STANDARDIZED PROCEDURE AND PROTOCOL



STANDARDIZED PROCEDURE AND PROTOCOL FOR Dermal Filler Treatment Administered By Dr. Louis MalcmacherPURPOSETo ensure safe and effective treatment of patients undergoing Dermal Filler injections at the office of Dr. Louis Malcmacher, the following policies and procedures have been developed.POLICYA Dentist with current state licensure shall be able to assess, consult and treat patients using Dermal Fillers, following the guidelines set forth. All Dermal Filler treatments/procedures shall be performed in a clean, safe environment, equipped with proper sharps disposal system, and universal precautions in place.All adverse reactions shall be reported immediately to Dr. Louis Malcmacher and will be documented in the patient’s chart.RECORD KEEPINGDr. Louis Malcmacher is responsible for maintaining patient records, including but not limited to, patient assessment, signed informed consent of risks, benefits, and potential adverse effects, treatment #, treatment sites.STANDARDIZED PROCEDURE AND PROTOCOLFOR Dermal Filler Treatment by Dr. Louis MalcmacherDr. Louis Malcmacher will:Complete assessment and medical history questionnaire with all new patients.All patients will undergo a medical history review. Upon passing medical screening, patient will be fully informed of risks, benefits, and potential adverse reactions and an informed consent will be signed. Dermal Filler Materials will be injected into the selected areas including but not limited to the nasolabial folds, oral commissures, and marionette lines.The minimum amount of material required to obtain a satisfactory result will be used.Patients will be given oral and written post-operative instructions.DEVELOPMENT OF PLANDr. Louis Malcmacher has developed this Standardized Procedure and Protocol for Dermal Filler Treatment by Dentists as a comprehensive working model. This model will be reviewed annually at an annual management meeting and documented in the minutes of the meeting and will be kept in the Administration office.This Standardized Procedure and Protocol have been approved by:__________________________________________________________ ________________Dentist Date ................
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