Virtual Consult
Doctor Training
Module
Everything you need to run exceptional, compliant, and profitable
virtual consultations under the Prime Emergency Dental brand.
Table of Contents
Washington State
Teledentistry Compliance
All virtual consults must comply with Washington State dental practice law (RCW 18.32) and WAC 246-817. Review the following before your first call.
When you conduct a virtual consult for Prime Emergency Dental, you are practicing dentistry under your own Washington State license. Practice within your scope, document every call, and never provide guidance you would not be comfortable defending to the Washington State Dental Quality Assurance Commission (DQAC).
| Requirement | What It Means for You |
|---|---|
| WA License Required | You must hold an active, unrestricted Washington State dental license. Out-of-state licenses do not qualify unless reciprocity is formally established. |
| Video + Audio Required | Washington defines a billable teledentistry service as real-time audio AND video. Audio-only phone calls are not billable and do not satisfy the legal standard. |
| No Definitive Diagnosis | Without in-person examination and radiographs, you may not issue a definitive diagnosis. You may assess, triage, and provide clinical impressions with clear caveats. |
| No Controlled Substances | Washington state prohibits prescribing controlled substances (Schedule II–V, including opioids) via teledentistry. Antibiotics only — see Section 07. |
| HIPAA Compliance | All sessions are conducted via Doxy.me which is fully HIPAA-compliant with a signed BAA. Do NOT use FaceTime, Zoom, or any unapproved platform. |
| Informed Consent | Patient consent is captured digitally before the call via a mandatory checkbox on the website. You must verbally confirm the patient understands the limitations of a virtual consult. |
| Record Keeping | A SOAP note must be completed within 15 minutes of every call. This is a Washington State documentation requirement and your legal protection. |
| Scope of Practice | You may not exceed your dental license scope. If you are a general dentist, do not provide specialist-level guidance outside your competency. |
Standards of
Participation
These standards define what it means to represent Prime Emergency Dental on a virtual call. Consistent failure to meet them is grounds for removal from the program.
Standard 1 — Professional Appearance
You represent Prime Emergency Dental on every call. Patients paid $69 — they expect a professional, polished, credible physician-level encounter.
- Hair must be clean, neat, and professionally styled — as you would appear in the clinic
- Attire must be professional: scrubs, white coat, or business professional. No casual wear, hoodies, or t-shirts
- Face must be clean-shaven or facial hair neatly groomed and maintained
- Background must be neutral and professional — plain wall, clinic setting, or clean home office. No clutter, no visible beds or kitchens
- Lighting must be adequate — face clearly visible, no backlighting from windows behind you
- No eating, drinking (except water), or gum chewing during calls
- No distractions visible — no TV in background, no other people walking through the frame
Standard 2 — Patient Time & Respect
Patients are in pain and paid good money. A rushed 3-minute call is a chargeback, a bad review, and a violation of this program.
- Minimum call duration is 8 minutes — no exceptions for compensation eligibility
- No multitasking during calls — full, undivided attention on the patient at all times
- Let the patient finish describing their symptoms before you respond
- Use plain language — avoid clinical jargon unless the patient is medically sophisticated
- Acknowledge their pain directly. Lead with empathy before clinical assessment
- Never make the patient feel like a burden or an inconvenience
Standard 3 — All Calls Route to Prime Emergency Dental
Every patient who needs in-person care is referred exclusively to Prime Emergency Dental. Never to your own practice. Never to any other clinic. No exceptions.
- You may NOT refer patients to your own practice or any other dental office
- You may NOT suggest "check with your regular dentist" if urgent care is needed
- Current location: 22315 Highway 99, Suite G, Edmonds, WA 98026 · (425) 864-7600
- The referral script is in Section 05 — use it on every call
Standard 4 — Hours & Response Time
When you are on the schedule, you must be available and camera-ready. Last patient accepted at 9:30PM.
