170 Forensic dentistryanxious to help but concerned about the proper management of their patients’
health records.
In addition to state regulations regarding record keeping, since 2003
the Health Insurance Portability and Accountability Act (HIPAA) and the
accompanying and ironically named Administration Simplification (AS) pro-
visions address the security and privacy of health data, particularly protected
health information (PHI). HIPAA and most state dental regulations provide
exemptions for the release of original records for the purpose of identifying
the dead.^5 Investigators must be educated to explain the rules and politely
demand that dentists or the dental office staff provide the original dental
record, including financial ledger, written records, health and dental history
forms, and all original radiographs. With the current ability to digitize a
dental chart, the duplication of an original record can be relatively easily per-
formed. Duplication of the record in this fashion provides the dental office
and the forensic investigator with a digital copy of the record and the amount
of time that the treating office is without the original record is minimized.
Also, after the record is duplicated and the original record is returned to the
dental office, a phone consultation can be performed with the treating dentist
to allow for clarification of any of the notes or charting peculiarities. During
the process of antemortem material collection, the practitioner should also
be asked if there are dental models or appliances that may be useful in the
identification process.
Meticulous evaluation of the original materials facilitates the creation of
an accurate record of the status of the patient’s mouth at the time of the last
dental visit. It is important to review all written records and radiographs and
to give special attention to the most recent procedural notes, patient ledgers,
and radiographs. Dental treatment is regularly performed after the latest
radiographic and clinical examination.
The antemortem forensic record should be recorded in a format that
accurately portrays the latest known status of that patient’s dental status
(Table 9.2).9.4.3 Comparison
After the postmortem and antemortem records are completed, the compari-
son process can proceed. Although this is commonly done manually for indi-
vidual identifications, in multiple fatality incidents it is likely that a computer
program will be used for the search and comparison of the antemortem and
postmortem records. WinID3© is a computer program commonly used in
North America that will assist the forensic dentist or forensic investiga-
tor to establish and maintain antemortem and postmortem databases.^6
WinID was developed by Dr. Jim McGivney as an expanded and enhanced
Windows version of the earlier DOS-based CAPMI program developed by