[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-284175-105":53,"doc-detail-284175-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","dental-clearance-form-medical-documentation","Dental Clearance Form - Medical Documentation","","This document provides a formal Dental Clearance Form for patients scheduled for open-heart surgery at the Cleveland Clinic. It outlines the essential requirements for dental assessment, specifying that patients must undergo a comprehensive examination including full-mouth X-rays or a panorex within six months prior to their scheduled procedure. Dentists are required to evaluate the patient for signs of acute dental infection, document their findings, and coordinate with the patient's cardiologist regarding pre-operative medication or anticoagulation protocols. The form includes specific fields for dentist certification and surgeon contact details to ensure seamless communication between dental and surgical care teams. It emphasizes the clinical importance of eliminating oral infection risks before major cardiac operations, providing a structured template for verifying oral health status to maintain patient safety standards throughout the surgical pathway.",{"@graph":63,"@context":122},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/dental-clearance-form-medical-documentation/284175/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/dental-clearance-form-medical-documentation/284175.png","ImageObject",442,249,{"name":88,"@type":89},"supergirl","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-27","2026-09-17",true,{"@type":98,"interactionType":99,"userInteractionCount":8},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114,118],{"name":105,"@type":106,"acceptedAnswer":107},"Who is required to complete this dental clearance form?","Question",{"text":108,"@type":109},"The patient's dentist must complete all sections of this form before the patient's scheduled open-heart surgery at the Cleveland Clinic.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What dental imaging is required for clearance?",{"text":113,"@type":109},"To be cleared for surgery, the patient must have a dental exam that includes full-mouth X-rays and/or a panorex within the 6 months prior to the surgery date.",{"name":115,"@type":106,"acceptedAnswer":116},"What should a dentist do if a patient has an acute dental infection?",{"text":117,"@type":109},"The dentist must document the infection on the form and call the surgeon at the phone number listed on the document.",{"name":119,"@type":106,"acceptedAnswer":120},"Are there exceptions to needing this clearance?",{"text":121,"@type":109},"Yes, patients who have had all their teeth removed or those who wear dentures do not need to obtain dental clearance before surgery.","https://schema.org",{"og:url":78,"og:type":124,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":126,"canonical":78},"index,follow",{"doc_id":128,"site_id":56},284175,1790147791,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":88,"user_avatar":133,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":8,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":139,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":61,"update_tm":143,"read_time":9},962088121634,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","DENTAL CLEARANCE FORM  \nPLEASE HAVE YOUR DENTIST COMPLETE ALL SECTIONS OF THIS FORM  \nAND FAX IT TO 216.445.9608  \nIf you have had your teeth removed/wear dentures, you do NOT need to get dental clearance before your surgery.  \nSurgeon’s Name:   Phone \\#  Patient’s Name:   Cleveland Clinic \\#   \nThe patient is tentatively scheduled for open-heart surgery the week of:  / /   \nPlease contact the patient’s cardiologist for pre-op medication or anticoagulation recommendations.  \nDate of patient’s last dental exam:  / /   \nIMPORTANT NOTE: In order for the patient to be cleared for surgery, he/she must have a dental exam that includes full-mouth X-rays and/or panorex within the 6 months prior to the above surgery date and must not have any signs of acute infection.  \nDoes the patient have any acute dental infections? p Yes p No If yes, please document and call the surgeon at the number listed above.  \nDentist’s Name:   Dentist’s Signature:   Date:  / /  Time:    \nPhone \\#   Fax \\#    \nThank you for your cooperation.  \nSYDELL AND ARNOLD MILLER FAMILY [clevelandclinic.org/heart](clevelandclinic.org/heart)  \nHEART & VASCULAR INSTITUTE  \n9500 Euclid Avenue, Cleveland, Ohio 44195 [clevelandclinic.org/heart](clevelandclinic.org/heart)  \n© 2000-2019 Cleveland Clinic. All rights reserved. Rev. 4/19  \n370845","cbCaidPVtSTLr52I","https://ap.wps.com/l/cbCaidPVtSTLr52I","pdf",45183,"English","# Dental Clearance Form Requirements\n## Clinical Guidelines for Dentists\n## Professional Information and Certification","[{\"question\":\"Who is required to complete this dental clearance form?\",\"answer\":\"The patient's dentist must complete all sections of this form before the patient's scheduled open-heart surgery at the Cleveland Clinic.\"},{\"question\":\"What dental imaging is required for clearance?\",\"answer\":\"To be cleared for surgery, the patient must have a dental exam that includes full-mouth X-rays and/or a panorex within the 6 months prior to the surgery date.\"},{\"question\":\"What should a dentist do if a patient has an acute dental infection?\",\"answer\":\"The dentist must document the infection on the form and call the surgeon at the phone number listed on the document.\"},{\"question\":\"Are there exceptions to needing this clearance?\",\"answer\":\"Yes, patients who have had all their teeth removed or those who wear dentures do not need to obtain dental clearance before surgery.\"}]","Dental Clearance Form - Medical Documentation | PDF",1789628393]