Dental Records Request Form Template for England and Wales

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Key Requirements PROMPT example:

Dental Records Request Form

"I need a Dental Records Request Form for my practice in Cardiff that complies with NHS Wales guidelines and includes specific sections for radiograph requests and third-party authorization, to be implemented by March 2025."

Document background

The Dental Records Request Form is designed to streamline the process of accessing dental records while ensuring compliance with UK data protection regulations. This document is essential when patients need copies of their dental records for various purposes, including continuing care, insurance claims, or legal proceedings. The form includes necessary fields for patient identification, specific record requests, and proper authorization, adhering to the requirements set forth by the UK GDPR and Data Protection Act 2018. It serves as a standardized method for dental practices in England and Wales to process record requests efficiently while maintaining patient privacy and regulatory compliance.

Suggested Sections

1. Patient Information: Full name, date of birth, contact details, NHS number (if applicable)

2. Request Details: Specific records requested, date range, format preference

3. Identity Verification: Requirements for proof of identity

4. Authorization: Patient signature and date, or authority to act on patient's behalf

5. Practice Details: Dental practice information and contact details

Optional Sections

1. Third Party Authorization: Used when someone other than patient requests records

2. Deceased Patient Section: Used for requests regarding deceased patients

3. Fee Information: If applicable, details of any charges

Suggested Schedules

1. Identity Verification Checklist: List of acceptable ID documents

2. Privacy Notice: Information about how the request data will be processed

3. Third Party Authorization Form: Additional form for third party requests

Authors

Alex Denne

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

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Healthcare
Medical Administration
Insurance
Legal Services

Relevant Teams

Administration
Medical Records
Compliance
Legal
Reception

Relevant Roles

Dental Practice Manager
Dentist
Dental Administrator
Compliance Officer
Medical Records Coordinator

How Genie AI reduced drafting time by 75% for a legal firm

Let's create your Dental Records Request Form

Authors

Alex Denne

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