The Consent For Dental Treatment document is a critical legal instrument used in New Zealand dental practices to obtain and document informed consent from patients before proceeding with dental procedures. This document is mandated by New Zealand healthcare regulations, particularly the Health and Disability Commissioner Act 1994 and the Dental Council Code of Practice on Informed Consent. It serves multiple purposes: providing comprehensive information about proposed treatments, documenting patient understanding and agreement, protecting both patient rights and practitioner interests, and ensuring compliance with healthcare regulations. The form should be completed prior to any significant dental procedure and maintained as part of the patient's permanent record.
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1. Patient Information: Patient's personal details, contact information, and relevant medical history
2. Practitioner Information: Details of the treating dentist and dental practice
3. Proposed Treatment: Detailed description of the recommended dental procedure(s) and treatment plan
4. Risks and Benefits: Comprehensive explanation of potential risks, complications, and expected benefits of the treatment
5. Alternative Treatments: Description of alternative treatment options and consequences of no treatment
6. Cost Information: Estimated costs of treatment and payment terms
7. Patient Acknowledgment: Confirmation that the patient understands the information provided and agrees to proceed
8. Consent Declaration: Formal consent statement and signature blocks for patient/guardian and practitioner
1. Sedation/Anesthesia Consent: Additional consent section for procedures requiring sedation or anesthesia
2. Photography Consent: Permission to take and use clinical photographs for documentation or educational purposes
3. Student Involvement: Consent for supervised dental students to participate in treatment
4. Interpreter Declaration: For cases where an interpreter is used to explain the consent
5. Guardian Authorization: For patients under 16 or those lacking capacity to consent
6. COVID-19 Declaration: Additional health screening and acknowledgment of COVID-19 risks
1. Treatment Plan Details: Detailed breakdown of proposed treatment steps and timeline
2. Pre-operative Instructions: Specific instructions for patient preparation before treatment
3. Post-operative Care: Detailed instructions for post-treatment care and recovery
4. Fee Schedule: Itemized list of treatment costs and payment terms
5. Medical History Form: Comprehensive medical history questionnaire
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Clinical Operations
Patient Services
Administration
Legal & Compliance
Quality Assurance
Records Management
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Relevant Roles
Dentist
Dental Surgeon
Dental Specialist
Dental Practice Manager
Dental Assistant
Dental Hygienist
Dental Therapist
Practice Administrator
Clinical Director
Compliance Officer
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Healthcare Risk Manager
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