医疗口腔美容顾客档案封面.docx

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1、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PastIenta1.History备忘求Memo其他Other医疗美容医院PAIENTNAME:DATE:PhibingDcp1.hIntcqxu

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3、41516Pmbing1.rth1.n1.ep11xP1.aquc1.P)erCakdeMCjPmg11nisPrognosisIntcqpnnHqueP)erProbingDepth3231302928272625242322212019Ig171.EMMND4If1TrirsHA-fr-t1昌旦旦旦下I-1.MonC1.assII1.!1.i一(Zfzzq;C=1三三三bF1.三y)W3(一犷)0CWMeO0111一-一一：.：1InD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*t

4、3231302928272625242322212019IB17ProbingP1.artP,CuIumC)PROGRESSNOTESPatieytName:FoRE.ACHENTRY:1. Inchangcdochanged(exp1.ain)HcahhStatus2. Nccomp1.aints,findingsordiagnoses3. DeKTibCtreatmentPrsidedduringvisit4. Stp1.annedIrtannentforcextvisit病历号MR、Page*一DateToOIhOrAreaTreatmenbProgressNotesDoctor,sSignatureDateToo1.hOrAreaTrCaImCn1.JPrOgrCJiSNotesDoctor,sSignature