brevaComprehensive dental examination
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: [ ]