<<Exit

Texas Register Preamble


The State Board of Dental Examiners proposes amendments to §108.8 Records of the Dentist. The proposed amendments are the result of several meetings with representatives from the Texas Department of Health, the Health and Human Services Commission, the three Texas dental schools, National Heritage Insurance Corporation and members of the Board and staff to discuss records keeping requirements for dentists. The effect of the amendments is to provide more specific rules for dental practitioners to follow in making and maintaining dental records. Vague and redundant language has been deleted and replaced with clearer, more definite requirements.

Former subsection (a), with changes, has been relocated to subsection (b). Former subsection (b) has been relocated, verbatim, to subsection (a). The new subsection (a) defines the term "dental records" and requires documentation of information obtained. Language in the former subsection (b) mentioned "x-rays" and "radiographs." The terms are synonymous making the clause redundant. The word "x-ray(s)" is deleted where used and the word "radiograph" and its permutations is substituted.

The new subsection (b) places an affirmative duty upon a practitioner to make, maintain and keep adequate records. The sentence in the former subsection which read "...Adequate records are records from which diagnoses can be made and which clearly and accurately document all of the facts related to the treatment of a dental patient, including diagnoses, treatments and progress of care..." has been deleted because of vagueness. Subsequent language in the new subsection and subsection (c) provides specificity to the elements that comprise an "adequate" dental record.

New language in subsection (b) clearly sets out what must be contained in all dental records, whether a patient receives dental services or not. The language also requires, as a minimum, that vital signs, including, but not limited to blood pressure and heart rate be obtained unless there is a reason not to do so. Paragraph (5) requires an explanation if vital signs are not taken.

New subsection (c) clarifies what must be documented when dental services are provided. Language of the former rule could be interpreted to require accounting for all these elements, even though no dental treatment was rendered. Language in new subsection (c), paragraph (9) repeats verbatim the language found in the former subsection (c) except that the last sentence has been deleted. That sentence read "...all such drugs and substances which are kept in the dental office or under the control of the dentist are to be maintained by a centralized inventory which shall indicate dates acquired, description and quantity of drugs, date, method, quantity dispensed, and the patient to whom the drug is dispensed..." In view of the language of new subsection (c), paragraph (10), formerly subsection (d), repeated verbatim, the former language is redundant, because the mentioned requirements are found in the Texas Controlled Substances Act.

Paragraph (2) subparagraph (B) of new subsection (c) recommends adherence to guidelines for prescribing dental radiographs. Paragraph (4) now requires preparation of a treatment plan if dental services are provided. Paragraph (8) requires that informed consent, conforming to the requirements of §108.7(6) of this title (relating to Minimum Standard of Care, General), be obtained in writing. Reading §108.7 (6) in conjunction with §108.8 (c)(4) and (8) clarifies that a treatment plan is an important part of a patient's dental records. Paragraph (11) addresses the need to be able to identify the individual who provided dental services and the person who made the entries in a dental record. Occasions arise, especially in group practices, where a patient is seen by more than one provider. It is important to know who provided dental services to a patient at each visit. Paragraph (12) recognizes that there may be times when, in the judgment of a dental provider, certain procedures are not done. In those instances paragraph (12) removes the possibility that a procedure was done, but not documented.

Former subsection (c) is repeated verbatim in paragraph (9) with the exception of the last sentence, which has been deleted, as explained above.

Former subsection (d) is repeated verbatim in paragraph (10).

Former subsections (e) (f) (g) and (H) have been redesignated as (d), (e), (f) and (g) and are repeated verbatim, except for substitution of the word "radiograph" for "x-ray."

Jeffry R. Hill, Executive Director, State Board of Dental Examiners, has determined for the first five-year period the amended rule is in effect there will be no fiscal implications for local or state government as a result of enforcing or administering the rule.

Mr. Hill also has determined that for each year of the first five years the amended rule is in effect the public benefit anticipated as a result of amending the rule will be that the standards for dental records will be clearer, and that the quality of dental records will improve.

There will be fiscal implications for small or large businesses. The Board cannot assess the magnitude of the impact, but it is not expected to be significant. Whatever the impact, it will tend to affect large and small businesses at similar percentages of cost increase, if any. Therefore the SBDE has determined that compliance with the proposed amended rule will not have an adverse economic impact on small businesses when compared to large businesses.

Comments on the proposal may be submitted to Mei Ling Clendennen, Assistant Executive Director, State Board of Dental Examiners, 333 Guadalupe, Tower 3, Suite 800, Austin, Texas 78701, (512) 463-6400. To be considered, all written comments must be received by the State Board of Dental Examiners on or before August 20, 2001.

The amended rule is proposed under Texas Government Code §2001.021 et.seq; Texas Civil Statutes, the Occupations Code §254.001 which provides the State Board of Dental Examiners with the authority to adopt and enforce rules necessary for it to perform its duties, and to ensure compliance with laws relating to the practice of dentistry.

The proposed amended rule does not affect other statutes, articles, or codes.



Next Page Previous Page

Link to Texas Secretary of State Home Page | link to Texas Register home page | link to Texas Administrative Code home page | link to Open Meetings home page