a supervisor.
Though even the most prepared DHCW can have an accident, one of the ways to help prevent
these from occurring are to practice handling and develop skills, use materials appropriately,
dispose of used disposable sharps immediately, ask for help from other DHCWs, and pace
oneself when setting up and breaking down/cleaning up after procedures.
If there is an accident of this nature that occurs in the lab, then the process differs. Even if the
DHCW has an “exposure” with an extracted tooth, there should be no cause for concern, as the
tooth is previously sterilized in a solution. The DHCW may not even need to go to HUHS, albeit
the appropriate accident form should always be completed and brought to the Assistant Director
of Labs and Clinical Materials. Moreover, if the DHCW is working on an impression (taken
from a patient in the clinics), the student should follow the same protocol in completing the form
and consider going to HUHS for a consult—as, depending on the sterility of the impression, it
could be considered an exposure.
Moreover, if students experience an exposure at an off-site clinic (working there as part of the
HSDM curriculum) and that facility DOES NOT have a protocol, then students should see the
Assistant Director of Clinical Support Services or the Assistant Director of Financial and Patient
Services or regarding a HUHS follow-up. This service would only be for students—not the
patient, as s/he is not an HDC patient.
ANTIBIOTIC RECOMMENDATIONS
Patients who present to HDC with a history of cardiac conditions associated with endocarditis or
with prosthetic joint replacement (under certain conditions) cannot have dental procedures
performed that require antibiotic prophylaxis, unless they have been pre-medicated.
If a patient is unsure of the status of his/her heart condition or prosthetic joint, the patient should
see his/her primary care physician to confirm whether or not antibiotic prophylaxis is required.
Ideally, the status should be confirmed in writing by the patient’s physician. The Evaluation for
Endocarditis Prophylaxis Form (posted in Appendix 1.6) is designed to help capture this
information. This completed form should also be scanned into the Attachments section of
axiUm, specifically “Information About Patient.” A patient who presents for a hygiene
appointment without the necessary written documentation can also be cleared by telephone with
the patient’s physician. The telephone confirmation must be documented in axiUm (in Tx Notes
if provider speaks with physician; in Contact Notes if a staff member speaks with physician).
Patients without documentation of their antibiotic prophylaxis requirement may not undergo
treatments, for which prophylaxis is recommended, and will have to be rescheduled.
Exhibit 15 shows recommendations, per Eastern Dentists Insurance Company (EDIC), that are
posted in both FGP and TP operatory cabinets:
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More information can be found within the Prevention of Bacterial Guidelines (posted in
Appendix 1.7).
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ADA PARAMETERS OF CARE ON BLOOD PRESSURE
American Dental Association (ADA) parameters of care clearly require an initial and periodic
Blood Pressure (BP) on all dental patients, and more frequent ones on known hypertensives. At
HSDM, we require that BP be taken: 1. Every six months; 2. If the patient is hypertensive; and 3.
If the patient is scheduled for surgery. It is important to follow these measures, regardless of
whether or not the patient suffers from or is at risk for cardiovascular disease. This is because
many patients do not know that they are suffering from high blood pressure. If the blood pressure
reading is outside of the normal range (i.e. >139/89 mm Hg), the patient will be referred to
his/her primary care provider (PCP); if the patient does not have a PCP, then she/he will be
referred to a walk-in care clinic (e.g. CVS Minute Clinic, Walmart Clinic, Community Health
Center, etc.) or Brigham & Women's Hospital (BWH) at 617-732-6043 for further evaluation.
Additionally, a brochure printed from axiUm on hypertension and prehypertension should be
provided to the patient. The patient’s PCP should also evaluate unusually low blood pressure
readings.
Exhibit 16: This chart reflects blood pressure categories defined by the American Heart
Association (AHA).
Blood Pressure Systolic Diastolic

Category mm Hg (upper #) mm Hg (lower #)
Normal
less than 120 and less than 80
Prehypertension 120 – 139 or 80 – 89
High Blood Pressure

140 – 159 or 90 – 99
(Hypertension) Stage 1
High Blood Pressure

160 or higher or 100 or higher
(Hypertension) Stage 2
Hypertensive Crisis
Higher than 180 or Higher than 110
(Emergency care needed)
All such findings must be recorded in axiUm as part of the Medical History Form, which needs
to be approved by the overseeing faculty instructor in the case of pre-doc students. Referrals
need to made using the electronic External Referral Form, which needs to be approved by the
overseeing faculty instructor in the case of pre-doc students.
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MATERIAL AND CHEMICAL SPILLS
The Emergency Spill Cabinet is located on the 1st floor stairwells between FGP clinic and REB,
as seen in Exhibit 17.
In the event of a chemical spill, the DHCW should:
1. Ensure s/he and others around the spill area (including patients) are okay. Relocate others to
another operatory, if necessary—e.g. if smell of spilled chemical or product is overwhelming.
2. Inform one in a supervisory role or ask another DHCW to inform her/him while the affected
DHCW cordons off the spill area and does not allow reentry by others.
3. Extinguish all open flames—only if necessary. Fire extinguishers are located throughout
HDC.
4. Obtain kitty litter (if necessary) from the spill cart. To reduce vaporization of organics
(smelly odors) apply “SoluSorb” or activated charcoal powder found in the spill cabinet.
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5. The supervisor who is notified should then notify the Office of Administration and Finance
(617-432-1405 or 617-432-0950), as an extra precaution, in case additional cleaning help is
needed. This is typically the highest level of escalation that occurs at HDC.
6. If the spill is sufficiently hazardous or noxious, the DHCW should call EH&S (617-432-
1720) or the Longwood Operation Center (617-432-1901) and evacuate the area. This is a
less common occurrence at HDC, but it is good to be prepared and know whom to call at this
level of escalation.
DISPOSAL OF EXPIRED CHEMICALS AND PHARMACEUTICALS
Audience: Authorized DHCWs (DAs, Hygienists, STs, Materials and Lab Staff, and Clinic
Management)
There is a difference between expired chemicals and pharmaceuticals.
ONLY expired chemicals should be disposed of here following these instructions:

• All expired chemicals need to be brought to Room 007. The chemical needs to be tagged
and placed in the “expired chemicals” bin; the waste tag needs to be filled out completely
and dated.
• Please notify the EH&S Coordinator (in absence, see appropriate floor manager: FGP,
TP, or Clinical Operations Labs and Materials Managers) after the chemicals have been
tagged. An online pick request will be made.
• Empty chemical bottles can be thrown in the trash. Please do not recycle and empty
chemical bottles.
• Flammable aerosol cans (empty or full) need to be disposed of in the “expired chemicals”
bin. The aerosol cans must be tagged.
NOTE: Expired Pharmaceuticals (Massachusetts Schedule 6) should be given directly to the

EH&S and Infection Control Administrator (desk is located in the HDC 2nd floor, behind the
front desk – phone number: 617-432-1007), who will arrange for reverse distribution.
NEVER simply leave expired chemicals or pharmaceuticals here at this desk.
HSDM EMERGENCY EVACUATION PROCEDURES
Exhibit 18 shows the HSDM Emergency Evacuation Procedures, distributed by the Office of
Administration and Finance:
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INSTRUMENTS, EQUIPMENT (INCLUDING SENSORS), AND MATERIALS
HSDM strives to maintain a quality, cost-effective system for providing properly sterilized
instruments, cassettes, handpieces, and equipment for use by students at HDC. In order to
maintain such a system, policies and procedures are established (and continue to be improved
upon) to minimize instrument losses and to assure the appropriate sterility of instruments. All
DHCWs are expected to respect and comply with these policies.
Materials are available throughout HDC and are kept stocked in clinic floor cabinets and
operatories, basement labs, Materials Management, and dispensary areas.
It is important to keep things organized as well as compliant with infection control. Refer to
HDC Infection Control Manual for more information. This is also imperative for safety
precautions.
Additionally, in Sterilization (located in TP), instruments in cassettes and other containers are
barcoded. Sterilization Technicians (STs) are able to track instruments and currently check-out
and check-in instruments via the axiUm Dispensary module. More improvements continue to be
made to this system.
Additionally, in late June 2015, a Dental Materials Committee (DMC) was assembled to help
discuss and review current materials used. The DMC will continue to meet throughout the year,
and updates/announcements will be provided to the HDC community via email.
END USER RESPONSIBILITY POLICY
The HDC policy for the use of TP and FGP instruments, equipment and dental chairs is that
ALL USERS (whether provider or other DHCW) MUST CHECK-IN INSTRUMENTS
AND EQUIPMENT IN THE SAME CONDITION AS THEY WERE CHECKED-OUT,
except that they are no longer sterile. The instruments in the cassettes must be returned in the
appropriate order and in the appropriate cassettes/containers. Additionally, ALL USERS MUST
LEARN PROPER CARE FOR CHAIRS AND NOT LEAVE DAMAGED ITEMS
UNREPORTED.
Only approved materials, ordered by authorized staff, may be used. Any questions should
be referred to both the Materials Management team as well and the clinic managers—who
can advise and discuss options. Additionally, for AGE Ortho specifically, the Materials
Management team and other clinic staff and faculty created the Orthodontic Material Reference
Guide Volume I (posted on eCommons), which details approved Ortho-specific products. Copies
of this guide will be available on each clinic floor in Winter/Spring 2016. Moreover, only HDC-
approved equipment can be used. New equipment cannot simply be brought up to the
clinic floor for immediate use. There is process, and it is the responsibility of FGP providers
(for FGP-specific items) and Senior Tutors and AGE Program Directors (for TP-specific items)
to get the proper approval from clinic management. Serial numbers for all clinical equipment are
tracked, as well as the respective manufacturer—for security and maintenance purposes.
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At the beginning of each TP session, each provider (and in some cases, another DHCW) will
request dental instruments (and equipment, if needed) from the sterilization clean-side window.
The STs will locate and check-out the requested items. For FGP, at the beginning of each
session, each provider (and in some cases, another DHCW) will retrieve dental instruments from
the FGP clean dispensary, as needed.
In all cases, providers should take items for one patient at a time and should not retrieve
items for any more patients. When the appointment is completed, and before a new patient
is seated, all used, unused, and unopened items (which were brought to the operatory)
should be neatly placed back into the cassette and returned (in a transport bin) to the dirty
carts (wearing all required Personal Protective Equipment—PPE) available in the wet labs
for each clinic. IMPERATIVE: Please see the HDC Infection Control Manual for more
specifics instructions. As we are a small facility, and given our resources, we only have a set
number of items for all to use, so all DHCWs should be mindful of utilizing only what is needed.
It is the responsibility of each provider to inspect all items for completeness—prior to delivering
patient care. If a provider finds that items have missing, broken, or seemingly “dirty” contents,
s/he should IMMEDIATELY address this via a new process—the HDC Repair and Missing
Equipment System—launched in August 2015. Tag Repair/Equipment Kits (with labeling
materials) will be provided in the FGP wet lab, TP wet lab, and Sterilization dirty-side—so that
all DHCWs can access. Steps and workflow are featured in Exhibit 19:
STEPS for DHCWs:
When returning equipment/ cassettes to the dirty cart or bin and there are broken or missing
equipment/instruments, please take these steps:
Red Tape=Broken Equipment/Instrument

• Place a small piece of red tape around item and another small piece outside of cassette.
(Do not place red tape over barcode on cassette)!
• Leave all other instruments, handpieces etc. in the cassette.
Orange Tag=Miscellaneous such as:

• Rusty
• Dirty
• Soapy
• Wet packet
Use a surgical marker to list miscellaneous problem on orange tag.
Yellow Tag=Missing Item

• List missing item on yellow tag
Use a surgical marker to list missing item on yellow tag.
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A Tag Repair/Equipment Kit can be found in three different areas: FGP wet lab, TP wet lab,
and Sterilization dirty-side. See Exhibit 20.
WORKFLOW:
Students, DAs, DHs,

FGP Providers returns
equipment/ cassettes
to cart/bin.
Missing/broken
equipment/
instruments are tagged
or red tape
placed.
Sterilization team
scans
equipment/cassettes Equipment/Instruments
into axiUm, sterilizes sterilized and placed in
and returns Material Management bin
equipment/cassettes for repair/replacement.
to shelves
Materials Management
collects, repairs and
returns
equipment/cassettes
to Sterilization.
Repeated failure to comply with any of the instruments, equipment, and materials policy
can lead to disciplinary action.
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Handpieces
The same end user responsibility applies to handpieces for use in TP and FGP. These handpieces
are contained in a cassette system that contains high speed and slow speed components—specific
to each floor, as the handpiece delivery units for TP and FGP slightly differ. Therefore, TP
handpieces can only be used in TP; FGP handpieces can only be used in FGP.
Exhibit 21 shows FGP and TP handpiece components:
In FGP, two types of regular handpieces are used.
Older model of FGP handpieces still in circulation is as follows:
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Newer model of FGP handpieces in circulation is as follows:
TP handpieces in circulation:
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Materials
There are different material (disposable and reusable) organizations within HDC.
The TP allocation of materials is as follows:

