Recently, I saw a new patient who already had requested that her records be transferred to my office. Her former dentist has been changing his record-keeping system to an electronic one, including digital radiographs and clinical photographs. The fees she paid for the records seemed equivalent to those charged for paper and photographic copying, even including postage. The records transfer was made with no problem, but when she arrived for her first visit, she expressed a little annoyance at the copying charges, given that the records were transferred electronically. She and I both wonder what ethical guidance there is for both the transfer of records and fee charges, especially given the mixture of practices with digital and conventional record-keeping systems. It could be argued that because dentistry is a free-market business, the former dentist could charge for his service whatever the market would bear. However, in exchange for granting a license that allows a dentist the privilege of practicing dentistry for its citizens, each state, through legislative statutes and boards of dentistry, regulates how a dental practice operates in certain respects. Dentistry is not an ordinary business, but a profession, and as professionals who are members of the American Dental Association (ADA), we have agreed to practice at a higher ethical level, both as clinicians and as businesspeople. While we often are granted significant latitude in establishing fees, many states have specific restrictions on charges for the transfer of patient records. For example, in Florida, charges for paper copies of records generally are limited to the fee charged by local county clerks for similar duplication.1§456.057(4,16), Fla. Stat. (2007).Google Scholar The Florida Board of Dentistry specifically states that the fee for copying radiographs shall not exceed the cost of duplication.2Board of Dentistry Rule 64B5-17.0009, Fla. Admin. Code (2007).Google Scholar Some states designate a maximum fee per page or film. Other states' statutes may not be as specific, however. Most seem to be written to permit a practice to defray material and personnel costs for paper and photographic duplication, but there always has been a debate about those labor costs with traditional film duplication. Statutory interpretation could be narrower with electronic duplication, but most states have not kept up to date with the current, less labor-intensive technology. This is becoming especially problematic because many technical issues may be encountered as records are sent, not only between practices that use digital technology (many of which have incompatible software formats), but also to and from practices that use traditional records. The ADA Principles of Ethics and Code of Professional Conduct (ADA Code)3American Dental Association Principles of ethics and code of professional conduct, with official advisory opinions revised to January 2005. ADA, Chicago2005Google Scholar is a little more restrictive. Of the five basic ethical principles and underlying relevant codes of professional conduct, the applicable Principle here is the first one, Patient Autonomy, and Code section 1.B, Patient Records, which states, in part, that “dentists shall provide any information in accordance with applicable law that will be beneficial for the future treatment of [the] patient.” Further clarification is provided by the ADA Council on Ethics, Bylaws and Judicial Affairs Advisory Opinion 1.B.1, Furnishing Copies of Records: A dentist has the ethical obligation on request of either the patient or the patient's new dentist to furnish in accordance with applicable law, either gratuitously or for nominal cost, such dental records or copies or summaries of them, including dental X-rays or copies of them, as will be beneficial for the future treatment of that patient. This obligation exists whether or not the patient's account is paid in full. While not specifically determining a proper fee, the ADA Code clearly calls for such a charge to not impede the free flow of all patients' record information between dentists and even suggests they may do so “gratuitously.” This mind-set also makes sense from a practice management standpoint. Since patients leave a practice for many reasons, it would seem appropriate to keep the welcome mat out given that many times, those patients will return. It seems obvious that the ADA Code does not support and, indeed, frowns on making duplication of patient records—paper or electronic—a source of profit from an exiting patient. In summary, if the costs of duplication go down, so should the charges.