The Dental Records Release Form is a crucial document used in Irish dental practices and healthcare institutions to facilitate the legal and secure transfer of patient dental records. This form becomes necessary when patients require their records to be shared with other healthcare providers, need copies for personal use, or when records are requested by authorized third parties. The document ensures compliance with the General Data Protection Regulation (GDPR), the Irish Data Protection Act 2018, and the Dentists Act 1985. It includes specific provisions for patient identification, record specification, and authorization, while incorporating necessary data protection notices and patient rights information. The form serves as both a legal record of consent and a procedural guide for handling sensitive medical information.
Your data doesn't train Genie's AI
You keep IP ownership of your information
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
OR
Let Ƶ's market-leading legal AI identify missing terms, unusual language, compliance issues and more - in just seconds.
1. Patient Information: Full identification details of the patient including name, date of birth, address, and contact information
2. Requesting Party Information: Details of the person/entity requesting the records, if different from the patient
3. Dental Practice Information: Details of the dental practice holding the records, including registration numbers
4. Records Request Details: Specific description of which records are being requested (e.g., x-rays, treatment notes, etc.) and the time period covered
5. Purpose of Release: Statement of the intended use of the released records
6. Authorization Statement: Legal statement authorizing the release of records, including GDPR-compliant consent language
7. Duration of Authorization: Timeframe for which the authorization is valid
8. Patient Rights Notice: Statement of patient's rights regarding their records and data protection
9. Signature Block: Space for patient (or authorized representative) signature, date, and witness if required
1. Emergency Release Authorization: Additional terms for urgent release of records in emergency situations
2. Minor Patient Section: Additional section when the patient is under 18, requiring parent/guardian authorization
3. Third Party Authorization: Additional section when records are being released to someone other than the patient or another healthcare provider
4. Digital Records Format: Specific section for requesting digital format records and delivery method
5. Fee Schedule: Section detailing any applicable fees for record copying and transfer
6. Special Instructions: Section for any special handling or delivery instructions
1. Schedule A - Record Details: Detailed list of specific dental records being requested
2. Schedule B - Transfer Method: Specifications for how the records will be transferred, including security measures
3. Schedule C - Fee Structure: Detailed breakdown of any applicable fees
4. Appendix 1 - Identification Requirements: List of acceptable forms of ID for verification
5. Appendix 2 - Patient Rights: Detailed explanation of patient rights under GDPR and Irish law
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Dental Services
Medical Services
Insurance
Legal Services
Healthcare Technology
Records Management
Relevant Teams
Legal
Compliance
Medical Records
Patient Services
Operations
Administration
Data Protection
Quality Assurance
Clinical Operations
Relevant Roles
Dentist
Dental Practice Manager
Healthcare Administrator
Compliance Officer
Medical Records Manager
Data Protection Officer
Legal Counsel
Practice Administrator
Healthcare Operations Manager
Quality Assurance Manager
Patient Services Coordinator
Clinical Director
Find the exact document you need
Request For Authorization Letter
A formal document under Irish law requesting authorization or permission to act on behalf of another party or perform specific actions, subject to Irish legal requirements.
Download
Legal Authorization Letter
An Irish law-compliant document that formally delegates specific powers or authority from a grantor to an authorized representative.
Download
Authorisation Form
An Irish law-governed document that formally grants specific permissions or authority from one party to another, compliant with Irish legislative requirements.
Download
Direct Credit Authorisation Form
An Irish-law governed banking form that authorizes regular automated credit transfers to a designated bank account, compliant with SEPA regulations.
Download
Collection Authorisation Form
An Irish law-compliant authorization form for debt collection activities, incorporating GDPR and consumer protection requirements.
Download
Client Authorisation
An Irish law-governed authorization document establishing a client's formal grant of authority to a representative to act on their behalf.
Download
Authorization Letter For ATM Card
An Irish law-compliant authorization letter granting specific ATM card usage rights to a designated individual, subject to Irish banking regulations and EU directives.
Download
Authorisation Letter On Behalf
An Irish law-governed formal letter that authorizes a designated party to act on behalf of another, establishing clear parameters for delegated authority.
Download
Authorisation Letter For Vehicle
An Irish legal document granting authorization for a specified individual to operate a vehicle, meeting all relevant Irish regulatory requirements.
Download
Brand Authorisation Letter
An Irish law-governed letter authorizing specific usage of brand assets and intellectual property, setting out terms and conditions for brand utilization.
Download
Authorization Letter To Receive Parcel
An Irish law-compliant authorization letter enabling a designated person to collect a parcel on behalf of the intended recipient.
Download
Client Authorisation Form
An Irish-law governed authorization form establishing the scope of authority granted by a client to a service provider, including necessary regulatory compliance elements.
