Dental Office

Manual
Table of Contents
A. Administration
Mission Statement ………………………………………….. 1
Vision Statement ………………………………………...... 2
Business Organizational Pattern ………………………….. 3
Practice Location, Practice Hours ………………………….. 4
Yearly Calendar of Operations ………………………….. 5
Dental Clinic Floor Plan ………………………………….. 7
B. Dental Team Members
Licensed Dentist ………………………………………...... 8
Duties and Responsibilities
Metrics
Dress Code
Registered Dental Hygienist ………………………….. 9
Duties and Responsibilities
Metrics
Dress Code
Dental Office Receptionist ………………………………….. 11
Duties and Responsibilities
Metrics
Dress Code
Code of Conduct ………………………………………….. 13
C. Services ………………………………………………….. 17
Services Offered
Fee Schedule
D. Equipment and Supplies ………………………………….. 19
List of Equipment and Supplies
Sample Inventory List
E. Collection Policy ………………………………………….. 23
F. Chart of Accounts ………………………………………….. 24
G. Forms ………………………………………………………….. 28
H. Marketing plan ………………………………………….. 35

1
 MISSION
We will provide international standards and quality of services to our patients to their
convenience that will results a long term, patient and services relationship.

VISION

The Molar Band Dental Office envision to be one of the best and renowned Dental
Office in the country. We are establishing quality and efficient dental service to the
patient. May God Almighty help us.

2
BUSINESS ORGANIZATIONAL PATTERN

As a beginner, I would like to be in an Associateship type of

organization and be an employee in an established organization, like be a
dentist in a well establish hospital. It will be a good start for me to gain
experience first without having to raise a start-up cost. Though, it would be
a disadvantage that there will be limited income, it will be beneficial for me
to learn how things are done first in this business before I start my own
dental clinic.
And after I earn enough money and have built a good reputation to
my patients, I can then be in a sole proprietorship and establish my own
dental clinic for the Private Practice.

3
 PRACTICE LOCATION & PRACTICE HOURS

The dental clinic will be located in Sta. Ana, Taguig, and will operate
Mondays to Sundays with the following clinic schedule:

CLINIC SCHEDULE
Mon-Sat 8:00AM-4:00PM
Sun 1:00PM-4:00 PM

4
 YEARLY CALENDAR OF OPERATIONS
The dental clinic will operate every day, except for days the management
deem to announce otherwise. The following dates shows monthly events and
holidays through-out the year.

JANUARY
01-02 New Year
(Regular Holiday)
NO WORK
03 Monthly Staff Meeting
Monthly Inventory
FEBRUARY
05 Monthly Staff Meeting
Monthly Inventory
05 Chinese New Year
(Special Non-working Holiday)
WITH WORK
25 EDSA Revolutionary Anniversary
(Special Non-working Holiday)
NO WORK
MARCH
05 MON Monthly Staff Meeting
Monthly Inventory
APRIL
05 Monthly Staff Meeting
Monthly Inventory
09 Araw ng Kagitingan
(Regular Holiday)
WITH WORK
MAY
01 Labor Day
(Regular Holiday)
WITH WORK
07 Monthly Staff Meeting
JUNE
04 Monthly Staff Meeting
Monthly Inventory
12 Independence day
(Regular Holiday)
WITH WORK
JULY
02 Monthly Staff Meeting
Monthly Inventory
5
AUGUST
06 Monthly Staff Meeting
Monthly Inventory
21 Ninoy Aquino day
(Special Non-working Holiday)
WITH WORK
27 National heroes day
(Regular Holiday)
WITH WORK
SEPTEMBER
03 Monthly Staff Meeting
Monthly Inventory
OCTOBER
01 Monthly Staff Meeting
Monthly Inventory
NOVEMBER
1 Allsaints
(Special Holiday)
2 All souls
(Special Non-working Holiday)
NO WORK
5 Monthly Staff Meeting
Monthly Inventory
30 Bonifacio day
(Regular Holiday)
WITH WORK
DECEMBER
O3 Monthly Staff Meeting
24-26 Christmas
(NO WORK)
30 Rizal Day
(Regular Holiday)
NO WORK
31 Monthly Inventory

6
DENTAL CLINIC FLOOR PLAN

6.00m

6.00m

7.00m

7
 DENTAL TEAM MEMBERS

1. DENTIST

Duties and Responsibilities:

The dentist’s primary duties and responsibilities include examining the

dental and oral health of patients of all ages and administering treatment
accordingly.
 Educate the patient regarding the best oral health habits
 Diagnosing oral disease
 Providing satisfactory and timely treatments
 Cleaning and repairing teeth, extracting teeth when necessary, fitting
crowns, and administering anesthesia prior to dental procedures
 Interpreting x-rays and diagnostic test
 Creating treatment plans to maintain or restore the oral health of their
patients.
 Prescribe medications as necessary
 Referring patients to specialists when required
 Carefully document all medications, diagnoses, treatments, and
consultations
 Supervise the work of professional, technical and administrative staff

