The Generic Dental Records Release Form is a crucial document used when patients need to obtain copies of their dental records or authorize their transfer to another party. This form, designed for use in the United States, ensures compliance with HIPAA regulations and state-specific privacy laws. It's commonly used when changing dental providers, seeking second opinions, or providing records for insurance or legal purposes. The form includes essential elements such as patient identification, specific records being requested, recipient information, and required authorizations to protect both the patient's privacy rights and the dental practice's legal obligations.
Your data doesn't train Genie's AI
You keep IP ownership of your information
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
OR
Let Ƶ's market-leading legal AI identify missing terms, unusual language, compliance issues and more - in just seconds.
1. Patient Information: Full name, date of birth, contact information, and patient identification number
2. Provider Information: Dental practice name, address, and contact information
3. Records Request Details: Specific records being requested and date range
4. Recipient Information: Name and contact information of person/entity receiving records
5. Authorization Statement: Legal statement authorizing release of records
6. Signature Block: Patient or authorized representative signature and date
1. Fee Schedule: Details of any applicable fees for records release when state law permits charging for records
2. Third Party Authorization: Additional authorization section when records are being released to someone other than the patient
3. Electronic Delivery Authorization: Specific authorization section for when records will be sent electronically
1. Fee Schedule Appendix: Detailed breakdown of applicable fees as per state law
2. State-Specific Notices: Required notices or disclosures specific to the state
Authors
Relevant legal definitions
Clauses
Relevant Industries
Relevant Teams
Relevant Roles
Find the exact document you need
Military Medical Record Request Form
U.S. legal document for requesting military medical records in compliance with federal privacy laws.
find out more
Employment Background Check Release Form
A U.S. legal document authorizing employers to conduct background checks on job candidates while ensuring compliance with federal and state regulations.
find out more
Phi Consent Form
A U.S. HIPAA-compliant authorization form for the use and disclosure of protected health information.
find out more
Phi Authorization Form
A U.S. HIPAA-compliant form authorizing the disclosure of protected health information to specified recipients.
find out more
Dr Work Release Form
A U.S. compliant medical document authorizing an employee's return to work with specified conditions and restrictions.
find out more
Police Vehicle Release Form
A U.S. legal document authorizing the release of an impounded vehicle from police custody to its rightful owner or representative.
find out more
Authorization For Release Of Protected Health Information Phi
A U.S. HIPAA-compliant authorization form permitting the release of protected health information between specified parties.
find out more
Form For Requesting Medical Records
A HIPAA-compliant form used in the US for requesting personal medical records from healthcare providers.
find out more
Share Medical Information Form
A HIPAA-compliant authorization form used in the United States for sharing protected health information between specified parties.
find out more
Release Of Records Request Form
A U.S.-compliant form used to request and authorize the release of records from organizations or institutions.
find out more
Release Of Information Statement
A U.S. legal document authorizing the controlled disclosure of confidential information between specified parties.
find out more
Release Form From Police Department
A U.S. legal document authorizing police departments to release official records while ensuring compliance with federal and state privacy laws.
find out more
Printable Work Release Form
A U.S. legal document authorizing an employee's return to work following medical leave, including any necessary work restrictions or accommodations.
find out more
Military Dependent Medical Records Request Form
A U.S. military healthcare system form for requesting medical records of military dependents, compliant with federal privacy regulations.
find out more
Medical Records Pick Up Form
A U.S.-compliant form authorizing the release and pick-up of medical records, ensuring HIPAA compliance and patient privacy protection.
find out more
Letter For Medical Records Request
A HIPAA-compliant formal request for medical records under U.S. federal and state laws.
find out more
Generic Dental Records Release Form
A HIPAA-compliant U.S. form authorizing the release of dental records from provider to patient or designated recipient.
find out more
Employee Photo Consent Form Gdpr
A dual-jurisdiction (US/EU) consent form for employee photo usage that complies with GDPR and US privacy requirements.
find out more
Dental Release Of Information Form
A U.S.-compliant legal document authorizing the release of dental records from a provider to specified recipients while maintaining HIPAA compliance.
find out more
CT Medical Records Release Form
A HIPAA-compliant authorization form used in the U.S. to permit the release of medical records to designated recipients.
find out more
Consent For Use And Disclosure Of Health Information Form
A U.S. HIPAA-compliant authorization form allowing healthcare providers to use and share protected health information.
find out more
Authorization To Release Rental History
A U.S. legal document authorizing the release of tenant rental history information while complying with federal and state privacy laws.
find out more
Authorization To Release Credit Information Form
A U.S. legal document granting permission to access an individual's credit report and financial information, compliant with FCRA and state privacy laws.
find out more
Authorization To Disclose Medical Information Form
A U.S. HIPAA-compliant form authorizing the release of specified medical information to designated recipients.
find out more
Authorization Release Form For Background Check
A U.S. legal document authorizing employers to conduct background checks on potential or current employees in compliance with federal and state regulations.
find out more
Athletic Medical Release Form
A U.S. legal form authorizing emergency medical treatment for athletes and providing liability protection for healthcare providers and athletic organizations.
find out more
Minor Medical Treatment Authorization Form
A U.S. legal document authorizing medical treatment for minors when parents/guardians are not present.
find out more
Medical Consent Form For Temporary Guardian
A U.S. legal document authorizing a temporary guardian to make medical decisions for a minor when the primary guardian is unavailable.
find out more
Authorization For Release
A U.S. legal document granting permission to share specified information between parties, compliant with federal and state privacy laws.
find out more
Written Authorization To Release Information
A U.S.-compliant legal document authorizing the release of specific personal information between designated parties.
find out more
Workers Comp Medical Release Form
A U.S. legal document authorizing the release of medical information for workers' compensation claims processing.
find out more
Work Release Form Hospital
A U.S. legal document providing medical clearance for employees to return to work, including any necessary restrictions or accommodations.
find out more
Veterinary Medical Release Form
A U.S. legal document authorizing veterinary professionals to provide medical treatment to an animal in the owner's absence.
find out more
Universal Medical Release Form
A HIPAA-compliant authorization form used in the United States for releasing medical records to specified parties.
find out more
Service Release Form
A U.S.-compliant legal document that confirms service completion and releases parties from related future claims or obligations.
find out more
Revocation Of Release Of Information Form
A U.S. legal document used to withdraw previous authorization for sharing personal information, compliant with federal and state privacy laws.
find out more
Release Form For Video Recording
A U.S. legal document granting permission to record and use an individual's image and likeness in video content.
find out more
Records Request Form Medical
A U.S.-compliant form used to request and authorize the release of medical records under HIPAA regulations.
find out more
Public Adjuster Release Form
A U.S. legal document that releases a public adjuster from further obligations upon completion of insurance claim services and receipt of payment.
find out more
Physician Medical Release Form
A U.S. legal document authorizing healthcare providers to release patient medical information in compliance with HIPAA regulations.
find out more
ұԾ’s Security Promise
Genie is the safest place to draft. Here’s how we prioritise your privacy and security.
Your documents are private:
We do not train on your data; ұԾ’s AI improves independently
All data stored on Genie is private to your organisation
Your documents are protected:
Your documents are protected by ultra-secure 256-bit encryption
We are ISO27001 certified, so your data is secure
Organizational security:
You retain IP ownership of your documents and their information
You have full control over your data and who gets to see it
.png)