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The Authorization To Release Dental Information document is essential in Indian healthcare practice for managing the secure and compliant transfer of patient dental records. This document becomes necessary when patients need their dental records transferred between providers, shared with insurance companies, or released to other authorized parties. It ensures compliance with Indian healthcare regulations, including the Dental Council of India Regulations and data protection requirements. The authorization typically specifies what information can be released, to whom, for what purpose, and for how long the authorization remains valid. This document is particularly important in maintaining patient privacy rights while facilitating necessary information sharing in healthcare settings.

1. Patient Information: Full legal name, date of birth, contact information, and patient identification number if applicable

2. Authorizing Party Declaration: Statement confirming the person's authority to authorize release (patient themselves, legal guardian, or authorized representative)

3. Recipient Information: Details of the person/entity to whom the dental information will be released, including name, address, and contact information

4. Information to be Released: Specific description of dental records to be released (e.g., x-rays, treatment history, billing records)

5. Purpose of Release: Statement indicating the reason for releasing the information

6. Duration of Authorization: Time period for which the authorization remains valid

7. Rights and Disclaimers: Statement of patient's rights including right to revoke authorization and any limitations

8. Signatures: Space for patient/authorized person's signature, date, and witness signature if required