Download
Authorisation Letter For Passport Collection
An Irish law-governed authorization letter enabling a designated person to collect a passport from the Irish Passport Office on behalf of the applicant.
Download
Online Credit Card Authorization Form
An Irish law-compliant Online Credit Card Authorization Form for secure payment processing, meeting EU and local regulatory requirements.
Download
Eft Agreement
An Irish law-governed agreement establishing terms and conditions for electronic funds transfer services, compliant with EU and Irish financial regulations.
Download
Release Authorization
An Irish law-governed document that formally authorizes the release of specified information or assets, ensuring compliance with Irish legal requirements and GDPR.
Download
Authorization Letter To Pick Up Parcel
An Irish law-compliant authorization letter enabling a designated person to collect a parcel on behalf of the intended recipient.
Download
Authorization Letter To Use Credit Card
An Irish-compliant legal document authorizing a designated person or entity to use the cardholder's credit card under specified terms and conditions.
Download
Salary Deduction Form
An Irish law-compliant form authorizing employer deductions from employee wages with documented consent and GDPR compliance.
Download
Parental Consent Letter For Visa Application
An Irish-law governed consent letter from parents/guardians authorizing a minor's international travel and visa application, with notarized authentication.
Download
Consent To Disclosure Of Information
An Irish law-governed document for obtaining GDPR-compliant consent for personal information disclosure and processing.
Download
Authorization Letter For Motorcycle
An Irish-compliant legal document authorizing a designated individual to operate or manage a motorcycle on behalf of its owner.
Download
Authorization Letter For Cheque
An Irish-compliant formal document authorizing a designated person to handle or process a cheque on behalf of the account holder.
Download
Consent To Disclose Personal Information
An Irish law-compliant consent form for personal data disclosure and processing, aligned with GDPR and Irish Data Protection Act requirements.
Download
Letter Of Authorization For Utility Bill
An Irish-law governed authorization letter enabling a designated party to manage utility accounts and related matters on behalf of the account holder.
Download
Refund Authorization Letter
An Irish-compliant formal document authorizing the return of funds to a customer, including essential refund details and processing instructions.
Download
Authorization Letter To Process Electric Connection
An Irish legal document authorizing ESB Networks or designated parties to process electrical connection services at a specified property, compliant with CRU regulations.
Download
Authorization Letter With ID
An Irish-compliant authorization letter that includes identity verification elements, granting specific permissions from one party to another.
Download
Personal Authorization Letter
An Irish law-compliant document that formally delegates specific powers or permissions from one party to another, with clear scope and limitations.
Download
Authorization Letter To Withdraw Money On My Behalf
An Irish-law governed authorization letter granting specific authority to withdraw funds from the authorizer's bank account, subject to Irish banking regulations.
Download
Authorization Letter To Deposit Check
An Irish law-compliant authorization letter enabling a designated person to deposit a check on behalf of the check recipient.
Download
Authorised Signatory Letter
An Irish law-governed document that formally authorizes specific individuals to sign documents and enter into commitments on behalf of a company.
Download
Authorization Letter For Requesting Documents
An Irish law-compliant authorization letter that enables a designated party to request and collect specific documents on behalf of the authorizer.
Download
Consent Letter For International Passport
An Irish law-compliant consent letter authorizing the issuance of an international passport for a minor, submitted to the Irish Passport Office with required authentication.
Download
Permit Letter Of Authorization
An Irish law-compliant formal document granting specific permissions from one party to another to act on their behalf.
Download
Authorization For Release Of Medical Information
An Irish law-compliant authorization form for the release of medical information, incorporating GDPR and local data protection requirements.
Download
Landlord Authorization Letter
An Irish law-compliant authorization letter enabling a landlord to formally delegate specific property-related responsibilities to a designated representative.
Download
Consent Letter From Parent For International Passport
An Irish law-compliant parental consent letter required for obtaining a minor's international passport, including necessary declarations and authorizations.
Download
Travel Consent Form
An Irish legal document providing formal authorization for a minor's travel, ensuring compliance with child protection and immigration requirements.
Download
Authorization Letter For Residency
An Irish legal document authorizing an individual's residency at a specified address, commonly used for immigration and administrative purposes in Ireland.
Download
ұԾ’s Security Promise
Genie is the safest place to draft. Here’s how we prioritise your privacy and security.
Your documents are private:
We do not train on your data; ұԾ’s AI improves independently
All data stored on Genie is private to your organisation
Your documents are protected:
Your documents are protected by ultra-secure 256-bit encryption
We are ISO27001 certified, so your data is secure
Organizational security:
You retain IP ownership of your documents and their information
You have full control over your data and who gets to see it
.png)