Public Health Supervision
Below is a sample agreement
for public health supervision. This
document can be used as a general guide when writing your public health
supervision agreement to ensure that all requirements of the rules are addressed
in your agreement. We would encourage
you to use this form, however, you may also create your own agreement that
addresses the requirements of 650 IAC 10.5(153).
For specific questions
on supervision agreements or the rules related to public health supervision,
call the board office and speak to Jennifer Hart at (515) 281-0997.
Download
A Public Health Supervision Agreement Here
*Requires
Adobe PDF*
If you would prefer
to receive the document as a Microsoft Word file, contact the board office
at (515) 281-0997 or at via e-mail at Jennifer.Hart@Iowa.gov
and a Word file can be e-mailed to you.
A copy of the completed
public health supervision agreement must be filed with the Oral Health Bureau
at the Iowa Department of Public Health.
This will enable the department to help facilitate access to dental
care and also to assess the impact of the new rules. Mail a copy of the completed agreement to:
Iowa Department of Public Health
Remember, however, that any questions about the rules or the specific requirements should be directed to the board office.
Reporting
Requirements
Each dental hygienist who has rendered services under public health supervision must complete a summary report at the completion of a program or, in the case of an ongoing program, at least annually. The report shall be filed with the Oral Health Bureau of the Iowa Department of Public Health on forms provided. Download a reporting form here:
Download Reporting Form for Services Completed
*Requires
Adobe PDF*
If you have questions about the reporting form or would like additional information about other programs available at the Oral Health Bureau, please visit their web site at http://www.idph.state.ia.us/hpcdp/oral_health.asp or call (515) 281-3733.