Dental Records Release Form (HIPAA)

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A dental records release form is a document that authorizes a health care provider to use or disclose a patient’s dental records. The form contains details like the types of records allowed for release, how the patient’s information can be used, and when the authorization expires.

Dental Records Release Form (HIPAA)

A dental records release form is a document that authorizes a health care provider to use or disclose a patient’s dental records. The form contains details like the types of records allowed for release, how the patient’s information can be used, and when the authorization expires.

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Last updated April 4th, 2024

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A dental records release form is a document that authorizes a health care provider to use or disclose a patient’s dental records. The form contains details like the types of records allowed for release, how the patient’s information can be used, and when the authorization expires.

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How a Dental Records Release Works

Before a dental office can share or use private medical records, patients must complete a release form to grant them permission. The form will outline the following:

  • The specific dental records the patient wants to be shared or used
  • The purpose of the disclosure
  • The names of the individuals or entities allowed to share or use the records
  • The names of the individuals or entities allowed to receive the records
  • When the authorization expires
  • The patient’s rights under HIPAA

Once the patient completes and signs the release form, the dental office can release the records according to the written instructions provided.