DENTAL EXAM REQUIREMENTS
LYON COLLEGE
CC PAM 145-4, Para 2-55 requires dental films for casualty identification purposes for
all participants in the ROTC program who must use government-owned or government
contracted transportation. The PMS is to ensure the Cadet’s dental records contain
sufficient documentation to aid in forensic identification.
MANDATORY OR VOLUNTARY DISCLOSURE AND EFFECT ON INDIVIDUAL
NOT PROVIDING INFORMATION: All data is mandatory. Individuals who do not
provide this data will not be allowed to be transported on any government owned or
government contracted transportation, no exception(s) to this rule are allowed.
I certify that my dental representative listed below has on file in my dental records
descriptive profiles, bitewing x rays, orthodontic profiles or dental x-rays for me.
Cadet Name: _____________________________________________________________
SSN: _________________________ Dentist Phone: (______)______-_______________
Name of Dentist: _________________________________________________________
Dentist Address: __________________________________________________________
______________________________ ________________________
Cadets Signature Date
AUTHORIZATION TO RELEASE DOCUMENTS
I authorize my dentist, dental office, or medical treatment facility that is in possession of
my dental records or other records with my descriptive profiles, bite wing x-rays,
orthodontic profiles or dental x-rays to release this information pertaining to these
documents and copies of these items to the US Army ROTC or other Department of
Defense Representative.
______________________________ ________________________
Cadet’s Signature Date
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