• A Bay: Pre-doc Crown and Bridge Materials
• B Bay: Pre-doc Operative, Perio, Endo, and Pedo* Materials
• C Bay: AGE Orthodontics
• D Bay: AGE Prosthodontics
• E Bay: AGE Periodontics
*Pedo Portable Cart kept in Room 216-218.
Exhibit 22 shows pre-doc cabinets (AB Bays) in TP:
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The FGP allocation of materials differs, as there is a walk-in dispensary (for materials,
instruments, cassettes) designated for FGP providers and other DHCWs who work on that floor.
TP providers cannot access this dispensary for work being done on the TP floor; albeit, if a TP
provider is working in FGP, s/he will need to access the dispensary for an FGP handpiece and
any other necessary items. Moreover, and in the rarest circumstances, if a TP provider is working
in TP, but was given permission by a clinic manager to use an FGP item, then the item will be
lent to the TP provider.
Dental Gold for FGP and AGE Prosth students is distributed by the Assistant Director of Lab and
Clinical Materials in the basement. If providers plan to do lab work on off-clinic hours and need
gold, please notify the Assistant Director of Lab and Clinical Materials by 4pm that day.
HDC LABORATORY FACILITIES
1. PLC and AGE Prosth Lab

All HDC labs, including the plaster and casting room, are to be maintained in good order.
Providers are expected to assist in keeping the laboratory spaces neat and clean by cleaning
up after they use the facilities. No equipment or supplies may be left overnight at the
workbenches. The use of TP and FGP materials and instruments is strictly prohibited
in this area. The only valid reason would be if a clinic manager gave permission for a
student to use for practice for a board exam.
A schedule is posted weekly on the entrance door to the PCL and notifies students of times
when special courses are scheduled and/or the labs are not available for student use.
As the HDC Infection Control Manual states, appropriate attire and PPEs must be worn, and
food and drink (other than water) is not allowed in these areas.
2. Wet Labs
Wet labs are only available during HDC clinic hours. It is the responsibility of each provider
and DHCW to observe routine cleaning regulations when using it. Additionally, everyone
must help prevent equipment failure by following proper procedures when utilizing the
equipment and reporting any problems to the Assistant Director of Financial and Patient
Services or Assistant Director of Clinical Support Services. There is a weekly cleaning
schedule posted, where DAs rotate the responsibility.
INTERNAL LABORATORY WORK
The Assistant Director of Lab and Clinical Materials does limited work for the FGP. This work
is primarily restricted to restorations of cases that have been created off-site and are incorrect.
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OUTSOURCED/EXTERNAL LABORATORY WORK
HDC has a preferred relationship with certain lab vendors. These relationships exist to assure
consistency of quality and to enable HSDM to attain the best pricing for lab services. It is
expected that these PREFERRED LABS will always be used by students, and neither lab
staff nor any faculty instructor are authorized to select a lab other than a PREFERRED
LAB. If you have questions/concerns about any of the laboratories, please be in touch with
either the Assistant Director of Lab and Clinical Materials or the PLC Lab Coordinator and they
will communicate with the laboratory directly.
Below, please find the list of PREFERRED LAB vendors. These vendors are selected for a
biennial (two year) contract based on location, quality, and customer service. HDC encourages
your feedback, both positive and negative, so that issues may be resolved in a timely manner.
Lab Vendors:
H&O
Northshore
Oral Arts Dental Laboratories
Oral Design
Dickermann
Advanced Dental Design Lab
Cusp
Pro precision guides
Ortho-specific Lab Vendors:

NEO
Allesee ortho
Avedent global dental service
Great Lakes Ortho
TP Orthodontics
LIMITATIONS
Pre-doc Cases
• H&O Dental Labs
• Oral Dental Arts Laboratories
• Exceptions for use of another axiUm-listed lab must be discussed and approved by a full-
time faculty provider/supervisor.
AGE Student Cases

Any axiUm-listed lab that has been approved by Program Director.
FGP Providers can use all axiUm-listed labs designated by an X; please note, for Ortho—if you
can’t find your lab with an “X,” please select the “non-X” version.
Below please find the guidelines that apply to all pre-doc and AGE cases.
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1. Prior to any treatment beginning, comprehensive team (Perio, Endo, Implant) treatment
planning is to be coordinated, and the PSLs will send these plans to insurance for Prior
Authorization estimates and financial planning. All treatment plans and Lab Orders must
be approved and swiped by a faculty member;
2. On the day of the initial prep & temp, complete case charges for the services rendered
must be entered into axiUm as “in process”;
3. 50% of this total charge is due at the time of INITIAL PREP. The PSLs will estimate the
amount due, taking into consideration insurance benefits;
4. If the patient cannot make the full 50% deposit, direct the patient to your PSL to make
financial arrangements;
5. Upon receipt of the 50% deposit, the PSL will stamp the Lab Order which can then be
sent to the lab. This also applies to all INTBIO (axiUm) orders;
6. Students are required to post charges and complete each phase/sequence of treatment in
axiUm;
7. Payment in full is due when a student wants to pick up the lab case and prior to final
insertion, and;
8. Patients must be escorted to the front desk at the end of each visit.
All outsourced/external lab vendors deliver cases Monday through Friday, between 10am-2pm.
DIGITAL DENTAL LAB (DDL)
The DDL [open to faculty, AGE providers, and staff (with a formal request)] is divided into two
rooms: Room A hosts eight computers with surgical and restorative planning software; Room B
hosts the scanners, milling unit, accessories, and ceramic oven.
1. No food or beverages allowed in the DDL.
2. Users of the DDL should immediately report any operational issues to either the
Assistant Director of Lab and Clinical Materials (617-432-1462) or Lab Coordinators. If
there is a technical issue, users need to log a ticket with HSDM IT:
hsdm_support@hsdm.harvard.edu.
3. In order to reserve the DDL for a class, an email needs to be sent to ODE staff at
rooms@hsdm.harvard.edu
4. The DDL computer software and machines should only be used by those who are trained
and feel comfortable using them!
5. Pre-doc students need to be accompanied by a faculty instructor or AGE student at
all times to access to the DDL and any machine.
6. Materials for restorations (e.g. CEREC blocks) need to be made in advance through
axiUm, as we do NOT stock them.
7. Users cannot leave any patient records behind or computer screens (with patient
info) unattended in the DDL. There is a gray locked trash bin (to dispose of confidential
data) in there, should anyone need.
8. The DDL is under camera surveillance at all times.
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CEREC
HDC providers have access to CEREC machines, which enable trained providers to create final
crowns for insertion. The procedure has been incorporated into the student curriculum, so TP
providers will be appropriately instructed through clinical practice. “CEREC” is an internal lab
code which should be used for each crown created in the patients’ axiUm record. In addition to
the standard lab guidelines noted above, the following additional steps for all CEREC cases must
be adhered to:
1. Plan ahead and order the blocks at least five business days in advance, as we do not
stock them.
2. Make sure a Sirona Bluecam/Omnicam interoral scanner is available for the day of
restoration.
3. Please use the sign-out sheet for the Omnicam in the DDL.
4. Request the materials in axiUm under CEREC (and not InMat as for implant parts or
denture teeth), write the company name (Ivoclar), color and order number (e.g.
605328). See Exhibit 23:
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5. Once you get an axiUm message that your block is in, please bring a signed/dated print
out form from the PSLs in order to receive the CEREC material (same procedure, as
if you want to pick up your lab case/ proof of payment).
6. If you are milling, please fill out the information sheet next to the milling unit. See
Exhibit 24:
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7. If you are using the Ivoclar ceramic oven for crystallization/glazing, make sure to leave
the working place clean and return the brushes back in the appropriate place.
GUIDED SURGERY
At this time, the only labs able to process guided surgery cases are Dickerman Lab and
ProPrecision Guides. As these labs are not awarded a contract and, therefore, are not a
PREFFERED LAB vendor, only lab staff are authorized to process the guided surgery cases
which are sent to these vendors. Please place any guided surgery cases in the bin marked
Guided Surgery (Room 009) and enter under the lab code “GSURG” or “PROPRE,” in axiUm.
General Procedures Pertaining to All Providers:
• Faculty Group Practice

• AGE Endo Students
• AGE Implant Students
• AGE Ortho Students
• AGE Perio Students
• AGE Prosth Students
• ITI Scholars
• Pre-doc Students
Exceptions for work being done in non-PREFERRED LABS can only be made when there are
extraordinary circumstances, which require a special expertise not available at the PREFERRED
LABS. In these cases, the Senior Tutor or AGE Program Director must sign the lab
prescription (Rx) slip/form. Lab Rx forms that indicate an alternative lab, without the required
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signatures, will be changed and sent to the preferred lab instead. Students will be personally
liable for any additional costs of a lab case completed by an unauthorized transaction with
a non-PREFFERED LAB.
All lab work is to be handled and logged by lab staff or the Implant Liaison Coordinator. All
patient payments are to be made to HDC, and under no circumstances is a patient ever to
be asked to make a direct payment to a student for lab work or any other service.
TP PROVIDER-SPECIFIC LAB PROCEDURES (PRE-DOC & AGE)
1) A Lab Rx form is completed in axiUm by the student provider.

 The name of the preferred lab is selected from a drop-down menu on the electronic lab
form. If an exception to the preferred lab is to be requested, the approval of the Senior
Tutor or the AGE Program Director must be obtained immediately.
 Include student personal contact information (phone and email) in the “Details” field of
the electronic lab, so that the lab can communicate with the student directly.
2) Once approved by a faculty instructor, the student prints the Lab Rx form and label
(REMEMBER: Student provider’s email must be on this form!).
3) The student brings the printed Lab Rx form to the PSLs for financial approval. Once the
PSLs confirmed that the patient has paid at least 50% of the total fee, they will stamp their
approval on the printed form. No lab case can be sent out until 50% of the total fee has been
received. The student provider will be held financially responsible for internal and
external laboratory costs incurred that are not paid by the patient. It is in your best
interest to confirm receipt of payment BEFORE submitting the Lab Rx form.
4) The approved Lab Rx form and the case are brought to the lab staff (if Prosth) and DA (if
Ortho) to be checked-out in the Lab Tracker Module. They will confirm that: All
appropriate approvals of the faculty instructor and PSLs have been obtained; the case is
appropriate for the lab selected; and all required components have been included. It is the
student’s responsibility to prepare the case adequately before it is checked-out.
5) Once the case has been checked-out by the staff, the student will package the case with all
appropriate components to be shipped. Packing materials for pre-doc students will be
housed in the PLC. Packing materials for AGE students will be housed in the AGE Prosth
Lab. Please take great care in packaging cases, as models can break during transport. If
models break in transport, the student will need to recast and resend the models.
6) Place the packaged lab case (ready for pick-up) in the appropriate lab bin (Room 009).
7) Student Providers [all pre-doc and AGE students (including those AGE groups who
practice in FGP)] use collecting bin outside of Room 009 as the drop-off location.
Vendors will pick-up daily, between 10am-2pm. In all cases, providers should make sure to
use either the appropriate vendor lab bag OR write the name of the lab vendor clearly on the
box/bag.
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8) When the case is completed and dropped-off at the school, it is received by the lab staff who
do a quality review (with the exception of 3rd year pre-docs, whose quality review is
conducted by Prosth faculty—see QA Process below). The lab staff will check-in the case
in the axiUm Lab Tracker Module, which will automatically send an Internal Message to
the student to notify them that the completed case has arrived. All completed cases are stored
in the PLC locked cabinets, with the exception of AGE Ortho cases which will all be
dropped-off and stored in Room 009.
9) With proof of full (100%) payment, the student provider can pick-up the completed
cases from the PLC and must sign the invoice to indicate possession of the case. Once the
case is removed from the PLC, the lab case is the student provider’s responsibility, and
s/he will be accountable for the case if it is lost or damaged.
Failure to comply with these procedures may result in suspension of clinical privileges and/or
charges to the provider for excessive lab bills.
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QUALITY ASSURANCE (QA) PROCESS FOR PRE-DOCS
Exhibit 26:
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FGP LAB PROCEDURES
1) A Lab Rx form is completed in the axiUm by the FGP provider and s/he prints out the Lab
Rx form and label (provider email must be on this form!).
2) In the Lab Tracker Module, provider checks-out the case. Please note that the provider
will be held financially responsible for internal and external laboratory costs incurred
which are not paid by the patients. It is in your best interest to confirm receipt of payment
BEFORE submitting the case to a laboratory.
3) Provider packs the case with all appropriate components to be shipped. Packing materials
for the faculty are housed in the FGP Wet Lab. Please take great care in packaging cases,
as models can break during transport. If models break in transport, the student will need
to recast and resend models.
4) Place the packaged lab case in the appropriate lab box to be shipped. Lab boxes are
located in the FGP Wet Lab on the upper right shelves.
5) FGP Faculty Providers use the clear plastic box in the FGP Wet Lab as the drop-off
location. The Assistant Director of Lab and Clinical Materials or the PLC Coordinator will
pick-up at ~10am on a daily basis. In all cases, providers should make sure to use either the
appropriate vendor lab bag OR write the name of the lab vendor clearly on the box/bag.
6) When the case is completed and dropped-off at the school, it is received by the lab staff, who
check-in the case in the Lab Tracker Module. This will automatically send an Internal
Message to the faculty provider to notify them that the completed case has arrived.
7) Completed cases will be placed in the faculty cabinets in the FGP Wet Lab, with the
exception of FGP Ortho cases which all be dropped-off and stored in Room 133.
8) The lab staff will give one copy of the invoice to the Business Office in Room 133; the
second copy with remain with lab case. If a faculty provider has a question about the cost
of the case (which s/he can view in the Lab tab of axiUm), s/he should contact the
Business Office immediately.
Failure to comply with these procedures may result in suspension of clinical privileges and/or
charges to the provider for excessive lab bills.
SHIPPING PROCEDURES
All cases must be packaged and ready to be shipped by 3pm each day. If they are received after
3pm, they will be shipped on the next business day.
For vendors who require cases to be mailed directly, they will be packaged and mailed via UPS.
For shipping labels for Prosth, please see lab staff; for Ortho, please see DA. For vendors who
have an on-site representative pick-up and drop-off completed cases, the representatives will
pick-up all cases from Room 009. This will, as previously described, require lab staff to collect
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all cases (~10am) from the FGP Wet Lab and bring them to Room 009. Due to HIPAA, we
cannot have external laboratory representatives walking into the FGP Wet Lab.
OTHER LAB COMPONENTS

