Professional Documents
Culture Documents
Dental Health Record: Department of Education
Dental Health Record: Department of Education
DEPARTMENT OF EDUCATION
Region
Division
Name:
Age: Sex Birth Date Date
Event:
Parent/Guardian:
Coach:
DATE OF VISIT
YEAR LEVEL REMARKS TEMPORARY TEETH
DATE INDEX D.F.T.
EXAMINATION NO. T /DECAYED
SEALANT (GI) NO. T/MISSING
PERMANENT FILLING NO. T/ FILLED
ART TOTAL D.F.T.
EXTRACTION TOTAL SOUND TEETH
ORAL PROPHYLAXIS
REFERRAL PERMANENT TEETH
OTHER ORAL TREATMENT INDEX D.F.T.
NO. T /DECAYED
NO. T/ FILLED
TOTAL D.F.T.
DENTIST
(signature over printed name)
PRC: LICENSE: Date Examined:
Regional Meet Remarks/Findings:
DENTIST
(signature over printed name)
PRC: LICENSE: Date Examined:
Palarong Pambansa Remarks/Findings:
DENTIST
(signature over printed name)
PRC: LICENSE: Date Examined: