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Dental Records Transfer Request Form Northern Colorado Periodontics I hereby request and authorize the transfer of my protected dental health records, or the protected health records of the below

How to fill out dental records transfer request

How to fill out dental records transfer request

1. Step 1: Obtain the necessary dental records transfer request form from your dentist or dental office.
2. Step 2: Fill out your personal information, including your full name, contact information, and date of birth.
3. Step 3: Provide details about your previous dentist or dental office, such as their name, address, and contact information.
4. Step 4: Indicate the reason for transferring your dental records and provide any additional information, if required.
5. Step 5: Review the completed form for accuracy and ensure all required fields are filled out.
6. Step 6: Sign and date the dental records transfer request form.
7. Step 7: Submit the completed form to your new dentist or dental office, either in person, by mail, or through their preferred method of submission.
8. Step 8: Follow up with your new dentist or dental office to confirm that they have received your dental records transfer request.

Who needs dental records transfer request?

1. Anyone who is changing dentists or dental offices and wants to have their dental records transferred to the new provider.
2. Patients who are seeking a second opinion from a different dentist may also need to submit a dental records transfer request.
3. In some cases, dental records may need to be transferred for legal or insurance purposes.
4. Dental specialists or other healthcare professionals who require access to a patient's dental records may also need a transfer request.

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What is dental records transfer request?

A dental records transfer request is a formal document that allows a patient to request the transfer of their dental records from one dental provider to another.

Who is required to file dental records transfer request?

Typically, the patient or their legal guardian is required to file the dental records transfer request in order to authorize the release of their dental information.

How to fill out dental records transfer request?

To fill out a dental records transfer request, the requester should provide their personal information, the name and contact details of the current provider, and the name of the new provider, along with any specific information or records they wish to transfer.

What is the purpose of dental records transfer request?

The purpose of the dental records transfer request is to ensure continuity of care by allowing a new dental provider access to a patient's historical dental records for informed treatment.

What information must be reported on dental records transfer request?

The transfer request must include the patient's full name, date of birth, addresses, contact information, the name and address of the current dental provider, and the name and address of the new provider.