rgant dental cam Y13.6: I Not "De-anent Priorities: Nana: Non-urgont non-urgent Urgent Referred to Sick Carl: I Radiographs authorized: PM: Prephytatas authorized: Yes I No I (Approval valid IS months from examination data) BW& Panortsc Pa Nam S --ea n 1 —5--C.c r-e_ E • Numbs, -7G 3 IS: