especially important when: • Referrals are time-sensitive • There is risk if care is delayed • No POA or formal decision-maker is identified


As always, limit the information shared to what is necessary.


What to Avoid: In navigating these situa- tions, there are a few common pitfalls to avoid: • Assuming HIPAA prevents all commu- nication


• Relying on cognitively impaired patients to manage referrals independently


• Failing to identify a responsible decision-maker


• Skipping documentation of capacity concerns and follow-up efforts


Establish an Internal Protocol: To ensure consistency across the practice, consider implementing a simple workflow: • Identify risk factors (advanced age, cognitive impairment, unaccompanied patient)


• Assess and document capacity • Identify a decision-maker (POA, guard- ian, facility contact, or emergency contact)


• Communicate appropriately with those involved in the patient’s care • Document all actions taken


Some practices also incorporate care coordi- nation consent forms, staff training, or chart flags to reinforce these processes.


At its core, this issue reflects a shared profes- sional responsibility: ensuring vulnerable patients do not fall through the cracks. With thoughtful communication, clear documen- tation, and a team-based approach, dental practices can support both patient care and compliance with confidence.


This article was developed from a member call to the MDA with these related questions. The MDA consulted with other member dentists and referenced the California Dental Association article, “Treating elderly patients: Minimize risk with informed consent and updated health history” to provide resources and write this article, which is intended for informational purposes only and does not constitute legal advice. Access that article at bit.ly/3Pp9k2S. This article is not intended as legal advice. Dentists should consult their legal counsel or professional liability carrier for guidance specific to their practice and state regulations.


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ISSUE 1 | SPRING 2026 | focus 23


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