Series Title (Agency Series #): Description, Retention (Legal Citation)
Intake Forms (DOH32-001): Records used to assess a person's eligibility for treatment in the Dental Access program and referral (if applicable). Also used as data entry tool for client database. Intake forms show person's name and address, personal information, date of assessment, provider referred to or reason for refusal, and notes.
Retention: Retain 2 years. (2009-0001/029)
No-Show Invoices (DOH32-003): Documents $25 charge billed to the DAP program by dental service providers for patients who don't show up for their appointments. Invoice shows invoice number, date, payee's name and address, social security number or tax identification number, and dentist's signature.
Retention: Retain 3 years. (MOAR 166-150-0110(1))
Referral Records (DOH32-002): Documents patients referred to participating dentists from the DAP program. Records include referral sheet, referral log, and sometimes patient outcome forms. Information includes patient's name and address, dates of referral and appointment, description of complaint needing treatment, medical history, dentist, appointment information, services delivered, and comments.
Retention: Retain 2 years. (Unscheduled)
Statistical Reports (DOH32-004): Documents program activities for research and reference. Compiled and maintained for internal reference as well as to comply with division requirements. Reports show type of clinic visit, services provided, specialty referrals and procedures, cancellations, and historical comparisons.
Retention: Retain 5 years. (MOAR 166-150-0005(31))