Department of Oral & Maxillofacial Surgery

Chattagram International Dental College & Hospital

Date:

Demographic data of the patient:
Name:
Age:
Sex:
Religion:
Occupation:
Address:

Request for histopathology
Chief complain:

Past medical history:
Specimen specification:
Site:
Size:
Specimen:
Clinical appearence of the lesion:

Type of biopsy:

Differential diagnosis:



Treatment provided:









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