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Exam Clinic Notes
Exam Clinic Notes
Preferred Name/Nickname
Chief Complaint
Recommendation
Diagnosis
Healthy
Gingivitis
Other
Other
Where
Generalized
Lower Anterior
Other
Other
Bleeding
None
Light
Moderate
Heavy
Where
Generalized
Lower Anterior
Other
Other
Calculus
None
Light
Moderate
Heavy
Where
Generalized
Lower Anterior
Other
Other
Plaque
None
Light
Moderate
Heavy
Where
Generalized
Lower Anterior
Other
Other
Treatment
Full Set of X-Rays
Intraoral Video
Adult Prophy
Polish
Floss
Periocharts
BiteWings
Additional Observations
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Urgent Attention
Recession
Wisdom Teeth
Attrition
Where
Generalized
Specific Tooth Number
Tooth Number
Candidate for occlusal/night guard
Perio
Early
Moderate
Advanced
Where
Generalized
Lower Anterior
Other
Other
Additional Notes
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Hygienist
Exam Specialist
Recommendations
Re-CARE
SRP
Ortho
Night Guards
In-Home
Other
Other
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