- You must join a patient's waiting room within 10 minutes of them entering
- If you cannot respond within 10 minutes, immediately notify the coordinator
- Two missed patients without notice in a single shift = shift may be removed
- You must be camera-ready before your shift starts — not in the process of getting ready
Standard 5 — No Opioids. Ever.
- Washington state prohibits prescribing controlled substances via teledentistry
- Antibiotics only — see Section 07 for the approved list
- For pain: recommend the ibuprofen + acetaminophen alternating protocol (Section 07)
- If a patient demands opioids, decline professionally and refer to in-person care
Standard 6 — No Definitive Diagnosis
- Never say "You have X" — say "This appears consistent with X"
- Always qualify: "I would need to see you in person and review X-rays to confirm"
- This protects you legally and naturally creates the in-person referral
Standard 7 — SOAP Note Within 15 Minutes
- Every call requires a SOAP note — even if the patient disconnects early
- No SOAP note = no compensation for that call
- Template is in Section 08
Standard 8 — Camera & Conduct
- Treat every call exactly as you would an in-person patient encounter
- No side conversations with people off-camera during the call
- Do not drive, walk, or move during a call — you must be stationary
- If your internet drops, call the patient back using the phone number they provided
Technical Setup
Before Every Shift
You will be given login credentials to the Prime Emergency Dental Doxy.me Professional account. Here is everything you need to get online and ready.
doxy.me/primeemergencydental/primeemergencydental
How to Access the Waiting Room Queue
- Log into doxy.me with your provided credentials
- You will see the waiting room dashboard — patient names appear as they enter after paying
- Click "Start Visit" to join a patient's call
- If multiple patients are waiting, they are served in queue order — first in, first seen
- After each call, click "End Visit" — the next patient moves up automatically
Equipment Requirements
| Item | Requirement |
|---|---|
| Internet | Minimum 10 Mbps upload. Test at fast.com before every shift. Have phone hotspot as backup. |
| Camera | Built-in laptop camera is acceptable. External webcam preferred for higher image quality. |
| Microphone | Headset with microphone strongly preferred — eliminates echo and background noise. AirPods work. |
| Lighting | Ring light or lamp positioned in front of your face. Never a window behind you. |
| Browser | Google Chrome or Firefox. Keep updated. Do not use Safari — Doxy.me has known Safari issues. |
| Device | Laptop or desktop strongly preferred. Phone is last resort only. |
Pre-Shift 8-Point Checklist
- Internet tested at fast.com — minimum 10 Mbps upload confirmed
- Camera tested in Doxy.me — face clear, lighting adequate, background professional
- Microphone tested — no echo, no background noise
- Professional appearance confirmed — attire, grooming, camera-ready
- Logged into Doxy.me waiting room, status set to Available
- SOAP note template open and ready (Section 08)
- Prime Emergency Dental address and phone visible at your desk
- E-prescribing platform open and ready if you anticipate Rx calls
The Call Flow
Step by Step
Every virtual consult follows this exact 12-step sequence. Do not skip steps.
Patient Enters Queue
You receive a Doxy.me notification. Patient has already paid $69 and signed consent. Join within 10 minutes.
Open the Call
Click Start Visit. Wait for patient video to load. Greet professionally — see script in Section 05.
Confirm Identity & Consent
Confirm patient's name. Verbally confirm they understand this is a virtual triage — not a definitive diagnosis.
Chief Complaint
Ask the patient to describe their pain and symptoms fully. Do not interrupt. Listen completely before speaking.
Visual Assessment
Ask the patient to use a flashlight and show you the affected area. Assess swelling, tissue color, visible decay, facial asymmetry.
Clinical Questions
Run through the clinical assessment questions in Section 05. Document all relevant findings as you go.
Clinical Impression
Provide your impression using approved language. Never a definitive diagnosis — always qualified with "appears consistent with."
Rx If Indicated
If an antibiotic is warranted, prescribe per Section 07 only. Send electronically to patient's pharmacy.
