(1) All dentists engaged in the practice of dentistry in the state of Montana must submit written reports to the board within seven days of any incident, injury or death resulting in temporary or permanent physical or mental disability, or death involving the application of general anesthesia, conscious sedation or nitrous oxide/oxygen sedation administered to any dental patient for whom said dentist, or any other dentist, has rendered any dental or medical service. Routine hospitalization to guard against postoperative complications or for patient comfort need not be reported where complications do not thereafter result in injury or death as herein before set forth. The report required by this rule shall include, but not be limited to, the following information:

(a) a description of the dental procedure;

(b) a description of the physical condition of the patient unless Class I (as defined by the American Society of Anesthesiologists);

(c) a list of drugs and dosages administered and routes of administration;

(d) a detailed description of techniques used in the administration of the drugs utilized;

(e) a description of the adverse occurrences;

(f) a description in detail of symptoms of any complications, including, but not be limited to, onset of problems and symptoms of the patient; and

(g) a description of the patient's condition upon termination of any procedure undertaken.