Section 9.02. Work authorizations.

  Work authorizations shall include data which is substantially similar to the form set forth below:

DENTAL LABORATORY WORK AUTHORIZATION

OFFICIAL WISCONSIN FORM

TO:   DATE:    

FROM: Dr.     Tel. No.  

Address       License No. and State    

FOR:        

Patient Name or Identification Number      

(Give name of manufacturer for materials and teeth)

TEETH: Anterior: Porcelain   Plastic       Shade and Molds      

       

Posterior: Porcelain   Plastic    

Shade and Molds      

       

METAL: Gold   Chrome Alloy   Others            

BASE MATERIAL:       OTHER MATERIALS:        

Signature      

DATE TO BE RETURNED    

Use reverse side for additional instructions

(1)  Each work authorization shall be retained and filed by the issuing dentist and by the dental laboratory for a period of at least 3 years from the date of issuance. The filed work authorization shall be available for inspection by the board or its representatives during such period.

(2)  No dental laboratory shall have in its possession any prosthetic dentures, bridges, orthodontic or other appliances or structures to be used as substitutes for or as a part of natural teeth or jaws or associated structures, or for the correction of malocclusions or deformities, either completed or being fabricated, without having in its possession a signed work authorization for such items.

(3)  No dental laboratory shall advertise that it provides any service directly to the public.

(4)  The board, its agents or employees may inspect dental laboratories' records of work authorization. Any dental laboratory which violates any provisions of this chapter, or refuses to allow the board, its agents or employees to inspect the work authorization records is subject to such penalties as provided in s. 447.09 , Stats.

History: Cr. Register, April, 1972, No. 196 , eff. 5-1-72; renum. from DE 6.02 and am., Register, February, 1982, No. 314 , eff. 3-1-82; CR 13-060 : am. (intro.), (1), (2), (4) Register June 2014 No. 702 , eff. 7-1-14.