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STATE OF MAINE BOARD OF DENTAL PRACTICE 143 State House Station, Augusta, ME 043330143CERTIFICATION FORM SEDATION AND/OR GENERAL ANESTHESIA(Updated 12/2020)This certification form is required pursuant
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How to fill out sedation andor general anesformsia

01
Begin by gathering all the necessary forms required for sedation and/or general anesthesia.
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Carefully read and understand each form to ensure you are familiar with the information required.
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Fill in the patient's personal information accurately, including their full name, date of birth, address, and contact details.
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Provide details about the procedure or surgery that the patient will be undergoing.
05
Indicate any known medical conditions, allergies, or previous surgeries the patient has had.
06
Specify the type of sedation or general anesthesia being administered, along with the dosage or concentration.
07
Review and sign any consent forms necessary for the sedation and/or general anesthesia.
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If applicable, provide emergency contact information in case of any complications during the procedure.
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Double-check the filled forms for any errors or missing information before submitting them.
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Submit the completed forms to the relevant healthcare provider or facility.

Who needs sedation andor general anesformsia?

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Sedation and/or general anesthesia may be required for various medical and dental procedures, including:
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- Surgeries that involve a significant level of pain or discomfort.
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- Procedures that require the patient to remain still or unconscious to ensure their safety and comfort.
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- Dental treatments such as root canals, extractions, or implant surgeries.
05
- Diagnostic procedures that may cause anxiety or discomfort, such as colonoscopies or endoscopies.
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- Pediatric procedures to help manage fear, anxiety, or uncooperativeness in young children.
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- Patients with certain medical conditions or disabilities that make them unable to tolerate pain or hold still during a procedure.
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- Individuals who experience extreme anxiety or phobia regarding medical procedures.
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Sedation and general anesthesia are medical techniques used to induce a state of relaxation or unconsciousness in patients during procedures to minimize pain and discomfort.
Healthcare professionals administering sedation or general anesthesia, such as anesthesiologists, nurse anesthetists, or certain surgery centers, are required to file necessary reports.
To fill out sedation or general anesthesia forms, ensure accurate documentation of the patient’s details, type of procedure, medications used, dosages, and monitoring information.
The purpose of sedation and general anesthesia is to provide comfort, alleviate pain, and ensure safety during medical or surgical procedures.
Required information includes patient demographics, type of sedation or anesthesia used, medications administered, vital signs, and any complications encountered.
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