Dental Records Release Form
Access a free Dental Records Release Form for your practice. Streamline your clinical documentation with this template and example.
Fact Checked by Ericka Pingol.
What is a Dental Records Release Form?
A Dental Records Release Form is a critical document that facilitates the secure and lawful exchange of patient dental health information between medical practitioners or facilities.
This form is necessary when a patient decides to switch dentists, requires a specialist’s opinion, or needs to consolidate their dental history. Using a well-crafted records release form ensures compliance with health information privacy regulations. It provides explicit, documented consent from the patient for the transfer of their sensitive dental records. It is an explicit authorization to secure the patient's protected health information and the dental practice's liability.
Moreover, a Dental Records Release Form is also used in emergencies when patients cannot communicate their dental history and treatment information. This form allows authorized individuals or healthcare providers to access the necessary information quickly and efficiently, ensuring the best quality of care for the patient.
Printable Dental Records Release Form
Download this Dental Records Release Form to facilitate the secure and lawful exchange of patient dental health information between medical practitioners or facilities.
What details are in a Dental Records Release Form?
A standard Dental Records Release Form includes the following:
- Patient's name, date of birth, and contact information
- The name and address of the current dental practice or healthcare facility holding the records
- The name and address of the new dental practice or healthcare facility that will receive the records
- Date of transfer/release of records
- A clear statement authorizing the release of dental records to the specified recipient
- Details about the specific information to be released, such as dental history, treatment reports, X-rays, and lab results
- A statement acknowledging that the patient understands and consents to the release of their records
- Signature of the patient or their legal guardian
- Signature of a witness or a healthcare provider who can attest to the patient's consent
How to use this Dental Records Release Form
Carepatron has created a simple Dental Records Release Form template to streamline your documentation process. Follow these steps to get started:
Step 1: Download the form
Get a copy of the Dental Records Release Form using the link on this page. You may also download it from the Carepatron app or our resources library.
Step 2: Print or use the digital version
You can print the form and fill it out by hand or use the digital version to enter the information directly.
Step 3: Fill out the form
Provide all required information on the form, including patient details, current and new dental practice information, and specific records to be released.
Step 4: Sign and date the form
The patient or their legal guardian must sign and date the form to authorize the release of their records. A witness or healthcare provider must also sign to verify the patient's consent.
Step 5: Send the form
Submit the completed form to your current dental practice or healthcare facility, ideally during regular business hours. They will process the request and transfer the requested records to the specified recipient.
Dental Records Release Form example (sample)
We've created a sample Dental Records Release Form to showcase how to use the template for your convenience. This sample is for educational purposes only and should not be used for official purposes.
Download this free Dental Records Release Form example here:
When are these release forms used?
You can use Dental Record Release Forms in various situations, such as:
When a patient is transferring from one dental practice to another
Patients may need to transfer their dental records when they move to a new location or change dental providers. The release form allows for the smooth transfer of these records without delay.
When a patient is seeking a second opinion
If a patient wants a second opinion about their oral health, they may need to authorize the release of their records from their current dental practice to the new one.
When a patient is undergoing specialized treatment
In cases where a patient receives specialized dental treatment or seeks care from a specialist, their records may need to be transferred between different healthcare providers for continuity of care.
When requested by insurance companies or legal authorities
Insurance companies or legal authorities may require access to a patient's dental records for billing purposes or in case of a legal dispute. In such cases, the patient must complete a dental records release form.
When a patient is changing jobs or insurance providers
If an individual changes their job or insurance provider, they may need to transfer their dental records to their new employer or insurer. The release form makes this process more efficient and convenient.
Why use Carepatron as your dental software?
Experience the future of dental practice management with Carepatron. Streamline your workflow, enhance patient engagement, and ensure your practice thrives in a digital age.
Our practice management software is designed with the latest technology, making it easy to use and accessible on any device:
- Efficient appointment management: With Carepatron, you can easily schedule and manage patient appointments. The software offers a user-friendly interface that allows you to view, edit, or cancel appointments with just a few clicks.
- Automated billing and invoicing: No more manual invoicing or billing errors. Carepatron automates the billing process, ensuring accurate and timely patient invoices.
- Easy clinical documentation: Carepatron offers customizable templates for clinical notes, treatment plans, and consent forms. Say goodbye to paper-based records and hello to a more efficient and organized documentation process.
- Integrated electronic health records (EHR): Our software seamlessly integrates with EHR systems, allowing you to access patient health records in one place. This integration eliminates the need for multiple logins and improves patient care by providing a comprehensive view of their health history.
Make the switch to Carepatron and enjoy the future of dental practice management.
Sign up today to get started!
Commonly asked questions
A Dental Release Form, a consent form, is a legal document that a patient must sign before receiving dental treatment. This form outlines the details of the procedure and ensures that the patient is informed about the risks, benefits, and alternatives before proceeding.
Consent forms are crucial for dental practices because they record that patients have been informed and consented to the treatment. It is a critical part of patient care and legal compliance, helping to protect both the patient and the practice.
In certain circumstances, a patient's representative, such as a parent, legal guardian, or holder of a medical power of attorney, can sign a Dental Release Form on behalf of the patient. This is common if the patient is a minor, incapacitated, or otherwise unable to provide informed consent by themselves.
