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PRESCRIBING DENTIST FOR LABORATORY USE ONLY CLINICAL ADDRESS AGE CADCAM PREP DATE DATE REQUIRED DEVICE SHADE STAGE BK IN MODEL DIE SCAN METAL PRESS CER INSP INV ALLOY TECH DATE WE CONFIRM THE PATIENT IMPRESSIONS SUPPLIED HAVE BEEN DISINFECTED IN ACCORDANCE WITH THE CURRENT GUIDELINES When signed in this box by Wade Dental Laboratories Limited the device(s) meet the relevant essential requirements (unless shown differently overleaf) of the Medical Devices Directive and this is the statement for that purpose. MDD No. CA 002617 STUMP SHADE PHOTOGRAPH / X-RAY ENCLOSED / EMAIL PATIENT’S NAME custom made device for the exclusive use of M / F YES / NO NB ITEMS RETURNED ARE NOT STERILE KEEP AWAY FROM EXTREMES OF HEAT AND COLD 209 RAYLEIGH ROAD HUTTON BRENTWOOD ESSEX CM13 1LZ 01277 222882 www.wadedl.com [email protected] DENTAL IMPLANTS RESTORATIVE & COSMETIC DENTISTRY LAB USE ONLY 8 R L LL1 7 R L LL2 LR6 LL3 5 R L LL4 4 R L LL5 3 R L LL6 2 R L LL7 2 R U UR3 UR4 UR5 UR6 7 R U UR8 UL1 UL2 UL3 UL4 UL5 UL6 UL7 1 R L LL8 1 R U UL8 CASE NO PRESCRIBING DENTIST FOR LABORATORY USE ONLY CLINICAL ADDRESS AGE CADCAM PREP DATE DATE REQUIRED DEVICE SHADE STAGE BK IN MODEL DIE SCAN METAL PRESS CER INSP INV ALLOY TECH DATE WE CONFIRM THE PATIENT IMPRESSIONS SUPPLIED HAVE BEEN DISINFECTED IN ACCORDANCE WITH THE CURRENT GUIDELINES When signed in this box by Wade Dental Laboratories Limited the device(s) meet the relevant essential requirements (unless shown differently overleaf) of the Medical Devices Directive and this is the statement for that purpose. MDD No. CA 002617 STUMP SHADE PHOTOGRAPH / X-RAY ENCLOSED / EMAIL PATIENT’S NAME custom made device for the exclusive use of M / F YES / NO NB ITEMS RETURNED ARE NOT STERILE KEEP AWAY FROM EXTREMES OF HEAT AND COLD 209 RAYLEIGH ROAD HUTTON BRENTWOOD ESSEX CM13 1LZ 01277 222882 www.wadedl.com [email protected] DENTAL IMPLANTS RESTORATIVE & COSMETIC DENTISTRY LAB USE ONLY 8 R L LL1 7 R L LL2 LR6 LL3 5 R L LL4 4 R L LL5 3 R L LL6 2 R L LL7 2 R U UR3 UR4 UR5 UR6 7 R U UR8 UL1 UL2 UL3 UL4 UL5 UL6 UL7 1 R L LL8 1 R U UL8 CASE NO
