64B5-17.006. Prescription Forms

(1) Approved prescription forms must contain all information necessary for completion of the assigned work and must include at a minimum:

(a) Title – “Laboratory Procedure Prescription;”

(b) Name, address and license number of the registered dental laboratory;

(c) Name, address and license number of the Florida licensed dentist who owns the prescription form and is authorizing the procedure;

(d) Patient’s name or number;

(e) Date sent to lab;

(f) Signature of the licensed dentist, which may be an electronic signature;

(g) Sufficient descriptive information to clearly identify each separate and individual piece of work to be performed by the dental laboratory; and

(h) Specification of materials to be contained in each work product.

(2) Copies of prescription forms must be maintained, either on paper or stored electronically in an encrypted data base, in the prescribing dentist’s office for a period of four (4) years following the date the prescription was issued. The original prescription shall be retained in a file by the dental laboratory for a period of four (4) years .

(3) A registered dental laboratory may perform work for another registered dental laboratory if that work is performed pursuant to a written authorization form containing all information necessary for completion of the assigned work and must include at a minimum;

(a) Title – “Laboratory Procedure Authorization;”

(b) Name, address and license number of the originating registered dental laboratory;

(c) Name, address and license number of the registered dental laboratory performing the work;

(d) Evidence that the originating laboratory has obtained a valid prescription which shall include the name, address and license number of the licensed dentist who wrote the original prescription authorizing the procedure.

(e) Sufficient descriptive information to clearly identify each separate and individual piece of work to be performed by the dental laboratory; and

(f) Specification of materials to be contained in each work product.

Rulemaking Authority 466.021 FS. Law Implemented 466.021 FS. History–New 12-21-99, Amended 3-23-06, 10-9-06, 5-28-09.