Module 2: Patient Management

Most Open Dental problems that look like billing problems, recall problems, or reporting problems start as patient record problems. A duplicate chart splits one person's history. A wrong guarantor sends a statement to an adult child's ex-spouse. A patient marked Inactive silently falls off recall. None of these are software bugs. They are data-entry decisions, and they are made dozens of times a day at the front desk.

This module covers the Family module and the patient record in depth: how Open Dental models families, how to add and edit patients, how to choose the right patient status, how to merge duplicates without making things worse, and how to use notes, commlogs, and popups so that important information gets seen. As with every module in this independent course, practice in the trial demo database or a test copy of your data (see Module 1), and check your version's manual if a screen differs.

Key takeaways

Every patient belongs to exactly one family, and each family has one guarantor who is financially responsible. The guarantor does not need to be a patient.
Search thoroughly before adding anyone, including inactive and archived records. Most duplicates come from searches that were too narrow.
Patient status is not a label, it changes behavior. Changing a status to anything other than Patient automatically disables recall.
Merging patients is permanent and cannot be undone. Restrict the Patient Merge permission and use a written pre-merge checklist.
Put each kind of information in its designed place: medical alerts, financial notes, address and phone notes, appointment notes, commlogs, and popups each have a job.

How Open Dental thinks about patients and families

Open Dental does not store patients as isolated records. Every patient is a member of a family, even if the family has one member. The family has a guarantor: the person responsible for the account. In the Family module, the guarantor appears first in the family member list and in bold. The account in the Account module is organized around that family, which is why the guarantor decision matters so much for statements and balances (covered in Module 6).

The Family module shows, for the selected patient:

The family member list, with the guarantor in bold at the top.
The patient information grid, whose rows you can customize through Display Fields.
The recall grid, showing each recall type with due and scheduled dates (Module 3).
The insurance plans grid, with subscriber details (Module 5).

The toolbar includes Add (a new family member), Delete, Set Guarantor, Move (to another family or a new family), Add Insurance, and Discount Plan. If you enable Patient Clone or Super Families in Show Features, extra buttons appear for those.

Search before you add: the duplicate-prevention habit

The fastest way to create a duplicate is to search once, see nothing, and click Add Pt. A disciplined search takes fifteen seconds. Teach it as a fixed sequence:

Open Select Patient (Ctrl + P).
Check Show Inactive Patients and Show Archived/Deceased/Hidden Clinics before searching for anyone who says they have been here before, or anyone whose family has.
Search by last name only, or the first few letters of it. Typing the full first and last name misses records with typos, hyphenated names, or maiden names.
If nothing appears, search by phone number or birthdate if your grid shows them, and try the first name alone in case the last name changed.
Ask the caller whether anyone else in the household is a patient. If so, search for them and look at their family list.
Only then create a new record.

Open Dental also has a preference that lets the first-name search box match preferred names. If your patients commonly go by nicknames, look for it in Preferences with the search box and consider turning it on.

Common mistake: Treating "not found" as "new patient" when the search was done with the default checkboxes. Returning patients who were marked Inactive years ago are hidden from a default search. Creating a fresh record for them orphans their history, old balance, and radiographs on the original record.

Adding a new patient, step by step

A single new patient or a new family

In Select Patient, click Add Pt for one person or Add Many to enter several family members at once. Anything you typed into the search fields carries over.
In the Edit Patient Information window, enter legal last and first name, then Preferred Name if the patient uses one. Staff will greet the patient by the preferred name; claims need the legal one.
Confirm Status is Patient (the default) for someone being seen, or NonPatient for a parent or subscriber who is not.
Enter birthdate, gender, and position (marital status). Age calculates automatically.
Enter address, then phone numbers: wireless, home, and work. Set Text OK according to the patient's actual consent, not a default guess.
Set contact preferences: Prefer Contact Method, Prefer Confirm Method, and Prefer Recall Method. These drive how confirmations and recall reminders are sent in Module 3.
Use Address and Phone Notes for things like "call cell after 5 p.m." or a second phone number.
Set Primary Provider (and secondary provider if your office uses it) and Billing Type. Leave the patient-level Fee Schedule blank unless you have a specific reason; the manual describes it as rarely used.
Add the referral source under Referred From. If you ever want to know where new patients come from, this is where that data starts. See our chapter on marketing and patient acquisition for why it matters.
Fill in any field marked with an asterisk (a Required Field for your office), then click OK or Save.

