CARE PLAN EVALUATION FORM Student_SubiyG’ Misya _Date__O3- 24- 2018 Patient Name__{ 4 Instructor__Mys. Rogers GRADING CRITERIA: Asscore of 1 will be given if no significant errors are identified Ascore of % will be given if 1-3 significant errors are identified ‘Asscore of 0 will be given if required information Is missing or deemed inaccurate by the instructor L 1. Patient information Is present. to 2. Medical History findings are present. _!__ 3, Medical History risks are identified. ta Social and Dental history findings are present. ts. Social and Dental history findings are present. 6. Dental Examination findings are present. 7. Dental Examination risk are present. _|_8. Plaque score calculated correctly. _| 9. Bleeding score calculated correctly. _| 10. Periodontal information assessed correctly, 11. Dental Hygiene diagnosis problems stated correctly. _( 12. pental Hygiene diagnosis risk factors or etiology stated. _{__ 13. Planned intervention education stated clearly for each clinical findings. _{_14. planed intervention oral hygiene is appropriate for each clinical finding. (15. L16 stated clearly. 16, STG 3 goals stated appropriate for LTG 1 17, LTG2 stated clearly. (18. 163 st6 stated appropriate for LTG 2 19. LTG stated clearly. _{__.20. STG stated clearly. —|_21. Prognosis