For all external lab cases that require components: First, lab components will be ordered in-
house once an axiUm Lab Order is submitted. Once the components arrive, the case and
component will go out together to the lab.
PROTOCOL FOR RESTORATIVE AND SURGICAL MATERIALS REQUESTS
Purpose:
To clarify the procedures necessary in requesting any surgical or restorative components

including but not limited to implants, bone, membrane, peridex, impression materials, etc.
Audience:
This protocol applies to all HDC providers who are:

• Pre-doc students
• AGE students
• ITI Fellows
I. Scheduling of Appointments:
Appointments should be scheduled into axiUm. The “Tx Discipline” should be Perio, Implant, or
OS depending upon what is being performed. The “Appt. Status” should always be Surgery. In
the TP, the only two chairs that support implant equipment are F2 and F3.
Prior to scheduling these appointments a current treatment plan must be active and
approved by the patient, provider, and the Senior Tutor or AGE Program Director.
Materials will not be ordered or dispensed otherwise.
Should the patient carry insurance, a Prior Authorization Form should be submitted to the
insurance company in advance of the surgical date.
Patient financial preparation along with coordination of multiple providers should also be done
prior to the scheduling of any surgical/prosthetic procedures.
II. Placing Lab Orders:
All requests for surgical materials should be ordered at a minimum of five business days in
advance of the appointment—using the axiUm Lab Order Module:
In axiUm, go to EHRChart/Labs
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Create a Lab Order and complete entirely. A provider can only create a Lab Order if the Tx is
planned and approved. If a provider has any questions about which “Lab Code” to use, please
contact the Implant Liaison Coordinator or the Assistant Director of Lab and Clinical Materials.
Implant-supported products are: Straumann, Nobel, and 3i. HDC rarely orders other items
including, special items (e.g. specific bone or membrane), and these may take longer to arrive.
Providers are highly encouraged to communicate with a AGE Program Director or Senior
Tutor to make a decision about appropriate items and place all orders well in advance.
An email will be sent to providers (as an FYI) once materials have arrived.
III. Picking Up Lab Orders, Ensuring Payment, and Making Changes if Necessary:
All requested items will be ordered, pulled in advance, and placed in a bag (if restorative) or in
treatment tub (if surgical) ALONG WITH the axiUm Lab Order printout that needs to be signed
off by a PSL. The PSL can only sign off if the patient has paid prior to treatment. Appropriate
payment must be made prior to releasing the requested items. Regardless of restorative or
surgical materials, all materials will be held by the Implant Liaison Coordinator and will only be
released to the requesting provider.
Exhibit 26: See flowchart and sample Lab Order below which applies to all lab orders AND
involves designated lab staff:
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A provider can pick up materials from the Implant Liaison Coordinator only on the day of
the appointment.
If, on the day of, a provider realizes the implant size, healing abutment size, and/or bone graft
material quantity or type is not adequate, s/he needs to see the Implant Liaison Coordinator to
see if the material is in stock. If so, the Implant Liaison Coordinator will provide them and will
remind the provider to note any changes in the supplies in the “Tx History Notes” section of
axiUm. The exact type of materials that were actually used MUST be recorded!
If, however, the materials are entirely new and/or there are changes to the procedure, there might
be a change to fees.
IV. Completing the Procedure, Returning Items, and Completing Biological Material form:
At the end of the procedure, the provider should see the Implant Liaison Coordinator and the
PSLs to make sure that patient is charged for all materials that were used, including last minute
changes. The provider should accompany the patient to the front desk to see PSLs for check-out.
The following should be returned immediately to Implant Liaison Coordinator and no later
than 12pm for AM session and 5pm for PM session:
• Used Materials (i.e. boxes or sticker label)
• Unused Materials (i.e. any unopened items)
• Red or blue tub and axiUm Lab Order form
If a provider fails to return materials, s/he will not receive materials for the next procedure
until prior materials are returned. Materials are not to be kept for a later date; a new
request must be filled out for a new patient/new procedure, etc.
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To record used biological materials info in axiUm, the provider should go to EHRChart/Tx
History and complete the Biological Material Implant form, recording all items used. This
form can only be created once the procedure is completed. This form is key, and should
there ever be a recall, we need to be able to easily locate the appropriate information so that we
can inform the patient. Please note: If the provider is a pre-doc student, the form has to be
approved/swiped by a faculty instructor. This is not the case with AGE students.
V. Cancelled Appointments and Unused Materials:
If a patient cancels before the appointment date, the provider should inform the Implant Liaison
Coordinator and the PSLs.
If a patient cancels the day of the appointment, materials will not be distributed to the provider.
In axiUm, the provider should delete her/his lab order and create a new one should the patient
decide to reschedule.
FGP Providers should see the Implant Liaison Coordinator for stock items. However, to
ensure exact components and accurate fees are collected, it is highly advised that FGP providers
follow the following protocols taken from the student process above, and especially:
1. Orders (for non-stock items) must be placed no later than (5) business days from the
scheduled procedure.
2. Procedures need to be charged in axiUm. If for some reason, there will be no charge or a
reduced charge, the provider must create a Treatment Adjustment Record (TAR) and state
the purpose for this adjustment.
3. A record must be made regarding any used biological materials used. Once the procedure
is completed, the provider should go to EHRChart/Tx History and complete the
Biological Material Implant form, recording all items used.
RE-MAKE PROCEDURES
If you are not satisfied with the completed lab case, please notify the Business Office that the
case needs to be re-worked so they can withhold payment, if applicable, until satisfactory work
has been completed. Complete the appropriate steps in axiUm to submit re-make to laboratory.
LAB QUESTIONS
If you have questions about lab procedures, contact Lab Coordinators in Room 009.
BOARD EXAMS
Via the American Board of Dental Examiners (ADEX) Dental Examination, HSDM/HDC offers
the CDCA on-site for pre-doc students ONLY. Two CDCA exams take place on-site: the Patient
Simulated Endodontics and Fixed Prosthodontics (manikin) portion of the exam occurs in early
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September; and the patient-based (clinical) Perio and Restorative portion occurs in early March.
Pre-doc students must register and pay all exam-associated fees. Patient screenings will be held
at the end of December through February, leading up until the March exam. These screenings
can also be used for the CCE exam (a non-board, but internal pre-doc exam that is slightly
modeled after the CDCA March exam) and for WREB exam screenings as well. The WREB
exam is held off-site, and pre-docs must register and pay all exam-associated fees.
For those AGE students who still need to take the CDCA or WREB board exams, it is an
individual endeavor and s/he will need to:
 Register and pay for all exam-associated fees.

 Find her/his own patients.
 Find an exam facility.
 Utilize equipment and supplies provided by the facility.
HDC will only provide imperative equipment and supplies not supplied by the facility.
For any further details please contact the Director of Clinical Operation—the CDCA
Coordinator—and stay tuned for more information from the CDCA Coordinator, CDCA faculty
contacts, and other staff involved in this endeavor.
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SECTION XIII: PATIENT CARE
ORAL DIAGNOSIS, ORAL RADIOLOGY, AND NEW PATIENT INTAKE
The Oral Diagnosis (OD) and Oral Radiology (OR) curriculum has been developed with the
educational objective to teach students to be scholars and outstanding clinicians of general
dentistry. Learning the art and science of diagnostic skills is best accomplished in actual clinical
conditions. Under close supervision, pre-docs are introduced to and ultimately partake in initial
evaluation and diagnosis of new patients. The TP clinic maintains the clinical intake services for
all HDC. These services provide students with sequential clinical learning experiences in
diagnosis and radiology, treatment planning, and emergency care. The students learn to
recognize, diagnose, and treat dental/oral problems.
The OD and OR rotation occurs on the 2nd floor in TP: Monday AM; Tuesday AM & PM; select
Wednesday PM; Thursday AM & PM; and no rotation on Friday.
OD and OR helps HDC to:

1. Screen all patients who come to HDC and decide what radiographs will be needed.
2. Prepare and record a history and a broad provisional working diagnosis.
3. Provide a learning experience for the students in overall patient evaluation, history
taking, diagnosis, and the exposure of radiographs.
4. Determine in which clinic of HDC (Pre-doc, AGE, GPR, or FGP) the patient should be
treated. If a patient is not a good candidate for any clinic within HDC, the supervising
OD faculty must inform the patient.
OD and OR Screening Examination Procedures include:

1. Patient fills out forms as described earlier on page 38.
2. OD faculty and student review (and document in axiUm) while in OD suite with patient:
• Chief complaint
• Medical History via the Triage Form
• Dental History
3. The patient, while in OD suite, receives a cursory exam of:

• External head and neck
• Intra-oral soft and hard tissue
• This information is all documented in axiUm under the Oral Diagnosis Screening
Form and daily treatment history notes. A request for appropriate radiographs is
made.
4. Radiographs are taken by the assigned OR student, assigned DA, or faculty. This will
consist of images that are deemed necessary based on the history and clinical
examination, and may include periapical and/or bitewings, and/or panoramic images.
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Refer to Guidelines for Prescribing Dental Radiographs (posted in Appendix 1.8).
5. Patient remains seated in chairs outside of Room 220 until the images are ready for
viewing, then returns to OD suite for completion of screening exam.
6. All images must be mounted and receive an initial reading. The radiological report made
as part of OD or OR is a training program and is not intended for use in OD or by the
student to whom the patient is eventually assigned.
7. Images shall be fully interpreted by the primary care pre-doc student, AGE student, or
faculty to whom the patient is assigned. Faculty shall confirm the radiographic findings
on images interpreted by students.
When the OD appointment is scheduled, the patient is informed of the maximum cost for the
visit. The patient is also told that s/he is required to pay the appropriate fees at the time of the
visit. This information is repeated when the appointment is confirmed. Before the scheduled
appointment, the patient makes payment to the PSLs at the front desk.
The NPI appointment is when pre-doc students see a patient for the first time (whether the
patient is entirely new and was recently seen in OD or if the patient is a “transfer patient”—i.e.
someone already seen here, but with a new student now). For more specifics, pre-docs can refer
to the Senior Tutors Manual/3rd & 4th Year Guides.
OTHER PRE-DOC ROTATIONS
Pre-doc rotations encompass more than OD and NPI; they also include Oral Surgery (OS),
Emergency, Recall, and external sites—not to mention the student’s allotted time to see her/his
own patients. Please refer to the Senior Tutors Manual/3rd & 4th Year Guides and ongoing emails
from ODE for more information. If there are any questions RE pre-doc rotations and schedules,
students should contact the Pre-doc Clinical Curriculum Coordinator.
PATIENT CARE IN GENERAL
At HDC, the following should be standard. In the case of students, faculty instructors need to be
present to supervise and approve. All providers should:
1. Complete thorough medical, family, dental histories; medication list, chief complaint, etc.
at initial appointment. Thereafter, the provider should ask the patient at each
appointment, “Any updates to your medical history or medication history since we last
saw you?” The provider must always answer the “Reviewed Medical History” field and
(if applicable) the “Reviewed Medication List” field.
2. Perform physical head and neck exam and records pertinent findings.
3. Treatment plan the appropriate radiographic exam.
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Students, specifically, should also adhere to the following:
1. Student in OR rotation performs appropriate radiographic technique:

