Form TX Plan Worksheet W Teeth

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Form TX Plan Worksheet W Teeth

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Numele, prenumele: _______________________

Data: ___________

Examenul clinic:_________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Examenul paraclinic:_____________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Diagnostic:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

Plan de tratament:_______________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

Agend:
Data

Etapele de tratament

A efectuat singur

A efectuat cu
ajutorul medicului

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