The Dental Records Release Form is a critical document used in Malaysian healthcare settings when patient dental records need to be transferred between parties. This form becomes necessary when patients require their records for secondary opinions, insurance claims, legal proceedings, or transfers to new dental providers. The document must comply with Malaysia's Personal Data Protection Act 2010, the Dental Act 2018, and other relevant healthcare regulations. It includes specific provisions for patient identification, record specifications, intended use, and authorization details. The form serves as both a legal protection for dental practices and a standardized method for handling sensitive patient information transfers.
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1. Patient Information: Complete identifying information of the patient including full name, IC/passport number, date of birth, and contact details
2. Requesting Party Information: Details of the person/entity requesting the records, including name, relationship to patient (if applicable), and contact information
3. Records Description: Specific description of dental records being requested (e.g., x-rays, treatment history, billing records)
4. Purpose of Release: Clear statement of the purpose for which the records are being requested and how they will be used
5. Authorization Statement: Explicit authorization from the patient permitting the release of specified dental records
6. Duration of Authorization: Specification of how long the authorization remains valid
7. Privacy Notice: Statement regarding how the information will be protected and used in accordance with PDPA 2010
8. Signatures: Space for patient (or legal representative) signature, date, and witness signature if required
1. Legal Representative Authorization: Additional section when records are requested by someone other than the patient, including proof of authority to act on patient's behalf
2. Fee Schedule: Section detailing any applicable fees for record copying and transmission, if charges apply
3. Emergency Release: Special provisions for emergency situations requiring expedited release of records
4. Prohibition of Re-disclosure: Additional terms prohibiting the receiving party from sharing the records with other parties
1. Schedule A - Record Itemization: Detailed list of specific records being requested with dates and types
2. Schedule B - Fee Structure: Breakdown of applicable fees for different types of records and delivery methods
3. Appendix 1 - Identification Documents: Copies of required identification documents for verification purposes
4. Appendix 2 - Legal Authority Documentation: Where applicable, documents proving legal authority to request records (power of attorney, court order, etc.)
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Dental Services
Insurance
Legal Services
Healthcare Technology
Medical Records Management
Regulatory Compliance
Healthcare Administration
Relevant Teams
Legal
Compliance
Medical Records
Administration
Patient Services
Quality Assurance
Risk Management
Documentation
Front Office
Clinical Operations
Relevant Roles
Dentist
Dental Practice Manager
Healthcare Administrator
Compliance Officer
Medical Records Officer
Legal Counsel
Privacy Officer
Insurance Claims Processor
Healthcare Documentation Specialist
Dental Assistant
Practice Administrator
Quality Assurance Manager
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