• exposure of the radiograph
• processing the radiographs
• mounting of the radiographs
2. Student interprets radiograph(s).
3. Student prepares acceptable differential diagnosis/provisional working diagnosis.
4. Student prepares appropriate sequential Treatment Plan, in consultation with the Senior
Tutor or the AGE Program Director—who also need to approve the Treatment Plan.
5. Student counsels patient about treatment needs probable cost.
6. Student performs treatment to completion and maintenance until graduation.
7. Patient is reassigned by the Senior Tutor or the AGE Program Director.
POLICY ON EXTRACTIONS PERFORMED BY PRE-DOC STUDENTS
All extractions performed by pre-doc students at HDC must be proctored by oral and
maxillofacial surgery (OMFS) faculty or other faculty (in certain cases). Pre-doc “student-
performed” extractions may not be proctored by AGE students or students of any other specialty.
Non-OMFS faculty may proctor pre-doc student extractions only when three or fewer extractions
of Class II mobility or greater are necessary in conjunction with another treatment, such as
periodontal surgery in the same quadrant or insertion of an immediate denture. Pediatric dental
faculty may proctor pre-doc student extractions in the pedo dental clinic.
Emergency dental extractions on pre-doc student’s patients must be referred to the OMFS pre-
doc clinic held during the OS rotation in the FGP OR suites. An attending OMFS surgeon is
present there for 80% of TP sessions. Emergency extractions for pre-doc students’ patients that
are non-life-threatening may be scheduled during the next available session during which an
OMFS surgeon is present in the clinic (less than 24 hours), by contacting the attending OMFS
surgeon personally. Such extractions may have to be performed by the attending faculty or the
OMFS surgeon. When OMFS faculty or students are not available at HDC, the patient can be
seen on an emergency basis at the Massachusetts General Hospital (MGH) OMFS clinic. The
PSLs can assist in making these appointments with MGH.
If a pre-doc student’s patient is experiencing a serious or life-threatening emergency, then the

attending OMFS surgeon will assess the situation and would call a Dr. Harvard if further help is
needed.
COMPREHENSIVE PATIENT ASSIGNMENT COORDINATION
It is the objective of HDC to produce outstanding clinicians by teaching and providing

comprehensive oral health care. To achieve this goal, it is necessary to appropriately assign and,
in the case of TP clinic, monitor the student's progress with patients. This is done by interacting
directly and closely with the OD/OR Faculty, Senior Tutors, AGE Program Directors, and other
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faculty instructors.
1. Assignment Process
At the time of screening, an Oral Diagnosis Screening Form is completed and is the tool by
which the patient is assigned. Once the patient is assigned, s/he is listed with pre-doc
students by the Senior Tutors or AGE Program Directors. No student can provide care to a
patient to whom s/he has not been assigned!
2. Reassignment (Transfer) Process

No pre-doc or AGE student is allowed to progress without fulfilling obligations in regard to
satisfactory disposition of patients. Patients assigned to pre-doc students will have their
Treatment closely monitored by faculty, who will reassign students within the treatment team
when necessary. AGE students must inform the Program Director of any patient with an
incomplete Treatment Plan that the student is unable to complete, so that the patient can be
reassigned. Patients assigned to graduating students will be reassigned by the Senior Tutor
or AGE Program Director, or placed on maintenance as needed.
3. Recall/Hygiene Rotations
FGP has five Hygienists who perform recall for FGP patients. In TP, students are responsible
for patient recall until graduation insofar as the curriculum permits. There is a
Forsyth/MCPHS dental hygiene student rotation in Fall and Spring—and this is
predominately charged with handling recall for AGE, and there is part-time Hygienist staff
member to help cover pre-doc recall and other hygiene needs, schedule permitting.
QUALITY IMPROVEMENT
Quality Improvement at HSDM is a vital component. A Quality Improvement (QI) Committee is

in place to help support the concept that through collaboration and systematic review, clinical
systems will be more effective, students, staff, and faculty will demonstrate improved
performance, and patient outcomes will be improved. Through ongoing endeavors of the
organization’s leadership, faculty, clinical and administrative staff, HSDM strives to provide the
best possible comprehensive care with available resources, while being consistent with the
mission, vision, and strategic plans of the organization.
Updates to this are being made in 2016.
CARIES RISK ASSESSMENT AND MANAGEMENT
This process contains procedures for pre-docs ONLY.
Caries Risk Assessment and Management: Over the past 24 months the Restorative
Dentistry and Biomaterials Science Department Chair and key clinical faculty have
developed a Caries Decision Tree tool for Caries Risk Assessment (CRA). Students
complete the age appropriate CRA form in axiUm, make a management plan with the on
floor restorative instructor, and provide the patient with information/instructions on how
to manage and treat their CRA Level.
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CRA1 Caries Risk Management Low
CRA2 Caries Risk Management Moderate
CRA3 Caries Risk Management High and Extremely High
Patients are re-assessed at designated time intervals (3-12 months), and the CRA will be
repeated and the CRA management plan adjusted as indicated.
The process is divided into four stages, which may be completed in two or more separate
appointments.
Stage 1: Initial Diagnosis and Risk Assessment

Caries diagnosis, and differential diagnosis, will be discussed with the instructor. The
CRA axiUm form is completed with a subsequent assignment of caries risk. The student
should be able to defend the determination of caries risk at the time of caries risk
assessment.
Stage 2: Development of Treatment Plan

The student should be able to develop a treatment plan to control the present disease and
maximize the chances of preventing future disease. The student must be able to defend
the non-operative and operative treatment plan, including frequency of re-assessment and
recall.
Stage 3: Completion of the Treatment Plan

It is expected that the student will complete the plan developed in stage two. If risk-based
recalls are completed while the restorative plan is active, the student should record patient
responses to dietary modifications, use of prescribed prescriptions, etc. Code D0425 will
be added into the patient chart in order to record for the Saliva Test in CRA procedure, as
detailed below.
Stage 4: Re-evaluation of Caries Activity and Risk Status

A re-evaluation of risk factors must be done following completion of the initial treatment
phase. The interval to be determined based on the initial caries risk assessment.
Exhibit 27 details a workflow put forth by pre-doc restorative faculty:
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PROTOCOL FOR HANDLING DENTAL EMERGENCIES OF TP PATIENTS
A fundamental principle of professional responsibility of students is that s/he will seek to

prevent, anticipate, and treat emergency problems of the patients to whom s/he is assigned. All
providers must advise their patients of the procedures to be followed in case a dental
emergency occurs outside of our business hours. The procedures discussed below are not to
be confused with the “Dr. Harvard” procedures (already covered in this manual)—which apply
to regular business hours.
Patients of Record
a. During Regular Clinic Hours:

Students should instruct their patients of the following procedures for contacting a doctor if they
have a dental emergency. All patients experiencing unexpected or severe pain, trauma, bleeding,
fever, swelling, difficulty swallowing are to be seen as soon as possible.
Patients should contact HDC (617-432-1434, ext. 1). During regular clinic hours, the patient’s
call will be answered by a Telephone Specialist who will triage the calls and take one of the
following actions:
• Appoint the patient to one of the designated emergency slots, to be seen by a 4th year
student who is on the Emergency Rotation.
• If there is not a readily available appointment in TP, the Telephone Specialist will
appoint the patient with the GPR Program on Emergency Coverage in the FGP or to
the AGE Endodontic student providing emergency coverage.
Students who receive phone calls directly from a patient are not to diagnose or recommend
treatment until they have made a notation in the patient’s record and discussed the emergency
problem with a faculty member who approves the note. The dental student then contacts the
patient with the recommended course of treatment. All patients experiencing pain, trauma, fever,
swelling, bleeding or difficulty swallowing are to be instructed to go to the nearest emergency
room.
b. When HDC is Closed

HDC cannot be used to deliver care except during regular business hours. Students cannot enter
HDC off-hours to provide care. Patients calling the HDC after hours are instructed (via the
automated message) to contact either the GPR student or faculty member on-call by calling a
designated number. The GPR student or faculty member on-call will triage the emergency needs
of the patient, treat as needed (during regular business hours), or verbally refer to another facility
(i.e. an emergency room) for immediate care. The GPR student or faculty member will note the
patient’s call in axiUm and notify the patient’s primary dentist/student of the patient contact
through an internal axiUm email.
Patients Who Have Never Been Treated at HSDM:
a. During Regular Clinic Hours
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The patient’s call will be answered by a Telephone Specialist who will triage the calls.
They will then take one of the following actions:
• Appoint the patient to one of the designated emergency slots, to be seen by a 4th
year student who is on the Emergency Rotation.
• If there is not a readily available appointment at HDC or if the patient prefers a
student provider the Telephone Specialist will appoint the patient with the GPR
Program on Emergency Coverage in the FGP.
The patient registers at the front desk of the practice where they are being seen (patient
type is TP for pre-doc and FGP for AGE Endo). A standard fee covers the usual
emergency visit and a radiograph. Any permanent treatment (e.g. amalgam) will be an
additional charge.
If the patient wants to receive comprehensive treatment at HDC, s/he MUST be

