Subchapter C. MINIMUM STANDARDS OF CONDUCT
AND PRACTICE
Sec.
33.201. Use of titles and other designations.
33.202. Fictitious names.
33.203. Advertising.
33.204. Assignment of duties.
33.205. Practice as a dental hygienist.
33.205a. Practice as an expanded function dental assistant.
33.205b. Practice as a public health dental hygiene practitioner.
33.206. Identifying information on prescriptions.
33.207. Prescribing, administering and dispensing controlled substances.
33.208. Prescribing, administering and dispensing medications.
33.209. Preparing, maintaining and retaining patient records.
33.210. Storage of drugs.
33.211. Unprofessional conduct.
33.211a. Sexual misconduct.
33.212. Misleading, deceptive, untrue or fraudulent representations.
33.213. Use and replacement of dental amalgams—statement of policy.
33.214. Disclosure of financial or ownership interest—statement of policy.
33.215. Use of lasers in the dental office—statement of policy.
33.221—33.223.[Reserved]
33.224—33.226.[Reserved]
33.231. [Reserved].
33.232—33.234.[Reserved]
33.241. [Reserved].
33.242. [Reserved].
33.250. Suspected child abuse—mandated reporting requirements.
33.251. Photographs, medical tests and X-rays of child subject to report.
33.252. Suspected death as a result of child abuse—mandated reporting requirement.
33.253. Immunity from liability.
33.254. Confidentiality—waived.
33.255. Noncompliance.
33.256. Child abuse recognition and reporting—mandatory training requirement.
33.257. Child abuse recognition and reporting course approval process.
33.291. [Reserved].§ 33.201. Use of titles and other designations.
(a) Dentists, dental hygienists and expanded function dental assistants may use only the following titles when formally holding themselves out to the public as members of their respective professions:
(1) Dentists.
(i) ‘‘Doctor’’ or ‘‘Dr.’’ if the licensee’s name and a title permitted under subparagraph (ii) or (iii) follows immediately. The Board specifically prohibits the use of the word ‘‘Doctor’’ or its abbreviation except in combination with one of these titles.
(ii) ‘‘Dentist,’’ ‘‘Doctor of Dental Surgery,’’ ‘‘Doctor of Dental Medicine,’’ or a title such as ‘‘Orthodontist,’’ signifying a specialty recognized by the Board in which the dentist has advanced training in conformity with § 33.203(d)(1) (relating to advertising), when preceded by the licensee’s name.
(iii) ‘‘D.D.S.’’ or ‘‘D.M.D.,’’ when preceded by the licensee’s name.
(2) Dental hygienists.
(i) ‘‘Dental Hygienist’’ or ‘‘D. H.,’’ when preceded by the licensee’s name.
(ii) ‘‘Registered Dental Hygienist’’ or ‘‘R.D.H.,’’ when preceded by the licensee’s name.
(3) Expanded function dental assistants. ‘‘Expanded function dental assistant’’ or ‘‘EFDA’’ when preceded by the certificate holder’s name.
(b) In addition to the titles approved under subsection (a), licensees may use, in conjunction with their names, designations of advanced degrees earned from accredited institutions and designations of advanced professional status—such as diplomate or fellow.
(c) References in this section to the licensee’s or certificate holder’s name shall be interpreted to mean the name appearing on the licensee’s or certificate holder’s current license or certificate but to allow for the use of initials preceding the licensee’s or certificate holder’s surname.
Authority The provisions of this § 33.201 amended under sections 2—5.1, 10—11.5 and 11.7 of The Dental Law (63 P. S. § § 121—124.1, 129—129.1, 130, 130e and 130h).
Source The provisions of this § 33.201 adopted January 18, 1965; amended May 13, 1977, effective May 14, 1977, 7 Pa.B. 1284; amended June 23, 1995, effective June 24, 1995, 25 Pa.B. 2492; amended May 12, 2000, effective May 13, 2000, 30 Pa.B. 2359. Immediately preceding text appears at serial page (253124).
§ 33.202. Fictitious names.
(a) Dentists may use a fictitious name that is not false, misleading or deceptive.
(b) Dentists who wish to practice under a fictitious name shall submit to the Board a fictitious name registration and the fee specified in § 33.3 (relating to fees). The dentist who submits the registration shall be associated with the facility and shall assume responsibility for compliance with this section. The owner of the facility, if different from the applicant, shall be identified on the registration.
(c) Changes in the ownership of a dental facility, changes in the designation of the responsible dentist, changes in the scope of practice or changes in professional staffing, shall be reported in writing within 10 days.
(d) Advertisements in any medium shall include the name, as it appears on the current biennial renewal certificate, and the degree—D.D.S. or D.M.D.—of at least one licensed dentist who is associated with the dental facility. The lettering for the name of the dentist shall be at least equal in size to the lettering used for the fictitious name. The dentist referred to in this subsection and the dentist who registered to use the name under subsection (b) shall be jointly responsible for the advertisement.
(e) A directory listing the names of the dentists practicing at that location shall be prominently displayed in the entrance or reception area of the dental facility.
(f) The names of dentists who have practiced under the fictitious name shall be maintained in the records of the dental facility for at least 5 years following their departure from the practice.
(g) The use of the name of a dentist no longer actively associated with the practice may be continued for up to 1 year.
(h) Dentists who are specialists under § 33.203(d)(1) (relating to advertising) may incorporate their area of specialization in their fictitious name. A specialist in one area may include another recognized specialty area, or a nonspecialty area, in a fictitious name (examples: a specialist in orthodontics using Central Orthodontics and Pediatric Dentistry or a specialist in periodontics using Central Periodontics and Cosmetic Dentistry) only if the specialist conspicuously discloses, in every medium in which the name is used, that specialty status does not extend to the other specialty or nonspecialty area.
(i) Dentists who are not specialists under § 33.203(d)(1) may incorporate any area of dentistry in their fictitious name, including the recognized specialties, only if the name, in every medium in which it is used, is accompanied by the conspicuous disclosure that services are provided by a general dentist.
(j) A fictitious name may not include the word ‘‘clinic’’ unless the name designates a public or quasipublic facility as defined in § 33.1 (relating to definitions).
(k) A fictitious name may not include the word ‘‘institute’’ unless the name designates an educational or research facility.
(l) A fictitious name may not, by the use of plurals or otherwise, misrepresent the number of dentists practicing at a facility or the number of dentists at the facility who are specialists under § 33.203(d)(1).
Source The provisions of this § 33.202 adopted June 23, 1995, effective June 24, 1995, 25 Pa.B. 2492; amended May 23, 1997, effective May 24, 1997, 27 Pa.B. 2547. Immediately preceding text appears at serial pages (223032) to (223034).
Cross References This section cited in 49 Pa. Code § 33.203 (relating to advertising).
§ 33.203. Advertising.
(a) Advertising is permitted to provide the public with a sufficient basis for making an informed selection of a dentist. For purposes of this section, the term ‘‘advertising’’ includes signs, letterheads, business cards, and printed or broadcast announcements of services to the public.
(b) Advertising that is false, misleading or deceptive is prohibited under section 4.1(a)(10) of the act (63 P. S. § 123.1(a)(10)). Advertising is false, misleading or deceptive if it does one or more of the following:
(1) Contains a material misrepresentation of fact, or omits a fact necessary to make the statement considered as a whole not materially misleading.
(2) Is likely to create an unjustified expectation about results the dentist can achieve.
(3) Compares the advertising dentist’s services with the services of other dentists unless the comparison can be factually substantiated.
(c) A dental advertisement in any medium shall contain the name of at least one dentist whose services are being advertised. Each dentist whose name appears in the advertisement shall assume responsibility for the advertisement and shall use the name that appears on the dentist’s current biennial renewal certificate. A dentist who advertises under a fictitious name shall comply with § 33.202 (relating to fictitious names).
(d) A dental advertisement in any medium may identify the dentist as a specialist in a particular area of dentistry, state that the practice is limited to a particular area of dentistry or merely designate the kinds of dental services available. In addition, the following shall be met:
(1) An advertisement may not hold out or imply that the dentist is a specialist in any area unless the conditions in subparagraphs (i) and (ii) are satisfied. Holding out as a specialist includes the use of the terms ‘‘specialist’’ and ‘‘limited to specialty of’’ or of words such as ‘‘endodontist’’ and ‘‘pediatric dentist,’’ which denote a practitioner of the dental specialties listed in subparagraph (i).
(i) The area must be recognized by the Board as a dental specialty. The Board has adopted the American Dental Association’s (ADA’s) standards for recognizing the following specialties:
(A) Dental public health.
(B) Endodontics.
(C) Oral and maxillofacial surgery.
(D) Oral pathology.
(E) Orthodontics.
(F) Pediatric dentistry.
(G) Periodontics.
(H) Prosthodontics.
(ii) The dentist shall have successfully completed a specialty training program approved by the ADA’s Commission on Dental Accreditation.
