Appendix B. Oral Cancer Examination Physician Referral

Appendix B. Oral Cancer Examination Physician Referral.

Mr./Ms./Mrs. ____________________________________ was seen in our office for a dental exam. As part of the general appraisal of all patients, we completed an extraoral and intraoral examination. Our assessment revealed an area we believe warrants further evaluation. Please see the information provided below:

Location:

 

 

Description:

 

 

From the office of:
Dr. _________________________________
Address: ____________________________________________________________
Phone number: _______________________

Please call our office if you have any questions or need more information.

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