Delegation, Referrals, and Collaborative Practice
What this domain tests
This domain tests the boundary between what a dentist may delegate and what must stay with the dentist, how lawful referrals work, and how supervision functions in public health and school-based settings.
Non-delegable dentist duties
Diagnosis, treatment planning, prescribing, and final clinical responsibility cannot be delegated. A dentist who authorizes hygienists to practice must ensure the authorization is real: the dentist knows the patient, has established a plan, and remains reachable at the required level of supervision.
Delegation rules
- Delegation runs to a person licensed or specifically certified for that function, never to whoever is available.
- A hygienist cannot re-delegate hygiene services to an uncertified assistant.
- Supervision must be contemporaneous and documented, not reconstructed by telephone after the appointment.
- The delegating dentist answers for the service performed and for the record documenting it.
Referrals
A dentist refers when the need exceeds competence or the scope of the practice, and must do so without abandoning the patient. Referral compensation is the bright line: paying or receiving anything of value purely to induce a referral is prohibited under Georgia law and, for federally funded patients, under federal anti-kickback rules. A disclosed referral fee is still an unlawful referral fee.
Collaborative and public health practice
Hygiene services in settings such as health departments and school programs may proceed under general supervision if a written protocol signed by a supervising dentist establishes the services, the population, the recordkeeping, communication with the dental home, and the referral route back for definitive care. The protocol is what creates the legal authority; remove it and the same services become unauthorized.
Worked example
A public health hygienist delivers sealants at a school with a signed protocol, prior dentist authorization, and a referral plan, while the supervising dentist is off-site. That is lawful general supervision. The same hygienist doing the same sealants in a private office for a patient the dentist has never examined is not.
Traps
- Treating "collaborative" as a synonym for independent practice.
- Assuming an emergency referral excuses the failure to document.
- Believing a supervisory signature on a protocol covers services the protocol never lists.