Sir/Madam,

A patient named ……………………………………………of age …………..Male/Female is a

known cardiac patient(stent placed)and under medication for past…………

years.

He needs a written medical opinionfrom his/her general physician for dental

extraction (serial extraction) under local anesthesia with adrenalin.

kindly evaluate other relevant medical history and provide your opinion

regarding fitness of patient for dental extraction.

Thank you

1.Bp (digital spygmomanometer) on

………….at……….. is………………………

2.Random blood sugar(digital) on

………………….at……….is ……………………….

(kindly cross chek the values if needed)