Pain Management Guidance
Provide the OTC alternating ibuprofen + acetaminophen protocol. See Section 07.
Route to Prime Emergency Dental
Deliver the routing close script from Section 05. Provide address, phone, hours, and $69 credit explanation.
Close the Call Warmly
Confirm patient has address, phone number, and next steps. Do not end abruptly. Professional, caring close.
SOAP Note — Within 15 Minutes
Complete the SOAP note immediately after the call. Template in Section 08. This is required for compensation.
Patient Scripts
These scripts are your guide. The opening, consent confirmation, routing close, and emergency escalation must be delivered consistently on every call.
Opening the Call
"Hello, [Patient Name] — I'm Dr. [Your Name] with Prime Emergency Dental. Thank you for reaching out today. Before we begin, I want to quickly confirm: you understand this is a virtual triage consultation, and I'll need to see you in person for a complete examination and X-rays to give you a definitive diagnosis — is that correct?"
Chief Complaint
"Perfect. Tell me everything that's going on — when did this start, where exactly is the pain, and how would you describe it? Take your time."
Visual Assessment Request
"Thank you — that's really helpful. I'd like to take a look if you're able. Can you grab a flashlight or turn on your phone's flashlight, open as wide as you comfortably can, and show me the area? Hold your camera close — I just want to see as much as possible."
Clinical Assessment Questions
- On a scale of 1 to 10, what's your current pain level?
- Is the pain constant or does it come and go?
- Does anything make it better or worse — heat, cold, biting, lying down?
- Do you have any facial swelling? Does it feel warm to the touch?
- Do you have a fever, chills, or difficulty swallowing?
- Have you noticed any pus, bad taste, or drainage?
- Is there any difficulty opening your mouth fully?
- Have you taken any medication? What and when?
- Do you have any drug allergies?
- Are you pregnant or nursing?
- Do you have any significant medical conditions or take blood thinners?
Clinical Impression
"Based on what you've described and what I can see, this appears consistent with [clinical impression — e.g., a dental abscess / acute pulpitis / pericoronitis]. I want to be clear that I cannot give you a definitive diagnosis without seeing you in person and reviewing X-rays — but what you're describing needs to be evaluated and treated promptly."
Prescribing Antibiotics — If Indicated
"Given what I'm seeing, I'm going to prescribe an antibiotic to start managing any infection. I'll send it directly to your pharmacy. What pharmacy do you use and what's their phone number?"
OTC Pain Management
"For pain right now, alternate ibuprofen 400–600mg and acetaminophen 500–1000mg every three to four hours — don't take them at the same time, but alternate them. That combination works better than either alone. Take ibuprofen with food, and do not exceed the daily limits on the packaging."
Routing Close — Non-Negotiable
Every call ends with this routing. No exceptions. Do not improvise this part.
"Here's what I want you to do next: come in to see us at Prime Emergency Dental in Edmonds. This is our emergency-only office — open 7 days a week, 9AM to 8PM, no referral needed. Based on what I've seen today, you need a full exam and X-rays so we can properly diagnose and treat this the same day. And the $69 you paid today is credited toward your exam — you only pay $30 more when you arrive."
"Our address is 22315 Highway 99, Suite G in Edmonds — right on Highway 99. Our phone is (425) 864-7600. You can also book at primeemergencydental.com. I strongly encourage you to come in today or first thing tomorrow."
Closing the Call
"Is there anything else you'd like to ask me before we wrap up? [Pause.] Great — please take care of yourself, start the antibiotic as soon as you can if I've prescribed one, and please don't delay coming in. We're here for you. Take care."
