Release of Dental Records and X-Rays


Introduction: In accordance with Delaware Law related to the release of dental records, it is the policy of this office to transfer the records of the patient to either the new dentist or the patient upon receipt of written request (Title 24, Professional Regulations, Chapter 11, Board of Dental Practice, Subchapter 5).  The original records will remain the property of Townsend Family and Cosmetic Dentistry. Payment is required to cover the cost of duplication and/or copying patient records.  This payment must be provided in the form of cash or credit card.  Once payment is provided, the records will be duplicated within 3 days of receipt of the payment.  In compliance with the Health Insurance Portability and Accountability Act (HIPAA), governmental identification must be presented before the records are released. Release of the records are limited to the new dentist or the patient; records will not be released to other individuals (unless the patient is a minor child).

Charge: If you request your full set of x-rays only, the charge for duplication is $35.00.  If you request both your dental records and treatment notes, the cost for duplication is $45.00.  We kindly request that you provide either cash or credit card. Checks cannot be accepted. For your convenience, a credit card authorization form is available (see link below). This payment must be provided before we can duplicate records. 

Outstanding Balances: The release of your dental records does not negate any outstanding balances on your account.  You are still responsible for that balance and legal action will be pursued to collect that balance. You will be responsible for the balance as well as collection and legal costs associated with collecting the debt.

If you are interested in obtaining your x-rays and/or dental records from our office, please print out the following form: Authorization for Release of Dental Records and X-rays.  Please be advised this is a pdf form and it can only be opened through Adobe Acrobat Reader.  You may contact our office if you are unable to open the document.  We will be more than happy to provide a hard copy via fax or mail. 

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We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.