Dentists must obtain informed consent for every treatment you propose and perform on patients or from the patient's legal guardian or decision-maker. Offenders who refuse dental treatment will be required to sign a Refusal of Treatment Against Medical Advice form (P. 82000201).This form allows a patient to refuse a dental X-Ray imaging due to safety concerns or the availability of alternative options. The ADA Principles of Ethics and Code of Professional Conduct. Tags. The Board has the authority to refuse to grant a license to an applicant or to discipline a dentist or dental hygienist licensed in Georgia. Find all of the forms needed for claims, authorizations and more. Claim Forms For DeltaCare® USA claims and encounters. Please allow up to five business days for processing. You must participate in the decision-making process. Medicare Advantage Medical Claim Forms.