GP17 forms and patient signatures

Electronic signatures

Your PMS supplier may have the system to capture patient signatures electronically for the GP17-1 PR and GP17-O PR form using a digital signature pad or tablet. Electronic signatures are optional for PMS suppliers who wish to offer that service to their customers and electronic signatures must be retained for 2 years.

The General dental treatment GP17-1 PR form

There are two areas for recording patient/representative’s signature:

• Declaration on acceptance – Part 1b on form
• Declaration on completion – Part 2 on form

For a continuation case, where another dentist within your practice started the treatment, you can continue to use the same form, as it is for the same course of treatment. The paper GP17 forms must be kept for 2 years but may be scanned and held digitally if you have computer back-up, and you should be able to produce a legible copy if requested.

The Orthodontic GP17-O PR form

There are three areas for recording the patient/representative’s signature at various stages of treatment:

• Declaration on acceptance – Part 1a/b on form
• Declaration on fitting of appliance – Part 2 on form
• Declaration on completion – Part 3 on form

Part 4 is to be used to record the claim reference numbers for the claims submitted at various stages of a course of treatment:

• Enter claim reference number when Declaration on Acceptance signed
• Enter claim reference number when Declaration on Fitting of Appliance signed
• Enter claim reference number when Declaration on Completion signed

Note: The claim reference number for the Interim Payment and the Final Payment could be the same.

If the claim is for anything else, for example, examination, retainers or retention, the patient/representative would sign a new form at the declarations on Acceptance (Part 1a/b) and Completion (Part 3) and you would enter the claim reference number in Part 4 at Reference 1.

For an Orthodontic transfer case where the patient started treatment at a different practice, you should follow the guidance above regarding the patient signatures. However, as you will not be claiming an interim payment, this field will be left blank.

For a continuation case where another dentist within your practice started the treatment, you can continue to use the same form, as it is for the same course of treatment. If the first dentist has already claimed the interim, the second dentist cannot, as only one interim payment is allowed per course of treatment. The paper GP17 forms must be kept for 2 years but may be scanned and held digitally if you have computer back-up, and you should be able to produce a legible copy if requested.