The definitions in this section apply throughout this chapter unless the context clearly indicates otherwise:

(1) "Clinical record" means the portion of the patient record that contains information regarding the patient exam, dental hygiene care plan, treatment discussion, treatment performed, patient progress, progress notes, referrals, studies, tests, imaging of any type and any other information related to the dental hygiene care or treatment of the patient.

(2) "Committee" means the dental hygiene examining committee.

(3) "Dental hygienist" means an individual licensed under chapter 18.29 RCW and this chapter.

(4) "Department" means the Washington state department of health.

(5) "Financial record" means the portion of the patient record that contains information regarding the financial aspects of a patient's treatment including, but not limited to, billing, treatment plan costs, payment agreements, payments, insurance information or payment discussions held with a patient, insurance company or person responsible for account payments.

(6) "Group home" means a licensed facility that provides its residents with twenty-four hour supervision. Depending on the size, a group home may be licensed as an adult family home under chapter 70.128 RCW or an assisted living facility under chapter 18.20 RCW. Group homes provide community residential instruction, supports, and services to two or more clients who are unrelated to the provider.

(7) "Home health agency" has the same meaning as in chapter 70.126 RCW.

(8) "Hospital" has the same meaning as in RCW 70.41.020.

(9) "Notation" means a condensed or summarized written record.

(10) "Nursing home" has the same meaning as in RCW 18.51.010(3).

(11) "Patient record" is the entire record of the patient maintained by a practitioner that includes all clinical and financial information related to the patient.

(12) "Secretary" means the secretary of the department of health or the secretary's designee.

(((1))) An applicant for a dental hygiene license shall submit to the department the following:

(((a)))(1) An initial application on forms provided by the department;

(((b)))(2) The fee required under WAC 246-815-990;

(((c)))(3) Proof of successful completion of the Washington state dental hygiene drug and law jurisprudence exam as required by the department; ((and (d)))

(4) Proof of completion of seven clock hours of HIV/AIDS education as required in chapter 246-12 WAC, Part 8((.

(a) Have));

(5) Official transcripts verifying successful completion of ((a))an approved dental hygiene education program ((approved by the secretary under WAC 246-815-030 sent directly from the dental hygiene program to the department))and proof of successful completion of any applicable expanded education programs approved under WAC 246-815-030. Official transcripts must be sent directly to the department by the dental hygiene education program(s). No other proof of successful completion is acceptable;

(((b) Have))(6) Official verification of passing the National Board Dental Hygiene written examination((. Results)), as offered by the American Dental Association. Official verification must be sent directly to the department from the American Dental Association Department of Testing Services; and

(((c) Have))(7) Official verification of passing the dental hygiene examinations as required in WAC 246-815-050. ((Results))Official verification must be sent directly to the department from the testing agency.

(1) To be eligible for initial dental hygiene licensure, the applicant must have successfully completed a dental hygiene education program approved by the secretary ((of the department of health)). The secretary ((adopts the standards of the American Dental Association))accepts dental hygiene programs that are accredited by the Commission on Dental Accreditation ((("CODA")))(CODA) relevant to the accreditation of dental hygiene schools((, in effect through June 2007. In implementing the adopted standards, the secretary approves those dental hygiene education programs that are currently accredited and received initial "CODA" accreditation on or before June 30, 2007,)). Provided, that the accredited education program's curriculum includes didactic and clinical competency in:

(a) ((Didactic and clinical competency in))The administration of injections of local anesthetic;

(b) ((Didactic and clinical competency in))The administration of nitrous oxide analgesia;

(c) ((Didactic and clinical competency in))The placement of restorations into cavities prepared by a dentist; and

(d) ((Didactic and clinical competency in))The carving, contouring, and adjusting contacts and occlusions of restorations.

(2) Dental hygiene expanded functions education programs approved by the secretary ((of the department of health pursuant to the American Dental Association Commission on Dental Accreditation))consistent with CODA standards whose curriculum does not include the didactic and clinical competency ((enumerated in))as required under subsection (1)(a) through (d) of this section will be accepted if the applicant has successfully completed an expanded functions education program(s) approved ((pursuant to WAC 246-815-110, 246-815-120, and))under WAC 246-815-130.

(((3) A form will be provided in the department of health licensure application packages for the purpose of education verification.