scheduled to return for an OD screening appointment. Otherwise, we will be unable to
treat again for emergency treatment.
b. After-Clinic Hours
Patients who contact the HDC after-hours who are not patients of record or have not been
seen for over two years will be instructed by the GPR student or faculty member on-call
to go to one of the area hospitals for treatment.
POLICY FOR USE OF IONIZING RADIATION FOR DIAGNOSTIC USES
One of HSDM’s primary responsibilities in the Pre-doc program is to prepare highly qualified,
competent individuals to perform independently as dentists. The education of HSDM students in
the discipline of dental radiology is an integral aspect of this responsibility, as dentists must be
their own radiologists. Long-term biological effects from exposure to ionizing radiation are
possible. As such, institutional policies, which are intended to assure most effective use of
ionizing radiation within HSDM, are necessary. The objective of this policy statement is to
identify those procedures and methods which provide students with an appropriate educational
experience and which provide patients with the minimal amount of radiation consistent with the
production of high quality radiographs. In this manner, high standards of quality in education
and patient care will continue to be maintained at the HSDM.
The underlying assumption of this policy statement is that every exposure carries with it some
attendant risk. Therefore, all persons engaged in the practice of dentistry must take all possible
steps to maximize the benefits and minimize the risks involved in the use of ionizing radiation.
Patients should be exposed only when there is an expectation of an improved diagnosis or an
influence on the treatment being rendered or contemplated. HDC, in-compliance with CDC
policies and Harvard EH&S policies, converted from conventional radiology to digital radiology
in August 2009. As a result, the level of radiation exposure has diminished significantly with the
taking of radiographs.
1. Physical Facilities
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a. All radiographic equipment and facilities shall be in compliance with all applicable
University, State and Federal rules, laws, and regulations, including:
b. Regulations for the Administration and Enforcement of the Radiation Control for Health
and Safety Act of 1968, FDA, PHS, DHHS, July 1980 (FDA) 80-8035;
c. Massachusetts Radiation Control Regulations;
d. NCRP Reports Nos. 35, 39, and 51;
e. Massachusetts Department of Public Health;
f. Harvard University Regulations;
g. Radiological facilities shall be designed and utilized to eliminate unnecessary exposures
to students, operators and patients.
h. All radiographic equipment shall be calibrated annually. The exposure rate (time in
impulses) for each machine will be determined and posted by each machine. The
equipment shall be periodically assessed for quality of function, and the results shall be
documented and kept with the Assistant Dean for Clinical Affairs and Special Projects.
i. All radiographic equipment and facilities within the HSDM are under the supervision of
the Head of the Department of Oral and Maxillofacial Radiology.
2. Criteria for Exposure
a. Patient Qualification
i. All radiographs shall be ordered by a dentist on the faculty of HSDM and
licensed by the Commonwealth of Massachusetts. All radiographs are planned
through axiUm and noted as “Planned” in the EHR. Once the radiograph is taken,
the planned procedure will be set to “Complete”, with the provider’s name as
signature. This will automatically document the exposure count in the patient’s
record. Providers can also manually adjust the exposure count in case a
radiograph was taken more than once. The dentist instructor overseeing the
student will approve the radiograph through axiUm and in this manner document
his/her name.
ii. Radiographs for new patients will be ordered only after clinical examination of
the patient, consideration of past medical and dental histories, availability of prior
suitable radiographs, and patient consent.
iii. Radiographs shall only be prescribed during patient treatment when they are
judged to be required for improved diagnosis or to influence the treatment
outcome.
iv. All patients presenting for x-ray examination shall be treated with courtesy and
dignity. The privacy of patient will be respected, per the Patient Rights and
Responsibilities.
v. All female patients will be asked if they are pregnant.
vi. Patients shall not be exposed for teaching or administrative purposes unless a
compelling diagnostic need has been determined by a faculty member.
vii. The deliberate irradiation of persons for purposes of research or other studies in
which no direct benefit to the irradiated person is intended shall only be
undertaken by properly qualified and trained individuals. Such irradiation shall be
given only with the written consent of authorities in charge of the institution, the
advice of an appropriate expert body, and subject to all local and federal
regulations (and signed informed consent of the patient).
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viii. Ordinarily, a full-mouth survey will not be repeated at less than three year
intervals and bite wings will not be repeated at less than yearly intervals unless
there are specific clinical indications. These guidelines are consistent with those
posted by ADA.
b. Operation Qualifications
The use of dental x-ray equipment shall be restricted to:
i. Individuals with appropriate professional degrees (DMD, DDS, MD);
ii. Technologists meeting the requirements of the National Registry of
Radiological Technicians; dental assistants and hygienists who meet the standards
in the Massachusetts State Law;
iii. Students and auxiliaries with appropriate training, functioning under the
supervision of a qualified faculty member;
iv. Students shall demonstrate technical competence on mannequins before they
expose patients;
v. Students will be allowed no more than three individual retakes on a single
radiographic survey without the direct supervision of a faculty or staff member.
c. Exposure Procedures
i. The operator/student must wear appropriate clinic attire and other PPE. Wear
gloves when exposing radiographs and handling contaminated film packets.
ii. Only the patient will be in the operatory during radiation exposure. If assistance
is required for children or physically challenged patients, a member of the
patient's family or caretaker should assist but no individual occupationally
exposed shall be permitted to hold patients or films.
iii. During each exposure, the operator shall stand behind a protective barrier.
iv. Dental x-ray machines will be equipped with open-ended cylinders limiting the x-
ray beam diameter to 2 3/4" at the patient's face.
v. Precision film holding instruments with rectangular collimators shall be used.
The fingers of the operator or patient will not be used to hold film, although the
patient may hold the precision instrument.
vi. Extra-oral machines will be collimated so that the beam size does not exceed the
image receptor.
vii. Extra-oral exposures will employ screen film combinations of the highest speed
consistent with their diagnostic purpose.
viii. All patients will be draped with a leaded apron and thyroid shield.
ix. Only digital sensors will be used for intraoral radiography.
x. The patient will be observed directly during each exposure to ionizing radiation.
xi. The number of radiographs should be limited to the minimum required for a
complete diagnostic workup.
xii. Elective radiographs will not be taken on patients who are known to be pregnant.
Specific emergency radiographs will be taken as necessary.
xiii. 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 apex at least once.
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xiv. Radiographs that are incorrectly mounted within the mounts for the patient can
easily be moved to another mount within the EHR Emago module. Any student
assigned to the patient and/or faculty member has access to do so. Radiographs
that are accidently mounted with the wrong patient will be moved by the axiUm
database manager after requesting through the EHR’s internal message system.
Requests for removal of radiographs are managed similarly.
d. Processing Radiographs
i. All digital radiographs taken of a patient will be automatically dated and placed in
the EHR. The individual taking the radiograph is responsible for assuring that
new patients are entered in the EHR when prompted by the digital radiology
system and mounting the radiographs according to the electronic mounts available
in the EHR. An interpretation of the radiographic examination will be recorded in
the EHR by the dentist or student. The EHR will automatically record the
numbers and kinds of exposures with the assigned student’s and assigned faculty
member’s name attached.
ii. Radiographic images will be maintained in the patient's EHR for a period of
twenty years following termination of treatment. Previous “wet films” are
maintained in the patient’s paper chart in a similar manner.
e. Occupational Exposure
i. In September 2009, with the changeover to digital radiology which has an
extreme low radiation exposure, the requirement to wear film badges was
eliminated, as per State and University policy.
DOCUMENTATION OF ORAL RADIOLOGICAL FINDINGS
Patient Radiograph Exposure Counts

Each time a patient is exposed, the exposure count should be adjusted in axiUm. This will be
automatic for billed radiographs. When taking additional radiographs (a redo) the provider is
responsible for adjusting the exposure count. axiUm prompts the provider for this automatically.
Radiographs that are being taken without charge are planned and documented through a separate
mechanism in axiUm, which also automatically count the exposures as well as allows the
provider to update the exposure count in case of more than one exposure (redo) for a planned
radiograph.
The note in axiUm should include a description of the radiographic findings. A description of the
radiographic appearances of any radiological examination depends in part on the reason for
which the examination was requested. The principal reason for a radiographic survey is an
evaluation of the teeth and jaws for the presence of common dental diseases to assist in the
formulation of a Treatment Plan aimed at restoring or preserving the masticatory apparatus.
Secondly, if the survey yields information suggestive of metabolic or malignant bone disease,
additional radiographic and clinical examinations are needed.
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STUDENT ROTATIONS IN ORAL RADIOLOGY
The HSDM OR curriculum has been developed with the educational objective to teach students
to be scholars and outstanding clinicians of general dentistry. Learning radiographic technique
and interpretive skills are best accomplished in actual clinical conditions. Under close
supervision, 3rd year students are introduced to and perform radiographic exposures. In addition,
the student will interpret a number of radiographs beginning with normal anatomy and common
dental conditions. During the course of rotations, students will advance to more complex
interpretation scenarios.
In the 3rd year, each student is required to complete six rotations in the OR Clinic. At the end of
each rotation, the student and instructor each fill out the appropriate evaluation forms for the
exercise, which are mutually reviewed, then filed in the appropriate notebooks. A log
monitoring the number of rotations completed is also maintained. Please defer to faculty who
supervise this rotation.
METHOD OF PAYMENT FOR RADIOGRAPHY
1. See current Fee Schedule for specific fees with the PSLs at the front desk.
2. Policy:
a. At screening, patient must pay the fee for examination and radiographs with the PSLs
before receiving exposure.
b. Any additional radiographs required to establish a diagnosis and/or aid in treatment
planning of an assigned patient will be charged to a maximum of the full mouth series
fee regardless of the day(s) that the exposures are made.
c. The fee covers orthodontic, endodontic and prosthetic working films for the specific
treatment.
SCREENING/TREATMENT OF “LICENSURE-ELIGIBLE” PATIENTS AT HDC
ONLY students who are full-time students at HSDM can use TP to screen patients for exams,
e.g. WREB and CDCA. Recent graduates CANNOT see patients at HDC due to liability issues;
they can, however, ask current students or faculty to help with the screening process.
Patients who are screened MUST receive a screening examination. A new patient chart in
axiUm MUST be generated, with all the required paperwork/chartings/radiographs. A Treatment
Plan must be generated for each patient so that they understand the nature of the work that needs
to be done. IF the student only completes a portion of the treatment, the patient should be
transferred (through the Senior Tutor) to another student for the remainder of the treatment if
they choose to stay at HDC.
USE OF HDC PATIENTS AT OFF-SITE CLINICS
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Patients who are screened at HDC can be seen at other facilities—AS LONG AS THE
PATIENTS CONSENT to this treatment. HDC is not obligated for the costs associated with the
off-site treatment of these patients.
HDC patients can return to HSDM for the remainder of their care as outlined in the signed
Treatment Plan(s).
ROUTINE CASE DOCUMENTATION OF PHOTOGRAPHS
All photographs of patients can only be taken with the patients’ written consent and
authorization. These photographs must be retained digitally in the patients’ dental records.
These dental records belong to HSDM/HDC and must be filed in Emago.
If a student or faculty provider needs a copy of these photographs for presentations, they may
make an electronic copy only after signing the Statement of Confidentiality. All electronic
photographs must not be taken home or saved on a personal laptop or computer because of the
potential breach of confidentiality and privacy. Rather, they should be saved on the HMS domain
or portable memory stick that is encrypted and password protected in accordance with HIPAA
regulations. See IT team for further clarification.
PHOTOGRAPHING INSTRUCTIONS
1. Dentate Patients
a. Pre-Treatment
i. A direct front view of anterior teeth and gingiva with lips fully retracted on both
sides and with the teeth in centric occlusion.
ii. Mirror views, right and left facial surfaces of teeth and gingiva.
iii. Mirror views, right and left lingual of lower arch.
iv. Full occlusal views of upper and lower arches taken with mirrors.
v. Any other views which may be helpful documenting, diagnosing and/or treatment
planning the case.
2. Edentulous Patients
a. Pre-Treatment
i. Full face direct view and profile view in rest jaw relation with dentures.
ii. A direct front view of anterior portion of dentures with lips fully retraced on both
sides and with the teeth in centric position.
iii. Full-face direct front view and profile view in rest jaw relations without dentures.
iv. Full occlusal views of the upper and lower residual ridges and adnexa taken with
mirrors.
v. Any other views which may be helpful in documenting, diagnosis, and/or
treatment planning the case.
b. Post-Treatment
i. Full-face direct front view and profile view in rest jaw relation with dentures.
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ii. A direct front view of anterior portion of dentures with lips fully retracted on both
sides and with the teeth in centric occlusion.
iii. Any other views which may be helpful in documenting the case.
It is expected that the student will take many more photographs of each patient as treatment
progresses for use in case presentations at HSDM and later in her/his career.
The standard procedure for duplication of photographs for the patient's record is as follows:
• Take the required photographs.
• Show these to an instructor or Senior Tutor or AGE Program Director and (with him/her)
select required and other appropriate slides for importing into axiUm.
• When importing them into axiUm, photographs must be labeled with date and time and
mounted into the “Photograph” mount. axiUm will queue for the date and time – this
should be the date and time the photograph was taken—not the date/time of import.
• Photographs can be imported in the REB Computer Lab.
• HSDM policy states you are strictly prohibited from storing any patient info on portable
devices.
ORAL PATHOLOGY REQUISITIONS/BIOPSY AND CULTURE SPECIMENS
Biopsy and culture specimen services for HDC are procured from Strata. The procedure for
requesting this service is follows:
a. Obtain and complete the Oral Pathology Requisition Form (available outside of Room
129 and near FGP patient waiting area; extra forms are located on the OR Suite 137).
b. Place biopsy specimen in formaldehyde bottle provided by Strata with patient name on
label. Strata should be contacted at 1-800-325-7284 for a pick-up. Their formal
address—printed in the form—is Strata Pathology Services, One Cranberry Hill, Suite,
303, Lexington, MA 02421.
c. Place requisition form and specimen bottle in the red bag outside of Room 129.
As in the case of handling extracted teeth, all PPE should be worn during specimen retrieval and
handling. Remove gloves to complete the Oral Pathology Requisition Form. (For more
information on PPE, please refer to the HDC Infection Control Manual.
Reports forwarded to HDC with pathology results must be reviewed with the student’s faculty
instructor for appropriate treatment planning. Once reviewed, biopsy and culture reports must be
filed and become a permanent part of the patient record in axiUm.
MEDICAL GUIDELINES
1. Drug Prescriptions
A patient is assigned a pharmaceutical drug when signs and symptoms require such
treatment. Documentation is done through the electronic prescription module in axiUm and
must include the following information:
a. Date of issuance;
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b. Name, dosage, strength per dosage unit of the medication prescribed;
c. Quantity of dosage units;
d. Directions for use, including cautionary statements; and
e. Statement indicating the number of times to be refilled.
[Prescription of Narcotic Substances]
A copy of the completed prescription form is automatically attached to the patient’s chart in
axiUm. Once completed the prescription form requires the signature of a licensed dentist;
therefore, pre-doc students must have the prescription approved when creating it in axiUm and
also get it signed by the faculty instructor overseeing the patient’s care.
Additionally, the HSDM Medication Storage Protocol (posted in Appendix 1.9) states that
certain medications are available upon approval of the Medical Director/Vice Dean and
immediate documentation of authorized staff.
2. Screening for Hypertension Referrals. Refer to page 65.
3. Prevention of Bacterial Endocarditis

