The Orthodontic Records Release Form is a critical document used in Canadian healthcare practices when patients or healthcare providers request the transfer of orthodontic records. This document becomes necessary when patients change providers, seek second opinions, move to different locations, or require their records for personal or legal purposes. The form ensures compliance with both federal privacy legislation (PIPEDA) and provincial health information laws, while providing a structured process for the secure transfer of sensitive medical information. It includes detailed specifications of the records being released, authorization parameters, and privacy protections. The document serves as both a legal authorization and a tracking mechanism for the transfer of orthodontic records, protecting the interests of all parties involved while maintaining proper documentation of the release process.
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1. Patient Information: Basic identifying information including name, date of birth, contact details, and patient ID number
2. Practice Information: Details of the releasing orthodontic practice, including name, address, and contact information
3. Records Being Released: Detailed checklist of specific records being released (e.g., x-rays, photographs, treatment plans, progress notes)
4. Release Authorization: Legal authorization statement and terms of the release
5. Recipient Information: Details of the healthcare provider or entity to whom records are being released
6. Duration of Authorization: Timeframe for which the authorization is valid
7. Patient Rights Statement: Statement of patient's rights regarding their records and this authorization
1. Fee Agreement: Section detailing any applicable fees for records release, used when the practice charges for record copies
2. Records Transfer Method: Specification of how records will be transferred (electronic/physical), used when multiple transfer options are available
3. Urgent Request: Additional terms for expedited processing, used when immediate transfer is required
4. Minor Patient Provisions: Additional provisions when the patient is a minor, used for patients under 18
5. Third Party Authorization: Authorization for release to someone other than a healthcare provider, used when records are being released to non-medical entities
1. Schedule A - Record Inventory: Detailed inventory of all records being released, including dates and types of records
2. Schedule B - Fee Schedule: If applicable, breakdown of fees for different types of records and processing options
3. Appendix 1 - Privacy Notice: Standard privacy notice explaining how the released information will be protected
Authors
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Dental Services
Medical Records Management
Healthcare Administration
Healthcare Compliance
Healthcare Technology
Relevant Teams
Legal
Compliance
Medical Records
Patient Services
Administration
Privacy
Operations
Quality Assurance
Relevant Roles
Orthodontist
Dental Office Manager
Healthcare Administrator
Compliance Officer
Medical Records Coordinator
Privacy Officer
Dental Practice Administrator
Patient Services Coordinator
Healthcare Legal Counsel
Records Management Specialist
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