(4) The standards of the American Dental Association Commission on Dental Accreditation relevant to the accreditation of dental hygiene schools are available from the American Dental Association, 211 East Chicago Ave., Chicago, IL 60611-2678, 312-440-2500, http://www.ada.org/.))

(1) ((The dental hygiene examination will consist of both written and practical tests approved by the committee, as described in this section.)) An applicant seeking licensure in Washington by examination must successfully complete ((all of)) the following:

(a) ((The))A dental hygiene ((national board examination.

(c)))clinical examination approved by the committee:

(i) The Western Regional Examining Board (WREB) dental hygiene ((practical))clinical examinations ((from))effective May 8, 1992((.));

(((i)))(a) Patient evaluation clinical competency including an extra-oral and intra-oral examination;

(((ii)))(b) Prophylaxis clinical competency;

(((iii)))(c) Local anesthesia written and clinical competency; and

(((iv)))(d) Restorative clinical competency.

(((d) In lieu of the WREB examination (or any of its subparts), the secretary may accept a substantially equivalent examination (or substantially equivalent subparts).

(3) The applicant will comply with all written instructions provided by the department of health.))

((A license to practice as a dental hygienist in Washington may be issued pursuant to RCW 18.29.045 provided the applicant meets the following requirements:))An individual may be eligible for a Washington state dental hygiene license if the applicant:

(1) ((The applicant))Has successfully completed a dental hygiene education program ((which is approved by the secretary of the department of health pursuant to))in compliance with the requirements listed in WAC 246-815-030.

(2) ((The applicant has been issued))Holds a valid, current, nonlimited license ((by successful completion of a dental hygiene examination)) in another state.

(4) Has successfully completed a dental hygiene examination where the other state's ((current)) licensing standards ((must be))are substantively equivalent to the licensing standards in the state of Washington. The other state's examination must have included the following portions and ((minimum level))standards of competency ((standards)).

(a) Written tests - The written tests ((include:

(i)))mean the National Board of Dental Hygiene examination as required in WAC 246-815-020.

(((ii) A state written test covering the current dental hygiene subjects that are tested for Washington state.))

(b) Practical tests - All portions ((shall))must be graded anonymously by calibrated practicing dental hygienists or dental hygienists and dentists. ((The calibration process shall consist of training sessions which include components to evaluate and confirm each examiners ability to uniformly detect known errors on pregraded patients and/or dentoforms.)) Examiners will be calibrated to the ((established standard of minimum level))standards of competency. The examination must have equivalent patient selection criteria for the patient evaluation, prophylaxis and anesthesia portions. ((The Western Regional Examining Board (WREB) practical tests.)) In lieu of the WREB or CRDTS practical tests, the secretary may accept substantially equivalent tests. The practical tests include:

(i) Patient evaluation clinical competency including an extra-oral and intra-oral examination;

(ii) Prophylaxis clinical competency;

(iii) Anesthesia clinical competency; and

(iv) Restorative clinical competency.

(((3) The applicant holds a valid current license, and has been currently engaged in clinical practice at any time within the previous year as a dental hygienist in another state or in the discharge of official duties in the United States Armed Services, Coast Guard, Public Health Services, Veterans' Bureau, or Bureau of Indian Affairs. Verification of licensure must be obtained from the state of licensure, and any fees for verification required by the state of licensure must be paid by the applicant.

(4) The applicant has not engaged in unprofessional conduct as defined in the Uniform Disciplinary Act in RCW 18.130.180 or is not an impaired practitioner under RCW 18.130.170 in the Uniform Disciplinary Act.))(c) If the secretary finds that another state's licensing standards are substantively equivalent except for portion(s) of the examination, the applicant may take that portion(s) to qualify for interstate endorsement. The applicant must successfully complete the portion(s) of the exam to qualify for interstate endorsement.

(5) ((Applicants must complete))Has completed seven clock hours of HIV/AIDS education as required in chapter 246-12 WAC, Part 8.

(6) ((The applicant demonstrates to the secretary knowledge of Washington law pertaining to the practice of dental hygiene))Has passed the Washington state drug and law jurisprudence examination.

(7) ((The applicant completes the required))Submits a completed application ((materials and pays the required application fee. Applications for licensure by interstate endorsement are available from the department of health dental hygiene program))on forms provided by the department.

(8) ((If the secretary of the department of health finds that the other state's licensing standards are substantively equivalent except for a portion(s) of the examination, the applicant may take that portion(s) to qualify for interstate endorsement. That portion(s) of the exam must be successfully completed to qualify for interstate endorsement and an additional examination fee as well as the licensure by interstate endorsement fee shall be required))Pays fees as required in WAC 246-815-990.

(1) ((The representative of the education program must complete the required application materials and pay the required nonrefundable fee.

(4) The application may include))An applicant for approval of a non-CODA accredited dental hygiene expanded functions education program shall submit to the department:

(2) The department may conduct a site visit and evaluation at the discretion of the secretary ((of the department of health))prior to approval.

(((5)))(3) An approved dental hygiene expanded function education program shall report in writing all modifications of the approved program to the department ((of health and shall be required to pay the nonrefundable evaluation fee if the secretary of the department determines that the modification(s) substantially affects an area included in WAC 246-815-120))at least sixty days prior to modification.

(1) Curriculum for expanded function dental hygiene education programs approved by the secretary ((of the department of health shall))must include didactic and clinical competency in:

(a) ((Instruction in))The administration ((of injections)) of a local anesthetic((.

Block: Long buccal, mental, inferior alveolar and PSA)), which must include infiltration, field block and block dental injection techniques for anesthesia of maxillary and mandibular periodontium and teeth.

(b) ((Instruction in))The administration of nitrous oxide analgesia. ((The basic curriculum shall require didactic and clinical competency.))

(c) ((Instruction in))Restorative dentistry ((and specifically)), including how to place restorations into a cavity prepared by the dentist and thereafter carve, contour, and adjust contacts and occlusion of the restoration. ((The basic curriculum shall require didactic and clinical competency.))

(2) ((Representatives of))An expanded function dental hygiene education programs may apply for approval of one or more of (((1)(a)-(c) above))the expanded functions identified in subsection (1)(a) through (c) of this section. Approval of the specific expanded function(s) educational program will be based on the applicable curriculum listed in (((1)(a)-(c) above.

(3) It shall be the responsibility of the approved expanded functions education program to evaluate the students curriculum needs on an individual basis for successful completion of their approved program.))subsection (1) of this section.

(1) To renew a ((license a)) dental hygienist license, an individual must:

(a) Complete fifteen clock hours of continuing education each year following the first license renewal;

(b) Maintain a current basic life support (BLS) ((card)) for health care providers certification; and

(c) Sign a declaration attesting to the completion of the required number of hours as part of the annual renewal requirement.

(2) The department will not authorize or approve specific continuing education courses. Continuing education course work must contribute to the professional knowledge and development of the dental hygienist or enhance services provided to patients.

((For the purposes of this chapter, acceptable))(3) Continuing education is defined as any of the following activities:

(a) Continuing education ((means)) courses offered or authorized by industry recognized local, state, private, national and international organizations, agencies or institutions of higher learning. Examples of sponsors or types of continuing education courses may include, but are not limited to:

(((a)))(b)(i) The Washington State Dental Association, American Dental Association, National Dental Association, Washington ((State)) Dental Hygienists' Association, American Dental Hygienists' Association, National Dental Hygienists' Association, including the constituent and component/branch societies;

(((b) Basic life support (BLS)))(ii) BLS for health care providers, advanced cardiac life support (ACLS), Occupational Safety and Health Administration (OSHA)/Washington Industrial Safety and Health Act (WISHA), or emergency related training such as courses offered or authorized by the American Heart Association or the American Cancer Society((;)), or any other organizations or agencies;

(((c)))(iii) Self-study through study clubs, books, research materials, or other publications. The required documentation for this activity is a summary of what was learned, not to exceed five hours per year;

(((d)))(iv) Distance learning. Distance learning includes, but is not limited to: Correspondence course, webinar, audio/video broadcasting, audio/video teleconferencing, computer aided instruction, e-learning/online-learning, or computer broadcasting/webcasting that includes an assessment tool upon completion;

(((e)))(v) A licensee who serves as an educator or who lectures in continuing education programs or courses, that contribute to the professional knowledge of a licensed dental hygienist may accumulate hours for the content preparation of the program or course, not to exceed ten hours per year;

(((f)))(vi) Attendance at a continuing education program with a featured speaker(s);

(((g)))(vii) Courses relating to practice organization and management, medical/dental insurance courses, or retirement, not to exceed five hours per year;

(((h)))(viii) Dental hygiene examination standardization/calibration workshops and dental hygiene examination item writer workshops, not to exceed ten hours per year;

(((i)))(ix) Provision of clinical dental hygiene services in a documented volunteer capacity when preceded by educational/instructional training prior to provision of services, not to exceed five hours per year. Volunteering must be without compensation and under appropriate supervision;

(((j)))(x) A licensee who serves as a public health official or employee, contractor for a state or local health agency, community prevention education expert, or works in a field that relates to prevention activities in public health dentistry, may accumulate hours for the content preparation of providing services, education, or training to the underserved, rural, and at risk populations, not to exceed five hours per year; and

(((k)))(xi) College courses.