Adding someone to an existing family

Select any member of the family.
In the Family module, click Add. The new record opens with the family's address and billing information pre-filled.
Complete the new member's details and save. They now share the family's guarantor and account.

Insurance comes after demographics and is covered in Module 5. Resist the urge to add insurance to a record you have not finished setting up.

Office manager tip: If your office uses online intake forms through eServices, forms can reduce typing, but someone still has to decide whether the submitted form belongs to an existing record or a new one. Put that decision in the same search sequence above, so web forms do not become a new source of duplicates.

Editing records and keeping them complete

To edit, select the patient and double-click the patient information area in the Family module. A few features help keep families consistent:

Same for entire family options let a change to certain fields (such as address or the Ask to Arrive Early value) update every family member at once. When a family moves, this is how you avoid updating five records by hand.
Ask to Arrive Early takes a number of minutes. When set, a reminder with the requested arrival time appears each time an appointment is made for that patient, which is useful for patients who need extra paperwork or reliably run late.
Family Relationships record how a patient relates to others in the system, such as guardian, spouse, or parent.

Required Fields

Setup > Required Fields lets you mark fields in the Edit Patient Information and Add Family windows as required. You can add conditions so a field is required only in certain cases, such as based on age or status; when you add multiple conditions, all of them must be met. Staff see an asterisk on required fields and get a warning if they skip one. They can still proceed, but the manual notes that skipping is logged in the Audit Trail, which gives the office manager a way to spot shortcuts.

A sensible required list for most offices: birthdate, at least one phone number, address, Text OK, primary provider, and referral source for new patients. Do not require twenty fields. Staff will learn to click past warnings, and then the warning means nothing.

Guarantors, family structures, and moving patients

Choosing the guarantor is a financial decision, not a clerical one. The guarantor is the person who receives statements and is responsible for the family's balance.

Setting and changing the guarantor

Select the family member who should be responsible.
In the Family module, click Set Guarantor.
Confirm the bold name at the top of the family list has changed, and check the Account module to see how the family balance now appears.

Moving a patient to another family

The Move button transfers a patient to a different existing family or to a new family of their own. The manual flags several consequences worth knowing:

The family's urgent financial note and family financial notes do not move with the patient.
Moving a guarantor into another family effectively combines the two families and their accounts and notes.
The guarantor cannot be moved or deleted unless they are the only family member. Set someone else as guarantor first.
If your office sends accounts to a collection service integrated with Open Dental, check with that service before moving members of an account that has been sent.

Deleting is more restricted still: a family member can only be deleted when they have no procedures, claims, payments, or commlog entries. That is intentional. For anyone with history, change the status instead.

Common family scenarios

Situation	Typical setup	Watch out for
Child whose parent is not a patient	Parent added as NonPatient and set as guarantor; child as Patient in the same family	Do not leave the child as guarantor of their own account
Adult child who now pays their own bills	Move them to a new family where they are the guarantor	Settle or transfer any existing balance first; the family financial notes stay behind
Separated or divorced parents	Put the child in the family of the parent responsible for the bill, per your financial policy; some offices use Super Families to link households	Statements going to the wrong household; document the arrangement in the appropriate financial note
Spouses or partners	One family, one guarantor	If they want separate statements, they need separate families
Residents of a care facility	Super Families can group patients from one facility (Show Features must enable it)	Only turn the feature on if you will maintain it

Common mistake: Building "families" around households for convenience. If two roommates are put in one family, one of them becomes financially responsible for the other's bill on every statement. Families in Open Dental are billing units first. Build them around who pays.

Patient status types, used correctly

The Status field on each patient controls much more than a label. The manual lists these options and effects:

Status	What it means	When to use it	What it changes
Patient	An active patient (the default)	Anyone you currently see or expect to see again	Only status that keeps recall active
NonPatient	Someone who needs a record but is not a patient	Parents, guarantors, insurance subscribers who are not treated here	Recall disabled; keeps the person clearly distinct from people you treat
Inactive	No longer an active patient	Patients who have lapsed under your written policy, or asked not to be contacted for recall	Recall disabled; hidden from Select Patient unless Show Inactive Patients is checked
Archived	Not coming back	Moved away, transferred records, dismissed from the practice	Recall disabled; editing requires the Archived Patient Edit permission; hidden from default searches
Deceased	The patient has died	Only when confirmed	Recall disabled; prompts to remove future appointments; can lock the displayed age at date of death
Prospective	Never been in, but might become a patient	New-patient callers who have not scheduled or have not yet arrived, depending on your policy	Recall disabled; keeps prospects distinct from active patients

There is also a hidden Deleted status that users do not see; deleted patients disappear from the program, and the merge process uses the Archived status for the record that was merged away.

