CHAPTER 27
STANDARDS OF PRACTICE AND
PRINCIPLES OF PROFESSIONAL ETHICS
650—27.1(153) General.
	27.1(1) Dental ethics. The following principles relating to dental ethics are compatible with the Code of Professional Ethics and advisory opinions published in August 1998 by the American Dental Association. These principles are not intended to provide a limitation on the ability of the board to address problems in the area of ethics but rather to provide a basis for board review of questions concerning professional ethics. The dentist’s primary professional obligation shall be service to the public with the most important aspect of that obligation being the competent delivery of appropriate care within the bounds of the clinical circumstances presented by the patient, with due consideration being given to the needs and desires of the patient. Unprofessional conduct includes, but is not limited, to any violation of these rules.
	27.1(2) Dental hygiene ethics. The following principles relating to dental hygiene ethics are compatible with the Code of Ethics of the American Dental Hygienists’ Association published in 1995. Standards of practice for dental hygienists are compatible with the Iowa dental hygienists’ association dental hygiene standards of practice adopted in May 1993. These principles and standards are not intended to provide a limitation on the ability of the dental hygiene committee to address problems in the area of ethics and professional standards for dental hygienists but rather to provide a basis for committee review of questions regarding the same. The dental hygienist’s primary responsibility is to provide quality care and service to the public according to the clinical circumstances presented by the patient, with due consideration of responsibilities to the patient and the supervising dentist according to the laws and rules governing the practice of dental hygiene.
	27.1(3) Dental assistant ethics. Dental assistants shall utilize the principles of professional dental and dental hygiene ethics for guidance, and the laws and rules governing the practice of dental assisting.
650—27.2(153,272C) Patient acceptance. Dentists, in serving the public, may exercise reasonable discretion in accepting patients in their practices; however, dentists shall not refuse to accept patients into their practice or deny dental service to patients because of the patient’s race, creed, sex or national origin.
650—27.3(153) Emergency service. Emergency services in dentistry are deemed to be those services necessary for the relief of pain or to thwart infection and prevent its spread.
	27.3(1) Dentists shall make reasonable arrangements for the emergency care of their patients of record.
	27.3(2) Dentists shall, when consulted in an emergency by patients not of record, make reasonable arrangements for emergency care.
650—27.4(153) Consultation and referral.
	27.4(1) Dentists shall seek consultation, if possible, whenever the welfare of patients will be safeguarded or advanced by utilizing those practitioners who have special skills, knowledge and experience.
	27.4(2) The specialist or consulting dentist upon completion of their care shall return the patient, unless the patient expressly states a different preference, to the referring dentist or, if none, to the dentist of record for future care.
	27.4(3) The specialist shall be obliged, when there is no referring dentist and upon completion of the treatment, to inform the patient when there is a need for further dental care.
	27.4(4) A dentist who has a patient referred for a second opinion regarding a diagnosis or treatment plan recommended by the patient’s treating dentist, should render the requested second opinion in accordance with these rules. In the interest of the patient being afforded quality care, the dentist rendering the second opinion should not have a vested interest in the ensuing recommendation.
650—27.5(153) Use of personnel. Dentists shall protect the health of their patients by assigning to qualified personnel only those duties that can be legally delegated. Dentists shall supervise the work of all personnel working under their direction and control.
650—27.6(153) Evidence of incompetent treatment.
	27.6(1) Licensees or registrants shall report to the board instances of gross or continually faulty treatment by other licensees or registrants.
	27.6(2) Licensees or registrants may provide expert testimony when that testimony is essential to a just and fair disposition of a judicial or administrative action.
650—27.7(153) Representation of care and fees.
	27.7(1) Dentists shall not represent the care being rendered to their patients or the fees being charged for providing the care in a false or misleading manner.
	27.7(2) A dentist who accepts a third-party payment under a copayment plan as payment in full without disclosing to the third-party payer that the patient’s payment portion will not be collected is engaging in deception and misrepresentation by this overbilling practice.