(2) A dentist who is a specialist in one area under paragraph (1) and advertises, in conjunction with the specialty, that services are provided in another recognized specialty area, or in a nonspecialty area (examples: a specialist in orthodontics announcing additional services in pediatric dentistry or a specialist in periodontics announcing additional services in placing dental implants) shall conspicuously disclose that specialty status does not extend to the other specialty or nonspecialty area.
(3) A specialist under paragraph (1) may not hold out or imply that general dentists associated with the practice are specialists.
(4) A dentist who is not a specialist under paragraph (1) may list the area in which the dentist practices or to which the practice is limited. If the advertisement identifies an area by a term that designates a recognized specialty under paragraph (1)(i), the advertisement shall conspicuously disclose that services are provided by a general dentist. For example, an advertisement that announces services in prosthodontics or oral surgery shall include the general dentist disclosure, whereas an advertisement that announces services such as crown and bridge work or extractions may omit the disclosure.
(5) Neither general dentists nor specialists may hold out or imply that a nonspecialty area of dentistry has specialty status. For example, dentists may not state that they specialize in or limit their practice to temporomandibular joint disorders or implantology but may announce services in, or a practice limited to diagnosing or treating temporomandibular joint disorders, or placing dental implants.
(e) A dental advertisement in any medium may contain the fees charged by the advertising dentist for dental services, as defined in subsection (k). If a minimum fee is advertised, the advertisement shall contain a statement disclosing that the advertised fee is the minimum fee charged for the advertised service and that the actual fee may vary depending on the degree of complexity involved in treatment. The disclosure statement shall be at least as prominent in the context of the advertisement as the fee information contained in the advertisement. If the fee information is verbal, the disclosure statement also shall be verbal and shall be at least equal to the fee information in volume, quality and duration. If the fee information is in writing, the disclosure statement also shall be in writing and shall be at least equal to the fee information in size, legibility and length.
(f) A dental advertisement in any medium may state that dental services, as defined in subsection (k), will be rendered free of charge.
(g) For at least 60 days following final publication or broadcast of an advertisement containing information about fees or free services, the advertising dentist shall neither increase the advertised fees nor charge fees for services advertised as free unless the advertisement specifically and conspicuously stated that the advertised fees or free services would be available for a shorter period of time. When a dental patient agrees, within the 60-day period or the period otherwise stated in the advertisement, to accept a treatment plan for services for which fees have been advertised, the advertising dentist may not charge a fee higher than the advertised fee, even if the services are rendered beyond the 60-day period or the period otherwise stated in the advertisement. When a dental patient
agrees, within the 60-day period or the period otherwise stated in the advertisement, to accept a treatment plan for services advertised as free, the advertising dentist may not charge fees for services, even if the services are rendered beyond the 60-day period or the period otherwise stated in the advertisement.
(h) A dental advertisement in any medium may state the dentist’s office hours.
(i) A recorded copy of an advertisement on radio or television shall be retained for 1 year following the final broadcast of the advertisement. The dentist who is responsible for the advertisement under subsection (c) shall furnish the Board with a copy of the advertisement within 20 days of being requested to do so.
(j) If the narrator of a dental advertisement on radio or television is represented as a dentist, that person shall be the dentist so represented.
(k) This subsection contains definitions of some but not all of the various types of dental services for which fees may be advertised under subsection (e). Whenever a fee is advertised for one of the defined terms listed in paragraphs (1)—(10), the meaning of the term, as used in the advertisement, is at least as inclusive as the definition set forth in this subsection. These definitions will help ensure that commonly used terms for dental services convey the same meanings in advertisements, thus providing consumers with a better opportunity to compare fees for equivalent services.
(1) Examination. A study of the structures of the oral cavity, including the recording of the condition of the structures and the appropriate history. At a minimum, the study shall include the charting of caries; the notation of periodontal disease, occlusal discrepancies, and oral lesions; and a written diagnosis. If a dentist intends to render services in addition to the examination and to charge a separate fee for the additional services, the dentist shall disclose this separate fee to the patient before rendering the additional services.
(2) Treatment planning. A written statement of treatment recommendations following an examination and diagnosis. This statement shall include an itemized treatment recommendation and an itemized fee statement.
(3) Radiographs. X-rays of the hard and soft oral structures to be used as an aid to diagnosis.
(4) Oral prophylaxis. Scaling and polishing of teeth by a licensed dentist or dental hygienist.
(5) Restorative dentistry. Procedures involving restoration of tooth structure. The advertisement shall indicate type of restoration and materials to be used.
(6) Endodontics. Treatment of the dental pulp, its replacement with suitable material and associated surgery, if indicated.
(7) Orthodontics. Prevention and treatment of irregular dentition.
(8) Periodontics. Treatment of diseases of the hard and soft tissue surrounding and supporting the oral dentition, including curettage, root planing, surgery, splinting, equilibration and hygiene control procedures.
(9) Prosthodontics. Restoration and replacement of teeth and other oral structures by artificial devices, including:
(i) Fixed prosthetics. Crowns and bridges. The advertisement shall indicate the type of prosthesis and materials to be used.
(ii) Removable prosthetics. Partial and full dentures. The advertisement shall indicate type of prosthesis and materials to be used.
(10) Surgery. Surgical treatment of hard or soft tissues, extractions, and treatment of oral pathology, injuries, pain, dysfunction, deformities or other conditions of the oral cavity and its surrounding structures.
Source The provisions of this § 33.203 adopted June 23, 1995, effective June 24, 1995, 25 Pa.B. 2492.
Cross References This section cited in 49 Pa. Code § 33.201 (relating to use of titles and other designations); and 49 Pa. Code § 33.202 (relating to fictitious names).
§ 33.204. Assignment of duties.
Dental procedures shall be assigned to a competent person who the dentist deems appropriate as defined by and consistent with the act.
Source The provisions of this § 33.204 adopted June 23, 1995, effective June 24, 1995, 25 Pa.B. 2492.
§ 33.205. Practice as a dental hygienist.
(a) Scope of professional practice. A dental hygienist may offer to perform or perform services that involve:
(1) Placement of subgingival agents.
(2) Periodontal probing, scaling, root planning, polishing or another procedure required to remove calculus deposits, accretions, excess or flash restorative materials and stains from the exposed surfaces of the teeth and beneath the gingiva.
(3) Evaluation of the patient to collect data to identify dental hygiene care needs.
(4) The application of fluorides and other recognized topical agents for the prevention of oral diseases.
(5) Conditioning of teeth for and application of sealants.
(6) Taking of impressions of the teeth for athletic appliances.
(7) Administration of local anesthesia by regional injection in accordance with § 33.115 (relating to local anesthesia permit).
(b) Prohibition against independent practice. A dental hygienist is prohibited from establishing or maintaining an office or other workplace for the provision of dental hygiene services separate or independent from the office or other workplace in which the supervision of a dentist is provided.
(c) Practice sites. A dental hygienist may engage in professional practice at the following sites under the supervision of a dentist as required in subsection (d):
(1) In dental facilities.
(2) In public or private institutions such as schools, hospitals, public health care agencies, nursing homes, mobile health units and homes for juveniles, the elderly and the handicapped.
(3) In institutions under the jurisdiction of Federal, State or local health agencies.
(d) Supervision.
(1) In subsection (c)(1) practice sites (dental facilities), a dental hygienist shall provide professional services as follows:
(i) A dental hygienist may provide the professional services identified in subsection (a)(1) under the direct supervision of a dentist, except that these services may be provided under general supervision if the dentist has reviewed the patient’s dental records and medical history and has written a prescription or given an order for the placement of subgingival agents by the dental hygienist.
(ii) A dental hygienist may provide the professional services identified in subsection (a)(2) under the general supervision of a dentist when the patient is free of systemic disease or suffers from mild systemic disease, as determined by the dentist with input from the dental hygienist and upon review of the patient’s medical history.
(iii) A dental hygienist may provide the professional services identified in subsection (a)(2) under the direct supervision of a dentist when the patient is suffering from systemic disease which is severe, incapacitating, or life threatening, as determined by the dentist with input from the dental hygienist and upon review of the patient’s medical history.
(iv) A dental hygienist may provide the professional services identified in subsection (a)(3)—(6) under the general supervision of a dentist.
(v) A dental hygienist may provide the professional services identified in subsection (a)(7) only under the direct supervision of a dentist. For purposes of this subparagraph, direct supervision means supervision by a dentist who has examined the patient and authorized the procedure to be performed, is physically present in the dental facility and available during the performance of the procedure, and takes full professional responsibility for the completed procedure.
(2) In subsection (c)(2) and (3) practice sites (public and private institutions and institutions under the jurisdiction of Federal, State or local health agencies), a dental hygienist shall provide professional services as follows:
(i) A dental hygienist may provide the professional services identified in subsection (a)(1) under the direct supervision of a dentist, except that these services may be provided under general supervision if a dentist has reviewed the patient’s dental records and medical history and has written a prescription or given an order for the placement of subgingival agents by the dental hygienist.
