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Run: Dental Sedation Consent and Monitoring Record

Record informed consent, pre-sedation screening, continuous monitoring, medications, and discharge for dental sedation procedures in one place. Use it to doc...

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Procedure and Patient Identification

Procedure Date (required)

Patient Identifier (required)

Use the clinic's internal patient ID or chart number. Do not enter SSN.

Procedure Type (required)

Sedation Provider (required)

Name and role of the clinician responsible for sedation and monitoring.

Informed Consent and Disclosure

Has informed consent been obtained for sedation? (required)

Summary of Consent Discussion (required)

Briefly summarize the procedure, expected effects, risks, benefits, and alternatives discussed with the patient.

Risks Explained (required)

Alternative Options Discussed (required)

Patient or Guardian Signature (required)

Pre-Sedation Assessment

ASA Classification (required)

Fasting Status Confirmed (required)

Known Allergies

List relevant allergies or enter 'None reported'.

Reasonable Accommodation or Communication Needs

Document ADA reasonable-accommodation needs, interpreter support, mobility assistance, or communication preferences.

Monitoring Record

Monitoring Methods Used (required)

Monitoring Interval (Minutes) (required)

Enter the routine interval used for recording vital signs.

Monitoring Log (required)

Medications and Events

Sedative Medications Administered (required)

List medication name, dose, route, and time administered.

Supplemental Oxygen Administered (required)

Adverse Events or Interventions

Event Details

Recovery and Discharge

Recovery Vitals Stable (required)

Discharge Criteria Met (required)

Escort Confirmed (required)

Post-Procedure Instructions Provided (required)

Summarize discharge instructions, warning signs, and follow-up guidance.

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Email (required)

Your name (optional)

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