8 - DentalCertificate

Republic of the Philippines
DEPARTMENT OF EDUCATION
X
Region
MISAMIS ORIENTAL
Division
DENTAL HEALTH RECORD Latest 1½ x 1½ picture
Name: LABADAN, TRISH KAYE H. SEPT. 7, 2018

Age: 15 Sex FEMALE Birth Date 30-May-03 Date
Event: ATHLETICS - RUNNING
Parent/Guardian: DANNY T. LABADAN
Coach: ALFRED G. TINGCANG
CONDITION AND TREATMENT NEEDS GINGIVITIS

PERIODONTAL
CONDITION
RIGHT 55 54 53 52 51 61 62 63 64 65 LEFT DISEASE
TEMPORARY TEETH MALOCCLUSION
SUPERNUMERA
RY TOOTH
RETAINED
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 DECIDOUS
PERMANENT TEETH TEETH
DECUBITAL ULCER
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 CALCULUS
CONDITION CLEFT PALATE
ROOT FRAGMENT
TREATMENT NEEDS
TEMPORARY TEETH
FLUOROSIS
RIGHT
85 84 83 82 81 71 72 73 74 75 LEFT
OTHERS (Specify)
CONDITION
DATE OF VISIT
YEAR LEVEL REMARKS PERMANENT TEETH
DATE INDEX D.F.T.
EXAMINATION NO. T /DECAYED
SEALANT (GI) NO. T/ FILLED
PERMANENT FILLING TOTAL D.F.T.
ART
EXTRACTION TEMPORARY TEETH
ORAL PROPHYLAXIS INDEX D.F.T.
REFERRAL NO. T /DECAYED
OTHER ORAL TREATMENT NO. T/MISSING
NO. T/ FILLED
TOTAL D.F.T.
TOTAL SOUND TEETH
SYMBOLS FOR MOUTH EXAMINATION SYMBOLS FOR ACCOMPLISHMENT

X - TOOTH INDICATED DU - DECUBITAL ULCER XT - EXTRACTED PERMANENT TOOTH
FOR EXTRACTION MAL - MALOCLUSSION xt - EXTRACTED TEMPORARY TOOTH
F - TOOTH INDICATED FLU - FLUOROSIS Am - AMALGAM FILLING
FOR FILLING Gn - NORMAL Com - COMPOSITE FILLING
HEAVY - TOOTH WITH TEMPORARY Gm - MODERATE GINGIVITIS
SHADE FILLING (1-2 QUADRANTS) ARTIFICIAL RESTORATION
RC - RECURRENT CARIES Gs - SEVERE GINGIVITIS JC - JACKET CROWN
RF - ROOT FRAGMENT (3-4 QUADRANTS) I - INLAY
M - MISSING TOOTH CMR - COMPLETE MOUTH REHAB OP - ORAL PROPHYLAXIS
(√) - SOUND ERUPTED PERMANENT ZOE - ZINC OXIDE UEGENOL FILLING
TOOTH TF - TEMPORARY FILLING
R - REFERRED TO PRIVATE DENTIST
UN - UNERUPTED TOOTH
Division Meet Remarks/Findings:

Presence of 3rd Molar Yes No
DENTIST If yes, pls. specify:
(signature over printed name) Patially erupted Fully erupted:
PRC: LICENSE: Date Examined:
Regional Meet Remarks/Findings:
Palarong Pambansa Remarks/Findings:
X
Region
MISAMIS ORIENTAL
Division
Name: DOMLO-AN, KATRINA M. SEPT. 7, 2018

Age: 15 Sex FEMALE Birth Date 17-Jun-03 Date
Parent/Guardian: MARCOS D. DOMLO-AN

PERIODONTAL
CONDITION
SUPERNUMERA
RY TOOTH
RETAINED
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 DECIDOUS
DECUBITAL ULCER
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 CALCULUS
ROOT FRAGMENT
TREATMENT NEEDS
TEMPORARY TEETH
FLUOROSIS
RIGHT
85 84 83 82 81 71 72 73 74 75 LEFT
OTHERS (Specify)
CONDITION
DATE OF VISIT
DATE INDEX D.F.T.
ART
NO. T/ FILLED
TOTAL D.F.T.
TOTAL SOUND TEETH


X
Region
MISAMIS ORIENTAL
Division
Name: ABUT, IAN JEPPIE V. SEPT. 7, 2018

Age: 17 Sex MALE Birth Date AUG. 16, 2001 Date
Parent/Guardian: ROGER Y. ABUT

PERIODONTAL
CONDITION
SUPERNUMERA
RY TOOTH
RETAINED
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 DECIDOUS
DECUBITAL ULCER
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 CALCULUS
ROOT FRAGMENT
TREATMENT NEEDS
TEMPORARY TEETH
FLUOROSIS
RIGHT
85 84 83 82 81 71 72 73 74 75 LEFT
OTHERS (Specify)
CONDITION
DATE OF VISIT
DATE INDEX D.F.T.
ART
NO. T/ FILLED
TOTAL D.F.T.
TOTAL SOUND TEETH


FOR PALARONG PAMBANSA ONLY

X
Region
MISAMIS ORIENTAL
Division
Name: CABALLERO, RONALYN C. SEPT. 7, 2018

Age: 14 Sex FEMALE Birth Date OCT. 15, 2003 Date
Event: ATHLETICS - THROWING
Parent/Guardian: DAHPNY C. CABALLERO

PERIODONTAL
CONDITION
SUPERNUMERA
RY TOOTH
RETAINED
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 DECIDOUS
DECUBITAL ULCER
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 CALCULUS
ROOT FRAGMENT
TREATMENT NEEDS
TEMPORARY TEETH
FLUOROSIS
RIGHT
85 84 83 82 81 71 72 73 74 75 LEFT
OTHERS (Specify)
CONDITION
DATE OF VISIT
DATE INDEX D.F.T.
ART
NO. T/ FILLED
TOTAL D.F.T.
TOTAL SOUND TEETH


X
Region
MISAMIS ORIENTAL
Division
Name: PAGALAN, NOVE M. SEPT. 7, 2018

Age: 15 Sex FEMALE Birth Date NOV. 21, 2002 Date
Parent/Guardian: ERNIE N. PAGALAN

PERIODONTAL
CONDITION
SUPERNUMERA
RY TOOTH
RETAINED
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 DECIDOUS
DECUBITAL ULCER
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 CALCULUS
ROOT FRAGMENT
TREATMENT NEEDS
TEMPORARY TEETH
FLUOROSIS
RIGHT
85 84 83 82 81 71 72 73 74 75 LEFT
OTHERS (Specify)
CONDITION
DATE OF VISIT
DATE INDEX D.F.T.
ART
NO. T/ FILLED
TOTAL D.F.T.
TOTAL SOUND TEETH


X
Region
MISAMIS ORIENTAL
Division
Name: MABILIN, DIANNA C. SEPT. 7, 2018

Age: 14 Sex FEMALE Birth Date SEPT. 15, 2003 Date
Event: ATHLETICS - JUMPING
Parent/Guardian: ALBERTO C. MABILIN

PERIODONTAL
CONDITION
SUPERNUMERA
RY TOOTH
RETAINED
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 DECIDOUS
DECUBITAL ULCER
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 CALCULUS
ROOT FRAGMENT
TREATMENT NEEDS
TEMPORARY TEETH
FLUOROSIS
RIGHT
85 84 83 82 81 71 72 73 74 75 LEFT
OTHERS (Specify)
CONDITION
DATE OF VISIT
DATE INDEX D.F.T.
ART
NO. T/ FILLED
TOTAL D.F.T.
TOTAL SOUND TEETH


