Sample Documents (Dental CT)
The IAC is pleased to include sample documents to assist practices in providing quality care to their patients. These documents meet or exceed the requirements of the Standards, and they may be used to develop facility policies and reporting forms, whether your practice is seeking accreditation or simply working to standardize or improve current practices.
Please Note: The following documents are SAMPLES only. Protocols submitted with the application must be customized to reflect the practice.
- Dental CT FAQ (1.22MB)
- Acute Medical Emergency Policy (49KB)
- Dental CT Reporting Policy (58KB)
- Incident/Adverse Events Policy (41KB)
- Patient Complaint Policy (27KB)
- Patient Confidentiality Policy (61KB)
- Patient Identification Policy (43KB)
- Patient Pregnancy Policy (61KB)
- Primary Source Verification Policy (37KB)
- Preliminary Reports Policy (43KB)
- Dental CT Patient and Radiation Safety Policy (49KB)
- Medical Director Attestation for Consultant Use [SAMPLE] (58KB)
*Facilities are required to attach a letter from the facility's Medical Director (on the facility's letterhead) providing the consultants permission to complete the application for accreditation on the facility's behalf.
Sample Dental CT Reports
- Sample QI Policy (72KB)
- Sample QI Evaluation Form (Use of this evaluation form will meet all the required IAC Dental CT Quality Improvement Standards effective March 1, 2016.)
- Guidance for Radiation Protection Survey & Dose Assessment (10KB)
- Medical Physicist or Qualified Expert Report (104KB)
- FDA Information Regarding Cone-Beam Computed Tomography
On this webpage, the FDA is providing: information about the use of cone-beam computed tomography in dentistry particularly in the pediatric population; information for patients, parents and health care providers to help reduce unnecessary radiation exposure from dental cone-beam computed tomography; and, resources for manufacturers of dental cone-beam computed tomography devices.