You are on page 1of 2

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 10-Q 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
BOYS
ACHICO ARIES
ALBATERA JOHN JENREV
ALVAREZ JHON MICHAEL
AUTENTICO JONEL
BASA DAVID MIGZ
BASSIG JOHN MARVIC
BUCAD JOHN PAUL
CAMPO REY MARK GIL
DE JESUS CLYDE DENVER
DILLA JEZREEL
ILDEFONSO PHYLEEN BRUCE
MAJERANO CHRIS JHONRYL
MALICAD MARK DAVE
MANGUNE JHIAN
OBUYES ROCKY
RESPICIO JEREMIAH PEDRITO
RIGA HADI
SARIPADA RACHMAN
TAMBAGO CJ KHURT
ZAPATA E.J. MILES
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

You might also like