Fill, sign and download Dental Treatment Plan Template online on Handypdf.com Online Dental Treatment Consent Form Template Create a dental treatment consent form in minutes with this straightforward and coding-free template. Dental Patient Treatment Plan forms, 5.5 x 8.5 Record patient conditions, recommended services and fees in one, compact and convenient form. )-246(Sore spots)]TJ 0 -1.125 TD [(altered speech and difficulty in eating are common prob)20(lems)15(. 'g=Yb[P/(,_g Nursing Care Plan Form. )-246(\(Initials_____________\))]TJ ET Q q 1 i 0 792 612 -792 re 0 792 m W n 0 792.06 612 -792 re W n BT /F9 1 Tf 14 0 0 14 324.84 376.058 Tm 0 0 0 1 k /GS2 gs (n)Tj 1 Tr 0 0 0 1 K 0 J 0 j 0.24 w 10 M []0 d 0 0 TD (n)Tj 0 Tr 0 0 0 0 k -0.06 0.05 TD (n)Tj 1 Tr 0 0 TD (n)Tj ET Q q 1 i 0 792 612 -792 re 0 792 m W n 0 792.06 612 -792 re W n BT /F6 1 Tf 8 0 0 8 360 376.758 Tm 0 0 0 1 k /GS2 gs -0.007 Tc 0.04 Tw [(9)-7(. h�bbd```b``Z"��d.������@$��d] "��@$�l ��`�f �+L�M` �����pF+c0�D��pH�~�� 螙 �� ��?�0 q] It shows that you planned for the conditions you diagnosed, prioritized your treatment, and used a logical approach to providing treatment. !XEi=bdN:mrV'-)kb_9]2^&BEc3L(L)PEd'" )-246(Immediate dentures ma)30(y require)]TJ T* [(consider)10(ab)20(le adjusting and se)30(v)25(e)0(r)10(al relines)15(. )-246(I)]TJ T* [(understand that a more e)30(xpensiv)25(e filling that initially diagnosed)]TJ T* [(ma)30(y be required due to additional deca)30(y)100(. CONSULTATION DESIRED (If yes, complete Section III, on reverse side) L I. N E. C O. 0 i understand that the fees listed on this claim may not be covered by or may exceed my benefits plan i understand that i am financially responsible to my dentist for the entire cost of the treatment. )-246(I)]TJ T* [(understand that a more e)30(xpensiv)25(e filling that initially diagnosed)]TJ T* [(ma)30(y be required due to additional deca)30(y)100(. REMOV)]TJ ET 0 0 0 1 K 0 J 0 j 0.464 w 10 M []0 d 103.855 462.763 m 135.697 462.763 l S BT 8 0 0 8 135.697 463.483 Tm (AL OF TEETH)Tj ET 135.697 462.763 m 194.873 462.763 l S Q q 1 i 0 792 612 -792 re 0 792 m W n 0 792.06 612 -792 re W n BT /F7 1 Tf 8 0 0 8 54 454.483 Tm 0 0 0 1 k /GS2 gs 0 Tc 0.028 Tw [(Alter)-25(nativ)25(es to remo)15(v)25(al ha)20(v)25(e)0( been e)30(xplained to me \(root canal)]TJ 0 -1.125 TD [(ther)10(ap)30(y)100(,)0( cro)15(wns)15(, and per)-15(iodontal surger)-30(y)100(,)0( etc.\) and I author)-15(iz)15(e the)]TJ T* [(Dentist to remo)15(v)25(e)0( the f)30(ollo)15(wing teeth and an)15(y others necessar)-30(y)]TJ T* [(f)30(or reasons in par)10(ag)10(r)10(aph #3. 165,339 total views, 25 views today. White c… Standard Dental Treatment Form — 39.2 KB The Canadian Dental Association is the nation's voice for dentistry dedicated to the promotion of optimal oral health, an essential component of general health, and to the advancement of a unified profession. )-246(I ha)20(v)25(e)0( had the oppor)-40(tunity to read this f)30(o)0(r)-25(m)0( and ask questions)15(. SECTION I - PLANNED TREATMENT AND SEQUENCE OF ACCOMPLISHMENT. Dental Practice Consulting Analysis Plan Implementation. %PDF-1.6 %���� 51Ss"):ts>5;QG[HGSVtK\6tA#47? DENTURES)]TJ ET 0 0 0 1 K 0 J 0 j 0.464 w 10 M []0 d 379.191 295.038 m 427.688 295.038 l S Q q 1 i 0 792 612 -792 re 0 792 m W n 0 792.06 612 -792 re W n BT /F7 1 Tf 8 0 0 8 324 286.758 Tm 0 0 0 1 k /GS2 gs 0 Tc 0.028 Tw [(I understand the w)10(ear)-15(ing of dentures is difficult. )-246(I)]TJ T* [(understand that it is m)15(y)0( responsibility to retur)-25(n f)30(or deliv)25(er)-30(y of the)]TJ T* [(dentures)15(. My questions have been answered to my satisfaction. X-RA)]TJ ET 0 0 0 1 K 0 J 0 j 0.464 w 10 M []0 d 103.855 633.763 m 124.593 633.763 l S BT 8 0 0 8 124.593 634.483 Tm (YS)Tj ET 124.593 633.763 m 136.591 633.763 l S Q q 1 i 0 792 612 -792 re 0 792 m W n 0 792.06 612 -792 re W n BT /F7 1 Tf 8 0 0 8 141.481 634.483 Tm 0 0 0 1 k /GS2 gs 0 Tc (\(Initials_____________\))Tj ET Q q 1 i 0 792 612 -792 re 0 792 m W n 0 792.06 612 -792 re W n BT /F9 1 Tf 14 0 0 14 54.84 606.783 Tm 0 0 0 1 k /GS2 gs (n)Tj 1 Tr 0 0 0 1 K 0 J 0 j 0.24 w 10 M []0 d 0 0 TD (n)Tj 0 Tr 0 0 0 0 k -0.06 0.05 TD (n)Tj 1 Tr 0 0 TD (n)Tj ET Q q 1 i 0 792 612 -792 re 0 792 m W n 0 792.06 612 -792 re W n BT /F6 1 Tf 8 0 0 8 90 607.483 Tm 0 0 0 1 k /GS2 gs 0 Tc 0.033 Tw [(2. )-246(\(Initials_____________\))]TJ ET Q q 1 i 0 792 612 -792 re 0 792 m W n 0 792.06 612 -792 re W n BT /F9 1 Tf 14 0 0 14 324.84 295.058 Tm 0 0 0 1 k /GS2 gs (n)Tj 1 Tr 0 0 0 1 K 0 J 0 j 0.24 w 10 M []0 d 0 0 TD (n)Tj 0 Tr 0 0 0 0 k -0.06 0.05 TD (n)Tj 1 Tr 0 0 TD (n)Tj ET Q q 1 i 0 792 612 -792 re 0 792 m W n 0 792.06 612 -792 re W n BT /F6 1 Tf 8 0 0 8 360 295.758 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.038 Tw [(10. 33 0 obj <>/Filter/FlateDecode/ID[<9511481D317806D8688C9333BA1FDE9C>]/Index[10 46]/Info 9 0 R/Length 110/Prev 181890/Root 11 0 R/Size 56/Type/XRef/W[1 3 1]>>stream
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