Republic of the Philippines ZL Departmen are & HEALTH AND NUTRITION CENTER Pasig City ORAL HEALTH EXAMINATION RECORD FOR TEACHING AND NON-TEACHING pERSONNEL 0. ve viAeAN) Age: 92 Gender:_ Male. Marital Status District: one ato 9 School: CANCOLG ALAS BIAS. Hypertension Epilepsy ‘lergies Diabetes Bkeding Disorder Others: Cardiovascular Disease Asthma — Pres Spealy DENTITION STATUS INDEX: DMFT wa Z| 7 | [No.of x ‘STATUS ) ¥ | Me EoD ag | 17] 16 | 15 | 14] 13 | 12] a2] 21 | 22 | 23 | 24 | 25 | 26 | 27 | 28 | oor Timissing |_| ‘T/Filled \ as | a7 | a6 | 45 | 44 | 43 [42 | 41 | 32 | 32 | 33 | 34 | 35 | 36 | 37 | 38 | TOTAL 3 0 q saws [|_| TREATMENT RECORD (ep EOFS REMARKS DENTIST v2, hay SELL ARIZA AN. BARTOLONE, OF i eal TE Wor v0SS380—| [ Fal Coa DENTAL PROF THESES aie ———_ fe Gags Pleme Speaty a Perot Diese need to Deatwe: YL] Remus Otter Abormal Condos Pee Spey: enacts: Please Specify, svmots FoR MOUTH XAMINATION Aviat Rasionaice — F Goemecaiatandemcin Ph remamty tins stadetcinm SY Sma yids rn tac Me Sine = Riga emaet ehmat et ‘gt holga og cep Gi Git lorem Cement