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Cabinet Dentar

Localitatea___________
Judeul______________

FIA PARODONTAL
Nr.________ Data_____________CNP _.._.._.._.._.._.._.._.._.._.._.._.._

STATUS PARODONTAL NAINTE DE TRATAMENT


Indici de plac:

Indici de tartru:

Indici de sngerare:

Parodontometria:

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STATUS PARODONTAL DUP TRATAMENT


Indici de plac

Indici de sngerare

Parodontometria

Tratamente:_________________________________________________________________________________________
Cod
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Sunt de acord cu tratamentul efectuat n acest cabinet.

Semntura,

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