Dental Release Of Information Form

Dental Release Of Information Form Template for England and Wales

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Key Requirements PROMPT example:

"I need a Dental Release of Information Form to authorize the transfer of my complete dental records from London Bridge Dental Practice to my new dentist in Manchester, ensuring all X-rays and treatment history from the past five years are included."

Document background

The Dental Release of Information Form is essential for managing patient data privacy and consent in dental practices across England and Wales. This document is required whenever dental records need to be shared with third parties, whether for continuing care, insurance purposes, or legal proceedings. The form ensures compliance with UK data protection laws and healthcare regulations while protecting patient confidentiality. It includes specific details about what information can be released, to whom, and for what purpose, serving as a crucial record of patient consent and authorization.

Suggested Sections

1. Patient Information: Basic identifying information including name, date of birth, contact details

2. Request Details: Specific information being requested and purpose of the request

3. Consent Declaration: Express consent for information release and period of validity

4. Recipients Information: Details of who will receive the information

5. Data Protection Notice: Statement about how information will be used and protected

Optional Sections

1. Third Party Authorization: Used when someone other than the patient is authorizing release, applicable when legal representative or guardian is acting on patient's behalf

2. Specific Exclusions: Information patient wishes to exclude from release, used when patient wants to restrict certain information

3. Emergency Contact: Alternative contact details, included when requested by receiving party or for urgent matters

Suggested Schedules

1. Identity Verification Documents: Copies of required ID documentation

2. Proof of Authority: Documentation proving authority to act on patient's behalf, if applicable

3. Specific Records Request List: Detailed list of specific records being requested

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok��˰� | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

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Let's create your Dental Release Of Information Form

Authors

Alex Denne

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