Dental Records Release Form Template for Singapore

Create a bespoke document in minutes, or upload and review your own.

4.6 / 5

4.8 / 5

Let's create your Dental Records Release Form

1. Select your governing law and document type:

2. Enter your key requirements:

3. Create your document to edit, review or download

Get your first 2 documents free

Your data doesn't train Genie's AI

You keep IP ownership of your information

Key Requirements PROMPT example:

Dental Records Release Form

"I need a Dental Records Release Form to transfer my complete dental history from Singapore Smile Clinic to Dr. Lee's Dental Practice in preparation for my orthodontic treatment starting March 2025, including all X-rays and treatment notes from the past five years."

Document background

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.

Suggested Sections

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

Optional Sections

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

Suggested Schedules

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

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

Authorized Representative
Consent
Dental Practice
Dental Records
Disclosure
Healthcare Provider
Patient
Personal Data
Protected Health Information
Recipient
Release Authorization
Treatment Records
Valid Period

Clauses

Authorization and Consent
Confidentiality
Data Protection
Duration and Expiry
Fees and Charges
Governing Law
Information to be Released
Patient Rights
Purpose of Disclosure
Recipient Details
Revocation Rights
Third Party Access
Use Limitations
Verification and Authentication

Relevant Industries

Healthcare
Insurance
Legal

Relevant Teams

Medical Records
Administration
Compliance
Legal
Operations

Relevant Roles

Dentist
Dental Practice Manager
Dental Administrator
Compliance Officer
Medical Records Officer

How a Sales & Marketing Lead uses Genie AI to reduce contract drafting time by 95%

Let's create your Dental Records Release Form

Authors

Alex Denne

Find the exact document you need

To Whom It May Concern Authorization Letter

Salary Deduction Form

Parental Consent Letter For Visa Application

Medical Consent Form For Minors

Consent To Disclosure Of Information

Consent Authorization

Authorization Letter To Get Diploma

Authorization Letter To Claim Parcel

Authorization Letter To Claim ATM Card

Authorization Letter To Claim Allowance

Authorization Letter For Visa Collection

Authorization Letter For Legal Purposes

Authorization Letter For Deed Of Sale

Authorization Letter For Cheque

Authorization Letter Credit Card

ACH Payment Form

Consent To Disclose Personal Information

Board Resolution For Authorisation To Represent The Company

Authorisation Letter For Vehicle

Authorisation Letter For Bank

Passport Delivery Authorization Letter

Authorization Letter With Attached ID

Authorization Letter To Process Business Permit

Authorization Letter For Visa Application

Authorization Letter To Sign Agreement On Behalf Of Company

Authorization Letter To Deposit Check

Direct Debit Authorisation Form

Letter To Bank For Change In Authorised Signatory

Authorization For Disclosure Of Information Form

Client Authorisation Form

Collection Authorisation Form

Authorization Letter For Salary

Authorized Representative Verification Letter

Automatic Deposit Form

Authorization For Release Of Information Form

Third Party Authorization Letter

Bank Consent Letter

Authorization Letter For Proof Of Address

Authorization Letter For Payment

Authorization Letter For Check Encashment

Authorization Letter For Getting Money

Authorization Letter For Electric Connection

Authorization Letter For Diploma

Authorization Letter For Affidavit Of Loss

Board Resolution For General Authorisation

Third Party Credit Card Authorization Form

Third Party Authorization Form

Permission Release And Consent Form

Payroll Deduction Form

Tenant Authorization Letter

Payroll Deduction Authorization Form

Signature Authorization Form

Payroll Authorization Form

Return Merchandise Authorization Form

Return Authorization Form

Release Of Authorization Form

Payment Authorization Form

Passport Authorization Form

Recurring ACH Payment Authorization Form

Proxy Letter For Authorization

Property Authorization Letter

Preauthorized Debit Form

Parental Authorization Form

Owner Authorization Form

Overtime Authorization Form

Non Borrower Credit Authorization Form

Minor Authorization Form

Medical Release Form For Minor

Medical Release Form For Adults

Credit Check Consent Form

Credit Card Payment Authorization Form

Credit Card Information Form

Credit Card Authorization Letter For Air Ticket Booking

Credit Card Authorization Form

Credit Bureau Consent Form