Recare Exam

DENTIST: [SELECT/INSERT: Dentists]
RDA: [SELECT/INSERT: RDA]
RDH: [SELECT/INSERT: Hygienist]

Informed verbal consent given by [AUTO: Patient First Name] [AUTO: Patient Last Name] [SELECT/INSERT: CONSENT FOR TX] for treatment today.

MEDICAL history reviewed & INCLUDES: [SELECT/INSERT: MedHx/DentalHx]
Premedication Required: [SELECT/INSERT: PREMED]

Checked Cl 5 Indicators on all cassettes used for procedure as well as indicators on bagged instruments: [SELECT/INSERT: Cl5 Indicator Strip Checked]

Miele Sterilization codes scanned:

Informed verbal consent given by [AUTO: Patient First Name] [AUTO: Patient Last Name] for treatment today.
Radiographs: [SELECT/INSERT: Radiographs]
Intraoral photos: [SELECT/INSERT: Intraoral]

a) Patients chief concern:

b) Extraoral- WNL

c) TMJ- WNL
Palpation of the Masseter Test: WNL
Load TMJ joint Test: WNL

d) Intraoral- WNL
Oral Habits-
Molar Occlusion-
Skeletal Occlusion- N/A

Overjet-     mm
Overbite-    %

Do they use a CPAP?

Does patient have a Splint?
Do they use Splint?

Have they had orthodontics?
Do they wear Retainers? Fixed or removable?
Do they have Partial Dentures

is there anything they would like to improve with their smile/teeth?

Additional Comments-


Treatment Options:
1) HYGIENE MAINTENANCE

Treatment Plan:
1) HYGIENE MAINTENANCE

Next Visit: [UNRESOLVED PLACEHOLDER: NEXT VISIT]
Date Booked: