Prior to surgery, it is important to verify that the patient has had a dental exam within the past 6 months, has no current dental infection, no active cavities, gum disease, abscessed teeth, fractured teeth or fillings, loose teeth or other oral pathology and no anticipation of dental care
Medical clearance for Dental Treatment Patient: _____ DOB: _____ Dear Dr. _____, Our mutual patient, _____, is scheduled for dental treatment. Treatment may include: _____ Cleaning (simple or deep) _____ Radiographs
Dental Clearance Letter | PDF - Scribd
Dental-Clearance-Letter - Free download as PDF File (.pdf), Text File (.txt) or read online for free. This dental clearance letter from Drs. Bracey, Olcott, and Narayanan verifies that a patient scheduled for total joint replacement surgery has received a dental exam within the past 6 months, has no current dental infections or issues, and is ...
Dental Medical Clearance Form - SampleForms.com
A Dental Medical Clearance Form is a document used to confirm a patient’s medical suitability for undergoing dental treatments. This form provides details on any existing health conditions that may affect treatment outcomes and allows healthcare providers to manage any potential risks.
Dental Medical Clearance Form & Example | Free PDF Download
A Dental Medical Clearance Form is a document requested by dental professionals prior to performing certain dental procedures, like a surgical procedure, that could potentially impact a patient's overall health, especially if they have underlying conditions like coronary artery disease, periodontal disease, oral infections, or other chronic ...
Dental Clearance Form & Example | Free PDF Download
To begin, download the printable Dental Clearance Form template from our website. This document collects crucial information about a patient’s dental and medical history, ensuring dentists can tailor treatments accordingly.
Our mutual patient, as noted above, is scheduled for dental treatment at our office. Treatment may include: Physicians: Please complete the section below. Please evaluate this patient’s medical history and advise us of any special considerations that should be made. Does the patient require antibiotic prophylaxis?
Dental Clearance Letter - Fill and Sign Printable Template Online
Dental clearance is communication between a medical provider and a patient's dentist to validate that planned medical/surgical treatment is safe for the patient and to review the potential need for dental treatment prior to the medical/surgical treatment.
Prior to OAT, it is important to verify that this patient has had a dental exam within the past six months, has no current dental infection and no anticipation of extensive restorative dental or orthodontic care within the next six months excluding filings.
MEDICAL CLEARANCE FOR DENTAL TREATMENT Date: Attention: Patient Name: Date of Birth: Our mutual patient, as noted above, is scheduled for dental treatment at our office. Treatment may include: Cleaning (simple or deep) Root Canal Therapy Radiographs (x-rays) Periodontal gum surgery