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DENTAL CLINIC CONSENT to PERFORM DENTISTRY I hereby authorize and direct the dentists of CHCI Dental Clinic and/ or dental auxiliaries of his/her choice, to perform upon my child (or Legal ward) the following dental trea
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Document Date: 2013-08-12 18:57:19


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injection site / /

MedicalCondition

infection / nausea / allergic reactions / numbness / pain / vomiting / coma / fainting / /

MedicalTreatment

physical restraint / surgery / /

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