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How To: HIPAA Compliant Photo Release Forms | GMedia Digital Marketing in Dallas, TX

Updated: Jan 11, 2023

Not sure what to post to your practice’s social media accounts? Photos and videos of real patients are a great choice, and tend to have strong social media engagement metrics. Examples include treatment procedure videos, photos of happy patients showing off social signs, and positive patient testimonials.

Just remember to make sure your practice stays HIPAA compliant whenever you take and share images of your patients by providing a valid Photo Release Form in addition to your standard HIPAA Compliance and Notice of Privacy Practices forms.

Your HIPAA compliant photo release form must include all of the following elements:

  • The Parties Involved: You must include the name of your practice (the covered entity) or the name of the dentist as the party requesting PHI, and the name of the patient consenting to the photo release.

  • Description of Use: Clearly define how the patient’s image will be used.

  • Expiration Date: Clearly define the period of time for which the consent is being given.

  • Patient’s Right to Revoke: Clearly state that the patient can revoke the use of their image in writing at any time, and include simple steps on how to do so.

  • Health Benefits Are Not Conditional: The HIPAA photo release form should clearly state that health benefits will not be withheld from the patient if the consent form is not signed or if the revocation process is exercised.

  • Authorization: The patient must sign and date the document. If the party giving consent is a minor or a special needs individual with a legal guardian, the guardian must sign and date the form.

We know you’re busy, so if you don’t have the time to write up your own HIPAA compliant photo release form feel free to use ours! It’s free to download and form fillable – Just remember to fill in your dentist’s or your practice’s name in the blank spaces. Happy posting!

HIPAA Compliant Patient Photography Release Form - Form Fillable
Download PDF • 45KB



Tel: (972)882-9200 / (972)882-9222


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