(ii) A dental hygienist may provide the professional services identified in subsection (a)(2)—(6) under the general supervision of a dentist. For the purposes of this paragraph, general supervision is defined as supervision by a dentist who authorizes and takes full professional responsibility for the provision of the services. A single authorization may, when appropriate, apply to one or more classes or categories of students/patients.
(iii) A dental hygienist may provide the professional service identified in subsection (a)(7) only under the direct supervision of a dentist. For purposes of this subparagraph, direct supervision means supervision by a dentist who has examined the patient and authorized the procedure to be performed, is physically present and available during the performance of the procedure, and takes full professional responsibility for the completed procedure.
(3) For professional services not identified in subsection (a)(1)—(7) or § 33.302 (relating to requirements for personnel performing radiologic procedures), the dentist shall compare the listed services and the supervision required with the unlisted service and utilize the appropriate supervision. Supervision for noncomparable services will be determined by the Board on a modality basis.
(4) Notwithstanding the supervision requirements in this subsection, a dental hygienist may provide oral health education and perform preliminary dental screenings in any setting without the supervision of a dentist.
Authority The provisions of this § 33.205 amended under section 3(d), (j.2) and (o) of The Dental Law (63 P. S. § 122(d), (j.2) and (o)).
Source The provisions of this § 33.205 adopted June 23, 1995, effective June 24, 1995, 25 Pa.B. 2492; amended December 11, 2009, effective December 12, 2009, 39 Pa.B. 6982; corrected February 26, 2010, effective December 12, 2009, 40 Pa.B. 1082. Immediately preceding text appears at serial pages (346659) to (346662).
Cross References This section cited in 49 Pa. Code § 33.1 (relating to definitions); 49 Pa. Code § 33.110 (relating to volunteer license); and 49 Pa. Code § 33.205b (relating to practice as a public health dental hygiene practitioner).
§ 33.205a. Practice as an expanded function dental assistant.
(a) Scope of professional practice.
(1) An expanded function dental assistant may offer to perform or perform the following services:
(i) Placing and removing rubber dams.
(ii) Placing and removing matrices.
(iii) Placing and removing wedges.
(iv) Applying cavity liners and bases.
(v) Placing and condensing amalgam restorations.
(vi) Carving and contouring amalgam restorations.
(vii) Placing and finishing composite resin restorations or sealant material, or both.
(viii) Performing coronal polishing as defined in § 33.1 (relating to definitions).
(ix) Performing fluoride treatments, including fluoride varnish.
(x) Taking impressions of teeth for study models, diagnostic casts or athletic appliances.
(2) Each of the professional services identified in paragraph (1) shall be performed under the direct supervision of a dentist.
(b) Prohibitions. An expanded function dental assistant may not perform the following procedures:
(1) Complete or limited examination, diagnosis and treatment planning.
(2) Surgical or cutting procedures of hard or soft tissue.
(3) Prescribing drugs, medicaments or work authorizations.
(4) Final inspection and approval of restorative and other treatment which affects occlusion and necessary occlusal adjustments.
(5) Pulp capping, pulpotomy and other endodontic procedures.
(6) Placement and intraoral adjustments of fixed and removable prosthetic appliances.
(7) Administration of local anesthesia, parenteral or inhalational sedation, nitrous oxide analgesia or general anesthesia.
(8) Take impressions other than for study models, diagnostic casts or athletic appliances.
(c) Supervision. Expanded function dental assistants shall perform under the direct supervision of a dentist. Direct supervision means that a dentist is in the dental office or treatment facility, personally diagnoses the condition to be treated, personally authorizes the procedure and remains in the dental office or treatment facility while the procedure is being performed by the expanded function dental assistant, and, before dismissal of the patient, personally evaluates the work performed by the expanded function dental assistant.
Authority The provisions of this § 33.205a amended under sections 2—5.1, 10—11.5 and 11.7 of The Dental Law (63 P. S. § § 121—124.1, 129—129.1, 130, 130e and 130h); and section 4 of the act of April 29, 2010 (P. L. 176, No. 19).
Source The provisions of this § 33.205a adopted May 12, 2000, effective May 13, 2000, 30 Pa.B. 2359; amended September 7, 2012, effective September 8, 2012, 42 Pa.B. 5736. Immediately preceding text appears at serial pages (348144) and (360159).
Cross References This section cited in 49 Pa. Code § 33.117 (relating to EFDA program approval).
§ 33.205b. Practice as a public health dental hygiene practitioner.
(a) Scope of professional practice. A public health dental hygiene practitioner may perform the dental hygiene services set forth in § 33.205(a)(2)—(6) (relating to practice as a dental hygienist) in the practice settings identified in subsection (c) without the authorization, assignment or examination by a dentist. A public health dental hygiene practitioner may perform the dental hygiene services set forth in § 33.205(a)(1) and (7) in accordance with § 33.205(d).
(b) Requirement of referral. A public health dental hygiene practitioner shall refer each patient to a licensed dentist on an annual basis. Documentation of the referral must be maintained in the patient’s dental record. The failure of the patient to see a dentist as referred will not prevent the public health dental hygiene practitioner from continuing to provide dental hygiene services to the patient within the scope of professional practice set forth in subsection (a).
(c) Practice settings. A public health dental hygiene practitioner may perform dental hygiene services without the supervision of a dentist in the following practice settings:
(1) Public and private educational institutions that provide elementary and secondary instruction to school aged children under the jurisdiction of the State Board of Education, and in accordance with all applicable provisions of the Public School Code of 1949 (24 P.S. § § 1-101—27-2702), the regulations relating to the certification of professional personnel in 22 Pa. Code Chapter 49 (relating to certification of professional personnel), and the regulations of the Department of Health in 28 Pa. Code § 23.35 (relating to dental hygienists).
(2) Correctional facilities. For purposes of this section, correctional facilities include Federal prisons and other institutions under the jurisdiction of the United States Department of Justice, Bureau of Prisons which are located within this Commonwealth; institutions, motivational boot camps and community corrections centers operated or contracted by the Department of Corrections; and jails, prisons, detention facilities or correctional institutions operated or contracted by local, county or regional prison authorities within this Commonwealth.
(3) Health care facilities, as defined in section 802.1 of the Health Care Facilities Act (35 P.S. § 448.802a), including a general, chronic disease or other type of hospital; a home health care agency; a home care agency; a hospice; a long-term care nursing facility; a cancer treatment center; an ambulatory surgical facility or a birth center.
(4) Any other facility licensed and regulated by the Department of Health or a successor agency.
(5) A ‘‘facility,’’ as defined in section 1001 of the Human Services Code (62 P.S. § 1001), including an adult day care center; child day care center; family child care home; boarding home for children; mental health establishment; personal care home; assisted living residence; nursing home, hospital or maternity home.
(6) Any other facility licensed and regulated by the Department of Human Services or a successor agency.
(7) Domiciliary care facilities, as defined in section 2202-A of The Administrative Code of 1929 (71 P.S. § 581-2).
(8) Older adult daily living centers, as defined in section 2 of the Older Adult Daily Living Centers Licensing Act (62 P.S. § 1511.2).
(9) Continuing-care provider facilities, as defined in section 3 of the Continuing-Care Provider Registration and Disclosure Act (40 P.S. § 3203).
(10) Federally-qualified health centers, as defined in section 1905(1)(2)(B) of the Social Security Act (42 U.S.C.A. § 1369(1)(2)(B)). For purposes of this section, the term includes Federally-qualified health center lookalikes that do not receive grant funds under section 330 of the Public Health Service Act (42 U.S.C.A. § 254b).
(11) Public or private institutions under the jurisdiction of a Federal, State or local agency.
(12) Free and reduced-fee nonprofit health clinics.
(13) An office or clinic of a physician who is licensed by the State Board of Medicine under the Medical Practice Act of 1985 (63 P.S. § § 422.1—422.53) or by the State Board of Osteopathic Medicine under the Osteopathic Medical Practice Act (63 P.S. § § 271.1—271.18), that is located in a dental health professional shortage area, as determined by the United States Department of Health and Human Services, Health Resources & Services Administration, and published on the Pennsylvania Department of Health’s web site at www.health.pa.gov. For purposes of this paragraph, an office or clinic of a physician includes a ‘‘satellite location’’ as defined in § 18.122 (relating to definitions) or ‘‘satellite operations’’ as defined in § 25.142 (relating to definitions).
(14) A ‘‘facility,’’ as defined in 28 Pa. Code § 701.1 (relating to general definitions) that is licensed by the Department of Drug and Alcohol Programs to provide drug and alcohol treatment services.
(d) Recordkeeping. A public health dental hygiene practitioner shall maintain a dental record which accurately, legibly and completely reflects the dental hygiene services provided to the patient. The dental record must be retained for at least 5 years from the date of the last treatment entry. The dental record must include, at a minimum, the following:
(1) The name and address of the patient and, if the patient is a minor, the name of the patient’s parents or legal guardian.
(2) The date dental hygiene services are provided.
(3) A description of the treatment or services rendered at each visit.
(4) The date and type of radiographs taken, if any, and documentation demonstrating the necessity or justification for taking radiographs, as well as the radiographs themselves.
(5) Documentation of the annual referral to a dentist.
Authority The provisions of this § 33.205b issued under section 3(d), (j.2) and (o) of The Dental Law (63 P.S. § 122(d), (j.2) and (o)); and amended under sections 3(o) and 11.9(b)(10) of The Dental Law (63 P.S. § § 122(o) and 130j(b)(10)).
Source The provisions of this § 33.205b adopted December 11, 2009, effective December 12, 2009, 39 Pa.B. 6982; amended January 15, 2021, effective January 16, 2021, 51 Pa.B. 304. Immediately preceding text appears at serial pages (371899) to (371900) and (363515).
Cross References This section cited in 49 Pa. Code § 33.1 (relating to definitions); and 49 Pa. Code § 33.302 (relating to requirements for personnel performing radiologic procedures).
§ 33.206. Identifying information on prescriptions.
(a) The name, address, telephone number and dental license number of the prescribing dentist shall appear on prescriptions for drugs, services or supplies.
(b) Noncompliance with subsection (a) will be considered unprofessional conduct and will subject the noncomplying dentist to disciplinary action as authorized in section 4.1(a)(8) of the act (63 P. S. § 123.1(a)(8)).
Source The provisions of this § 33.206 adopted June 23, 1995, effective June 24, 1995, 25 Pa.B. 2492.
§ 33.207. Prescribing, administering and dispensing controlled substances.
(a) When prescribing, administering or dispensing controlled substances as defined in section 4 of The Controlled Substance, Drug, Device and Cosmetic Act (35 P. S. § 780-104), a dentist shall comply with, or cause compliance with, the following minimum standards:
(1) Scope of authority. A dentist may prescribe, administer or dispense a controlled substance only:
(i) In good faith in the course of the dentist’s professional practice.
(ii) Within the scope of the dentist-patient relationship.
(iii) In accordance with treatment principles accepted by a responsible segment of the profession.
(2) Dental examination and medical history. A dental examination shall be conducted and a medical history shall be taken before a dentist initially prescribes, administers or dispenses a controlled substance to a patient. The examination and medical history shall be complete enough to justify the prescription, administration or dispensation of the controlled substance. The examination shall focus on the patient’s dental problems, and the resulting diagnosis shall relate to the patient’s specific complaint. The patient’s dental record shall contain written evidence of the examination and medical history.
(3) Records.
(i) On each occasion when a controlled substance is prescribed, administered or dispensed to a patient, an entry shall be made in the patient’s dental record containing the following information:
(A) The name, quantity and strength of the controlled substance.
(B) The directions for use.
(C) The date of issuance.
(D) The condition for which the controlled substance was issued.
(ii) For the purpose of this subsection, health care facility records will be considered part of the patient’s dental record. A patient’s dental record that contains entries pertaining to the issuance of controlled substances shall be retained by the dentist for a minimum of 5 years following the date of the last entry of any kind in the record.
(4) Emergency prescriptions. If an emergency requires the issuance of a prescription, an appropriate short-term prescription may be telephoned to a pharmacist. An emergency prescription for a Schedule II controlled substance shall be covered by a written prescription delivered to the dispensing pharmacist within 72 hours. A dentist may not order a renewal or a refill of an emergency prescription unless the order is in writing and the dentist has given the patient a dental examination and has taken a medical history as required by paragraph (2).
(5) Exception. This subsection, except for paragraph (1), does not apply when a controlled substance is prescribed, administered or dispensed to a patient in a health care facility regulated by the Department of Health or by the Department of Public Welfare.
(b) A dentist’s failure to comply with this section will be considered unprofessional conduct and will subject the noncomplying dentist to disciplinary action as authorized in section 4.1(a)(8) of the act (63 P. S. § 123.1(a)(8)).
(c) This section does not restrict or limit the applicability of The Controlled Substance, Drug, Device and Cosmetic Act (35 P. S. § § 780-101—780-144) or of another statute or regulation and does not relieve a dentist from complying with more stringent standards that may be imposed by another regulation or statute.
Source The provisions of this § 33.207 adopted June 23, 1995, effective June 24, 1995, 25 Pa.B. 2492.
Cross References This section cited in 49 Pa. Code § 33.208 (relating to prescribing, administering and dispensing medications); 49 Pa. Code § 33.209 (relating to preparing, maintaining and retaining patient records); and 49 Pa. Code § 33.212 (relating to misleading, deceptive, untrue or fraudulent representations).
§ 33.208. Prescribing, administering and dispensing medications.
(a) When prescribing, administering or dispensing medications not included under § 33.207 (relating to prescribing, administering and dispensing controlled substances), dentists shall comply with, or cause compliance with, the following minimum standards:
(1) Scope of authority. A dentist may prescribe, administer or dispense medication only:
(i) In good faith in the course of the dentist’s professional practice.
(ii) Within the scope of the dentist-patient relationship.
(iii) In accordance with treatment principles accepted by a responsible segment of the profession.
(2) Dental examination and medical history. A dental examination shall be conducted and a medical history shall be taken before a dentist initially prescribes, administers or dispenses medication to a patient. The examination and medical history shall be complete enough to justify the prescription, administration or dispensation of the medication. The examination shall focus on the patient’s dental problems, and the resulting diagnosis shall relate to the patient’s specific complaint. The patient’s dental record shall contain written evidence of the examination and medical history.
(3) Records. On each occasion when medication is prescribed, administered or dispensed to a patient, an entry shall be made in the patient’s dental record containing the following information:
(i) The name, quantity and strength of the medication.
(ii) The directions for use.
(iii) The date of issuance.
(iv) The condition for which the medication was issued.
(4) Emergency prescriptions. If an emergency requires the issuance of a prescription, an appropriate short-term prescription may be telephoned to a pharmacist. A dentist may not order a renewal or a refill of an emergency prescription unless the order is in writing and the dentist has given the patient a dental examination and has taken a medical history as required by paragraph (2).
(b) A dentist’s failure to comply with this section will be considered unprofessional conduct and will subject the noncomplying dentist to disciplinary action as authorized in section 4.1(a)(8) of the act (63 P. S. § 123.1(a)(8)).
Source The provisions of this § 33.208 adopted June 23, 1995, effective June 24, 1995, 25 Pa.B. 2492.
Cross References This section cited in 49 Pa. Code § 33.209 (relating to preparing, maintaining and retaining patient records); and 49 Pa. Code § 33.212 (relating to misleading, deceptive, untrue or fraudulent representations).
§ 33.209. Preparing, maintaining and retaining patient records.
(a) A dentist shall maintain a dental record for each patient which accurately, legibly and completely reflects the evaluation and treatment of the patient. A patient dental record shall be prepared and maintained regardless of whether treatment is actually rendered or whether a fee is charged. The record shall include, at a minimum, the following:
(1) The name and address of the patient and, if the patient is a minor, the name of the patient’s parents or legal guardian.
(2) The date of each patient visit.
(3) A description of the patient’s complaint, symptoms and diagnosis.
(4) A description of the treatment or service rendered at each visit and the identity of the person rendering it.
(5) Information as required in § 33.208 (relating to prescribing, administering and dispensing medications) and this section with regard to controlled substances or other medications prescribed, administered or dispensed.
(6) The date and type of radiographs taken and orthodontic models made, as well as the radiographs and models themselves. Notwithstanding this requirement, the dentist may release orthodontic models to the patient. This transaction shall be memorialized on a form which is signed by the patient. The signed form shall become part of the patient’s record.
(7) Information with regard to the administration of local anesthesia, nitrous oxide/oxygen analgesia, conscious sedation, deep sedation or general anesthesia. This shall include results of the preanesthesia physical evaluation, medical history and anesthesia procedures utilized.
(8) The date of each entry into the record and the identity of the person providing the service if not the dentist of record-for example, dental hygienist, expanded function dental assistant, dental assistant, and the like.
(b) A patient dental record shall be retained by a dentist for a minimum of 5 years from the date of the last dental entry.
(c) Within 30 days of receipt of a written request from a patient or a patient’s parents or legal guardian if the patient is a minor, an exact copy of the patient’s written dental record, along with copies of radiographs and orthodontic models, if requested, shall be furnished to the patient or to the patient’s new dentist. This service shall be provided either gratuitously or for a fee reflecting the cost of reproduction.
(d) The obligation to transfer records under subsection (c) exists irrespective of a patient’s unpaid balance for dental services or for the cost of reproducing the record.
(e) Dentists shall provide for the disposition of patient records in the event of the dentist’s withdrawal from practice, incapacity or death in a manner that will ensure their availability under subsection (c).
(f) The components of a patient dental record that are prepared by a dentist or an agent and retained by a health care facility regulated by the Department of Health or the Department of Public Welfare shall be considered a part of the patient dental record required to be maintained by a dentist, but shall otherwise be exempt from subsections (a)—(e). The components of a patient dental record shall contain information required by applicable Department of Health and Department of Public Welfare regulations—see, for example, 28 Pa. Code § 141.26 (relating to patient dental records)—and health care facility bylaws.
(g) This section does not restrict or limit the applicability of recordkeeping requirements in § § 33.207 and 33.208 (relating to prescribing, administering and dispensing controlled substances; and prescribing, administering and dispensing medications).
(h) A dentist’s failure to comply with this section will be considered unprofessional conduct and will subject the noncomplying dentist to disciplinary action as authorized in section 4.1(a)(8) of the act (63 P. S. § 123.1(a)(8)).
Authority The provisions of this § 33.209 amended under sections 3(c) and 11.2(a) of the Dental Law (63 P. S. § § 122(o) and 130c(a)).
Source The provisions of this § 33.209 adopted June 23, 1995, effective June 24, 1995, 25 Pa.B. 2492; amended May 12, 2000, effective May 13, 2000, 30 Pa.B. 2359; amended May 13, 2005, effective May 14, 2005, 35 Pa.B. 2880. Immediately preceding text appears at serial pages (266034) to (266036).
Notes of Decisions Patient’s Complaint
The State Board of Dentistry’s findings that the dentist failed to properly record the parents’ complaint was supported by substantial evidence, where, based on the expert testimony, the Board found that the dentist should have recorded the parents’ complaint that their son had black spots on his teeth or recorded ‘‘no complaints’’ on the child’s record, and where the Board stated that while the dentist recorded the child’s cavities, such an activity constituted a diagnosis, which is a separate recording requirement. Watkins v. State Board of Dentistry, 740 A.2d 760 (Pa. Cmwlth. 1999).
Cross References This section cited in 49 Pa. Code § 33.340 (relating to duties of dentists who are unrestricted permitholders); and 49 Pa. Code § 33.340a (relating to duties of dentists who are restricted permit I holders); and 49 Pa. Code § 33.340b (relating to duties of dentists who are restricted permit II holders).
§ 33.210. Storage of drugs.
Dentists who administer or dispense drugs shall comply with the following standards:
(1) Each drug storage area shall be maintained in a clean and orderly condition.
(i) The storage area shall be dry, well ventilated and well lighted. Provision shall be made for adequate dust, humidity and temperature controls to ensure drug stability.
(ii) The storage area shall contain only drugs and related supplies and equipment which are necessary for the administration and dispensing of drugs to the dentist’s own patients.
(iii) Drugs in the storage area shall be accurately labeled. Until a drug is administered or dispensed to a dental patient, it shall be kept in the manufacturer’s original container showing the manufacturer’s lot number and the expiration date.
(iv) Drugs in the storage area shall be free from adulteration. Appropriate procedures shall be established to minimize the hazards of cross contamination.
(v) Outdated or deteriorated drugs shall be identified as such and shall be segregated in the storage area pending their return to the manufacturer or their appropriate disposal. The dentist shall maintain records reflecting the final disposition of these products.
(2) Controlled substances shall be stored in a substantially constructed, locked container such as a cabinet or safe. Access to the locked container where controlled substances are kept in order to clean, replenish supplies or perform other necessary functions shall be allowed only when a dentist is present and supervising.
(3) The dentist shall provide for the safe, secure and sanitary disposal of drug-containing refuse.
(4) This section prescribes minimum standards for the storage of drugs in dental offices. It does not relieve a dentist from complying with more stringent standards that may be imposed by another regulation or by statute.
(5) A dentist’s failure to comply with this section will be considered unprofessional conduct and will subject the noncomplying dentist to disciplinary action as authorized in section 4.1(a)(8) of the act (63 P. S. § 123.1(a)(8)).
Source The provisions of this § 33.210 adopted June 23, 1995, effective June 24, 1995, 25 Pa.B. 2492.
§ 33.211. Unprofessional conduct.
(a) Dentists. Unprofessional conduct, as defined in section 4.1(a)(8) of the act (63 P. S. § 123.1(a)(8)), includes the following conduct by a dentist:
(1) Knowingly or negligently employing as a dentist, dental hygienist or expanded function dental assistant a person whose license or certificate is not current or has been suspended or revoked.
(2) Failing to carry out supervisory responsibility with regard to auxiliary personnel or dental residents/interns.
(3) Delegating to a person duties that the dentist knows, or has reason to know, the person is not competent to perform or not authorized to perform.
(4) Withdrawing dental services after a dentist-patient relationship has been established so that the patient is unable to obtain necessary dental care in a timely manner.
(5) Physically, sexually or verbally abusing a patient.
(6) Unnecessarily exposing a patient to ionizing radiation.
(7) Failing to follow current infection-control recommendations issued by the Federal Centers for Disease Control or to ensure that auxiliary personnel and other supervisees follow these Federal guidelines.
(8) Failing to provide necessary dental care to a patent in a timely manner or to apprise the patient of the need for the care.
(9) Failing to make available to a patient, within 30 days of a request, information sufficient to enable the patient to complete an insurance form.
(b) Dental hygienists. Unprofessional conduct, as defined in section 4.1(a)(8) of the act includes the following conduct by a dental hygienist:
(1) Practicing as a dental hygienist without the supervision of a dentist.
(2) Performing a service that the dental hygienist knows, or has reason to know, the hygienist is not competent to perform or not authorized to perform.
(3) Physically, sexually or verbally abusing a patient.
(4) Failing to follow current infection-control recommendations issued by the Federal Centers for Disease Control.
(5) Unnecessarily exposing a patient to ionizing radiation.
(c) Expanded function dental assistants. Unprofessional conduct, as defined in section 4.1(a)(8) of the act includes the following conduct by an expanded function dental assistant:
(1) Practicing as an expanded function dental assistant without the direct supervision of a dentist.
(2) Performing a service that the expanded function dental assistant is not competent or not authorized to perform.
(3) Physically, sexually or verbally abusing a patient.
(4) Failing to follow current infection-control recommendations issued by the Federal Centers for Disease Control.
(5) Providing ionizing radiation in violation of § 33.302 (relating to auxiliary personnel performing radiologic procedures).
Authority The provisions of this § 33.211 amended under sections 2—5.1, 10—11.5 and 11.7 of the Dental Law (63 P. S. § § 121—124.1, 129—129.1, 130, 130e and 130h).
Source The provisions of this § 33.211 adopted January 18, 1965; amended September 12, 1975, effective September 13, 1975, 5 Pa.B. 2397; amended January 20, 1978, January 21, 1978, 8 Pa.B. 203; amended July 20, 1990, effective July 21, 1990, 20 Pa.B. 3972; amended June 23, 1995, effective June 24, 1995, 25 Pa.B. 2492; amended May 12, 2000, effective May 13, 2000, 30 Pa.B. 2359. Immediately preceding text appears at serial pages (223044) to (233045).
§ 33.211a. Sexual misconduct.
(a) Disciplinary action authorized. Unprofessional conduct, as defined in section 4.1(a)(8) of the act (63 P. S. § 123.1(a)(8)), includes sexual misconduct by a dentist, a dental hygienist, a public health dental hygiene practitioner or an expanded function dental assistant (EFDA), and subjects the Board-regulated practitioner to disciplinary action under section 4.1(a)(8) and section 10.1 of the act (63 P. S. § 129.1).
(b) Impaired professional program. A Board-regulated practitioner who engages in conduct prohibited by this section will not be eligible for placement into an impaired professional program in lieu of disciplinary action or correction.
(c) Consent. Consent is not a defense to conduct prohibited by this section.
(d) Exclusion. This section does not apply to conduct between a Board-regulated practitioner and the Board-regulated practitioner’s spouse or a person cohabitating with the Board-regulated practitioner.
Authority The provisions of this § 33.211a adopted under sections 4.1(a)(8) and 10.1 of the Dental Law (63 P. S. § § 123.1 (a)(8) and 129.1).
Source The provisions of this § 33.211a adopted November 14, 2008, effective November 15, 2008, 38 Pa.B. 6279.
§ 33.212. Misleading, deceptive, untrue or fraudulent representations.
As used in section 4.1(a)(2) of the act (63 P. S. § 123.1(a)(2)), the phrase ‘‘misleading, deceptive, untrue or fraudulent representations’’ includes the following conduct by dentists, dental hygienists and expanded function dental assistants:
(1) Misrepresenting or concealing a material fact in obtaining, renewing or seeking reinstatement of a license or certificate.
(2) Misrepresenting or concealing a material fact in obtaining payment for dental services.
(3) Writing a prescription for a controlled substance or other medication in the name of a person other than for whom the controlled substance or other medication is intended under § § 33.207 and 33.208 (relating to prescribing, administering and dispensing controlled substances; and prescribing, administering and dispensing medications).
(4) Falsifying a patient’s record regarding treatment or the issuance of a controlled substance or other medication.
Authority The provisions of this § 33.212 amended under sections 2—5.1, 10—11.5 and 11.7 of the Dental Law (63 P. S. § § 121—124.1, 129—129.1, 130, 130e and 130h).
Source The provisions of this § 33.212 adopted January 18, 1965; amended September 12, 1975, effective September 13, 1975, 5 Pa.B. 2397; reserved April 28, 1989, effective April 29, 1989, 19 Pa.B. 1840; amended June 23, 1995, effective June 24, 1995, 25 Pa.B. 2492; amended May 12, 2000, effective May 13, 2000, 30 Pa.B. 2359. Immediately preceding text appears at serial page (223045).
