Arizona1
Resources

Resources

Adverse Occurrence Report

Forms

Report used if a death, or incident requiring emergency medical response, occurs in a dental office or dental clinic during the administration of or recovery from general anesthesia, deep sedation, moderate sedation, or minimal sedation.

Online submission (Once all required fields are completed, a "Click to Sign" button will display at the bottom of your screen.)

Affiliated Practice

Other Applications

Suggested forms and Instructions for reporting an affiliated practice relation between a Dentist and a Dental Hygienist. 
(Please download, complete the document and submit to [email protected] or mail to 1740 W Adams, Suite 2470 Phoenix, AZ 85007)

12-2291

Title 12 Court and Civil Proceedings
Chapter 13 Evidence
Article 7.1 Medical Records

Definitions

12-2292

Title 12 Court and Civil Proceedings
Chapter 13 Evidence
Article 7.1 Medical Records

Confidentiality of medical records and payment records

12-2293

Title 12 Court and Civil Proceedings
Chapter 13 Evidence
Article 7.1 Medical Records

Release of medical records and payment records to patients and health care decision makers; definition

12-2294

Title 12 Court and Civil Proceedings
Chapter 13 Evidence
Article 7.1 Medical Records

Release of medical records and payment records to third parties

12-2294.01

Title 12 Court and Civil Proceedings
Chapter 13 Evidence
Article 7.1 Medical Records

Release of medical records or payment records to third parties pursuant to subpoena

12-2295

Title 12 Court and Civil Proceedings
Chapter 13 Evidence
Article 7.1 Medical Records

Charges

12-2296

Title 12 Court and Civil Proceedings
Chapter 13 Evidence
Article 7.1 Medical Records

Immunity

12-2297

Title 12 Court and Civil Proceedings
Chapter 13 Evidence
Article 7.1 Medical Records

Retention of records

12-571

Title 12 Court and Civil Proceedings
Chapter 5.1 Actions Relating To Health Care
Article 1 General Provisions

Qualified immunity; health professionals; nonprofit clinics; previously owned prescription eyeglasses

13-3412

Title 13 Criminal Code
Chapter 34 Drug Offenses

Exceptions and exemptions; burden of proof; privileged communications

13-3620

Title 13 Criminal Code
Chapter 36 Family Offense

Duty to report abuse, physical injury, neglect and denial or deprivation of medical or surgical care or nourishment of minors; medical records; exception; violation; classification; definitions

13-904

Title 13 Criminal Code
Chapter 9 Probation And Restoration Of Civil Rights

Suspension of civil rights and occupational disabilities

20-1057.12

Title 20 Insurance
Chapter 4 Particular Types of Insurers

Contracts; dentist; covered services; definition

20-1342.06

Title 20 Insurance
Chapter 6 Particular Types of Insurance

Contracts; dentists; covered services; definition

20-1402.04

Title 20 Insurance
Chapter 6 Particular Types of Insurance

Contracts; dentists; covered services; definition

20-847

Title 20 Insurance
Chapter 4 Particular Types of Insurers

Contracts; dentists; covered services; definition