Pre-Appointment Checklists

Please have the receptionist prepare the Consultation Area prior to my arrival to include the following items:

Patient should have already received the Pre-Operative Instructions for Periodontal Surgery (1 of 6).
Surgical Treatment Plan and Associated Fees should be attached to outside of patient's chart.
Have patient complete an updated Medical History Update Form (2 of 6).
X-ray should be attached to outside of chart:
- Panoramic is mandatory for all 3rd molar extractions.
- Periapicals are acceptable for all other extractions.
- All X-rays must be less than one (1) year old.
Oral Surgery Forms should be inside or attached to the chart.
Post-Operative Gauze Package (preferably in an autoclave bag).

If patient is having I.V. Sedation:

Ask patient to use restroom, if necessary, prior to my arrival.
Remind patient not to eat or drink at least six (6) hours prior to appointment.
Remind patient that they must have an escort to accompany them to the office, to remain with them throughout the procedure, and to take them home following the procedure.

Thank You.

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OPERATORY (SURGICAL) SUPPLIES

Please have your assistant prepare the Surgical Operatory prior to my arrival, to include the following items:

Local Anesthetic:
- 2% Lidocaine w/ 1:100,000 epi - 2 carpule
- 0.5% Marcaine or Vivicaine w/ 1:200,000 epi - 8 carpules
Patient Napkin
Monoject Syringe 12ml.
2 x 2 Gauze
15 Surgical Blade
Chromic Gut C-3 5-0 18"
Chromic Gut C-6 4-0 27"
27 Gauge Long Needle
Medium & Small Gloves
Sterilization Pouches (12" x 18")
Saline Bottles
Vicryl Rapide Ud PC1 5-0 18"
Autoclave

Thank you.