(((3)))(4) The department may randomly audit up to twenty-five percent of practitioners for compliance with the requirements in this section after the credential is renewed as allowed by chapter 246-12 WAC, Part 7.

((The purpose of defining standards of dental hygiene conduct or practice is to identify minimum responsibilities of the registered dental hygienist licensed in Washington in health care settings and as provided in the Dental Hygiene Practice Act, chapter 18.29 RCW, and the Uniform Disciplinary Act, chapter 18.130 RCW. The standards provide consumers with information about quality care and provides the secretary guidelines to evaluate safe and effective care. Upon entering the practice of dental hygiene, each individual assumes the responsibility, public trust, and a corresponding obligation to adhere to the standards of dental hygiene practice.

The licensed dental hygienist shall have knowledge of the statutes and regulations governing dental hygiene practice and shall function within the legal scope of dental hygiene practice.))A dental hygienist working under the appropriate supervision of a licensed dentist shall perform the following tasks:

(1) A dental hygienist who treats patients shall maintain legible, complete, and accurate patient records.

(2) The patient record must contain the clinical records and the financial records.

(3) The clinical record must include at least the following information for each entry:

(a) The signature, initials, or electronic verification of the individual making the entry note;

(b) The identity of who provided treatment if treatment was provided;

(c) The date of each patient record entry;

(d) The physical examination findings documented by subjective complaints, objective findings, an assessment of the patient's condition, and plan;

(e) A dental hygiene treatment plan based on the analysis of assessment findings;

(f) Up-to-date dental hygiene and medical history that may affect dental hygiene treatment;

(g) A complete description of all treatment/procedures administered at each visit;

(h) An accurate record of any medication(s) administered;

(i) Referrals and any communication to and from any health care provider;

(j) Notation of communication to or from the patient or minor patient's parent or guardian, including:

(i) Notation of the informed consent discussion. This is a discussion of potential risk(s) and benefit(s) of proposed treatment, and alternatives to treatment, including no treatment;

(ii) Notation of posttreatment instructions or reference to an instruction pamphlet given to the patient;

(iii) Notation regarding patient complaints or concerns associated with treatment, this includes complaints or concerns obtained in person, by phone call, email, mail, or text; and

(iv) Termination of hygienist-patient relationship.

(4) Clinical record entries must not be erased or deleted from the record.

(a) Mistaken handwritten entries must be corrected with a single line drawn through the incorrect information. New or corrected information must be initialed and dated.

(b) If the record is an electronic record then a record audit trail must be maintained with the record that includes a time and date, history of deletions, and edits and corrections to the electronically signed records.

(1) A dental hygienist working for health care facilities or senior centers under RCW 18.29.056 shall keep readily accessible patient records for at least six years from the date of the last treatment.

(2) A dental hygienist shall respond to a written request from a patient to examine or copy a patient's record within fifteen working days after receipt. A dental hygienist shall comply with chapter 70.02 RCW for all patient record requests.

(3) A dental hygienist shall comply with the Health Insurance Portability and Accountability Act, 45 C.F.R. Part 164.

A dental hygienist working for a health care facility under RCW 18.29.056 is limited to providing treatment to patients, students and residents of the health care facility. The services performed while employed, retained or contracted by the health care facility must be provided in a location affiliated with one of the health care facilities defined in RCW 18.29.056(2).

(1) Licenses must be renewed every year on the practitioner's birthday as provided in chapter 246-12 WAC, Part 2. ((The secretary may require payment of renewal fees less than those established in this section if the current level of fees is likely to result in a surplus of funds. Surplus funds are those in excess of the amount necessary to pay for the costs of administering the program and to maintain a reasonable reserve. Notice of any adjustment in the required payment will be provided to practitioners. The adjustment in the required payment shall remain in place for the duration of a renewal cycle to assure practitioners an equal benefit from the adjustment.))

(2) The following nonrefundable fees will be charged: