w> hledical History Information™” | Periodontal Case Type Date BP Medications | Hth SiS, Mod Adv -°/| Reviewed _| chronic “Aggressive . manic £ ise [ Student Name Heather Vanolew on Ufesded aol 8 Supra | ° 2 | PR | | Gingival Description: Bc D Galculue ion: R Lae ‘Sub xX x 2 | OR 2 _| Hard Tissue Assessment: bite Calculus Plaque Score_) _% Part! ** Failure to complete starred items resuits in a “0” for total points E z ee ee Initial Patient Oral Exam: | Probing | OHI | TXPlan | PostTX | Prof | Points | Points% | X.25 | Partl Assessment with DDS | See below Evalwi | Points | Total Score Faculty 5 10 10 5 5 a 50 yx [i Ta) 5 = ie BO Too) =| aS jumber of | Supra ‘Sub Percent Tissue [+4234 | X78 ] Part Supra. Totals Trauma ‘Score L AN GA Dae [ves (ho) G2, Grading Instructor Signature: Total Score: | fo Student Signature Patient Crecit/1_)2 Intra Oral &Extra Oral Significant Findings: Consider the following when describing findi location, symptoms, asymmetry and duration. (Must mention 5 descriptors. 1 point deduction for each missing descriptor.) *"Professionalism points eared : Size, shape, color, surface texture, consistency, Head! Neck! Lymph Nodes: WNL_v 1. Sequence of treatment 2. Time management FacolLips : wnt_/ peaen a 3. Complete record keeping* TMJ: WNL Oral Mucosa: wnt_Z 6. Prof. behavior w/ patient * 7. Prof. behavior w/ instructor* WNL_ 8. Team work 9. Professional appearance 10. Operatory organization edie raised WNL, Tongue:_Jx Floor of Mouth: Hard/Soft Palate/Oral Pharynx: WNL_/ Biserad Weer albe, iawdias steel, gdvettion