医疗口腔美容顾客档案封面.docx

病历号:负责医生Physician:初渗11FirstInspectionDa1.e:你通过什么方式得知我院？Howdidyouknowourc1.inic?网站口杂志口介绍其他口InternetMagazineIntroduceOther姓名Name也生年月D.O.B年龄AGE性别SEX男M女F国籍Nationa1.ity职业Occupation电话PhonC手机Ce1.1.Phone地址Address病况ChiefComp1.ain既往齿科状况PastI>enta1.History备忘求Memo其他Other医疗美容医院PAIENTNAME:DATE:PhibingDcp1.hIntcqxuxP1ikacP)orCakuItMCi!2345678910I1.121314IS161.E1.END1.主A-氏耳-ExistingRcMorntioiw-3MfUsurfacePbqUefIn1.ctprexiiiu1.>÷B1.eedingnnPmbinj:-rw4ut1TOSuppufatioivS1.IfJ(TSmm4iFreeGingiva1.MarginW收斤nrM1.jWWI!JB三00Qr重端XkkJ066iTTm)淡-X1.Yt-1一I=目旨目目=k=xMUC。般Hgiva1.1.>>e世“(uWW1.1.Iii.HPmgnosis-GE4RH23456789IOI1.1213141516Pmbing1.rth1.n1.ep11>xP1.aquc1.P)erCakdeMCjPmg11nisPrognosisIntcqpnnHque<P)erProbingDepth3231302928272625242322212019Ig171.EMMND4If1TrirsHA-fr-t1昌旦旦旦下I-1.M<)bMobi1.ity:1.2.3I-三昌:日;T三14Ib，三H三三三Spacing7j目目A目B、&MTjFuva>onC1.assII1.!1.i一(Zfzzq;C=1三三三bF1.三y)W3©(一犷£)0©CWMeO©0©111<OsJ.r-t-4fcjr工*A日目日、,日曰目t=T*-1f-rrrEM“Mafuxmy>一-一一：.'：1'InD口T、E*，=：，”二I一一=一-"一V-Q一.W.j三F三三三I三I三=1=W=1S1.1Z.1.1Z=2F1UW3、-1FMFBncnImpiuniy*t3231302928272625242322212019IB17ProbingP1.a>rtP,CuIumC)PROGRESSNOTESPatieytName:FoRE.ACHENTRY:1. Inchangcdoc<hanged(exp1.ain)HcahhStatus2. Nccomp1.aints,findingsordiagnoses3. DeKTibCtreatmentPrsidedduringvisit4. St«p1.annedIrtannentforcextvisit病历号MR、Page*一DateToOIhOrAreaTreatmenbProgressNotesDoctor,sSignatureDateToo1.hOrAreaTrCaImCn1.JPrOgrCJiSNotesDoctor,sSignature