Work authorization shall mean a written order for dental technological work which has been issued by a licensed dentist. It shall be in a form prescribed by regulations of the Board and shall contain the following:
- (a) The name and address of the individual or organization to do the work. (b) Identification of the patient by name or number. (c) The date on which the authorization was written. (d) A description of the work to be done, with diagrams, if necessary. (e) A specification of the type and quality of materials to be used. (f) The signature of the dentist, his complete address, and the number of his State license.