Referred for -                                                                                                                        Nurse present - (Name)
PMH
Medication
Allergies
SH                                        Smoke: /day.                        Alcohol:                                   Occupation:
Exam - EOE
-  IOE
Soft tissues
Radiographs      PA /OPG              Report:
Diagnosis

Treatment options offered to patient :
1. Conservative: Observe and manage symptoms
2. Endodontic: Root canal treatment
3. Extraction of with risk of nerve damage, oro-antral communication and sinus symptoms.
Tx Plan : Patient has opted for extraction of..

Warnings in print and stressed again verbally - Pain, swelling, bruising, stitches, jaw stiffness, infection, damage to adjacent teeth, Possible fracture & / or dislocation of lower jaw, prolonged or permanent numbness of lower lip and / or tongue, oro-antral communication
Consent form : signed
Procedure stated -
LA given - Lidocaine / Adren 1:80,000 X 2.2ml x Batch No: P-15 Exp 2021 01
- Articaine / Adren 1:100,000 X 2.2ml x Batch No: B25294AA Exp 2021 03

TREATMENT :-
Haemostasis achieved, Post-op instructions
Presc Tabs Metronidazole 400mg tds X 5 days
Tabs Ibuprofen 400mg qds X 7 days                  Delete as necessary
Tabs paracetamol 500mg ii 6hrly (40 tabs)
Pt has own analgesics
Follow-up plan / ? Recall - DTC / ref back ODS // TCA
Signed