Clinical Guidelines
Can & Cannot Do
| ✅ You CAN | ❌ You CANNOT |
|---|---|
| Assess visible symptoms via video | Issue a definitive diagnosis |
| Provide a clinical impression with caveats | Order or interpret radiographs |
| Prescribe approved antibiotics (Section 07) | Prescribe opioids or controlled substances |
| Recommend OTC pain management | Perform or advise on any procedure |
| Triage urgency level (routine / urgent / ER) | Refer to any practice other than Prime Emergency Dental |
| Confirm the patient's $69 credit toward in-person visit | Negotiate or modify the pricing structure |
| Send antibiotic Rx electronically to pharmacy | Provide a written report or formal diagnosis letter |
| Advise ER if signs of spreading infection or airway risk | Delay ER referral if patient shows systemic signs |
Urgency Classification
| Level | Signs & Guidance |
|---|---|
| 🟡 ROUTINE Come in this week | Mild pain, no swelling, no systemic signs. Refer to Prime Emergency Dental — can schedule within 2–3 days. |
| 🔴 URGENT Come in today | Moderate–severe pain, localized swelling, possible abscess, unable to eat or sleep. Refer to Prime Emergency Dental immediately — open 9AM–8PM. |
| 🚨 EMERGENCY Call 911 / Go to ER | Rapid spreading swelling, floor of mouth involvement, difficulty swallowing or breathing, high fever (>101.5°F), Ludwig's Angina signs. DO NOT route to dental clinic. |
Rx Protocols
Approved Medications Only
Washington state teledentistry regulations prohibit prescribing controlled substances via teledentistry. The following antibiotics are approved for dental infections.
| Antibiotic | Dosing & Notes |
|---|---|
| Amoxicillin 500mg | #30 — Take 1 capsule three times daily for 7–10 days. First-line for dental infections. Use if no penicillin allergy. |
| Amox-Clavulanate (Augmentin) 875mg | #20 — Take 1 tablet twice daily for 7–10 days. Use for resistant infections or prior amoxicillin failure. |
| Clindamycin 300mg | #30 — Take 1 capsule three times daily for 7–10 days. Use if penicillin/amoxicillin allergy. Warn patient about GI side effects. |
| Metronidazole 500mg | #30 — Take 1 tablet three times daily for 7–10 days. Adjunct with amoxicillin for severe infection — do not use alone. Advise no alcohol. |
| Azithromycin 250mg (Z-Pack) | Use only if allergy to both penicillin AND clindamycin. 500mg Day 1, then 250mg Days 2–5. |
Hydrocodone, Oxycodone, Codeine, Tramadol, Diazepam, or any controlled substance (Schedule II–V). Violating this rule is grounds for immediate removal from the program and potential license action by the Washington State DQAC.
OTC Pain Protocol — What to Recommend
- Ibuprofen 400–600mg every 6–8 hours with food (max 2,400mg/day)
- Acetaminophen 500–1,000mg every 6 hours (max 4,000mg/day; 2,000mg if liver concerns)
- Alternate the two — do not take simultaneously
- Topical: Orajel or benzocaine gel for temporary surface numbing
- Cold compress to facial swelling — 10 minutes on, 10 minutes off
- Never recommend aspirin for toothache — risk of bleeding complications
SOAP Note
Documentation
A SOAP note must be completed within 15 minutes of every call — including calls where the patient disconnected early or refused care. No SOAP note = no compensation.
PATIENT NAME: _________________________________ PHONE: _______________________
Pain scale: _______ / 10 Quality: [ ] Sharp [ ] Throbbing [ ] Aching [ ] Pressure
Duration: _____________ Onset: [ ] Sudden [ ] Gradual
Modifying factors: [ ] Heat [ ] Cold [ ] Biting [ ] Spontaneous [ ] Lying down
Swelling: [ ] Yes [ ] No Fever: [ ] Yes [ ] No Difficulty swallowing: [ ] Yes [ ] No
Current medications / allergies: ___________________________________________________
Facial swelling: [ ] Yes [ ] No Location: _____________
Visible abscess / sinus tract: [ ] Yes [ ] No
Trismus (limited opening): [ ] Yes [ ] No
Systemic signs reported: [ ] Yes [ ] No Details: ___________________________
Urgency level: [ ] Routine — come in this week [ ] Urgent — come in today [ ] ER immediately
Note: Virtual assessment only — no radiographs, no clinical examination.
