lembar rekam medik gigi amelocare
Post on 20-Dec-2015
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LEMBAR REKAM MEDIK GIGI STOVIT GOES TO SCHOOL AND SOCIETY
FAKULTAS KEDOKTERAN GIGI - UNIVERSITAS AIRLANGGA
Jl. Prof Dr. Moestopo No. 47 – Surabaya
NAMA :
USIA : ( L / P ) | TENSI :
ALAMAT :
NO. HP / TELP. :
RWYT PENYAKIT :
8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
V IV III II I I II III IV V
V IV III II I I II III IV V
Pilih Perawatan Yang Dilakukan :
Konservasi Bedah Mulut Prostodonsia
Penyakit Mulut Orthodonsia
Periodonsia Pedodonsia
Diagnosa Perawatan :
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OPERATOR (ISI NAMA & NIM) :
NO. REGISTRASI : - - -
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