Text Request, Missing Prescription, and a Patient Phone Call
A dental practice's office manager sends the laboratory a text message with an attached intraoral scan and asks for a zirconia crown for 'J.D.' by Friday. The message gives the tooth as 26, shade A2, and says 'same as last time.' No written prescription, signed authorization, or patient identifier beyond initials is provided. The scan file has no margin marked, and the occlusion is not trimmed. The dentist is on leave and the office manager says the dentist will sign 'later.' The laboratory's policy requires a signed prescription before design, a unique patient identifier, and a verified scan with a marked margin. The patient later calls the laboratory directly, asks whether the crown is ready, and requests a shade change to A1. The laboratory has not started the case. The dentist's office is 40 minutes away, and the laboratory has a full schedule for the next three days. The lab must decide what to do with the request, the scan, and the patient call.
1. What legal and ethical issues arise from the text request and the missing prescription?
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Issues: A text from an office manager is not a written prescription. The lab lacks a signed authorization, a unique patient identifier, and a verified scan with a marked margin. Fabricating from that request could create an unauthorized restoration, a wrong-site or wrong-patient error, and liability for the lab. The initials 'J.D.' and 'same as last time' are not sufficient identification. The unmarked margin and untrimmed occlusion also make the scan technically inadequate for design.
Action: Do not start the case. Send the office manager a written request for a signed prescription from the dentist, including patient name and identifier, tooth number, material, shade, design, and delivery date. Ask for a verified scan with a marked margin and trimmed occlusion, or a new scan. Document the request and the hold in the lab record.
2. How should the lab respond to the patient's phone call and the office manager's promise of a later signature?
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Patient call: Do not confirm that the patient has a case at the lab, do not discuss the tooth, shade, or delivery date, and do not accept a shade change from the patient. Tell the patient that the laboratory cannot discuss case details directly and that they should contact the dental office. Record the call time and the fact that no clinical information was released.
Office manager: Explain that the promise of a later signature is not enough; the lab will hold the case until the signed prescription and acceptable scan are received. If the dentist is on leave, a secure electronic prescription or a signed order from another authorized clinician may be acceptable under the lab's policy, but a verbal or text approval is not. Do not let the Friday deadline override the documentation requirement.
3. What should the lab do about the incomplete scan file?
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Incomplete scan: The scan is not design-ready. The margin must be marked and the occlusion trimmed before CAD design. The lab should return the scan with a specific deficiency list: no margin line, untrimmed occlusion, and no verified patient identifier. Request a rescan or a corrected file. If the dentist cannot provide it, the lab should not mill or print the crown. This protects fit, occlusion, and traceability; a rushed design from an incomplete scan is more likely to fail than a delayed, documented case.