FIŞĂ DE TRATAMENT

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DATA NAŞTERII:___________________________________________________________

ADRESA:___________________________________________________________________

Telefon:____________________________________________________________________

ALERGII:___________________________________________________________________

BOLI CONTAGIOASE:_______________________________________________________

PROBLEME DE SĂNĂTATE:__________________________________________________

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DATA ÎNCEPERII TRATAMENTELOR:_________________________________________

TEST ANESTEZIC:__________________________________________________________

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CULORI:

OGLINDA DENTARĂ:

ALTE MENŢIUNI:
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