nitrous oxide inhalation analgesia - Minnesota Board of Dentistry

SECTION 8: Board/Sedation Committee (for office use only)Summary of Inspection/EvaluationComments/Concerns:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Recommendations:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Inspector must return completed forms to the Board of Dentistry within two weeksInspector Name_______________________________Signature_________________________________Date _________________Sedation Committee Approval: _____________________Signature: _____________________________________Date: _______________*Pursuant to Minnesota Rule 3100.3600, Supt. 11: On-site inspection; requirements and procedures, and Rule 3100.3600,Subp.9,B,(4) and (6).The Minnesota Board of Dentistry greatly appreciates the material provided for thisdocument by:• The American Association of Oral and Maxillofacial Surgeons (AAOMS)• The Institute of Medical Emergency Preparedness ( IMEP)10