The Orthodontic Release Form is a crucial document used in Australian dental practices when a patient's orthodontic treatment has been completed or is being terminated. This document serves multiple purposes: it formally acknowledges the completion of treatment, confirms that all financial obligations have been met, outlines post-treatment responsibilities including retainer wear, and releases the practice from further treatment obligations. The form is designed to comply with Australian healthcare regulations and professional standards, including requirements set by the Dental Board of Australia. It may also be required for insurance purposes and forms an important part of the patient's medical records. The document should be customized based on state-specific requirements and whether the patient is a minor requiring guardian consent.
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1. Patient Information: Full legal name, date of birth, contact details, and Medicare/private health insurance information of the patient
2. Practice Information: Details of the orthodontic practice, treating practitioner, and practice contact information
3. Treatment Acknowledgment: Description of the orthodontic treatment received and confirmation that treatment is complete
4. Post-Treatment Responsibilities: Patient's responsibilities regarding retainer wear and follow-up appointments
5. Release Statement: Formal statement releasing the practice from further obligations related to the completed treatment
6. Records Release: Authorization for the release or transfer of orthodontic records
7. Financial Settlement: Confirmation that all financial obligations related to the treatment have been settled
1. Minor Patient Consent: Additional section required when the patient is under 18, including parent/guardian details and consent
2. Transfer of Care: Used when patient care is being transferred to another practitioner or jurisdiction
3. Outstanding Treatment: Required when treatment is being terminated before completion, detailing remaining treatment needs
4. Private Health Insurance: Additional details required for private health insurance claims and obligations
5. Ongoing Care Recommendations: Specific recommendations for future dental/orthodontic care beyond standard retention
1. Treatment Summary: Detailed summary of the orthodontic treatment provided, including start and end dates
2. Retention Instructions: Specific instructions for retainer wear and maintenance
3. Post-Treatment Photos: Final orthodontic photographs showing treatment completion
4. Follow-up Schedule: Schedule of recommended follow-up appointments and checks
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Dental Services
Medical Services
Insurance
Professional Services
Relevant Teams
Legal
Compliance
Medical Records
Administration
Clinical Operations
Risk Management
Patient Relations
Insurance Processing
Relevant Roles
Orthodontist
Dental Practice Manager
Healthcare Administrator
Dental Assistant
Treatment Coordinator
Compliance Officer
Medical Records Manager
Insurance Coordinator
Legal Counsel
Risk Management Officer
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