The Dental Photo Consent Form is a critical document used in New Zealand dental practices to obtain informed consent for taking and using patient photographs. This document becomes necessary whenever dental practitioners need to take photographs for treatment planning, documentation, education, or research purposes. The form ensures compliance with New Zealand's Privacy Act 2020, Health Information Privacy Code 2020, and relevant healthcare regulations. It outlines the specific types of photographs to be taken, their intended uses, storage methods, and the patient's rights regarding their images. The document includes provisions for both adult patients and minors requiring guardian consent, and can be adapted for various purposes including clinical documentation, teaching, research, or marketing with appropriate optional clauses.
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1. Patient Information: Patient's full name, date of birth, contact details, and patient ID number
2. Purpose of Photography: Clear explanation of why dental photographs are being taken (e.g., treatment planning, documentation, education)
3. Types of Photographs: Description of what types of photographs will be taken (e.g., intraoral, extraoral, full face, profile)
4. Usage and Disclosure: Detailed explanation of how the photographs will be used, stored, and potentially shared
5. Duration of Consent: How long the consent remains valid and circumstances under which it might expire
6. Patient Rights: Statement of patient's rights including right to withdraw consent and request deletion of photos
7. Declaration: Formal consent statement and signature blocks for patient/guardian and dental professional
1. Educational Use Consent: Additional section when photos might be used for teaching or educational purposes
2. Marketing Use Consent: Optional section for when photos might be used in marketing materials or social media
3. Research Use Consent: When photographs might be used for research purposes
4. Guardian Details: Required when the patient is a minor or lacks capacity to consent
5. Interpreter Declaration: Required when an interpreter is used to explain the consent
6. Cultural Considerations: Specific considerations for handling images in accordance with cultural preferences
1. Photo Types Schedule: Detailed list of specific types of photographs that will be taken with technical descriptions
2. Privacy Policy Summary: Summary of the practice's privacy policy relating to image storage and handling
3. Patient Rights Information: Detailed information about patient rights under NZ privacy and health legislation
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Dental Services
Medical Imaging
Healthcare Education
Medical Research
Professional Services
Insurance
Relevant Teams
Clinical Operations
Administration
Legal & Compliance
Patient Records
Photography & Imaging
Education & Training
Research & Development
Quality Assurance
Data Protection
Customer Service
Relevant Roles
Dentist
Dental Surgeon
Orthodontist
Dental Hygienist
Dental Practice Manager
Dental Assistant
Clinical Photographer
Healthcare Administrator
Privacy Officer
Legal Compliance Officer
Dental Educator
Research Coordinator
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