Dental Sedation Monitoring Log
Patient Name
Date of Procedure
Sedation Provider
Dentist
ASA Classification
I
II
III
IV
Sedation Type
Oral
IV
Nitrous Oxide
Other
Pre-Operative Assessment
Time
BP
Pulse
Respiration
O
2
Saturation (%)
Level of Consciousness
Medications Administered
Comments
Post-Operative Assessment
Recovery Time
Discharged By
Discharge Criteria Met
Yes
No
Comments