RD4A - MENSANA SIOC - Dental Assessment

SIOC - Dental assessment

Location

Location(*)

Please select a location!

Patient Number(*)

Please enter patient number!

Gender(*)

Male

Female

Please make a selection!

Age(*)

Please enter patient's age!

Medical History

Invalid Input

Dental Examination

To apply a status to a tooth, select a code and then tap a tooth to apply it to.

status dental code

Upper Right

Invalid Input

15/55

Invalid Input

14/54

Invalid Input

13/53

Invalid Input

12/52

Invalid Input

11/51

Invalid Input

Lower Right

Invalid Input

45/85

Invalid Input

44/84

Invalid Input

43/83

Invalid Input

42/82

Invalid Input

41/81

Invalid Input

Lower Left

Invalid Input

35/75

Invalid Input

34/74

Invalid Input

33/73

Invalid Input

32/72

Invalid Input

31/71

Invalid Input

Upper Left

Invalid Input

25/65

Invalid Input

24/64

Invalid Input

23/63

Invalid Input

22/62

Invalid Input

21/61

Invalid Input

Referal of patient and Summary of consult

Reason / Summary of consultant(*)

Please give a reason or enter a summary!

Did you refer the patient?(*)

Yes

Please make a selection!

Additional Notes

Invalid Input

SIOC - Dental assessment

Location

Main Complaint

Intra-Oral Exam

Dental Habits

Dental Examination

Dental Treatment

Referal of patient and Summary of consult