"Prescription" defined; form and contents of prescription

"Prescription" means a written order for dental technological work which has been issued by a licensed dentist. A prescription must be in a form prescribed by the board in regulation and must contain: (1) the name, address, and certificate number of the individual or organization to do the work; (2) identification of the patient by name or number; (3) the date on which the authorization was written; (4) a description of the work to be done, with diagrams, if necessary; (5) a specification of the type and quality of materials to be used; (6) the dentist's signature, complete address, and state license number.