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Dental Services MANILA HEALTH DEPARTMENT

Daily Dental Accomplishment


MHD Form E8-08-004 DAILY DENTAL ACCOMPLISHMENT

PA PF TF EXO

ABSCESS DRAINAGE

ABSCESS DRAINAGE
FL
SEALANT

PERIODONTAL TX
DENTAL FILE NO.

TOOTHCOUNT

TOOTHCOUNT

TOOTHCOUNT

TOOTHCOUNT

RELIEF OF PAIN

RELIEF OF PAIN
NAME

HEADCOUNT

HEADCOUNT

HEADCOUNT

HEADCOUNT

OFC UPON OE
OP/SCALING
ADDRESS /GRD. - SECTION G10-U BIRTHDAY

ORAL EXAM
FAMILY NO.

2ND DOSE
1st DOSE

REFERRAL

REFERRAL

OFC CMR
GUM TX

IIOHC
AGE

AEBF
NEW
SEX

OHE
OLD

STB

E/C

E/C
GIRLS
ANTONIO JOVELYN
BARBOZA KRISTINE MAE
BAUTISTA ELAIZA
BLANCO ELLA JADE
BUCIO ALLESON
CADIZ IRISH GUILLE ANNE
CRISTO ARRIANE DHEZZYHEY
DALAGAN MARIDEN
DATIG AIKKA
DIMAAMPAO SOFIA
FORBES ROAN CHARLIZE
GENERALO SAARA SOPHIA
GUNTANG EUNICE JANE
IGNACIO GEISHA VER
ONARO PRINCESS MAE
PALOMARES DANIA NADIN
PURISIMA ASHLEY KEITH
RELOJ EMILYN
TORIO RIANA ELLA
TEMP

d/D
PERM
Dental Services
MHD Form E8-08-004

TEMP
Daily Dental Accomplishment

e/M

PERM

TEMP
f/F

PERM

TEMP
x/X

PERM

TEMP
T PRESENT

PERM

TEMP
S TEETH

PERM

DENTAL CARIES

GINCIVITIS

PERIODONTAL DISEASE

ORAL DEBRIS

CALCULAR DEPOSIT

DENTOFACIAL ANOMALY

Allergies

Hypertension/ CVA
MANILA HEALTH DEPARTMENT

Diabetes Mellitus
DAILY DENTAL ACCOMPLISHMENT

Blood Disorders
Cardiovascular/
Heart Diseases
Thyroid Disorders

Hepatitis
MEDICAL HISTORY STATUS

Malignancy
History of Previous

Hospitalization

Blood Transfussion

Tattoo

Sugar Sweetened
Beverages/ Food
Drinker/ Eater

Alcoholic Drinker

Tobacco User

Betel Nut Chewer


DIETARY/SOCIAL HISTORY STATUS

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