Transfer Of Dental Records Form

Transfer Of Dental Records Form Template for England and Wales

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Key Requirements PROMPT example:

"I need a Transfer Of Dental Records Form to move my family's dental records from our current NHS practice in Manchester to our new private dentist in London, ensuring all x-rays and treatment histories from the past 5 years are included."

Document background

The Transfer Of Dental Records Form is essential when patients change dental providers in England and Wales. This document ensures the lawful and secure transfer of dental records, including treatment histories, x-rays, and clinical notes. It's designed to comply with UK GDPR, healthcare regulations, and professional standards set by the General Dental Council. The form serves as both authorization for transfer and documentation of the chain of custody, protecting patient rights and maintaining professional obligations in dental record management.

Suggested Sections

1. Patient Details: Full name, date of birth, contact information, and NHS number if applicable

2. Current Dentist Information: Details of the transferring dental practice including practice name, address, contact details, and dentist registration number

3. New Dentist Information: Details of the receiving dental practice including practice name, address, contact details, and dentist registration number

4. Records Description: Detailed list of records being transferred including treatment records, x-rays, and dates covered

5. Consent Declaration: Patient's explicit consent statement for the transfer of records, including GDPR compliance declaration

6. Signatures: Space for patient signature, date, and witness signature if required

Optional Sections

1. Third Party Authorization: Additional section for cases where records are requested by someone other than the patient (e.g., legal guardian or authorized representative)

2. NHS Treatment Declaration: Special declarations required for NHS patients regarding ongoing treatment and NHS obligations

3. Emergency Contact Information: Optional section for including emergency contact details during the transfer process

Suggested Schedules

1. Schedule A - X-Ray Transfer List: Detailed inventory of all radiographs being transferred, including dates and types

2. Schedule B - Treatment History Summary: Chronological summary of dental treatments, procedures, and medications

3. Schedule C - Identity Verification: Checklist and copies of ID documents used to verify patient identity

4. Schedule D - Data Protection Notice: Detailed information about how the patient's data will be handled during and after transfer

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

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Authors

Alex Denne

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