Cross References This section cited in 49 Pa. Code § 33.404 (relating to reporting continuing education credit hours).
§ 33.213. Use and replacement of dental amalgams—statement of policy.
(a) Background. The safety of dental amalgams, specifically, whether the mercury in amalgams causes or contributes to a variety of health problems, has become a recurring issue in dentistry. The Food and Drug Administration has determined that while elemental mercury has been associated with adverse health effects at high exposures, the levels released by amalgam fillings are not high enough to cause harm in patients. The Board is not aware, however, of conclusive evidence that the use of alternative restorative materials or removal of amalgams will prevent, cure or ameliorate disorders other than those associated with confirmed allergic reactions to mercury. Nonetheless, nonallergic patients may request the use of alternative restorative materials or replacement of amalgam restorations in the belief, or merely the hope, that a medical condition will thereby disappear or improve. Dentists receiving these requests must make ethical and professional decisions compatible with the best interests of their patients.
(b) Purpose. Section 4.1(a)(8) and (9) of the act (63 P. S. § 123.1(a)(8) and (9)) authorizes the Board to take disciplinary action against licensees who engage in unprofessional conduct or commit acts of negligence, incompetence or malpractice. The replacement of amalgams may implicate both provisions by, for example, generating complaints of unnecessary or even harmful treatment. The Board therefore provides the following guidelines to assist its licensees in conforming their behavior to the requirements of the act. In a disciplinary action brought against a dentist for treatment associated with replacing amalgams, the Board will consider whether these guidelines were followed.
(c) Guidelines.
(1) The Board recommends that, before replacing amalgams in a nonallergic patient, the dentist:
(i) Explain to the patient the current status of research on the safety of dental amalgams.
(ii) Provide the patient with information on contraindications and costs associated with removal/replacement of amalgam restorations.
(iii) Advise a patient relying on third-party payment to ascertain whether the insurer will cover removal/replacement procedures.
(iv) Encourage a patient seeking amelioration of a medical condition to consult with a physician and, as appropriate, secure from the physician documentation of recommendations made to the patient.
(v) Memorialize in writing the disclosures made to the patient and the patient’s informed consent.
(2) The Board recognizes the right and duty of dentists to refuse to replace amalgam restorations when, in their professional judgment, this procedure would not be in the best interests of the patient.
Source The provisions of this § 33.213 adopted January 18, 1965; amended September 12, 1975, effective September 13, 1975, 5 Pa.B. 2397; amended June 23, 1995, effective June 24, 1995, 25 Pa.B. 2492; amended October 25, 2013, effective October 26, 2013, 43 Pa.B. 6385. Immediately preceding text appears at serial pages (311481) to (311482).
§ 33.214. Disclosure of financial or ownership interest—statement of policy.
(a) Purpose. This section provides guidelines for compliance with the act of May 26, 1988 (P. L. 403, No. 66) (35 P. S. § § 449.21—449.23), which requires practitioners of the healing arts, before referring a patient to a facility or entity engaged in providing health-related services, tests, pharmaceuticals, appliances or devices, to disclose to the patient any financial or ownership interest of the practitioner in the facility or entity.
(b) Definitions. The following words and terms, when used in this section, have the following meanings, unless the context clearly indicates otherwise:
Appliances or devices—The term includes therapeutic equipment, instruments and prosthetic appliances.
Disclose to the patient—The practitioner of the healing arts makes known to the patient at the time a referral is made that the practitioner has a financial or ownership interest in the facility or entity to which the patient is referred. The practitioner shall also inform the patient of the patient’s freedom to choose an alternate provider.
Facility or entity—The term includes another practitioner of the healing arts, licensed health care practitioner, partnership, association, group practice, business corporation and professional corporation not on the premises of the practitioner.
Financial interest of the practitioner or ownership by the practitioner in the facility or entity—A financial or ownership interest to any extent or degree, including interests held by the practitioner, the practitioner’s spouse or the practitioner’s minor children.
Health-related services—The term includes radiologic services, physical therapy, counseling and laboratory services.
Pharmaceutical—Pertaining to a drug or pharmacy.
Practitioner of the healing arts—A dentist or dental hygienist.
Referral—The act of prescribing, ordering, directing, redirecting or recommending to a patient a specific facility or entity which provides a health-related service, test, pharmaceutical, appliance or device, either by means of prescription, recommended course of treatment, or direction concerning diagnostic or therapeutic treatment or services.
Test—The term includes a test necessary for dental diagnosis or treatment.(c) Use of patient disclosure forms.
(1) It is the practitioner’s responsibility to disclose to the patient a financial or ownership interest when making a referral covered by the act. Meaningful disclosure shall be given to each patient at the time a referral is made. The disclosure may be made orally or in writing. In either event, the Board recommends that the disclosure be memorialized, dated and signed at the time of referral by the practitioner and the patient, and that the practitioner maintain written evidence of the disclosure. If the practitioner delegates the disclosure to another person in the practitioner’s office, the Board recommends that the disclosure be memorialized, dated and signed by the person making the disclosure and the patient.
(2) The memorialization of the disclosure shall be substantially in the following form:
I ACKNOWLEDGE THAT I HAVE BEEN ADVISED BY MY DENTIST/DENTAL HYGIENIST THAT HE/SHE HAS A FINANCIAL OR OWNERSHIP INTEREST IN THE FACILITY OR ENTITY TO WHICH HE/SHE HAS REFERRED ME, AND THAT HE/SHE HAS ADVISED ME THAT I AM FREE TO CHOOSE ANOTHER FACILITY OR ENTITY TO PROVIDE THE SERVICE, DRUG, DEVICE OR EQUIPMENT.
(3) In an enforcement proceeding before the Board, the memorialization referred to in paragraphs (1) and (2) shall constitute presumptive evidence that the practitioner made the required disclosure. The disclosure to the patient is not, however, the act of the patient signing the form but is, rather, the act of the practitioner disclosing to the patient the practitioner’s financial or ownership interest and advising the patient of the patient’s freedom of choice.
(d) Guidelines for disclosure. With regard to patients who are minors, unconscious, of unsound mind or otherwise incompetent to understand their freedom of choice in selection of a facility or entity, disclosure shall be made to the guardian, spouse or closest adult next of kin. Disclosure of a practitioner’s interest cannot be accomplished unless patients are competent to understand their freedom of choice. A practitioner will not be disciplined for failure to disclose in the event of an emergency which prevents consulting the patient or the patient’s representative.
Source The provisions of this § 33.214 adopted May 13, 1977, effective May 14, 1977, 7 Pa.B. 1284; amended June 23, 1995, effective June 24, 1995, 25 Pa.B. 2492. Immediately preceding text appears at serial pages (151838) to (151839).
§ 33.215. Use of lasers in the dental office—statement of policy.
(a) Background and purpose. The use of lasers in experimental and institutional settings has raised questions with regard to using this technology in the dental office. In addressing this issue, the Board has been mindful of its principal mandate: protection of the public. Section 4.1(a)(8) and (9) of the act (63 P. S. § 123.1(a)(8) and (9)) authorizes the Board to take disciplinary action against licensees who engage in unprofessional conduct or who commit acts of negligence, incompetence or malpractice. The use of lasers may implicate both provisions by, for example, generating complaints of incompetent treatment or treatment that fails to conform to acceptable standards of practice. The Board offers the following guidelines to assist its licensees in conforming their behavior to the act. In a disciplinary action brought against a dentist for treatment involving a laser, the Board will consider whether these guidelines were followed.
(b) Guidelines. A dentist who uses a laser in private practice shall:
(1) Be familiar with and conform to regulations on lasers promulgated by the Food and Drug Administration.
(2) Possess clinical competency in the use of lasers. The Board recommends a minimum of 6 hours of instruction given by an accredited institution or by a manufacturer of lasers sponsored by such an institution. The instruction should include hands-on training and should cover all known risks to patients, staff and the practitioner.
Source The provisions of this § 33.215 adopted June 23, 1995, effective June 24, 1995, 25 Pa.B. 2492.
§ § 33.221—33.223. [Reserved].
Source The provisions of these § § 33.221—33.223 adopted January 18, 1965; amended September 12, 1975, effective September 13, 1975, 5 Pa.B. 2397; reserved June 23, 1995, effective June 24, 1995, 25 Pa.B. 2492. Immediately preceding text appears at serial page (151839).
§ § 33.224—33.226. [Reserved].
Source The provisions of these § § 33.224—33.226 adopted January 18, 1965; reserved September 12, 1975, effective September 13, 1975, 5 Pa.B. 2397. Immediately preceding text appears at serial pages (9789) to (9790).
§ 33.231. [Reserved].
Source The provisions of this § 33.231 adopted January 18, 1965; amended September 12, 1975, effective September 13, 1975, 5 Pa.B. 2397; amended April 28, 1989, effective April 29, 1989, 19 Pa.B. 1840; reserved June 23, 1995, effective June 24, 1995, 25 Pa.B. 2492. Immediately preceding text appears at serial page (151840).
