Update-Note-Template-New-Patient-Consult (4).pdf - Site...

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1/16 Site administration Copy Template Manage Collection: Teesit Green Question Types Click or Drag to add a question Options Multi Line Textbox Single Line Textbox Multi Choice Checkbox Single Choice Radiobox Single Choice Dropdown Template Details Template name * New Patient Consultation Group * Orthodontic Template Designer 35 questions Cancel Preview Complete Template Edit Option Question * Orthodontic Consultation Type * Multi Line Paragraph Answer: Patient presented to an initial orthodontic consultation. Edit Option Question * Type * Help
2/16 Accompanied by Single Choice Radiobox Answers * Add line Self Remove Mother Remove Father Remove Guardian [ ] Remove Edit Option Question * Patient Chief Complaint Type * Multi Choice Checkbox Answers * Crooked teeth (Crowding) Remove Malalignment and bite relationship Remove Spacing Remove Bite relationship with increased overjet Remove Bite relationship with increased overbite Remove Incisor proclination Remove Anterior crossbite Remove Posterior crossbite Remove Missing tooth [ ] Remove Impacted tooth [ ] Remove Small upper lateral incisor [ ] Remove Habit [ ] Remove
3/16 Add line TMJ problem Remove Refer from [ ] Remove Relapse Remove to continue treatment that started from other ort Remove is ... Remove Edit Option Question * Medical History Type * Multi Choice Checkbox Answers * Asthma with no medications Remove Asthma controlled with medications Remove Heart problems Remove Blood pressure Remove Diabetes Remove Epilepsy Remove Blood disorder Remove Osteoporosis Remove Infectious disease Remove Smoker Remove Pregnant Remove Previous surgery [ ], Hospitalisation Remove
4/16 Add line No relevant medical history Remove Edit Option Question * Dental History Type * Multi Choice Checkbox Answers * Add line No recent dental check up and cleaning Remove Recent dental check up and cleaning less than 6 Remove Recent dental check up and cleaning more than Remove Heavily restored dentition Remove Previous orthodontic treatment Remove Previous trauma to tooth [ ] Remove Previous RCT Remove Prothetic replacement [ ] Remove TMJ sounds/pain Remove TMJ lock Remove Airway problem Remove Early loss of deciduous tooth Remove Habit [ ] Remove Edit Option Question * Type *

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