Comprehensive dental examination
United States | Dentistry

Blank documentation outlines for US practice. Adapt to the encounter and your practice requirements; complete only findings and care actually documented.

ENCOUNTER
Patient name: [ ]
Date of birth: [ ]
Date and time of encounter: [ ]
Clinician: [ ]

HISTORY
Chief concern: [ ]
Medical history, medications and allergies reviewed: [ ]
Dental history, symptoms and home care: [ ]

EXAMINATION
Extraoral and intraoral findings: [ ]
Teeth examined using Universal tooth numbers or letters: [ ]
Existing restorations and tooth-specific findings: [ ]
Periodontal findings and chart reference: [ ]
Occlusion and other findings actually assessed: [ ]
Radiographs obtained or reviewed and interpretation: [ ]

ASSESSMENT AND TREATMENT PLAN
Diagnoses and supporting findings: [ ]
Treatment priorities, options and alternatives discussed: [ ]
Patient preferences and decisions: [ ]
Referrals and next appointment: [ ]