Metrics
 Production – 300000-450000/month
 Parent Retention & referrals – 95% retention + 2% referrals

Appearance and Dress Code:

 Descent dress shirt or blouse and slacks with freshly laundered and ironed
white lab coat. Scrub uniforms can be worn occasionally with white lab
coat.
 Must always look professional through your attire and avoid looking
sloppy.
 Maintain good personal hygiene and be well groomed, neat in
appearance, and appropriately dressed.
 Hats, mini skirts and shorts, athlete shoes, sandals and flipflops are not
allowed.
 Shoes must not be open toed.
 Clothing that reveals your back, your chest, stomach, too much cleavage,
or your under clothing is not appropriate.

8
2. REGISTERED DENTAL HYGIENIST

Duties and Responsibilities:

Supports dental care delivery by preparing treatment room, patient,

instruments, and materials; passing instruments and materials; performing
procedures in compliance with the dental practice act
 Prepares treatment room for patient by adhering to prescribed procedures
and protocols
 Prepares patient for dental hygiene treatment by welcoming, soothing,
seating, and draping patient
 Maintains instrumentation for dental treatments by sharpening, sterilizing,
and selecting instruments; positioning instruments for dentist’s access;
suctioning; passing instruments
 Provides materials by selecting, mixing, and placing materials on
instruments
 Evaluates patient’s oral health
 Detects disease by completing oral cancer screening; feeling and visually
examining gums; exposing and developing radiographic studies.
 Completes dental prophylaxis
 Documents dental care services by recording vital signs and medical and
dental histories; charting in patients records.
 Maintains safe and clean working environment by complying with
procedures, rules, and regulations

9
Metrics:
 Hygiene Production – 100000-150000/month
 Periodontal Percentage – 55% minimum
 Parent Retention & referrals – 95% retention + 2% referrals

Appearance and Dress Code:

 Wear clean and ironed scrub uniforms.
 Maintain good personal hygiene and be well groomed, neat in
appearance, and appropriately dressed.
 Hats, mini skirts and shorts, athlete shoes, sandals and flipflops are not
allowed.
 Shoes must not be open toed.
 Clothing that reveals your back, your chest, stomach, too much cleavage,
or your under clothing is not appropriate.
 Long hair must be manageable, and either pulled up or back so it does not
impair yours or the dentist’s view of the patient, or fall into the patient’s
personal space.
 Dangling earrings are not permitted.

10
3. OFFICE RECEPTIONIST

Duties and Responsibilities:

Serves patients and visitors by greeting, welcoming, and directing them

appropriately; notifies the dentist on duty of patient arrival; scheduling
appointments; maintains records and accounts.
 Welcomes patients and visitors by greeting them, in person or on the
telephone; answering or referring inquiries.
 Optimizes patients’ satisfaction, provider time, and treatment room
utilization by scheduling appointments in person or by telephone.
 Keeps patients appointments on schedule by confirming patients
appointments, notifying the provider of the patients’ arrival, reviewing
service delivery compared to schedule, reminding provider of service
delays.
 Ensures availability of treatment information by filing retrieving patient
records.
 Maintains patients’ accounts by obtaining, recording, and updating
personal and financial information.
 Obtains revenue by recording and updating financial information;
recording and collecting paients charges; controlling credit extended to
patients; filing, collecting and expediting third-party claims.
 Maintains business office inventory and equipment by checking stock to
determine inventory level; anticipating needed supplies; placing and
expediting orders for supplies; verifying receipt of supplies; scheduling
equipment service and repairs.
 Protects patient’s rights by maintaining confidentiality of personal and
financial information.
 Maintains operations by following policies and procedures; reporting
needed changes.
 Contributes to team effort by accomplishing related results as needed.

Metrics
 New Patient Exams – 30-50/month
 Production
 Collections – 97%-100%
 Business Inventory – 4-5%

11
Appearance and Dress Code:
 Wear clean and ironed scrub uniforms.
 Maintain good personal hygiene and be well groomed, neat in
appearance, and appropriately dressed.
 Hats, mini skirts and shorts, athlete shoes, sandals and flipflops are not
allowed.
 Shoes must not be open toed.
 Clothing that reveals your back, your chest, stomach, too much cleavage,
or your under clothing is not appropriate.
 Long hair must be manageable, and either pulled up or back so it does not
impair yours or the dentist’s view of the patient, or fall into the patient’s
personal space.
 Dangling earrings are not permitted.

