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Your Name Here, DDS/DMD Month 30, 2013

Your Name Here, DDS/DMD Month 30, 2013. Patient’s Chief Complaint. Medical History. Dental History (chronologically how they’ve gotten to this point). Medications. Preexisting Implant Information (type, size, when they were placed). Diagnosis. Perio : Dentition: TMD/MFP:.

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Your Name Here, DDS/DMD Month 30, 2013

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  1. Your Name Here, DDS/DMD Month 30, 2013

  2. Patient’s Chief Complaint

  3. Medical History

  4. Dental History (chronologically how they’ve gotten to this point)

  5. Medications

  6. Preexisting Implant Information (type, size, when they were placed)

  7. Diagnosis • Perio: • Dentition: • TMD/MFP:

  8. Diagnostic Notes

  9. Patient Photos Full face smiling Full face profile

  10. Patient Photos Close up smile Close up profile

  11. Patient Photos Tipped down smile Rest position

  12. Patient Photos Retracted - teeth apart Retracted - MI

  13. Patient Photos Upper occlusal Lower occlusal

  14. X-rays

  15. Patient Chart

  16. Tentative Treatment Plan

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