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Physician Report and Medical Clearance for Dental Surgery BRYAN T MOORE DDS PA Dear M. D. Date of Request Our mutual patient is planning on having dental surgery with local anesthesia and possibly IV conscious sedation. Potential intra-operative medications include Lidocaine with Epinephrine with epinephrine and Nitrous Oxide. Potential post-operative medications include Ibuprofen and Tylenol. Please evaluate his/her medical condition and report back to us in writing with the following...

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