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4.3.1 General Anesthesia
The dental provider is required to maintain the following documentation in the client's dental record:
• The medical evaluation justifying the need for anesthesia
•Description of relevant behavior and reference scale
•Other relevant narratives justifying the need for general anesthesia
•Client's demographics, including date of birth
•Relevant dental and medical history
•Dental radiographs, intraoral/perioral photography, or diagram of dental pathology
•Proposed dental plan of care
•Consent signed by parent or guardian giving permission for the proposed dental treatment and acknowledging that the reason for the use of IV sedation or general anesthesia for dental care has been explained
•Completed Criteria for Dental Therapy Under General Anesthesia form
•The parent or guardian dated signature on the Criteria for Dental Therapy Under General Anesthesia form attesting that they understand and agree with the dentist's assessment of their child's behavior
•Dentist's attestation statement and signature, which may be put on the bottom of the Criteria for Dental Therapy Under General Anesthesia form or included in the record as a stand alone form
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