9 . Instructed how to cbtaLn urgent and non-urgent dental care: Yes: I No: Treatment Pnortes: None: Ncn-urgent non-urgent Urgent Referred to Stck Cail: Radiographs PM: 6Ws: Panore:c authorized: • Prophylaxis authortzed: Yes I No (Approval valid 18 months from examination data) Patient Nam