12
 CODE OF CONDUCT
EMPLOYEE CODE OF CONDUCT

1. Employees are expected to foster an environment which reflects the values of

Caring, Learning, Integrity and Respect, adhering to high ethical standards
while performing their duties.
2. An Employee Code of Conduct offers guidance to its employees on standards
of integrity and business conduct. No code can address every situation an
employee may encounter; As a result, employees are expected to be guided
by the letter and the spirit of the Code, and to exercise good judgment. In
circumstances where they are unsure as to the proper course of action; they
are to seek guidance from their immediate supervisor.
3. Knowledge of College Policies and Regulations
3.1. Employees need to be aware of and comply with the legislation and
regulations that affect how they carry out their duties.
3.2. Employees are expected to be familiar with the clinic policies relevant to
their responsibilities and conduct themselves in a manner consistent with
those policies.
4. Respect in the Workplace
4.1. Employees are expected to demonstrate behaviors which reflect the
values of Caring, Learning, Integrity and Respect in all their interactions.
4.2. Employees are expected to promote and support a respectful, inclusive
and safe work environment where everyone is treated with respect and
dignity.
4.3. Employees are to act with transparency and impartiality to make sound
unbiased decisions in order to avoid any perception of conflict of interest.
This would include ensuring that they do not benefit personally or
professionally from any decision made within the context of their job, or
allow outside interests to conflict with the employee’s position at the clinic,
use the assets of the clinic for personal gain or supervise a family
member.
5. Professional Behavior
5.1. Employees are expected to give their professional service to the best of
their capabilities in accordance with the established standards of care.
5.2. Employees must always be on time in attending to their duties and
responsibilities; avoid absences and tardiness.
5.3. Employees are expected to act in a professional manner which includes
meeting obligations, being truthful, being cooperative with the clinic
administration, maintaining integrity in their work and civility in their
conduct and communications.
5.4. Employees must conduct themselves in a manner befitting a professional
of high esteem and of compliance to the Code of Ethics of your
profession.

13
 5.5. Employees are expected to present themselves in a professional manner
including appropriate dress and personal appearance in keeping with the
nature of the work they performed and the public image of the clinic they
represent.
5.6. Employees are expected to contribute to a healthy and safe workplace by
complying with all safety legislation and/or policies and by taking all
reasonable precautions to ensure their own safety and that of others.
5.7. Employees are expected to ensure that their conduct does not jeopardize
the good order and proper functioning of clinic operations and that they
do not use clinic property or assets for anything other than legitimate
clinic business, in accordance with policies pertaining to Conflict of
Interest. 
6. Employee Relationships. Employees who work together may naturally form
friendships either in or outside of the workplace. This relationship between
peers is encouraged, as it can help in communication and collaboration.
6.1. But, employees are expected to focus on their work and keep personal
disputes outside the workplace.

POLICY ON CYBER SECURITY AND DIGITAL DEVICES

This section deals with all things digital at work. Some guidelines are set
for using computers, phones, our internet connection and social media to ensure
security and protect the clinic’s assets.

1. Internet usage
The corporate internet connection is primarily for business. But, it
can occasionally be used for personal purposes as long as it don’t
interfere with the employee’s job responsibilities. Also, employees are
expected to temporarily halt personal activities that slow down the internet
connection (e.g. uploading photos) if asked to.

An employee must not use the internet connection to:

 Download or upload obscene, offensive or illegal material.
 Send confidential information to unauthorized recipients.
 Invade another person’s privacy and gain access to sensitive
information.
 Download or upload pirated movies, music, material or software.
 Visit potentially dangerous websites that can compromise our network
and computers’ safety.
 Perform unauthorized or illegal actions, like hacking, fraud or
buying/selling illegal goods.

2. Cell phone
The use of cell phones at work is allowed. But, it must be ensured
that the employee’s devices won’t distract them from his/her work or
disrupt the workplace. Employees must follow these rules:

14
  Cell phones must be used in a manner that benefits the employee’s
work (business calls, productivity apps, calendars.)
 Keep personal calls brief and use an empty meeting room or common
area so as not to disturb the patients and other staff.
 Avoid playing games on phone or texting excessively.
 Don’t use cell phone to record confidential information.
 Don’t download or upload inappropriate, illegal or obscene material
using the corporate internet connection.

3. Corporate email
Email is essential to work. An employee should use the company
email primarily for work, but some uses of your company email for
personal reasons may be allowed.
 Work-related use. The corporate email may be used for work-related
purposes without limitations. For example, employee may sign up for
newsletters and online services that will help them in his/her job or
professional growth.
 Personal use. The corporate email may be used for personal reasons
as long as it is kept safe, and avoid spamming and disclosing
confidential information. For example, employee can send emails to
friends and family and download ebooks, guides and other safe
content for his/her personal use.
 No matter how the employee use the corporate email, they are
expected to AVOID
o Signing up for illegal, unreliable, disreputable or suspect websites
and services.
o Sending unauthorized marketing content or emails.
o Registering for a competitor’s services, unless authorized.
o Sending insulting or discriminatory messages and content.
o Spamming other people’s emails, including your coworkers.
4. Social media
Practical advices is here provided to prevent careless use of social
media in the workplace. Two types of social media uses is addressed:
using personal social media at work and representing the company
through social media.
 Using personal social media at work
The employees are permitted to access their personal accounts
at work. But, they are expected to act responsibly, according to the
clinic’s policies and ensure that they stay productive. Specifically,
employees are asked to:
o Discipline yourself. Avoid getting sidetracked by your social
platforms.
o Ensure others know that your personal account or statements don’t
represent our company. For example, use a disclaimer such as
“opinions are my own.”