X
Region
MISAMIS ORIENTAL
Division
Name: GASANG, AJEE HERNIE M. SEPT. 7, 2018

Age: 15 Sex MALE Birth Date OCT. 14, 2002 Date
Parent/Guardian: CHRIS S. GASANG

PERIODONTAL
CONDITION
SUPERNUMERA
RY TOOTH
RETAINED
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 DECIDOUS
DECUBITAL ULCER
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 CALCULUS
ROOT FRAGMENT
TREATMENT NEEDS
TEMPORARY TEETH
FLUOROSIS
RIGHT
85 84 83 82 81 71 72 73 74 75 LEFT
OTHERS (Specify)
CONDITION
DATE OF VISIT
DATE INDEX D.F.T.
ART
NO. T/ FILLED
TOTAL D.F.T.
TOTAL SOUND TEETH



8 - DentalCertificate

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8 - DentalCertificate

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Republic of the Philippines

DENTAL HEALTH RECORD Latest 1½ x 1½ picture

Name: LABADAN, TRISH KAYE H. SEPT. 7, 2018

Parent/Guardian: DANNY T. LABADAN

Coach: ALFRED G. TINGCANG

CONDITION AND TREATMENT NEEDS GINGIVITIS

SYMBOLS FOR MOUTH EXAMINATION SYMBOLS FOR ACCOMPLISHMENT

Division Meet Remarks/Findings:

DENTAL HEALTH RECORD Latest 1½ x 1½ picture

Name: DOMLO-AN, KATRINA M. SEPT. 7, 2018

Parent/Guardian: MARCOS D. DOMLO-AN

Coach: ALFRED G. TINGCANG

CONDITION AND TREATMENT NEEDS GINGIVITIS

SYMBOLS FOR MOUTH EXAMINATION SYMBOLS FOR ACCOMPLISHMENT

Division Meet Remarks/Findings:

DENTAL HEALTH RECORD Latest 1½ x 1½ picture

Name: ABUT, IAN JEPPIE V. SEPT. 7, 2018

Parent/Guardian: ROGER Y. ABUT

Coach: ALFRED G. TINGCANG

CONDITION AND TREATMENT NEEDS GINGIVITIS

SYMBOLS FOR MOUTH EXAMINATION SYMBOLS FOR ACCOMPLISHMENT

Division Meet Remarks/Findings:

FOR PALARONG PAMBANSA ONLY

DENTAL HEALTH RECORD Latest 1½ x 1½ picture

Name: CABALLERO, RONALYN C. SEPT. 7, 2018

Parent/Guardian: DAHPNY C. CABALLERO

Coach: ALFRED G. TINGCANG

CONDITION AND TREATMENT NEEDS GINGIVITIS

SYMBOLS FOR MOUTH EXAMINATION SYMBOLS FOR ACCOMPLISHMENT

Division Meet Remarks/Findings:

DENTAL HEALTH RECORD Latest 1½ x 1½ picture

Name: PAGALAN, NOVE M. SEPT. 7, 2018

Parent/Guardian: ERNIE N. PAGALAN

Coach: ALFRED G. TINGCANG

CONDITION AND TREATMENT NEEDS GINGIVITIS

SYMBOLS FOR MOUTH EXAMINATION SYMBOLS FOR ACCOMPLISHMENT

Division Meet Remarks/Findings:

DENTAL HEALTH RECORD Latest 1½ x 1½ picture

Name: MABILIN, DIANNA C. SEPT. 7, 2018

Parent/Guardian: ALBERTO C. MABILIN

Coach: ALFRED G. TINGCANG

CONDITION AND TREATMENT NEEDS GINGIVITIS

SYMBOLS FOR MOUTH EXAMINATION SYMBOLS FOR ACCOMPLISHMENT

Division Meet Remarks/Findings:

DENTAL HEALTH RECORD Latest 1½ x 1½ picture

Name: GASANG, AJEE HERNIE M. SEPT. 7, 2018

Parent/Guardian: CHRIS S. GASANG

Coach: ALFRED G. TINGCANG

CONDITION AND TREATMENT NEEDS GINGIVITIS

SYMBOLS FOR MOUTH EXAMINATION SYMBOLS FOR ACCOMPLISHMENT

Division Meet Remarks/Findings:

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