Release Of Liability Form For Dental Treatment Template for Philippines

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Key Requirements PROMPT example:

Release Of Liability Form For Dental Treatment

"I need a Release of Liability Form for Dental Treatment for my new dental clinic in Manila, specifically covering cosmetic dental procedures like veneers and teeth whitening, with extra emphasis on potential allergic reactions and aesthetic expectations."

Document background

The Release Of Liability Form For Dental Treatment is an essential document for dental practices operating in the Philippines, designed to protect both healthcare providers and patients during dental procedures. This document becomes necessary before performing any significant dental treatment, particularly those involving risks or complex procedures. It serves multiple purposes: documenting informed consent, explaining treatment risks and benefits, establishing liability limitations, and ensuring compliance with Philippine healthcare regulations including the Dental Act of 2007 and DOH guidelines. The form should be used prior to beginning any dental treatment where there are potential risks or complications, and it must be properly executed with all required signatures and witness attestations to be legally valid under Philippine law.

Suggested Sections

1. Parties: Identification of the dental practice/dentist and the patient (including contact details and professional license numbers where applicable)

2. Background: Brief context explaining the purpose of the document and the proposed dental treatment

3. Definitions: Clear explanations of technical terms, medical procedures, and legal terminology used in the document

4. Treatment Description: Detailed description of the proposed dental procedure(s) and expected outcomes

5. Risks and Complications: Comprehensive list of potential risks, side effects, and complications associated with the treatment

6. Patient Acknowledgments: Patient's confirmation of understanding the risks, receiving adequate information, and voluntary consent to proceed

7. Release of Liability: Specific terms of the liability release, including scope and limitations

8. Emergency Authorization: Authorization for emergency medical care if needed during treatment

9. Governing Law: Specification that the agreement is governed by Philippine law

10. Execution: Signature blocks for all parties, including witness signatures and date

Optional Sections

1. Medical History Declaration: Section for patient to declare relevant medical history and conditions - used when the practice doesn't have a separate medical history form

2. Photography Consent: Authorization for taking and using dental photographs - included when before/after documentation is needed

3. Insurance and Payment: Details about insurance coverage and payment terms - included when treatment involves significant costs or insurance claims

4. Cancellation Policy: Terms regarding appointment cancellation and associated fees - used in private practices with specific scheduling policies

5. Alternative Treatments: Description of alternative treatment options - included for complex procedures where multiple treatment options exist

6. Language Confirmation: Confirmation that the patient understands the language used - included when serving diverse populations

Suggested Schedules

1. Schedule A - Detailed Treatment Plan: Specific details of the proposed treatment, including procedures, materials, and timeframes

2. Schedule B - Fee Schedule: Breakdown of treatment costs and payment terms if applicable

3. Appendix 1 - Pre-Treatment Instructions: Specific instructions for patient preparation before the procedure

4. Appendix 2 - Post-Treatment Care: Detailed post-procedure care instructions and emergency contact information

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

Clauses

Relevant Industries

Healthcare

Dental Services

Medical Services

Professional Services

Legal Services

Relevant Teams

Legal

Compliance

Risk Management

Patient Relations

Medical Records

Administration

Clinical Operations

Front Desk

Quality Assurance

Relevant Roles

Dentist

Dental Surgeon

Orthodontist

Dental Practice Manager

Healthcare Administrator

Legal Counsel

Compliance Officer

Risk Management Officer

Patient Relations Manager

Dental Assistant

Dental Hygienist

Medical Records Officer

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