15
 o Avoid sharing intellectual property (e.g trademarks) or confidential
information. Ask your manager or the owner first before you share
company news that’s not officially announced.
o Avoid any defamatory, offensive or derogatory content. You may
violate our clinic’s anti-harassment policy if you direct such content
towards patients, clients or partners.
 Representing the clinic through social media
If you handle our social media accounts or speak on our
company’s behalf, we expect you to protect our company’s image and
reputation. Specifically, you should:
o Be respectful, polite and patient.
o Avoid speaking on matters outside your field of expertise when
possible.
o Follow our confidentiality and data protection policies and observe
laws governing copyrights, trademarks, plagiarism and fair use.
o Coordinate with our [PR/Marketing department] when you’re about
to share any major-impact content.
o Avoid deleting or ignoring comments for no reason.
o Correct or remove any misleading or false content as quickly as
possible.

16
 SERVICES

Procedures Fee
ORAL EXAMINATION
Consultation 500
oral prophylaxis with tongue scraping 600
oral prophylaxis without tongue scraping 00
root planing and scaling 5000
PROSTHODONTICS
porcelain fused to metal crown and bridge 12000
complete denture 15000
removable partial denture 10000
ORTHODONTHICS 
braces (mild case) metal ceramic 120000
braces (mild case) invisalign 200000
braces (severe case)metal ceramic 150000
braces (severe case) invisalign 220000
retainer invisalign 10000
retainer metal 5000
RESTORATION 
Sealant 600
flouride application with tray 500
temporary filling 500
light cure class 1,3,4,5 simple 800
light cure class 2 complicated 800
space closure 1000
ENDODONTICS 
10000/
root canal treatment
canal
ORAL SURGERY 
Apicoectomy 15000
Impaction 12000
alveolectomy/alveoplasty 10000
torus palatinus 15000
Frenectomy 15000
Epulis 10000
simple extraction 800
ankylosed tooth 3000
15000/
socket preservation after extraction
socket

17
periodontal surgery 15000
X-RAY SERVICES 
Periapical 250
Panoramic 800
Cephalometric 1200

18
 EQUIPMENT AND SUPPLIES
The following is list of all the supplies and equipment the clinic needs for
its operations. It is presented in a form of inventory sheet. This sheet will be
utilized by the receptionist for the monthly manual inventory.

DENTAL OFFICE INVENTORY SHEET

Date: ______________________
Time: ______________________
Name: _____________________
Signature: __________________

Area/Locatio Quantity/
Item Description Remarks/ Condition
n unit
Reception
Area
Computer Monitor
CPU
Printer
Ink refill set
telephone
Chair
Desk
Internet modem
Cash register
Credit card Processing
machine
sofa set
center table
air conditioning unit
Supplies
Storage Area
acrylic clear (selfcure) 120grams
alginate
amalgam capsule
anesthesia (lidocaine)
needle (guage .27 long)
needle (guage .30 small)
composite (set)
topical anesthesia
prophy brush

19
 prophy paste
rubber cup
suturing needles
suturing thread
clean stand
disposable syringe
endo block
gutta percha points #15-
40
k-files
nerve broach
paper points
rubber dam sheet
Bib
Gloves
Cup
saliva ejector
cotton rolls
cotton balls
Mask
Tissue rolls
Floss
Dycal
supersnap
polishing strip
matrix bond
wood wedge
dental cements
Plaster
cast stone
xray film
Hand tubs disinfectant
Cleaning bleach
Treatment
Area
Desk
computer Chair
Computer Monitor
CPU
air conditioning unit
dental chair unit
fixed cabinets
Light cure

20
 micromotor
high speed handpiece
airmotor
dental chair
x-ray machine
sterilizer machine
ultrasonic machine
Instrument's
Cabinet
restorative burs
prothodontic burs
oral prohylaxis
instruments
restorative instruments
four basic instruments
oral surgery instruments
endodontic instruments
rubber dam clamps
rubber dam frame
rubber dam clamp forcep
bib clip
Tray
toffle mire
mixing bowl
Spatula
impression tray

After the manual counting and checking of supplies and equipment in the
dental office, data may then be transferred to an inventory software program to
better monitor the inventory of the office. The following table is an accessible
inventory program from Microsoft Excel where the person in-charge may easily
monitor which supply needs ordering or which equipment may need updates or
repairing.

