Dental Record Template

Dental records release form template.

Dental record template. The dental records release form is a document that is provided by a dental patient or the parent or guardian of the patient if the patient is a minor or of proper relations for the purpose of obtaining dental records from another dentist or dental specialist. The downloadable dental forms section is here to help. Dental practices need to have the proper paperwork and forms available for office use and for patients to sign. This information is necessary for the dentist to have the ability.

Dental forms are available from the dental record as individual tablets or assembled in patient charts. Custom forms and charts are also available. Available on gold plan. The digital record offers the hipaa compliant online dental back up prescription pads and paper dental forms and charts and much more.

Forms can be ordered individually or in pre assembled charts. This template is available in the gold plan with many perks. The dental forms and charts from the dental record are the only record keeping products endorsed by the ada. Dental forms come in a variety of colors and sizes and include medical history examination consent hipaa and more.

Authorization to release dental information the execution of this form does not authorize the release of information other than the terms specifically described below. Hipaa authorization records release form. Write this type of letter when you are asking your dentist to send your records from your care at their office. The dental board of australias guidelines for dental records section 3 helpfully lists all information to be recordedbut while they may seem clear cut they are not prescriptive in many areas which may lead to practitioners inadvertently leaving themselves exposed.

When transferring information to another dental office we only send current x rays bitewing x rays full mouth x rays panorex within the last 5 yrs and treatment dates for prophys cleanings exams scale root planning. You will typically ask them to send the records directly to you or to another dentist. Use this form when disclosing certain dental records with the patients consent.