Initial Data Base and Recommendations

Initial data base provides essential
hard tissue documentation

Use this form to document exams for both adults and children. Use the columns for notations instead of the tooth diagram to make data collection quick and accurate. (Writing notations such as #30 MOD in the pathology column is as specific as drawing the MOD as "red dots" on a tooth picture.) Electively, tooth diagrams may be used in the conventional way.

This form becomes the blueprint for your treatment plan. Treatment appointments with all details mapped out, can be arranged on the C-111L Treatment Schedule form.

  • Present restorations and conditions
  • Professional recommended hard tissue baseline
  • Accepted format for adults and children
  • Notations in columns or on tooth diagrams
  • Priority of treatment
C-102R Initial Data Base and Recommendations
$18.00 / 200 $34.00 / 400
$64.00 / 800 $120.00 / 1600



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