Dental medical clearance forms are documents which are provided by an individual’s dentist and addressed to the physician who will administer a set of medical examinations to the individual or the dentist’ patient. The form may have an included formal letter as the first section which is essential for informing the physician about the intentions and the reason why the document needs to be filled out immediately.Along with the letter is a section for the physician’s report regarding the patient’s condition and medical state. It is vital that the physician will indicate if the patient will be suitable for particular dental procedures to secure the patient’s safety and health.

Dental Treatment Medical Clearance Form

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Confidential Dental Medical Clearance Form

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Dental Group Medical Clearance Form

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Dental Medical Clearance Request Form

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Dental Clinic Institute Clearance Form

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When to Use a Dental Medical Clearance Form?

Though anyone can head to the dentist and have his or her tooth extracted whenever necessary, it is always a precautionary action that before any tooth extraction will occur, the patient must present a dental medical clearance form. In lieu of this, the following instances will demand the use of the form:

Whenever There Is a Treatment Request

Bonding, placing braces and teeth whitening are some of the known dental treatments which are usually in great demand nowadays. For this instance, the patient must receive a dental treatment medical clearance form for his or her physician which states if he or she has allergies with the anesthesia and other medication that the dentist may use before and during the treatment. The patient’s physician should also be fully informed with the form of medical examination required to be taken by the patient to secure that the risks will be enlisted well on the clearance document.

When the Patient Is a Child and Minor

Kids and minor children are the members of the population who are mostly involved with having a fear of the dentist or of the dental clinic itself. This fear is known as a dental phobia which is often associated with the scary stories that adults told to their children. However, this fear will be minimized when there is an ample range of knowledge about the risks and possibilities during the dental operation. With a pediatric dental medical clearance form, the child and his or her legal guardian will be able to determine through the aid of a licensed physician if the operation is applicable for the child’s health. This form will indicate the information of the licensed physician as well as his or her observations of the child and the identities of the child’s parents or legal form guardians.

If a Patient Is Pregnant

When a patient is pregnant, double precautionary measures must be conducted before any treatment, medication, and equipment will be used since one fearful or risky action form may put the child in the womb in grave danger. A dental medical clearance for pregnant patients will be the appropriate document to cater the patient’s health information. The date for her expected labor or due date is also stated on the form to allow the medical providers in determining the right time to execute the dental operation. The necessary medical forms and documents are listed on the form to provide a checklist which will be reviewed before any action will be taken for the patient which may include the patient’s radiography results and trimester treatment reports.

When a Patient needs a Surgery

Regardless if a surgery is related to the patient’s kidney or shoulders, the surgeon must assure that the patient does not have any form of dental infection to assure his or her well-being. The dentist and the patient’s physician has to conduct a medical and dental examination to the patient to determine the state of his or her gums, teeth and all areas of the patient’s oral health.

Dental Patient Medical Clearance Form

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Dental Physician Medical Clearance Form

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Dental Surgery Medical Clearance Form

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Dental Treatment Medical Clearance Form

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Family Dental Medical Clearance Form

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Significant Areas in a Dental Medical Clearance Form

A dental medical clearance form is not only for the medical state of the patient, but for other relevant information as well. Below are the areas which hold a significant role for the purpose of the clearance form:

The Parties

The term “parties” refers to people who are involved in the dental procedure which is known as the patient, the chosen physician and the dentist. Their identifications must be clearly stated on the form ranging from their legal names, addresses, individual contact information, as well as the patient’s date of birth. It is essential to have these data to indicate who is expected to sign and be responsible for the document’s completion and submission prior to conducting the dental procedure.

Dental Treatment Plan

This refers to chosen consent to treatments of the patient and the possible reaction of the patient’s medical state in the duration of the operation. The medications to provide and injected to the patient will also be included in this area which is necessary for helping the patient’s physician to determine if the patient is allergic or is not suitable for the medicine’s formulation.

Patient’s Health

This will be completed by the physician who is expected to conduct an in-depth and appropriate medical and physical assessment for the patient before the dental operation will be done. The physician has to write down his or her initials for his or her decision as to whether the health of the patient will be capable of dealing with the risks of the operation or if there are limitations for the patient. A set of suggestions and recommendations for the type of dental medication and operations may also be stated by the physician to contribute for the patient’s safety and health security.

Signatures of the Medical Providers

This is the last section which certifies that the form has been used and has contained the necessary details for the patient and the other parties involved. The importance of having the signatures on the form is highly similar to signing a contract agreement which will signify the form’s legality and granted consent.

Pediatric Dental Medical Clearance Form

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Pregnancy Dental Medical Clearance Form

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Shoulder Replacement Dental Clearance Form

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Dental Services Medical Clearance Form

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How to Create a Dental Medical Clearance Letter

Constructing a dental medical clearance letter is identical to making a letter of consent which should seek the intention of acquiring a permit from the authorized and addressed people. Nonetheless, the steps below will aid any patient and dentist in creating an effective dental medical clearance letter:

Step 1: Indicate the Logo of your Dentistry Company

Depending on the style or format of your employee clearance letter, you can have the logo at the center or at the right side of the letter. The main aspect to remember is to have the logo as the first element of your letter to assure that the company is being acknowledged and presented to the client.

Step 2: State the Title or the Subject of your Letter.

Specifically, the subject will be “Dental Medical Clearance Letter” which is expected to be typed at the center and a space below the company’s logo. By having the title, the client feedback will be able to determine and have a glimpse of the letter’s main purpose.

Step 3: Write as to Whom you Address the Letter

If the letter is for the dentist to state the dental condition of the client or a patient, then you must know and write the full legal name of the dentist along with his or her professional title. A few general information of the addressee such as his or her address and contact numbers may also be stated below his or her identification.

Step 4: Construct the Body.

Formal and business letter are not the only documents which should start with a proper greeting but also a clearance letter which promotes politeness and formalities for all the involved parties. The body of your letter should properly state the detailed intention why the letter was sent and what forms of approval will be accepted as a response. The type of patient assessment and examination required should also be included in the body to inform the addressee. Additionally, the body should indicate the dates when the patient or the client had his last examination and the chosen dates for the medical or dental operations.

Step 5: Sign the Form.

Your signature as the individual who has sent the form is essential to indicate that the form is legit and that the needs are immediate. Below your signature must be your title or professional relationship with the patient if you are the patient’s regular doctor or dentist.

Step 6: Include a Set of Instructions

Your addressee must know where to send the results right after the examination or where he or she will respond regarding the letter. This is why you should state your updated mailing address and not rely on the yellow pages from phone companies as their data may not be updated if you have been in a change of address in your company.

Dental Medical Clearance Letter Template

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Regardless if you are using a dental medical clearance form or will be making a clearance letter for your dentist and physician, you must keep the aforementioned information in mind for you to be knowledgeable about the varieties and steps of constructing documents. Nonetheless, you must also be aware of your generic physical and medical state to secure your health and that you will not be dealing with numerous risks during any medical procedure that you will take in the future.

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