21
22
 COLLECTION POLICY
Third-Party Insurance Policies
This office does not and never will participate in capitation and/or reduced
fee-for-service programs. Any phone calls, mail, or solicitors for such plans are to
be turned away. Patients who have non-capitation insurance will be required to
have an insurance card and the insurance company must be called and verified
before they are considered for assignment of benefits. Once a patient has been
verified, the following information needs to be retrieved from the insurance
company: address to mail claims to; deductibles, if any, and what they apply to;
excluded treatments (i.e. crowns are not covered); if the payments are usual and
customary or fee schedule; and if prophys are limited per year. All this
information can be provided to the patients as needed.
Assignment of benefits will be taken again, only if verification has been
approved. Otherwise, the patient is considered "cash paying" until verification
can be established.
Patients who receive treatment with insurance will be told up front (before
treatment begins) as to their estimated portion of the bill. That portion is due on
the date of service; no exceptions are to be given. Patients need to be aware that
the amount they are paying is an estimated portion based on what their
insurance has told us, and if insurance does not pay or pays less, they are
responsible for the balance. We gladly process insurance forms for patients.
Insurance claims are to be submitted each day as the charges are posted.
Narratives and X-rays need to be mailed with larger claims and all crown and
bridge cases. Periodontal charting should be sent with all periodontal cases.
Claims are to be filed in duplicate. One copy goes to the insurance
company and one is filed by month and in ABC order. As claims are paid, the
EOB (explanation of benefits) is to be attached to our copy and filed in a
separate file under "paid claims" for that month. Claims not paid within 5 weeks
must be called on and proper steps taken to expedite payment. Also, Visa and
Mastercard will be accepted. For treatment plans of considerable amounts, we
will help the patient file for financing through a bank.
Financial Arrangements

A 5 percent discount is given to patients whose treatment plan is over

10000 and pay cash up front.
If a patient needs to come back 5 times to complete a 50000 treatment
plan, then payments would be 10000 each visit.
Treatment plans under 10000 are expected on the day of service.

23
 CHART OF ACCOUNTS
These account categories will be used for the dental office operations.
Asset Accounts
Accoun To Description/
Account Title
t No. Increase Explanation of Account
Checking account balance, currency,
101 Cash Debit coins, checks received from customers
but not yet deposited
Amounts owned to the clinic for
Accounts
120 Debit services performed or products sold
Receivable
but not yet paid for
Merchandise Cost of merchandise purchased but not
140 Debit
Inventory yet been sold
Cost of supplies that have not yet been
150 Supplies Debit used. Supplies that have been used
are recorded in supplies expense
Cost of insurance that is paid in
Prepaid
160 Debit advance and includes a future
Insurance
accounting period
Cost to acquire and prepare land for
170 Land Debit
use by the clinic
Cost to purchase or construct building
175 Buildings Debit
for use by the clinic
Amount of the building’s cost that has
Accumulated
been allocated to Depreciation
178 Depreciation – Credit
Expense since the time the building
Buildings
was acquired
Cost to acquire and prepare equipment
180 Equipment Debit
for use by the clinic
Amount of the equipment’s cost that
Accumulated
has been allocated to Depreciation
188 Depreciation – Credit
Expense since the time the equipment
Equipment
was acquired

Liability Accounts
Account To Description/
Account Title
No. Increase Explanation of Account
The amount pf principal due on a
210 Notes Payable Credit formal written promise to pay loans
from banks are included in this account

24
 Amount owed to suppliers who
Accounts provided goods and services to the
215 Credit
Payable clinic but did not require immediate
payment in cash
Amount owed to employees for hours
220 Wages Payable Credit
worked but not yet paid
Amount owed for interest in Notes
Payable up until the date of the
balance sheet. This is computed by
230 Interest Payable Credit
multiplying the amount of the note time
the effective interest rate times the time
period
Amounts received in advance for
delivering goods and services. When
Unearned
240 Credit the goods are delivered or the services
Revenue
are provided, this liability amount
decreases
Mortgage Loan A formal loan that involves a lien on
250 Credit
Payable real estate until the loan is paid

Owner’s Equity Accounts

Account To Description/
Account Title
No. Increase Explanation of Account
Amount the owner invested in the
company (through cash or other
290 Lasam, Capital Credit
assets) plus earning of the company
not withdrawn by the owner
Amount of the owner of the sole
proprietorship has withdrawn for
personal use during the accounting
295 Lasam, Drawing Debit year. At the end of the year, the
amount of this account will be
transferred to Lasam, Capita (account
290)

25
Operating Revenue Accounts
Account To Description/
Account Title
No. Increase Explanation of Account
Amounts earned from providing
services to clients, either for cash or on
credit. When a service is provided on
Service credit, both this account and Accounts
310 Credit
Revenues Receivable will increase. When the
service is provided for immediate cash,
both this account and Cash will
increase.

