Kartu Status Gigi Dan Mulut

KARTU STATUS GIGI DAN MULUT NO.
REGISTER:
POLI GIGI PUSKESMAS SEDATI
Nama : .........................................................................................................................
Tempat & tanggal lahir : .........................................................................................................................
Jenis kelamin : ........................................................................................................................
Alamat : .........................................................................................................................
ANAMNESA ............................................................................................................................................
....................................................................................................................................................................
....................................................................................................................................................................
........................
RIWAYAT PENYAKIT
....................................................................................................................................................................
....................................................................................................................................................................
....................................................................................................................................................................
ODONTOGRAM
PEMERIKSAAN INTRA ORAL
....................................................................................................................................................................
....................................................................................................................................................................
....................................................................................................................................................................
....................................................................................................................................................................
PEMERIKSAAN EKSTRA ORAL
....................................................................................................................................................................
....................................................................................................................................................................
....................................................................................................................................................................
....................................................................................................................................................................
TANGGAL DIAGNOSA TERAPI PARAF

PETUGAS
TANGGAL DIAGNOSA TERAPI PARAF
PETUGAS

Kartu Status Gigi Dan Mulut

Diunggah oleh

Informasi Dokumen

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Kartu Status Gigi Dan Mulut

Diunggah oleh

Hak Cipta:

Format Tersedia

KARTU STATUS GIGI DAN MULUT NO.

POLI GIGI PUSKESMAS SEDATI

Tempat & tanggal lahir : .........................................................................................................................

Jenis kelamin : ........................................................................................................................

PEMERIKSAAN EKSTRA ORAL

TANGGAL DIAGNOSA TERAPI PARAF

Anda mungkin juga menyukai