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OdontoGram

OdontoGram

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Dipublikasikan oleh Syamsul Arifin
FOrmat odontogram
FOrmat odontogram

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Published by: Syamsul Arifin on Jun 14, 2013
Hak Cipta:Attribution Non-commercial

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09/13/2013

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ODONTOGRAM

Bangsal : No RM :
No Reg :
Nama : L/P Umur :
No File : ................................
Alamat : ............................................................................................................................................................
Phone : ............................ HP : ..................................... Pekerjaan : .................................................
DATA MEDIK :
1. Gol. Darah : ............................................ 5. Hemofili : ............................................................
2. Tensi / Rwt : ................/.................../ Hi/Ho/N !. He"atitis : ............................................................
#. RP$ : % / & '. Aler(i : ............................................................
). D* : % / & +. ,ain % lain : ............................................................
ODONTOGRAM :
-kl.si : N//ross0ite 1."ern.mar : % / & ...........................................................
Tor.s "alatin.s : % / & 2 k % s % 0 3 Diastema : ...................................................................
Tor.s man4i0.la : % / & 2 k % s % 0 3 Anomali lain : ....................................................................
Palat.m : 4 / s / r
T(l. Pemeriksaan 5 4ia(nosis Tin4akan / Rese" Dr( Tt4

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