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)

Restricted Permit to Volunteer, formerly known as: Volunteer Health Services Registration

Other Applications

After some research, it was discovered that the legislative intent for creating the general Volunteer Health Services Registration process was based on the Board's Restricted Permit process. Please be patient as we reconstruct the Restricted Permit application. In the meantime, the Board will continue to receive Volunteer Health Services Registrations to volunteer your dental services at charitable dental clinic or organization. Your application must be submitted by you; no one may submit or attest to its veracity other than you. Your application shall consist of a completed application itself

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