Continuity of care
Medical records
& transfer request.
Complete the request below to prepare your record-release email.
To: Dr. Suwan Kim, Su Dental Hospital
Subject: Request for Issuance of My Medical Records and Transfer of Care
I am a former patient of Su Dental Hospital. I have been informed that Dr. Hosan Park, who previously provided my dental care, is now practicing at Cera Dental Clinic. To ensure the continuity, safety and consistency of my treatment, I wish to continue receiving care from the same attending dentist.
Accordingly, pursuant to Article 21 of the Medical Service Act of the Republic of Korea, I formally request:
- Copies of all medical records held by the institution.
- All dental radiographic images, including panoramic, periapical and CT images.
- Where possible, a written summary of treatment history and recommended ongoing or future treatment.
- Release directly to me or, with my consent, transmission to Cera Dental Clinic.
Please complete and sign below. Bring or submit a copy of your identification separately.