1. Date
2. Patient identification
3. Diagnosis
4. Review of medical history, medications, and vital signs
5. Oral examination
6. Anesthesia (dose and block technique used)
7. Procedure, including statement of progress of procedure and complications
8. Discharge instructions
9. Medications prescribed (drug and amount or copy of prescription)
10. Return appointment (scheduling)
11. Signature (legible or printed underneath)
FIGURE A-1 Example of an oral surgery note.