DENTAL PRACTICE COMPLIANCE CHECKLIST TEMPLATE

Created by ChecklistGuro (https://checklistguro.com)

--- HIPAA COMPLIANCE ---
[ ] Business Associate Agreements (BAAs) Reviewed? (Yes, No, In Progress)
[ ] Last Privacy Rule Training Date
[ ] Designated Privacy Officer Assigned? (Yes, No)
[ ] Summary of Privacy Rule Updates & Training
[ ] Patient Access Request Procedures in Place? (Yes, No)
[ ] HIPAA Risk Assessment Report
[ ] Number of Patient Data Breaches Reported (Past Year)

--- OSHA SAFETY & INFECTION CONTROL ---
[ ] Last Sharps Container Disposal Date
[ ] Hand Sanitizer Dispenser Fill Level (inches)
[ ] Surface Disinfectant Used (EPA Registered) (Bleach Solution, Quaternary Ammonium, Hydrogen Peroxide, Other (Specify))
[ ] PPE Availability (Check all that apply) (Gloves, Masks, Gowns, Eye Protection)
[ ] Last Autoclave Maintenance Date
[ ] Autoclave Spore Testing Result (Pass, Fail, Not Performed)
[ ] Notes on any safety or infection control concerns

--- PATIENT RECORD MANAGEMENT ---
[ ] Last Record Audit Date
[ ] Summary of Record Audit Findings
[ ] Record Storage Method (Paper-Based, Electronic (EHR), Hybrid)
[ ] Number of Paper Records (if applicable)
[ ] Retention Schedule Compliance (Yes, No, N/A)
[ ] Last Consent Form Review Date
[ ] Notes on Consent Form Updates/Revisions

--- FINANCIAL COMPLIANCE ---
[ ] Current Fee Schedule Review Date
[ ] Billing Software Version (Version 1.0, Version 2.0, Version 3.0, Other)
[ ] Last Audit of Claim Denials
[ ] Claim Denial Rate (%), Current Period
[ ] Summary of Recent Coding Updates Implemented
[ ] Compliance Training for Billing Staff (Completed?) (Yes, No)
[ ] Copy of Current Fee Schedule

--- STATE & FEDERAL REGULATIONS ---
[ ] Last Review Date of Federal Regulations
[ ] Summary of Recent Federal Regulatory Updates
[ ] DEA Registration Number (Federal)
[ ] State Dental Board Reporting Requirements (Annual Reporting, Quarterly Reporting, No Reporting Required)
[ ] Date of Last State Dental Board Audit
[ ] Summary of State-Specific Dental Practice Act Compliance
[ ] Compliance with Stark Law? (Yes, No, N/A)

--- CONTROLLED SUBSTANCES MANAGEMENT ---
[ ] Last Inventory Date
[ ] Initial Quantity of [Specific Substance]
[ ] Quantity Used/Dispensed
[ ] Quantity Returned/Wasted
[ ] Date of Discrepancy (if any)
[ ] Explanation of Discrepancy (if any)
[ ] Method of Destruction (if any) (Witnessed Destruction, Return to Supplier, Other)
[ ] Inventory Record Documentation (Attach)
[ ] Signature of Person Performing Inventory

--- EMERGENCY PREPAREDNESS ---
[ ] Last Emergency Drill Date
[ ] Emergency Contact List â€“ Primary Contact
[ ] Emergency Contact List â€“ Secondary Contact
[ ] Emergency Evacuation Plan Description
[ ] Emergency Supplies Checked (First Aid Kit, Flashlights, Backup Power, Communication Devices)
[ ] Quantity of Fire Extinguishers & Inspection Date
[ ] Location of Emergency Shut-Offs (Water, Gas, Electricity)
[ ] Procedure for Medical Emergencies (e.g., Patient Cardiac Arrest)

--- CONSENT FORMS & DOCUMENTATION ---
[ ] Consent Form Received Date
[ ] Patient Explanation of Procedure
[ ] Patient Questions and Concerns
[ ] Patient Understanding (Fully Understands, Partially Understands, Does Not Understand)
[ ] Patient Signature
[ ] Witness Signature (if required)
[ ] Scanned Consent Form (if applicable)

--- EQUIPMENT MAINTENANCE & CALIBRATION ---
[ ] Last Calibration Date - Ultrasonic Scaler
[ ] Ultrasonic Scaler Power Output (Watts)
[ ] Last Maintenance Date - Dental Chairs
[ ] Details of Dental Chair Maintenance (e.g., lubrication, upholstery)
[ ] X-Ray Machine Exposure Rate (mR/s)
[ ] Last X-Ray Machine QA Test Date
[ ] Autoclave Validation Method (Biological Indicator, Chemical Indicator, Physical Indicator)
[ ] Last Autoclave Validation Date

--- EMPLOYEE TRAINING & CREDENTIALS ---
[ ] Employee Name
[ ] Last Training Date (HIPAA)
[ ] Next Training Date (OSHA)
[ ] Completed Training Modules (HIPAA Training, OSHA Infection Control, Radiology Safety, Chart Management, Emergency Procedures)
[ ] Copy of Certification/License
[ ] License Number
[ ] Expiration Date (License)

--- END OF TEMPLATE ---
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