WSR 15-24-118
(Dental Quality Assurance Commission)
[Filed December 1, 2015, 4:14 p.m.]
Supplemental Notice to WSR 15-03-067.
Preproposal statement of inquiry was filed as WSR 09-13-097.
Title of Rule and Other Identifying Information: WAC 246-817-310 Maintenance and retention of records, new WAC 246-817-304, 246-817-305, and 246-817-315. Creating new rules and renaming and amending an existing rule to set requirements for dental treatment record content, retention and accessibility. This is a supplemental notice to WSR 15-03-067.
Hearing Location(s): Department of Health, 310 Israel Road S.E., Room 152/153, Tumwater, WA 98501, on January 22, 2016, at 8:05 a.m.
Date of Intended Adoption: January 22, 2016.
Submit Written Comments to: Jennifer Santiago, P.O. Box 47852, Olympia, WA 98504-7852, e-mail, fax (360) 23-2901 [236-2901], by January 15, 2016.
Assistance for Persons with Disabilities: Contact Jennifer Santiago by January 15, 2016, TTY (800) 833-6388 or 711.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The proposal renames and modifies WAC 246-817-310 and creates three new rules, WAC 246-817-304, 246-817-305, and 246-817-315. The proposed rules create definitions, detail patient record content requirements, move business record related requirements to a new rule, and separate business and patient record accessibility. The current proposal is different from the previous proposal as it adds definitions, changes retention time, modifies detail [detailed] patient record content requirements, and modifies when business records can be obtained and by whom.
Reasons Supporting Proposal: A complete and accurate patient record is vital for patient safety and for appropriate regulation. Thorough records are necessary to inform the work of other treatment providers who subsequently treat the patient, as well as for the commission when investigating complaints and regulating practitioners. The proposed rules clarify what should be included in patient records and ensure that patient records are complete, legible, and consistent. The commission agreed with stakeholder comments at the March 6, 2015, hearing and modified the rules accordingly.
Statutory Authority for Adoption: RCW 18.32.655 and 18.32.0365.
Statute Being Implemented: RCW 18.32.655 and 18.32.0365.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Washington state dental quality assurance commission, governmental.
Name of Agency Personnel Responsible for Drafting, Implementation, and Enforcement: Jennifer Santiago, 111 Israel Road S.E., Tumwater, WA 98501, (360) 236-4893.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The proposed rule would not impose more than minor costs on businesses in an industry.
A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Jennifer Santiago, P.O. Box 47852, Olympia, WA 98504-7852, phone (360) 236-4893, fax (360) 236-2901, e-mail
December 1, 2015
Charles Hall, D.D.S., Chair
Dental Quality Assurance Commission
WAC 246-817-304 Definitions.
The following definitions apply to WAC 246-817-304 through 246-817-315 unless context requires otherwise:
(1) "Clinical record" is the portion of the record that contains information regarding the patient exam, diagnosis, treatment discussion, treatment performed, patient progress, progress notes, referrals, studies, tests, imaging of any type and any other information related to the diagnosis or treatment of the patient.
(2) "Financial record" is the portion of the 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.
(3) "Notation" is a condensed or summarized written record/note.
(4) "Patient record" the entire record of the patient maintained by a practitioner that includes all information related to the patient.
WAC 246-817-305 Patient record content.
(1) A licensed dentist 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:
(a) For each clinical record entry note, the signature, initials, or electronic verification of the individual making the entry note;
(b) For each clinical record entry note, identify who provided treatment if treatment was provided;
(c) The date of each patient record entry, document, radiograph or model;
(d) The physical examination findings documented by subjective complaints, objective findings, an assessment or diagnosis of the patient's condition, and plan;
(e) A treatment plan based on the assessment or diagnosis of the patient's condition;
(f) Up-to-date dental and medical history that may affect dental treatment;
(g) Any diagnostic aid used including, but not limited to, images, radiographs, and test results. Retention of molds or study models is at the discretion of the practitioner, except for molds or study models for orthodontia or full mouth reconstruction shall be retained as listed in WAC 246-817-310;
(h) A complete description of all treatment/procedures administered at each visit;
(i) An accurate record of any medication(s) administered, prescribed or dispensed including:
(i) The date prescribed or the date dispensed;
(ii) The name of the patient prescribed or dispensed to;
(iii) The name of the medication; and
(iv) The dosage and amount of the medication prescribed or dispensed, including refills.
(j) Referrals and any communication to and from any health care provider;
(k) Notation of communication to or from the patient or 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, recommended tests, and alternatives to treatment, including no treatment or tests;
(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, e-mail, mail, or text; and
(iv) Termination of doctor-patient relationship; and
(l) A copy of each laboratory referral retained for three years as required in RCW 18.32.655.
(4) Clinical record treatment 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, edits and/or corrections to electronically signed records.
AMENDATORY SECTION (Amending WSR 95-21-041, filed 10/10/95, effective 11/10/95)
WAC 246-817-310 ((Maintenance and)) Patient record retention ((of records)) and accessibility requirements.
((Any dentist who treats patients in the state of Washington shall maintain complete treatment records regarding patients treated. These records shall include, but shall not be limited to X rays, treatment plans, patient charts, patient histories, correspondence, financial data and billing. These records shall be retained by the dentist for five years in an orderly, accessible file and shall be readily available for inspection by the DQAC or its authorized representative: X rays or copies of records may be forwarded to a second party upon the patient's or authorized agent's written request. Also, office records shall state the date on which the records were released, method forwarded and to whom, and the reason for the release. A reasonable fee may be charged the patient to cover mailing and clerical costs.
Every dentist who operates a dental office in the state of Washington must maintain a comprehensive written and dated record of all services rendered to his/her patients. In offices where more than one dentist is performing the services the records must specify the dentist who performed the services. Whenever requested to do so, by the secretary or his/her authorized representative, the dentist shall supply documentary proof:
(1) That he/she is the owner or purchaser of the dental equipment and/or the office he occupies.
(2) That he/she is the lessee of the office and/or dental equipment.
(3) That he/she is, or is not, associated with other persons in the practice of dentistry, including prosthetic dentistry, and who, if any, the associates are.
(4) That he/she operates his office during specific hours per day and days per week, stipulating such hours and days.)) (1) A licensed dentist shall keep readily accessible patient records for at least six years from the date of the last treatment.
(2) A licensed dentist shall respond to a written request to examine or copy a patient's record within fifteen working days after receipt. A licensed dentist shall comply with chapter 70.02 RCW for all patient record requests.
(3) A licensed dentist shall comply with chapter 70.02 RCW and the Health Insurance Portability and Accountability Act, 45 C.F.R. destruction and privacy regulations.
WAC 246-817-315 Business records accessibility.
If requested as part of an authorized investigation, a licensed dentist who operates a dental practice in the state of Washington shall provide to the secretary:
(1) Documentation that the licensed dentist is:
(a) The owner, purchaser, or lessee of the dental equipment;
(b) The owner, purchaser, or lessee of the office the dentist occupies; and
(c) Associated with other persons in the practice of dentistry, whether or not the associate is licensed to practice dentistry.
(2) All contracts or agreements relating to the dental practice business relationships with co-owners, partners, and associates.