Dental Treatment Record
Progress Notes

Essential for treatment documentation

Progress notes are a vital part of any charting system. They are the legal record of what has transpired with a patient.

With this form, document:

  • Anesthetic - type, number of carpules, etc.

  • Nitrous Oxide / Oxygen Percentages

  • Complications

  • Informed consent

  • Phone discussions with patient, specialists or physicians

  • Complete description of all treatment and any extenuating circumstances

  • Provider Signature

Everything that occurs with a patient must be written down. If corrections need to be made, make a single line through the incorrect entry. No erasure or "white out" should be used. An optional consideration is the Piggyback System ( C-301R and C-401R)


  • Date of treatment 
  • Auxiliary - name or initials
  • Tooth or quadrant
  • Surfaces
  • Services description
  • Provider signature
  • ADA Code - allows for proper billing and insurance coordination
  • Fee for procedure
C-101R Dental Treatment Record Progress Notes
$18.00 / 200 $34.00 / 400
$64.00 / 800 $120.00 / 1600




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