[Issued 11-01-20]
Each member receiving dental care at a mobile and/or portable dental treatment facility must receive an information sheet at the end of the visit. The information sheet must contain:
(1) The name of the dentist, dental hygienist, and/or dental assistant who provided the dental services at the mobile and/or portable dental treatment facility;
(2) A valid business telephone number and/or other emergency contact number for the dental group and/or dentist that provided the dental services at the mobile and/or portable dental treatment facility;
(3) A listing of the treatment rendered, including, when applicable, billing codes, fees, and tooth numbers;
(4) A description of any follow-up treatment that is needed or recommended; and
(5) Referrals to specialists or other dentists if the individual providers were unable to provide the necessary treatment, and additional care is needed.