a. The Population at Risk:
Some forms of dental treatment may be associated with transitory bacteremia. These
bacteria may lodge on damaged or abnormal heart valves or endocardium causing a
bacterial endocarditis. At the present time, it is not possible to predict which patients
may develop this infection but several groups that are at risk have been identified. These
include patients with previous endocarditis, prosthetic cardiac valves, cardiac transplant
recipients who develop cardiac valvulopathy, and congenital heart disease (CHD): 1)
unrepaired cyanotic CHD, including palliative shunts and conduits, 2)completely repaired
congenital heart defects with prosthetic material or device during the first six months
after the procedure, 3) repaired CHD with residual defects. Other patients that may be at
risk include those with recent prosthetic joint replacements. Refer to pages 62-64 for
more.
b. Dental Procedures
Any procedure in the oral cavity that is likely to cause bleeding can potentially cause
bacteremia. These procedures include all types of surgery (extractions biopsy, exposing
teeth, gingivectomy, etc.), prophylaxis, endodontic therapy, placing orthodontic bands
where the gingival margin might be traumatized, restorative procedures which violate the
gingival margin in the process of cavity preparation and placement of the matrix band.
c. Antibiotic Regime
The guidelines published by American Dental Association (JADA June 2007;138:739-
760.) and the American Heart Association (AHA Circulation, Apr 2007; doi:10.1161)
must be followed for the prevention of bacterial endocarditis. The oral route of
administration is generally more convenient in HDC and is probably as effective if
administered correctly. Refer to pages 62-64 for more.
d. Patient Management
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Once a patient has been identified as being "at risk," her/his treatment needs must be
assessed so that a rational Treatment Plan can be devised. As resistant bacteria can
develop during any antibiotic regime, it is prudent to wait one month before prescribing a
similar course of antibiotic. Alternatively, a different regime can be used for a subsequent
procedure. It may also be convenient to concentrate dental treatment during one course
of antibiotics.
Patients who are taking antibiotics for other medical or dental conditions must be
evaluated so that the appropriate sub-acute bacterial endocarditis (SBE) regimen can be
instituted. (For example, patients currently taking penicillin cannot be effectively
covered for SBE prophylaxis with amoxicillin).
e. Consultation
If anyone has questions about a specific patient, refer to faculty instructors, who should
be available to advise you. Moreover, In order to coordinate teaching from the various
clinical departments and provide integrated comprehensive care for patients,
consultations are generally required for each patient from the Endodontic, Orthodontic,
Oral Surgery, Periodontic, and Prosthodontic departments. Resulting recommendations
should be entered into the patient's EHR, dated, and electronically signed by the doctor
consulted. It may also be necessary to consult with faculty members regarding patient
care. Consultations provide opportunities to gain experience in oral diagnosis and
treatment planning. A specific Treatment Plan, as well as alternate one, will be
developed for each patient.
TREATMENT PLAN
A Treatment Plan is a detailed list of all treatment to be performed in the proper sequential order.
This plan is based upon the integration of the various diagnoses and recommendations from
consultations. Oral Diagnosis Screening, Consent to Treatment, Treatment Plan, and Financial
are all signed legibly in ink by a licensed dentist and patient. There may be several treatment
plans offered for consideration by the patient.
Prior to beginning any definitive treatment other than emergency services, an approved
Treatment Plan must be developed and consent must be given. This plan will be followed, in the
sequence outlined, throughout the entire treatment of the patient. Treatment Plans require the
signatures of faculty within each department in which a consultation was received. The overall
Treatment Plan is to be signed by the student’s Senior Tutor or AGE Program Director.
At the start of each session, a faculty member must review the electronic health record for
sequence of services which will be performed that day, authorizing the start of the procedure.
When the treatment is completed, a faculty member must review and electronically sign/swipe
notes and the Treatment Plan, indicating that the step has been satisfactorily completed.
Because steps in the Treatment Plan are set out in the sequence, which will result in the best
comprehensive care of the patient, it is necessary to follow the plan accordingly. Therefore, if a
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prior step has not been satisfactorily completed, any following steps may not be started, except in
the case of an emergency.
Once the formalized Treatment Plan has been accepted and signed by the patient, the appropriate
treatment plan, together with the Current Dental Terminology (CDT) procedure code and a brief
description of the treatment are approved in the electronic record and can only be altered by
Senior Tutors or AGE Program Directors.
Effective communication and full discussion of treatment planning costs to the patient is a key to
collections. This is done professionally and tactfully, with consideration for the patient’s needs
and financial status. The PSL will work with students/students to best achieve this goal. The
Treatment Plan is an excellent vehicle in presenting the patient’s needs, the cost of care, and the
payment policies of the Practice.
CDT codes and categories, information on Treatment Planning, and phasing and sequencing is
provided below in Exhibit 28:
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HDC staff
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REFERRALS
1. Oral Radiology
Prior to ordering full mouth x-rays, inquiries should be made of the patient concerning a
history of recent x-rays taken elsewhere, pregnancy, and/or infectious diseases.
For any x-rays, an Oral Radiology Form should be completed and set to “In Process.” The
student on rotation in OR, upstairs in TP, escorts the patient to the TP x-ray area, and x-rays
are taken. Before an x-ray is taken, all patients must pay the appropriate fee.
Routine referrals cannot be made after 4pm. On occasion, the OR rotation may have a heavy
volume of patients, making it necessary to delay the taking of x-rays, especially full mouth
series, until a later date.
Pre-doc and AGE students are encouraged to perform x-rays on their own patients, initially
with supervision. The completed Oral Radiology Form request with signatures of student
and faculty instructor must be present before film will be dispensed.
2. Internal Referrals
Services, which are beyond the scope of the assigned student, may be referred internally to
the appropriate AGE Program or FGP provider. In this case, an Internal Referral Form is
opened in axiUm and sent to the AGE Program Director, AGE student, or FGP provider.
Appropriate follow-up by the assigned student is expected. All internal referrals for students
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are coordinated through the Senior Tutors or the AGE Program Directors. The following
programs do have additional guidelines that should be followed:
a. Oral Surgery
In order to obtain oral surgical services, the requested treatment is entered in the patient's
record on Oral & Maxillofacial Surgery Internal Referral Form, dated and signed by the
student and a faculty instructor. In addition, teeth to be extracted must be entered on the
form along with the appropriate remarks.
The patient's record must be complete, including appropriate x-rays, and be reviewed and
signed by an instructor before appointing the patient for Oral Surgery.
Students meet with the Oral Surgery Instructor(s) for case presentation. With the
Instructor’s approval, appointments for OS can be made in the electronic schedule.
Charges for OS treatment are to be paid at the time the surgery is performed. Students
must inform their patients of this policy and the total fee prior to the surgery.
b. Endodontics
All student referrals to the Endodontics Department must be made via the Senior Tutors
or the AGE Program Directors.
3. Outside/External Referrals
On occasion, patients are referred for treatment to be handled outside of HDC. A faculty
instructor must initiate such a referral with the pertinent information written into the patient's
record. The Senior Tutor or AGE Program Director must approve the referral. This does not
apply to emergencies occurring outside of HDC’s hours.
4. Self-referrals for 3rd and 4th Year Pre-docs

Patients considered “self-referrals” must be registered in axiUm by a Telephone Specialist.
Pre-docs should instruct the self-referrals to call the 617-432-1434, mainline whereby they
can speak with one of three Telephone Specialists who will be able to register them. It is also
important to remind the self-referrals that they need to be assessed for suitability for our
practice, and nothing is a guarantee. It is imperative that pre-docs make sure self-referrals
register. Pre-docs also need to notify the Pre-doc Clinical Curriculum Coordinator for the
Senior Tutors at least 48 hours prior to the appointment.
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SECTION XIV: FINANCIAL PROCESS
OVERVIEW
The HDC payment policy is payment in-full at the time of service for patients who do not have a
third-party benefit (i.e. insurance). All co-payments and deductibles are due at the time service
is rendered. With TP, in particular, it is part of the educational process for students, with the
help of the PSLs and faculty instructors, to learn sound practice management principles and
financials related to their patient accounts.
Exhibit 29 shows acceptable forms of payment.
HDC participates with the following dental insurance agencies:

• DELTA DENTAL (both TP and FGP)
• BLUE CROSS BLUE SHIELD (BC/BS) of MA DENTAL BLUE (both TP and FGP)
• BOSTON TEACHER’S UNION (BTU) (only FGP)
• CIGNA (both TP and FGP)
• MASS HEALTH/DORAL (only TP)
• COMMONWEALTH CARE ALLIANCE (both TP and FGP)
Prior Authorization estimates can be submitted to the insurance company ONLY when a
Treatment Plan is signed by the patient or parent/legal guardian, if the patient is a minor. Please
see PSLs at front desk for any assistance with this assistance.
It is important that when discussing treatment and finances, a provider NEVER tells a patient:
“Your insurance will cover that [a procedure].” A patient’s insurance coverage is determined by
their employer—and plans may differ: E.g. two patients may have Delta Dental Premier with
vastly different plans of coverage. Providers should ask the PSLs discuss all insurance questions
with the patient.
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FINANCIAL TERMINOLOGY
The following are commonly used financial terms at HDC:
Fee-For-Service: All services are rendered on a fee-for-service basis, payable at the time of
service. Payment for a comprehensive Treatment Plan and payments may be subdivided, i.e.
sequenced and phased in axiUm. If a provider requests a change in a routine payment schedule, it
must be handled by the PSLs in advance of the treatment.
Initial X-Rays and Exam: OD patients are told in advance by telephone what the fee will be,
which is payable in full at the time of the appointment.
Emergency Treatment: Concerning an emergency treatment, HDC charges a fee in addition to

charges for treatment done unto the patient. This fee is payable at the time of the appointment.
Treatment Plan, Estimate and Work Schedule: Every patient accepted for comprehensive care
will have a Treatment Plan that will include a cost estimate, approximate timeframe/phased and
sequenced, date and signature by the student and Senior Tutor or the AGE Program Director
before treatment has begun. Once the patient understands options available, the patient will then
sign the Treatment Plan, indicating his/her acceptance.
Payment Schedule: If a payment is overdue in TP, the student is notified in advance and, is
asked to remind the patient to bring payment; in FGP, the PSLs assist with this. If payment is
not made, the appointment must be rescheduled. Should a patient financial account
become delinquent, the record is “locked” and will not be released to the student until the
account in current.
Laboratory Fees: As described in Section XII, all axiUm Lab Order Forms must be
approved in advance. The provider will be held financially responsible for internal and/or
external laboratory costs not paid by the patients. No case will be sent to the laboratory unless
the case is paid according to payment schedule. E.g.
1. For edentulous patients for whom dentures have been prescribed, one half of the total fee
must be paid prior to beginning the treatment and one half at the time of delivery.
2. For patients requiring inlays, onlays, gold crowns, cast and post and core fee must be
paid in full prior to issuance of gold and/or request for outside laboratory services.
3. A request for porcelain crowns to an outside laboratory must have one half of the total
fee paid. Requisitions for gold or laboratory work must be initialed by the PSL indicating
that this requirement has been observed. Providers must have a signed Lab Order Form
by a PSL before final cases are given to students to verify that balances are paid.
Prior Authorization: Some patients are eligible for dental insurance benefits, which require
authorization prior to treatment. To obtain this authorization, the detailed Treatment Plan must
be taken to a PSL, who will complete a Prior Authorization Form. A delay of approximately
four to six weeks can be expected before prior approval is obtained. During this interval,
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any required emergency treatment may be rendered, as well as limited periodontal and
restorative treatment. No partial dentures, inlay, or crown and bridge treatment will be started
without necessary approval from the insurance agency. In completely edentulous patients,
treatment may be rendered up to the ordering of teeth while waiting for prior approval.
Treatment Adjustment Record (TAR): Any financial write-off, re-treatment, or adjustment

needs to be recorded via a TAR in axiUm. The TAR must be entirely completed, with the “Type
of adjustment” selected (financial or clinical), as well as specific information regarding the
procedure, amount, and explanation (e.g. D2790, #8, $xxx.xx…). Students must obtain signature
approval from their Senior Tutor or AGE Program Director. Then, the TAR must be set to “In
Process” and the PSLs need to be made aware to help complete.
MASS HEALTH (MEDICAID)
For patient with Mass Health/Doral, eligibility must be verified prior to treatment, as
patients are often misinformed or confused about eligibility. Treatment Plans for all Mass
Health patients MUST be reviewed by the PSLs.
Instructions for the Processing Mass Health Prior Authorization Form. This is completed by
the provider, who should indicate:
• Patient's Name and Date-of-Birth (DOB)
• Mass Health Fee Schedule Service Code
• Tooth Number
• Reason for Services
The provider should also:

• Attach duplicate x-rays and periodontal charting, where applicable.
• Return the form with documentation to PSLs for approval and processing.
Mass Health is based on set fee schedule. Following approval, the claim is submitted to Mass
Health for payment. Providers should not begin any treatment until prior approval is
received.
Service Not Covered by Mass Health: Mass Health provides limited coverage for patients over
the age of 21 and does not cover patients over the age of 65. All Mass Health patients must be
informed of non-covered services by the provider before beginning treatment. A list of all
covered and non-covered services are available with the PSLs. Mass Health patients shall be
billed during the monthly billing period for any outstanding fees not covered by Mass Health.
RYAN WHITE HIV/AIDS PROGRAM
All existing HDC patients covered by the Ryan White HIV/AIDS Program have received a letter
asking them to register with the Boston Public Health Commission HIV Dental Ombudsman
Program.
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TP patients with Mass Health have been asked to apply for the Special Circumstance
consideration. If the Special Circumstance is received, Mass Health will be billed for covered
services.
In FGP, if a patient does not have dental insurance, the FGP dentist can transfer care to TP to be
assigned to a student. The FGP dentist will receive minimal reimbursement for procedures that
are a part of the Ryan White HIV/AIDS Program.
New patients need to first register with the Dental Ombudsman Program. Upon completion of
enrollment, the Program will notify the PSL Coordinator (who sits at the FGP front desk). A new
patient appointment will be made in OD.
For any questions regarding this program, please see the PSL Coordinator. The program
covers everything, except for Implant and Ortho procedures; also, bone grafting is covered so
long as not done on day of surgery.
Special Circumstances/Part F Reimbursement
Patients who qualify for Special Circumstances will follow the procedure for Mass Health for
prior authorization.
Patients with no insurance and those who do not qualify for Mass Health Special Circumstances
will be registered as Ryan White and all visits and procedures tracked for Part F reimbursement.
These services include all dental codes with the exception of Implant surgery—D6010 and all
Ortho procedures D8000-D8999.
INSURANCE
All pre-doc Treatment Plans involving third party insurance must be presented to the PSLs
for Prior Authorization. Payment by means of dental insurance is never automatic, and the
PSLs cannot send out any insurance claims without complete information from the student or
faculty providers.
HDC Policies Regarding Patient Dental Insurance
1. The financial policy states that the patient is directly responsible for payment for services
rendered. All insurance plans are agreements made between the patient and the individual
insurance companies.
2. HDC does cooperate in filling out any required forms to allow the patient to claim
reimbursement from the third party lender.
3. Oral Surgical Services covered by numerous third party lenders and performed by HDC
Oral Surgeons in a hospital can be arranged through the billing service of the hospital.
HDC is not responsible for any service performed by a hospital.
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4. As mentioned above on page 120, HDC participates with the following dental insurance
agencies:
• DELTA DENTAL PREMIER (both TP and FGP)
• BLUE CROSS BLUE SHIELD (BC/BS) of MA DENTAL BLUE (both TP and
FGP)
• BOSTON TEACHER’S UNION (BTU) (only FGP)
• CIGNA (both TP and FGP)
• MASS HEALTH/DORAL (only TP)
• COMMONWEALTH CARE ALLIANCE (both TP and FGP)
COLLECTIONS PROCEDURES
This process for collections involves the PSL Team.
Internal Collection Letters (ICL)

Required: letter with notice of non-return if sent to collection.
 Sent to accounts with balances 90+ days overdue
 Work must be completed
 No outstanding insurance claims
 Ortho if patient’s co-pays overdue
 Under 18 address to Guarantor/Parent
ROSSI Transmittal - Include:

 Rossi “New A/C Data Entry” Form
 PL reflecting write-off/zero balance
 ICL
 ALL other correspondence & notes
 Highlight Amount(s) of Debt
 Must Federal Express to Rossi
HDC file
 Copy all documents sent to Rossi
 Highlight in YELLOW patient name, A/C number, and last entry on PL
which should be the W/O & notes
 File in Active Section (YELLOW) in Collection/Rossi Binders
Writing Off Bad Debt

 COL+ Write Off Reversal
 COL- Write Off Collections
Moreover, to help with collections on a daily basis, HDC staff run the “Missing Charge Report”
and reach out to providers to ensure charges get entered in.
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HSDM DISCOUNT POLICY
The following are the policies of HSDM/HDC regarding the granting of discounts for dental
services provided at HDC. All faculty, staff, and students involved are expected to comply with
these policies and refer any questions regarding these policies to the Assistant Dean for Clinical
Affairs and Special Projects or the Vice Dean/Medical Director. Staff and faculty do not qualify
for discounts.
Eligible parties:
• DENTISTRY STUDENTS: Students who have matriculated and are currently enrolled
in one of the degree and/or specialty certificate programs offered by HSDM or HMS.
• IMMEDIATE FAMILY OF STUDENTS: For purposes of this policy, immediate

family is limited to the following: Grandmother, grandfather, mother, father, brothers,
sisters, children, and spouse.
Requirements: ALL DISCOUNTS REQUIRE A SIGNED TAR AND A FULLY APPROVED

COMPREHENSIVE TREATMENT PLAN WITH ALL PROCEDURES AND SPECIALTIES
LISTED. THERE IS A $3,000 LIFETIME MAXIMUM PER PATIENT; in some instances this
can be waived by the Medical Director.
Insurance: Individuals who have dental insurance coverage may take advantage of their
discount only if their insurance maximum has been exceeded for the year or if the procedure is
not covered by their insurance policy.
AVAILABLE DISCOUNTS:
FOR DENTISTRY STUDENTS:

• 100% on work completed by pre-doc students.
• 25% on work completed by AGE students.
• Exceptions:
o Students must supply or pay for gold and implant components.
o Students must pay lab fee, if lab work is not done by a dental student, and instead by an
external lab vendor.
FOR DENTISTRY STUDENTS' IMMEDIATE FAMILY:

• 15% on work completed by pre-doc students and AGE students.
• Exceptions: No discounts on removable partial dentures; sedation (IV or nitrous).
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SECTION XV: ADMINISTRATIVE CONTACTS
PHONE DIRECTORY
Office of Clinical Affairs and Operations, General HDC Contacts:
• Dr. John Da Silva, Vice Dean and Medical Director,(617) 432-1440

• Dr. German Gallucci, Executive Director of Harvard Dental Center, (617) 432-5764
• Catherine Ramos, Assistant Dean for Clinical Affairs and Special Projects, (617) 432-4276
• Myra Majewski, Director of Clinical Operations, (617) 432-6188
• Scott Jason, Clinical Applications Director, (617) 432-7220
• Susan Cottrell, EH&S and Infection Control Administrator, (617) 432-1007
• Yves de Jesus, Coordinator for Clinical Affairs and Clinical Operations, (617) 432-1406
• Latisha Gunter, Lead Telephone Specialist, (617) 432-6621
• Juana Colon, Telephone Specialist, (617) 432-5763
• Sandra Abrego, Telephone Specialist, (617) 432-6622
Harvard Dental Center Managers:
• Lee Mann, Assistant Director of Clinical Support Services, (617) 432-0917

• Andreas Radics, Assistant Director of Lab and Clinical Materials, (617) 432-1462
• Sherry Wilson-Johnson, Assistant Director of Financial and Patient Services, (617) 432-
5346
Labs/Materials/Sterilization:
• Mohamed Alaeddin, Lab Coordinator, (617) 432-1382

• Julian Bergschneider, Materials Management Coordinator, (617) 432-1421
• Charles Mwele, Lab Coordinator, (617) 432- 5273
• Sterilization,(617)432-5244
• Katherine White, Implant Liaison Coordinator, (617) 432-4060
• Steve Witkus, Procurement Specialist, (617) 432-6626
PSLs/Phone Specialists:
• Lisa Lavargna, PSL Coordinator, (617) 432-4289

• Eleni Kayas, PSL, (617) 432-2473
• Niulka Martinez, PSL, (617) 432-6624
• Rebecca Santiago, PSL, (617) 432-7499
• Dayecember Simms, PSL, (617) 432-2469
• Susan St. Martin, PSL, (617) 432-6628
• William Walker, PSL, (617) 432-6619
Business Office:
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• Barbara Caffelle, Accounting Assistant, (617) 432-4275
• Geneve Lewis, Staff Assistant, (617) 432-4275
Miscellaneous
• Harvard Campus Security, (617) 432-1379
• HUPD, (617) 432-1212
• HUHS, Vanderbilt Hall, (617) 432-1370
• HUHS, Holyoke Center (24 hrs.), (617) 495-5711
• Material Spills within HDC, (617) 432-0950
• Chemical/Bio/Radiation Spills in REB, (617) 432-1720
• EH&S, (617) 432-1720
• BWH Emergency Department, (617) 732-5653
• OMFS, MGH, (617) 726-2740 or 726-2241
• Boston Children’s Hospital, (617) 355-6000
127
SECTION XVI: CREDENTIALING
CREDENTIALING REQUIREMENTS FOR FACULTY MEMBERS
For any new faculty member practicing at HDC, the following is required prior to the faculty
member practicing:
• Completed Application for Initial Credentialing submitted to the Office of Clinical
Affairs for verification and processing.
 Credentialing Packet & CV
 Massachusetts License
o Limited/Temporary License (renewed annually)
o Full License (renewed every 2 years on 3/31)
 NPI Number
 CPR/BLS Certificate
 CRICO Application
 CRICO Confirmation Page
 HDC Annual Training Modules
 BCBS Provider Application
 Cigna Provider Application
 Delta Dental Provider Application
 Visa, if applicable
 Federal DEA, if applicable
 Massachusetts Controlled Substances Registration, if applicable
 Immunization Records
• Approval by the Credentialing Committee.
• Assigned and approved Privileges by the Credentialing Committee.
Applications are available through the Office of Clinical Affairs.
128
CREDENTIALING REQUIREMENTS FOR AGE STUDENTS
For any AGE students practicing at HDC, we require:

 Credentialing Packet & CV
 Massachusetts License
o Limited/Temporary License (renewed annually)
o Full License (renewed every 2 years on 3/31)
 NPI Number
 CPR/BCLS Certificate
 CRICO Application
 CRICO Confirmation Page
 Immunization Records
 BCBS Provider Application
 Cigna Provider Application
 Delta Dental Provider Application
 Visa, if applicable
 Federal DEA, if applicable
 Massachusetts Controlled Substances Registration, if applicable
For AGE students practicing off-site at hospitals, we require:

 Massachusetts License Number
 NPI Number
 CRICO Face Page
For interns/externs visiting from other institutions, we require:

 6 Training Modules
 Proof of Professional Liability
 Proof of Medical Insurance
 Proof of Immunization Records
Incoming AGE Students/Orientation Procedures:
Incoming HDC-based AGE students are sent the “Pre-Matriculation Memo #1” in January,
which includes:
 Info for non-U.S. citizens re: SSN
 MA limited license application & link for MA full license application
 Link for NPI application
 CRICO application
 Information Regarding: MCSR/DEA
 Information Regarding: Training Modules and CPR
All incoming HDC-based AGE students will attend a credentialing session hosted by the Office
of Clinical Affairs and Operations and the Office of Dental Education during orientation. At the
129
credentialing session, they will complete any outstanding applications, credentialing packet, and
the BCBS, Cigna and Delta Dental Provider Applications.
130
SECTION XVII: APPENDIX
1.1 HSDM STATEMENT OF CONFIDENTIALITY
131
1.2. REQUEST TO INSPECT AND/OR COPY HEALTH RECORDS
132
1.3 PATIENT AUTHORIZATION FOR SPECIFIC DISCLOSURE OF PHI
133
1.4 ANNUALLY REQUIRED TRAINING
Title: Annually Required Training

Department: Harvard School of Dental Medicine (HSDM)
Policy Type: HSDM-wide
Applies to: Entire HSDM Workforce
Approved by: Dean of Administration and Finance
Approval Date: 05/14/2015
Effective Date: 05/14/2015
Revision Date(s):
Next Review Date: 05/14/2017
Contact Person: HSDM Compliance Officer
1. Introduction
All HSDM students, faculty, staff, Harvard appointees and 3rd parties must take annual training
to remain in compliance with school requirements.
2. Scope
This policy applies to all HSDM students, faculty, staff, Harvard appointees and 3rd parties.
Failure to comply with this policy could result in appropriate disciplinary actions being taken up
to, and including, termination.
3. Policy
1. All HSDM students, faculty, staff, Harvard appointees and 3rd parties working within the
HDC and/or have direct patient interaction must take the following HSDM training
modules upon start of employment/matriculation and on an annual basis thereafter:
o HIPAA Overview FY16:
http://eureka.harvard.edu//Eureka/aicc_directLaunch.cfm?course_ID=1350
o Information Security FY16:
o Bloodborne Pathogen Training FY16:
o Emergency Protocols FY16:
o Hazardous Waste Training FY16:
134
2. All HSDM students, faculty, staff, Harvard appointees and 3rd parties who do NOT work
within the HDC and/or have direct patient interaction must take the following HSDM
training modules upon start of employment/matriculation and on an annual basis
thereafter:
Entire HSDM Community

Researchers (PIs and lab staff) – With No Clinic Duties:

