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Get LA Audubon Dental Group Medical Clearance For Dental Treatment 2009-2024

, is scheduled for dental treatment. Treatment may include: Cleaning (simple or deep) Radiographs Fillings, Crowns, Bridges Extraction (simple or surgical) Root Canal Therapy Nitrous oxide Local anesthetic (with epinephrine) Other The patient has indicated the following medical conditions: Please evaluate this patient s medical history and advise us of any special considerations that should be made. Antibio.

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