The Dental Record

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Information Management Forms

The Problem/Priority List documents each treatment to be performed, in order of priority. The form shows at a glance the treatments you provided and those not yet performed.

The Medical Record Release form is for the authorization for release of medical information. This form must be completed and signed by the patient/guardian in order for the provider to release the patient's medical records.

Use the Referral, Insurance, Prescription Correspondence Log to record any communication about a patient between your office and specialists, insurance companies, or other outside parties.

The Telephone Information form helps your staff record information on new patients, emergency patients, and existing patients.

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Wisconsin Dental Association, 6737 West Washington Street, Suite 2360, West Allis, WI 53214
(414) 276-3954 • (800) 243-4675