Decision rules for statuses

Do not use Inactive as a to-do list. Patients who are overdue for hygiene are not inactive. They belong on the Recall List or the reactivation workflow in Module 3. Marking them Inactive turns their recall off, which guarantees you will stop reminding them.
Write down your inactive policy. For example, a hypothetical office policy might be: "After a set number of unanswered recall attempts and no visit in a set period, the office manager reviews and may change status to Inactive." Pick your own thresholds, write them down, and apply them in a monthly batch, not ad hoc at the desk.
Use Archived for real endings. Records transfers, moves, and dismissals. Note the reason in a commlog so the next person understands why.
Use Prospective consistently or not at all. If some staff use it and others do not, your new patient reports will be unreliable.

Office manager tip: Restrict who can change statuses away from Patient, and check changes in the Audit Trail monthly. A status change is a quiet way to lose a patient from recall, and it rarely gets noticed until hygiene production dips.

Merging duplicate patients without making things worse

Duplicates will happen no matter how good your search habit is. Open Dental's tool is at Tools > Misc Tools > Merge Patients, and it is gated by the Patient Merge permission. Before you use it, understand the rules the manual lays out:

Merges are permanent and cannot be undone.
You pick a Patient to merge into (the record you keep) and a Patient to merge from (the duplicate).
Most data, such as procedures, appointments, and payments, moves from the duplicate into the keeper.
Patient information (demographics) is kept only from the Patient to merge into. The keeper's Medical Urgent note and family urgent financial note are the ones that survive.
If first name, last name, or birthdate do not match, a warning shows the differences, but the merge can still proceed.
The merged-from record becomes Archived and can be found with the archived and merged checkboxes in Select Patient.
Duplicate data such as extra insurance plans or recalls must be cleaned up by hand afterward.
If you use imaging software, the manual advises that the keeper should be the record linked to imaging.

A safe merge procedure

Confirm both records are the same human being: legal name, birthdate, address history, and ideally a conversation with the patient. Twins, Jr. and Sr., and parents and children with the same name are the dangerous cases.
Decide which record is the keeper. Usually it is the older record with the most history, the imaging link, and the correct family placement.
Copy any newer or more accurate demographics (a new phone number, a new address, a corrected birthdate) from the duplicate onto the keeper before merging, because the duplicate's patient information will not survive.
Note any medical alerts or urgent notes on the duplicate and copy them to the keeper if needed.
Print or save a view of both ledgers so you can compare balances afterward.
Run the merge: Tools > Misc Tools > Merge Patients, keeper as Patient to merge into, duplicate as Patient to merge from. Read any warning before confirming.
Clean up afterward: remove the duplicate insurance plan attachment if one was created, check the recall grid for doubled recall types, and confirm the family placement and guarantor.
Check the Account module to be sure the family balance makes sense, and add a commlog noting the merge and why.

Common mistake: Merging two different people. Because merges cannot be undone, merging a father and son with the same name mixes two medical histories, two ledgers, and two sets of radiographs into one record. That is a clinical safety problem and a privacy problem. Limit Patient Merge to one or two trained people, and never merge on the basis of a name match alone.

Notes, alerts, and popups without cluttering the chart

Open Dental has many places to store free text, and the most common failure is putting everything in one of them. When every note is a popup, staff click through popups without reading. When medical alerts live in billing notes, the clinical team never sees them. Use each place for its intended job.

Information	Best place	Why
Critical medical alert (for example, a severe allergy or premedication need)	Medical Urgent note, plus the structured medical history (allergies, medications, problems)	Designed for clinical visibility; structured entries support alerts and reporting
Billing arrangement or family financial issue	Family urgent financial note or family financial notes	Shows to billing staff at the family level; stays with the family
When and how to reach someone	Address and Phone Notes	Shows where the front desk looks when calling
Something about one visit	Appointment note	Appears in the appointment bubble on hover
A call, text, email, or conversation	Commlog	Dated, typed, and searchable history of contact
Something every user must see before doing anything	Popup, with a disable date	Interrupts the user, which is only appropriate for true must-knows
Clinical documentation of treatment	Procedure notes in the Chart module	Part of the clinical record (Module 4)

Popups done right

Popups are messages that appear when a user switches to a patient. Create them from the Popups button on the main toolbar with the patient selected. Each popup has a level:

Patient: appears when anyone selects this patient.
Family: appears when anyone selects any member of the family.
Superfamily: appears for any member of the super family (only if that feature is in use).

Each popup also has a Date Time Disabled field. Set it whenever the message has a natural end, such as "Collect $150 on account before next visit," so the popup retires itself instead of nagging forever. After someone acknowledges a popup, it will not reappear on that workstation for at least 10 minutes, and changes to popups are logged in the Audit Trail.

Office manager tip: Set a quarterly reminder to review active popups. A simple rule works: if a popup does not require someone to act or avoid something at the next encounter, it is a note, not a popup. Move it.

Commlog: the record of every contact

A commlog is a dated entry recording communication with a patient. Add one from the Commlog button on the main toolbar, and from other windows such as Edit Appointment and the Recall List. Each entry has a date and time, a type (defaults include ApptRelated, Insurance, Financial, Recall, and Misc, managed in Setup > Definitions under Commlog Types), a mode (such as phone, email, text, mail, or in person), a sent or received direction, and a note.

Commlogs appear in the Account module and, depending on chart view settings, in the Chart module's progress notes. Open Dental also creates some automatically, for example when texts are sent or postcards are printed from the confirmation list. That combination makes commlog the right place for "left voicemail about recall," "patient disputes balance, will call insurance," and "requested records be sent to new dentist."

Write commlogs so a stranger could understand them in a year: what happened, what was agreed, and what happens next. For a practice, that history is protection in a billing dispute and a gift to whoever inherits the patient.

A monthly patient-records audit for office managers

Records drift. A short monthly review keeps them clean:

Search Select Patient for common duplicate patterns: the same last name and birthdate appearing twice, or records with no birthdate at all.
Review status changes in Tools > Audit Trail and confirm each followed your written policy.
Review active popups and retire stale ones.
Spot-check five new patients from the month: required fields, referral source, contact preferences, guarantor, and insurance attached to the right person.
Check that newly added family members landed in the right family and that guarantors make financial sense.

If you are building written procedures around this, our chapter on systems and workflows covers how to turn checks like these into routines people actually follow.

Practice exercises

Complete these in the trial demo database or a designated test copy. The trial is limited to 30 patients, so delete or reuse practice records as you go.

Module 2 hands-on tasks

Search for a demo patient using only the first three letters of the last name, then repeat with Show Inactive Patients checked.
Create a new family with Add Many: a parent as NonPatient guarantor and two children as Patients. Confirm the parent appears in bold.
Add a third child with the Family module Add button and confirm the address pre-filled.
Change the family's address using a Same for entire family option and confirm every member updated.
Use Move to move one child into a new family of their own, then note what changed in the Account module.
Change a test patient's status to Inactive and look at the recall grid to confirm recall was disabled. Change it back and re-check.
Set up two Required Fields in Setup > Required Fields, including one with a condition, and try saving a patient without them.
Create a duplicate of a test patient, then merge it using Tools > Misc Tools > Merge Patients following the safe merge procedure. Find the archived record afterward.
Create a Family-level popup with a Date Time Disabled a few minutes in the future and confirm it stops appearing after that time.
Add three commlogs of different types and find them in the Account module and in the Chart module progress notes.

What's next

With clean patient records in place, you can schedule them. Module 3: Scheduling and the Recall System covers operatories, provider schedules, appointment types and time patterns, blockouts, confirmations, the ASAP list, and the recall setup that most offices get wrong. For the strategy behind the settings, pair it with our chapter on scheduling strategy.

ChairsideSource is not affiliated with or endorsed by Open Dental Software, Inc. This is independent educational content. Menus and features change between versions: verify against the official Open Dental manual and contact Open Dental support before changing settings that affect live patient data. This guide is educational content and does not constitute legal, financial, tax, or clinical advice. Laws and regulations vary by state and change over time. Consult your own dental-specific attorney, CPA, and state dental board before acting.