Le sildénafil présent dans Kamagra exerce une inhibition réversible de la PDE5, modulant la cascade GMPc et favorisant une vasodilatation localisée. L’absorption digestive varie selon la forme utilisée, comprimés classiques ou gels oraux. La distribution tissulaire est large et la liaison protéique élevée, avoisinant 96 %. La métabolisation hépatique génère un métabolite actif contribuant à l’effet pharmacologique global. La demi-vie reste courte, avec disparition plasmatique en quelques heures. Les interactions significatives concernent surtout les nitrés organiques et inhibiteurs puissants du CYP3A4. Dans les publications techniques, kamagra en ligne est souvent cité dans le cadre d’analyses comparatives portant sur les différences de formulations et de cinétique d’absorption.

Phassfamilydentistry.com

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1 Patient Information
2 Dental Insurance
Who is responsible for this account? __________________________ Date ___________________________________________________ Relationship to Patient _____________________________________ SS/HIC/Patient ID # _____________________________________________ Insurance Co. ____________________________________________ Patient Name ____________________________________________ Group # ________________________________________________ _______________________________________________________ Is patient covered by additional insurance? □ Yes □ No Subscriber’s Name ________________________________________ Address ________________________________________________ Birthdate _____________________ SS# _____________________ City _____________________________________________________ Relationship to Patient _____________________________________ State ________________________ Zip ______________________ Insurance Co. ____________________________________________ E-mail ______________________________________________________________________________________________________________ Group # ________________________________________________ Sex □ M □ F Birthdate _______________________Age ________ ASSIGNMENT AND RELEASE
I certify that I, and/or my dependent(s), have insurance coverage with _____________________________________________ and assign directly to Occupation _______________________________________________ Dr.___________________________________________ all insurance benefits, if Patient Employer/School ____________________________________ any, otherwise payable to me for services rendered. I understand that I am financially responsible for all charges whether or not paid by insurance. I authorize Employer/School Address __________________________________ the use of my signature on all insurance submissions.
_______________________________________________________ The above-named dentist may use my health care information and may disclose such information to the above-named Insurance Company(ies) and their agents for Employer/School Phone (_____) _____________________________ the purpose of obtaining payment for services and determining insurance benefits or the benefits payable for related services. This consent will end when my current Spouse’s Name _____________________________________________ treatment plan is completed or one year from the date signed below.
Birthdate ________________________________________________ Signature of Patient, Parent, Guardian or Personal Representative SS# _____________________________________________________ Please print name of Patient, Parent, Guardian or Personal Representative Spouse’s Employer _________________________________________ Whom may we thank for referring you? ________________________ 3 Phone Numbers
Home (______) _______________________ Work (______) ___________________ Ext ______ Alt. Phone (______) _________________ Spouse’s Work (______) _______________________________________ Best time and place to reach you _____________________________ IN CASE OF EMERGENCY, CONTACT (Specify someone who does not live in your household.)
Name ______________________________________________________ Relationship _____________________________________________ Home Phone (______) ________________________________________ Work Phone (______) _____________________________________ 4 Dental History
Reason for today’s visit __________________ Cigarette, pipe, or cigar smoking □ Yes □ No Date of last dental visit __________________ Date of last dental X-rays ________________ Food col ection between the teeth □ Yes □ No Place a mark on “yes” or “no” to indicate if you Sores or growths in your mouth □ Yes □ No How often do you floss? _________________ – O V E R –
#21774 – Medical Arts Press 1-800-328-2179 5 Health History
Physician’s Name_________________________________________________________ Date of last visit ________________________________ Have you ever used a bisphosphonate medication? Common brand names are Fosamax, Actonel, Atelvia, Didronel, Boniva. □ Yes □ No Have you ever taken any of the group of drugs collectively referred to as “fen-phen?” These include combinations of Ionimin, Adipex, Fastin (brand names of phentermine), Pondimin (fenfluramine) and Redux (dexfenfluramine). □ Yes □ No Place a mark on “yes” or “no” to indicate if you have had any of the following: AIDS/HIV Women:
Are you pregnant?
Due date_______ ___________________________ Medications
Allergies
List any medications you are currently taking and the correlating diagnosis: ________________________________________________________ ________________________________________________________ ________________________________________________________ Pharmacy Name _________________________________________ Phone (______) __________________________________________ 6 Updates (To be filled in at future appointments)
Has there been any change in your health since your last dental appointment? □ Yes □ No For what conditions? _____________________________________________________________________________________________________ Are you taking any new medications?______________ If so, what? ______________________________________________________________ Patient’s Signature _________________________________________________________________ Date ______________________________ Doctor’s Signature _________________________________________________________________ Date ______________________________ Has there been any change in your health since your last dental appointment? □ Yes □ No For what conditions? _____________________________________________________________________________________________________ Are you taking any new medications?______________ If so, what? ______________________________________________________________ Patient’s Signature _________________________________________________________________ Date ______________________________ Doctor’s Signature _________________________________________________________________ Date ______________________________ Patient Record of Disclosures
In general, the HIPAA privacy rule gives individual's the right to request a restriction of uses and disclosures of their protected health information. The individual is also provided the right to request confidential communications or that a communication of their protected health information be made by alternative means, such as sending correspondence to the individual's office instead of the individual's home. I wish to be contacted in the following manner (check all that apply): Home Telephone
___ Ok to leave message with detailed information ___ Leave message with call back number only Work Telephone
___ Ok to leave message with detailed information ___ Leave message with call back number only Written Communication
___ Ok to mail to my provided home address ___ Ok to mail to my provided work/office address _________________________________________ Print _________________________________________ Sign

Source: http://www.phassfamilydentistry.com/New-Patient-Forms.pdf