	27.7(3) A dentist shall not increase a fee to a patient solely because the patient has insurance.
	27.7(4) Payments accepted by a dentist under a governmentally funded program, a component or constituent dental society sponsored access program, or a participating agreement entered into under a program of a third party shall not be considered as evidence of overbilling in determining whether a charge to a patient or to another third party on behalf of a patient not covered under any of these programs, constitutes overbilling under this rule.
	27.7(5) A dentist who submits a claim form to a third party reporting incorrect treatment dates is engaged in making unethical, false or misleading representations.
	27.7(6) A dentist who incorrectly describes a dental procedure on a third party claim form in order to receive a greater payment or incorrectly makes a noncovered procedure appear to be a covered procedure is engaged in making an unethical, false or misleading representation to the third party.
	27.7(7) A dentist who recommends or performs unnecessary dental services or procedures is engaged in unprofessional conduct.
	27.7(8) Rescinded IAB 5/14/03, effective 6/18/03.
650—27.8(153) General practitioner announcement of services. General dentists who wish to announce the services available in their practices are permitted to announce the availability of those services so long as they avoid any communications that express or imply specialization. General dentists shall also state that the services are being provided by a general dentist.
650—27.9(153) Unethical and unprofessional conduct.
	27.9(1) Licensee or registrant actions determined by the board to be abusive, coercive, intimidating, harassing, untruthful or threatening in connection with the practice of dentistry shall constitute unethical or unprofessional conduct.
	27.9(2) A treatment regimen shall be fully explained and patient authorization obtained before treatment is begun.
	27.9(3) A licensee or registrant determined to be infected with HIV or HBV shall not perform an exposure-prone procedure except as approved by the expert review panel as specified in Iowa Code section 139A.22, established by the Iowa department of public health, or if the licensee or registrant works in a hospital setting, the licensee or registrant may elect either the expert review panel established by the hospital or the expert review panel established by the Iowa department of public health for the purpose of making a determination of the circumstances under which the licensee or registrant may perform exposure-prone procedures. The licensee or registrant shall comply with the recommendations of the expert review panel. Failure to do so shall constitute unethical and unprofessional conduct and is grounds for disciplinary action by the board.
	27.9(4) Knowingly providing false or misleading information to the board or an agent of the board is considered unethical and unprofessional conduct.
650—27.10(153) Retirement or discontinuance of practice.
	27.10(1) A licensee, upon retirement, or upon discontinuation of the practice of dentistry, or upon leaving or moving from a community, shall notify all active patients in writing, or by publication once a week for three consecutive weeks in a newspaper of general circulation in the community, that the licensee intends to discontinue the practice of dentistry in the community, and shall encourage patients to seek the services of another licensee. The licensee shall make reasonable arrangements with active patients for the transfer of patient records, or copies thereof, to the succeeding licensee. “Active patient” means a person whom the licensee has examined, treated, cared for, or otherwise consulted with during the two-year period prior to retirement, discontinuation of the practice of dentistry, or leaving or moving from a community.
	27.10(2) Nothing herein provided shall prohibit a licensee from conveying or transferring the licensee’s patient records to another licensed dentist who is assuming a practice, provided that written notice is furnished to all patients as hereinbefore specified.
650—27.11(153,272C) Record keeping. Dentists shall maintain patient records in a manner consistent with the protection of the welfare of the patient. Records shall be permanent, timely, accurate, legible, and easily understandable.
	27.11(1) Dental records. Dentists shall maintain dental records for each patient. The records shall contain all of the following:
	a. 	Personal data.
	(1)	Name, date of birth, address and, if a minor, name of parent or guardian.