Operating Expense Accounts

Account To Description/
Account Title
No. Increase Explanation of Account
Expenses incurred for the work
performed by the salaried employees
Salaries during the accounting period. These
500 Debit
Expense employees normally receive a fixed
amount on weekly, monthly, or monthly
basis.
Expenses incurred for the work
performed by the non-salaried
Wages
510 Debit employees during the accounting
Expense
period, These employees receive an
hourly rate of pay
Supplies Cost of supplies used up during the
540 Debit
Expense accounting period.
Cost of occupying rented facilities
560 Rent Expense Debit
during the accounting period.
Costs for electricity, heat, water, and
Utilities
570 Debit sewer that were used during the
Expense
accounting period.
Telephone Cost of telephone used during the
576 Debit
Expense current accounting period
Costs incurred by the company during
Advertising the accounting period for ads,
610 Debit
Expense promotions and other selling and
expenses (other than salaries)
Cost of long-term assets allocated to
Depreciation
750 Debit expense during the current accounting
Expense
period.

26
Non-Operating Revenues and Expenses, Gains, and Losses
Account To Description/
Account Title
No. Increase Explanation of Account
Interest and dividends earned on bank
accounts, investments or notes
Interest receivable. This account is increased
810 Credit
Revenues when the interest is earned and either
Cash or Interest Receivable is also
increased.
Occurs when the company sells one of
Gain on Sale of
910 Credit its assets (other than inventory) for
Assets
more than the asset’s book value.
Occurs when the clinic sells one of its
Loss on Sale of
960 Debit assets (other than inventory) for less
Assets
than the asset’s book value.

27
 FORMS
For an organized operations in the dental office, certain forms must be
filed and accomplished by the patient and or the dentist and or the receptionist.
This forms must be always updated and kept organized by the receptionist. The
following are the basic categories of forms that must be managed by the
receptionist.
A. Vital records are essential documents that cannot be replaced. These
include patient clinical and financial records and the office’s corporate charter
and deed, mortgage, or bill of sale. These records should be kept in a
fireproof theft-proof vault or safe, and copies often are kept in a protected,
offsite location. Vital records are essential documents that cannot be
replaced.
B. Important records are extremely valuable to the operation of the office, but
they are not vital. They include accounts payable and receivable, invoices,
canceled checks, inventory and payroll records, and other federal regulatory
records. Such records may be needed for a tax audit or if a question arises
about a financial transaction. Important records generally should be retained
for 5 to 7 years. Most offices keep them for about 7 years or in accordance
with federal or state regulations.
C. Useful records include employment applications, expired insurance policies,
petty cash vouchers, bank reconciliations, and general correspondence. This
category is difficult to define, because one office may consider a document
useful, whereas another might find it indispensable. These records usually
are retained for 1 to 3 years. Before discarding a document, it is always wise
to check with the dentist or other staff members to see if it is still needed.
D. Nonessential records are the documents that lie around, have little
importance, and take up space. They include such items as notes to you,
reminders of meetings, outdated announcements, and pamphlets. Common
sense dictates when these materials may be discarded.

PATIENT CLINICAL RECORD

The clinical record is a collection of all the information about the patient’s
dental treatment. Although each patient’s clinical record is used during dental
treatment, updating and maintaining this record is the administrative assistant’s
responsibility. Success in maintaining clinical records requires cooperation and
efficiency from each member of the dental healthcare team. Accurate clinical
records are vital for several reasons, as follows:
• In treatment of the patient, clinical records serve as a road map. They
contain the patient’s history and outline future treatment.
• In a malpractice suit, the dental record is legally admissible as evidence. It
can be used for or against the dentist.

28
 • In third-party payment plans, the dental consultants representing the carrier
may review the clinical chart and other parts of the clinical record to
determine if services have been rendered adequately.
• The record acts as verification of treatment rendered for Internal Revenue
Service purposes.
• Components of the clinical records are vital in forensic odontology, the field
of dentistry concerned with identification of individuals based on dental
evidence.

A patient’s clinical record commonly has the following components:

• Patient file envelope or folder
• Registration form
• Health history and update forms
• HIPAA acknowledgment form
• Clinical chart or examination form
• Progress notes form
• Dental diagnosis, treatment plan, and estimate sheet
• Medication history and prescription forms
• Laboratory requisitions
• Consent forms
• Consultation and referral reports
• Letters
• Postal receipts
• Treatment record/progress notes
• Radiographs
• Copies of laboratory tests

Other forms may include the patient’s consent forms on the procedure
they are being provided. A sample of these forms are as followed:

29
PATIENT’S CHART

30
31
32
33
 Patient Info Label Here

DENTURE TREATMENT CONSENT FORM

Please Read And Initial The Items Checked Below. Also, Read And Sign The Section At The Bottom Of Form.

