Teaching and Non-Teaching Dental Health Card.xlsx

	A	B	C	D	E	F	G	H	I	J	K	L	M	N	O	P	Q	R	S	U
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3	Republic of the Philippines
4	DEPARTMENT OF EDUCATION
5	Region XI
6	DIVISION OF DAVAO DEL SUR
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8	ORAL HEALTH EXAMINATION RECORD FOR TEACHING AND NON-TEACHING PERSONNEL
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10	Region			Division						District							School
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12	Name																Age:			Sex:
13	Date of Birth :										Marital Status :
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15	Medical History:
16		Hypertension					Epiliepsy							Allergies
17		Diabetes					Bleediung Disroder							Others
18		Cardio-Vascula Dis					Asthma								Pls Specify
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21		DENTITION STATUS																	INDEX: DMFT
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23	Status																		No. of Decayed	X
24		18	17	16	15	14	13	12	11	21	22	23	24	25	26	27	28		No. of Decayed	F
25																			No. of Missing
26																			No. of Filled
27		48	47	46	45	44	43	42	41	31	32	33	34	35	36	37	38
28	Status																		Total
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30	Periodontal Condition					DENTAL PROSTHESIS										Remarks
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32		Normal				Denture Wearer				Y		N
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34		Gingivitis				Pls specify
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36		Periodontal Disease				Need for Denture				Y		N
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38	Other Abnormal Condition					Pls specify
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41	Pls. specify
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43		SYMBOLS FOR MOUTH EXAMINATION										Artificial Restorations					SYMBOLS FOR ACCOMPLISHMENT
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45		X	Carious tooth indicated for extraction				F2	Permanently filled tooth with recurrence of decay				JC	Jacket Crown				OP	Oral Prohylaxis
46			Carious tooth indicated for extraction					Permanently filled tooth with recurrence of decay				AB	Abutment				Xt	Extracted Permanent Tooth
47		F	Carious tooth indicated for Filling				Heavy shade:		Permanent filling			P	Pontic				Ag	Amalgam Filling
48			Carious tooth indicated for Filling				Heavy shade:		Permanent filling			I	Inlay				Sy F	Synthetic Porcelian
49		RF	Root Fragment				Outline of tooth with Temporary Filling					RPD	Removable Partial Denture				GIC	Glass Ionomer Cement
50												FB	Fixed Bridge				ZnOF	Zinc Oxide Filling
51		M	Missing Tooth									CD	Complete Denture				R	Referred to Private Dentist
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