* (1) The name and address of the dental laboratory to which it is directed.
* (2) The case identification.
* (3) A specification of the materials to be used.
* (4) A description of the work to be done and, if necessary, diagrams thereof
* (5) The date of issuance of the authorization.
* (6) The signature and address of the licensed dentist or other dental practitioner by whom the work authorization is issued.