File name: Printable Dental Records Release Form Pdf
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👉Printable Dental Records Release Form Pdf
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When transferring information to another dental office we only send current x-rays (bitewing x-rays, full mouth x-rays and panorex) within the last 5 years and treatment dates for prophy’s . Edit On Any Device · Trusted By Millions · Online Customers Support · Paperless SolutionsTypes: Affidavits, Bills of Sale, Contracts, LLC Formation, Real Estate. When transferring information to another dental office we only send current x-rays (bitewing x-rays, full mouth x-rays & panorex) To send just this basic information described above please . How to use this Dental Records Release Form. Carepatron has created a simple Dental Records Release Form template to streamline your documentation process. It's one of the many consent forms we have and follows the Health Insurance Portability and Accountability Act (HIPAA) mandates. Follow these steps to get started: Step 1: Download the form. DENTAL RECORDS RELEASE FORM Author: Cohen and Drescher Created Date: 5/23/ AM. RELEASE TO:_____ I request and authorize the above-named doctor or health care provider to release the information specified below to the organization, agency or individual named on this request. I understand that the information to be released includes information regarding the following condition(s). Get a copy of the printable Dental Records Release Form using the link on this page. You may also download it from the Carepatron app or our resources library. You can print the form and fill it out by hand or use the digital version to enter the information directly. DENTAL RECORDS RELEASE / AUTHORIZATION FORM PATIENT INFORMATION: Name (please print): Date of Birth: Address: Phone: E-Mail: The above-named Patient authorizes (Name of Practice) to send or transfer records as follows. When transferring information to another dental office we only send current x-rays (bitewing x-rays, full mouth x-rays & panorex) To send just this basic information described above please check here.