gent dental care: Yes: I No: Treatrnent Priorities: None: Non-urgent non-urgent Urgent Referred to Sick Can: Radiographs authorized: PM: - Prophybcds 811 (Approval vaad 18 i No date) k Yes months from examination BWs: Panorer Patient Name: ,,-- $4Q n i -3 -e_c Thy E Dent; • -1 9. si