§ § 33.232—33.234. [Reserved].
Source The provisions of these § § 33.232—33.234 adopted September 12, 1975, effective September 13, 1975, 5 Pa.B. 2397; reserved June 23, 1995, effective June 24, 1995, 25 Pa.B. 2492. Immediately preceding text appears at serial pages (151840) and (135711).
§ 33.241. [Reserved].
Source The provisions of this § 33.241 adopted January 18, 1965; amended September 12, 1975, effective September 13, 1975, 5 Pa.B. 2397; reserved June 23, 1995, effective June 24, 1995, 25 Pa.B. 2492. Immediately preceding text appears at serial page (135711).
§ 33.242. [Reserved].
Source The provisions of this § 33.242 adopted September 12, 1975, effective September 13, 1975, 5 Pa.B. 2397; amended April 28, 1989, effective April 29, 1989, 19 Pa.B. 1840; reserved June 23, 1995, effective June 24, 1995, 25 Pa.B. 2492. Immediately preceding text appears at serial page (135712).
§ 33.250. Suspected child abuse—mandated reporting requirements.
(a) General rule. Under 23 Pa.C.S. § 6311 (relating to persons required to report suspected child abuse), all Board regulated practitioners are considered mandated reporters. A mandated reporter shall make a report of suspected child abuse in accordance with this section if the mandated reporter has reasonable cause to suspect that a child is a victim of child abuse under any of the following circumstances:
(1) The mandated reporter comes into contact with the child in the course of employment, occupation and practice of the profession or through a regularly scheduled program, activity or service.
(2) The mandated reporter is directly responsible for the care, supervision, guidance or training of the child, or is affiliated with an agency, institution, organization, school, regularly established church or religious organization or other entity that is directly responsible for the care, supervision, guidance or training of the child.
(3) A person makes a specific disclosure to the mandated reporter that an identifiable child is the victim of child abuse.
(4) An individual 14 years of age or older makes a specific disclosure to the mandated reporter that the individual has committed child abuse.
(b) Staff members of public or private agencies, institutions and facilities. Whenever a Board regulated practitioner is required to make a report under subsection (a) in the capacity as a member of the staff of a medical, dental or other public or private institution, school, facility or agency, that Board regulated practitioner shall report immediately in accordance with subsection (c) and shall immediately thereafter notify the person in charge of the institution, school, facility or agency or the designated agent of the person in charge.
(c) Reporting procedure. A mandated reporter shall immediately make a report of suspected child abuse to the Department of Human Services by either:
(1) Making an oral report of suspected child abuse by telephone to ChildLine at (800) 932-0313, followed by a written report within 48 hours to the Department of Human Services or the county agency assigned to the case in a manner and format prescribed by the Department of Human Services. The written report submitted under this subparagraph may be submitted electronically.
(2) Making an electronic report of suspected child abuse in accordance with 23 Pa.C.S. § 6305 (related to electronic reporting) through the Department of Human Service’s Child Welfare Information Solution self-service portal at www.compass.state.pa.us/cwis. A confirmation by the Department of Human Services of the receipt of a report of suspected child abuse submitted electronically relieves the mandated reporter of the duty to make an additional oral or written report.
(d) Written or electronic reports. A written or electronic report of suspected child abuse, shall include the following information, if known:
(1) The names and addresses of the child, the child’s parents and any other person responsible for the child’s welfare.
(2) Where the suspected child abuse occurred.
(3) The age and sex of the subject or subjects of the report.
(4) The nature and extent of the suspected child abuse, including any evidence of prior abuse to the child or sibling of the child.
(5) The name and relationship of the person or persons responsible for causing the suspected abuse and any evidence of prior abuse by those persons.
(6) Family composition.
(7) The source of the report.
(8) The name, telephone number and e-mail address of the person making the report.
(9) The actions taken by the person making the report, including actions taken under 23 Pa.C.S. § § 6314—6317.
(10) Other information required by Federal law or regulation.
(11) Other information that the Department of Human Services may require by regulation.
Authority The provisions of this § 33.250 issued under the Child Protective Services Law, 23 Pa.C.S. § 6383(b)(2); and section 3(o) of The Dental Law (63 P. S. § 122(o)); amended under section 3(o) of the Dental Law (63 P.S. § 122(o)); and the Child Protective Services Law, 23 Pa.C.S. § 6383(b)(2).
Source The provisions of this § 33.250 adopted November 8, 1996, effective November 9, 1996, 26 Pa.B. 5410; amended July 31, 2020, effective August 1, 2020, 50 Pa.B. 3854. Immediately preceding text appears at serial pages (311485) to (311487).
Cross References This section cited in 49 Pa. Code § 33.251 (relating to photographs, medical tests and X-rays of child subject to report); 49 Pa. Code § 33.253 (relating to immunity from liability); 49 Pa. Code § 33.254 (relating to confidentiality—waived); and 49 Pa. Code § 33.255 (relating to noncompliance).
§ 33.251. Photographs, medical tests and X-rays of child subject to report.
A Board regulated practitioner may take or cause to be taken photographs of the child who is subject to a report and, if clinically indicated, cause to be performed a radiological examination and other medical tests on the child. Medical summaries or reports of the photographs, X-rays and relevant medical tests taken shall be sent to the county children and youth social service agency at the time the written report is sent, or within 48 hours after an electronic report is made under § 33.250(c)(2) (relating to suspected child abuse—mandated reporting requirements), or as soon thereafter as possible. The county children and youth social service agency shall have access to actual photographs or duplicates and X-rays and may obtain them or duplicates of them upon request.
Authority The provisions of this § 33.251 issued under the Child Protective Services Law, 23 Pa.C.S. § 6383(b)(2); and section 3(o) of The Dental Law (63 P. S. § 122(o)); amended under section 3(o) of the Dental Law (63 P.S. § 122(o)); and the Child Protective Services Law, 23 Pa.C.S. § 6383(b)(2).
Source The provisions of this § 33.251 adopted November 8, 1996, effective November 9, 1996, 26 Pa.B. 5410; amended July 31, 2020, effective August 1, 2020, 50 Pa.B. 3854. Immediately preceding text appears at serial page (311487).
Cross References This section cited in 49 Pa. Code § 33.253 (relating to immunity from liability); 49 Pa. Code § 33.254 (relating to confidentiality—waived); and 49 Pa. Code § 33.255 (relating to noncompliance).
§ 33.252. Suspected death as a result of child abuse—mandated reporting requirement.
A Board regulated practitioner who has reasonable cause to suspect that a child died as a result of child abuse shall report that suspicion to the coroner or medical examiner of the county where death occurred or, in the case where the child is transported to another county for medical treatment, to the coroner or medical examiner of the county where the injuries were sustained.
Authority The provisions of this § 33.252 issued under the Child Protective Services Law, 23 Pa.C.S. § 6383(b)(2); and section 3(o) of The Dental Law (63 P. S. § 122(o)); amended under section 3(o) of the Dental Law (63 P.S. § 122(o)); and the Child Protective Services Law, 23 Pa.C.S. § 6383(b)(2).
Source The provisions of this § 33.252 adopted November 8, 1996, effective November 9, 1996, 26 Pa.B. 5410; amended July 31, 2020, effective August 1, 2020, 50 Pa.B. 3854. Immediately preceding text appears at serial pages (311487) to (311488).
Cross References This section cited in 49 Pa. Code § 33.253 (relating to immunity from liability); 49 Pa. Code § 33.254 (relating to confidentiality—waived); and 49 Pa. Code § 33.255 (relating to noncompliance).
§ 33.253. Immunity from liability.
Under 23 Pa.C.S. § 6318 (relating to immunity from liability) a Board regulated practitioner who participates in good faith in the making of a report of suspected child abuse, making a referral for general protective services, cooperating or consulting with an investigation including providing information to a child fatality or near fatality review team, testifying in a proceeding arising out of an instance of suspected child abuse or general protective services or engaging in any action authorized under 23 Pa.C.S. § § 6314—6317, shall have immunity from civil and criminal liability that might otherwise result by reason of the Board regulated practitioner’s actions. For the purpose of any civil or criminal proceeding, the good faith of the Board regulated practitioner shall be presumed. The Board will uphold the same good faith presumption in any disciplinary proceeding that might result by reason of a Board regulated practitioner’s actions under § § 33.250—33.252 (relating to suspected child abuse—mandatory reporting requirements; photographs, medical tests and x-rays of child subject to report; and suspected death as a result of child abuse—mandated reporting requirement).
Authority The provisions of this § 33.253 issued under the Child Protective Services Law, 23 Pa.C.S. § 6383(b)(2); and section 3(o) of The Dental Law (63 P. S. § 122(o)); amended under section 3(o) of the Dental Law (63 P.S. § 122(o)); and the Child Protective Services Law, 23 Pa.C.S. § 6383(b)(2).