Pharmacy: _____________________________________ Phone: _______________________
OTC pain management discussed: [ ] Yes [ ] No
Patient referred to: Prime Emergency Dental — 22315 Hwy 99 Suite G, Edmonds WA 98026 — (425) 864-7600
Patient accepted referral: [ ] Yes [ ] No [ ] Undecided
Follow-up: [ ] In-office ASAP [ ] ER if worsening [ ] Monitoring
Doctor Signature: _________________________________ License #: _______________
Routing Patients to
Prime Emergency Dental
| Detail | Information |
|---|---|
| Clinic Name | Prime Emergency Dental — Edmonds |
| Address | 22315 Highway 99, Suite G, Edmonds, WA 98026 |
| Phone | (425) 864-7600 |
| Hours | Open 7 Days a Week, 9AM – 8PM including all holidays |
| Booking | primeemergencydental.com · Walk-ins always welcome |
| $69 Credit | Patient's consult fee is applied — they pay just $30 more for a $99 total exam |
Under no circumstances may you refer a patient to any dental practice other than Prime Emergency Dental — including your own personal practice. Violation of this rule results in immediate removal from the program and forfeiture of compensation for that session.
Emergency
Escalation Protocol
Some patients will have conditions requiring immediate ER care — not a dental office. You must recognize these signs and act decisively and immediately.
These are life-threatening signs. Do NOT route to Prime Emergency Dental.
- Difficulty breathing or shortness of breath
- Difficulty swallowing — particularly if worsening rapidly
- Swelling of the floor of the mouth, neck, or throat
- Trismus (cannot open mouth at all) combined with neck swelling
- High fever (>101.5°F / 38.6°C) combined with severe swelling
- Patient appears confused, lethargic, or has altered mental status
- Signs of Ludwig's Angina — bilateral submandibular swelling, elevated tongue, drooling
Emergency Script
"I need to be honest with you — what you're describing is beyond what we can safely manage in a dental setting right now. I need you to go to the nearest emergency room immediately, or call 911 if you're having any trouble breathing or swallowing. This is serious and I don't want you to delay. Can you get to an ER or call 911 right now?"
Compensation,
Scheduling & Accountability
Earnings Per Call
Scheduling
- Shifts are reserved in advance through the Prime Emergency Dental coordinator
- Minimum shift commitment is 2 hours
- Any hours within the 8AM–10PM window, 7 days a week
- Schedule changes require 24 hours notice — same-day cancellations are tracked
- Consistent same-day cancellations result in reduced scheduling priority
Performance Standards
| Metric | Minimum Standard |
|---|---|
| Response Time | Patient joined within 10 minutes — 95% of calls |
| Call Duration | Minimum 8 minutes per completed compensated consult |
| SOAP Note Completion | 100% — no exceptions |
| Clinic Referral Rate | Minimum 80% of patients referred to Prime Emergency Dental |
| Patient Complaints | Zero tolerance for unprofessional conduct |
Grounds for Removal
- Referring patients to any practice other than Prime Emergency Dental
- Prescribing controlled substances via teledentistry
- Issuing definitive diagnoses without in-person examination
- Repeated failure to meet response time standards without notice
- Failure to complete SOAP notes consistently
- Patient complaints regarding unprofessional conduct or appearance
Quick
Reference Card
Print this section and keep it visible at your workstation during every shift.
Doctor Acknowledgment & Signature
By signing below, I confirm that I have read and fully understood this training module, that I hold an active and unrestricted Washington State dental license, and that I agree to abide by all standards, compliance requirements, clinical protocols, and routing rules contained herein. I understand that failure to comply may result in removal from the Prime Emergency Dental Virtual Consult Program.
Questions? Contact the Coordinator.
Prime Emergency Dental · 22315 Highway 99, Suite G, Edmonds, WA 98026 · (425) 864-7600 · primeemergencydental.com