 I realize that full or partial dentures are artificial, constructed of plastic, metal,
and/or porcelain. The problems of wearing these appliances have been
explained to me, including looseness, soreness, and possible breakage. I realize
the final opportunity to make changes in my new dentures (including shape, fit,
size, placement, and color) will be the “teeth in wax” try-in visit. I understand
that most dentures require relining approximately three to twelve months after
initial placement. The cost for this procedure is not included in the initial
denture fee.

Initial_________

Signature of
Patient___________________________________________________________Date__________
_____

Signature of Parent/Guardian if Patient is a

minor___________________________________Date_______________

Witness________________________________Date_________________________

34
 CONSENT FOR TOOTH EXTRACTIONS AND OTHER ORAL SURGERIES

I hereby give permission to __________________________________, D.D.S. to perform the

following procedures and such additional procedures as are considered necessary on the basis
of findings during said procedure:

EXTRACTION OF TEETH #’S ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
AND/OR _______________________________________________________________________

I consent this to be done with local anesthesia only and other medications listed below.

A. ___________________________________B. _____________________________________

The following alternative methods have been explained to me:

1.
2.
3.

These alternative methods of treatment are practical and possible, but i desire the treatment
mentioned in paragraph #1. I also certify the reasons why the above-named procedures above
carry certain common inherent risks such as, but not limited to:

A. drug reactions and side effects

B. post-operative bleeding
C. post operative infection or bone inflammation (dry socket).
D. necessary removal of bone during tooth extraction.
E. possible involvement of the sinus of the upper jaw during removal of upper back teeth
requiring possible surgery for repair at a future date.
F. possible involvement of the nerve within the lower jaw during removal of lower molar
teeth, resulting in usually temporary but possible permanent numbness and /or tingling in
the lower lip, right and/or left side.

I am aware the practice of dentistry and oral maxillofacial surgery is not an exact science and i
acknowledge that no guarantees have been made to me as a result of the procedures
authorized above.

_____________________ ____________________________________________________
DATE FIRST LAST MI (PLEASE PRINT)

_____________________ ____________________________________________________
WITNESS SIGNATURE OF PATIENT OR RESPONSIBLE PARTY

35
 MARKETING PLAN
The goal of this business is to provide high quality general dentistry with a
moderate to high price using the highest technology possible. Prices will be
justified by the advanced technology used and the lifestyle conveniences that the
dental practice will offer. The dental practice will be positioned as a place one
can get high quality dental work in an environment of convenience and
technology.

Current Market Size and Growth Potential

The dental profession is one with a very low failure rate and a high
propensity for profit. According to Business Mirror, the country’s dental industry
looks promising compared to the last decade, and that this is evident with the rise
of giant dental clinics and the emergence of small ones all over the country. The
field of dental care is rapidly changing and evolving, from the basic tooth
extraction, it now offers a wide range of services. And with the technology and
advancements progress, many Filipino dentists are now keen on advancing their
field of studies and specialization to keep up with the competition. All these can
attest to the growth of the industry.
The average salary of a dentist in the Philippines is more or less 250,000
per year according to Pay Scale. As the growing population becomes better
educated and more wealthy, people demand better dental care. The
advancements in cosmetic dentistry provide new venues of service for the
general dentist to offer. Also, with the increase in non-capitation dental
insurance, many people who could not previously afford dental work are now part
of the patient pool.

Customer Profile and Target Market

Kids to adults
Dental patients who are willing to pay reasonable medium to high prices of
the service they actually need
Middle to high income
Families
Professionals who needs convenience that we can offer
Married, with children

36
Business Growth Plan

Market Penetration
Patients I have encountered during my associateship, most especially those who
prefer me as their dentist will receive letters of notification of the change of my
business. I will give information about the new clinic and tell the patient that I
hope to maintain their business and dental services with me. I may also offer free
family consultations to discuss any concerns the patient might have. We will also
advertise our benefits in the local papers and telephone books and send out
direct-mail information advertising our practice. Advertisements will be taken out
in the social media and local paper promoting discounts on whitening
procedures. Once the patient comes in for whitening, I will sit down with the
patient and discuss other ways to improve the aesthetics of their teeth. If they like
the service that they are given, they may become patients or at least give good
word-of-mouth advertisement. Other incentives will be given to attract new
patients and maintain current ones.

Internal Marketing
The goal of Internal Marketing is to make current patients continue their
patronage and to encourage them to refer our services. This can be done by first
and foremost treating them with respect. This office will also give each patient the
highest quality dental treatment possible, while offering competitive prices.
Treatment is to be presented to patients by the doctor only. Treatment will be
presented by encouraging the patient to ask questions and asking open-ended
questions to prompt discussion. Visual aids will be used when necessary and
intraoral pictures will also be utilized. A benefit for the patient will be given to help
them see the need for treatment (i.e. "So that tooth doesn't fracture further and
cause you more expense and pain, I recommend we start a crown on that tooth
as soon as possible.").
To stimulate referrals from existing patients at the end of the dental
appointment we stress to them their importance in our dental office and request
that they refer family and friends to our office. In order to maintain a strong
patient base and retain active patients, a patient should have either a restorative
appointment and recall appointment or be in the recall system to call on a
specific month for a specific procedure. Various other ways to promote our office
to already active clients and induce them to refer our practice to others include:

