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Dental Ordering
Examination
Treatment Plan
Order
Perio Chart
Diagnosis
Patient Type
Instructions to Cashier
Total Unbilled Amount :
Total Billed Amount :
Order History
Treatment Plan
Previous Treatment Plan
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Treatment Plan History
Examination
Previous Examination
Ref. Hospital
Previous Examination
ExtraOral Exam
Lymph Nodes
A Symmmetries
Swelling
Pain
Others, Specify
Periodontal Screening
If any abnormalities please specify below
Gingival Soft Tissue (Generalized or localizes)
Color
Margins
Papillae
Consistency
Architecture
IntraOral Exam
If any abnormalities please specify below
Lips
Cheeks
Tongue
Pharynx
FOM
Others
Probing
Bleeding
Supression
Pocketing
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2
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Poc
Rec
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1
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8
Poc
Rec
8
7
6
5
4
3
2
1
1
2
3
4
5
6
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8
Poc
Rec
Mob
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1
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Poc
Rec
Mob
Examination History
Perio Chart
Patient Type
Diagnosis History
Impacted distal
Impacted mesial
Abcess
Unerepted tooth
Watch tooth
Caries/Decay
Incipient caries
congenittaly missing
Creacked tooth
Fractured tooth
Open contact distal
Open contact mesial
Hypersensitive
Recession
Abrassion
Maximum Credit Limit :
0.00
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