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  • Odontogram: Rumah Sakit Surabaya Medical Service JL. Kapuas No 2 Surabaya

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    Faila
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    This odontogram document records a patient's dental information including their name, date of birth, medical history, blood type, blood pressure readings, and any existing medical conditions. It also notes the patient's occlusion, presence of any extra teeth, diastema, tori, and other anomalies or issues observed in the palate or mandible. The odontogram is used to record dental examinations, diagnoses, treatments, prescriptions, and the signature of the treating dentist.

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    This odontogram document records a patient's dental information including their name, date of birth, medical history, blood type, blood pressure readings, and any existing medical conditions. It also notes the patient's occlusion, presence of any extra teeth, diastema, tori, and other anomalies or issues observed in the palate or mandible. The odontogram is used to record dental examinations, diagnoses, treatments, prescriptions, and the signature of the treating dentist.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    8 views1 page

    Odontogram: Rumah Sakit Surabaya Medical Service JL. Kapuas No 2 Surabaya

    Uploaded by

    Faila
    This odontogram document records a patient's dental information including their name, date of birth, medical history, blood type, blood pressure readings, and any existing medical conditions. It also notes the patient's occlusion, presence of any extra teeth, diastema, tori, and other anomalies or issues observed in the palate or mandible. The odontogram is used to record dental examinations, diagnoses, treatments, prescriptions, and the signature of the treating dentist.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    of 1

    RUMAH SAKIT SURABAYA MEDICAL SERVICE RM-

    JL. Kapuas No 2
    Surabaya

    ODONTOGRAM
    Nama :
    L No. Rekam Medik
    Tgl Lahir :
    P
    DATA MEDIK :

    1. Gol. Darah : 5.Hemofili :


    2. Tensi/Riwayat : / /Hi/Ho/N 6.Hepatitis :
    3. RPJ : -/+ 7.Alergi :
    4. DM : -/+ 8.Lain-lain :
    ODONTOGRAM :

    Oklusi : N/Crossbite Supernumerary : -/+


    Torus Palatinus : -/+ (k-s-b) Diastema :
    Torus Mandibula : -/+ (k-s-b) Anomali lain :
    Palatum : d/s/s
    Tgl Pemeriksaan & Diagnosis Tindakan / Resep Drg Ttd

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