The Early Removal Of Braces Consent Form is a critical document used in UAE dental practices when patients request to terminate their orthodontic treatment before the professionally recommended completion date. This document is essential for compliance with UAE Federal Law No. 4 of 2016 on Medical Liability and Dubai Health Authority (DHA) regulations governing dental practices. It serves multiple purposes: documenting the patient's informed decision, outlining potential risks and consequences of early removal, protecting both patient and provider rights, and establishing a clear record of the modified treatment plan. The form includes detailed patient information, current treatment status, reasons for early removal, risk acknowledgments, and necessary signatures, with additional provisions for minors or cases requiring interpretation services.
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1. Patient Information: Patient's full name, Emirates ID, date of birth, contact information, and medical record number
2. Treatment Provider Information: Orthodontist's name, medical license number, clinic details and contact information
3. Current Treatment Status: Description of current orthodontic treatment progress and recommended remaining treatment duration
4. Reason for Early Removal: Documentation of patient's stated reasons for requesting early removal of braces
5. Risks and Consequences: Detailed explanation of potential dental and orthodontic consequences of early braces removal
6. Treatment Outcomes: Clear statement that ideal treatment outcomes may not be achieved with early removal
7. Financial Implications: Statement regarding any financial implications, including forfeiture of remaining treatment fees
8. Patient Acknowledgment: Patient's confirmation of understanding all risks and voluntary decision to proceed
9. Signatures: Signature blocks for patient (or legal guardian), orthodontist, and witness
1. Guardian Consent: Required when patient is under 18 or legally incompetent - includes guardian's details and relationship to patient
2. Interpreter Declaration: Required when consent discussions are conducted through an interpreter - includes interpreter's details and confirmation of accurate translation
3. Treatment Transfer: Required when patient plans to continue treatment with another provider - includes process for records transfer
4. Medical Conditions: Required when early removal is related to specific medical conditions - includes details of relevant medical issues
1. Schedule A - Current Dental Records: Current photographs, X-rays, and treatment progress records
2. Schedule B - Projected Treatment Outcomes: Visual comparison of current status, projected outcome with early removal, and original treatment goal
3. Schedule C - Post-Removal Care Instructions: Detailed instructions for dental care after braces removal and retention requirements
4. Appendix 1 - Patient Education Materials: Educational materials about the importance of completing full orthodontic treatment
Relevant legal definitions
Orthodontic Treatment
Early Removal
Treatment Plan
Informed Consent
Healthcare Provider
Treating Orthodontist
Patient
Legal Guardian
Medical Records
Treatment Outcome
Retention Phase
Relapse
Dental Appliances
Fixed Orthodontic Appliances
Treatment Completion Date
Original Treatment Goals
Post-Treatment Care
Clinical Assessment
Witness
Emirates ID
Medical Liability
Dental Practice
Treatment Modification
Patient Records
Healthcare Facility
Early Removal
Treatment Plan
Informed Consent
Healthcare Provider
Treating Orthodontist
Patient
Legal Guardian
Medical Records
Treatment Outcome
Retention Phase
Relapse
Dental Appliances
Fixed Orthodontic Appliances
Treatment Completion Date
Original Treatment Goals
Post-Treatment Care
Clinical Assessment
Witness
Emirates ID
Medical Liability
Dental Practice
Treatment Modification
Patient Records
Healthcare Facility
Clauses
Patient Identification
Provider Identification
Medical Assessment
Risk Disclosure
Patient Acknowledgment
Treatment Modification
Financial Terms
Records and Documentation
Consent Declaration
Medical Liability
Patient Rights
Confidentiality
Treatment Termination
Post-Treatment Care
Witness Confirmation
Governing Law
Language Declaration
Execution
Provider Identification
Medical Assessment
Risk Disclosure
Patient Acknowledgment
Treatment Modification
Financial Terms
Records and Documentation
Consent Declaration
Medical Liability
Patient Rights
Confidentiality
Treatment Termination
Post-Treatment Care
Witness Confirmation
Governing Law
Language Declaration
Execution
Relevant Industries
Healthcare
Dental Services
Medical Services
Professional Services
Orthodontics
Relevant Teams
Legal
Medical Records
Patient Relations
Clinical Operations
Quality Assurance
Risk Management
Administration
Compliance
Front Office
Relevant Roles
Orthodontist
Dental Specialist
Clinic Manager
Healthcare Administrator
Medical Records Officer
Patient Relations Coordinator
Legal Compliance Officer
Quality Assurance Manager
Risk Management Officer
Practice Manager
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