Centennial Park Dental
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Practice Address* OPG ImagingCBCT Scan
CBCT Scan* Full JawSectional
Clinical Indications and Reason*
Radiographic Stent* Dentist will sendPatient will bring with them to appointmentN/A
Scan Selection* MandibleMaxillaBoth JawsSectional/Quadrant
Service-Level Agreement for the referral of patients to Centennial Park Dental for Dental Cone Beam CT Examinations This agreement is between the Referring Practice, Referring Practitioner and the CENTENNIAL PARK DENTAL
I agree to use the referral criteria as per the European Guidelines: Radiation Protection No. 172 and provide adequate clinical information in order for each examination to be justified.
I will make my own arrangement for the reporting of the CBCT scans acquired at Centennial Park Dental. This will be done by someone adequately trained as per HPA-CRCE-010-Guidance on the safe use of Dental Cone Beam CT. I confirm that I am adequately trained to interpret cone beam CT scans as per HPA-CRCE-010-Guidance on the safe use of Dental Cone Beam CT. I will ensure that my training remains up to date.
I will make my own arrangementsRadiology report required from the Centennial Park Dental
Please detail exactly what you would like included in the report
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