Opioid Overdose Emergency Algorithm Form

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Name of Facility

Corporation Name (If you don't have one, enter the name of your practice)

Your Full Name

Email

Phone Number

Street Address of your Dental Practice

Levels of Anesthesia (check all that apply)

Local Anesthesia

Minimal Sedation

Moderation Sedation

Nitrious Oxide

Pediatric Sedation

Deep Sedation/General Anesthesia

I have read and understood the AAFDO disclaimer.

I want to purchase:

Opioid Overdose Emergency Algorithm Form - $19.97

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