The Dental Records Release Form is a critical document used in Singapore's healthcare system to facilitate the secure and compliant transfer of dental records between healthcare providers or to authorized third parties. This form is necessary when patients need to share their dental history for continued treatment, insurance claims, legal proceedings, or other legitimate purposes. It ensures compliance with Singapore's PDPA, the Private Hospitals and Medical Clinics Act, and Singapore Dental Council guidelines. The form includes detailed patient information, specific consent clauses, and clear documentation of what records are being released and to whom.
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1. Patient Information: Patient's full name, NRIC/passport number, contact details, and date of birth
2. Authorization Statement: Explicit consent statement for the release of dental records, including PDPA compliance declaration
3. Records Description: Detailed description of dental records being authorized for release (e.g., x-rays, treatment history, prescriptions)
4. Recipient Information: Details of the person or entity authorized to receive the records, including contact information
5. Duration and Scope: Validity period of the authorization and scope of information to be released
6. Rights and Declarations: Statement of patient rights and acknowledgment of understanding
1. Third Party Authorization: Required when someone other than the patient is authorizing the release (e.g., parent, guardian, power of attorney)
2. Special Instructions: Any specific handling or delivery instructions for the records
3. Urgency Declaration: Section to indicate if records are needed urgently for ongoing treatment
4. Mental Capacity Declaration: Required when dealing with patients who may lack mental capacity to provide consent
1. Schedule A - Identification Documents: Copies of required identification documents (NRIC/passport)
2. Schedule B - Legal Authorization Documents: Additional legal documents such as power of attorney, court orders, or proof of guardianship where applicable
3. Schedule C - List of Requested Records: Detailed itemization of specific dental records being requested
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