
Get Get The Printable Dental Records Release Form 2020-2025
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How to fill out the Get The Printable Dental Records Release Form online
Filling out the Get The Printable Dental Records Release Form online is a straightforward process that allows you to authorize the release of your dental records. This guide will walk you through each section of the form to ensure you complete it accurately and efficiently.
Follow the steps to complete the form seamlessly.
- Click the ‘Get Form’ button to access the form and open it in your chosen editor.
- In the first section, enter the patient's name in the designated field. Ensure the name matches the records held by the dental office to avoid any delays.
- Next, provide the patient's date of birth in the corresponding field. This information helps to verify the patient’s identity.
- Address the doctor by confirming that you authorize them to release your dental information. You do not need to rephrase this section, as it is a standard authorization.
- Specify that you want the records sent to Dr. Alan Litvinov’s office, as noted in the form, which includes the address and contact information.
- Indicate any additional records you would like to receive, such as current x-rays, to fully prepare for your dental treatment.
- Sign the form where indicated as a patient, parent, or guardian. Include your signature to validate the authorization.
- Fill in the date of your signature to document when you authorized the release.
- For digital images, note that you would like the dental office to provide digital x-rays in printed color format and ensure CT images come with a certified MD Radiologist's review letter.
- Finally, review the completed form for accuracy, then save your changes, download the document, print it, or share it as needed.
Start your process today by completing the Get The Printable Dental Records Release Form online.
To request your dental records, reach out to your dental provider directly, either via phone or in writing. Clearly state your request, and be prepared to provide identification or complete a release form. This formal request is essential for securing your records. To make this easier, you can Get The Printable Dental Records Release Form from our platform.
Fill Get The Printable Dental Records Release Form
RELEASE TO: I request and authorize the above-named doctor or health care provider to release the information. To pick up my records. Your treatment notes will be released, if you want us to release other information then please mark below. INFORMATION TO BE DISCLOSED: Treatment plan â–¡. I, (print patient or guardian name). ,. Com: __x___Bitewing Xrays. Processing your request for copies of records and radiographs (X-rays) takes approximately TEN (10) WORKING. SECTION III - RELEASE AUTHORIZATION. I understand that: a. PLEASE PROVIDE A COPY OF THE DENTAL RECORD AS INDICATED BELOW: _____ Bitewing X-rays (if less than 1 year old).
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