The Dental Medical Release Form Template is a crucial document used in Australian dental practices to gather comprehensive patient information and obtain informed consent for dental treatments. This document is necessary whenever a new patient begins treatment or when significant updates to existing patient records are required. It encompasses detailed medical history, current medications, allergies, and specific consent for dental procedures, ensuring compliance with Australian healthcare regulations including the Privacy Act 1988, Health Practitioner Regulation National Law Act 2009, and state-specific dental practice requirements. The form serves multiple purposes: risk assessment, legal protection, patient information collection, and treatment authorization, making it an essential tool for dental practices in maintaining proper patient records and meeting regulatory obligations.
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1. Patient Information: Basic personal details including full name, date of birth, contact information, and Medicare number
2. Emergency Contact Details: Name, relationship, and contact information for primary and secondary emergency contacts
3. Medical History: Comprehensive section covering current medications, allergies, chronic conditions, and previous surgeries
4. Dental History: Previous dental procedures, current concerns, and last dental visit details
5. Consent Declaration: Standard consent for dental examination, treatment, and procedures
6. Privacy Statement: Declaration regarding the collection, use, and protection of personal and medical information in accordance with the Privacy Act 1988
7. Financial Responsibility: Acknowledgment of financial obligations and payment terms
8. Signature Block: Space for patient/guardian signature, date, and witness signature if required
1. Insurance Information: Details of private health insurance coverage, to be included if the practice processes insurance claims
2. COVID-19 Screening: Additional health screening questions related to COVID-19, to be included during pandemic conditions
3. Interpreter Declaration: To be included when the patient requires an interpreter, including certification of accurate translation
4. Clinical Photography Consent: Optional consent for taking and using clinical photographs for treatment planning or educational purposes
5. Medicare Consent: Additional section for practices that bulk bill or process Medicare claims
6. Guardian Authorization: Required when the patient is a minor or lacks capacity to provide consent
1. Medical Conditions Checklist: Detailed checklist of common medical conditions for patient reference and completion
2. Medications List: Template for listing current medications, dosages, and frequencies
3. Dental Practice Policies: Summary of practice policies including cancellation policy and payment terms
4. Privacy Policy Summary: Detailed explanation of how patient information is handled and protected
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Dental Services
Medical Services
Allied Health
Health Insurance
Medical Administration
Relevant Teams
Administration
Clinical Operations
Patient Services
Legal & Compliance
Risk Management
Medical Records
Front Office
Practice Management
Relevant Roles
Dentist
Dental Hygienist
Dental Assistant
Practice Manager
Dental Receptionist
Healthcare Administrator
Compliance Officer
Legal Counsel
Risk Manager
Patient Services Coordinator
Medical Records Officer
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