FAMILY NAME ________________________________________
Student ________________________________________Grade ___ Phone ______________________
Student ________________________________________Grade ____
Address_____________________________________________________________________________
IN CASE OF EMERGENCY OR EARLY DISMISSAL, PLEASE INDICATE WHO IS TO BE NOTIFIED IN PRIORTY ORDER. (Please list on back of form those authorized to check out your child.)
( ) Mother ______________________________________Phone_________________________Cell_______________________
( ) Father ______________________________________ Phone ________________________ Cell ______________________
( ) Grandparent ________________________________ Phone________________________ Cell ______________________
( ) Grandparent ________________________________ Phone________________________ Cell ______________________
( ) Physician ____________________________________ Phone ________________________
( ) Hospital _____________________________________ Phone ________________________
( ) Other desired procedure_________________________________________________________________________________ E-mail Address____________________________________________________________________________________________ Important Numbers ________________________________________________________________________________________ Allergies _______________________________________ Chronic Conditions _________________________________________ May give ( ) Tylenol ( ) Benadryl ( ) Sudafed ( ) Other _________Child_____________________________ May give ( ) Tylenol ( ) Benadryl ( ) Sudafed ( ) Other _________Child_____________________________
EMERGENCY PROCEDURE FORM 20__ - 20__ FAMILY NAME ________________________________________
Student ________________________________________Grade ___ Phone ______________________
Student ________________________________________Grade ____
Address_____________________________________________________________________________ IN CASE OF EMERGENCY OR EARLY DISMISSAL, PLEASE INDICATE WHO IS TO BE NOTIFIED IN PRIORTY ORDER. (Please list on back of form those authorized to check out your child.)
( ) Mother ______________________________________Phone_________________________Cell_______________________
( ) Father ______________________________________ Phone ________________________ Cell ______________________
( ) Grandparent ________________________________ Phone________________________ Cell ______________________
( ) Grandparent ________________________________ Phone________________________ Cell ______________________
( ) Physician ____________________________________ Phone ________________________
( ) Hospital _____________________________________ Phone ________________________
( ) Other desired procedure_________________________________________________________________________________
E-mail Address____________________________________________________________________________________________ Important Numbers ________________________________________________________________________________________ Allergies _______________________________________ Chronic Conditions _________________________________________
May give ( ) Tylenol ( ) Benadryl ( ) Sudafed ( ) Other ______________Child_______________________ May give ( ) Tylenol ( ) Benadryl ( ) Sudafed ( ) Other ______________Child_______________________
ADDITIONAL INFORMATION Name ________________________________________________ Phone _______________________ Name________________________________________________ Phone________________________ Name ________________________________________________ Phone _______________________ Name________________________________________________ Phone________________________ Name________________________________________________ Phone________________________ PLEASE MAKE SURE THE FRONT IS MARKED FOR DISPENSING OF MEDICATION ADDITIONAL INFORMATION Name ________________________________________________ Phone _______________________ Name________________________________________________ Phone________________________ Name ________________________________________________ Phone _______________________ Name________________________________________________ Phone________________________ Name________________________________________________ Phone________________________ PLEASE MAKE SURE THE FRONT IS MARKED FOR DISPENSING OF MEDICATION
Smile reconstruction with 6 upper anterior restoration in tetracycline discoloration and enamel hypoplasia Alexius Eron Tondas*, Erna Kurnikasari** *PPDGS Prostodonsia Fakultas Kedokteran Gigi Universitas Padjadjaran **Bagian Prostodonsia Fakultas Kedokteran Gigi Universitas Padjadjaran Kondisi gigi-gigi seseorang dan jaringan sekitarnya sangat mempengaruhi estetika sebuah senyu
Chapter 8 What would you do if you realized you had become addicted to marijuana?After reading the following statements, respond to each one by writing yes or no. 1. The use of illegal drugs on college campuses in the United States is widespread. 2. I have never experimented with illegal drugs (marijuana, cocaine, heroin, LSD). 3. The use of marijuana should be legalized. 4. Cocaine