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)

FORM FEATURES

• 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

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Sample Form in PDF format

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