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Treatment of Impaction

Ensure informed consent with this consent template.


This letter provides information on impaction with editable text to customize the message to the patient regarding their treatment.

The consent template automatically populates patient and clinic information and provides both patient and witness signature boxes to adhere to the UETA and E-Sign acts for capturing electronic signatures.


View a sample PDF of this template.

Image of template.


Request this template for your ICE Health Systems environment.

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VersionOrigin / ContributorsCreative Commons
1Private PracticeAttribution 4.0 International