Section A - Authorization to Obtain Medical Records
I authorize Sarah Luetke, PLLC DBA Sound Dental Care and its network of providers to obtain the resident's medical records from the care facility for the purpose of providing dental care. With my completed enrollment, I provide my general informed consent and authorize Sarah Luetke, PLLC DBA Sound Dental Care to request, record, and archive the resident’s diagnoses, current medications, historical medications, and history of healthcare providers.
Section B - Authorization to Coordinate Care with Primary Care Provider
I authorize Sarah Luetke, PLLC DBA Sound Dental Care to obtain authorization for dental services from the resident’s physician of record or from the facility’s medical staff if dental services are authorized in the Care Selection section.
Section C - Process for Dental Referrals
Sound Dental Care's team of dental hygienists employed by Sarah Luetke, PLLC DBA Sound Dental Care are uniquely qualified to provide preventative dental services and the medical management of dental health. Sound Dental Care also maintains a network of denturists that are on hand to deliver full dentures and partial dentures without needing to leave the facility in some locations. If the Sound Dental Care team finds an area of concern that may warrant offsite care, the Sound Dental Care staff will leave a care report and referral with the facility and ensure that the primary care provider is briefed on the recommendations. If a patient is able to leave the facility, Sound Dental Care does recommend an annual exam with his or her dentist of record. Sound Dental Care does not provide crowns, bridges, fillings, root canals or extractions in the facility given that these procedures often carry additional risk for the elderly. If these types of procedures are required, Sound Dental Care will refer patients to a contracted dentist or a dentist in the local community to ensure that the health and safety needs of the patient are being met. Emergent needs will be coordinated between the primary care provider and a dentist in the local community.
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