e. Authorization for Performance of Procedure. The SF 522, Request for
Administration of Anesthesia and for Performance of Operations and Other Procedures,
(figure 2-8) should be a part of the patient's dental health record. This form is used to
secure written permission to perform specific procedures.
Figure 2-8. SF 522, Request for Administration of Anesthesia and for Performance of
Operations and Other Procedures
.
MD0510
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