Get Form (#2687) - Dsps - Wisconsin.gov

Filling out the Form (#2687) related to reporting adverse occurrences in anesthesia administration is an essential task for dental professionals in Wisconsin. This guide provides clear, step-by-step instructions to help users fill out the form accurately and efficiently online.

Follow the steps to fill out the form correctly.

1. Press the 'Get Form' button to access the Form (#2687) online and open it in your document editor.
2. Begin by entering the name of the dentist in the designated section. Provide the last name, first name, and middle initial.
3. Next, input the license number in the respective field to validate your credentials.
4. Fill in the address of the dentist including the street, city, state, and zip code for proper identification.
5. Enter the daytime telephone number in the provided format, ensuring the number is current and accurate.
6. Indicate the date of the occurrence by filling in the day, month, and year in the designated fields.
7. Describe the patient's reaction in the provided section, giving as much detail as necessary.
8. List the names and telephone numbers of all participants in the dental procedure, along with any witnesses to the adverse occurrence.
9. Detail the type of dental procedures performed in the dedicated section, ensuring you give a thorough description.
10. Describe the preoperative physical condition of the patient to provide context for the occurrence.
11. Provide a detailed account of the techniques utilized in the administration of all drugs used during the dental procedure.
12. Elaborate on the description of the adverse occurrence, including symptoms, treatments given, and responses to treatment.
13. Finally, describe the patient’s condition upon termination of any dental procedures undertaken.
14. List all drugs and dosages administered before and during the dental procedures in the respective sections.
15. Ensure that the information is certified as correct by signing and dating the form where indicated.
16. After filling out the form, users can choose to save their changes, download, print, or share the completed form.

Complete your Form (#2687) online today to ensure compliance with reporting requirements!