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Printable Dental Release Form
"I need a Printable Dental Release Form for my private dental practice in Cardiff that includes comprehensive GDPR compliance language and allows for the release of both digital and physical records to specialist referral clinics."
1. Patient Information: Full name, contact details, date of birth, and other identifying information of the patient
2. Dental Practice Information: Practice details, treating dentist information, and registration numbers
3. Treatment Details: Description of procedure(s) performed or to be performed
4. Release Statement: Core release language and scope of the release, including liability limitations
5. Data Protection Notice: Information about how personal and medical data will be processed and stored
6. Signatures: Patient and witness signatures, dates, and confirmation of understanding
1. Guardian Information: Required for minors or those lacking capacity - includes guardian details and authority
2. Medical History: Relevant when release relates to specific conditions or treatments
3. Photography Consent: Additional consent for taking and using dental photographs or imaging
4. NHS Treatment Declaration: Required when treatment is provided under NHS arrangements
1. Treatment Records: Copies of relevant dental records and treatment plans
2. Imaging Records: Related X-rays or dental imaging documentation
3. Patient Information Leaflets: Standard aftercare instructions and patient guidance materials
Authors
Patient
Treatment
Dental Records
Release
Consent
Personal Data
Medical Information
Treatment Date
Treating Dentist
Legal Guardian
Witness
Clinical Images
X-rays
Treatment Plan
Confidential Information
Healthcare Provider
Third Party Recipients
Medical History
Authorised Representative
Practice Premises
Treatment Summary
GDC Standards
NHS Services
Private Treatment
Consent
Release Authorization
Data Protection
Confidentiality
Record Transfer
Treatment Description
Medical History
Liability
Information Disclosure
Third Party Access
Record Retention
Patient Rights
Practice Obligations
Emergency Contact
Photography Consent
Information Accuracy
Witness Requirements
Governing Law
Revocation Rights
Record Usage
Duration of Authorization
Indemnification
Signature Requirements
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