Note: Research Bloodborne Pathogen and Hazardous Waste Training is provided through
Harvard’s EH&S group and should not be confused with modules mentioned here. Please
contact the Director of Core Laboratories if you have questions on this.
3. All individuals taking the training must answer all questions correctly before receiving
credit for completing the training.
4. All HSDM students, faculty, staff, Harvard appointees and 3rd parties will be requested to
renew their training requirement during the month of July of each year.
5. Individuals on-boarded in the 4th Quarter (April-June) of a Fiscal Year AND who do
NOT work within the HDC and/or have direct patient interaction will not need to retake
the training modules unless the material has been modified.
135
1.5 TWO ACCIDENT FORMS
Medical Emergency Record (MER)
136
137
138
Non-OSHA Reportable Injury Form
139
1.6 EVALUATION FOR ENDOCARDITIS PROPHYLAXIS FORM
140
1.7 PREVENTION OF BACTERIAL ENDOCARDITIS
Guidelines from the American Heart Association

Published April 2007
Guidelines for Endocarditis Prophylaxis
The guidelines say patients who have taken prophylaxis antibiotics routinely in the past but no
longer need them include people with:
• Mitral valve prolapse
• Rheumatic heart disease
• Bicuspid valve disease
• Calcified aortic stenosis
• Congenital heart conditions (ventricular septal defect, atrial septal defect, and
hypertrophic cariomyopathy)
The new guidelines are aimed at patients who would have the greatest danger of a bad outcome
if they developed a heart infection. Preventative antibiotics prior to a dental procedure are
advised for patients with:
• Artificial heart valves
• A history of endocarditis
• Certain specific, serious congenital (present from birth) heart conditions, including:
o Unrepaired or incompletely repaired cyanotic congenital heart disease, including
those with palliative shunts and conduits
o A completely repaired congenital heart defect with prosthetic material or device,
whether placed by surgery or by catheter intervention, during the first six months
after the procedure
o Any repaired congenital heart defect with residual defect at the site or adjacent to
the site of a prosthetic patch or a prosthetic device
• A cardiac transplant that develops a problem in a heart valve.
The new recommendations apply to many dental procedures, including teeth cleaning and
extractions. Patients with congenital heart disease can have complicated circumstances. They
should check with their cardiologist if there is any question at all as to the category that best fits
their needs.
The AHA guidelines emphasize that maintaining optimal oral health and practicing daily hygiene
are more important in reducing the risk of IE than taking preventative antibiotics before a dental
visit.
Regimens for a Dental Procedure
Situation Agent Regimen – Single Dose 30-60 minutes

before procedure
Adults Children
141
Oral Amoxicillin 2gm 50 mg/kg
Ampicillin 2 g IM or IV* 50 mg/kg IM or IV

Unable to take oral OR
medication Cefazolin or ceftriaxone 1 g IM or IV 50 mg/kg IM or IV
Allergic to penicillins Cephalexin**† 2g 50 mg/kg
or ampicillin OR
Oral Clindamycin 600 mg 20 mg/kg
OR
Azithromycin or clarithomycin 500 mg 15 mg/kg
Allergic to penicillins Cefazolin or ceftriaxone† 1 g IM or IV 50 mg/kg IM or IV
or ampicillin and OR
unable to take oral Clindamycin 600 mg IM or IV 20 mg/kg IM or IV
medication
*IM – intramuscular; IV – intravenous

**or other first or second generation oral cephalosporin in equivalent adult or pediatric dosage
† Cephalospolorins should not be used in an individual with a history of anaphylaxis,
angioedema, or urticaria with penicillins or ampicillin.
Total Joint Infection Prophylactic Antibiotic Prophylaxis (PAP) 1 is aimed at preventing

hematogenous prosthetic joint infections in dental patients who have undergone total joint
arthroplasties and applies to dental procedures that have a higher bacteremic risk (see below).
Not Indicated:
1. Patients with pins, plates or screws
2. Total joint replacement patients (including high-risk patient) who are undergoing a low risk
dental procedure such as fluoride treatment, X-rays or orthodontic appliance adjustment.
Indicated:
1. All patients during the first two (2) years after prosthetic joint replacement.
2. Immunocompromised/immunosuppressed patients
a. Inflammatory arthropathies (e.g.: rheumatoid arthritis, systemic lupus
erythematosus)
b. Drug -induced immunosuppression
c. Radiation-induced immunosuppression
3. Patients with co-morbidities (e.g.)
a. Previous prosthetic joint infections
b. Malnourishment
c. Hemophilia
d. HIV infection
e. Insulin-dependent (Type 1) diabetes
f. Malignancy
1
2002 American Dental Association and American Academy of Orthopedic Surgeons
142
Dental procedures that have a higher bacteremic risk:
 Dental extractions
 Periodontal procedures including surgery, subgingival placement of antibiotic fibers/strips,
scaling and root planing, probing, recall maintenance
 Dental implant placement and replantation of avulsed teeth
 Endodontic (root canal) instrumentation or surgery only beyond the apex
 Initial placement of orthodontic bands but not brackets
 Intraligamentary and intraosseous local anesthetic injections
 Prophylactic cleaning of teeth or implants where bleeding is anticipated
Suggested antibiotic prophylaxis regimens*
 Patients not allergic to penicillin: cephalexin, cephradine or amoxicillin: 2 grams orally 1

hour prior to dental procedure.
 Patients not allergic to penicillin and unable to take oral medications: cefazolin 1 gram or
ampicillin 2 grams IM/IV 1 hour prior to the procedure.
 Patients allergic to penicillin: clindamycin: 600 mg orally 1 hour prior to the dental
procedure.
 Patients allergic to penicillin and unable to take oral medications: clindamycin 600 mg IV, 1
hour prior to the procedure.
*No second doses are recommended for any of these dosing regimens.
143
1.8 GUIDELINES FOR PRESCRIBING DENTAL RADIOGRAPHS
PATIENT AGE AND DENTAL DEVELOPMENT STAGE

TYPE OF Child with Primary Child with Adolescent Adult, Adult,
ENCOUNTER Dentition (prior to first Transitional with Dentate or Edentulous
eruption of first Dentition (after Permanent Partially
permanent tooth) eruption of first Dentition Edentulous
permanent (prior to
tooth) eruption of
third molars)
New Patient* Individualized Individualized Individualized radiographic Individualized
being evaluated for radiographic exam radiographic exam consisting of posterior radiographic
dental diseases and consisting of selected exam consisting bitewings with panoramic exam, based on
development periapical/occlusal of posterior exam or posterior bitewings clinical signs and
views and/or posterior bitewings with and selected periapical symptoms.
bitewings if proximal panoramic exam images. A full mouth
surfaces cannot be or posterior intraoral radiographic exam is
visualized or probed. bitewings and preferred when the patient
Patients without selected has clinical evidence of
evidence of disease and periapical generalized dental disease or
with open proximal images. a history of extensive dental
contacts may not treatment.
require a radiographic
exam at this time.
Recall Patient* Posterior bitewing exam at 6-12 month intervals if Posterior Not applicable
with clinical caries proximal surfaces cannot be examined visually or with a bitewing
or at increased risk probe. exam at 6-18
for caries** month
intervals
Recall Patient* Posterior bitewing exam at 12-24 month Posterior Posterior Not applicable
with no clinical intervals if proximal surfaces cannot be bitewing bitewing
caries and not at examined visually or with a probe. exam at 18-36 exam at 24-
increased risk for month 36 intervals
caries** intervals
Recall Patient* Clinical judgment as to the need for and type of radiographic images for the Not applicable
with periodontal evaluation of periodontal disease. Imaging may consist of, but is not limited
disease to, selected bitewing and/or periapical images of areas where periodontal
disease (other than non-specific gingivitis) can be identified clinically.
Patient for Clinical judgment as to need for and type Clinical Usually not indicated.
monitoring of of radiographic images for evaluation judgment as
growth and and/or monitoring of dentofacial growth to need for
development and development. and type of
radiographic
images for
evaluation
and/or
monitoring of
dentofacial
growth and
development.
Panoramic or
periapical
exam to
144
assess
developing
third molars.
Patient with other Clinical judgment as to need for and type of radiographic images for evaluation and/or
circumstances monitoring in these circumstances.
including, but not
limited to, proposed
or existing implants,
pathology,
restorative/endodont
ic needs, treated
periodontal disease
and caries
remineralization
*Clinical situations for which radiographs may be indicated include but are not limited to:
A. Positive Historical Findings
1. Previous periodontal or endodontic treatment
2. History of Pain or Trauma
3. Familial history of dental anomalies
4. Postoperative evaluation of healing
5. Remineralization monitoring
6. Presence of implants or evaluation for implant placement
B. Positive Clinical Signs/Symptoms

1. Clinical evidence of periodontal disease
2. Large or deep restorations
3. Deep carious lesions
4. Malposed or clinically impacted teeth
5. Swelling
6. Evidence of dental/facial trauma
7. Mobility of teeth
8. Sinus tract (“fistula”)
9. Clinically suspected sinus pathology
10. Growth abnormalities
11. Oral involvement in known or suspected systemic disease
12. Positive neurologic findings in the head and neck
13. Evidence of foreign objects
14. Pain and/or dysfunction of the temporomandibular joint
15. Facial asymmetry
16. Abutment teeth for fixed or removable partial prosthesis
17. Unexplained bleeding
18. Unexplained sensitivity of teeth
19. Unusual eruption, spacing or migration of teeth
20. Unusual tooth morphology, calcification or color
21. Unexplained absence of teeth
22. Clinical erosion
**Factors increasing risk for caries may include but are not limited to:
1. High level of caries experience or demineralization
2. History of recurrent caries
3. High titers of cariogenic bacteria
4. Existing restoration(s) of poor quality
5. Poor oral hygiene
145
6. Inadequate fluoride exposure
7. Prolonged nursing (bottle or breast)
8. Frequent high sucrose content in diet
9. Poor family dental health
10. Developmental or acquired enamel defects
11. Developmental or acquired disability
12. Xerostomia
13. Genetic abnormality of teeth
14. Many multisurface restorations
15. Chemo/radiation therapy
16. Eating disorders
17. Drug/alcohol abuse
18. Irregular dental care
From: American Dental Association, U.S. Food & Drug Administration.
The Selection of Patients for Dental Radiograph Examinations. Available on www.ada.org; additional information
available via
http://www.ada.org/~/media/ADA/Member%20Center/FIles/Dental_Radiographic_Examinations_2012.ashx
146
1.9 HSDM MEDICATION STORAGE PROTOCOL
147
148

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CLINICAL POLICIES AND

Office of Clinical Affairs and Clinical Operations

AADR=American Association for Dental Research

AAE=American Association of Endodontists

AAFP=American Academy of Fixed Prosthodontics

AAID=Academy of Implant Dentistry

AAMI=Association for the Advancement of Medical Instrumentation

AAOMS=American Association of Oral and Maxillofacial Surgeons

AAP=American Academy of Periodontology

AAPD=American Academy of Pediatric Dentistry

ACLS=Advanced Cardiovascular Life Support

ACP=American College of Prosthodontists

ADA=American Dental Association

ADCA=American Dental Coders Association

ADEA=American Dental Education Association

ADEX=American Board of Dental Examiners

ADHA=American Dental Hygienists Association

AED=Automated External Defibrillator

AGE=Advanced Graduate Education

AHA=American Heart Association

ANSI=American National Standards Institute

AOD=Academy of Operative Dentistry

AY=Academic Year (effective late August/early September)

BFACA=Business and Financial Administration and Clinical Administration (part of

BLS=Basic Life Support

BMI=Body Mass Index

BORID=Board of Registration in Dentistry

BPHC=Boston Public Health Commission

BWH=Brigham & Women’s Hospital

CAMBRA=Caries Management by Risk Assessment

CART=Communication Access Realtime Translation (Hearing Impaired Service)

CCE=Clinical Comprehensive Exam

CCR=Comprehensive Care Rotation (formerly ADR)

CDA=Certified Dental Assistant

CDC=Centers for Disease Control and Prevention

CDCA=Commission on Dental Competency Assessments (formerly NERB)

CDT=Current Dental Terminology

CHA=Cambridge Health Alliance

CMR=Code of Massachusetts Regulations

COA-Certified Orthodontic Assistant

CODA=Commission on Dental Accreditation

COHRI=Consortium for Oral Health Research and Informatics

CORI=Criminal Offender Record Information

CRICO=Controlled Risk Insurance Company

DANB=Dental Assisting National Board

DDL=Digital Dental Lab

DMC=Dental Materials Committee

DMD=Doctor of Dental Medicine

DDS=Doctor of Dental Science

DEA=Drug Enforcement Administration

DHCW=Dental Health-Care Workers

DPH=(Massachusetts) Department of Public Health

EDIC=Eastern Dentists Insurance Company

EHR=Electronic Health Record

EH&S=Environmental Health & Safety

EMT=Emergency Medical Technician

EPA=(United States) Environmental Protection Agency

FCC=Foundational Continuity Clinic

FDA=(United States) Food and Drug Administration

FGP=Faculty Group Practice

FY=Fiscal Year (Effective July 1st through June 30th)

GPR=General Practice Residency

HDC=Harvard Dental Center