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Orthodontic Records Release Form
"I need an Orthodontic Records Release Form for transferring my daughter's complete treatment records from London Smile Clinic to her new orthodontist in Manchester, with specific provisions for x-rays and 3D scans taken in January 2025."
1. Patient Information: Basic details including name, date of birth, contact information
2. Records Requested: Specific types of records being requested (x-rays, photographs, treatment plans, etc.)
3. Purpose of Release: Stated purpose for requesting records
4. Authorization Statement: Legal statement authorizing release of records
5. Data Protection Notice: Statement regarding handling of personal data under GDPR
1. Third Party Authorization: Used when records are to be released to someone other than the patient
2. Urgent Request Declaration: Used when records are needed urgently for ongoing treatment
3. Parent/Guardian Authorization: Required for patients under 18 or lacking capacity
1. Record Inventory: Detailed list of specific records being released
2. Fee Schedule: If applicable, costs associated with record copying and release
3. Identity Verification Documents: Copies of ID documents used to verify patient identity
Authors
Provider
Orthodontic Records
Authorized Representative
Treatment Records
Clinical Photographs
Radiographs
Study Models
Treatment Plan
Clinical Notes
Personal Data
Special Category Data
Data Controller
Data Processor
Release Authorization
Transfer Request
Consent
Third Party Recipient
Healthcare Provider
Practice
Medical Records
Record Transfer
Urgent Request
Identity Verification
Professional Standards
Confidential Information
Data Protection Legislation
Processing Fee
Working Days
Valid Request
Data Protection
Confidentiality
Records Identification
Release Terms
Transfer Method
Processing Time
Fees and Charges
Identity Verification
Third Party Authorization
Consent
Liability
Purpose Declaration
Patient Rights
Record Accuracy
Timeframe
Security Measures
Emergency Provisions
Professional Standards
Record Format
Delivery Method
Retention Period
Revocation Rights
Verification Requirements
Governing Law
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