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Dental X Ray Release Form Template for England and Wales

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Key Requirements PROMPT example:

Dental X Ray Release Form Template

I need a Dental X Ray Release Form Template for my private dental practice in Cardiff, which will be used to transfer patient X-rays to a specialist orthodontist practice, with specific provisions for digital transfer methods and enhanced data security measures.

Document background
The Dental X Ray Release Form Template is designed to facilitate the secure and compliant transfer of dental radiographic images while protecting patient privacy and ensuring regulatory compliance. This document is essential when patients require their X-rays to be shared with other healthcare providers, seek second opinions, or change dental practices. The form adheres to English and Welsh legal requirements, including UK GDPR, IR(ME)R 2017, and healthcare data protection regulations. It serves as both a record of consent and a formal authorization for the release of sensitive medical information.
Suggested Sections

1. Patient Information: Full name, date of birth, contact details, NHS number of the patient

2. Requesting Entity Details: Name and contact information of the requesting dental practice or healthcare provider

3. X-Ray Details: Date of X-rays, type of X-rays, reason for release

4. Consent Statement: Clear statement of consent for release of X-rays including data protection notices and GDPR compliance

5. Signatures: Space for patient signature, date, and witness signature if required

Optional Sections

1. Third Party Authorization: Additional section when X-rays are to be released to someone other than the patient

2. Time Limitation: Section specifying if the release authorization is only valid for a specific period

3. Special Instructions: Section for any specific handling or delivery instructions

4. Capacity Assessment: Section required when dealing with patients who may lack capacity under the Mental Capacity Act 2005

Suggested Schedules

1. Identity Verification Documents: Schedule for attaching copies of required identification documents

2. Previous Consent Forms: Schedule for attaching any relevant previous release forms or permissions

3. Data Protection Notice: Detailed information about data protection rights and GDPR compliance

Authors

Alex Denne

Head of Growth (Open Source Law) @ ºìÐÓÖ±²¥ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Relevant legal definitions




















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Industries

UK GDPR and Data Protection Act 2018: Core data protection legislation governing how personal and medical data must be handled, stored, and shared in the UK

IR(ME)R 2017: The Ionising Radiation (Medical Exposure) Regulations 2017 - Specific regulations governing the use of radiation in medical procedures and ensuring patient safety

IRR17: The Ionising Radiation Regulations 2017 - Regulations focusing on radiation protection and safety measures in medical settings

GDC Standards: General Dental Council Standards and Guidelines establishing professional requirements for dental practice

CQC Requirements: Care Quality Commission requirements for healthcare providers including dental practices

Access to Health Records Act 1990: Legislation governing access to and maintenance of health records

Medical Act 1983: Fundamental legislation governing medical practice and record-keeping in the UK

Mental Capacity Act 2005: Legislation protecting and empowering people who may lack the mental capacity to make certain decisions about their care

Common Law Duty of Confidentiality: Legal principle requiring healthcare providers to maintain patient confidentiality and protect sensitive information

Informed Consent Principles: Legal and ethical requirements for obtaining proper informed consent from patients before medical procedures

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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