FREE 11+ Sample Dental Release Forms in MS Word | PDF

A few times a year, people need to have their dental health checked by their dentists. It is essential to maintain a healthy mouth, teeth, and gums. A yearly visit to the dentist will improve the appearance and the quality of life.

The maintenance of a patient’s dental health is an ethical and a legal obligation of the dentist. If a patient finds the need to obtain their dental records, for the reason of a permanent relocation or the need to transfer to a different dental health provider, a request form is needed to acquire these documents. The Sample Forms that you will find on this page will help you with the right documents to obtain the needed records from your current dentist.

Sample HIPAA Dental Release Form

Dental Records Release Authorization Form

Dental Records Release Form in PDF

Standard Dental Release Form in PDF

Dental X-Ray Release Form Example

Dental Release of Records Form

Uses of Dental Records

A thoroughly maintained dental record has a variety of uses. A completely detailed dental record is essential for a good dental care to ensure that the treatments and the continuity of service is provided to the patient. Dental records help dentists monitor the state of the oral health of a patient. It is also used to carry out different treatments and to monitor the success or the failure of a specific treatment. A person’s dental records also play a crucial part in forensic dentistry, specifically in the identification, detection, and solution of a crime in an event of a civil proceeding and a natural or man-made disaster, such as a fire or the identification of a dead person’s body.

What Should a Dental Record Ideally Contain?

A dental record is a detailed record that contains the information of a dental patient. A dental practitioner is responsible for a complete and accurate dental record. You may also check our Records Release Forms and Liability Waiver Forms, which you may find useful.

• Patient Record – All information should be recorded using an ink or in an electronic format. These records should contain all the information needed regarding the patient: a complete recording of the patient’s dental history and personal information.

Medical and Dental Release Form

Sample Dental Photo Release Form

Veterinary Dental Release Form

Dental Procedure Release Form

Patient Authority to Release Dental Records Form in PDF

Dental Release of Information Form

 

• Business Record – A complete dental record should include details of the patient’s billing with the date and amount, copies of claims forms provided by the patient, and any information related to name, address, nature of the laboratory services done, and the patient’s laboratory charges.
• Drug Record – Certain drugs for different conditions are prescribed by dentists to the patient. A dental record should contain these drugs for future references and to ensure that these drugs are taken with extreme care. These records are also used to prevent any side effects that may affect the patient. A drug record of the patient should include
  • the date, time, and method of administering of the drug;
  • the name, strength, quantity, and form of the drug prescribed;
  • directions for the use of the drug; and
  • the condition of the patient being treated and the dental treatment provided.

 

Dental records are an important part of a patient’s dental health. These records should always be constantly updated by the dental provider to ensure the quality and the protection of a patient’s dental health and must be available should the patient need them. If you find the need to obtain your dental records, the forms that are available on this page will help you get started. Our Medical Records Release Forms may also be useful to you.