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Patient Intake Forms

Patient Records Request

All patients will have the ability to review, inspect and/or obtain a copy of the PHI in the Dental Health Record.

Patients may request to review and inspect their Dental Records at any time. A patient does not have the right to immediate access to his or her medical/dental record under the HIPAA Privacy Rule.

Patients may request a paper copy and/or electronic file, of their Dental Record by completing and signing an Authorization to Release Protected Health Information (PHI) Form. All patient requests will be completed within 10 business days.