Dental Assistant Competency Checklist One program to handle all talent management needs from acquisition to development Personal Information HiddenOverall ScoreName(Required) First Middle Last Last 4 Digits of Social Security Number Email(Required) HiddenDate MM slash DD slash YYYY Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlyOperatory set upDA is able to prepare operatory for routine dental procedures specified by provider(Required) 1 2 3 4 Amalgam set upDA is able to correctly set up for amalgam procedures(Required) 1 2 3 4 Composite set upDA is able to correctly set up for composite procedures(Required) 1 2 3 4 RCT set upDA is able to correctly set up for RCT procedures(Required) 1 2 3 4 Crown/Bridgeset upDA is able to correctly set up for crown/bridge procedures(Required) 1 2 3 4 Oral Surgeryset upDA is able to correctly set up for routine and complex oral surgeryprocedures(Required) 1 2 3 4 ObservationDA is able to anticipate Dentist's needs during the procedure(Required) 1 2 3 4 RadiologyDA has completed training tapes, passed exam, and is 18 years or older(Required) 1 2 3 4 DA uses safe radiation exposure practices(Required) 1 2 3 4 DA uses lead apron appropriately(Required) 1 2 3 4 DA wears personal safety radiation badge consistently(Required) 1 2 3 4 DA uses correct exposure setting for patients size(Required) 1 2 3 4 DA knows pregnancy radiation protocols and procedures(Required) 1 2 3 4 DA chooses the correct Kodak mount for the radiographic exam being performed(Required) 1 2 3 4 DA accurately fills Kodak mounts with x-rays in the correct orientation(Required) 1 2 3 4 DA labels x-rayswith correct tooth numbersin Kodak(Required) 1 2 3 4 DA knows how to create a Context in Kodak(Required) 1 2 3 4 DA can complete an FMX series in 30 minutes or less including panorex(Required) 1 2 3 4 DA must achieve good diagnostic quality with accuracy of 90% on digital x-rays(Required) 1 2 3 4 PanorexDA is able to correctly follow opening and closing procedures with the panorex and its software(Required) 1 2 3 4 DA can correctly position patient in panorex(Required) 1 2 3 4 DA uses correct infection control technique between patients(Required) 1 2 3 4 DA can correctly apply software settings according to the patient’s body type and produce a diagnostic quality panorex film(Required) 1 2 3 4 SterilizationDA is able to demonstrate correct procedures required to handle both non-sterile and sterilized instruments(Required) 1 2 3 4 DA is able to remove Blood and debrisfrom instruments prior to bagging or wrapping(Required) 1 2 3 4 DA demonstrates the correct use of personal protective equipment(Required) 1 2 3 4 DA is aware of cross contamination potential(Required) 1 2 3 4 DA demonstrates pre-autoclave instrument preparation: bags, dates, wrap(Required) 1 2 3 4 DAknows the correct autoclave setting to be used(Required) 1 2 3 4 DA is able to recognize non-sterile vs. sterilized instruments(Required) 1 2 3 4 DA follows the guidelinesin the Dental Sterilization SOP(Required) 1 2 3 4 DA is able to demonstrate correct procedures to complete spore testing for heat sterilizers (Autoclave/Statim(Required) 1 2 3 4 DA demonstrates correct documentation procedures for heat sterilizers (Autoclave/Statim)(Required) 1 2 3 4 Operatory, Disinfection, MaintenanceDA demonstrates correct Operatory Opening Procedures(Required) 1 2 3 4 DA demonstrates correct Operatory closing procedures(Required) 1 2 3 4 DA correctly disinfects the operatory between patients(Required) 1 2 3 4 DA follows the guidelines in the Dental Room Turn Around SOP(Required) 1 2 3 4 SchedulingDA can schedule appointments in eCW(Required) 1 2 3 4 DA can modifyeCW appointment statuses (cancel, No Show, ready, rescheduled, confirmed, andrefuse/unable)(Required) 1 2 3 4 DA Correctly records Dentist/Hygienist next visit instructions in eCW(Required) 1 2 3 4 DA demonstrates appropriate phone etiquette(Required) 1 2 3 4 eCW Record MaintenanceDA Understands and Observes HIPAA Regulations(Required) 1 2 3 4 DA understands the eCW schedule and all color tracking in eCW(Required) 1 2 3 4 DA is able to update the following categories in eCW progress notes: Medications, Medical History, Allergies, Surgical History, Hospitalization History, Social History, and Vitals(Required) 1 2 3 4 DA correctly answers patient smoking, chewing tobacco, and alcohol screening questions in Social History section of eCW 90% of the time(Required) 1 2 3 4 DA is able to check patient’s pain level and blood pressure. These need to be correctly entered in the Vitals section of eCW 90% of the time(Required) 1 2 3 4 DA understands which eCW template to use for the HPI section of the eCW progress note(Required) 1 2 3 4 Routine ProceduresDA understands how to print patient education through eCW and does this for 90% of initial and periodic exam appointments(Required) 1 2 3 4 DA is able to assign eCW note to a provider(Required) 1 2 3 4 DA is able to switch appointment from one provider to another when moving an appointment in eCW(Required) 1 2 3 4 Open Dental ChartingDA is able to accurately chart in Open Dental from Dentist /Hygienist dictation(Required) 1 2 3 4 DA is able to use all of the charting tools in Open Dental (chart restorations, missing teeth, primary teeth, move teeth, and draw on tooth chart)(Required) 1 2 3 4 DA is able to correctly write a complete group note in Open Dental for a procedure that they performed (such as impressions)(Required) 1 2 3 4 DA should be able to save the tooth chart to images in Open Dental for 90% of exam appointments(Required) 