TO ALL OF OUR PATIENTS, FAMILY, AND FRIENDS:

Infection prevention is the cornerstone of every successful dental practice. Every day, our top priority is keeping our patients healthy and safe.   While transmission of infectious agents in the dental setting is rare, we continually reinforce the importance of "best practices" and CDC standards.

In these uncertain times, we want our patients to be confident that we have taken extra steps to ensure our office remains a safe environment for everyone.

·         We have doubled our efforts, to prevent the transmission of all contaminants, including COVID19.

·         We have established protocols to ensure infected patients are rescheduled before coming to the office.

·         We are evaluating all patients at the beginning of each appt to ensure COVID-19 symptoms are not present.

Thank you for your patience as we implement these extended safety precautions. We look forward to seeing you at your next visit!


DOOR TO THE OFFICE IS LOCKED

RING DOOR BELL TO INDICATE YOUR ARRIVAL

PLEASE READ THE FOLLOWING

COVID-19 DENTAL PROCEDURES:


~No team members, patients, or any other persons will be allowed into the reception area at any time.

~Any non-patients are to ring doorbell to indicate their arrival & we will be with you shortly.

~ Patients are to ring doorbell to indicate their arrival & have a seat on the bench & we will be with you shortly.

~The clipboard below has a Covid19 disclosure questionnaire & patient consent form for any patient needing them.

~A team member wearing masks & gloves will get forms & temperature reading for screening process.

~Screening Process: answering the patient disclosure questionnaire, signing patient consent & temperature reading.

~ Only after screening process is passed, will patients be brought into the office by a team member.

~If any symptoms are present, patient will be referred to a physician or sent to E.R.. to be evaluated ASAP.


PRE-VISIT

~If possible, patient forms should be completed and returned by mail, email, text, or other means prior to their visit.

~Forms are available on our website: www.rustyrileydmd.com to scan or print.

~Patients should thoroughly brush their teeth prior to their appointment.


VISIT

~After screening process is passed, patients will be escorted directly to the cleaning station by a team member.

~At cleaning station, all patients are to sanitize their hands.

~At cleaning station, all patients are to rinse their mouth with 1.5% hydrogen peroxide for 60 seconds.

~Both hand sanitizing & mouth rinsing must be completed before patients will be seated for treatment.

~Only the scheduled patient will be allowed into the office for the appt, unless a minor then 1 parent allowed.


PATIENT DISMISSAL

~ONLY 1 PATIENT AT A TIME IS ALLOWED IN THE CHECK OUT AREA.

~The office must limit the number of patients, in the office, at any time, no double-booking patients.

~Fewer scheduled appointments during the day & appointment delays will occur.


SOCIAL DISTANCING GUIDELINES

~Patients should ALWAYS be kept at least 6 feet from team members unless team members are wearing PPE.

~EVERYONE should wear a mask when moving through the office.


PATIENT PROTECTION

~ALL PATIENT BELONGINGS MUST STAY WITH PATIENTS AT ALL TIMES.

~No reading materials will be provided to patients, so if needed, please bring reading material.


COVID-19 PATIENT DISCLOSURE QUESTIONNAIRE

1. Do you presently have any of the following respiratory symptoms?

Cough? Yes No

Fever? Yes No

Shortness of breath? Yes No

Sore throat? Yes No

2. Have you or any immediate family member had any of the following respiratory symptoms with the last 2 weeks:

Cough? Yes No

Fever? Yes No

Shortness of breath? Yes No

Sore throat? Yes No

3. Have you traveled internationally within the last 2 weeks to any of the following countries?

China? Yes No

Italy? Yes No

South Korea? Yes No

Japan? Yes No

Iran? Yes No

Other level 3 countries? Yes No

4. Have you traveled domestically within the last 2 weeks? Yes No

5. If yes, what states were visited? ________________________________________________________________


Temperature at time of Check-in: ________________


COVID-19 PANDEMIC DENTAL TREATMENT NOTICE & ACKNOWLEDGEMENT OF RISK FORM

Our goal is to provide a safe environment for our patients and staff, and to advance the safety of our local community. This document provides information we ask you to acknowledge and understand regarding the COVID-19 virus. The COVID-19 virus is a serious and highly contagious disease. The World Health Organization has classified it as a pandemic. You could contract COVID-19 from a variety of sources. Our practice wants to ensure you are aware of the additional risks of contracting COVID-19 associated with dental care. The COVID-19 virus has a long incubation period. You or your healthcare providers may have the virus and not show symptoms and yet still be highly contagious. Determining who is infected by COVID-19 is challenging and complicated due to limited availability for virus testing. Due to the frequency and timing of visits by other dental patients, the characteristics of the virus, and the characteristics of dental procedures, there is an elevated risk of you contracting the virus simply by being in a dental office. Dental procedures create water spray which is one way the disease is spread. The ultra-fine nature of the water spray can linger in the air a long time, allowing for transmission of the COVID-19 virus to those nearby. You cannot wear a protective mask over your mouth to prevent infection during treatment as your health care providers need access to your mouth to render care. This leaves you vulnerable to COVID-19 transmission while receiving dental treatment. I confirm that I have read the Notice above and understand and accept that there is an increased risk of contracting the COVID-19 virus in the dental office or with dental treatment. I understand and accept the additional risk of contracting COVID-19 from contact at this office and also acknowledge that I could contract the COVID-19 virus from outside this office and unrelated to my visit here. I have read and understand the information stated above:


Signature:_____________________________________________________________________


Witness:_______________________________________________________________________


Date:_______________________________________