Be on time and if you cannot, personally apologize to the patient for any
inconveniences this has caused him or her
Greet patients by name (both dentist and staff)

37
 Install a music system
Have multiple telephone lines
Call patients at home after significant treatment to ensure patient is doing
well
Install a "good-bye" mirror so patients can check their appearance before
leaving the office
Offer coffee or other beverages
Keep reading material current
Provide referral cards which offers both the referring current patient and
the new patient a discount of certain services
Have personal information written on a notecard attached to chart to give
dentist conversational topics
Send a special note for occasions such as weddings, graduations,
birthdays, etc.
Decorate office internally and externally for holidays
Have toys for children to play with
Give patients magnets, toothbrushes, etc. with dental practice name and
logo
Give a picnic, barbecue, or other outdoor event during the summer for
your patients

External Marketing
External Marketing deals with promoting the dental practice to potential patients.
This can take the form of referrals, free publicity, or advertising. Examples of
each of these are:

Advertise through social media

Send a welcome letter to new residents in community
Run newspaper advertisements
Become involved with local activities
Participate in career days for area students
Get acquainted with community leaders
Join civic, religious, and community organizations
Patronize your patients' businesses
Offer to write a monthly column on dental health issues or a
Question/Answer column

38
Possible Pitfalls
 Locating a suitable practice —There is the possibility that the perfect
practice does not exist in our desired location.
 Not having a "quality" client base —By working in a practice, I will have
the opportunity to assess the quality of the clients. I will have built up a
client pool of my own that will hopefully follow me to my new practice.
 Not having large enough initial client base —We will select a practice only
after intense study of its active patient base, collection percentage, etc.

Positive Aspects

Market conditions are right for location selected

Pre-existing client base
A business agreement that meets both my personal, financial and
professional goals
Industry trends are favorable

Estimated Initial Investment Start-up Cost

The following amounts were the estimated initial investment cost for start-
up. This may be produced through bank loans and existing savings of the owner.
Land/Space Will be acquired from family
property
Over-all Construction ₱1,000,000
Equipment and ₱ 750,000
Supplies
Legal Services ₱ 200,000
Miscellaneous ₱ 50,000
Expense
₱2,000,000

39
Potential Overhead

40
 Jan Feb Apr May Jun Jul Aug Sep Oct Nov Dec
INCOME
DDS 500000 500000 500000 500000 500000 500000 500000 500000 500000 500000 500000
Hygienist 150000 150000 150000 150000 150000 150000 150000 150000 150000 150000 150000
Gross Sales 650000 650000 650000 650000 650000 650000 650000 650000 650000 650000 650000
Cash Receipt (90%) 585000 585000 585000 585000 585000 585000 585000 585000 585000 585000 585000
Accounts Receivable (10%) 65000 65000 65000 65000 65000 65000 65000 65000 65000 65000 65000

Cost of Goods Sold

Laboratory Fees 58500 58500 58500 58500 58500 58500 58500 58500 58500 58500 58500
Dent Supplies 45500 45500 45500 45500 45500 45500 45500 45500 45500 45500 45500
GROSS INCOME 546000 546000 546000 546000 546000 546000 546000 546000 546000 546000 546000

EXPENSES
Advertising 13000 13000 13000 13000 13000 13000 13000 13000 13000 13000 13000
Insurance 26000 26000 26000 26000 26000 26000 26000 26000 26000 26000 26000
Interest Expense (F) 150,000 150000 150000 150000 150000 150000 150000 150000 150000 150000 150000
Legal Services (F) 30,000 30000 30000 30000 30000 30000 30000 30000 30000 30000 30000
Offi ce Supplies 32500 32500 32500 32500 32500 32500 32500 32500 32500 32500 32500
Taxes and Liscenses 4500 4500 4500 4500 4500 4500 4500 4500 4500 4500 4500
Utilities 26000 26000 26000 26000 26000 26000 26000 26000 26000 26000 26000

Wages
DDS (F) 45,000 45000 45000 45000 45000 45000 45000 45000 45000 45000 45000
Hygienist 25000 25000 25000 25000 25000 25000 25000 25000 25000 25000 25000
Receptionist 16,000 16000 16000 16000 16000 16000 16000 16000 16000 16000 16000
Salaries Benefits 81900 81900 81900 81900 81900 81900 81900 81900 81900 81900 81900
Other Expenses (F) 20,000 20000 20000 20000 20000 20000 20000 20000 20000 20000 20000
TOTAL EXPENSES 469,900 469900 469900 469900 469900 469900 469900 469900 469900 469900 469900
NET PTOFIT 76,100 76100 76100 76100 76100 76100 76100 76100 76100 76100 76100

41