1 2 3 4 DA needs to sign the Open Dental “Prevention Counseling” procedure code 90% of all appointments(Required) 1 2 3 4 DA can create an Open Dental CommLog and Popup(Required) 1 2 3 4 DA can set complete Open Dental appointment card with correct procedures and provider (who completed the procedures) for 90% of appointments(Required) 1 2 3 4 DA is able to accurately transfer procedure codes from Open Dental to eCW and complete all sections of the eCW “Procedure Codes” section(Required) 1 2 3 4 DA can navigate eCW enough to find:Past encounters, Patient Discount, last Health HX, Insurance, Patient Documents(Required) 1 2 3 4 Consent FormsDA is able to correctly completeconsent forms for N2O, extractions and RCT TX in Open Dental. Consents must be signed and printed(Required) 1 2 3 4 Price QuotesDA is able to correctly complete quotefor RCT, crown/bridge, endo, partials/dentures, operative, and oral surgery treatment(Required) 1 2 3 4 LabDA is able to take impressions while following cross-contamination protocols(Required) 1 2 3 4 DA is able to pour clinically acceptable models without air bubbles(Required) 1 2 3 4 DA is able to complete lab slip in Open Dental(Required) 1 2 3 4 DA canexplain steps and time involved in partial/denture process(Required) 1 2 3 4 DA cantake a blood sugar level and correctly enter the information into eCW so that it counts for Meaningful Use(Required) 1 2 3 4 AuthorizationsLegal Consent(Required) I agree to the terms and conditions.Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. By signing this document you are agreeing that you have reviewed this Consumer Disclosure and consent and intend to transact business electronically; to use electronic signatures instead of wet ink signatures and paper documents, and to receive notices and disclosures electronically. You are not required to sign documents electronically or to receive notices and disclosures electronically. If you prefer not to transact business electronically, you may request paper copies from the “sending party” and withdraw your consent at any time, as described below. Scope of Consent By utilizing this Service, you agree to receive electronic signature documents with all related and identified documents, notices, and disclosures provided during your relationship with the “sending party.” You may withdraw your consent, at any time, by following the procedures outlined below. Paper Copies You are not required to sign documents electronically, or receive notices or disclosures electronically, and may request paper copies of documents or disclosures, if you prefer. You also have the ability to download and print any signed or unsigned documents sent to you through the electronic signature service. We may also email you a copy of all documents you sign using the electronic signature service. If you wish to receive paper copies instead of electronic documents you may close this web browser and request paper copies from the “sending party” by following the procedures outlined below. The “sending party” may apply a charge for additional expenses incurred by printing and mailing paper copies. Withdrawal of Consent You may withdraw your consent to receive electronic documents, notices or disclosures at any time. In order to withdraw consent you must notify the “sending party” that you wish to withdraw your consent to transact business electronically and to provide your future documents, notices, and disclosures in paper format. If at any time, after withdrawing your consent you choose to use our electronic signature system your use of this Service will, once again, evidence your consent to receive documents, notices, and disclosures, electronically. You may withdraw your consent to receive electronic notices and disclosures or execute an electronic signature by following the procedures described below. Withdrawing your consent, requesting a paper copy, or updating your contact information You always have the ability to download and print any documents sent to you through our electronic signature system. To withdraw your consent to conduct business electronically, sign documents electronically, and receive documents, notices, or disclosures electronically, please contact the “sending party” directly; by telephone, by email (sent to the “sending party” with any of the topics outlined below stated in the subject line of your email) or by postal mail to their mailing address specified to receive such notices. “Withdrawal of Consent To Transact Business Electronically” To allow the “sending party” to identify and facilitate your withdrawal of consent to transact business electronically, please provide your name, email address, the date on which you are withdrawing your consent, your telephone number and mailing address. “Requesting A Paper Copy” To allow the “sending party” to identify you to provide a paper copy of the document requiring your signature, the notice, or disclosure, please provide the sending party with your name, email address, mailing address, telephone number, and name of the document of which you are requesting a paper copy . “Update Your Contact Information” To allow the “sending party” to identify you in order to update your contact information, please provide them with your name, email address, mailing address, and telephone number. The “sending party” will inform you of any fees related to costs for printing and mailing paper copies or your withdrawal consent to transact business electronically.CAPTCHANameThis field is for validation purposes and should be left unchanged.
