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no date of treatment should appear on this form. h�b``e``�a �60�F fa�h@�b� A��6���NHG�W��H6�lt>��c����/�� �:�`f2m�5� l>ӑ�>�@� . )-246(I)0( giv)25(e m)15(y)0( per)-25(mission to the Dentist to mak)20(e an)15(y/all)]TJ T* [(changes and additions as necessar)-30(y)100(. REMOV)]TJ ET 0 0 0 1 K 0 J 0 j 0.464 w 10 M []0 d 103.855 462.763 m 135.697 462.763 l S BT 8 0 0 8 135.697 463.483 Tm (AL OF TEETH)Tj ET 135.697 462.763 m 194.873 462.763 l S Q q 1 i 0 792 612 -792 re 0 792 m W n 0 792.06 612 -792 re W n BT /F7 1 Tf 8 0 0 8 54 454.483 Tm 0 0 0 1 k /GS2 gs 0 Tc 0.028 Tw [(Alter)-25(nativ)25(es to remo)15(v)25(al ha)20(v)25(e)0( been e)30(xplained to me \(root canal)]TJ 0 -1.125 TD [(ther)10(ap)30(y)100(,)0( cro)15(wns)15(, and per)-15(iodontal surger)-30(y)100(,)0( etc.\) and I author)-15(iz)15(e the)]TJ T* [(Dentist to remo)15(v)25(e)0( the f)30(ollo)15(wing teeth and an)15(y others necessar)-30(y)]TJ T* [(f)30(or reasons in par)10(ag)10(r)10(aph #3. Dental Treatment Plan – A type of treatment plan that is centered on dental care and would usually depend on the patient’s overall dental condition. )]TJ 0 -3.325 TD [(Signature of P)40(atient_______________________________________________________________)-1000(Date____________)]TJ 0 -2.4 TD [(Signature of P)40(arent/Guardian if patient is a minor_______________________________________ Date____________)]TJ ET Q endstream endobj 4 0 obj << /ProcSet [/PDF /Text ] /Font << /F6 5 0 R /F7 6 0 R /F9 7 0 R >> /ExtGState << /GS1 8 0 R /GS2 9 0 R >> >> endobj 11 0 obj << /Type /Halftone /HalftoneType 1 /HalftoneName (Default) /Frequency 60 /Angle 45 /SpotFunction /Round >> endobj 12 0 obj << /Type /Halftone /HalftoneType 5 /Red 13 0 R /Green 14 0 R /Blue 15 0 R /Gray 16 0 R /Cyan 13 0 R /Magenta 14 0 R /Yellow 15 0 R /Black 16 0 R /Default 16 0 R >> endobj 16 0 obj << /Type /Halftone /HalftoneType 1 /Frequency 70.711 /Angle 45 /SpotFunction /Round >> endobj 15 0 obj << /Type /Halftone /HalftoneType 1 /Frequency 66.667 /Angle 0 /SpotFunction /Round >> endobj 14 0 obj << /Type /Halftone /HalftoneType 1 /Frequency 63.246 /Angle 18.435 /SpotFunction /Round >> endobj 13 0 obj << /Type /Halftone /HalftoneType 1 /Frequency 63.246 /Angle 71.565 /SpotFunction /Round >> endobj 8 0 obj << /Type /ExtGState /SA false /OP false /HT /Default >> endobj 9 0 obj << /Type /ExtGState /SA false /OP true /HT 12 0 R >> endobj 17 0 obj << /Type /FontDescriptor /Ascent 720 /CapHeight 720 /Descent -178 /Flags 262176 /FontBBox [-167 -232 1007 1013] /FontName /HPIPCF+Helvetica-Black /ItalicAngle 0 /StemV 208 /XHeight 524 /CharSet (/six/L/hyphen/W/T/seven/M/period/X/A/ampersand/B/N/Y/eight/C/O/nine/zero/D/P/parenleft/one/space/E/two/parenright/F/R/three/G/S/four/I/U/H/five/comma/V) /FontFile3 18 0 R >> endobj 18 0 obj << /Filter [/ASCII85Decode /FlateDecode] /Length 3321 /Subtype /Type1C >> stream My questions have been answered to my satisfaction. )-246(I)]TJ T* [(understand that a more e)30(xpensiv)25(e filling that initially diagnosed)]TJ T* [(ma)30(y be required due to additional deca)30(y)100(. 36. 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Lion Brand Shawl In A Ball Moonstone, How To Draw Summer Things, Japanese Boxwood Hedge, Bbq Pork Shoulder, What Happens If You Kill Articuno In Crown Tundra, Dive Ball Pixelmon, Logistic Regression Machine Learning,

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