The Dental Records Release Form is a critical document used in German dental practices to facilitate the legal and compliant transfer of patient dental records. This document becomes necessary when patients need their records transferred to other healthcare providers, require copies for insurance purposes, or need to share their dental history for various authorized purposes. It ensures compliance with the General Data Protection Regulation (GDPR), the German Federal Data Protection Act (BDSG), and specific healthcare regulations governing dental practices in Germany. The form includes comprehensive patient identification, explicit consent mechanisms, and clear specifications about the scope of records to be released, while protecting patient privacy rights and maintaining professional standards in accordance with German dental practice regulations.
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1. Patient Information: Essential patient identification details including full name, date of birth, address, and contact information
2. Dental Practice Information: Details of the releasing dental practice, including practice name, dentist's name, address, and contact information
3. Records to be Released: Specific description of dental records being requested for release, including time period covered
4. Purpose of Release: Statement of the intended purpose for the release of dental records
5. Recipient Information: Details of the person or entity to whom the records will be released
6. Authorization Statement: Legal statement confirming patient's authorization for release of records
7. Duration of Authorization: Specification of how long the authorization remains valid
8. Rights Statement: Information about patient's rights regarding the release, including right to revoke authorization
1. Minor Patient Section: Additional section for cases involving patients under 18, requiring parent/guardian authorization
2. Legal Representative Authorization: Section for cases where someone other than the patient is legally authorized to request records
3. Emergency Release: Expedited release authorization for emergency medical situations
4. Electronic Transfer Consent: Specific authorization for electronic transmission of records, if applicable
5. Fee Agreement: Section detailing any applicable fees for record copying and transfer, if charging is intended
1. Types of Records Checklist: Detailed checklist of specific dental record types (X-rays, treatment plans, clinical notes, etc.)
2. Fee Schedule: If applicable, detailed breakdown of fees for different types of records and delivery methods
3. Identity Verification Documents: List of acceptable identification documents required for verification
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Dental Services
Medical Services
Insurance
Legal Services
Relevant Teams
Legal
Compliance
Medical Records
Patient Administration
Data Protection
Front Office
Insurance Coordination
Healthcare Administration
Relevant Roles
Dentist
Dental Practice Manager
Healthcare Administrator
Compliance Officer
Data Protection Officer
Medical Records Coordinator
Legal Counsel
Insurance Coordinator
Patient Relations Manager
Practice Administrator
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