Dental Practice Compliance Checklist Template
Ensure your dental practice is audit-ready! Our Dental Practice Compliance Checklist Template simplifies regulatory adherence, covering patient safety, HIPAA, OSHA, and more. Download now and streamline your compliance efforts.
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HIPAA Compliance
Ensuring patient privacy and data security.
Business Associate Agreements (BAAs) Reviewed?
Last Privacy Rule Training Date
Designated Privacy Officer Assigned?
Summary of Privacy Rule Updates & Training
Patient Access Request Procedures in Place?
HIPAA Risk Assessment Report
Number of Patient Data Breaches Reported (Past Year)
OSHA Safety & Infection Control
Maintaining a safe environment for patients and staff, adhering to OSHA guidelines.
Last Sharps Container Disposal Date
Hand Sanitizer Dispenser Fill Level (inches)
Surface Disinfectant Used (EPA Registered)
PPE Availability (Check all that apply)
Last Autoclave Maintenance Date
Autoclave Spore Testing Result
Notes on any safety or infection control concerns
Patient Record Management
Procedures for handling patient records, consents, and documentation.
Last Record Audit Date
Summary of Record Audit Findings
Record Storage Method
Number of Paper Records (if applicable)
Retention Schedule Compliance
Last Consent Form Review Date
Notes on Consent Form Updates/Revisions
Financial Compliance
Ensuring accurate billing, coding, and revenue cycle management.
Current Fee Schedule Review Date
Billing Software Version
Last Audit of Claim Denials
Claim Denial Rate (%), Current Period
Summary of Recent Coding Updates Implemented
Compliance Training for Billing Staff (Completed?)
Copy of Current Fee Schedule
State & Federal Regulations
Adherence to relevant state and federal laws and regulations.
Last Review Date of Federal Regulations
Summary of Recent Federal Regulatory Updates
DEA Registration Number (Federal)
State Dental Board Reporting Requirements
Date of Last State Dental Board Audit
Summary of State-Specific Dental Practice Act Compliance
Compliance with Stark Law?
Controlled Substances Management
Protocols for handling, dispensing, and documenting controlled substances.
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)
Inventory Record Documentation (Attach)
Signature of Person Performing Inventory
Emergency Preparedness
Procedures for handling emergencies, including fire, medical incidents, and natural disasters.
Last Emergency Drill Date
Emergency Contact List – Primary Contact
Emergency Contact List – Secondary Contact
Emergency Evacuation Plan Description
Emergency Supplies Checked
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
Review and verification of consent forms for procedures and treatments.
Consent Form Received Date
Patient Explanation of Procedure
Patient Questions and Concerns
Patient Understanding
Patient Signature
Witness Signature (if required)
Scanned Consent Form (if applicable)
Equipment Maintenance & Calibration
Ensuring all dental equipment is properly maintained and calibrated.
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
Last Autoclave Validation Date
Employee Training & Credentials
Verification of employee training, certifications, and licenses.
Employee Name
Last Training Date (HIPAA)
Next Training Date (OSHA)
Completed Training Modules
Copy of Certification/License
License Number
Expiration Date (License)
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