05 Formato de Modelos Prontuario
05 Formato de Modelos Prontuario
05 Formato de Modelos Prontuario
(Identificação do Profissional)
NOME DO PROFISSIONAL
CIRURGIÃO-DENTISTA - CLÍNICO GERAL
CRO-(UF) N° _______
Endereço completo
Prontuário n° ________________.
Nome ________________________________________________________________________
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Nome ________________________________________________________________________
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Local, Data Assinatura do Paciente ou seu Responsável Legal
EXAME FÍSICO
GERAL: _________________________________________________________________
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EXTRA-ORAL: ___________________________________________________________
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INTRA-ORAL: ___________________________________________________________
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EXAME DENTAL – DESCRIÇÃO DENTE – A - DENTE
18 _______________________________________________________________________
17 _______________________________________________________________________
16 _______________________________________________________________________
15 (55) ___________________________________________________________________
14 (54) ___________________________________________________________________
13 (53) ___________________________________________________________________
12 (52) ___________________________________________________________________
11 (51) ___________________________________________________________________
21 (61) ___________________________________________________________________
22 (62) ___________________________________________________________________
23 (63) ___________________________________________________________________
24 (64) ___________________________________________________________________
25 (65) ___________________________________________________________________
26 _______________________________________________________________________
27 _______________________________________________________________________
28 _______________________________________________________________________
38 _______________________________________________________________________
37 _______________________________________________________________________
36 _______________________________________________________________________
35 (75) ___________________________________________________________________
34 (74) ___________________________________________________________________
33 (73) ___________________________________________________________________
32 (72) ___________________________________________________________________
31 (71) ___________________________________________________________________
41 (81) ___________________________________________________________________
42 (82) ___________________________________________________________________
43 (83) ___________________________________________________________________
44 (84) ___________________________________________________________________
45 (85) ___________________________________________________________________
46 _______________________________________________________________________
47 _______________________________________________________________________
48 _______________________________________________________________________
ODONTOGRAMA
Registro de Anormalidades e Patologias
Situação Periodontal – Exames Complementares
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