I request and authorize the above-named doctor or health care provider to release the information specified below to the organization, agency or individual named on this request. I understand that the information to be released includes information regarding the following condition(s):

It’s a good idea to have patients sign a consent form giving you permission to release their records to another healthcare provider and to keep that document as part of the patient’s dental record.

Oct 30, 2024 · A Dental Records Release Form is a critical document that facilitates the secure and lawful exchange of patient records, specifically dental health information, between medical practitioners or facilities.

You have a right to an accounting of the disclosures of your protected dental information by provider or its business associates. The maximum disclosure accounting period is the six years immediately preceding the accounting request.

The Dental Medical Release Form serves as a legal authorization for patients to permit their dental providers to access and share medical records. This form is crucial in ensuring that healthcare providers can obtain necessary information to deliver effective treatment.

Information relating to the dental services provided to me including but not limited to date of service, type of service, treatment chart, x-rays, dentists’ notes, electronic documents available on the website or other information as listed below