	(2)	Name and telephone number of person to contact in case of emergency.
	b. 	Dental and medical history. Dental records shall include information from the patient or the patient’s parent or guardian regarding the patient’s dental and medical history. The information shall include sufficient data to support the recommended treatment plan.
	c. 	Patient’s reason for visit. When a patient presents with a chief complaint, dental records shall include the patient’s stated oral health care reasons for visiting the dentist.
	d. 	Clinical examination progress notes. Dental records shall include chronological dates and descriptions of the following:
	(1)	Clinical examination findings, tests conducted, and a summary of all pertinent diagnoses;
	(2)	Plan of intended treatment and treatment sequence;
	(3)	Services rendered and any treatment complications;
	(4)	All radiographs, study models, and periodontal charting, if applicable;
	(5)	Name, quantity, and strength of all drugs dispensed, administered, or prescribed; and
	(6)	Name of dentist, dental hygienist, or any other auxiliary, who performs any treatment or service or who may have contact with a patient regarding the patient’s dental health.
	e. 	Informed consent. Dental records shall include, at a minimum, documentation of informed consent that includes discussion of procedure(s), treatment options, potential complications and known risks, and patient’s consent to proceed with treatment.
	27.11(2) Retention of records. A dentist shall maintain a patient’s dental record for a minimum of six years after the date of last examination, prescription, or treatment. Records for minors shall be maintained for a minimum of either (a) one year after the patient reaches the age of majority (18), or (b) six years, whichever is longer. Proper safeguards shall be maintained to ensure safety of records from destructive elements.
	27.11(3) Electronic record keeping. The requirements of this rule apply to electronic records as well as to records kept by any other means. When electronic records are kept, a dentist shall keep either a duplicate hard copy record or use an unalterable electronic record.
	27.11(4) Correction of records. Notations shall be legible, written in ink, and contain no erasures or white-outs. If incorrect information is placed in the record, it must be crossed out with a single nondeleting line and be initialed by a dental health care worker.
	27.11(5) Confidentiality and transfer of records. Dentists shall preserve the confidentiality of patient records in a manner consistent with the protection of the welfare of the patient. Upon request of the patient or patient’s legal guardian, the dentist shall furnish the dental records or copies or summaries of the records, including dental radiographs or copies of the radiographs, as will be beneficial for the future treatment of that patient. The dentist may charge a nominal fee for duplication of records, but may not refuse to transfer records for nonpayment of any fees.
650—27.12(17A,147,153,272C) Waiver prohibited. Rules in this chapter are not subject to waiver pursuant to 650—Chapter 7 or any other provision of law.
These rules are intended to implement Iowa Code sections 153.34(7), 153.34(9), 272C.3, 272C.4(1f) and 272C.4(6).
[Filed 9/1/88, Notice 7/27/88—published 9/21/88, effective 10/26/88]
[Filed 2/1/91, Notice 12/12/90—published 2/20/91, effective 3/27/91]
[Filed 1/29/93, Notice 11/25/92—published 2/17/93, effective 3/24/93]
[Filed 7/30/93, Notice 6/9/93—published 8/18/93, effective 9/22/93]
[Filed 7/28/94, Notice 3/30/94—published 8/17/94, effective 9/21/94]
[Filed 1/27/95, Notice 12/7/94—published 2/15/95, effective 3/22/95]
[Filed 1/22/99, Notice 11/18/98—published 2/10/99, effective 3/17/99]
[Filed 7/21/00, Notice 5/17/00—published 8/9/00, effective 9/13/00]
[Filed 10/23/00, Notice 8/9/00—published 11/15/00, effective 1/1/01]
[Filed 1/19/01, Notice 11/15/00—published 2/7/01, effective 3/14/01]
[Filed 1/18/02, Notice 11/14/01—published 2/6/02, effective 3/13/02]
[Filed 4/25/03, Notice 12/11/02—published 5/14/03, effective 6/18/03]
[Filed 7/1/04, Notice 5/12/04—published 7/21/04, effective 8/25/04]
[Filed 2/5/07, Notice 11/22/06—published 2/28/07, effective 4/4/07]