Care Plan Evaluation Form Student Mayissa_Grado _ Date_4-3-17 at Patient Nove instruc Grading Criteria: patlout | A score of 1 will be given if no significant errors are identi 3 A score of % will be given if 1-3 significant errors are identified. A score of 0 will be given if required information is missing of deemed inaccurate by the instructor. t ( ! i 1. Patient information is present. 2. Medical History findings are present. 3. Medical History risks are identified, 4. Social and Dental history risk factors are noted form Medical/Dental History I 5. Social and Dental history risks are identified. 6. Dental E: aminations findi (from ALL) from all paperwork are present. 7. Dental Examination risks are present. 8. Plaque score calculated correctly 9. Bleeding score calculated correctly. 10. Periodontal case type assessed correctly } 11, Dental Hygiene diagnosis problems stated correctly. (List ALL problems, prioritize). 12, Dental Hygiene diagnosis etiology stated, _ 13, Planned intervention education stated clearly for each clinical finding, 14, Planned intervention oral hygiene is appropriate for each clinical findings 15. LTG | stated clearly. 16. STG 3 goals stated appropriately for LTG 1 _ 17. LTG 2 stated clearly ___ 18. STG 3 goals stated appropriately for LTG 2.