Source The provisions of this § 33.253 adopted November 8, 1996, effective November 9, 1996, 26 Pa.B. 5410; amended July 31, 2020, effective August 1, 2020, 50 Pa.B. 3854. Immediately preceding text appears at serial page (311488).
§ 33.254. Confidentiality—waived.
To protect children from abuse, the reporting requirements of § § 33.250—33.252 (relating to suspected child abuse—mandated reporting requirements; photographs, medical tests and X-rays of child subject to report; and suspected death as a result of child abuse—mandated reporting requirement) take precedence over the provisions of any client confidentiality, ethical principle or professional standard that might otherwise apply. In accordance with 23 Pa.C.S. § 6311.1 (relating to privileged communications), privileged communications between a mandated reporter and a patient does not apply to a situation involving child abuse and does not relieve the mandated reporter of the duty to make a report of suspected child abuse.
Authority The provisions of this § 33.254 issued under the Child Protective Services Law, 23 Pa.C.S. § 6383(b)(2); and section 3(o) of The Dental Law (63 P. S. § 122(o)); amended under section 3(o) of the Dental Law (63 P.S. § 122(o)); and the Child Protective Services Law, 23 Pa.C.S. § 6383(b)(2).
Source The provisions of this § 33.254 adopted November 8, 1996, effective November 9, 1996, 26 Pa.B. 5410; amended July 31, 2020, effective August 1, 2020, 50 Pa.B. 3854. Immediately preceding text appears at serial page (311488).
§ 33.255. Noncompliance.
(a) Disciplinary action. A Board regulated practitioner who willfully fails to comply with the reporting requirements in § § 33.250—33.252 (relating to suspected child abuse—mandated reporting requirements; photographs, medical tests and X-rays of child subject to report; and suspected death as a result of child abuse—mandated reporting requirement) will be subject to disciplinary action under section 4.1 of the act (63 P.S. § 123.1).
(b) Criminal penalties. Under 23 Pa.C.S. § 6319 (relating to penalties), a Board regulated practitioner who is required to report a case of suspected child abuse or to make a referral to the appropriate authorities and who willfully fails to do so commits a criminal offense, as follows:
(1) An offense not otherwise specified in paragraphs (2), (3) or (4) is a misdemeanor of the second degree.
(2) An offense is a felony of the third degree if all of the following apply:
(i) The mandated reporter willfully fails to report.
(ii) The child abuse constitutes a felony of the first degree or higher.
(iii) The mandated reporter has direct knowledge of the nature of the abuse.
(3) If the willful failure to report continues while the mandated reporter knows or has reasonable cause to suspect a child is being subjected to child abuse by the same individual, or while the mandated reporter knows or has reasonable cause to suspect that the same individual continues to have direct contact with children through the individual’s employment, program, activity or service, the mandated reporter commits a felony of the third degree, except that if the child abuse constitutes a felony of the first degree or higher, the mandated reporter commits a felony of the second degree.
(4) A mandated reporter who, at the time of sentencing for an offense under 23 Pa.C.S. § 6319, has been convicted of a prior offense under § 6319, commits a felony of the third degree, except that if the child abuse constitutes a felony of the first degree or higher, the penalty for the second or subsequent offense is a felony of the second degree.
Authority The provisions of this § 33.255 issued under the Child Protective Services Law, 23 Pa.C.S. § 6383(b)(2); and section 3(o) of The Dental Law (63 P. S. § 122(o)); amended under section 3(o) of the Dental Law (63 P.S. § 122(o)); and the Child Protective Services Law, 23 Pa.C.S. § 6383(b)(2).
Source The provisions of this § 33.255 adopted November 8, 1996, effective November 9, 1996, 26 Pa.B. 5410; amended July 31, 2020, effective August 1, 2020, 50 Pa.B. 3854. Immediately preceding text appears at serial page (371903).
§ 33.256. Child abuse recognition and reporting—mandatory training requirement.
(a) Except as provided in subsection (c), individuals applying to the Board for an initial license or certificate shall submit proof of completion of 3 hours of training in child abuse recognition and reporting requirements which has been approved by the Department of Human Services.
(b) Except as provided in subsection (c), licensees and certificate holders seeking renewal of a license or certificate issued by the Board shall complete, as a condition of biennial renewal of the license or certificate, 2 hours of approved continuing education in child abuse recognition and reporting requirements, as a portion of the total continuing education required for biennial renewal. For credit to be granted, the continuing education course or program must be approved by the Bureau, in consultation with the Department of Human Services, as set forth in § 33.257 (relating to child abuse recognition and reporting course approval process).
(c) An applicant, licensee or certificate holder may apply in writing for an exemption from the training/continuing education requirements set forth in subsections (a) and (b) provided the applicant, licensee or certificate holder meets one of the following:
(1) The applicant, licensee or certificate holder submits documentation demonstrating that:
(i) The applicant, licensee or certificate holder has already completed child abuse recognition training as required by section 1205.6 of the Public School Code of 1949 (24 P.S. § 12-1205.6).
(ii) The training was approved by the Department of Education in consultation with the Department of Human Services.
(iii) The amount of training received equals or exceeds the amount of training or continuing education required under subsection (a) or (b), as applicable.
(2) The applicant, licensee or certificate holder submits documentation demonstrating all of the following:
(i) The applicant, licensee or certificate holder has already completed child abuse recognition training required under 23 Pa.C.S. § 6383(c) (relating to education and training).
(ii) The training was approved by the Department of Human Services.
(iii) The amount of training received equals or exceeds the amount of training or continuing education required under subsection (a) or (b), as applicable.
(3) The applicant, licensee or certificate holder submits documentation demonstrating that the applicant, licensee or certificate holder should not be subject to the training or continuing education requirement. Each request for an exemption under this paragraph will be considered on a case-by-case basis.
Authority The provisions of this § 33.256 issued under section 3(o) of the Dental Law (63 P.S. § 122(o)); and the Child Protective Services Law, 23 Pa.C.S. § 6383(b)(2).
Source The provisions of this § 33.256 adopted July 31, 2020, effective August 1, 2020, 50 Pa.B. 3485.
Cross Reference This section cited in 49 Pa. Code § 33.401 (relating to credit-hour requirements).
§ 33.257. Child abuse recognition and reporting course approval process.
(a) An individual, entity or organization may apply for approval to provide mandated reporter training as required under 23 Pa.C.S. § 6383(b) (relating to education and training) by submitting the course materials set forth in subsection (b) simultaneously to the Department of Human Services (DHS), Office of Children, Youth and Families, and to the Bureau at the following addresses:
(1) Department of Human Services, Office of Children, Youth and Families, Health and Welfare Building, 625 Forster Street, Harrisburg, PA 17120 or electronically at RA-PWOCYFCPSL@pa.gov.
(2) Bureau of Professional and Occupational Affairs, 2601 North Third Street, P.O. Box 2649, Harrisburg, PA 17105-2649 or electronically at RA-stcpsl[lowbar]course[lowbar]app@pa.gov.
(b) Submissions must include all of the following:
(1) Contact information (mailing address, e-mail address and telephone number) for the agency/course administrator.
(2) General description of the training and course delivery method.
(3) Title of the course.
(4) Timed agenda and estimated hours of training.
(5) Learning objectives.
(6) Intended audience.
(7) All course related materials, including as applicable:
(i) Handouts.
(ii) Narrated script or talking points.
(iii) Interactive activities or exercises.
(iv) Videos and audio/visual content.
(v) Knowledge checks, quizzes or other means of assessing participant’s understanding of the material.
(vi) For online courses, a transcript or recording of audio training.
(8) Citation of sources, including written permission to use copyrighted material, if applicable.
(9) Anticipated credentials or experience of the presenter, or biography of presenter, if known.
(10) Printed materials used to market the training.
(11) Evaluation used to assess participants’ satisfaction with the training.
(12) Sample certificate of attendance/participation, which shall include:
(i) Name of participant.
(ii) Title of training.
(iii) Date of training.
(iv) Length of training (2 or 3 hours).
(v) Name and signature of the authorized representative of the provider. The signature may be an electronic signature.
(vi) Statement affirming the participant attended the entire course.
(13) Verification of ability to report participation/attendance electronically to the Bureau in a format prescribed by the Bureau.
(c) The Bureau will notify the applicant in writing upon approval of the course and will post a list of approved courses on the Bureau’s web site and the Board’s web site.
Authority The provisions of this § 33.257 issued under section 3(o) of the Dental Law (63 P.S. § 122(o)); and the Child Protective Services Law, 23 Pa.C.S. § 6383(b)(2).
Source The provisions of this § 33.257 adopted July 31, 2020, effective August 1, 2020, 50 Pa.B. 3854.
Cross References This section cited in 49 Pa. Code § 33.256 (relating to child abuse recognition and reporting—mandatory training requirement).
§ 33.291. [Reserved].
Source The provisions of this § 33.291 adopted September 12, 1975, effective September 13, 1975, 5 Pa.B. 2397; reserved June 23, 1995, effective June 24, 1995, 25 Pa.B. 2492. Immediately preceding text appears at serial page (135712).
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