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    University of Rizal System: Upper

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    Ces Reyes
    The document is an individual dental health record for a student or employee of the University of Rizal System Medical-Dental Unit. It contains fields to record the patient's name, date of birth, course details, tooth chart, dental examinations notes, treatment history, and counts of cavities, fillings, and missing teeth. Examination details include checking for oral debris, stains, gum disease, tooth and jaw abnormalities. Treatment may include fillings, extractions, fluoride applications.

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    University of Rizal System: Upper

    Uploaded by

    Ces Reyes
    696 views2 pages
    The document is an individual dental health record for a student or employee of the University of Rizal System Medical-Dental Unit. It contains fields to record the patient's name, date of birth, course details, tooth chart, dental examinations notes, treatment history, and counts of cavities, fillings, and missing teeth. Examination details include checking for oral debris, stains, gum disease, tooth and jaw abnormalities. Treatment may include fillings, extractions, fluoride applications.

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    Individual-Dental-Health-Record-Form

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    The document is an individual dental health record for a student or employee of the University of Rizal System Medical-Dental Unit. It contains fields to record the patient's name, date of birth, course details, tooth chart, dental examinations notes, treatment history, and counts of cavities, fillings, and missing teeth. Examination details include checking for oral debris, stains, gum disease, tooth and jaw abnormalities. Treatment may include fillings, extractions, fluoride applications.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    696 views2 pages

    University of Rizal System: Upper

    Uploaded by

    Ces Reyes
    The document is an individual dental health record for a student or employee of the University of Rizal System Medical-Dental Unit. It contains fields to record the patient's name, date of birth, course details, tooth chart, dental examinations notes, treatment history, and counts of cavities, fillings, and missing teeth. Examination details include checking for oral debris, stains, gum disease, tooth and jaw abnormalities. Treatment may include fillings, extractions, fluoride applications.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Republic of the Philippines

    UNIVERSITY OF RIZAL SYSTEM


    Province of Rizal
    MEDICAL – DENTAL UNIT

    INDIVIDUAL DENTAL HEALTH RECORD

    Campus ___________________

    Name: _______________________________________________________________________________________
    Last First M.I.
    College / Dept. ______________ Course/Grade/Yr/Section: ___________________Student/Employee No. ________
    Date of Birth: ____________________________ Civil Status: _____________________ Sex: __________________
    Address: _____________________________________________________________________________________
    (LABIO BUCCAL)
    OPERATION
    CONDITION
    55 54 53 52 51 61 62 63 64 65

    OPERATION
    CONDITION

    UPPER
    18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28

    48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38

    LOWER

    CONDITION
    OPERATION
    85 84 83 82 81 71 72 73 74 75

    CONDITION
    OPERATION
    (LABIO BUCCAL)

    YEAR

    DATE of EXAMINATION
    AGE LAST BIRTHDAY

    PRESENCE OF ORAL DEBRIS / STAINS / CALCULUS


    PRESENCE OF GINGIVITIS and/or PERIODONTIS
    PRESENCE OF PERIODONTAL POCKETS

    PRESENCE OF DENTO-FACIAL ANOMALY


    USE TOOTHBRUSH
    D
    TOOTH COUNT e T P T P T P T P T P
    CARIES INDICATED FOR FILING c
    a
    CARIES INDICATED FOR EXTRACTION y
    e
    ROOT FRAGMENT d
    MISSING DUE TO CARIES M X X X X X
    FILLED OR RESTORED F
    TOTAL DMF & df
    FLUORIDE APPLICATION

    URS-AF-GE-MED-F-2017-0010
    Republic of the Philippines
    UNIVERSITY OF RIZAL SYSTEM
    Province of Rizal
    MEDICAL – DENTAL UNIT

    TREATMENT RECORDS

    Operating
    Date Diagnosis Tooth No. Treatment Done
    Dentist

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