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    2020 - Dental Certificate

    Uploaded by

    Dennmark Igut
    This document is a dental health record from the Department of Education in the Philippines. It contains information such as the student's name, age, birthdate, parent/guardian, and coach. It tracks the condition and treatment needs of the student's temporary and permanent teeth, including notes on fillings, extractions, cleanings, and referrals. Examination findings and qualifications to participate in various athletic competitions are also noted.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd

    2020 - Dental Certificate

    Uploaded by

    Dennmark Igut
    42 views2 pages
    This document is a dental health record from the Department of Education in the Philippines. It contains information such as the student's name, age, birthdate, parent/guardian, and coach. It tracks the condition and treatment needs of the student's temporary and permanent teeth, including notes on fillings, extractions, cleanings, and referrals. Examination findings and qualifications to participate in various athletic competitions are also noted.

    Original Title

    2020_Dental Certificate

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    This document is a dental health record from the Department of Education in the Philippines. It contains information such as the student's name, age, birthdate, parent/guardian, and coach. It tracks the condition and treatment needs of the student's temporary and permanent teeth, including notes on fillings, extractions, cleanings, and referrals. Examination findings and qualifications to participate in various athletic competitions are also noted.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    42 views2 pages

    2020 - Dental Certificate

    Uploaded by

    Dennmark Igut
    This document is a dental health record from the Department of Education in the Philippines. It contains information such as the student's name, age, birthdate, parent/guardian, and coach. It tracks the condition and treatment needs of the student's temporary and permanent teeth, including notes on fillings, extractions, cleanings, and referrals. Examination findings and qualifications to participate in various athletic competitions are also noted.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    of 2

    Republic of the Philippines

    DEPARTMENT OF EDUCATION

    Region

    Division

    DENTAL HEALTH RECORD


    Latest 1½ x 1½ picture
    Name:
    Age: Sex Birth Date

    Event:
    Parent/Guardian:
    Coach:

    CONDITION AND TREATMENT NEEDS


    CONDITION
    RIGHT 55 54 53 52 51 61 62 63 64 65 LEFT
    TEMPORARY TEETH

    18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
    PERMANENT TEETH

    48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
    CONDITION

    TREATMENT NEEDS
    TEMPORARY TEETH
    RIGHT
    85 84 83 82 81 71 72 73 74 75 LEFT

    CONDITION

    YEAR LEVEL REMARKS


    DATE
    EXAMINATION
    SEALANT (GI)
    PERMANENT FILLING
    ART
    EXTRACTION
    ORAL PROPHYLAXIS
    REFERRAL
    OTHER ORAL
    TREATMENT

    SYMBOLS FOR MOUTH EXAMINATION SYMBOLS FOR ACCOMPLISHMENT


    X - TOOTH INDICATED DU - DECUBITAL ULCER XT - EXTRACTED PERMANENT TOOTH
    FOR EXTRACTION MAL - MALOCLUSSION xt - EXTRACTED TEMPORARY TOOTH
    F - TOOTH INDICATED FLU - FLUOROSIS Am - AMALGAM FILLING
    FOR FILLING Gn - NORMAL Com - COMPOSITE FILLING
    HEAVY - TOOTH WITH TEMPORARY Gm - MODERATE GINGIVITIS ARTIFICIAL RESTORATION
    SHADE FILLING (1-2 QUADRANTS) JC - JACKET CROWN
    RC - RECURRENT CARIES Gs - SEVERE GINGIVITIS I - INLAY
    RF - ROOT FRAGMENT (3-4 QUADRANTS) OP - ORAL PROPHYLAXIS
    M - MISSING TOOTH CMR - COMPLETE MOUTH REHAB ZOE - ZINC OXIDE UEGENOL FILLING
    (√) - SOUND ERUPTED PERMANENT TF - TEMPORARY FILLING
    TOOTH R - REFERRED TO PRIVATE DENTIST
    UN - UNERUPTED TOOTH
    District Meet Remarks/Findings:
    WITH THIRD MOLAR: REFERRED FOR DENTAL TREATMENT:
    DENTIST YES NO YES NO
    (signature over printed name) QUALIFIED TO PARTICiPATE:
    PRC: LICENSE: PTR# Date Examined: YES NO
    Division Meet Remarks/Findings:
    WITH THIRD MOLAR: REFERRED FOR DENTAL TREATMENT:
    DENTIST YES NO YES NO
    (signature over printed name) QUALIFIED TO PARTICIPATE:
    PRC: LICENSE: PTR# Date Examined: YES NO
    Regional Meet Remarks/Findings:
    WITH THIRD MOLAR: REFERRED FOR DENTAL TREATMENT:
    DENTIST YES NO YES NO
    (signature over printed name) QUALIFIED TO PARTCIPATE:
    PRC: LICENSE: PTR# Date Examined: YES NO
    Palarong Pambansa Remarks/Findings:
    WITH THIRD MOLAR: REFERRED FOR DENTAL TREATMENT:
    DENTIST YES NO YES NO
    (signature over printed name) QUALIFIED TO PARTICIPATE:
    PRC: LICENSE: PTR# Date Examined: YES NO
    FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

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